Two features of ObamaCare will substantially increase the demand, while (surprisingly) nothing in the law increases supply. And when people take steps to increase their access in response to growing waiting times, the success of some will increase the rationing problems for everyone else.
At this point we have no idea how many people will become newly insured under ObamaCare. For the first year out, the number of people with insurance may actually go down! But the administration's goal is to insure an additional 30 million people and eventually a lot of those people will acquire health plans. When they do, the economic studies predict that they will try to double their use of the health care system.
Adding to this increased demand will be new mandated benefits. The administration never seems to tire of reminding seniors that they are entitled to a free annual checkup. Then there are new benefits for women, including free contraceptives. And all of us will be entitled to a long list of preventive services — with no deductible or copayment.
But the health care system can't possibly deliver on all these promises. The original ObamaCare bill actually had a line item for increased doctor training. But this provision was zeroed out before passage, probably to keep down the cost of health reform. The result will be increased rationing by waiting.
Take preventive care. The health reform law says that health insurance must cover the tests and procedures recommended by the U.S. Preventive Services Task Force. What would that involve? In the American Journal of Public Health, scholars at Duke University calculated that arranging for and counseling patients about all those screenings would require 1,773 hours of the average primary care physician's time each year, or 7.4 hours per working day.
And all of this time is time spent searching for problems and talking about the search. If the screenings turn up a real problem, there will have to be more testing and more counseling. Bottom line: To meet the promise of free preventive care nationwide, every family doctor in America would have to work full-time delivering it, leaving no time for all the other things they need to do.
When demand exceeds supply in a normal market, the price rises until it reaches a market-clearing level. But in this country, as in other developed nations, Americans do not primarily pay for care with their own money. They pay with time.
How long does it take you on the phone to make an appointment to see a doctor? How many days do you have to wait before she can see you? How long does it take to get to the doctor's office? Once there, how long do you have to wait before being seen? These are all non-price barriers to care, and there is substantial evidence that they are more important in deterring care than the fee the doctor charges, even for low-income patients.
When people cannot find a primary care physician who will see them in a reasonable length of time, all too often they go to hospital emergency rooms. Yet one study found up to 20% of the patients who enter an emergency room leave without ever seeing a doctor, because they get tired of waiting. Be prepared for that situation to get worse.
Wednesday, December 11, 2013
Tuesday, December 10, 2013
A thoroughly enraged reader took exception to my Thanksgiving entry, claiming that the meal portrayed was inaccessible to most Americans. Here's the meal that caused the apoplectic reader to label me heartless because "most Americans" couldn't possibly have this home-made meal:
The courses (all home-made) included the traditional favories:
--sweet potatoes with sliced apples
--three kinds of home-made cranberry sauce (one with apples, one with orange)
And an international potluck:
-- mussels with spinach leaves and dipping sauce
--somosas with mint/cilantro sauce
--Hawaii style potato salad
--nimono (a holiday Japanese stew, also called nishime)
--Crackling pork belly with lemon grass and garlic
I decided to fact-test the enraged reader's claim of general inaccessibility of a home-cooked potluck dinner. First, how many meals did this dinner provide, including the soup that was made with the turkey carcass? This potluck dinner served a crowd on Thanksgiving, 6 more friends the following day, neighbors whom we delivered food to, and multiple meals of leftovers for the three of us. It has already made 40 adult servings of a bountiful multi-course meal, and counting the many meals remaining in leftovers and the soup, the total adult servings will be more like 50.
Our cost of ingredients for the traditional meal was less than $80, or roughly $2 per serving. The cost of all the potluck dishes brought by others was less than $30. The sparkling wine, ginger ale and red wines (all bought on sale) was about $20.
Total cost of the meal: $130, or $3.25 per serving, less than a "value meal" at a fast food outlet. If we add in meals made from leftovers (the turkey soup, etc.), the cost per serving drops to less than $3.
