Conservatives – We’re a Family, Not a Collective

Today’s Democrat Party is the Borg – remember when they were first introduced? The big bad. There was simply no way to stop them. But of course, the Federation won. More than that, the crew of the Enterprise won – because they behaved like the family that they are.

The power of a family to stop a collective is well known – even to the statists that created the Star Trek world.

We have to realize that we’re a family, and define ourselves clearly, as we really are, and use that power to win. It’s not easy, of course, but it is possible.

We discuss all of that, with geekiness and humor.

It’s all in the podcast


Your hosts

THIS WEEK’S LINKS:

http://www.thepartyofchoice.com/articles1/family-versus-collective-by-andy-peth

http://www.nationalreview.com/article/420055/conservatism-definition-difficult-produce

Seven Liberal Pieties That Only the Right Still Believes

Liberals Outraged At Mike Rowe Again. His Best Response Ever…

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5 Ways Bush Helped Elect Obama

[show_avatar email=mbuel76@gmail.com align=right user_link=website show_postcount=true]

1) Bush’s support of the minimum wage increase.

The minimum wage is a socialist policy.  Any time the Government tries to exert force over the market The vast majority of business leaders start at the bottom.

(which is made up of individuals), it’s exerting tyranny over the people.  Minimum wage controls, do not help disperse poverty, or increase the labor force.  They decrease the labor force, increase poverty, and decrease future business leadership.

Higher minimum wages lead directly to the rise in unemployment. (Fox Business News, source of image)

I have much more to say about the minimum wage, and why it’s unnecessary and will do so in a future blog post.  Briefly, it doesn’t fix poverty, it displaces labor, it creates grey and black markets for labor. Since the Republicans supported the minimum wage increase then, why don’t they know?  Do they hate the poor, like the left proclaims?

 

Henry J. Kaiser Foundation

 

2) Bush’s policies of Medicare Part D and Various Federal aid programs, that Democrats complain about, but refuse to repeal.
Throughout the 2006 to 2010 election cycle the Democrats complained 1). This includes the Iraq War and Medicare Part D.  Medicare Part D, for all intents and purposes is another 800 pound gorilla of debt.  Like Obamacare, if not cut it will bankrupt America. The Bush administration over eight years added 33% to the national debt (by 2012).

 

The Democrats don’t really want to cut it, they just use it as a wedge issue, to blame Republicans for massive spending. As far as African aid goes, it would be better spent from the private sector.  Most government aid, to every country is wasted money.  It’s also the reason those countries don’t spend the free money very well.
As well meaning as all of these programs are, they become more and more unsustainable as we go forward.  It doesn’t matter which party passes well meaning laws, if we run out of money, we run out of money.

 

Associated Press

3) Bush’s Democracy projects, to try and change the world.

We won the war in Iraq against Saddham Hussein.  After 8 long years, Obama finished the policies (badly, which I’ll get to.) declaring that the mission has been accomplished.

But what is the result of that accomplishment?  Thousands of lives lost in Iraq and Afghanistan to bring savages “democracy”.  As if Democracy is a sacred goal?  Democracy is tyranny of the majority.  You know what the majority in Iraq wants?

Tyranny of the Caliphate.

news.vice.com

Not Bush’s fault you say?  Certainly not completely, Obama left Iraq a vacuum of power.  However, the people of Iraq, by a majority are okay with the Islamic Caliphate of ISIS taking control of Iraq.  If Saddham Hussein was still in control of Iraq, there would be no ISIS.

The people have spoken.  Democracy is a dangerous ideal, our founders despised direct democracies. (That’s why we’re a Republic) This is again an issue of empathy versus money. We simply can’t free every country from their brutal dictator, and like Iraq, many of these people will just choose another brutal dictator.

associated press
Conservatives criticize Obama’s stimulus, but not Bush’s?  You wonder why the American’s don’t see the Republicans as an alternative to the Democrats?
The stimulus delayed the recovery in 2003. Greenspan blamed the war, it was Keynesianism that delayed the recovery.  The recovery kicked in to high gear, in late 2004 after the stimulus spending died down. It didn’t work for FDR, why would it work now (or then for Bush)?How can we consistently be against Obama’s stimulus, if Bush’s was okay?

 

michellemalkin.com

5) The attack on the freedom to fail (TARP, GM Bailouts, etc)

Michelle Malkin and Reason both, had great write ups on how Bush completely abandoned the free market principles that made this country great to “save” the free market system.  In fact, he set in place policies and government expansion that allowed Obama and his cronies.  The Financial Regulations put in place by Barney Frank, and his equally idiotic compatriot Chris Dodd.  The two buffoons who didn’t see a problem with Fannie and Freddie, wrote 2500 pages of regulations for the banking industry.

It’s not talked about much, however the Dodd-Frank financial bill is the Obamacare of the financial world.

Clarion Ledger – Marshall Ramsey

It happened, because Bush started the path allowing the Federal Governmetn to control private banking through TARP.  The goal?  Fix a problem caused by Democrats, Government and Obama.

While this may seem very negative of former President Bush, it’s brutally honest.  If I had a choice, I’d still vote for Bush over Gore or Kerry in 2004.  Just look at the colossal joke that John Kerry is in our State Department.  Reflection of past mistakes is necessary if we expect to improve.  Bush like Hoover, was a “pre-socializer”.  Hoover tried to expand Government
to help those suffering from the recession.  He even started the New Deal.  In my opinion, part of being a Constitutional Conservative or Libertarian is being a student of history, and seeing where policies fail, and where they are repeated.  Obama similar to FDR tried massive spending to save the economy. By his own graph, we’d be better off today without the stimulus.  That doesn’t even take into account that Obama’s BLS has changed the way the U6 is reported.  Labor Force Participation hasn’t been at 62.8% since Jimmy Carter.

