Minor Thoughts from me to you

Part-time Staples workers are furious that they could be fired for working more than 25 hours a week. 

The company implemented the policy to avoid paying benefits under the Affordable Care Act, reports Sapna Maheshwari at Buzzfeed. The healthcare law mandates that workers with more than 30 hours a week receive healthcare.

If Staples doesn't offer benefits, it could be fined $3,000 in penalties per person.

Buzzfeed spoke with several Staples workers who revealed their hours have been drastically cut over the past year. Many reported working as few as 20 hours. 

Obamacare sure has been good to low-income workers, who are struggling to get by.

∞

D. J. Jaffe taught me something that I had no idea about.

President Obama should focus any incremental expansions in social-service and health-care programs on those who need it most. Ninety percent of people with the most serious mental illness, schizophrenia, cannot work and therefore do not have private insurance — they rely on Medicaid. The new regulations will mean little to them. Medicaid reimburses states for roughly 50 percent of the cost of caring for the truly indigent. But an obscure provision of Medicaid law called the “IMD Exclusion” prevents Medicaid from reimbursing states for the care and treatment of people in state psychiatric hospitals. As a result, states bear 100 percent of the costs of state psychiatric hospitals and have learned that, by kicking people out of such institutions, they can get reimbursed by Medicaid for fifty percent of their care in the community. So kick them out they do. 

A report I co-authored with lead author Dr. E. Fuller Torrey of the Treatment Advocacy Center found that, in 1955, ten years before Medicaid was enacted, there were 340 public psychiatric beds available per 100,000 Americans. In 2005, there were only 17 public psychiatric beds available per 100,000. In other words, the number of beds per capita dropped 95 percent from 1955 to 2005. We are now short over 100,000 beds for the most seriously mentally ill — and that assumes we had perfect community services, which we don’t.

That's pretty bad. If the President wants political wins, I think this is worth pushing for. It's something that seems like it would really help and—in the wake of mass shootings by mentally ill individuals—he has a good chance of getting the NRA and other groups to support it.

∞

Congresswoman Cathy McMorris Rodgers and Congressman Fred Upton, writing in National Review:

The nutritional boards may cost a lot of dough, but at least the pizza-loving populace will be exposed to the caloric details of their feast, right? Hardly. Ninety percent of Domino’s customers never see the menu sign. That’s because they place their orders on the Internet or over the phone; whether the pie is delivered or picked up in-store, at best the consumer would see the calorie sign only after the order is placed.

Thanks to an Obamacare provision, restaurants will have to spend thousands of dollars putting up government mandated signs that few of their customers will ever see. All in the name of bullying you into eating healthier. Who's your nanny now?

∞

John Goodman talks about why Obamacare was flawed from the very beginning.

Do you remember the debates over the Affordable Care Act, aka ObamaCare? Now that repeal of the law has become a major campaign issue, it may be helpful to remember why Congress passed it in the first place.

Early in 2010, as the climactic votes neared, a parade of the legislation's defenders—from the House, Senate and Obama administration—appeared across the media. All had the same message: pre-existing conditions. They named the names of families "victimized" by companies that had refused to sell them insurance, had canceled their coverage or had refused to pay their medical bills.

The message surely resonated, but how many people have actually been affected since the law passed? The Affordable Care Act established a federally funded risk pool—the Pre-Existing Condition Insurance Plan—that allows individuals with such disqualifying conditions to buy a policy for the same premium a healthy person would pay. About 82,000 people have signed up as of July 31, according to the Kaiser Family Foundation's statehealthfacts.org.

That is not a misprint. Out of a population of more than 300 million, some 82,000 have the problem that was cited as the principal reason for spending $1.8 trillion over the next 10 years and in the process turning the entire health-care system upside down.

There is a much better way to ensure people with pre-existing conditions and you don't have to federalize health care in order to do it.

∞

The Congressional Budget Office has estimated ObamaCare will "reduce the amount of labor used in the economy by roughly half a percent" — about 800,000 full-time jobs. It seems likely that four especially steep cliffs — including two where marginal tax rates can approach 100% or more — will factor into work and hiring decisions.