Are the "poor" really too poor to buy fresh ingredients that add up to $3 per serving? Let's start with the fact that according to the U.S. Census Bureau, 49% of Americans Get Gov't Benefits; 82 million in Households on Medicaid. That means roughly 156 million Americans out of 317 million total population are receiving cash benefits (i.e. direct transfers) from the Federal government. Approximately 57 million receive Social Security retirement or disability benefits.
- It's Dec. 3 and the Obamacare web site is still broken for many people. CNN found that users still get error screens mid-stream. Others have found try-again-later messages. Worst of all, even if you do get through enrollment, you may still not actually be enrolled with any insurer.
- Cost of that broken web site? Estimated at $1 billion and counting. (Similar-size projects done by private companies *for their own core business* cost maybe $50 million.)
- Even Obama-loving, Democrat business owners are sour on Obamacare…after having taken away their employees' coverage, on the grounds that Obamacare with its new plan mandates is just too costly for them as employers, but somehow not too costly for their employees.
- Even President Obama's former press secretary, Robert Gibbs, thinks the Obama administration needs to become more honest. (Ouch!) Sadly, Sebelius didn't get the memo.
- Things look so bad for Democrats politically that even Obama's rubber-stamp, Sen. Al Franken, may be in trouble in 2014.
- Government-run health care doesn't work in the UK either, where more than 1000 NHS patients have died of simple dehydration since 2003. (Hmm…an unofficial way they get rid of pesky, money-draining patients?)
Monday, December 09, 2013
Jeanne Schulte Scott argued for the trade journal Healthcare Financial Management in March 2007 that then-President Bush had "put all his eggs into his 'privatization' basket" in his 2007 State of the Union address; nevertheless, he made health care the "issue du jour" for the 2008 presidential race. "Health care is hot!" she wrote, and then made a prediction that seems so quaint given all that's passed in the last four-and-a-half years:
The many would-be candidates for president in 2008 are falling over themselves offering their own proposals. We will soon see a "Giuliani-care" and "Obama-care" to go along with "McCain-care," "Edwards-care," and a totally revamped and remodeled "Hillary-care" from the 1990s.
The term took off from there, The Atlantic continued:
Headline writers squeezed for space gave the term momentum since "Obamacare" is so much shorter than "Obama's health care overhaul" or "Obama's health care bill." On May 30, 2007, The Hotline headlined a roundup of news about then-candidate Obama announcing his health care proposal "Obama: Here's Obamacare." A few days later, Jason Horowitz's story for the June 6 New York Observer (which also post dates its issues) was titled, "Stat! Clinton Readies Scalpel for Obamacare." Neither contains the term in the body of the story, so it was likely the work of an editor.
Timothy Noah wrote a series for Slate about "the health care primary," beginning June 19 with "Obamacare: Better Than It Looks." Stories on "Edwardscare: A Trojan Horse," "Hillarycare II: New and Improved," and "McCaincare: Provocative but Vague" followed.
Mitt Romney began using the term later in 2007, as a contrast to "Romneycare," clearly focused on policy differences, not race, 'Obamacare': The word that defined the health care debate:
It first appeared on the campaign trail in May of that year, when Romney distinguished his effort on health reforms as governor of Massachusetts.
"In my state, I worked on health care for some time. We had half a million people without insurance, and I said, 'How can we get those people insured without raising taxes and without having government take over heath care,'" he said in Des Moines, Iowa, advocating for states to find free market solutions.
"And let me tell you, if we don't do it, the Democrats will. If the Democrats do it, it will be socialized medicine; it'll be government-managed care. It'll be what's known as Hillarycare or Barack Obamacare, or whatever you want to call it."
On the campaign trail since, he has defended himself from charges of similarities between "Romneycare" and "Obamacare" — including a critique from a rival presidential candidate that the two amount to "Obamneycare."
Friday, December 06, 2013
The IRS Scandal involves:
- At least 292 conservative groups targeted
- At least 5 pro-Israel groups targeted
- Constitutional groups targeted
- Groups that criticized Obama administration were targeted
- At least two pro-life groups targeted
- A Texas voting-rights group was targeted
- Conservative activists and businesses were targeted.