Remember though, all of the acceptance for Obama’s policies came from Bush doing it first.  As childish as it is to point your finger at the other guy, and spout, “HE STARTED IT!”, Bush truly did start it.  Ultimately, that’s why Romney was a bad choice for competing for that seat.

Romney passed the predecessor to Obamacare.  Ryan accepted stimulus spending for Wisconsin.  If the Republican party doesn’t differentiate itself from the Democrat party, why would anyone vote for them?

Obamacare: Where We Stand, March 31st Edition

Health Overhaul Uninsured

The March 31st deadline for enrolling in Obamacare has come and gone. How fast time flies.

It was only late last year that the March 31st hard deadline was created. Oh, you don’t recall? The March 31 deadline for signing up was created in the end of October. Initially, you needed to have active insurance by March 31st, not just successful ‘enrollment’.  Under the law, to successfully meet the rules of the individual mandate, you needed to enroll by March 1st, in order to have active insurance by the deadline of March 31st.  And furthermore, this new deadline had been held as the final date; until, of course, the Administration allowed another waiver for anyone ‘enrolled’ to complete the enrollment process well into the month of April.

In any case, this is now, technically, the day by which most have pointed to as the first real target date by which the government should be making solid progress in insuring the uninsured, and providing an adequate pool of payers into the insurance exchanges.

What we know, and maybe more importantly, what we don’t know, is critical to understanding the debate that will revolve around health care for the next few months.

So what do we know, for certain?

We know that around 7 million enrollments have gone through the exchanges by the end of March. That is admittedly a relative success in and of itself for the administration, which had such a disastrous start to the enrollment period. In my piece in the end of December, I did believe they would get the exchanges fixed, but I still thought they would be hard pressed to reach the 7 million mark.

The problem now becomes what the definition of enrollments are.  Enrollments are NOT people who have actually successfully been insured.  They ARE people who have successfully chosen an insurance policy on the exchange, and placed it in their ‘shopping cart’ on the website.

I am sure many can already see the problems with this.  First, the system has no way of telling if you are a repeat customer.  I for one have two accounts that have insurance policies in my cart, neither which I ever plan to purchase.  I was simply testing the exchange website.  Am I being counted?  I am unsure, but I do know I am receiving emails regularly to remind me to complete my purchase.

Second, until you complete the payment process, you are not insured.  HHS has clearly stated this on many occasions. Health experts such as Bob Laszweski have stated that in his discussions with insurers, he puts the ‘unpaid policy’ number at somewhere in the range of 15-20%.  My own personal discussions with insurers backs this up; and on March 30th, HHS Sec. Kathleen Sebelius stated the rate was around 10-20%.  So there is general agreement on this issue.

The rate of people insured really is the crux of the issue for the overall cause of health care reform.  The other metrics are far less important in the long run.  Several surveys, including the Gallup survey, have shown a short-term decreases in the rate of uninsured, but it is uncertain whether this is statistical noise or a true permanent trend. A new RAND corporation survey that was leaked to the LA Times has also shown a trend in decreasing the uninsured.

My own opinion is that the rate of uninsured must be dropping.  The real question is, by how much, and by what method?

Let us remember that initially, the CBO predicted that the vast majority of those purchasing health care insurance on the Obamacare exchanges would be uninsured persons, looking for access to the health insurance.  If this had been the case, then we should see a dramatic decrease in the number of uninsured.

However, it is difficult to believe this is the case. The same RAND study referred to above also shows that only about 1/3 of those on the exchanges were previously uninsured. Jonathan Cohn of the New Republic uses specific state numbers, like the enrollments in Kentucky and New York, to show that the number of uninsured is outpacing CBO predictions.  However, that doesn’t seem to be the case nationwide; I am willing to stipulate there are probably a few states that are doing well, but overall, it appears they will miss their target.   Philip Klein of the Washington Examiner points out the counter case, that is that it appears the exchanges are underperforming when it comes to insuring the previously uninsured.

Even using Cohn’s arguments, even he accepts it is highly unlikely that even a simple majority of those on the exchanges nationwide were uninsured previously.  Thus, the majority of those purchasing on the exchanges were persons who were buying insurance already, but simply were looking for government subsidies so they could get a better deal.

What does this mean in the grand scheme?  It means that the decrease in the rate of uninsured will be less than expected by many.  That doesn’t mean the rate will not decrease; Medicaid enrollments alone should decrease the rate of uninsured by a couple of millon, at least. It just means those actually purchasing insurance on the exchanges, by and large, were not the uninsured at all.

The next issue that will arise is how all of these factors affect premiums for the coming year.  I have talked about the demographics affecting the exchanges; primarily that young people have not signed up at a rate as great as expected initially.  The CBO and HHS had initially predicted that about 39% of those in the exchanges would be composed of those ages 18-35.  The average, across the nation, appears to currently be less than 30%, a number that Kathleen Sebelius now has basically accepted publicly.

This is important because, to subsidize those that are older or in poor health, the insurance pools require more healthy (and generally younger) payors into the system. Without those payors, the general cost of premiums will increase.  Liberals argue that age is a poor metric to calculate whether people are healthy or not.  This is true.  However, do they really believe that the people rushing to buy health insurance are the healthy among us, and not the ill?  There is a selection bias obviously involved here, and it is far more likely that those with poor health are the first to arrive in line for health insurance under Obamacare.

Almost everyone now stipulates that insurance premiums will rise more than the baseline expectations for 2015.  In fact, overall costs are already increasingUSA Today reported that health costs are increasing at the fastest rate in a decade…and that is before these cost pressures arise to affect premiums.

