Why Obamacare failed - Chicago Tribune

Why Obamacare failed - Chicago Tribune

Come November, the grim trudge across the increasingly barren Obamacare landscape begins anew. Illinois consumers likely face staggering price hikes for individual insurance policies. Some types of plans could cost an average of 43 percent to 55 percent more. Ditto across the country: A first tranche of states approved 2017 rates with similarly cardiac-arrest-inducing premium increases.

Many Illinois consumers will find fewer choices because major carriers fled this market. UnitedHealthcare bolted. So did Aetna. Land of Lincoln Health collapsed mid-year, leaving policy holders to scramble for coverage that could cost them plenty. In many places across Illinois and the nation, people will find drastically fewer choices of plans than they did last year.

Those insurers fled because they didn't want to lose more money on a government-run market that is so far out of whack — a market they think likely will never be profitable for them. That isn't surprising, as we enumerate below.

But by diagnosing Obamacare, all of us can see the mistakes that any repair or replacement can avoid. So let's look at the failings and how they can drive solutions:

Obamacare failed because it flunked Economics 101 and Human Nature 101. It straitjacketed insurers into providing overly expensive, soup-to-nuts policies. It wasn't flexible enough so that people could buy as much coverage as they wanted and could afford — not what the government dictated. Many healthy people primarily want catastrophic coverage. Obamacare couldn't lure them in, couldn't persuade them to buy on the chance they'd get sick.

Obamacare failed because the penalties for going uncovered are too low when stacked against its skyrocketing premium costs. Next year, the penalty for staying uninsured is $695 per adult, or perhaps 2.5 percent of a family's taxable household income. That's far less than many Americans would pay for coverage. Financial incentive: Skip Obamacare.

Obamacare failed because insurance is based on risk pools — that is, the lucky subsidize the unlucky. The unlucky who have big health problems (and big medical bills) reap much greater benefits than those who remain healthy and out of the doctors' office. But Obamacare's rules hamstring insurers. They can't exclude people for pre-existing conditions, and can't charge older customers more than three times as much as the young. Those are good goals, but they skew the market in ways Obamacare didn't figure out how to offset. Result: Young and healthy consumers pay far more in premiums than their claims (probably) would justify in order to subsidize the unexpectedly large influx of older, sicker customers who require expensive care. Too many unlucky people, too few lucky people: That will collapse any insurance scheme.

Obamacare failed because it allowed Americans to sign up after they got sick and needed help paying all those medical bills. Insurance should be structured so that, although you don't know if you'll need it, you pay for it anyway, just in case; your alternative is financial doom. But if you can game the system and, for example, buy auto coverage after you crash into your garage, then you have no incentive to buy insurance beforehand.

Obamacare failed because it hasn't tamed U.S. medical costs. Health care is about supply and demand: People who get coverage use it, especially if the law mandates free preventive care. Iron law of economics: Nothing is free; someone pays. To pretend otherwise was folly. Those forces combined to spike the costs of care, and thus insurance costs.

Obamacare failed because too many carriers simply can't cover expenses, let alone turn a profit, in this rigidly controlled system. Take Blue Cross and Blue Shield of Illinois, the state's dominant Obamacare insurer. Last year, for every dollar the carrier collected, it spent $1.32 buying care and providing services for customers, according to BCBS President Maurice Smith. No wonder BCBS is proposing rate increases from 23 percent to 45 percent for its individual plans.

A question looms: Is Obamacare plunging in a so-called insurance death spiral? Is the market so unstable that plans are doomed to get more and more expensive, driving more Americans and more insurers out of the market until ... Obamacare thuds to the pavement?

We won't predict that, but neither do we see a mathematical alternative. What's clear is that the solutions to Obamacare are implicit in its failures. A repaired or replaced system has to be more flexible, letting insurers offer a wider range of plans so that consumers, not lawmakers or bureaucrats, dictate what's best for them. That system should protect those who carry continuous coverage, not coddle those who duck in and out of plans when their health needs change.

A new system also should scrap the job-killing Obamacare mandates that discourage companies from hiring and discourage workers from adding hours. Instead of gearing subsidies to incomes, let Americans not covered via an employer reap tax credits to help finance their insurance purchases on the open market. And tell us again: Why can't insurers sell policies across state lines? Imagine the pricing competition that would unleash.

We can deny the current system's failings, or we can parlay our evolving knowledge into something much better.

Put another way: The next president and Congress either reckon with Obamacare's failures or ... wait for the thud.

“What would you do? Just let people die?” | Foundation for Economic Education

“What would you do? Just let people die?” | Foundation for Economic Education

"Well then, what would you do? Just let people die?”

Those words were thrown at me the first time I debated a national healthcare program for America, way back in the 1990s. Through all the years since then, I have been hearing some version of them at regular intervals.

During the debate over the Patient Protection and Affordable Care Act (ACA), that question was the ultimate resort of anyone arguing in favor of the law: whatever its problems, it was better than letting tens of thousands of Americans die each year.

There are a couple of shaky assumptions underlying the question. The first is that health insurance does a great deal to increase health and reduce mortality. This seems obvious enough, but it’s surprisingly hard to tease out of the data.

For example, the creation of Medicare, which vastly expanded utilization of health care, seems to have produced no measurable impact on mortality among the elderly in its first 10 years of existence. There is ample evidence that health insurance protects people from financial risk — which isn’t surprising, because that’s what insurance is for. The evidence that it protects people from premature death is less compelling.

Of course, the financial risk is a real problem — a health-related financial disaster can be devastating for families that go through it. But even if we also assume that there are real, and large, health benefits from providing insurance to people, that still wouldn’t mean that the ACA was better than nothing. This is the fallacious syllogism that led America into the Iraq War:

1. Something must be done.

2. This is something.

3. Therefore, this must be done.

And thus we got a bloated, complicated law that still isn’t quite working as planned. Fewer people are insured than projected, the insurance is less generous than be expected, the exchanges are in financial trouble, the federal back end to pay insurers still hasn’t been built.

