Obamacare Lives!
Back when rate shock, website problems and lagging enrollment were threatening to unravel the new health care law before it fully took effect, I concluded a column on Obamacare’s repeated near-death experiences with the following warning to conservatives:
The welfare state’s ability to defend itself against reform, however, carries a cautionary message for Obamacare’s critics as well. What isn’t killed outright grows stronger the longer it’s embedded in the federal apparatus, gaining constituents and interest-group support just by virtue of its existence even if it doesn’t work out the way it was designed. And as disastrous as its launch has been, if the health care law can survive this crisis in the same limping, staggering way it survived Scott Brown and the Supremes, then it will be a big step closer to being part of the status quo, with all the privileges and political strength that entails.
So yes — it’s possible that this brush with death will be fatal, possible that the law will fall with the lightest, most politically painless push. But it’s still likely that Obamacare will be undone only if its critics are willing to do something more painful, and take their own turn wrestling with a system that resists any kind of change.
Back when rate shock, website problems and lagging enrollment were threatening to unravel the new health care law before it fully took effect, I concluded a column on Obamacare’s repeated near-death experiences with the following warning to conservatives:
The welfare state’s ability to defend itself against reform, however, carries a cautionary message for Obamacare’s critics as well. What isn’t killed outright grows stronger the longer it’s embedded in the federal apparatus, gaining constituents and interest-group support just by virtue of its existence even if it doesn’t work out the way it was designed. And as disastrous as its launch has been, if the health care law can survive this crisis in the same limping, staggering way it survived Scott Brown and the Supremes, then it will be a big step closer to being part of the status quo, with all the privileges and political strength that entails.So yes — it’s possible that this brush with death will be fatal, possible that the law will fall with the lightest, most politically painless push. But it’s still likely that Obamacare will be undone only if its critics are willing to do something more painful, and take their own turn wrestling with a system that resists any kind of change.
Obamacare, The Unknown Ideal
No, I haven’t lost my mind — or suddenly become an Ayn Rand disciple. It’s not my ideal; in a better world I’d call for single-payer, and a significant role for the government in directly providing care.
But Ross Douthat, in the course of realistically warning his fellow conservatives that Obamacare doesn’t seem to be collapsing, goes on to tell them that they’re going to have to come up with a serious alternative.
But Obamacare IS the conservative alternative, and not just because it was originally devised at the Heritage Foundation. It’s what a health-care system that does what even conservatives say they want, like making sure that people with preexisting conditions can get coverage, has to look like if it isn’t single-payer.
http://krugman.blogs.nytimes.com/2014/03/31/obamacare-the-unknown-ideal/
No, I haven’t lost my mind — or suddenly become an Ayn Rand disciple. It’s not my ideal; in a better world I’d call for single-payer, and a significant role for the government in directly providing care.
But Ross Douthat, in the course of realistically warning his fellow conservatives that Obamacare doesn’t seem to be collapsing, goes on to tell them that they’re going to have to come up with a serious alternative.
But Obamacare IS the conservative alternative, and not just because it was originally devised at the Heritage Foundation. It’s what a health-care system that does what even conservatives say they want, like making sure that people with preexisting conditions can get coverage, has to look like if it isn’t single-payer.
Mission Accomplished?––7.1 Million––Will the Obama Administration Come To Regret Today's Obamacare Enrollment Announcement?
Politics is about expectations.
The Obama administration blew the doors off Obamacare's enrollment expectations this week and scored big political points.
But in doing so, they may have set Obamacare's expectations going forward at a level that can only undermine their credibility and that of the new health law.
What happens when the real number––the number of people who actually completed their enrollment––comes in far below the seven million?
What happens when the hard data shows that most of these seven million were people who had coverage before?
What happens when it becomes clear that the Obamacare insurance exchanges are making hardly a dent in the number of those uninsured?
Yesterday, the Los Angeles Times reported that the non-profit Rand Corporation estimated that two-thirds of the first six million people to enroll in Obamacare were previously insured––only two million were previously uninsured.
If all of the one million people who signed up in the last week were previously uninsured, that would mean that only three million previously uninsured people have purchased coverage in the government-run exchanges.
Rand also estimated that about nine million people have enrolled directly with the insurance companies, bypassing the government-run exchanges. But Rand also reported that the vast majority of those were previously insured.
If 20% do not pay, as has been the case since Obamacare launched, then the real Obamacare exchange enrollment number is about 5.7 million.
According to the March report from the Obama administration, 83% of those signing up were subsidy eligible. If 83% of those 5.7 million were subsidy eligible, then about 4.7 subsidy eligible have signed-up in the first open enrollment. The Kaiser Family Foundation has estimated that 17.2 million people were subsidy eligible when the new health law launched. That would mean that only 27% of subsidy eligible people have enrolled––and 73% of those who were subsidy eligible have not.
The Obama administration blew the doors off Obamacare's enrollment expectations this week and scored big political points.
