22 thoughts on “Fool Me Once, Shame On You”

  1. OK, Rand, just because I find “Jim” difficult to take doesn’t mean I would go as far as describing the effort to reform health care as “lies.”

    I am an engineer and as an engineer I deal in “rough, round numbers” to get at least the scale of a design right. You know, if the GLOW of the “vehicle” is 600,000 pounds, you need something more than 600,000 pounds of rocket thrust on liftoff?

    So health care is about 15-20% of our GDP and our GDP is what, around 15E12 (15 trillion) dollars, so our health care spend approaches 3 trillion? So, on average and on aggregate, health care in America costs 10K per living, breathing person?

    10K per person, 40K for a family of 4 is a serious amount of money to work into the family budget. The system we have now is that for most people, the cost of healthcare is “pretax” and worked into the cost of your “benefits package” where you work. In other words, for those of lucky to have jobs in this economy, especially jobs that offer health insurance (yeah, yeah, prepaid health care), there is a gobnormous amount of hidden compensation that everyone gets, whether they are the lowest paid entry level employee for the CEO.

    So I guess much, not all, but much of what “Obamacare” is all about is the Exchanges, that is, making known what health care plans are even available to people who can’t get one through work, and to provide Yet Another Government Entitlement in the form of the sliding-scale semi-means tested subsidies to allow persons of modest income to afford a health care plan? And out of the 2-3 trillion annual cost of health care in America, yes, much but not all comes from the gummint through Medicaid, Medicare, VA, that this system is projected to require 200 billion in Federal spending per year once it is up and running?

    That said, I am beginning to agree with whoever at NRO said, “Chill, people, the 200 bil is Yet Another Federal Entitlement (YAFE), but the “socialization” of medicine has been an ongoing and long-term process.”

    But.

    Just because I stand by what I just said, this doesn’t mean everything is just roses. That pesky Law of Unintended Consequences. It looks to me that what Obamacare will “do” is incentivize business, by staying small, by shifting people to part time work, by offering be bare minimum of coverage by a legally sharp interpretation of the Affordable Care Act that we are reminded is “the law of the land, so live with it”, and so live with it is the best we can expect and live with it we shall.

    So what will happen, people will be “dumped” on the Exchanges, where health care for the some receiving the subsidies may be affordable and maybe not owing to most people not even having a spare 100 bucks or two to spend. In the end, we may end up shifting people from the most (i.e. the lucky) getting silent compensation from their employers in the form of a health care plan, but like Defined Benefit pensions, such will go the way of the dodo bird. Of the even more people on the Exchanges, what percentage will be willing and able to participate, and we may end up with a 200 bil/year YAFE and even more people than now not covered by a health plan (i.e. “health insurance”)?

    Yeah, there is a lot of hate directed at the ACA, but there is a ton of snark coming from the people who are fer it in the form of “Eat it, suckers!” (just saying that what the people who are for the ACA is not persuasive to us “on the fence”, also saying many of us (are lucky) and have health insurance, but how long will that last before we too have to brave the Exchanges for reasons relating to the new law).

    OK, I yield the floor to Jim who will tell me that I have it all wrong, but if I have to “eat it” by purchasing on the Exchangesm, this constitutes Karmic justice?/

  2. OK, Rand, just because I find “Jim” difficult to take doesn’t mean I would go as far as describing the effort to reform health care as “lies.”

    “If you like your health plan, you can keep it. If you like your doctor, you can keep your doctor.”

    Do you really think he believed that?

    1. ““If you like your health plan, you can keep it. If you like your doctor, you can keep your doctor.”

      Do you really think he believed that?”

      I can’t get into Mr. Obama’s mind as to what he believed, but at the time, I was deeply skeptical if this promise could hold.

      Yes, I think Mr. Obama believed what he said, and I would ascribe it to “magical thinking” and “unicorn (gas)” as the clean, renewable energy source. People believe a lot of things.

    2. I think he believed it in the sense that nothing in the law forces everyone to change their health plan or doctor. Remember that some previous attempts to reform health care (e.g. the Clinton plan, single-payer proposals, etc.) did propose throwing out all existing health insurance plans. It was reasonable for Obama to distinguish his proposal from those. You can imagine a spectrum of reform proposals, from ones that require very little change for the already insured to ones that require big changes. Obama was positioning his proposal towards the little change end of the spectrum, and that’s an accurate placement.

