Schadenfreude, and the Obamacare Timebomb

Considering the disaster of a rollout that Obamacare turned into, you would expect a lot more schadenfreude from the political right.  After all, it’s the President’s signature domestic policy.  For good or ill (and it’s mostly ill), this will be the domestic program that will be identified with President Obama.  And so far it’s a mess.  So why aren’t conservatives happy?  Part of it I think is that the right is still licking its wounds from the shutdown debacle.  They are still trying to heal a party that was pointless split for no good reason.  See?  I’m still trying to heal.  But the major part of this is that unlike a lot of wacky social programs that the left invents, screws up, and leaves to move on to the next big thing, healthcare is something that affects everyone.  The damage that Obamacare has done to the entire nation’s healthcare system, not just to the minority in the individual insurance market, is extensive, and much of it is permanent.  So there is no schadenfreude to be found in mocking the woman who said, “I was all for Obamacare until I found out I was paying for it.”

Fool, you’ve doomed us all.

If Obamacare had only ruined the healthcare system for those who supported it, then yes, the right would have the freedom to cackle with glee and point fingers, but eventually, this will affect everyone.

OK we’re still doing the finger pointing, but we’re not happy about it.

Right now the big Obamacare story is the website, which is a mess, but eventually the website will get fixed.  The problem goes far beyond the website.  The health insurance plans in the exchange depend on getting enough young health people to enroll to keep the cost of premiums down for the next year.  They need people paying but not using healthcare to afford the people who will enroll and will be sick and will be using healthcare; a lot.  That’s what insurance is all about after all.  If those young healthy people don’t show up and enroll, then you are left with more people taking out of the insurance pool than are putting into it.  That spells extremely high rates for premiums in 2015, or collapse of the exchange insurance groups.

And what could be pulling healthy young people from enrolling in an exchange insurance plan?  In a word; Medicaid.

So far (and admittedly this is a changing number) the majority of enrollees under the Obamacare exchanges are enrolling in Medicaid.  Under Obamacare the Medicaid expansion increased the Medicaid Eligibility to 138% of the Federal Poverty Line.  So all of those young healthy hipsters, particularly the ones who have extremely low incomes like students, are being enrolled, but they are being enrolled as Medicaid clients, not people in the actual private insurance groups.  So rather than contributing to the insurance pool, these healthy young people will basically be put on the dole, to drain the Treasury of funds to support healthcare that they could have otherwise been contributing to.

So if in the upcoming year we have insurance plans filled with the sick, while the healthy coast on Medicaid, than that’s a bomb that will blow Obamacare wide open.

Great plan geniuses.

Enhanced by Zemanta

Medicaid to Ian: Drop Dead!

For years ekg she has been my liberal foil, challenging my assumptions and sharpening my arguments.  But lately, she has just seemed …off.  Like virtually every liberal worth his or her bureaucracy, she is wildly in favor of a “public option” in the current health care bill.  The more “publicky,” the better. Medicare for all is the dream, and VA care for all is the fantasy.  Yeah, I don’t get that one either.  But unfortunately, it’s a point that seems so evident to the liberal mind that any opposition seems either evil or crazy.

Or racist of course.  We can’t forget that one!

So her arguments in support of “health reform” have been of the self evident variety.  Hardly worth the title of “reasoned discussion” at all.  In discussing the case of Ian Pearl, she pulls out the familiar trope of the evil insurance company denying coverage for the wronged, ill, Christ figure.  Her blog on Ian’s plight is one part righteous anger and two parts accusatory anger.

But I do take her seriously and try to address her disagreements with my position:

Ekg, I don’t want to make you sad, so let me address your points one at a time.