The biggest question left this year regarding Obamacare really is, how much will premiums increase?  If they increase at the same rate as the past 5 years (less than 4% a year on average) that will be a major success for the administration.  However, if they increase at a rate above 6% a year (and there are rumors the rates could increase by double digits), that could be catastrophic for the popularity of the program.

These are the core issues, though many other issues do remain.  Will people continue to be resentful to President Obama and Democrats for lying to them about being able to keep their insurance plans, and being able to keep seeing their same doctor?  Will the changes in their insurance policies make them more or less content?  Will increases in deductibles raise the ire of many Americans, who may or may not have understood those costs when they purchased their health policies?  These and many more questions remain, all of which ultimately will be more significant than the enrollment numbers of March 31st, 2014.

The only advice I can give is, be patient; only time will tell.

 

This was cross posted at Neoavatara

The Band-Aid Presidency

bandaid

 

Last night, in the most classic way imaginable, the Obama administration dumped a 800 lb lump of coal into the stockings of liberal America on the eve of the Christmas holiday.

The Administration announced that any person who had their health insurance cancelled late this year are no longer obligated to legally abide by the individual mandate, the central taxation component of the Affordable Care Act.  Additionally, these same people could satisfy the mandate requirement by purchasing catastrophic insurance alone, which previously was not considered sufficient to satisfy the mandate requirements.

The argument that the administration is making is ironic in so many ways.  They argue that the individual mandate, arguably the most important cog to the workings of Obamacare, is a ‘hardship’ to millions of Americans.  Furthermore, they are arguing that because of this hardship, they will simply delay that part of the law.

Think about the legality for a second:  President Obama is issuing a hardship exemption for something the Supreme Court has defined…as a tax.

Can you imagine the fun a Republican President can have with that power?

Let us also remember that this invalidates virtually every Democrat and liberal argument against a deal to avert October’s congressional shutdown.  Let us not forget that Senators Ted Cruz and Mike Lee put a proposal on the table to avert the shutdown if the administration simply agreed to a 1 year delay to the individual mandate.  Yesterday, Barack Obama did just that…proving that much of his stance on the shutdown was political theater, nothing more.

In the larger picture, this type of policy change largely defines the entire Obama Presidency. The pattern is as follows:  Obama and liberals propose a policy that, any common sense would tell you, cannot function in the real world. They pass this policy, often distorting the facts to the American public to get their support.  Once passed, they all of a sudden realize the idiocies contained in their plan, and rush to distance themselves from the plan they were recently advocating.  Once the policy becomes active, they realize that reality is more powerful than ideology, and thus, look for any and all ways to get themselves out of the mess they created.   And they use every ‘Band-Aid’ measure possible to cover-up the mess they have created.

The Band-Aids are piling up, and it does not only refer to health care.  Look no further than foreign policy this.  Obama’s Syria ‘Red line’ policy is a perfect example.  Obama talked a good game, but then realize that there was no way to enforce his red-line in the real world.  He quickly ran away from that policy, only to end up with a policy that, ironically, strengthened the power of a man Obama said was ‘evil’, Bashar Assad.

If you want to go further back, the Obama stimulus often had many of these characteristics as well. They passed statutes for ‘shovel-ready’ projects, and later realized there was no such thing.  They then pumped out the money, regardless of effect, to lackluster consequences.

Think of the fallacy of this latest Band-Aid on Obamacare.  The administration is arguing that they have imposed a hardship on at least 5 million Americans who lost their health insurance because of Obamacare.  So, to help these people, they are going to exempt them from the individual mandate.  However, these same people argued during the shutdown that any delay of the individual mandate would be catastrophic to the functionality of the entire ACA system.

Furthermore, the hardship claim is dubious.  Is Obama actually saying that it is more a hardship for people to lose their insurance and have to purchase it on his own exchange, than the hardship of forcing the previously uninsured to dig deep in their pocketbooks to purchase that very same insurance on the exchanges?  He is saying the previously uninsured have no burden of hardship as well?

Another liberal fallacy also dies: the argument that these were ‘substandard’ insurance policies.  Obama has now stated it is o.k. for people to move to catastrophic insurance, when the majority of this cohort had comprehensive insurance prior to Obamacare coming into effect.  In other words, Obamacare diminished  the quality of health insurance plans in America, and Obama is not legitimizing that change.

Each of the policy changes are chinks in the armor of Obamacare; that armor is now thin and rusting. This is a virtual universal delay of the individual mandate for 2014, no matter how liberals spin it.  They will never politically be able to argue that those that lost their insurance because of Obamacare bear more hardship than the uninsured do, and thus, they will be forced to exempt all Americans.  Ted Cruz wins the policy debate.

Even worse, this fixes nothing long-term.  This is a classic Obama ‘Band-Aid’.  Sure, it theoretically stops millions of people from being required to pay approximately $95 in tax penalty this April. But the real issue is not the tax, but the health care exchange.  By exempting all of these people, the administration makes the entire insurance system much less financially stable.

Insurers who were already dubious of the administration’s competence on this are now outright furious at being lied to, time and again.  They fear this will further push the risk portfolios of their insurance plans to the extreme, and thus, will increase their costs. That further increases cost pressures on health insurance premiums across the board, increasing costs for everyone. The Obamacare upward bending of the cost curve continues.

The ‘Band-Aids’ are all for show.  Ultimately, the problem is that the law itself was inherently broken.  These temporary measures actually fix nothing in the system. They are a political attempt at cover.  But nobody can protect Democrats from the onslaught of public anger that is going to arise when they realize what the ACA does, when the Band-Aids finally come off.