      The fact is that even without Obamacare people rarely get to hold onto their specific health insurance policy for long. My insurer has discontinued or significantly changed my policy every year or two, going back decades. The degree and rate of change Obama proposed for the already insured isn’t very different from the status quo ante.

    3. “If you like your health plan, you can keep it. If you like your doctor, you can keep your doctor.”

      Do you really think he believed that?

      Yes.

      I think he did, because his people told him that, because he’s surrounded by people with a very common delusion around Progressive Politics Actually Working.

      Dead wrong, of course.

    4. It’s entirely possible that Obama believed it because he just isn’t very bright. Remember back in 2010 when he complained about how his auto insurance company wouldn’t pay his claim because all he had was liability, not collision or comprehensive insurance?

      When I was young, just got out of college, I had to buy auto insurance. I had a beat-up old car. And I won’t name the name of the insurance company, but there was a company — let’s call it Acme Insurance in Illinois. And I was paying my premiums every month. After about six months I got rear-ended and I called up Acme and said, I’d like to see if I can get my car repaired, and they laughed at me over the phone because really this was set up not to actually provide insurance; what it was set up was to meet the legal requirements. But it really wasn’t serious insurance.

      I seriously doubt Obama knows much about health insurance and even less about health care. He’s a hack.

      1. That story isn’t Obama complaining. He’s illustrating, at his own expense, the fact that if it’s legal to sell crummy insurance, some people will buy it unawares, and only discover their mistake when it’s too late. He continues:

        Now, it’s one thing if you’ve got an old beat-up car that you can’t get fixed. It’s another thing if your kid is sick, or you’ve got breast cancer.

        So the general idea has been here that we should set up some minimum standards within the exchange, that a plan that people are buying into, whether it’s a small business or an individual, should be at least solid enough that if your kid got sick, they’re actually going to be treated; that if something happened that you weren’t left with a huge bunch of out-of-pocket costs.

        1. What if somebody wants that crummy insurance? It may be all they need to fit their needs. By what right does somebody come along and say, “you’re too stupid to make these kind of decisions so I’ll make them for you.”

          This is evil. Your taking adulthood away from people.

          1. Your [sic] taking adulthood away from people

            By that standard the government takes adulthood away from you when it inspects meat and requires airbags in cars.

            If you follow that link you can read how Republican heroes like Paul Ryan also support having minimal requirements for insurance, they just differ on the details. I suppose that means they are taking adulthood away as well.

        2. Liability insurance alone isn’t crummy insurance if your car is old and you don’t have a lot of money. It meets the legal requirements. He was just too stupid to know that liability only insurance won’t replace or repair your car if you have an accident.

          As for health insurance, people should be able to buy what they need, not what is dictated by government. A single man shouldn’t have to pay for a policy that covers pregnancy or mammograms but he can’t make that choice under Obamacare because those types of coverage are mandated. As a result, he’ll pay more for coverage that he’ll never use.

          Women as a group tend to have lower auto accident rates so their car insurance is cheaper, especially when you compare young female to young male drivers. Also, women as a group tend to live longer than men so they pay lower life insurance premiums. This is all reasonable. But in most states and under Obamacare, it’s illegal to charge women more for health insurance despite the fact that they consume far more health care over their lifetime than men. It seems fairness only works in one direction.

          When you buy auto insurance, you’re given many choices. If you don’t have much money or have an old car, you can go for liability-only coverage and even decide what the maximum coverage will be. If your car is being financed, you’ll have to have more insurance than that (required by the finance company, not the state) to repair or replace the car in the event of an accident. Even then, you can tailor your coverage with different deductable abouts. You can also choose to add or not include optional features like towing coverage, rental car coverage and the like.

          For health insurance, people should have the same choices. If they’re young and healthy, they may only want to cover hospitalization with a high deductable covered by a Health Savings Account. When I was in my 20s and even most of my 30s, I doubt I averaged more than one doctor visit a year. That wasn’t uncommon. People may want other things added to their coverage similar to those optional insurance items you can get with auto insurance. Instead, we’re forced by the states and Obamacare to pay for things we’ll never use. All that does is drive up the cost of insurace. Some of it is politically driven, such a lobbyists from a medical specialty working to get their services mandated by insurance so they can make more money. Other mandates come as pandering to one group to get everyone else to pay for their needs/desires such as “free” contaceptives.

          Obamacare is based on the idea of transferring wealth. The young pay more so the old and sick can pay less, and men pay more so women can pay less. All in the name of “fairness”.

