In a recent opinion piece for the New York Times, Governor Kasich argued that the way forward for health care reform is more government spending. He says:
One vital improvement would be to provide adequate tax credits, which would help keep health plans in the individual market and encourage — not undermine — robust competition. Companies should also be required to continue following reasonable guardrails like ensuring minimum coverage that is genuinely useful and covers pre-existing conditions. Once we see these repairs taking hold, Congress should then take up needed improvements to Medicaid as part of comprehensive entitlement reform.
Health Care Reform Starts With Controlling Health Care Costs
The problem I have Governor Kasich’s argument is that he ignores the elephant in the room, health care costs. I can understand how the federal subsidies have benefitted hospitals, doctors, pharmaceutical companies, and insurance companies but not the consumer. Each of these groups publicly stated they were going to make health care bigger, better, faster, and cheaper. I don’t see it happening. Kasich is arguing that the health insurance markets will get better if we throw more government money at them. This is the exact same argument ACA supporters have made for the last eight years. The failure of the ACA to control costs tells us we need a different strategy if we want a different outcome. After eight years of using a carrot to encourage health care reform, maybe it is time to use the stick.
Thinking Outside Of The Box Idea Number 1 – Repeal The Individual And Employer Mandate
One of the things I learned over the last couple of years is that the individual mandate is not necessary or important. Although the ACA supporters argued in the Supreme Court that it was necessary to avoid a death spiral in the health exchanges, the consumer is largely unaffected by premium increases. It is the federal government who bears the brunt of the cost increases since the consumer’s portion is limited to 8.13% of their income. Why will the consumer leave the exchange if their payment stays the same? The primary purpose of the individual mandate was to keep unsubsidized, healthy people in the exchanges. The lack of affordable health insurance forced healthy people to evaluate their health care options. They voted with their feet.
If our politicians really wanted to help the American people by putting more money in their pocket, the simplest solution is to repeal the individual mandate. In a letter to members of Congress, IRS Commissioner John Koskinen said about 6.5 million Americans paid an average penalty of $470 for not having health insurance in 2015. Ironically these Americans are the group who can least afford the penalty. As health insurance continues to get unaffordable for more people, we should expect that fewer people will be required to pay the penalty. If the government continues to get less and less money from this penalty, maybe we should admit that the individual and employer mandate are not working and never will. This would be a great time for both parties to join together and get rid of both mandates.
Only in America is the “clenched fist of truth” more violent than a beheading.
Dana Loesch Says The Ad First Aired In April – True
Surprisingly this ad first aired in April and had 17 national airings. The NRA ads are well done and some of them are memorable. I do not remember this ad. Why the big fuss over this ad two months after its initial airing? If this is an NRA publicity stunt, the Democrats fell for it. Here is a nice synopsis of the hoopla over the ad.
Senator Portman is one of my senators and typically an astute legislator. His objection to the Senate health care bill because of the opioid epidemic is puzzling. Technically we have been fighting the opioid epidemic for several years now. In 2015 it was readily apparent to the people selected for jury duty that Clermont county had a serious opioid problem. Ohio was one of the states that expanded Medicaid. If the expansion of Medicaid has helped diminish the opioid epidemic, I don’t see any indication of it. I went to his website and could not find any details on his proposal. You would think that he would have a well thought out plan by now.
Medicaid Will Continue To Play A Major Role In Fighting The Opioid Epidemic
Most people on Medicaid being treated for drug addiction are earning less than the federal poverty limit(FPL). Drug addicts typically do not work. As an example here is a story about a drug addict from Cincinnati who was not employed, The Obamacare repeal ‘could be a disaster’ for states fighting the opioid epidemic. Medicaid coverage for people earning less than the FPL is not affected by the Medicaid expansion. The people who will be affected are those drug addicts earning between 100% and 138% of the FPL. Since I doubt there are many drug addicts in this earnings bracket, the Medicaid expansion helps fight drug addiction in a trivial sense.
Is Medicaid Part of the Problem?
Many people think the opioid addiction problem starts with doctors over-prescribing Oxycontin. Ohio’s governor is recommending:
Gov. John Kasich’s order limits the amount of opiates primary care physicians and dentists can prescribe to no more than seven days for adults and five days for minors.