Worst of all, we’ve locked in most of the features that people hated about the old system: the lack of transparency, the endless battles with insurers over what is covered and what isn’t, the feeling that you are captive to behemoth government and corporate bureaucracies that are more interested in the numbers on their spreadsheets than in what you want out of your health care.

I do think that something should have been done. But not this something. What we should have done is created a system that focused on protecting people from the risk we know they face — catastrophic medical bills — and that sought to preserve the best of the American system rather than the worst — that is, to preserve our endless talent for innovation through markets rather than our decidedly lesser talent for creating and managing massive regulatory bureaucracies.

Government as the Insurer of Last Resort

How could a government program have freed up markets to innovate? Simple: by getting the government to do something it already does decently well, which is to function as the insurer of last resort. Deposit insurance, pioneered by the United States, has basically halted bank runs. Pension benefit guarantees have made sure seniors don’t end up in penury. (The Pension Benefit Guaranty Corporation could be better financed, but that doesn’t mean the idea itself is bad.) FEMA essentially functions as an insurer of last resort for people struck by natural disasters.

These programs introduce a certain amount of moral hazard, as people take more risks and underinsure themselves in the expectation that the government will pick up the tab. But when you look at the devastation these programs have mitigated, it is hard to call them anything but an overwhelming success.

How would a similar program work for health care? The government would pick up 100 percent of the tab for health care over a certain percentage of adjusted gross income — the number would have to be negotiated through the political process, but I have suggested between 15 and 20 percent.

There could be special treatment for people living at or near the poverty line, and for people who have medical bills that exceed the set percentage of their income for five years in a row, so that the poor and people with chronic illness are not disadvantaged by the system.

In exchange, we would get rid of the tax deduction for employer-sponsored health insurance, and all the other government health insurance programs, with the exception of the military’s system, which for obvious reasons does need to be run by the government.

People would be free to insure the gap if they wanted, and such insurance would be relatively cheap, because the insurers would see their losses strictly limited. Or people could choose to save money in a tax-deductible health savings account to cover the eventual likelihood of a serious medical problem.

Advantages of the Insurer-of-Last-Resort Alternative

Of course, anyone proposing an alternative to the ACA, or to the previous status quo, has to be able to say why the alternative is better. In this case, there are three answers to that challenge. First of all, it is dead simple, and the simpler a government program is, the better it works. The ideal government program can be explained to a third grader on a postcard, and this one comes close.

The second reason this is better is that it protects people from actual catastrophic costs better than the existing system, while also being more progressive. Warren Buffett will get nothing out of the system; someone with very little income will have all medical bills paid. No one will have to worry about being slapped with an unpayable bill if, say, an anesthesiologist turns out to be out of network.

But the third and most important reason this alternative is better is that it introduces a key element that has gone missing from health care since third-party payers started to take responsibility for the bills: transparent prices, and consumers who make decisions based on them.

Milton Friedman famously divided spending into four categories, which P. J. O’Rourke summarized thus:

1. You spend your money on yourself. You’re motivated to get the thing you want most at the best price. This is the way middle-aged men haggle with Porsche dealers.

2. You spend your money on other people. You still want a bargain, but you’re less interested in pleasing the recipient of your largesse. This is why children get underwear at Christmas.

3. You spend other people’s money on yourself. You get what you want but price no longer matters. The second wives who ride around with the middle-aged men in the Porsches do this kind of spending at Neiman Marcus.

4. You spend other people’s money on other people. And in this case, who gives a [damn]?

The first category is what produces market efficiency. Unfortunately, almost no one in the system does that. Instead, we have insurers spending their money on someone else, consumers spending someone else’s money on themselves, and the government spending other people’s money on someone else. No one gets what he or she wants, vast oceans of times are wasted fighting over what to buy, and it all costs too much.

Of course, some things are too expensive to get price discipline from this system: organ transplants, very early preemies, many forms of cancer. But there’s little price discipline in those areas now, so we wouldn’t be any worse off. Meanwhile, lots of areas, from hospital beds to the details of knee surgery, would for the first time in decades be subject to the decisions of consumers who care both about getting what they need and about how much they’re spending.

Conclusion

I spent years uninsured in my twenties, and remarkably, I got the best health care of my life, because doctors stopped performing tests and procedures “just in case” and thought hard about what was necessary. I was obviously taking an enormous financial risk, and the government can usefully mitigate that. But I was also an empowered consumer rather than a number in our vast healthcare bureaucracy. A better future for American health care would be one where more people are uninsured and fewer of them are at risk.

HOW RELEASE OF MENTAL PATIENTS BEGAN - NYTimes.com

HOW RELEASE OF MENTAL PATIENTS BEGAN - NYTimes.com

HOW RELEASE OF MENTAL PATIENTS BEGAN

By RICHARD D. LYONS

Published: October 30, 1984

THE policy that led to the release of most of the nation's mentally ill patients from the hospital to the community is now widely regarded as a major failure. Sweeping critiques of the policy, notably the recent report of the American Psychiatric Association, have spread the blame everywhere, faulting politicians, civil libertarian lawyers and psychiatrists.

But who, specifically, played some of the more important roles in the formation of this ill-fated policy? What motivated these influential people and what lessons are to be learned?

A detailed picture has emerged from a series of interviews and a review of public records, research reports and institutional recommendations. The picture is one of cost-conscious policy makers, who were quick to buy optimistic projections that were, in some instances, buttressed by misinformation and by a willingness to suspend skepticism.

