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Post Healthcare.gov Update
Created by John Eipper on 11/20/13 1:35 AM

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Healthcare.gov Update (Paul Pitlick, USA, 11/20/13 1:35 am)

I've been busy the past week. I started this post, but didn't have time to really sit down and finish it before something else would come up to drag it in a different direction. For example, Republicans began comparing the health exchange rollout to the Bush administration's Katrina response. Has anyone else noticed that Mr. Obama seems to perform best under pressure? My suspicion is that the exchange hullabaloo is more akin to the surge Mr. McCain got from nominating Sarah Palin as his running mate in 2008, or the day after the first Romney-Obama debate in 2012. Maybe we should develop some kind of a pool predicting the outcome of ObamaCare, and its effects on the future of the Obama administration, the Congress, the Democratic Party, the Republican Party, etc?

What started my response was a post by Randy Black (November 10), where he made the case that ObamaCare should be discontinued, as it is "being crushed by its Healthcare.gov disaster." To substantiate this, Randy cites: a) the failed federal Website (no questions from me about this, although some of the state exchanges seem to be working well); b) that there have been almost no enrollees from Massachusetts, North Carolina, and Oregon; c) that "Up to 11 million Americans will lose their right to keep their private health insurance plans by law"; and d) that "Kaiser Health News reports that California's Kaiser Permanente canceled 160,000 plans--half of its insurance plans in the state."

We're free to compile whatever data we wish in order to formulate an opinion, and then propose a course of action. My opinion is that the above citations are either irrelevant*, misleading**, or suspect***. Randy also overlooks the parts of ObamaCare which have already been implemented (non-discrimination in pricing for women and those with pre-existing conditions, no life-time caps, persons up to age 26 may still be covered on their parents' insurance) and seem to be doing OK. Clearly Randy's mind is made up, and I'm not going to change his opinion that ObamaCare (or RomneyCare, either) is a failure. I've written about some of this previously (https://waisworld.org/go.jsp?id=02a&o=77607 ), and discussed it in Adrian (http://www.youtube.com/watch?v=ZUrp3Y2Tac8 --skip about the first 10 minutes), so I won't go into further detail here.

However, rather than throwing out all of ObamaCare, I'd like to propose a different course of action, since my opinion is that the pre-ObamaCare financing of health care in the US had many more downsides**** than upsides*****. Throwing out ObamaCare means going back to where we have been. My proposal is that those states who don't want to participate in ObamaCare shouldn't be forced to. Our Founding Fathers developed the genius of a Federal system--why do all states have to be the same? Those who want ObamaCare (or gun control, or abortion-on-demand, or "amnesty" for undocumented people, etc., for that matter) should be allowed keep it. Those states that don't want any of these can do their own thing. But let's keep track of outcomes--i.e. costs and benefits, such as taxes, "quality of life," health statistics, etc. Eventually, we might actually be able to figure out what works best. This sounds kind of like science, which Republicans seem allergic to, but to keep making public policy on random whims just doesn't make sense.

Here are my specific responses to Randy:

*Irrelevant: it doesn't matter how many people have already signed up now; it begins to count by mid-December, but it doesn't really, really count until the end of March.

**Misleading: 80% of us will keep our current insurance--so no change; 14% are currently uninsured, but can be covered under Obamacare, so they'll be much better off; and 3% will lose their current insurance, but will be better off under Obamacare for less money. The other 3% (apparently Randy's 11 million) will lose their coverage and pay more. Summary: 80% no change, 17% (i.e. ~50 million) much better off to better off, 3% worse off. A ratio of >5:1 winners vs. losers isn't a spectacular public-policy achievement, but depending upon circumstances it might make sense.

See: http://talkingpointsmemo.com/livewire/chart-winners-and-losers-from-obamacare
and http://talkingpointsmemo.com/dc/what-happens-to-people-whose-insurance-is-cancelled-because-of-obamacare

***Suspect: there are some 7 million Kaiser patients in California: (http://share.kaiserpermanente.org/article/fast-facts-about-kaiser-permanente/ ). Thus, 160,000 is much less than half. Since most Kaiser patients get their coverage from their employers, perhaps 160,000 is 50% of a small number of individual plans and/or Medicaid.

****For those who were put to sleep in Adrian or weren't there--The US spends more on health care, either per capita or as a percent of GDP, than any other country in the world. Our results, as measured by parameters such as infant mortality, maternal mortality, and life-expectancy, are mediocre. In addition, about 600,000 families (almost 2 million people) will be driven into bankruptcy this year from excessive medical expenses. How many of these bankruptcies will occur in Randy's 11 million with bad insurance that they want to keep? Also, how many of those 11 million will lose their insurance for some phony reason if they develop a significant illness? I wish someone would answer those questions.

*****If you have insurance, you can get good to very-good medical care.

JE comments: Paul Pitlick's four-asterisk point (above) raises a very important question: how many of the cancelees are in substandard plans that would drive them into bankruptcy if they experience a health emergency?  And more significantly, will the "minimum standards" of coverage stipulated by Obamacare obviate this danger?