Obama On Obamacare: Honesty Is NOT The Best Policy

obama-obamacare-boston-speech

This weekend showed the mendacity of the Obama Administration on the continued debacle of the rollout of the Affordable Care Act.

Saturday was the deadline that Obama himself proclaimed for full functionality of the Healthcare.Gov website.  We were told, all last week, that the government was working day and night to achieve ‘success’.  And then Sunday morning, Voila!  The White House proclaimed they had achieved their goals.

Except for one problem:  the reality is that the website is far from fixed.

First, the metrics that the White House themselves have used for ‘success’ has been slowly been moving downward since Obama made his proclamation in early October.  At first, it was that 80% of applicants could complete their insurance purchasing process through the website.  Then, it was that 80% of people could actually complete the application on the website, and have the process completed in steps unrelated to the internet (paper applications, for example).  Now, the criteria is that at 80% of people can sign on to the website.  They no longer even discuss completing the process.

Even more laughable is that HHS states that they have achieved their goal of the website being up and running 90% of the time.  Let us put aside the fact that 90% success of a website is pathetic; what is even worse is that 90% is noninclusive of downtime from scheduled maintenance that the website requires almost daily.  So when the website isn’t down for fixes..it is functioning at 90%.  Not much of an achievement.

“Healthcare.gov on Dec. 1 is night and day from where it was on Oct. 1,” Jeff Zients, who was brought in to oversee fixes to the troubled Obamacare website, declared during a Sunday conference call.  That may be true, but that doesn’t mean we have achieved any level of success.

Furthermore, when HHS was specifically asked by Washington Post Health Care blogger Sarah Kliff whether their problem with the 834 forms (essential data necessary to insurers to complete the purchasing process) have been solved..they refused to answer.

My contacts in the insurance industry have said that there have been small improvements, but overall, the problems persist.  So much so, the insurance industry put out a statements stating that although the website has improved, major problems remain, and are nowhere near to fixed.

Today the White House was proclaiming that 100,000 people have signed up to Obamacare in November, claiming another victory.  Again, this can only be considered a victory if you wear rose-colored glasses.  Yes, it is better than the 26,000 sign ups in October, but a fraction of the 800k expected in November.  At the current pace, Obamacare would need approximately 56k purchasers a DAY to achieve their goal of 7 million by the end of March.

The White House would be better served by admitting the truth.  Admission of the faults in the program such as that the entire program is running well behind schedule, and needs to be delayed, and that the website may need to be rebuilt are simple realities that the public may be willing to forgive.  The administration seems to be unwilling or unable to make such an honest assessment, either because of political or practical realities.  But trying to fool the American people that any of these metrics are any type of ‘success’ is likely a level of mendacity that will only lead to failure.

 

What Really Worries Democrats About Obamacare

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Ignore the media, and the liberal spin.  There is one simple political reality:  Democrats across the board are extremely worried about the Affordable Care Act, and its effect on the 2014 elections.

I have quite a few connections to staffers and other behind-the-scenes people in the Democrat Party.  Talking to them, there is a consensus: they are in trouble.

Some of them fully believe that Barack Obama, Kathleen Sebelius and the rest of the President’s administration can right the ship, and some make the Obamacare system functional enough to please the public.

Most, however, don’t believe anything of the sort.

There is a reason for this:  for all the bluster and hot air about the Obamacare website debacle, that is the least of the worries for liberal supporters of the health insurance reform plan.  In fact, the failure of the website may actually be hiding some of the more pernicious aspects to the health care law.

So here is a timeline of the largest hurdles  the supporters of Obamacare face over the next twelve months:

 

November through December 2013

The enrollment numbers for the first month were terrible, and that is unlikely to dramatically change any time soon.  Initial numbers stated the total enrollment nationwide for October was a meager 50,000 or so.  That is less than 1/10th of 1% of the total necessary to keep the system sustainable.

Obamacare defenders will try to spin that the tens of thousands added on to the Medicaid system as a sign of success, but even people not familiar with the ACA understand it is easy to give away free stuff; It is another thing entirely to get Americans to pay their hard-earned money into the system, when that system may not provide them any great benefit in the near term.

The website functionality is going to be an ongoing challenge as well. President Obama and HHS Secretary Kathleen Sebelius both promised that the website would be working by the end of November.  That now appears to be another ‘incorrect promise’ and frankly, most IT experts I talk to would be surprised if the system is up and running before February.

Website Security will be an issue as this process continues as well. Consumer Reports and others already warned Americans that they should wait until major fixes in the security loopholes were corrected. On 11/19/13, there was testimony that the website places user data at “critical risk” despite recent government assurances it is safe to use.   Several security experts have predicted a large-scale breach in security. Imagine millions of Social Security numbers, credit card numbers, along with IRS tax data and health data being breached.

Amazingly, the entire ACA Payment system also has to be built, after three years.  There is no system at present to transfer funds from the Federal government to the states or to insurers.  And even more shocking? On November 18th, the head of the IT for the ACA admitted that at least 30% of the ENTIRE IT INFRASTRUCTURE still needed to be constructed.

To compound matters, the system also has a nonfunctional subsidy calculator.  What does this mean?  Right now, they are only estimating individuals expected subsidies.  However, if the estimate is incorrect and over estimates your subsidy, you could be liable for hundreds or thousands of dollars more in premiums next year.  This would be problematic in the best of situations.

To compound this problem, the administration is trying to shunt customers to private insurance websites, as a ‘work around’ for  the broken Federal exchange.  The problem is, it is technically against the law for purchases outside of the exchanges to receive federal subsidies.  What happens if a legal entanglement results in those subsidies to be ultimately rejected?  Customers could be in for a real disaster if they agree to purchase insurance, only to find they are not eligible for subsidies.