Many of the psychiatrists involved as practitioners and policy makers in the 1950's and 1960's said in the interviews that heavy responsibility lay on a sometimes neglected aspect of the problem: the overreliance on drugs to do the work of society.

The records show that the politicians were dogged by the image and financial problems posed by the state hospitals and that the scientific and medical establishment sold Congress and the state legislatures a quick fix for a complicated problem that was bought sight unseen.

'They've Gone Far, Too Far'

In California, for example, the number of patients in state mental hospitals reached a peak of 37,500 in 1959 when Edmund G. Brown was Governor, fell to 22,000 when Ronald Reagan attained that office in 1967, and continued to decline under his administration and that of his successor, Edmund G. Brown Jr. The senior Mr. Brown now expresses regret about the way the policy started and ultimately evolved. ''They've gone far, too far, in letting people out,'' he said in an interview.

Dr. Robert H. Felix, who was then director of the National Institute of Mental Health and a major figure in the shift to community centers, says now on reflection: ''Many of those patients who left the state hospitals never should have done so. We psychiatrists saw too much of the old snake pit, saw too many people who shouldn't have been there and we overreacted. The result is not what we intended, and perhaps we didn't ask the questions that should have been asked when developing a new concept, but psychiatrists are human, too, and we tried our damnedest.''

Dr. John A. Talbott, president of the American Psychiatric Association, said, ''The psychiatrists involved in the policy making at that time certainly oversold community treatment, and our credibility today is probably damaged because of it.'' He said the policies ''were based partly on wishful thinking, partly on the enormousness of the problem and the lack of a silver bullet to resolve it, then as now.''

The original policy changes were backed by scores of national professional and philanthropic organizations and several hundred people prominent in medicine, academia and politics. The belief then was widespread that the same scientific researchers who had conjured up antibiotics and vaccines during the outburst of medical discovery in the 50's and 60's had also developed penicillins to cure psychoses and thus revolutionize the treatment of the mentally ill.

And these leaders were prodded into action by a series of scientific studies in the 1950's purporting to show that mental illness was far more prevalent than had previously been believed.

Finally, there was a growing economic and political liability faced by state legislators. Enormous amounts of tax revenues were being used to support the state mental hospitals, and the institutions themselves were increasingly thought of as ''snake pits'' or facilities that few people wanted.

One of the most influential groups in bringing about the new national policy was the Joint Commission on Mental Illness and Health, an independent body set up by Congress in 1955. One of its two surviving members, Dr. M. Brewster Smith, a University of California psychologist who served as vice president, said the commission took the direction it did because of ''the sort of overselling that happens in almost every interchange between science and government.''

''Extravagant claims were made for the benefits of shifting from state hospitals to community clinics,'' Dr. Smith said. ''The professional community made mistakes and was overly optimistic, but the political community wanted to save money.''

'Tranquilizers Became Panacea'

Charles Schlaifer, a New York advertising executive who served as secretary-treasurer of the group, said he was now disgusted with the advice presented by leading psychiatrists of that day. ''Tranquilizers became the panacea for the mentally ill,'' he said. ''The state programs were buying them by the carload, sending the drugged patients back to the community and the psychiatrists never tried to stop this. Local mental health centers were going to be the greatest thing going, but no one wanted to think it through.''

Dr. Bertram S. Brown, a psychiatrist and Federal official who was instrumental in shaping the community center legislation in 1963, agreed that Presidents Eisenhower, Kennedy and Johnson were to some extent misled by the mental health community and Government bureaucrats.

''The bureaucrat-psychiatrists realized that there was political and financial overpromise,'' he said.

Dr. Brown, then an executive of the National Institute of Mental Health and now president of Hahnemann University in Philadelphia, stated candidly in an interview: ''Yes, the doctors were overpromising for the politicians. The doctors did not believe that community care would cure schizophrenia, and we did allow ourselves to be somewhat misrepresented.''

''They ended up with everything but the kitchen sink without the issue of long-term funding being settled,'' he said. ''That was the overpromising.''

Dr. Brown said he and the other architects of the community centers legislation believed that while there was a risk of homelessness, that it would not happen if Federal, state, local and private financial support ''was sufficient'' to do the job.

Resources Vanished Quickly

The legislation sought to create a nationwide network of locally based mental health centers which, rather than large state hospitals, would be the main source of treatment. The center concept was aided by Federal funds for four and a half years, after which it was hoped that the states and local governments would assume responsibility.

''We knew that there were not enough resources in the community to do the whole job, so that some people would be in the streets facing society head on and questions would be raised about the necessity to send them back to the state hospitals,'' Dr. Brown said.

But, he continued, ''It happened much faster than we foresaw.'' The discharge of mental patients was accelerated in the late 1960's and early 1970's in some states as a result of a series of court decisions that limited the commitment powers of state and local officials.

Dr. Brown insists, as do others who were involved in the Congressional legislation to establish community mental health centers, that politicians and health experts were carrying out a public mandate to abolish the abominable conditions of insane asylums. He and others note - and their critics do not disagree - that their motives were not venal and that they were acting humanely.

In restrospect it does seem clear that questions were not asked that might have been asked. In the thousands of pages of testimony before Congressional committees in the late 1950's and early 1960's, little doubt was expressed about the wisdom of deinstitutionalization. And the development of tranquilizing drugs was regarded as an unqualified ''godsend,'' as one of the nation's leading psychiatrists, Dr. Francis J. Braceland, described it when he testified before a Senate subcommittee in 1963.

Dr. Braceland, a former president of the American Psychiatric Association who is a retired professor of psychiatry at Yale University, still maintains, however, that under the circumstances the widespread prescription of drugs for the mentally ill was and is a wise policy.

