Doctor shortage? The Answer Is Yes: Absolutely.

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In an editorial in the New York Times on December 5th, Scott Gottlieb, an internist and fellow at the American Enterprise Institute, and Ezekiel J. Emanuel, a former health policy adviser to the Obama administration, argued that there is no up coming physician shortage to threaten the country in the face of the implementation of the Affordable Care Act.

I beg to differ.

Drs. Gottlieb and Emanuel are both very intelligent and knowledgeable about health care policy in this country.  And I do have the greatest respect for their expertise and their work in this arena.  However, in this case, I think they are largely deluding themselves.

First, let us stipulate that we all agree that most of the major medical associations in the U.S. fully believe a shortage is going to occur in short order, as the authors in this piece state quite openly.  Let us also stipulate that Gottlieb and Emanuel are not the first to deny there is a doctor shortage.  For example, mathematician Linda Green argued in Health Affairs journal last year there was no real doctor shortage, if you made some structural changes.  However, what we see, as we go through their logical progression, is that their assumptions face the cold, hard reality of the real world where doctors actually practice, instead of the theoretical world they seem to exist in.

In the editorial in the NY Times, the authors first point to the Massachusetts experiment with Romneycare as a reason that we should not believe that the doctor shortage will occur.  They state:

Take Massachusetts, where Obamacare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey.

There are many problems with this statement.  First and foremost is that Massachusetts is a poor analogy for the nation at large.  Massachusetts has the highest ratio of physicians per capita (462 doctors per 100,000 individuals). The national average?  About 300.  This means that Massachusetts has approximately 50% more physicians than the rest of the country on a per capita basis.

Now, even with that built-in advantage, the state had significant access disruption.  Let us put aside the fact that between 2009 and 2011, premiums in the state rose by 9.7 percent while benefits actually decreased by 5 percent. Deductibles during that time period rose 40 percent.  What Gottlieb and Emanuel failed to mention is that there are numerous surveys from the state showing that access to physicians is becoming problematic.

These results from a survey performed by the Massachusetts Medical Society:

The telephone survey of 838 doctors conducted in February and March found that 51 percent of internists are not accepting new patients, up from 49 percent the previous year. Fifty-three percent of family physicians, the other major group of primary care doctors, were also not taking new patients.

Even for patients fortunate enough to have a primary care doctor, waits for appointments continued to be lengthy. The average wait for an appointment with an internist was 48 days, which was five days shorter than last year, but the average wait for family medicine was 36 days, a week longer than in the 2010 survey.

Patients were also waiting longer to see specialists. The average wait for gastroenterologists, obstetricians/gynecologists, orthopedic surgeons and cardiologists were all higher than a year ago, the report said.

Now, Emanuel and Gottlieb are correct that these numbers have fluctuated, but that is to be expected.  Overall, however, access to physicians in Massachusetts has worsened over the past few years.  And don’t forget: Massachusetts is America’s best case scenario in regards to physician access.

Furthermore, even if their claim that there has been no decreased accesss in Massachusetts under Romneycare is true, that still doesn’t necessarily mean anything, because of the huge discrepancy in doctor to per capita ratio stated above.  Additionally, Massachuestts had the highest rate of insured in the country.  Therefore, the number of new patients entering the system that were previously uninsured is less than anywhere else in the nation.  To use a state such as Massachusetts that is skewed so heavily to one side of the scale seems to be foolish.

The editorial authors then go on to make several unsubstantiated claims:

Innovations, such as sensors that enable remote monitoring of disease and more timely interventions, can help pre-empt the need for inpatient treatment. Drugs and devices can also obviate the need for more costly treatments. Minimally invasive procedures, like laparoscopic surgeries, can be done more quickly with faster recovery times and fewer physicians.

There is virtually no evidence, anywhere, for this.This could be true, but it would take a massive improvement in current medical treatment methodologies that cannot be foreseen, and more importantly, are unlikely to occur in the near term.  I can speak for myself, as a radiologist who performs teleradiology on a significant scale; or my wife, who is Clinical Assistant Professor at a major medical center.  Neither of us can see the kind of transformation that Gottlieb, Emanuel, or Ms. Green are suggesting.  In short, these are dreams, not practical realities.

They go on to discuss what doctors call ‘physician extenders’, such as physician assistants, nurse practitioners, etc.  These professionals certainly have a place in the ever-expanding U.S. health care system.  They also can likely serve with more autonomy than they do today, in order to decrease the workload on physicians.  Of course, that would take a dramatic change not only in how we practice medicine, but also extensive changes in the medicolegal landscape of the country.