SIEGEL: “In states that have the Medicaid expansion, emergency room visits are up by 9 percent. Hospitals like that because patients that used to be uninsured now have their Medicaid card. But they are flocking into the ERs to get services they don’t often need. Did you know, Brian, that 15 percent of Medicaid patients are prescribed an opioid every year? Now, that’s the doctor’s fault for over-prescribing. But Medicaid allows doctors to over-prescribe and that’s one of the secret stories that we’re breaking right now, is that the opioid epidemic is tied to Medicaid as an enabler. Doctors are the problem. Medicaid is enabling it.”
Considering our lack of success fighting the opioid addiction battle I am not sure how much additional money I would commit to Medicaid efforts to fight drug addiction. A city in the local Cincinnati area, Middletown, budgeted $10,000 this year for Narcan, the antidote of choice for overdoses. They are on track to spend $100,000 this year. Assuming that the city will get reimbursed for most of these costs by Medicaid, how does extending Medicaid compensate Middleton for the uninsured addicts. If we agree that the opioid epidemic is a public health crisis that needs to be addressed, is giving more money to Medicaid the best addiction prevention and treatment idea we can come up with?
Still Searching For Affordable Health Care Options
Prior to the ACA the individual market was the only health insurance market that demanded affordable health insurance. Compared to the small, medium, and large business markets, the individual market was aggressively priced in most states in 2011. The price increases I experienced from 2011 to 2016 led me to believe that federalizing health insurance has encouraged cronyism and corruption. I can see where the insurance companies and politicians benefited but not customers like me. If the health care industrial complex wants me back they have to offer me affordable health insurance(<8.05% of AGI) with a lot less lying.
I believe that the ACA attitude toward health care reform was best expressed by Professor Gruber’s “lack of transparency is a huge political advantage” comment. This attitude explains why we succeeded in creating a dysfunctional, unsustainable health care system that surprisingly poisoned the waters for a single payer system, too. The next health care reform needs to be less political and more honest.
If society wants to subsidize high-risk pool, chronic care, and low-income customers than it is society’s responsibility. Trying to get the smallest insurance market with the most price sensitive insurance customers to pay a disproportionate share of the cost is just plain foolish. The government should make the rules in markets they are paying the majority of the cost. Let’s start calling the subsidized market what it really is, Medicaid Plus. Let the individual insurance market have the flexibility to go back to being the spearhead of health care cost control for healthy people. Let’s make health care great again for the customers.
There is nothing that says health care policies are not working than 13% annual increases in health insurance premiums for healthy people. My wife and I have not had a health insurance claim in over two decades and until this year we had a grandfathered health insurance plan. Since our health insurance plan and health status did not change, we have to conclude that unbridled wealth redistribution leads to cronyism and corruption. The insurance companies raised the rates because they could get away with it. What options did we have? Some people might call that an unintended consequence of the ACA, I call it cronyism. At some point the customer has to say, enough is enough. Not only did our most recent grandfathered health insurance premium exceed 8.05% of our adjusted gross income but so did every ACA plan. I am 63 years old. For the first time in my life, I can not find affordable health insurance. Sadly this is the ACA’s most important accomplishment.
Unbridled Wealth Redistribution Versus The Healthy Customer
This embrace of unbridled wealth redistribution has corrupted the only market that had any resemblance of a well-functioning market. The only way the ACA health exchanges would succeed at attracting healthy customers is if they offered affordable health insurance. Putting healthy customers in the same market as high-risk pool and subsidized customers was probably too much to ask. Where the subsidized customer is not price sensitive, the healthy customer is. The ACA health exchange is meaningless to the healthy customer if every health insurance plan costs more than 8.05% of a person’s adjusted gross income. It did not have to be this way. The ACA chose to leave cost control to the next administration.
Making Markets Work For The Healthy Customer
In 2015 my wife and I came to the conclusion that the health care industrial complex would not willingly change their ways so we started building up our HSA. At the end of 2016 I asked our insurance company if they would offer me a lower rate. They declined and we chose to drop our health insurance. The markets are working, the customer has spoken, and our health policies are dysfunctional. Although we are nervous about our choice, we think we can do a better job managing our health care than the health care industrial complex. It is amazing how fast the money builds up when you divert your old health insurance premium amount into a savings account. I am mildly optimistic we can get better health care advice for non-emergency room treatments if we tell our health care providers that we are a cash customer. Every month we get by without a cancer diagnosis makes us a little more confident we made the right decision. If the insurance companies want us back all they have to do is show us an affordable health insurance plan!