But in doing so, they may have set Obamacare's expectations going forward at a level that can only undermine their credibility and that of the new health law.
What happens when the real number––the number of people who actually completed their enrollment––comes in far below the seven million?
What happens when the hard data shows that most of these seven million were people who had coverage before?
What happens when it becomes clear that the Obamacare insurance exchanges are making hardly a dent in the number of those uninsured?
Yesterday, the Los Angeles Times reported that the non-profit Rand Corporation estimated that two-thirds of the first six million people to enroll in Obamacare were previously insured––only two million were previously uninsured.
If all of the one million people who signed up in the last week were previously uninsured, that would mean that only three million previously uninsured people have purchased coverage in the government-run exchanges.
Rand also estimated that about nine million people have enrolled directly with the insurance companies, bypassing the government-run exchanges. But Rand also reported that the vast majority of those were previously insured.
If 20% do not pay, as has been the case since Obamacare launched, then the real Obamacare exchange enrollment number is about 5.7 million.
According to the March report from the Obama administration, 83% of those signing up were subsidy eligible. If 83% of those 5.7 million were subsidy eligible, then about 4.7 subsidy eligible have signed-up in the first open enrollment. The Kaiser Family Foundation has estimated that 17.2 million people were subsidy eligible when the new health law launched. That would mean that only 27% of subsidy eligible people have enrolled––and 73% of those who were subsidy eligible have not.
We’re Not No. 1! We’re Not No. 1!
We in the United States grow up celebrating ourselves as the world’s most powerful nation, the world’s richest nation, the world’s freest and most blessed nation.
Sure, technically Norwegians may be wealthier per capita, and the Japanese may live longer, but the world watches the N.B.A., melts at Katy Perry, uses iPhones to post on Facebook, trembles at our aircraft carriers, and blames the C.I.A. for everything. We’re No. 1!
In some ways we indisputably are, but a major new ranking of livability in 132 countries puts the United States in a sobering 16th place. We underperform because our economic and military strengths don’t translate into well-being for the average citizen.
In the Social Progress Index, the United States excels in access to advanced education but ranks 70th in health, 69th in ecosystem sustainability, 39th in basic education, 34th in access to water and sanitation and 31st in personal safety. Even in access to cellphones and the Internet, the United States ranks a disappointing 23rd, partly because one American in five lacks Internet access.
“It’s astonishing that for a country that has Silicon Valley, lack of access to information is a red flag,” notes Michael Green, executive director of the Social Progress Imperative, which oversees the index. The United States has done better at investing in drones than in children, and cuts in social services could fray the social fabric further.
This Social Progress Index ranks New Zealand No. 1, followed by Switzerland, Iceland and the Netherlands. All are somewhat poorer than America per capita, yet they appear to do a better job of meeting the needs of their people.
The Social Progress Index is a brainchild of Michael E. Porter, the eminent Harvard business professor who earlier helped develop the Global Competitiveness Report. Porter is a Republican whose work, until now, has focused on economic metrics.
“This is kind of a journey for me,” Porter told me. He said that he became increasingly aware that social factors support economic growth: tax policy and regulations affect economic prospects, but so do schooling, health and a society’s inclusiveness.
The GOP must admit it was wrong on Obamacare
By ,
The fact that the Affordable Care Act (ACA) hit its original goal this week of signing up more than 7 million people through its insurance exchanges ought to be a moment of truth — literally as well as figuratively. It ought to give everyone, particularly members of the news media, pause over how reckless the opponents of change have been in making instant judgments and outlandish charges.
When the health-care Web site went haywire last fall, conservatives were absolutely certain this technological failure meant that the entire reform effort was doomed. If you doubt this, try a Google search keyed to that period relating the word “doomed” to the health-care law.
It should be said that the general public was much wiser. A CNN poll in November thatPost blogger Greg Sargent highlighted at the time found a majority (54 percent to 45 percent) saying that the problems facing the law “will eventually be solved.” Political moderates took this view by 55 percent to 43 percent, independents by 50 percent to 48 percent. Only Republicans — by a whopping 72 percent to 27 percent — and conservatives (by 66 percent to 33 percent) thought the law could never be fixed.
Their representatives in Washington, moderate conservatives as well as the tea party’s loyalists, followed the base’s lead. In mid-November, for example, Sen. Rob Portman (R-Ohio) told Fox News flatly that the law is “destined to fail,” “fundamentally flawed” and “not ready for prime time.”House Speaker John Boehner predicted dire outcomes before the Web site fiasco. He repeatedly insisted, as he did in July, that “even the Obama administration knows the ‘train wreck’ will only get worse.”
Parting companies and their employees’ health care
By Charles Lane,
The Supreme Court is pondering Hobby Lobby’s argument that Obamacare unlawfully burdens its corporate religious freedom by requiring it to offer employees health insurance coverage for certain forms of contraception.