Even without those considerations, however, what the authors fail to declare is that expansion of the use of these professionals has already been the case for several decades.  As stated by Dr. Richard Cooper in an article in the Journal of the American Medical Association in the November 13, 2013 edition (page 1932), between 1990 and 2012, the number of physicians increased by 50%, while the number of nurse practitioners and physician assistants increased by a whopping 500%.  Therefore, Gottlieb and Emmanuel are suggesting a larger expansion in the use of these professionals than has already occurred.  That kind of dramatic change is not practical, and filling the gap with a huge number of these personnel should be considered unlikely.

The one solution that is advocated by most medical studies, the expansion of medical schools and residencies, is dismissed by the authors here. But one indisputable fact is that the United States is producing far too few physicians.  This started during the Clinton era, when Medicare purposefully capped the number of residency positions funded.  This was done because the argument was that decreasing the number of residencies would push more doctors into primary care; that prediction never came to fruition. In fact, if residency programs had not been capped in 1997, and annual growth in the number of positions had continued at a historical basis, there would be no physician shortage today.

Medical schools, both Osteopathic and Allopathic, have steadily increased medical school seats since 2000.  According to Dr. Cooper, 27,000 medical graduates will be produced by 2020, a 50% increase from 2000.  This is still far too few to close the gap we suffer from today.

Dr. Cooper in his JAMA article pleads for consensus among policy advisors.  He states the following:

To do nothing ignores the powerful economic and demographic trends and leaves future generations to ponder why they and their loved ones must experience illness without access to competent and caring physicians.

Drs. Gottlieb and Emanuel do a disservice to the medical community by distorting the realities of the demographics involved among the physician community of the United States.   We will very likely need far more physicians than they project, and most experts believe that a shortage of 200,000 physicians by the year 2020 is very likely. Depending on wishful thinking and technological advances that cannot even be seen by the most acute vision imaginable is not a thoughtful policy position; it is a Hail Mary.  The government must quickly come to terms with the major disaster that awaits us if we do not respond to this looming health care problem.

 

Links:

http://www.forbes.com/sites/scottgottlieb/2013/12/05/obamacare-wont-create-a-doctor-shortage-but-that-doesnt-mean-youll-have-ample-access-to-physicians/

http://www.census.gov/statab/ranks/rank18.html

http://www.mass.gov/chia/docs/r/pubs/13/ar-ma-health-care-market-2013.pdf

http://www.wbur.org/2011/05/09/doctors-survey

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/15/doctor-shortage-what-doctor-shortage/

http://content.healthaffairs.org/content/32/1/11.full

http://jama.jamanetwork.com/article.aspx?articleID=1769903

 

CU Talks – Obamacare Is A Failure, And It Will Turn Out Fine – ep.032

Obamacare-exchange-550x360This week’s podcast is here!

Today the “fix” of Healthcare.gov was released, and promptly crashed. Obamacare and the website have failed, and will continue to do so. The laws of economics and human nature will not support any other end. The only question is what is to become of America given this failed policy?

  • Single Payer? That’s the goal that leftists openly seek. It may come faster than they dared dream, due to their drastic misunderstanding of the speed with which Obamacare would fail
  • Free Market? That’s the goal that the conservatives and libertarians seek. That reality has been approaching already, it’s already here in many ways. I argue that it IS the result, it WILL be a good thing, and it WILL happen faster than we think.

We should do everything we can to make that Free Market solution get here as quickly as possible.

Download or listen to the podcast now:


Announcements

Every Tuesday, 7pm Central: Some Things Considered – a half-hour weekly Hangout on Air show in which Josh Smith and John-Pierre Maeli will discuss, with various guests, a broad range of issues — political, legal, and…well, there really isn’t a third, all-encompassing adjective that readily comes to mind, but you get the picture. Josh and John-Pierre are members of the Conservative Union, their show deserves a watch.

Every Wednesday, 9pm Central: Hangout With the Chief – weekly live hangout with James Pisano, Coast Guard Chief Electronics Technician, smart guy, fun guy, interesting guy, fellow leader of the Conservative Union, and kind enough to allow me to call him friend. Watch live on our YouTube Channel


Every week:

Monday, 8pm Central – The Conservative Union Talks podcast (CU Talks)

Current Events from a Conservative standpoint

We will discuss the week’s happenings within the larger context of growing the conservative movement.

  • What does it mean to me?
  • How can we look at and talk about the news of the day in a way that grows the movement and keeps us happy, productive, and successful?

With your Hosts Leslie P & Nikolaos Dimopoulos

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.