Now, you are saying I don’t know what I am talking about because:

“1st.. Ian wouldn’t die from the ‘public option’… he would die from having to live in an assisted living home…”

So in order to live, Ian needs 24 hour home health care that is currently provided by his health insurance.  Now Ian is about to get the boot, the boot to Medicaid, which does not provide the sort of home health care that Ian needs, according to his parents to stay alive.  So once Ian is on Medicaid, his life will be nasty, brutish, and short.  Now assisted living is how Medicaid handles Muscular Dystrophy patients in Ian’s advanced condition.  So if Ian had never been covered under a private insurance plan, he would have been dead a while ago, correct?

But you say Medicaid is not a public option.  But the public option is government healthcare.  Do you think he would have a better deal under another government plan?

Which leads us to your second point…

”2nd medicaid isn’t the ‘public option’ .. that is what the poorest of the poor get. which no matter how bad(and it’s not), is still better than what millions have now..
The public option is low cost private insurance and it’s only low cost to the payer because the gov’t can purchase larger ‘blocks’ and get a better deal than a single person.”

If you’re correct, I’ve been following this issue for several months and have never heard that the public option is really private insurance.  In fact, I’m pretty sure you’re wrong on that, so I will call bullshit until you can show me.  What I think you are getting it confused with are the private plans that will be sold through the exchange.  Those will have standardized basic benefits, prices, and will be subsidized for lower income people.  That is not the” public option.”  The public option is a government plan, not really insurance, with benefits and prices designed by the government.  Now the public option might be administered by a private company, in the same way that Tricare is administered by private insurance companies in different Tricare regions of the country, but it’s not a private insurance plan.  If there is a public option and it is administered by private health insurance companies, which seems likely, the insurance companies still win!

So one if us is really, really wrong on our understanding of what the public option is.  As long as we have been going over this issue, that’s pretty damn funny.  I don’t care who ya are…

Now I couldn’t help but notice this:

“…healthcare companies pass the buck and raise the price while you cheer them on.. whether it’s because they are exempted under anti-trust laws or any other law doesn’t matter..”

I have not been exactly “cheering on” the health insurance companies while they raise prices.  Seeing as I’ve been in the middle of open enrollment at work, I find any cheers quite muted.  I’m trying to recall the last time I cheered price increases by health insurance companies in general and my health insurance in particular… let’s see, there was that time… no…how about… oh no…

I guess no.  No cheers from me.

As far as anti trust laws go in general, I find them foolish, since monopolies generally require either control of a particular resource or some sort of government grant that gives a legal monopoly to a company.  Baseball has an anti trust exemption since we don’t want multiple baseball leagues bouncing around the country.  We would rather the current owners suck up all the profits.  For health insurance companies, If Senator Leahy or the President wants to pull that trigger, I say, let ‘em.  Just about everything else in the bill is designed to increase health care costs, so what’s one more?

But the issue isn’t anti trust, it’s ERISA.  The federal law governing health plans gives a specific exemption from common contract law.  Under normal (and by this I mean both common and various state laws, although they may differ in specifics) contract law, a contract entered in good faith, even if there are flaws in the actual contract, such as doting the i or crossing the t , is still a valid contract.  Not so for health plans under ERISA.  The insurance company can retroactively cancel the contract of any member for any sort of contractual error.  They certainly have an incentive to dump high cost (i.e. really sick) patients if they can legally get away with it, and thanks to federal law, they can!

I guess lobbying really does pay.

Inevitably, when these hard luck rescission cases become big news, like Ian Pearl’s case or others that have become a cause celebre  for big government types such as the cases of Robin Beaton and Otto Raddatz’s, the reason they lost their health care was because of rescission; because the law allows them to.  Big government liberals easily forget the real villains in those cases:  ERISA.

Health Insurance II:  This time it’s personal.

“the quote you used was the PC/CYA reply to being asked why the VP would call someone like Ian or Chuck a fucking “dog”… which is something else you know, but chose to ignore because it doesn’t further your cause..

seriously.. how can you continue to protect an industry that would treat your wife the same way if she was diagnosed with MS tomorrow is simply beyond me..she would just be their new ‘dog’ to rid themselves of..”