''We had no alternative to the use of drugs for schizophrenia and depression,'' Dr. Braceland said. ''Before the introduction of drugs like Thorazine we never had drugs that worked. These are wonderful drugs and they kept a lot of people out of the hospitals.''

Testimony to Congress

His point is borne out repeatedly by references in Congressional testimony, such as the following exchange at a House subcommittee hearing between Representative Leo W. O'Brien, Democrat of upstate New York, and Dr. Henry N. Pratt, director of New York Hospital in Manhattan, who appeared on behalf of the American Hospital Association.

Mr. O'Brien: ''Do you know offhand how much New York appropriates annually for its mental hospitals?''

Dr. Pratt: ''It is the vast sum of $400 million to $500 million.''

Mr. O'Brien: ''So you see that, through a real attempt to handle this problem at the community level, the possibility that this dead weight of $400 million to $500 million a year around the necks of the New York State taxpayers might be reduced considerably in the next 15 or 20 years?

Dr. Pratt: ''I do, indeed. Yes, sir.''

He then told the subcommittee that ''striking proof of the advantages of local short-term intensive care of the mentally ill was brought out'' in a Missouri study.

Dr. Pratt's testimony and the Missouri study were repeatedly cited in subsequent Congressional debates on the community centers bill by such politicians as Senator Hubert H. Humphrey of Minnesota and Representative Kenneth A. Roberts of Alabama.

The Missouri study, which compared a group of 412 patients in two intensive treatment centers with patients admitted to five mental hospitals, showed that the average stays for patients in the large hospitals were 237 days longer than for similarly diagnosed patients at the treatment centers.

But Dr. George A. Ulett of St. Louis, the psychiatrist who directed the study as head of Missouri's Division of Mental Diseases, now says the numbers cited, though correct, were misinterpreted. ''We did have dramatic numbers, but the initial success of the community centers in Missouri hinged on the large numbers of psychiatrists and support personnel who staffed the centers at that time,'' Dr. Ulett said.

The centers were two pilot projects that were given special staff and attention to demonstrate what could be accomplished, he said. By linking the community centers to large teaching hospitals in major cities and providing adequate funds for their maintenance it was possible to attract the quality of staff that all but guaranteed better results than the old state hospitals, he said.

''Unfortunately,'' he said, ''over the years the budgets were progressively reduced, the professional staffs were cut, and the program regressed to right back where it started.''

Dr. Frank R. Lipton and Dr. Albert Sabatini of Bellevue Psychiatric Hospital in Manhattan, who have done research on the problems of the homeless, say one of the major flaws in the concept of deinstitutionalization was the notion that serious, chronic mental disorders could be minimized, if not totally prevented, through care provided within the local community.

''This philosophical and ideological shift in thinking was not adequately validated, yet it became one of the major conceptual bases for moving the locus of care,'' they said in a recent study.

Value and Danger in Drugs

Some problems have actually been brought on for mental patients by long-term use of drugs. This condition has been considered by Dr. Loren Mosher of the Uniformed Services Medical University in Bethesda, Md., who says that from 15 percent to 40 percent of such mental patients develop uncontrollable movements of the mouth and neck that can only be cured by taking people off the drugs.

The consensus seems to be that the more intelligent approach to the overall problem is to realize both the limitations and value of the drugs, the importance of combining drug treatment with proper care - either in hospitals or local clinics, depending on the individual case - and that mental illness is a sociological fact that cannot be ignored simply out of a desire to save tax dollars.

Jack R. Ewalt, who directed the staff of the Joint Commission when it was founded in 1955, says now that he remains ''a great believer in the use of drugs, but they are just another treatment, not a magic.''

''Drugs can help people get back to the community,'' he said, ''but they have to have medical care, a place to live and someone to relate to. They can't just float around aimlessly.''

Dr. Ewalt said the 1963 act was supposed to have the states continue to take care of the mentally ill but that many states simply gave up and ceded most of their responsibility to the Federal Government.

''The result was like proposing a plan to build a new airplane and ending up only with a wing and a tail,'' Dr. Ewalt said. ''Congress and the state governments didn't buy the whole program of centers, plus adequate staffing, plus long-term financial supports.''

10 Charts to Brighten Your Century : The Freeman : Foundation for Economic Education

10 Charts to Brighten Your Century : The Freeman : Foundation for Economic Education

Follow link to see charts.

1. There is a rape epidemic caused by rape culture.
...incidents of rape are lower than they have been in 40 years and have been reduced by more than half. It’s not clear what factors brought about such declines, but the declines should be acknowledged.
2. Police work is dangerous, so cops need military gear.
...it just isn't unusually deadly or dangerous — and it’s safer today than ever before. The data do not justify the kinds of armor, weapons, insecurity, and paranoia being displayed by police across the country.
3. Gun ownership increases violent crime.
The most remarkable statistic is that, since gun-related violence peaked in 1993, there has been an appreciable decline in gun violence ever since — all despite (or perhaps because of) significant national increases in gun ownership.
4. Concentrations of CO2 in the atmosphere will lead to catastrophic climate change.
...despite significant increases in carbon dioxide concentrations in the atmosphere, average global temperatures in the lower atmosphere have been virtually unchanged for more than 18 years.

What does this mean? At the very least, it means we should be dampening some of the climate-change hysteria, questioning the models that have predicted greater warming, and embracing a reasoned agnosticism about the issue until it’s better understood.

5. The rich are getting richer and the poor, poorer.

The truth is, the rich are getting richer and the poor are getting richer, too. In fact, globally, the poor are richer than they have ever been in human history.

But what about in the US? As columnist and professor Michael Shermer writes in Scientific American, “The top-fifth income earners in the U.S. increased their share of the national income from 43 percent in 1979 to 48 percent in 2010, and the top 1 percent increased their share of the pie from 8 percent in 1979 to 13 percent in 2010. But note what has not happened: the rest have not gotten poorer. They’ve gotten richer: the income of the other quintiles increased by 49, 37, 36 and 45 percent, respectively.”