 

January through June 2014

The first problem is one I have already written about:  Obama will have to break his promise that If you like your doctor, you can keep your doctor.  This promise could never have held true in the market that Obamacare creates, because as predicted, many of the policies purposefully eliminate expensive and elite institutions.

I personally have been booted off of several health care plans because of a cancer center I work at.  I know many doctors stating similar experiences at elite institutions such as Memorial Sloan-Kettering Cancer Center, Mayo Clinic, Cleveland Clinic, and other prestigious institutions. The most famous case was a cancer patient in California who wrote an editorial in the Wall Street Journal, and who could no longer see her oncologists and other treating physicians, because the California exchange had no policies that would include all of her physicians.

The next major debacle will be the surprise of high deductible payments. The majority of the policies being sold are the cheaper ones on the exchanges; the so-called Bronze and Silver plans.  The average yearly deductible, after paying your premium for these policies, is around $5,000.  There is a high degree of variability, but on average these are high deductible plans.  What will happen the first time there is a sick child, and a $5,000 deductible stands between that poor family and a life saving procedure?

One interesting twist will be the use of Obamacare Navigators.  This was a program the administration started to ‘guide’ customers through the process.  Sounds great.  Except for one problem:  many of the Navigators were not appropriately screened, and there has already been a fair amount of fraud in this group of government workers. Undercover videos of Navigators telling customers to defraud the government have already surfaced, and I am sure you will see dozens of those as time goes on.

 

July through September 2014

This is actually when the rubber meets the road.  By this point, no matter how incompetent the administration’s IT experts are, virtually everyone that wants to have insurance should have insurance.  The website problems, even if they still persist, should no longer be relevant.

The first question that will arise is how many people chose to pay the penalty?  For many of the lowest income persons, a penalty of $95 was all that was required to opt out; with the high expense of many plans, a fair number of people will choose this option.

More important is the ratio of healthy individuals compared to sick ones in the exchanges.  For the exchanges to survive, they require a very high ratio of healthy people buying in, in order to subsidize the rest of the population.  Recent data from Kentucky (supposedly a liberal success story) shows that the ratio of healthy to sick is closer to 1:4 than the close to parity required for financial sustainability.

What happens if this does not occur?  Insurers will enter the oft talked about ‘death spiral’.  They will be required to raise their future premiums in 2015, because the cohort of patients in their insurance pools are less healthy, and thus, more expensive to treat.  The death spiral occurs as young, healthy persons realize that the increased costs of their insurance is not worth it, and opt out…further increasing the ratio of sick persons in the insurance pools, and further increasing costs.  This is the scenario that most scares Obamacare proponents.

The irony of all this is this presumes that the individual mandate  is not delayed.  Right now, the Upton and Landrieu bills sit in Congress, and Obama has announced his executive order to ‘fix’ the problem of policy cancellations.  The more delay of the individual mandate, either by legal methods or presidential signature, the more likely it is that insurers will have costlier insurance pools that will drive up premium costs moving forward.

The next problem is how this huge new population of insured patients will be treated by a system that is already overburdened.  A doctor shortage very well could arise.  Something similar, but to a lesser scale, occurred during Romneycare’s implementation in Massachusetts.  Massachusetts was more prepared than most states, as it has the highest ratio of doctors to patients in the country.  Even then, access to physicians, especially specialists, was restricted substantially.  Now imagine the states with low doctor to patient ratios, and you can imagine the complications that could arise.

That doesn’t even take into consideration that many physicians are likely to opt out to the largest expanding health care insurance program in the country:  Medicaid.  Already in states like New York, about a third of doctors have opted out.  Many physicians, especially those tied to hospitals, cannot opt out.  But this decrease in available primary physicians to handle this huge new number of Medicaid patients (who are among the sickest and poorest patients around) could be a disaster, and there is no short term solution to this problem.

 

October through December 2014

This is where all the real excitement occurs.  Let us assume some how, some way, Democrats have survived the year without any major catastrophes, and are holding their head above water as the midterm elections come.  There are several huge hurdles still remaining.

The first, and largest by far, will be the kicking in of the employer mandate. Remember that this mandate was supposed to occur this year; however, because of the completely broken and unworkable system, Obama delayed it (outside of legal bounds no less).  But the employer mandate is the crux of the entire system; the majority of Americans get their insurance through their employer, and insuring this mandate is vital to that majority.

The problem arises in the fact that in the same way that millions are losing their private insurance plans today, even a greater number of employees are likely to either lose their plans or see drastic changes next year.  This was predicted by the Department of Health and Human Services as far back as 2010.  Now is when that change kicks in.

Furthermore, millions of small business owners will have to decide whether to pay for insurance, or send their employees into the exchanges; the same exchanges that are so far struggling to handle the volume and load.

For employers that are going to continue their insurance plans, another problem: they will likely get notices from insurance companies that the plans they currently purchased no longer exist.  Sound familiar?  And insurers will, under Federal law, have to do that a minimum of 60 days before cancellation, meaning…the beginning of November, at the very latest.

And, remember the ‘death spiral’ we discussed above?  If insurers face that hurdle, they are likely to raise rates across the board.  Here is the biggest problem of all: for all the talk about these changes affecting only the people on the exchanges, if and when a ‘death spiral’ or anything like it occurs, costs will rise for everyone.  That means increased premiums for businesses, which will likely be passed on directly to employees.  Some employers will also likely choose the easy option, which is shifting their employees to the exchanges.

And all this will be announced just weeks before the election.