Although I find myself offended at the term “dog” being used for either my wife or Chuck ( Ian I don’t know.  Sorry Ian, I’m sure you’re a nice guy and all…), the context seems to refer to the accounts, rather than the individuals.  But lets assume the worse.  The health insurance execs are meanies, they hate Ian, Chuck, and my wife and think they are dogs, and of course, hope they all die before too much money is spent on the sickly, when it could be much better spent on fabulous executive bonuses.   THIS is one of the key differences between people who trust the free market (as opposed to individual companies or executives) and people who trust the good naturedness of big government (stand by, teachable moment here):

I don’t care that companies may hate me, are greedy, or that they are looking out for their own self interest.  Of course they are!  They are in business to make a goddamn buck!  Not to wipe the tears from our eyes and give us a shoulder to cry on.

But it’s an observation that predates Adam Smith’s invisible hand:  Businesses and individuals in business are conducting commerce for their own ends.  However the result of that is that everyone’s interests are satisfied.  You want a widget, and a greedy company wants to make money by selling widgets.  Money and Widgets are exchanged, and voila!  Everyone gets what they want!  Contracts?  Same thing.  There is a centuries old body of law governing, “lets make a deal” between people.  As a general rule, it works pretty well.  It would probably work pretty well with health insurance too if our government allowed it.

But if your thinking on private enterprise and business is totally dependent on companies being filled with nice guys and gals who think providing profits to their shareholders is less important than holding your hand and skipping through the meadow on a spring day, then you are pretty much going to hate capitalism and the free market.

And of course, let’s really get personal:

“.. you are as much of an accomplice in this as the ones who do it knowingly.. you have a president who will work with you.. but instead the GOP shat in his hand and walk over to tongue-kiss the insurance companies because they have the money to rile up the rank and inbred and to fund their re-election bid…”

Wow!  Me!  Personally responsible for Ian Pearl’s unfortunate condition, or responsible for the Republicans in Congress sitting on their hands and not embracing the President’s wack-a-nut health plan?  Either way, it’s a lot of responsibility to rest on my shoulders.  In any case, it was the President who spent the summer playing “wash the molars” with the health insurance companies, not the Republicans.  All the poor health insurance companies wanted was forced, mandatory requirement that everyone in the country get health insurance, a windfall worth billions to them.  That’s why they kept their mouths shut all summer and generically praised “health reform.”  Particularly after it looked like the Public Option was off the table.

But a funny thing happened on the way to negotiations; the individual mandate and the fines to enforce it got weakened.  Weakened enough that suddenly the other higher costs enclosed in the health plan suddenly seem to outweigh the lesser amount of new customers the health insurance companies were expected to have the federal government  herd their way.  It is about self interest after all.  That’s what makes the world go round.  As fun as it would be to blame the Republicans for all this, or any of this for that matter, it’s strictly an inter-party squabble.  It’s Democrats versus the President.  Republicans?  They’re just out in the bleachers, yelling, “You lie” occasionally.

As for Ian, I don’t have a solution for him.  In that way, I’m no different than ekg.  I would have supported eliminating the part of ERISA that allows these situations to happen in the first place.  He would have either not lost his insurance, or if he had, his parents would have been able to sue the company in court.  That’s not an option available to him under current law.  But even if the Congress were to magically take an interest in that, I doubt it would be done in time to help Ian.

Other than that, I only have Ian’s parent’s word that care under Medicaid is a “death sentence.”  I don’t know if that is their take on their son’s situation or a doctor’s opinion, but in any case, I hope they are wrong.  He’s getting the liberal dream:  government healthcare.  No greedy health insurance companies involved.   It’s government healthcare for Ian soon, and government healthcare for all of us eventually if the President has his way.  But If both Medicaid and Medicare, would have Ian die, why should this be shoved down my throat?  It’s funny that the biggest supporters of government healthcare suddenly are frightened by the thought of someone actually getting it.