6. The air is getting dirtier due to more cars on the road.

In the United States, there are more than twice the vehicles on the road today than in 1980. Yet, the air quality has never been better. Remember pictures of Los Angeles in the 1980s? Smog. L.A. hasn’t seen that kind of filthy pea soup since Magnum PI.

7. We’re nearing  "peak oil."

Ever heard of Julian Simon? He’s the doomslayer who suggested we take any neo-Malthusian predictions of resource depletion with a grain of salt. Indeed, he suggested that because the human mind is the “ultimate resource,” resources would never run out. As long as there is a system of prices, property, and a profit motive, people will have incentives to conserve, innovate, or substitute. So what happened to peak oil? TheShale Revolution happened, just as Simon would have predicted. (Sorry, Professor Krugman.)

8. Our infrastructure is crumbling.

During the worst of the 2008 recession, one popular meme was that the nation’s infrastructure was “crumbling.” We were all to fear falling bridges and the general pothole-ification of America. Governments used such fearmongering to justify Keynesian stimulus policies through more taxpayer-funded investment in roads and bridges. But transportation analyst David Hartgen countered that false narrative right here in the pages of The Freeman.

9. The US health system ranks low among developed countries for health outcomes.

Not so fast. When one factors out deaths due to homicide and auto fatalities, the United States shoots to number one in health outcomes along a number of dimensions. Yes, health care is expensive. Yes, it’s convoluted. Yes, it’s corrupt — and it’s all thanks to political meddling. But the US health care system is still probably among the best in the world.

10.The Public Schools Need More Funding

Each year, the schools get more resources. Another Taj Mahighschool goes up. Another football stadium gets built. Another administrator’s salary goes up. Another union boss enjoys champagne in a hot tub. And what happens to educational outcomes? Forty years on … no change.

The Most Unconscionable Drug Price Hike I Have Yet Seen. In the Pipeline:

The Most Unconscionable Drug Price Hike I Have Yet Seen. In the Pipeline:

As has been pointed out, a price hike like this would be very hard to maintain without a government-protected monopoly.

There's a drug called Thiola (tiopronin) that most people have never heard of....Retrophin bought the marketing rights earlier this year (a move complicated by the company's CEO, investor Martin Shkreli, who may have let the news of the deal leak on his Twitter account).
That link mentions part of Shkreli's business plan as "acquiring the rights to obsolete remedies Shkreli says can be put to new and lucrative purposes", and by gosh, that's certainly accurate. Retrophin is increasing the price of Thiola from $1.50 per pill to over $30 per pill. Because they can - they stated when they bought the drug that their first move would be to raise the price. New dosages are formulations are also mentioned, but the first thing is to jack the price up as high as it can be jacked. Note that patients take several pills per day. Shkreli is probably chortling at those Mission Pharmacal hicks who didn't realize what a gold mine they were sitting on.
Now, there have been somewhat similar cases in recent years. Colchicine's price went straight up, and (infamously) so did the progesterone formulation marketed as Makena. But in both those cases, the small companies involved took the compound back through the FDA, under an agency-approved program to get marketing exclusivity. I've argued here (see those last two links) that this idea has backfired several times, and that the benefit from the clinical re-evaluation and re-approval of these drugs has not been worth their vastly increased cost. I think that drug companies should be able to set the price of their drugs, because they have a lot of failures to make up for, but this FDA loophole gives people a chance to do minimal development at minimal risk and be handed a license to print money in return.
But this isn't even one of those cases. It's worse. Retrophin hasn't done any new trials, and they haven't had to. They've just bought someone else's old drug that they believed could be sold for twenty times its price, and have put that plan right into action. No development costs, no risks whatsoever - just slap a new sticker on it and put your hands over your ears. This is exactly the sort of thing that makes people go into fist-clenching rages about the drug industry, and with damn good reason. This one enrages me, and I do drug research for a living.
So thank you, Martin Shkreli. You've accelerated the progress of the giant hammer that's coming down on on all of us over drug pricing, and helped drag the reputation of the pharmaceutical industry even further into the swamp. But what the hell do you care, right? You're going to be raking in the cash. The only thing I can say about Shkreli and Retrophin is that they make the rest of the industry look good in comparison. Some comparison.

Who's the Real Hobby Lobby Bully? - Bloomberg View

Who's the Real Hobby Lobby Bully? - Bloomberg View

Cards on the table: I think that institutions Hobby Lobby and Little Sisters of the Poor are obviously correct -- they are being forced by the government to buy something that they don’t want to buy. We can argue about whether this is a good or a bad idea, but the fact that it is coercive seems indisputable. If it weren’t for state power, the Little Sisters of the Poor would be happily not facilitating the birth-control purchases of its employees; the Barack Obama administration has attempted to force them to do otherwise. The U.S. Supreme Court has ruled that this coercion violates the Religious Freedom Restoration Act, and it must therefore cease.

I think a few things are going on here. The first is that while the religious right views religion as a fundamental, and indeed essential, part of the human experience, the secular left views it as something more like a hobby, so for them it’s as if a major administrative rule was struck down because it unduly burdened model-train enthusiasts. That emotional disconnect makes it hard for the two sides to even debate; the emotional tenor quickly spirals into hysteria as one side says “Sacred!” and the other side says, essentially, “Seriously? Model trains?” That shows in Justice Ruth Bader Ginsburg’s dissent, where it seems to me that she takes a very narrow view of what role religious groups play in the lives of believers and society as a whole.
The second, and probably more important, problem is that the long compromise worked out between the state and religious groups -- do what you want within very broad limits, but don’t expect the state to promote it -- is breaking down in the face of a shift in the way we view rights and the role of the government in public life.