The 50th employee: For companies with 49 workers that do not offer its employees health coverage, the hiring of just one more worker would carry a penalty of $40,000.

The low-income cliff: At 200% of the poverty level is a dividing line. Deductibles for married couples on one side may be $300 vs. $3,500 on the other, according to one estimate provided to the Kaiser Family Foundation by Towers Watson.

The moderate-income cliff: The cliff is even steeper for families at 400% of poverty. Just past that point, families would lose eligibility for ObamaCare subsidies, which can get quite valuable for older workers.

Older workers' cliff: Lastly, consider a 62-year-old worker with $38,500 in income, $4,000 from investments. Such a worker could qualify for a $6,500 ObamaCare subsidy, paying $3,700 toward premiums with perhaps a $2,000 deductible.

But if she retires and claims Social Security, with roughly $14,000 a year in benefits, her ObamaCare premium subsidy would rise to $9,400 with almost no deductible.

Factoring in a state and federal tax bill of $6,500, that worker would have an after-tax, after health cost (premium and deductible) income of $26,000, vs. $17,100 in the old early-retirement scenario. In other words, the pre-tax gap between working and retiring early would shrink from $20,500 to just $8,900.

∞

The National Federation of Independent Business (NFIB) published a breakdown of the coming changes to healthcare, due to Obamacare.

Employees will pay a long list of new taxes, some of them hidden. ... Drug companies will pay a new tax on brand-name prescription drugs, but the tax will be passed along to you through higher premiums.

Medical device manufacturers will pay a new 2.3% tax on their products but will pass the tax on to you through higher premiums. One industry analysis suggests this may cause a loss of more than 43,000 jobs. Medical devices range from bedpans to MRI machines.

Employees will lose choices. If your income and family size qualify you for Medicaid, PPACA won’t allow you to stay on your employer’s plan. Example: A couple with 3 children and income of $41,000 can get private insurance through an employer. If the couple has a fourth child, however, PPACA will force them to leave the employer’s insurance and go on Medicaid because the federal poverty level (FPL), which determines who is and is not on Medicaid, increases with family size.

If your household income tends to fluctuate, you may have to move back and forth between a private insurance policy and Medicaid – possibly multiple times per year. Each time this happens, you may have to change doctors, hospital, etc.

∞

Today’s New York Times features an opinion piece by J.D. Kleinke of the conservative American Enterprise Institute. Kleinke’s thesis is that ObamaCare’s conservative opponents should stop complaining. “ObamaCare is based on conservative, not liberal, ideas.”

If one defines conservative ideas as those that emphasize free markets and personal responsibility, there is zero truth to this claim.

Michael Cannon goes on to elaborate and then concludes with:

Even if one adopts the more forgiving definition that conservative ideas are whatever ideas conservatives advocate, there still isn’t enough truth to sustain Kleinke’s point. Yes, the conservative Heritage Foundation trumpeted ObamaCare’s regulatory scheme from 1989 until around the time a Democratic president endorsed it. But as National Review‘s Ramesh Ponnuru writes, accurately, “The think tankers were divided, with the Heritage Foundation an outlier. It was an outlier, too, in the broader right-of-center intellectual world.”

∞

John Goodman writes about something that will be a big problem, as medical knowledge increases. We're increasingly finding out that different people respond differently to the same treatment, depending on their genetics and the DNA of whatever is attacking them. As our knowledge about these differences increases, we will increasingly have individualized treatments.

Everything about ObamaCare — from its emphasis on pilot programs and demonstration projects to its faith in “evidence-based care” — is all about standardization. It’s about treating all patients with the same condition the same way. It’s about herd medicine. It’s about cookbook medicine. It’s about assembly line medicine. It’s as different from personalized care as different can be.

Unless we make large scale reforms to our existing regulations, we will increasingly end up knowing how to treat someone's condition yet it will illegal for the doctor to deviate from the standardized treatment in order to apply the personalized care that the patient needs.

∞

Personalized medicine is the future. It is where the science is going. It is where the technology is going. It is where doctors and patients will want to go.  Yet unfortunately for many of us, this is not where the Obama administration wants to go.