- At least 88 IRS agents were involved in the targeting scandal
- At least one conservative Hispanic group was targeted
- IRS continued to target groups even after the scandal was exposed
Last night during his interview with Chris Matthews, Barack Obama denied there was a so-called IRS scandal and said it was just something sensationalized by the media.
Our guide, like all guides on the island, had been one of the "political prisoners" on the island. Here he is, explaining about the 30-year sentence he had received as a "political prisoner":
You might have noticed some scare quotes around the description of this guy as a "political prisoner." Let me explain.
One of the tourists asked him what his purported offense was. The tourist prefaced his question with a statement saying that he understood that the guide, like many people on the island, had been a political prisoner. But, what was the offense that the government had claimed he had engaged in? It took a bit of polite insistence on the part of the questioner, but the answer that emerged was that the guide had received the sentence for firing rockets at a fuel depot. Our persistent questioner asked if he had actually done that — or had the charges been entirely made up? The tourist sounded a little confused, because the guide had described himself as a political prisoner, and this didn't sound like an accusation of WrongThink. The guide said he had done it, to fight against the racist and repressive government. He hastened to add that there had been no people at the fuel depot. It was just a strategic target.
As I walked out of the prison building, I asked my wife if she was enjoying the tour we were receiving from the terrorist. I was half-joking, but there is an aspect to history in which the winners get to write it, and the history of the struggle against apartheid is no exception.
There is an image of Mandela as the sort of South African version of Martin Luther King, Jr., but he was no such thing. He was the head of Umkhonto we Sizwe, the armed wing of the African National Congress, which carried out violent acts in which innocent people died. Then again, much of the violence occurred while he was in prison. He also fought against a repressive and racist government and won.
If people want to hail Mandela as a hero, I won't waste energy arguing with them. That is debatable. I just ask that people not portray him as some icon of lifelong opposition to violence. That, he most certainly was not.
Thursday, December 05, 2013
via my feedly.com reader
In the "sudden appearance" of organisms during the geologically brief Cambrian explosion, creationists imagine tangible evidence for the supernatural creation of animal "kinds." To their eyes, these rocks record the moment of creation when Yahweh declared: "Let the land produce living creatures according to their kinds." They point to Precambrian rocks with their lack of fossilized hard parts, then point to Cambrian layers with their copious fossils and say, "See! Right there: creation." The story is not so simple, of course; we now know a lot more about life in the period before the Cambrian. The ancient lineages that eventually diversified extend far back in time, a long fuse leading to the eventual explosion.
While the rapid evolution during the Cambrian is described as geologically brief, it is important to define what that means. On human timescales, the shortest estimation for the length of the Cambrian explosion, about 10 million years, is incomprehensibly long. Moreover, the tiny Cambrian arthropods likely had much faster maturations and much shorter lifespans than humans. Our anthropocentric perception of the flow of time, in which a family might have only three or four generations per century, is very different from the number of generations Cambrian critters produced. Ten million years provides plentiful time, as Lee et al. showed. Yet creationists insist that there was not enough time for such biological complexity to arise, without ever defining why that time frame is insufficient.
Tuesday, November 26, 2013
NEWSMAX: The Affordable Care Act contains provisions for "death panels," which decide which critically-ill patients receive care and which won't, according to Mark Halperin, senior political analyst for Time magazine.
"It's built into the plan. It's not like a guess or like a judgment. That's going to be part of how costs are controlled," Halperin told "The Steve Malzberg Show" on Newsmax TV.
MALZBERG, HOST: A lot of people said you weren't going to be able to keep your health care, but also they focused on the death panels, which will be coming, call them what you will, rationing, is part of it...
HALPERIN: No, I agree, and that's going to be a huge issue, and that's something else on which the president was not fully forthcoming and straightforward.
MALZBERG: So, you believe there will be rationing, a.k.a. death panels?
HALPERIN: It's built into the plan. It's not like a guess or like a judgment. That's going to be part of how costs are controlled.