All of us learned some version of “You have the right to your beliefs, but not to impose them on others” in civics class. It’s a classic negative right. And negative rights are easy to make reciprocal: You have a right to practice your religion without interference, and I have a right not to have your beliefs imposed on me.
This works very well in situations in which most of the other rights granted by society are negative rights, because negative rights don’t clash very often. Oh, sure, you’re going to get arguments about noise ordinances and other nuisance abatements, but unless your religious practices are extreme indeed, the odds that they will substantively violate someone else’s negative rights are pretty slim.
I’m not saying that America ever perfectly hewed to this sort of ideal. (Blue laws, anyone?) I’m just saying that the statement of this ideal was perfectly consistent with the broadly held conception of what government was for, which was to provide “public goods” in the classical economics sense,1 but otherwise mostly to keep other people from doing stuff to you, not to do things for you or force you to do them for other people.
In this context, “Do what you want, as long as you don’t try to force me to do it, too” works very well, which is why this verbal formula has had such a long life. But when you introduce positive rights into the picture, this abruptly stops working. You have a negative right not to have your religious practice interfered with, and say your church forbids the purchase or use of certain forms of birth control. If I have a negative right not to have my purchase of birth control interfered with, we can reach a perhaps uneasy truce where you don’t buy it and I do. But if I have a positive right to have birth control purchased for me, then suddenly our rights are directly opposed: You have a right not to buy birth control, and I have a right to have it bought for me, by you.
....
1 Public goods are not “goods provided by the government”; they’re goods that have to be provided by the government, because no one without taxing power can efficiently provide them. Police service is the classic public good because it is nonrivalrous (multiple people can enjoy it) and nonexclusive (you can’t keep other people from enjoying the benefits). If crime goes down, all of us enjoy lower crime, even if we don’t pay taxes. Defense of the borders is another classic public good, and other items such as roads and lighthouses are usually included.

The Hobby Lobby majority, summarized in (relatively) plain English - The Washington Post

The Hobby Lobby majority, summarized in (relatively) plain English - The Washington Post

1. Congress has decided that religious objectors may go to court to demand religious exemptions from federal laws, when the law makes them do things that they view as religiously forbidden. That’s not required as a constitutional matter under the Free Exercise Clause; the Court decided that in Employment Division v. Smith (1990). But in enacting the Religious Freedom Restoration Act (RFRA), Congress chose to give religious objectors a statutory right to such exemptions, at least in many cases:

Government shall not substantially burden a person’s exercise of religion

even if the burden results from a rule of general applicability, …

[unless the Government] demonstrates that application of the burden to the person …

is the least restrictive means of furthering [a] compelling governmental interest.

2. RFRA doesn’t exclude laws which impose a burden on closely held religious corporations. To be sure, a corporation is a legal fiction; it cannot itself practice religion, or for that matter do anything else. It acts only through people.

But — precisely because a corporation is just a legal fiction — when a law requires such a corporation to do something that its owners believe to be religiously forbidden, it burdens the religious freedom of those real owners, and not just of the fictional corporation itself. “[P]rotecting the free-exercise rights of corporations like Hobby Lobby … protects the religious liberty of the humans who own and control those companies.”

3. The owners of Hobby Lobby sincerely believe that it’s wrong for them to buy their employees insurance plans that they see as supporting abortion. They have no objection to contraception as such, but they view contraceptives that prevent the implantation of a fertilized egg as tantamount to abortion drugs.

The government acknowledges that its regulations require businesses to pay for such contraceptives (on pain of substantial monetary penalties). Therefore the law substantially burdens the owners’ religious practices, by requiring them to do something they think religiously forbidden.

To be sure, the law doesn’t require the employers to personally get abortions or perform abortions. But the employers sincerely believe that even buying insurance policies that pay for such abortions is religiously forbidden complicity in abortion.

It’s not for courts to second-guess the reasonableness of such judgments about how to define religiously forbidden complicity. “[T]he Hahns and Greens and their companies sincerely believe that providing the insurance coverage demanded by the HHS regulations lies on the forbidden side of the line, and it is not for us to say that their religious beliefs are mistaken or insubstantial.”

4. Of course, the legal system has many rules that require people to do what they think religiously wrong (or, the legal equivalent, to not do what they think religiously required). Not all religious exemptions can be granted. RFRA provides that, if denying the exemption is really the least restrictive means of serving a compelling government interest, a court should indeed deny the exemption.

But “[t]he least-restrictive-means standard is exceptionally demanding.” Under RFRA, if the government can — even by changing the way its programs operate, and at some cost to taxpayers — both adequately serve its compelling interests and provide an exemption to religious objectors, then it must do so.

And here, the government can indeed both provide free contraceptives (as the regulations under the Congressionally enacted Affordable Care Act provide) and exempt religious objectors (as the Congressionally enacted Religious Freedom Restoration Act provides).

First, the government could pay for the contraceptives directly. Though that would cost taxpayer money, religious exemptions sometimes do cost money, and the extra cost would be a tiny fraction of the ACA’s $130 billion expense per year. Indeed, RFRA’s sister statute, the Religious Land Use and Institutionalized Persons Act, provides that it “may require a government to incur expenses in its own operations to avoid imposing a substantial burden on religious exercise.”

Second, the government has already exempted some religious nonprofits from the law. Under this exemption, insurers would (1) exclude contraceptive coverage from the employer-paid health plan, and (2) separately pay for contraceptive coverage that the insurer would provide directly to the employees. (The government has concluded this is fair to insurers because the cost to them of contraceptives would be balanced by the savings from lower pregnancy costs and other health costs.) A similar plan is available for self-insured religious nonprofits.