 

After all of this, you begin to understand why those that truly understand the steps necessary in the next year to implement the full-scale of the Affordable Care Act are worried.  Right now, we are seeing the tip of the iceberg: gross incompetence in establishing a website for entry into this behemoth government monstrosity.

But once you enter this behemoth, you start to understand that there are numerous interweaving and interconnected cogs that will need to work relatively smoothly, or the system as a whole will flounder.

That doesn’t even tell the political story.  Every week, if not daily, there will be a story about individuals who are being harmed by the ACA.  Those stories will drown out any of the positive stories, because we know that ultimately the media highlights the negative.  As stated above, when a child or young mother is denied life saving treatment because of restrictions placed upon them by Obamacare, who takes the blame?

Liberals are trying to circle the wagons, to keep sustainable political support for the plan, in the hopes that the Obama Administration can fix the problems in short order.  But as you can see above, there is no simple fix.  Many of the ‘problems’ with Obamacare are inherent to the system that Democrats devised.  These were intended results.  How do you fix the plan, when it is the intent of the plan that is the problem in the first place.

So batten down the hatches, America…it is going to be a bumpy ride.

 

Democrats To America: We Lied, But You Should Apologize

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What a hilarious dynamic you now have in the Democrat Party.

The civil war I described earlier is between two, diametrically opposed views.  One is the Obama Progressive Idealistic wing: they will push Obamacare, no matter what.  If there is absolute, positive evidence that the program doesn’t work, it wouldn’t alter their belief that their plan must be enacted fully.  Reality matters little to this wing of the party; they simply are fanatical idealogues.

The other cohort is the Pragmatic ‘Do and Say Anything to win elections’ wing of the party.  This was most famously led by Bill Clinton, but now numerous Democrats that are (SURPRISE!) up for re-election next year have joined as well. Mary Landrieu, Kay Hagan, Mark Begich, and moderates such as Joe Manchin belong in this group.  They believe they must placate the angry American electorate first and foremost. What is ironic is this group doesn’t care about the success or failure of the ACA either; they simply want to do enough to get 50.1% of the vote next year.

And in the middle is the rest of America.

Americans feel betrayed.  They never truly supported the Affordable Care Act, but a majority of them trusted Barack Obama enough that they gave him the benefit of the doubt; that, more than anything explains Obama’s re-election.  The benefit of the doubt on the economy, on foreign affairs, and yes…on Obamacare.

That trust is now broken.

Look no further than the recent polling from numerous agencies.  Trust in Obama has collapsed entirely.  On most issues, Republicans are more trusted; remember, this was the party who a few weeks ago was less liked than many venereal diseases.  Obama is doing worse than that.

And what has Obama and Democrats done to respond to Americans discovering they have been lied to?  Basically, they blamed…everyone but themselves.  The list is long.

It was Republicans fault for not working with Democrats; even though the GOP correctly and appropriately predicted the problems that have now occurred.

It was the fault of the media, for not spinning more.

It was the fault of contractors, who failed to do their job, as if government oversight wasn’t the administration’s responsibility.

My favorite? It was the fault of average Americans. Why?  Because they were foolish or stupid to believe the lie in the first place.

If you think I am exaggerating, simply go read some of the ‘elite’ liberal columnists out there. This last excuse actually has become common place among the liberal intelligentsia.

The quandary that liberals are in leaves them between a rock and hard place.  Either they can follow their fanatical ideology, and fight for the Affordable Care Act, even though more and more evidence is coming to light that the plan cannot achieve the major goals set for by Obama himself.  The alternative is to pass something like Landrieu’s Senate plan, allowing people to keep their current health plans; that would blast a hole in the central tenet of Obamacare, which is to redistribute health care dollars from the healthy to the sick.

I actually agree with many liberals:  no amount of running away from Obamacare is going to save Democrats this time. They own this, in totality.  Ultimately, the only thing that would save them would be a competent rollout of the remainder of the system, which at this point seems highly unlikely.

Which means, when the 2014 election rolls around, we can truly see who deserves to be delivering, and receiving, apologies.

Obamacare’s Frightening Reality

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Here is a personal story.  My wife has a friend in New York who is in her early 40s and was found to have breast cancer last year.  The woman had metastatic disease, and her condition was considered grim.

This woman then was recommended by both my wife and I to go to Memorial Sloan-Kettering Cancer.  I trained there, and know it is one of the premier cancer centers in the world.

Luckily, this woman had health insurance, which her husband pays for out-of-pocket, because he runs a personal business.

Now, here is where it gets interesting. First, this woman is a huge Obama supporter. So much so, she campaigned for Obama in 2008 (she went to New Hampshire during the primaries, and stayed in a hotel there for several weeks on her own dime campaigning for the Obama effort).

I spoke to her last night, by coincidence.  And her opinion was shocking.  And it changed because of an Op/Ed from a cancer patient that was published in the Wall Street Journal last week.

The article was written by Edie Littlefield Sundby.  Ms.  Sundby is the victim of stage IV gallbladder cancer, a horrible disease that has a very poor 5 year survival rate.  She had been lucky to have excellent insurance, and had been treated at premier cancer centers at the University of California; Stanford University’s Cancer Institute; and the M.D. Anderson Cancer Center in Houston.  All three are consider top-tier cancer institutions.

However, she just found that her insurance has been cancelled because of regulations placed upon it by the Affordable Care Act.  She can still get insurance, but none of the choices available to her would allow her to continue to see all of her physicians, as  her old plan did.