25 years ago, according to a recent article in Science magazine, Richard Lenski put samples of E. coli bacteria into a dozen flasks filled with a solution of glucose and other nutrients, incubated them, stirred them, and every day removed 1 % and repeated the process, day after day, for 25 years (except for a brief interruption when he moved from one university to another). The author of the article, Elizabeth Pennisi, notes that Lenski's bacteria
You may read Pennisi's article for yourself, but what I (a nonbiologist) found most interesting was that evolution keeps going, even in a stable environment; there are no fitness peaks (at least among E. coli in bottles). Equally, the fact that several different lines learned to metabolize citrate by means of different series of mutations suggests (as in the Pennisi quotation above) that the course of evolution might be more predictable than we had thought.
are proving as critical to understanding the workings of evolution as classic paleontology studies such as Stephen Jay Gould's research on the pace of change in mollusks. Lenski's humble E. coli have shown, among other things, how multiple small mutations can prepare the ground for a major change; how new species can arise and diverge; and that Gould was mistaken when he claimed that, given a second chance, evolution would likely take a completely different course. Most recently, the colonies have demonstrated that, contrary to what many biologists thought, evolution never comes to a stop, even in an unchanging environment.
Fortunately there is some decent non-paywalled coverage of this experiment. Ars Technica has a write-up that describes the basic experiment and the findings in this newest paper, with a link to coverage the earlier result about the evolution of a citrate metabolism among some of the populations.
Sunday, November 24, 2013
When I joined the U.S. military in January 2011, a family member asked me: "Aren't you worried about being raped?" And she wasn't the only one. Many people cautioned me that I would be entering an institution synonymous with machismo, authoritarianism, and violence.
What I found instead was very different: professionalism, respect, and a strong presence of women in the highest ranks. I also found the most transparent, aggressive, and in-your-face Sexual Assault Prevention and Response (SAPR) program I had ever witnessed.
Under the UCMJ, any military service member or even retiree can be punished for offenses (UCMJ Article 77), including accessories (78) and anyone who conspires in the punishable activity (87). People who attempt to commit an offense and fail to succeed may also be court-martialed (80). And offenders may be punished for any lesser included offenses (79).
So even if the preponderance of evidence fails to support a conviction for rape or sexual assault, an accused soldier may still be discharged from the military and punished for a related offense like failure to obey an order (92), cruelty toward and maltreatment of a subordinate (93), unbecoming conduct (133), fraternization (134), or providing alcohol to a minor (134).
If service members fail to obtain justice through the regular process, which is largely at the discretion of their Commanding Officers (COs), there already is a way for them to circumvent the CO and file a complaint of wrongs against the CO under UCMJ Article 138.
That is why I have been surprised to hear U.S. Senators imply that service members currently have no recourse outside their CO and that a new, parallel organizational structure is needed.
Compare all this to the model for sexual assault prevention and response at the institution I belonged to before the military—Harvard College. There, complaints of sexual assault are filed with the Administrative Board, or "Ad Board," comprised of deans and faculty members. The written policies regarding sexual assault are far less favorable to victims, requiring non-consent to be expressed "verbally or physically" and requiring the Ad Board members to be "sufficiently persuaded" that an assault occurred.
In stark contrast to the stories I've heard about military perpetrators landing up in Leavenworth Prison, Harvard's history of dealing with sexual assault cases might easily give more encouragement to perpetrators than victims.
During my time at Harvard College, between 2005 and 2009, I had one friend who was sexually assaulted by a fellow student, another who was beaten by her boyfriend (a fellow student), and another who was involved in a highly improper and abusive relationship with a professor. Not one of these incidents was ever reported.
In the five years from 2005 to 2010, according to the Harvard Crimson, eight cases of sexual misconduct were brought before Harvard's Ad Board. Only three perpetrators were required to withdraw from Harvard College for at least six months, and none received a permanent expulsion.
So what do the numbers look like? Based on the administration's own estimates from 2010, Veuger projects that tens of millions of people with employer-based insurance policies will be 'affected' by Obamacare, their plans either modified or cancelled. A far cry from Professor's Gruber's claim that only 9 million Americans, "three per cent of the population, will have to buy a new product that complies with the A.C.A.'s more stringent requirements for individual plans."