John Goodman gives several examples of how personalized medicine has saved lives and improved health. This truly is exciting, cutting edge stuff. But it's not where the government wants to steer the healthcare industry.

ObamaCare's premise rests on the idea that everyone can be given the exact same treatments and medicine can be standardized in order to cut costs. So, it has no provisions for personalized medicine.

∞

John Goodman talks about what irritates him, in healthcare policy discussions.

It’s impossible to have a rational discussion about health policy when one side of the argument is irretrievably deceitful. Here are some things I find irritating, to say the least:

• A White House that claims the way to control health care costs is to follow “evidence-based” guidelines, doing only procedures that are cost effective.
• A White House that then uses taxpayer dollars to promote procedures that are not evidence-based or cost effective for blatantly political reasons.
• A sycophantic press corps and fellow-traveling health policy bloggers who either remain silent or actually apologize for this hypocrisy.

∞

During his first run for president, Barack Obama made one very specific promise to voters: He would cut health insurance premiums for families by $2,500, and do so in his first term.

But it turns out that family premiums have increased by more than $3,000 since Obama's vow, according to the latest annual Kaiser Family Foundation employee health benefits survey.

I must say, that's a totally unexpected result after increasing government regulations.

∞

Should (a) the "Cadillac tax" on employer-sponsored plans not be implemented as scheduled in 2018, and should (b) half of the Medicare savings provisions be repealed or otherwise not implemented the law will increase the deficit by up to $500 billion in its second decade.

That doesn't look good. Raise your hands if you think the government will really implement the "Cadillac tax", given that it would apply mostly to union benefits. And raise your hand if you think that the government will really crack down on Medicare, when old people are the most reliable voters in existence.

Anyone?

∞

Ramesh Ponnuru ponders what a Sarah Palin vs. Mitt Romney primary battle would look like.

He thinks it would probably be an ugly battle that could injure the party in a general election.

I think it'd be nice if neither one of them won. The one doesn't realize that she gives half of the country the screaming heebie-jeebies. The other can't admit that RomneyCare was a bad idea and is virtually indistinguishable from ObamaCare.

∞

All Republicans have to do is hold the House, win the Presidency in 2012 and pick up 3 seats in the Senate — and not have any defections in the Senate while voting. Then it's a lead pipe cinch that ObamaCare will be repealed.

∞

Megan McArdle talks about what health insurance might look like under the Obamacare health care exchanges. First, she quotes Aaron Carroll.

My conversations lead me to believe that many people are expecting that the plans offered in the exchanges will be Medicare-like in many ways. I feel like many people think they will have choice of doctor, choice of hospital, and the ability to dictate care. I'm not seeing how insurance companies will be able to offer such products at prices people can afford. As I talk to more and more people in the insurance industry, my thoughts seem confirmed.

Why does Aaron believe that?

For instance, we just told millions of people that they can go to the exchanges in 2014 and buy insurance. There won't be any lifetime or annual limits. There won't be denials for pre-existing conditions. There won't be any surcharges for having such conditions. And it's going to be "reasonably" priced.

I asked what insurance companies might offer under those conditions. After all, if it were really that easy to offer comprehensive insurance at a real discount, someone would already do it.

McArdle believes these exchanges will look pretty horrible by the time they actually roll around in 2014.

What people are expecting seems to be a very expensive form of insurance (no gatekeepers or restrictions) on the cheap. What they're going to get is cheap insurance that they will be forced to buy. Moreover, a significant number of workers are going to be dropped from their employer plans and dumped on the exchanges. An even more significant number of workers are going to be shunted onto Medicaid (as I understand it, if you're eligible for Medicaid under the new rules, you have to go into Medicaid, even if you want to buy insurance through the exchanges instead).

Medicaid is even more terrible than whatever stripped down products end up being offered on the exchanges, especially since providers hate taking it. There's been some attempt to alleviate this problem with a temporary boost to Medicaid reimbursement rates, but this will expire, leaving Medicaid patients with the same problem they have now in most states: a small number of providers willing to accept its paltry reimbursements. With millions of new Medicaid patients on the rolls, this problem is going to get worse.