People who have never dealt with cancer treatment would wonder, “Why not change your doctor?”  However, cancer is unlike most things in medicine.  A detailed therapy plan often is only available with certain institutions and doctors, and not everyone provides every therapy.  Moreover, after myself working at Sloan-Kettering, I have seen how these elite institutions provide far better results with stage IV and advanced cancers than many other institutions.

Now, this brings us back to my friend, the Obama supporter.  She is truly worried now.  She is still going to Memorial Sloan-Kettering for treatments, and likely will have to for the rest of her life.  But now, she is unsure if her insurance will be there when she needs it.  She and her husband have expected to get the cancellation letter in the mail, and right now, her search of New York’s health exchange has not given her a solution that would allow her to not only see her local doctor, but to see her physicians at the Cancer Center as well.

This is the reality of the ripple effects of the Affordable Care Act.  And you will continue to hear stories like this, over and over again.  And Democrats will have to defend their choices, now that they have real world consequences.  If the Obama Administration can convince people that they will maintain their same high level of care for a reasonable price, then all these worries go away.

Right now, Americans like my friend are not convinced.

Obamacare Rollout: What We Know, 1 Month Later

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So, as November 1st arrives, we were supposed to get a good feel if the rollout of the Affordable Care Act was going as planned, trajectory of insurance purchasers, relative cost comparions, etc.

We really have none of the above.

The website debacle has basically brought the entire process to a standstill.  People either were unable to purchase insurance, or were so turned off that they didn’t bother.

So what we don’t know, and the data lacking therein, far outnumbers the things that we demonstrably do know.

So, to get past the political spin, what data is there? What, if any, conclusions (partial or otherwise) can we make?  What do we know, for certain?

1.  The Website has issues; major issues. 

The website problem is not a simple fix.  Testimony this week on Capitol Hill clearly demonstrated that.  The officials from the Department of Health and Human Services, as well as contractors paid to build the web platform, didn’t agree on much, but they did agree on that.

A repeated promise was made in hearings however:  that the website would be operational by November 30th.  That is a dubious promise.  If the problems that exist in the website are as reported, it is not simply fixing a few lines of code that will make everything all right. There are major isuses, not only with the code but the basic structure of the system, the transfer of data from the web platform to-and-from major databases, and communication with the insurers themselves.

It will take a Herculean effort to truly make the system operational by the end of November.

Furthermore, the tech surge that President Obama largely seems to be rhetoric, as the majority of those chosen to run the new effort are long term Beltway insiders.  If anything should give you pause, that should.

2.  Medicaid enrollees are far outnumbering purchasers of insurers. 

This may be the most worrisome part of what has happened over the last month, even more than the website issues.  Fundamentally, the entire premise of the ACA rests on the balance of having new people buy insurance on the markets, to partially ‘subsidize’ those millions being added to the Medicaid rolls.

As a Washington Post article today noted, on many of these exchanges, Medicaid enrolles are ounumbering purchasers 9:1. That is a death knell for the system if it continues.  As the CBO reported from the beginning, we need closer to a 1:1 ratio (the CBO says the ratio of Medicaid enrollees:insurance purchasers should be approximately 9.1:7.9, to be precise) to maintain fiscal sustainability.

However, we simply don’t know if this is a short term blip or a long term trend.  This could all be a result of the poor website functionality, which then had a ripple effect in the marketplace.  Or it could honestly be that purchasers don’t like what they see, and may choose option B, the Obamacare tax penalty…which would be fiscally disastrous for the system.  That would be the leading edge toward the ‘death spiral’ that the Administration and insurance industry fears so much.

3.  The Administration has come catch up to do to make their enrollment targets for 2014. 

To maintain the system, they need a minimal number of paying customers in the Exchanges, as described above.  The number the CBO has stated is approximately 7 million by the target date (which, after the White House pushed it back, is now the end of March).

They had expected to sign up about 500,000 people by the end of October.  That number will be missed by a large margin.  Secretary of HHS Kathleen Sebelius refused to release the numbers, but most estimates state that the number of policies actually sold will be far less than 100,000

That number is not going to significantly improve in the month of November, because the website is still largely nonfuctional. Then comes the busy month of December, with the intrusion of the holidays.

My guess (and it is only a guess) is that they may not meet their goal for October 31 of 500k purchasers even as of January 1, 2014.

If that holds true, or even if they do better than expected and get up to 1 million person mark, that means that they will have to sign up 6 million persons in three months time.  That is a huge hill to climb.

4.  Liberals blaming Republicans for this mess don’t really have many facts backing up the claim.

Liberals to this day are blaming the ‘intransigence of Republicans’ for the failures in the system.  However, this has been simply disproven:  go to a number of states that have Democrat Governors and legislatures, that have been implementing Obamacare from the beginning, and see if they are doing better.

For the most part, they are not.  Take Oregon, who as of earlier this week, had not had any purchasers of insurance through their exchanges, though they have had tens of thousands of enrollees in Medicaid.  California, New York and others are not much better.

This is largely not a political problem at this point, but a problem of managerial competence or lack thereof.

5.  We have anecdotal evidence of people paying more for insurance after losing their insurance.

This is ONLY anecdotal evidence at this point; and that makes it very hard to really analyze.

Definitely millions of people are losing their current insurance because of the ACA and associated retgulations that are term limiting those insurance plans.  Democrats can blame the insurers, but that is a lie:  the full responsibilty of that process lies with the ACA.  The vast majority of these plans would still exist today if not for the ACA; it is as simple as that.

As for increased health care premiums, we won’t know for a long time if that is a systemic problem, or an isolated one.  Democrats claim those cases are the exception, Republicans claim they are the rule.  The truth is neither side has enough data to make such absolute claims.  And that data will take a long time in coming.  It may take months, but more likely years to know if the ACA is bending the cost curve up, down, or has no effect.  I have my suspicions, but there are only that:  suspicions.