Saturday, November 23, 2013
Friday, November 22, 2013
It's important to see how the supposed benefits fail in the case of the minimum wage, and Kevin Williamson does a typically great job debunking those arguments in his recent piece on the homepage. But the minimum wage also creates unconscionable social losses, particularly for the poorest of the poor.
The minimum wage is not a "protection," as progressives often style it. It doesn't confer a "right" to be paid any amount of money, because nobody has an obligation to hire you. The minimum wage only says that it's illegal to work for less than x, no matter how badly you need that job. To the extent the minimum wage is set above where the market clears on a given wage category, businesses will typically respond with some combination of raising wages, cutting hours, and laying people off.
Almost as soon as George Zimmerman was arrested, a report surfaced that girlfriend Samantha Scheibe, who made the dramatic phone call to 911, had been shopping her story to national media for several weeks – but no one would pay her what she wanted.
The Orlando Sentinel confirmed that at least one national media outlet (unnamed) had such communications:
WKMG's report that the women were seeking money for interviews with national news organizations was confirmed to the Sentinel by one such organization.Not unexpectedly, the Zimmerman defense team is letting it be known that this was a set-up
Wednesday, November 20, 2013
Well, now it seems President Obama has his own 16 words to answer for: "If you like your health care plan, you'll be able to keep your health care plan." (Actually, it was a little more than 16 words if you include what the president said next: "Period. No one will take it away. No matter what.")
Obama attempted to move the goal posts in his speech in Boston's Faneuil Hall Wednesday, declaring that if you like your current health plan, "For the vast majority . . . you can keep it." Sorry, he didn't say "the vast majority" back in 2009. He said you can keep your plan. Period. No matter what.
Indeed, Obama repeated this promise on at least 24 separate occasions — before and after the law went into effect. It was critical to his case. Without his 16-word pledge that no one would lose his or her health plans, Obamacare might never have become law.
But Obama's 16 words were untrue. Across the country, Americans are now seeing their health plans discontinued — and experts say the cancellations could eventually reach 16 million. As one woman in California who got a cancellation letter from her insurer told the Los Angeles Times, "All we've been hearing the last three years is if you like your policy you can keep it . . . I'm infuriated because I was lied to."
Indeed, there is good reason to believe that the administration not only knew but fully intended for all these people to lose their existing plans. The Health and Human Services Department specifically wrote regulations to ensure that they would — narrowing a provision in the law "grandfathering" in existing plans so that "40 to 67 percent" of those in the individual market would not be able to keep their policies. That's because moving millions of customers out of the individual and small group markets and into the exchanges is critical to making the scheme financially viable. Indeed, the survival of Obamacare depends on it.
It was Obama's objective from the start to destroy the market in order to fund Obamacare. He wants these people to lose coverage so they have no choice but to sign up for the exchanges. Obama all but admitted this in his Boston speech. "If you're getting one of these [cancellation] letters, just shop around in the new marketplace," he declared. In other words, don't worry if the plan you're happy with is being cancelled, just join Obamacare! That was the plan all along.
Tuesday, November 19, 2013
In fact, it's too easy. Any time it's cited, we should be suspicious that it's a mere cop-out.
Next I thought: Maybe it's just greed? Perhaps they jacked up the price just because they could. There was clearly competition from other vendors, but their corn dogs were all similarly priced. If I'd stopped thinking here I might have assumed there's a corn dog cartel that schemes in a smoky room and agrees to their inflated prices beforehand.
That seemed unlikely, so I took a step forward in the line.
Then I wondered about the cost of paying the City of Galveston for a vendor's license for the weekend. While I don't know the exact price, it's a safe assumption that it's not cheap. A quick glance at the vendor application page shows that vendors also need to pay a fire tent fee, a health permit fee, and a state sales tax registration fee. All these sunk costs are certainly factors in the production cost and subsequent price, but also come with the effect of limiting competition, to where a local guy on a bike cannot choose to meet the sudden demand by selling cheaper corn dogs from a bicycle stand. Maybe this guy set up in a dark alley selling black-market corn dogs—but if so, I didn't see him.