 

CU Talks – News of the Day, Made Good – ep.031

Thanksgiving-Brownscombe[1]This week’s podcast is here!

Happy Thanksgiving! We’re thankful for our families, our friends, our listeners, and our nation – the BEST nation on God’s green earth.

News of the day, with an optimistic outlook. Coca-cola does something amazing, shop AMERICAN MADE this Christmas, the Nuclear Option + Obamacare = OMG!!!!, and Saeed Abedani is still in Iranian prison.

Discussed during the show

Download or listen to the podcast now:


Announcements

Every Tuesday, 7pm Central: Some Things Considered – a half-hour weekly Hangout on Air show in which Josh Smith and John-Pierre Maeli will discuss, with various guests, a broad range of issues — political, legal, and…well, there really isn’t a third, all-encompassing adjective that readily comes to mind, but you get the picture. Josh and John-Pierre are members of the Conservative Union, their show deserves a watch.

Every Wednesday, 9pm Central: Hangout With the Chief – weekly live hangout with James Pisano, Coast Guard Chief Electronics Technician, smart guy, fun guy, interesting guy, fellow leader of the Conservative Union, and kind enough to allow me to call him friend. Watch live on our YouTube Channel


Every week:

Monday, 8pm Central – The Conservative Union Talks podcast (CU Talks)

Current Events from a Conservative standpoint

We will discuss the week’s happenings within the larger context of growing the conservative movement.

  • What does it mean to me?
  • How can we look at and talk about the news of the day in a way that grows the movement and keeps us happy, productive, and successful?

With your Hosts Leslie P & Nikolaos Dimopoulos

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.

 

CU Talks – Things Are Looking Up! – ep.030

3268982338_19122e89bd_o[1]Listen to this week’s podcast

Many tactics support a few strategies which help accomplish the goal. What’s the current state of play, how are we doing? Actually – quite well! Let’s step back and have a look.

Tactically we’re working multiple angles, and they may seem in conflict, but they aren’t, not at all, and a few of our great thinkiers are putting the pieces together for us. One tactic was to Defund Obamacare, that action clearly supported the goal of Repeal, and also woke up and energized the base, clarified our message to the public – the GOP opposes Obamacare, always and forever. The current tactic of passing Upton/Landrieu is not a capitulation, not a muddying of the waters. It is, in fact, a desperate attempt to do whatever we can to lessen the daily pain for Americans, while the political solution is still in process. It’s not an either-or, and it’s not a reversal. Felicia Cravens explained it well in her article, Walk and Chew Gum

The great news is that the strategy of focusing on Obamacare is beginning to bear fruit, and really help us move the needle on the ultimate goal of proving Progressivism to be a failure, and reinvigorating the public call for Free Markets. Yes, the focue on Ending Obamacare is a goal in itself, but it also serves the longer-term goal of reversing Progressivism. Obamacare is the big public issue, the Big Government failure that touches all American lives, and that we can use to prove what we’ve been saying all along – Government is not the solution. Government is the problem. Polls are bearing witness to the success of this strategy. As Ace explains – Big Government ideas seem really great, in theory, then they begin to get implemented and, of course, they fail, and the people change their opinions. There’s been a reversal in opinions as to whether the Federal Government should ensure Americans have Health Coverage. This is our moment to seize.

A writer at the liberal rag Politico understands the threat to Liberalism posed by Obamacare – not just its failure, but its “successes” as well.  We have to hit this message.


Announcements

Every Tuesday, 7pm Central: Some Things Considered – a half-hour weekly Hangout on Air show in which Josh Smith and John-Pierre Maeli will discuss, with various guests, a broad range of issues — political, legal, and…well, there really isn’t a third, all-encompassing adjective that readily comes to mind, but you get the picture. Josh and John-Pierre are members of the Conservative Union, their show deserves a watch.

Every Wednesday, 9pm Central: Hangout With the Chief – weekly live hangout with James Pisano, Coast Guard Chief Electronics Technician, smart guy, fun guy, interesting guy, fellow leader of the Conservative Union, and kind enough to allow me to call him friend. Watch live on our YouTube Channel


Every week:

Monday, 8pm Central – The Conservative Union Talks podcast

Current Events from a Conservative standpoint

We will discuss the week’s happenings within the larger context of growing the conservative movement.

  • What does it mean to me?
  • How can we look at and talk about the news of the day in a way that grows the movement and keeps us happy, productive, and successful?

With your Hosts Leslie P & Nikolaos Dimopoulos

Democrats To America: We Lied, But You Should Apologize

democratic-party-convention-simpsons - Copy

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.