6.  Conservatives should not rejoice; the plan can still be saved.

I know, this is a shocking statement coming from me, considering I have been so pessimistic about the system as a whole.  But the truth is, if there were competent managers in charge of this, this rollout could have gone much better.

The website debacle has a snowball effect, to be sure. We don’t know how many people, but certainly hundreds of thousands of people if not more would have gone on to the exchanges and, most likely with the help of subsidies, purchased insurance if they were allowed to.

Incompetence prevented that.

Where the rubber meets the road is getting people who will not receive a significant subsidy to purchase on the exchanges.  Now, this is really the hard part for Democrats.  So far, from what little I have seen, the insurance plans on the exchanges are more expensive and provide less financial coverage than many plans that were available prior to the ACA.

Democrats will counter that these plans provide ‘more’ coverage.  There is some truth to that, but much of that coverage is not really beneficial to the majority of consumers.  Furthermore, remember that the primary demographic that they must convince to open their pocketbooks and purchase insurance, instead of paying the penalty, is the young, healthy American.  How many of these people are thinking about ‘better’ coverage when they don’t use the coverage they have today?  Are they going to be willing to pay $100-$200 more a month for something they don’t use?

We simply don’t know the answer to that.

Overall, it has clearly been a rough month for supporters of Obamacare, as nothing seemingly has gone right in their rollout.  Can the system be saved? Yes, but it will take not only a Herculean task on the IT side, but a lot of selling by President Obama and the White House, along with a lot of luck, to convince people to do what is not in their short term interest (i.e. purchasing more expensive health insurance) while promising dubious long term benefits.

Obamacare’s Debacle Denialists: The Sebelius Hearing Version

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I have, both here and on social media, talked a lot about the denial the left is suffering from when confronting the realities of the train wreck that the Obamacare implementation has become.

Today’s hearing with Health and Human Service Secretary Kathleen Sebelius was a perfect example.

As the person in charge of this implementation, you would presume that she would have the most up-to-date information on the program.  That she would be able to quickly and promptly answer where in the process the repair of the exchange website we are.  And, that she could tell us what the legal standard for the law is.

You would be wrong on all counts.

To put it succinctly, Sebelius’s testimony also turned into a train wreck.

But let us give her credit.  Sebelius started the day by taking full responsibility for the website’s failures.  Good, right?  The only problem is, she spent the rest of the day trying to convince the hearing members that it wasn’t her fault, but everyone else’s.  She primarily blamed the contractors for not telling her the truth that there were problems with the site; that is, of course, now documented to be false.  They have documented that they were not provided the access or authority to test the site fully, and that authority only resides at HHS.

But it gets worse.  When questioned about the websites security measures, she could not confirm that it was ever tested for security leaks.  Again, to the contractors credit, they documented that they sent a memo to Sec. Sebelius in the end of September stating this fact…and yet HHS did little or nothing to insure the security of millions of Americans’ data.

Sebelius then made what I thought was going to be the most remarkably stupid comment of the day (but wasn’t) when she claimed…wait for it…that the website has never crashed.   She claimed,  “It is functional, but at a very slow speed and very low reliability.”  But as the graphic at the top of this post shows, the site was not functional during her testimony.  You would think she would have checked before going out there and made this ludicrous statement.

As if things couldn’t get worse, Sebelius was then asked why she didn’t go to the Washington, D.C. exchange to get her own insurance.  She claimed that because she is a Federal employee it would be illegal for her to do so.  The problem?  That is completely and factually incorrect, as the graphic from the HHS site shows:

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In other words, the HHS Secretary doesn’t know that the law she is trying to implement would allow her to join the D.C. exchange, as her own HHS website clearly shows. You cannot make this level of incompetence up.

After all that, you wouldn’t think that Ms. Sebelius could worsen this debacle; you would, of course, be wrong. During the exchange asking her about the legality of her joining the D.C. exchange, her hot mic caught this little tidbit:

Rep. Billy Long (R-Mo.) asked her to answer, “yes or no,” whether she’d be willing to drop her federal employee health coverage and buy insurance in the exchanges if she could.

“If you can, will you?” he said.

Sebelius claimed that she thought it would be illegal for her to use the exchanges — but that’s not actually true.

Then Rep. Henry Waxman (D-Calif.) made a unanimous consent request so he could ask a question out of turn. Sebelius turned to a colleague and said, “Don’t do this to me.” Those words were caught on her microphone.

Well, frankly, who could blame her?  I don’t want Obamacare to do this to any of us.

But the line of the hearing still hasn’t been mentioned.

Rep. Greg Harper (R-Miss.) asked Sebelius repeatedly whether President Barack Obama was responsible for the troubled rollout of the health-care law that has left HealthCare.gov, the website where consumers are supposed to purchase insurance, largely dysfunctional.

Sebelius repeated that she and the Department of Health and Human Services were ultimately responsible. This led to a back-and-forth between the two, in which Harper tried to pry the answer he wanted out of her before his time for questioning expired.

“While I think it’s great that you’re a team player and you’re taking responsibility, it is the President’s ultimate responsibility, correct?” he said.

“Well, you’re clearly, uh, whatever,” Sebelius said. “Yes. He is the President. He is responsible for government programs.”

Let me give you a little hint folks: if you are testifying in front of Congress, the body representing the American people, don’t ever respond to a question with the term “Whatever”.

The entire hearing was a debacle, and did nothing to support the claim of the left that the Obamacare implementation is in competent hands.  If anything, it gave more support to the argument that the Obamacare debacle denialist brigade is still in charge.

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