I suspected most of those vendors were from out of town, maybe out of state. So the cost of transporting all their equipment, in large, fuel-guzzling trucks, must also be a factor. And these people had to sleep somewhere for the weekend, so there's another cost that has to be considered.
OK, maybe they're not so evil after all. I took another step up in line.
And then there's the cost of compensating the employees. To work in those conditions, at that pace, for that amount of time, the compensation must be worth the effort. Sure, many of these stands are probably family-owned and -staffed, but still: The profits must be greater than what this amount time and energy could be worth in other lines of employment. In other words, all this must be worth more than they could make simply flipping burgers or whatever. And how many opportunities do they get to sell to this kind of crowd? There's not a rally every day.
This line of thought stirs feelings of empathy; these people work hard, and despite their seemingly high prices, probably don't make all that much when all things are considered. Maybe they're the ones being exploited.
Monday, November 18, 2013
Here's an idea: If you don't want people to feel that you've betrayed them, don't betray them. Don't promise, dozens of times without qualification, that they will be able to keep their health plans if they like them when you know that is not true.
Here's another suggestion: When you are apologizing for misleading people, don't seek to minimize the significance of your deception. "We're talking about 5 percent of the population," Obama told NBC's Chuck Todd. "It only affects a small amount of the population."
Obama was referring to the 14 million Americans who obtain health insurance through individually purchased policies, which is hardly a small number. According to studies by the Manhattan Institute and the Heritage Foundation, the policies these people find in Obamacare's insurance exchanges typically will cost more than what they have now.
Sunday, November 17, 2013
When Obama claims your old plan was "junk," he's not leveling with you. Your health plan wasn't canceled out of some kind of concern that you are insufficiently insured. Rather, you simply must pay more – and get less – to make Obamacare's finances work.
In the average state, Obamacare will increase underlying premiums by 41 percent. As we have long expected, the steepest hikes will be imposed on the healthy, the young, and the male. And Obamacare's taxpayer-funded subsidies will primarily benefit those nearing retirement—people who, unlike the young, have had their whole lives to save for their health-care needs.
Over the last day or two, the major breaking story has really been a throwback: in 2010, the Obama administration promulgated rules governing what plans that pre-existed Obamacare would be "grandfathered" under that statute, and allowed to continue. In the context of announcing its rules, the administration predicted that because of their restrictiveness, many millions of Americans would lose their existing insurance coverage, whether they liked it or not.
The Obama administration has run aground on the president's promise that if you like your health care plan, you can keep it: Scott Rasmussen finds that 55% of voters rate Obama's performance on health care as "poor." But, as Byron York notes, at least 27 Democratic senators made the same false promise to their constituents:
The list includes the entire Democratic leadership in the Senate as well as Democrats facing tough re-election races in 2014, like Mary Landrieu, Mark Begich, and Kay Hagan.
Cohn is right that there was no serious conversation about those tradeoffs back when Congress was considering the law's passage in 2009 and 2010. But why was that? It was because President Obama and his Democratic allies could not speak seriously — and honestly — about those tradeoffs and still pass their bill.
So instead, Obama assured Americans they could keep health care policies they liked. And it wasn't just Obama. "One of our core principles is that if you like the health care you have, you can keep it," Senate Majority Leader Harry Reid said in August 2009. "If you like what you have, you can keep it," said then-House Speaker Nancy Pelosi in October of the same year.
Many, many Democrats promised the same thing. They had to. If they had declared openly that millions of Americans would lose their current coverage and face higher premiums and deductibles — if Obama and Democratic leaders had said that, they would not have been able to maintain party unity in support of the bill, and the Affordable Care Act would never have passed Congress.
It would not have mattered that Republicans opposed the bill unanimously. A frank public discussion of Obamacare would have divided Democratic support, with the result being no new law at all.