The Early Stages Of A Democrat Civil War

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An interesting dynamic is brewing in Congress among Democrats, and with the White House in the middle, as their circular firing squad on Obamacare continues.

Greg Sargent of the Washington Post as well as other liberals have pointed out that Sen. Mary Landrieu’s Keeping the Affordable Care Act Promise Act , which is a various of Republican Rep. Fred Upton’s Keep Your Health Plan Act, is forcing the hand of Democrats in the House of Representative.

Landrieu’s plan is going to be hard for Red State Democrats to ignore.  Poll numbers on Obamacare are plummeting as the Administration’s incompetence becomes more apparent.  Sen. Kay Hagan’s vanishing lead in North Carolina will only hasten to increase the pressure on these vulnerable Senators.  Furtherm0re, even relatively safe liberals like Jeff Merkley of Oregon have signed on to Landrieu’s plan, showing the political pressure Democrats are under.

For the House, who has always been more steadfast in their support of President Obama, this puts them between a rock and a hard place. Most House Democrats are in safer districts than their Senate counterparts, and thus can afford to hold the line. But how much pressure is too much?

This builds an interesting dynamic of triangulation for the White House.  They need to balance the needs of their liberal allies in the Senate, while still making the political choices palatable to their friends in the House.

But this becomes more difficult by the day.  Again, from Sargent:

A senior Democratic aide tells me opposition to the Upton plan will be increasingly difficult to maintain among House Dems if the administration doesn’t offer a workable fix of its own. The aide adds the need to maintain House Dem opposition has been made more urgent by another problem: Senate Dems (the latest being Dianne Feinstein) supporting their own politically expedient “fixes” that could also undermine the law.

“Now that Feinstein has broken off, that makes it even more important that House Democrats stay together as much as possible — to keep Senate Ds from caving,” the senior Dem aide says. But the aide adds, in a reference to this week’s House action: ”We need an administrative fix that works before the vote.”

This puts all the pressure on Obama; but his choices are slim.  Delaying the individual mandate is actually very bad policy now (I personally oppose the Upton plan for a myriad of reasons). Obama cannot do that and not make the systemic problems worse.  There is no Presidential order that will give people their insurance back to them.  And the other legislative fixes are nonstarters either in the House or Senate.

So one of two dynamics shape up: one, the Senate passes Landrieu’s bill, and House Democrats are left fighting a losing fight against the Upton bill, in which case they will have to defend voting against this bill to the public.

The second option is that House Democrats fold, and Obama is forced to veto this bill, in which case all the blame falls upon him, after he just promised he would do ‘everything imaginable’ to fix the problem.

Either way, there isn’t any safe harbor for Democrats on this issue.  They are fooling themselves that any of this will  protect them from the wrath of the American voter if the ACA fails as incredibly as events so far have shown. From a political standpoint, I think at this point they would be better served to circle the wagons and defend their progressive policies.  But the panic instinct among politicians is so profound, they must appear like they are doing something productive, even when the target of their attacks are members of their own party, or their own President.

So the Democrat circular firing squad continues.

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.

What Christie/McAulliffe Victories Mean

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So, the media will talk a lot about the national significance of these two races, because there is not much else to talk about. This is a repeating event every four years, because there is nothing else to do between the Presidential and midterm elections.

So what can we really learn from these results?

1.  Off year elections don’t mean much.

Historically, these elections mean little to nothing.  You can take a lot of meaning into Christie and McDonnell winning four years ago, right before the Tea Party swept the 2010 elections, but there were many local issues that drove both candidates to victory that were far more important than national trends at the time.

I am sure many liberal bloggers will put a lot of weight into McAuliffe’s victory, and give credence to the argument that the shutdown helped him win, or the Obamacare debacle didn’t hurt him, or some other wacky theory.  But the reality is, McAuliffe ran a better campaign, that was better funded. It was as simple as that.

But, at least it gives the media and bloggers such as myself something to talk about.

2.  Chris Christie starts his Presidential run tonight.

This is among the worst kept political secrets in America, along with the fact that Hillary Clinton is running for the big job.  Christie sees an opening, as do other moderates.  Their view is the GOP has been losing elections because it has moved too far to the right, and that we need a strong moderate leader to take the helm.

Of course, forget the fact that the last two nominees of the GOP are the milquetoast Mitt Romney and the ‘Maverick’ John McCain. I think that claim is dubious.  For me, however, there are more important political trends that Christie’s re-election points to.