Climate science is interesting because its data and models are so bad! My inner scientist says that there is nothing that screams lousy climate data and models more than bad predictions. This is a pretty good example of garbage in creating garbage out. The joke is that climate science was created to make weathermen feel good about themselves. Oh wait, that joke is supposed to be about economists! When you combine climate science with economics, hilarious predictions will be forthcoming. There is no shame in climate science! Here is the transcript from the cartoon.
Boss: I invited a climate scientist to explain the risk of climate change to our company.
Climate Scientist: Human activity is warming the earth and will lead to a global catastrophe.
Dilbert: How do scientists know that?
Climate Scientist: It’s easy. We start with the basic science of physics and chemistry.
Climate Scientist: Then we measure changes in temperature and CO2 over time.
Climate Scientist: We put that data into dozens of different climate models and ignore the ones that look wrong to us.
Climate Scientist: Then we take that output and run it through long-term economic models of the sort that have never been right.
Dilbert: What if I don’t trust the economic models?
Why is it a “conspiracy theory” to think that a disgruntled Democratic National Committee staffer gave WikiLeaks the DNC emails, but not a conspiracy theory to think the emails were provided by Russia?
Which is the more likely scenario: That a frustrated employee leaked damaging emails to embarrass his bosses or a that foreign government hacked DNC computers for some still-unknown reason?
That’s a no-brainer, isn’t it?
The Washington Post is trying its best to write it off as a conspiracy theory. Recently two people gave the conspiracy pot a big stir. Kim Dotcom says he knows that Mr. Rich leaked the DNC emails to Wikileaks and a surgeon is raising questions about Mr. Richs treatment at the hospital. Since I believe that the simplest answer is probably correct, let’s look at some of the theories on Seth Rich’s murder.
The “Robbery Gone Bad” Theory
The “robbery gone bad” theory is the most popular explanation of his death. The problems with this theory are that nothing was stolen, it occurred at 4 am, and he was shot twice in the back. This looks like an unusual time for a professional or even a novice robber to be practicing their craft on the street. If you are a robber who is up at 4 am, you are probably trying to break into a house or to steal a car. A robber knows the difference between robbery and murder. Shooting someone in the back does not look like a robbery victim. Shooting someone in the back when they are trying to flee is an act of passion. The biggest problems with this scenario are why was he shot twice without a kill shot and where are the shell casings. The only reason to shoot him more than once is to make sure he does not testify. Shooting an unarmed man once can be explained as an unintended consequence of a fight. Shooting an unarmed man twice is a strong case for murder. A criminal would know this. Did the police find fingerprints on the shell casings and did they run the prints? A criminal would probably have their fingerprints in the system already.
The “Seth was assassinated” Theory
The “Seth was assassinated” theory explains the fact that nothing was stolen and the time of the shooting. There was nothing professional about this murder. Only an amateur would have left Seth alive.
The “Angry Person” Theory
A more likely scenario is that Mr. Rich got into a heated argument with a person on the street and when Mr. Rich tried to leave the fight he was shot in the back. This could be almost anyone walking the streets at 4 am with an emotional problem. The problem with this theory is imagining Mr. Rich talking with any person at 4 am. An intriguing possibility is that a person associated with the DNC found out that Mr. Rich was leaking emails to Wikileaks and went to confront him. Although this person may have been angry, they did not plan to kill him. The only person I can imagine Mr. Rich would allow getting close to him at 4 am is someone he knew. When the argument became violent and Mr. Rich tried to leave, it was in the heat of the moment that he was shot twice in the back. If you believe this theory then the list of suspects is small and this case should have been tied up before the election last year. Oops!
If Director Comey has as much integrity as his supporters claim then why did he not offer his resignation the day after the Presidential election regardless of who won? If Ms. Clinton won the election then it is obvious that she would request his resignation. For the good of FBI, he would comply. What is not obvious is why Director Comey stayed on after Mr. Trump won despite feeling “mildly nauseous’’ at the thought that his decisions about a probe into Hillary Clinton might have affected the outcome of the election? This sounds like a guy who is having trouble coming to work each day. After alienating both political parties and politicizing the FBI, his future was a political minefield. If he succumbed to political pressure in the Clinton email investigation, what were Republicans supposed to think about the Flynn investigation in this hyper-partisan political atmosphere? How could he satisfy either party? As long as he was there, there was no way to put a non-partisan FBI back together again. Director Comey was the weak link. The right thing for him to do was offer to resign and let someone else pick up the pieces.