These exemptions could easily be extended to for-profit religious objectors such as Hobby Lobby. Such an extension would mean the government can still ensure that contraceptives are provided at no cost to patients, but Hobby Lobby and similar objectors wouldn’t be required to do what they think their religions forbid.

5. This sort of accommodation is what Congress has mandated. When both the government’s compelling interests and religious objectors’ religious beliefs can be adequately accommodated, Congress said (in enacting RFRA) that they should be accommodated.

But Congress also said that these decisions must turn on the facts of each exemption request, and the options available for accommodating such accommodation requests. In future cases — for instance, ones involving race discrimination in employment, or insurance coverage for vaccination or blood transfusions — the result might be different.

It might not be possible in those cases (as it is in this case) to adequately accommodate both the government interests and the religious objections. If that’s so, then those religious exemptions would not have to be granted. Wisely or not, Congress has required courts to sort through religious exemption requests, granting some and denying others. This is what the Supreme Court has done here.

How Physician Licensing Hurts Medicine and Helps Pseudoscience : The Freeman : Foundation for Economic Education

How Physician Licensing Hurts Medicine and Helps Pseudoscience : The Freeman : Foundation for Economic Education

In his 1962 book Capitalism and Freedom, economist Milton Friedman speculated about an economic factor behind public acceptance of quack medicine. Friedman argued that physician licensing regulations created an economic incentive for substitutes to conventional medicine. He argued that licensure drastically cut the supply of medical professionals, driving consumers to unregulated alternatives.
“Whenever you establish a block to entry into any field, you establish an incentive to find ways of getting around it, and of course medicine is no exception. The rise of the professions of osteopathy and of chiropractic is not unrelated to the restriction of entry into medicine,” he argued. “On the contrary, each of these represented to some extent an attempt to find a way around restriction of entry.… These alternatives may well be of a lower quality than medical practice would have been without the restrictions on entry into medicine.”
Friedman explained that if licenses accomplish their purpose—keeping out marginal suppliers of medicine—then, for those who cannot afford a doctor, “the alternative is untrained practice by somebody; it may and in part must be by people who have no professional qualifications at all.” Friedman certainly had a point in 1962, but today, demand for alternative medicine comes primarily from people of greater means. Demand for basic care is inelastic and subsidized by the welfare state, while most alternative medical treatments aren’t covered by Medicaid, and the poor have less disposable income to spend on chiropractors, expensive supplements, and so on. In any case, licensing reduces supply, driving up the price of medical care, making substitutes look more attractive. The field becomes filled with quacks and snake oil salesmen, leading to more unqualified suppliers than would have prevailed under a free market with competitive private certification.
What is significant about the faith healer and the homeopath is not just that they tend to be cheaper than licensed doctors, but that they often fraudulently promise greater benefits for their service than even the best that medicine can provide. This situation would seem to indicate that the constraints imposed on the supply of health care by government may exacerbate the constraints placed on it by reality.
In nearly every case, what alternative medicine is actually selling is the placebo response, which is a real phenomenon that results from positive interactions with people you trust, whether they happen to wear lab coats or magic crystals. At the same time, because of the reduced supply, overqualified doctors spend a lot of time treating minor complaints. Their time is extremely valuable and in demand, creating high opportunity costs for talking with patients. Moreover, because third parties such as Medicare and insurance pay for nearly all health care, there is little competition between doctors, and almost none at all between doctors and less-skilled technicians who could treat simple complaints as effectively and at lower cost in a less-regulated environment.
These facts allow us to make two predictions that I believe are borne out. First, given the barriers to entry and cartel status of physicians, the quality of doctors' personal interactions with patients is likely to be lower than it would otherwise be. (For instance, one study found doctors listen to patients for just 23 seconds before interrupting them.) Second, people selling alternative and substitute services will compete on this margin by being friendlier, listening more, and promising extremely optimistic outcomes. The result for the patient is a placebo effect, and for society, a vast industry of well-intentioned but unqualified “alternative” providers.

9 Obamacare Predictions That Have Come True

9 Obamacare Predictions That Have Come True

Four years ago, many health policy analysts, including those at The Heritage Foundation, predicted some of the effects this law would have on Americans. These are all coming true.Here are nine of our predictions that have come to pass—and it’s not over yet.
1. The individual mandate is an enforcement nightmare.As a candidate, President Obama worried that an individual mandate to buy insurance would be unenforceable. He changed his mind once he became president. This year—the first year that the mandate penalties are to be imposed—he has already started backtracking on the enforcement of the provision he signed into law.
2. The law will create new disincentives to work.Between Obamacare’s higher taxes and its subsidies that drop off if you raise your income, there’s not a lot of incentive here to work harder and better your situation.
3. The law, particularly the employer mandate, will impose new costs on businesses that undercut jobs and wages.The employer mandate has been delayed until 2015, but the uncertainty Obamacare has created—and its 18 new tax hikes—have put a huge dent in job creation.
4. The law undermines competition and further consolidates health insurance markets.Heritage Foundation analysis of federal and state exchanges shows that the law has, in general, reduced competition and consolidated health insurance markets. Between 2013 and 2014, the number of insurers offering coverage on the individual markets in all 50 states has declined nationwide by 29 percent.
5. The law guarantees major premium increases.As Heritage predicted, the average annual premiums for single and family coverage in 2014 are rising in the state and federal health insurance exchanges all around the country. In 11 states, premiums for 27-year-olds have more than doubled since 2013; in 13 states, premiums for 50-year-olds have increased more than 50 percent.
>>> Get more details on all of these Obamacare effects6. The law discourages insurance enrollment among the young.The law’s insurance rules and new benefit mandates will make it cheaper for many younger Americans simply to remain uninsured and pay the penalty fine. It’s not surprising that young people have been staying away.
7. The law’s Medicare savings would not financially strengthen Medicare.The law’s proponents originally promised that “savings” from Medicare changes would be spent simultaneously in two places: helping Medicare and expanding Obamacare. But money can be spent only once, so that didn’t work.
8. The law’s Medicare changes will result in reduced benefits and threaten seniors’ access to care.The law’s impact is fairly straightforward: Fewer Medicare providers, reimbursed at rates progressively reduced over time, will create access problems for patients. Medicare cuts have been underway for several years now.
9. The law compels taxpayers to fund abortion and weakens protections of the right of conscience.Obamacare mandates health plans that include coverage of abortion. It also spawned the Health and Human Services regulatory mandate that forces American employers to provide coverage for abortion-inducing drugs. It is safe to say that four years ago, millions of Americans did not expect that the national health care law would become a vehicle for an aggressive government infringement of personal liberty or coerce Americans to fund medical procedures and drugs in direct violation of their ethical and religious convictions.