          1. For health insurance, people should have the same choices

            The worst case scenario with bad car insurance is you can’t fix your car. The worst case with bad health insurance is you die for lack of care. Why should the two situations be handled the same way?

            we’re forced by the states and Obamacare to pay for things we’ll never use

            You object to paying for things that other people will use. They might object to paying for things that you will use. But that’s the nature of insurance.

            The young pay more so the old and sick can pay less, and men pay more so women can pay less

            Everyone old was young once, and every man owes his existence to a woman. Those other people you are subsidizing include your future self and your mother and/or mother of your children. It’s hard to see you as the victim in this scenario.

          2. You’re once again confusing health insurance with health care. This has been a consistent disinformation campaign on the part of Democrats (or perhaps they’re too stupid to know the difference). Health care is the set of services, products and devices you receive from providers such as doctors, nurses, physical therapists, etc. Health insurance is how most people pay for health care. If you don’t have health insurance or your policy doesn’t cover something, you aren’t automatically denied the needed care, you just have to make other arrangements to pay for it.

            A young, healthy person normally consumes very little health care. In that case, a policy that covers hospitalization in the event of a severe accident or illness with ordinary office visits being paid out of pocket makes sense. A person who needs more health care can economically justify more comprehensive insurance. People are being denied the opportunity to make choices based on their needs. Instead, we have a bunch of politicians and bureaucrats dictating what they have to buy.

  3. Obama’s web site is crashing because they didn’t want you to know how unaffordable the “Affordable” Care Act is

    This is a great example of a headline stating the opposite of the the article contents. As the article explains, the initial load on the system was in part due to the fact that there wasn’t a way to browse plans before creating an account, which forced everyone through the overloaded account creation bottleneck (btw, there is a way to browse now). But that requirement to register was so that visitors would be shown their actual premiums (including subsidies), not an estimate that would almost certainly be incorrect.

    So the Forbes headline is: Obamacare’s Website Is Crashing Because It Doesn’t Want You To Know How Costly Its Plans Are

    And the article says: Obamacare’s Website Was Crashing Because It Wanted You To Know Exactly How Costly Its Plans Are

    Journalism!

  4. Yet Congress cannot find the will to repeal this? We truly have passed the point of no return in this once great Republic.

    1. Repealing a law takes more than will, it takes majorities in the House and Senate, plus the President (or else super-majorities in the House and Senate). The candidates for House, Senate and White House who promised to repeal the ACA got fewer votes than the candidates who promised to not repeal it. So of course it won’t be repealed — that’s how great Republics are supposed to work.

  5. My first attempt at this post was blocked by the spam filter. I guess talking about prem1ems and health 1nsurance triggers the filter. That makes it kind of hard to discuss this issue. Here goes an attempt to get around the filter.

    The House has the will to repeal it but the Senate does not. Even if the Republicans won contol of the Senate next year, it’s highly unlikely they’d have enough votes to override Obama’s inevitable veto.

    Healthcare and health 1nsurance are two different things but you’d never know it if all you did was listen to the politicians and pundits. Health care consists of the services and medications that you obtain from health care professionals such as doctors, nurses, etc. Health 1nsurance is how most people pay for it. Obamacare is mostly about how to pay for health care, not health care itself. The biggest exception is where the government will end up dictating (deliberate choice of word) what does or does not get covered.

    True health 1nsurance would cover non-routine medical-related expenses such as hospitalization costs. It shouldn’t cover every conceivable medical expense any more than auto insurance doesn’t cover purchasing gas, oil changes, other maintenance and paint jobs. Most young men consume very little health care. However, there is a form of legal discrimination in place that Obamacare not only doesn’t address but makes worse. Young women as a group tend to have fewer auto accidents and as a result, they pay lower auto insurance prem1ums. Likewise, women as a group tend to live longer so they pay lower life insurance prem1ums than men. However, women as a group consume much more health care than men but it’s illegal to charge them more for health 1nsurance.

    Once of the reasons why health 1nsurance costs so much and varies by state is that each state has a different list of mandated coverages. Obamacare tries to set a national set of mandated coverages. If you’re a single man, you’ll never use maternity care or mammograms but you’ll have to pay for them because they’re mandated coverages. Not only is Obamacare a wealth transfer from the young and healthy to the old and/or sick, it’s a transfer from men to women.

  6. Paul, your back of the envelope analysis leaves out some important issues. First we have to stop the Orwellian speech. Any politician talking about fixing health care is ignorant or a liar and they are too consistently evil to just be ignorant. Health care is fine for the most part and the things wrong with it need to be fixed by an informed consumer which is beyond anything the government can mandate.