First of all, Obama, Democrats and Republicans are making the stench of the beltway toxic to the American voter.  Christie, as the consummate outsider, can use that. He is fat, gruff, at time boorish but glaringly and painfully honest…everything that Barack Obama is not.  2014 and 2016 are likely to be election cycles where being an outsider is a boon, and Christie plays that role quite well.  Just wait and watch Hillary try to run away from her State Department and Obama roots as well.

Second, Obama’s gross incompetence is going to make Americans look for a true manager, and that to me means an obvious solution:  Governors.  Christie may not be the guy, but my guess right now is that a Republican governor from somewhere is going to win the GOP nomination.  Christie believes he is that guy; I am not so sure.

But let us not discount Christie’s achievement.  As Sean Trende pointed out in his piece today, Christie is likely the most conservative statewide elected politician in New Jersey in more than half a century. Christie has run a moderately conservative fiscal plan with a few socially conservative leanings in a far blue state…and is going to win running away. That is pretty unique in the GOP in the last generation.  I may not be the biggest Christie fan, but the achievement is remarkable nonetheless.

3.  The Virginia result is even less important.

Some liberals will say that this is because the GOP lost.  Actually, I have been predicting a loss here for six months, and have said since August that this will be a 5 point victory.

The count is not over, but it appears the race will be far closer than that.

Some well-known liberal bloggers were calling for a double-digit victory not two weeks ago.  So who is more delusional?

The problem with taking any large arching ramification from the Virginia is simple:  there were too many confounding factors.  First, Gov. Bob McDonnell got caught in a horrible corruption scandal, one nobody expected.  Even though Ken Cuccinelli was no ally of the Governors, and continued to try to distance himself, that stench never went away.

Second came the shutdown.  I am not sure how much effect it really had ultimately (I actually think as of election day most people have already forgotten it; exit polls will tell us more), but it certainly halted any effort Cuccinelli made to close the gap in early October.

Now, compound that with a relatively strong third-party candidacy from Robert Sarvis, with many Republicans defecting to the third-party, and I am not sure what to make of the entire mess.

With all that, the GOP candidate likely is going to lose by less than 4 points.  Of the few lessons we can learn from the race, one is this:  the polls should be ignored by the GOP when races are close.  McAuliffe outspent Cuccinelli 3:1, and in the late stages of this election, that could have driven up Democrat votes in D.C. and Richmond, and stifled conservative votes in those regions.  This was a winnable race.

Furthermore, the exit polls are very worrisome for Democrats.  Blame for the sequester?  46% Obama, 47% Republicans for Congress, according to VA exits. Obamacare was upside down, 46% to 53%.  The real terrible story for the GOP was single women, which they lost by…40 points.

4.  Cuccinelli is ideally a poor candidate for modern Virginia.

Virginia is a blue state.  That is the first reality.  Second, it is a major urban population, with the suburbs of Washington, D.C..  Thus, Virginia should be considered more along the lines of Pennsylvania than North Carolina.

As such, Cuccinelli is a poor candidate.  Assuredly, he made his name opposing Obamacare in the courts, but he was almost as well-known for his very strong beliefs in criminalizing certain societal acts, such as homosexual sex and his defense of sodomy laws in unique situations, turned off a large swathe of conservatives.  I know this as a fact, as many of my Virginia friends, those that would vote for Tea Party candidates like Rand Paul and Ted Cruz, absolutely refused to consider Cuccinelli.

The GOP must learn that it can stay a socially conservative party; but pushing legislation to dictate the actions behind closed doors of consenting adults simply is a non-starter, even among many (if not most) social conservatives.  Conservatives are largely moving toward become libertarian on these social issues.

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Overall, it was a mixed bag.  I think Democrats can take heart that they retook the Virginia Governorship, but by a much slimmer margin than the polls and conventional wisdom imagined.

For the GOP, they need to learn a couple of lessons.  First, ignore conventional wisdom.  Conventional wisdom stated this race could not be won, that Cuccinelli was done after the shutdown, and the race was a blowout.  All three  suppositions were false.  Cuccinelli’s clear negatives were on social issues, where the GOP needs to hone their msessage; nothing wrong with social conservatism, but it is not the primary issue voters are concerned with.

The shutdown was not the negative that the mainstream media wanted us to believe, three short weeks ago; that effect has already dissipated.  In fact, one can argue (and I admit is is arguable both ways) that Obamacare had more effect on this race ultimately than the shutdown did.  I am sure liberal and conservative commentators will be arguing that for months.

However, a big night clearly for Chris Christie, as he is going to be the clear frontrunneer for the GOP nomination, until a true conservative alternative can come and show they deserve it more.