Hobby Lobby’s case is that the Affordable Care Act confronts it with an impossible choice: paying for contraceptives that its owners’ faith prohibits as abortifacients; violating the employer-insurance mandate at huge legal risk and financial expense; or dropping coverage — which would cost $26 million in federal penalties and contradict the firm’s “desire to provide health benefits for their employees, which is itself religiously motivated,” as Hobby Lobby’s brief to the court puts it.
This argument has strengths and weaknesses, but surely its most audacious suggestion is that the court should give legal weight to Hobby Lobby’s religiously motivated “desire” to provide employees with health insurance — even though the health-care law guarantees that workers could still get coverage, through the health-care exchanges, if Hobby Lobby declined to provide it.
Sounds to me like Hobby Lobby’s religion requires the company — and only the company — to look out for its employees’ health needs. That sure is a highly specific religious duty.
No doubt Hobby Lobby provides this insurance out of a sincere intent to fulfill that duty. But I’ll bet the federal tax exemption for employer-paid health insurance plays a role, too.
Given that it benefits from this feature of the Internal Revenue Code, Hobby Lobby’s insistence on delivering health insurance to employees in precisely the manner its company conscience dictates strikes me as not only a matter of principle but also a subtle manifestation of the great American entitlement mentality.
I’ll leave it to the court to sort that out. The real question is: Why do we have to worry about thorny issues like this in the first place? We wouldn’t have to if nearly 150 million Americans weren’t covered through employer-paid health insurance.
Potential crises of corporate religious conscience are just the latest pitfall of the employer-based system, whose accidental origins lie in World War II wage controls that encouraged companies to compensate employees with health care and other “fringe benefits” instead of cash.
Workers risk losing benefits when they switch employers; the resulting “job lock” reduces labor-market flexibility. And the tax exemption encourages overconsumption of health care, which drives up costs for everyone.
On the surface, Obamacare reinforces the system through such devices as the insurance mandate for large employers such as Hobby Lobby. But in other ways, the 2010 law undermines it, such as by imposing an excise tax that offsets some of the tax subsidy for employer-paid benefits and by creating the exchanges as an alternative source of coverage.
Ezekiel Emanuel, a former top health-care adviser to President Obama, predicts in a new book that Obamacare’s incentives will cause large employers to cease offering health insurance; Emanuel thinks fewer than 20 percent of private-sector workers will still be getting it in 2025,down from nearly 60 percent now.
| Group Encourages Maine Consumers to Question Medical Tests | |||||||||||||||||||||||||||||
| 04/02/2014 Reported By: Patty B. Wight | |||||||||||||||||||||||||||||
Several studies have concluded that up to 30 percent of all medical tests and procedures are unnecessary and potentially unsafe. It's a problem, say critics of the health care system, that's persisted for decades and requires a fundamental culture shift. The medical director of Consumer Reports Health is in Maine this week to encourage patients and providers to "Choose Wisely" and create a different kind of relationship. Patty Wight has more.
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It was back pain that sent Heather Ayotte of Winthrop to her doctor about a year ago. She slipped and fell on ice, and the accident added to the pain she says she was already experiencing from fibromyalgia. When she talked to her doctor, he told her an x-ray or MRI could help get to the bottom of the issue. But he also presented a more conservative option.
"You know, let's do ice and heat and ibuprofen, and wait and see if it gets better on its own," Ayotte says, "without having to spend thousands and thousands of dollars out of my own pocket that I didn't have." Which is exactly what Ayotte did, and after a while, the pain from her fall did go away. This experience may not sound that extraordinary, but the fact that Ayotte and her doctor weighed her options and the costs is a marked shift from the model in which doctors order tests and patients dutifully obey. Dr. John Barnes is a primary care physician from Winthrop Family Medicine - the practice where Heather Ayotte received her care. He says a major culprit of this problem is time. "I think in medicine - at least in primary care - we're all taught to take the time to explain to people what we're recommending and why, and to answer their questions so they understand and make informed choices," Barnes says. "In so many instances these days, that's a theory more than a practice." "When you look at the scope of it, it's birth to death, pediatricians to geriatricians. Some of the most common things that we receive in health, we're receiving too much of," says Dr. John Santa, the medical director for Consumer Reports Health, Santa is in Maine to promote an initiative called "Choosing Wisely." It includes a list of more than 250 tests, procedures, and products that he believes are over-used: the prescribing of opioids for headaches, for example, or imaging for low back pain, which often leads to unnecessary surgery. Santa says the problem persists partly due to training, partly due to economics, and the current fee structure that pays per procedure. "I mean, I'll give you an example: As a general internist, I did EKG's that I knew were probably not necessary, and EKGs were 2 to 3 percent of my income," he says, "and it was hard to change that habit." Santa says patients also contribute to the problem by requesting products that aren't always needed, such as antibiotics. He says patient demand often traces back to advertising - as with the current overuse of testosterone treatments.
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