    So we are not talking about health care and must not allow them to use this red herring in any demagoguery in the debate. It isn’t about care. So what is it about? Money. Coverage. Control.

    That $10k per person per year is very misleading. It doesn’t take into account distribution: age and health, age and wealth, distribution of severity. Along with the fact that it wouldn’t require $10k if it was a true competitive situation rather than the horror we live with today. Insurance is really a very simple concept which politicians lie about because they really have no clue. True competitive insurance works. Insurance companies not giving good service to their customers go out of business because people are not nearly and stupid as government assumes. Government can only screw that up. Companies remain because they satisfy their customers.

    Where coverage is a problem, forcing healthy young people to pay for it or be penalized is not the answer. Poor people exist for a number of reasons. Government programs like ObamaCare create more poor. This is not a move in a positive direction. It is an ObamaNation.

    Forcing healthy young people into a system they don’t need is about control.
    Forcing everyone to buy ‘insurance’ with mandated requirements is about control.
    Forcing insurance companies to ignore pre-existent conditions is complete ignorance of what insurance is. There is a better way to handle that which doesn’t cost anywhere near $10k per person. That better way is called individual responsibility and genuine real insurance. Perhaps a government program should be paid for with a birth tax. This might foster a bit of individual responsibility around the very important decision parents should make about adding another child to this world.

    Monster bills with kitchen sink solutions are guaranteed to be a disaster. It’s how politicians avoid responsibility while getting what they want (fool the voters.)

    The idea that the nanny state should take care of us needs to be fought and fought hard.

    1. First we have to stop the Orwellian speech. Any politician talking about fixing health care is ignorant or a liar and they are too consistently evil to just be ignorant.

      Yes. Further, what was passed, and what most of us are talking about is not a fix to health care, but modification of what insurance is from what it used to be. Car insurance isn’t a car and won’t get you anywhere. Health insurance does not provide you healthcare. Thousands of jobs in an already high demand / low supply healthcare industry have been lost directly related to PPACA. It didn’t fix the problem of access to healthcare. It exacerbated the problems. That the supposed 10 million people without health insurance will not possibly get it before Jan 1, and be penalized, is just one more example of PPACA doing nothing for health care but certainly harming individuals.

  7. I should clarify… people are not nearly and stupid people tend to make better decisions regarding issues of self interest (with allowance for criminal and immoral behavior.)

  8. Obamacare will fail to produce any overall health benefit and, in fact, will make US healthcare worse.

    Why? Because it is based on Cargo Cult, slipshod, economically illiterate thinking. The problem with healthcare in the US is NOT that people do not have insurance. It is that the basic supply of medical plant, equipment, and personnel does not satisfy demand at the desired level. Obamacare will decrease the supply even further, as current providers of medical services experience accelerated attrition of personnel who do not want to work long and stress filled hours for peanuts, and the ranks of incoming professionals chose other, more rewarding and less stressful, lines of work. It is impossible… IMPOSSIBLE… to increase demand and decrease supply, and expect costs to moderate and universal benefits to flow. It. Will. Not. Happen.

    The approach is very akin to wage and price controls, which every economist worth anything agrees is an economically distorting and futile effort to balance supply and demand by government fiat. It is magical thinking of the first order. People are so conditioned by their own individual economic perspective, that if they go into a store, and they have money, they can buy whatever they want. But, the goods in that store represent a fixed quantity determined by supply and demand. The money is merely a medium for exchange. If everyone in the US were given a 100% raise tomorrow, it would do nobody any good, except the most acquisitive who could grab some additional goods before the inflation spiral kicked in.

    The key to providing healthcare to everyone is to first provide healthcare capacity for everyone. If the capacity isn’t there, then no insurance policy will, in truth, guarantee everyone healthcare. The bottleneck is not in financial manipulations. It is in actual provision of the service. If we want to provide quality, affordable healthcare to everyone, then the first order of business is to beef up the ranks of personnel, providing avenues for their educations which do not leave them swimming in debt which requires a high salary to service, and to increase the quantity and availability of medical plant and equipment. You’ve got to provide the real goods, not some abstract representation of them. Anything less will fail in its objective. It is a mathematical equation, and it will not bend to the dictates or fever dreams of our incompetent and stupid leaders who think they can conjure up goods and services out of thin air by, essentially, wishing for them.

  9. Want to actually lower the cost of medical care? Reform tort law and allow insurers to sell in any state – of course, that would require using the commerce clause as originally intended…

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