Obamacare delenda est. Because what you get with Obamacare probably isn't going to be anything that you'll actually like.

John Goodman looks at whether or not Obamacare will save lives. He starts out by defining the problem.

Being uninsured is like being unemployed. It happens to lots of people for short periods of time. Of all the people who are uninsured at a point in time, more than half will obtain insurance within 12 months and 90% will be insured within two years. So if you want to argue that being eligible for Medicaid is better than being uninsured for most people you have to have a theory that says that extending Medicaid to the temporarily uninsured saves lives.

It gets worse. Since Medicaid eligibility is conditional on income, people become eligible and ineligible as their incomes rise and fall. So like uninsurance, Medicaid eligibility also is a condition that affects a lot of people for short periods of time.

So now you need a theory that says that temporary enrollment in Medicaid for the otherwise temporarily uninsured adds to life expectancy. I know of no studies that test this proposition.

He then points out that, even if this is true, it's the exact opposite of what Obamacare does. Obamacare uses tax data (that can be up to two years out of date) to decide whether or not you can purchase health insurance on an exchange or whether you have to go on Medicare.

So what kind of reform would you want if you believe that temporary uninsurance is bad for health and continuous insurance is good? Obviously, you wouldn't want to enroll people in a plan where eligibility changes every time family income bobs up and down. You would instead want to encourage plans that cover people for long periods of time. The help (subsidy) you make available can bob up and down as income changes -- but enrollment shouldn't follow the same rollercoaster. The subsidy may be income dependent, but enrollment should not be.

Ideal health insurance actually would not include Medicaid at all. It would involve people enrolling in private plans that are portable, and travel with them from job to job. And this result is consistent with other research. For although there is some argument about how much difference health insurance makes, almost every study finds that private insurance is better than Medicaid.

Obamacare delenda est. Because it really is a bad way to solve the problem of health insurance.

Obamacare represents the biggest expansion of taxpayer-funded abortion in American history.

Thankfully John Boehner, our probable next Speaker of the House, is one of the most pro-life people in Washington. Boehner would like to pass a bill "to codify the Hyde amendment ... which would prohibit all taxpayer funding of abortion across the board." I hope he's successful.

Thanks Z, for the link to this video.

Health Care Cost Increase Is Projected for New Law - NYTimes.com

A government analysis of the new health care law says it will not slow the overall growth of health spending because the expansion of insurance and services to 34 million people will offset cost reductions in Medicare and other programs.

The study, by the chief Medicare actuary, Richard S. Foster, provides a detailed, rigorous analysis of the law.

In signing the measure last month, President Obama said it would "bring down health care costs for families and businesses and governments."

But Mr. Foster said, "Overall national health expenditures under the health reform act would increase by a total of $311 billion," or nine-tenths of 1 percent, compared with the amounts that would otherwise be spent from 2010 to 2019.

This analysis isn't really a surprise to me. It seems pretty obvious that adding lots and lots to uninsured people to Medicare will increase costs by quite a bit. And, this picture, is actually a best case scenario. It assumes that politicians won't act like politicians.

Mr. Foster says the law will save Medicare more than $500 billion in the coming decade and will postpone exhaustion of the Medicare trust fund by 12 years, so it would run out of money in 2029, rather than 2017. In addition, he said, the reduction in the growth of Medicare will lead to lower premiums and co-payments for Medicare beneficiaries.

But, Mr. Foster said, these savings assume that the law will be carried out as written, and that may be an unrealistic assumption. The cuts, he said, "could become unsustainable" because they may drive some hospitals and nursing homes into the red, "possibly jeopardizing access to care for beneficiaries."

If you believe that politicians are actually going to cut payments to Medicare physicians and hospitals, then you obviously haven't been paying attention to the votes that have been taken in Washington over the last two decades. Congress loves to talk about cutting payments to Medicare. Then, every time the cuts come due, there's a bipartisan rush to postpone the cuts. Government spending is going up. Way up.

Obamacare delenda est