Per Bylund: What Sweden Can Teach Us About ObamaCare - WSJ.com

Per Bylund: What Sweden Can Teach Us About ObamaCare - WSJ.com

Other stories include people waiting many hours before a nurse or anyone talked to them after they arrived in emergency rooms and then suffering for long periods of time before receiving needed care. A 42-year-old woman in Karlstad seeking care for meningitis died in the ER after a three-hour wait. A woman with colon cancer spent 12 years contesting a money-saving decision to deny an abdominal scan that would have found the cancer earlier. The denial-of-care decision was not made by an insurance company, but by the government health-care system and its policies.
This is why Swedes over the past two decades have been rushing to purchase medical coverage through private insurance, which guarantees and delivers timely and qualitative care. Insurance Sweden, the country's national insurance company trade organization, reports that in 2013 12% of working adults had private insurance even though they are already "guaranteed" public health care. The number of private policyholders has increased by 67% over the last five years, despite the fact that an average Swedish family already pays nearly $20,000 annually in taxes toward health care and elderly care, including what Americans call Medicare.

Sweden has started to self-correct, choosing a more sustainable path: private health-care options that allow for competition, customer choice and better overall care for Swedes. America should learn from Sweden's experience and follow the Nordic country's recent example, turning away from government-controlled health care to embrace a free-market solution.
It is possible to have truly affordable, qualitative and accessible care. But the only way to get this result is through a system where providers freely compete with each other to lower costs and raise quality. There is no short cut to well-functioning, affordable health care. Sweden's undesirable experience shows this very clearly.

Antibiotic surprise | Somewhat Reasonable

Link: http://blog.heartland.org/2014/01/antibiotic-surprise/

The thing about antibiotic resistance is that it takes resources for a bacterium to maintain it.  If you change antibiotics and attack from a different direction, not only does the bacterium have to re-tool, it's already weakened from spending the resources to build the first adaptation. Given enough time, it would lose the genes for the first adaptation to save resources, and then suddenly, the original antibiotic works again.

The trick is to have enough alternatives in stock to force bacteria to give up at least one of their adaptations.

Almost everyone these days uncritically accepts that the solution to antibiotic-resistant disease is to use fewer antibiotics. What about using more antibiotics? More varieties that is.
When doctors found penicillin was losing its efficacy as our first line of defense against bacterial infections, the medical community didn’t throw up its hands and use less. New antibiotics were developed! And thankfully so.
No… not stronger antibiotics. New varieties were developed that kept us ahead of the bacteria that ail us, humans and animals alike, to the point where doctors and veterinarians now have well in excess of 100 antibiotics to rely upon in fighting infection.
But now, thanks to overregulation resulting from tax-funded lobbying by anti-antibiotic, naturopathic, homeopathic, sustainability and organic activists, pharmaceutical companies have largely abandoned the development of new antibiotics. It simply does not pay to bring new antibiotic strains to market in the current regulatory environment. Pharmaceutical companies find it much simpler and more profitable to focus instead on treating phony ailments like attention-deficit disorder, obesity and erectile dysfunction.

Are We About To Face A Severe Doctor Shortage?

Are We About To Face A Severe Doctor Shortage?

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.

For example, the average wait to see a new family doctor in this country is just under three weeks. But in Boston, with ObamaCare-type reform, the wait is about two months.

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.

The disaster that is Obamacare (ongoing)

The disaster that is Obamacare (ongoing)

• 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?)

Mark Halperin: Obamacare Contains "Death Panels" | Video | RealClearPolitics

Link: http://www.realclearpolitics.com/video/2013/11/25/mark_halperin_obamacare_contains_death_panels.html#.UpPVCOdeqp4.twitter

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.

Just how many Americans will really have their health insurance affected by Obamacare? | AEIdeas

Link: http://www.aei-ideas.org/2013/11/just-how-many-americans-will-really-have-their-health-insurance-affected-by-obamacare/

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."

Articles: Forcing Mom into Medicaid was Part of the Plan

Link: http://www.americanthinker.com/2013/11/forcing_mom_into_medicaid_was_part_of_the_plan.html (via shareaholic.com)

Massachusetts: An Apples to Oranges Comparison | National Review Online

Link: http://www.nationalreview.com/critical-condition/339511/massachusetts-apples-oranges-comparison-grace-marie-turner

Marc Thiessen: Obama’s 16 words - The Washington Post

Link: http://www.washingtonpost.com/opinions/marc-thiessen-obamas-16-words/2013/10/31/17b955ae-4227-11e3-a624-41d661b0bb78_story.html?tid=pm_pop

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.

No Such Thing As Free Health Benefits - Reason.com

Link: http://reason.com/archives/2013/11/13/no-such-thing-as-free-health-benefits

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.