In any case, Healthcare.gov seems to be working out some of the kinks.  Still, to be absolutely honest, I'm relieved I don't have to pay it a visit.

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  • Thoughts on the US Healthcare Debate (Eugenio Battaglia, Italy 11/20/13 6:04 AM)
    Frankly I feel rather dumb, because in spite of my years of residence in the United States, the explanations of my relatives in California, international news and the very informative posts of both Randy Black and Paul Pitlick, I cannot understand what is going on with the so-called Obamacare.

    For me the only acceptable health care is something managed centrally from let's say the Social Security bureau. It should be the same for any resident in the USA and also for any US citizen abroad. And considering that it is better to have illegal immigrants in good health than in poor health, the coverage should be also for them (other ways should be found to eliminate the phenomenon of illegal immigration). In order to ensure that medical coverage is good, politicians should be under the same coverage and only under it, with absolutely no other additional coverage at the expenses of the taxpayers.

    As you may expect, in Italy National Health Care is run by the Regions in order to give power to the local politicians; the politicians have also another special coverage paid for by the citizens. Furthermore, there is private, extra-cost coverage which anyone with money can have in addition to the national plan. As you can see, there is a lot to improve upon here.

    JE comments: Eugenio Battaglia raises a question we often hear from Europe: what's the big stink in America about Obamacare? And why not just nationalize the whole shebang?

    A couple of months ago I heard from a Dartmouth buddy, a New Yorker who emigrated to Melbourne, Australia. He made the observation that for Aussies, so similar in many ways to Americans, "socialized medicine" is about as controversial as public libraries. Canadians make the same argument. (Come to think of it, this country has "socialized" libraries and schools--as well as roads, bridges, police, etc.)

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    • UK Health Care: Towards Privatization? (John Heelan, -UK 11/20/13 2:29 PM)
      In response to Eugenio Battaglia (20 November), the current UK government is desperately attempting to privatise as much of the National Health Service as it can get away with before the next election in 2015.

      Perhaps not surprisingly, it is alleged that the US Health industry poured about $1 million into the Conservative election war-chest prior to the last election in 2010.

      JE comments: Does John Heelan mean the US health insurance industry? Big Pharma? I wouldn't think the AMA (physicians) would get involved in UK politics.

      If these allegations are true, what a nefarious case of meddling in another country's policies.

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      • US Health Industry and UK Elections (John Heelan, -UK 11/21/13 1:31 PM)
        In response to JE's question (20 November) on the US "Health industry" making donations to Conservative candidates in the UK, I was referring primarily to US corporations providing private health services. Some of these are complaining that their UK competitors enjoy tax advantages by claiming charitable status.

        The more the UK government fillet the NHS system to give to private companies (the next likely target is to set up US-style trauma clinics), the more US health insurance carpet-baggers will flood this country.

        You might find the following website interesting. One report part refers to the ubiquitous J.P. Morgan, whose website apparently boasts "they serve: 1,100 hospitals, 10 of the top 10 health insurers, thousands of physicians groups, top five pharmacy benefit managers, six of the top eight pharmacy retailers. Has shares in JP Morgan Employee 98 Trust. JP Morgan heavily invests in healthcare."


        JE comments:  I wonder how much growth potential the US healthcare "carpetbaggers" see in the coming privatization in the British system.  A question for John Heelan:  isn't the UK public pushing back?
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        • US Health Care Industry "Carpetbaggers" in UK (John Heelan, -UK 11/22/13 1:45 AM)
          JE asked on 21 November, "how much growth potential [do] the US healthcare 'carpetbaggers' see in the coming privatization in the British system," and whether the UK public is pushing back.

          As an indicator of the UK health services market up for grabs, the 2012/2013 NHS net expenditure (resource plus capital, minus depreciation) is £105 billion (say about $160 billion).

          The UK public is fighting back, but hampered by voter apathy resulting from general disgust for UK politics and politicians, In my opinion, the current government--fearing it will not be reelected in 2015 (or even fearing that it might be)--is scrambling to transfer as quickly as possible public money onto into private pockets of home and overseas investors of private education and health services. (Already most of the UK's energy companies, airports and ferries are owned by overseas corporations, and now China will own part of the UK's nuclear industry.)

          JE comments: I've heard about the UK nuclear deal with China. Color me suspicious, but this doesn't sound like a wise move.

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      • US Health Care Industry and UK Elections (David Duggan, USA 11/22/13 2:01 AM)
        Is the situation described by John Heelan (20 November) any worse than the Chinese pouring lots of money (typically through domestic nationals) into the US elections?

        JE comments: On this 50th anniversary of the JFK assassination, we seem to be witnessing Suspicion of China day on WAIS! Imagine, say, the outcry if Iran were investing in US elections and the UK nuclear industry.

        Speaking of the JFK anniversary, recall that Randy Black saw Kennedy on that fateful day.  He has promised a comment by this afternoon.

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