Augurs and augering in

I’m not going to be posting anything for at least a week; in fact, I won’t be on the Internet at all. Not only have I driven myself crazy trying to figure out which way the country will jump on the ObamaCare debacle,* I’ve clicked and copied and written so much my poor arm is screaming in protest. (Darned pre-existing condition!) Clearly this is a sign from the universe to stop obsessing about this and think about something else for a while.

Over the next month or so, I’ll be doing what I always do when I get near my health insurance plan anniversary date: I’ll be comparing the available policies. This time around, I’ll also compare them to my no longer available current plan. As I get those comparisons done, I’ll post them. I can say right now, without looking at specific copays and deductibles, that the new coverage, at least from Blue Cross Blue Shield, is worse across the board than my current coverage.

How do I know? The new policies have no out-of-network coverage except for emergencies and prescription medicines. My current policy does. I’ve never used enough out-of-network care to hit my deductible but it’s a great comfort to know that if I need or want the kind of care I can’t get in-network, I can still get it without bankrupting myself.

It may be that other New Jersey insurance companies are selling individual policies that do have out-of-network coverage - I’ll have to figure that out as I go along.

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Notes:

* This is something fascinating about blogs, both reading and writing them. There seems to be an irresistible drive to predict what’s going to happen, to figure out what the country really thinks, to look for signs that the blogger’s (or reader’s) preferred point of view has been adopted, is being adopted, will be adopted. Yet no one can predict that and, really, all we have to do is wait and see. Very odd.

Teal deer

Wending my way through the Internet, I found a comment that led me to John Cochrane (The Grumpy Economist) and a paper he has written entitled “”After the ACA: Freeing the market for health care” (pdf). I had intended to read through it carefully (I’ve just skimmed parts of it) and pick out points to discuss; however, that’s not going to happen anytime soon so I’m just going to offer it up as a resource. What I did read was interesting, particularly Cochrane’s review of the current landscape.

Here’s how the paper begins:

Most health-economics policy discussion takes for granted the bulk of our regulatory structure. Opponents of the optimistically-named Affordable Care Act delight in pointing out its unintended consequences, mangled incentives, and exploding budgets. Fans work to patch it up with new layers of regulation or “reforms.”

I take a ground-up, first-principles approach instead. I survey the supply, demand, and market for health care, and health insurance, to think about how those markets should work to provide quality care, low cost, and technical innovation. A market-based alternative does [exist], and it is realistic.

I have no idea how much I’ll agree with once I have time to go through this thoroughly but after a month of reading quick posts on ObamaCare, the thought of sitting down with a 28-page document is very appealing.

(Reconstructing how I got to the pdf was kind of fun:

The top post on Greg Mankiw’s blog (which I get to on my own) sent me to

The Obamacare Suits/Geeks Divide which is well-worth reading itself, if only for his first point:

1. There is zero chance that rewriting five million lines of code is the answer. Either the solution is a lot simpler or there is no solution other than to start over.

Amen, brother. Scrolling through the comments there, I found:

this comment by someone called Shayne Cook which sent me to:

Shayne’s comment at EconLog which sent me to:

a post at the Grumpy Economist blog which sent me to:

the pdf.

Whew!

Black-market insurance

[To reiterate what I said in my previous post: This post is based on what I think I know about ObamaCare. It doesn’t have links to back up my understanding because I’ve picked up and integrated this understanding from lots and lots of reading over the past month (and previously) and I can’t easily find where I read what. I may be wrong about some or all of my understanding and if so, I hope someone lets me know. I can say I’ve read everything I claim to know somewhere; however, part of the problem with ObamaCare is that even people who should know how it works and/or who claim to know how it works often seem not to. So take everything in here with a large grain of salt.]

Back in February, I posted a comment over at Grim’s about what I called “Disaster Insurance” or, alternatively, "Failure To Sign Clients Up For Health Insurance In A Timely Fashion" policies. I described such insurance thusly:

Under Obamacare, I can elect not to get coverage and pay a fairly small fine/tax - certainly less than coverage would cost me. Then if I get a condition like Alzheimer's or cancer or congestive heart failure, I just buy health insurance.

The risk is that I'll suffer some sudden condition: heart attack, stroke, hit by a bus. If I'm unconscious as a result, I'll incur huge medical expenses before I'm well enough to buy health insurance.

So I wondered if it would be possible to sell something called perhaps "Disaster Insurance". I sign up, pay a small annual fee, and - if I get hit with one of those sudden conditions - the Disaster Insurer signs me up for health insurance and pays whatever charges I incur before I'm signed up.

This would require that I keep insurance applications on file with the Disaster Insurer and that the DI have some type of arrangement with hospitals to be notified if I show up in their Emergency Rooms - or perhaps I wear something like a MedicAlert bracelet that says I'm a DI customer. [snip]

Technically, they wouldn't be health insurance policies at all. They would be "Failure To Sign Clients Up For Health Insurance In A Timely Fashion" policies. That is, the policy doesn't say it will pay my health care costs; it says it will sign me up for health insurance as soon as I need it. Should it fail to do so - for any reason, including my being hit by a bus - it will make good what it has cost me.

Tricky but I suspect it could be made to work.

When I wrote that, I thought ObamaCare would have a 24/7/365 open enrollment period. That is, I believed that if I was diagnosed with leukemia or hit by a bus on June 23, I could sign up for health insurance on June 24. Once I realized that wasn’t the case, that ObamaCare open enrollment periods would be the usual brief window late in the year, I stopped thinking my DI idea would work. Now we weren’t talking about paying my health care costs for a few days or a couple of weeks. Rather the DI would be at risk of having to pay them them for up to almost 13 months.*

Interestingly, however, someone else is now thinking along those lines and seems to think such an idea will work. Martin Feldstein (via Greg Mankiw) is writing about what he calls “Obamacare’s Fatal Flaw”. He considers “the biggest danger to Obamacare’s survival” is the possibility (perhaps probability) that many healthy people who could buy in the individual market will pay the fine rather than pay for health insurance. If and when they become seriously ill, they will simply purchase health insurance then since they can’t be turned down for pre-existing conditions. This “wait-to-insure” strategy, he says, will work out well for the individual if the illness is something that doesn’t require immediate expensive treatment. On the other hand, conditions that do require immediate expensive treatment - like being hit by a bus or having a heart attack - would expose these individuals to huge bills and fear of this exposure may well drive people to sign up for health insurance as a precaution.

However:

...private insurance companies could solve that problem by creating a new type of “emergency insurance” that would make enrolling now unnecessary and allow individuals to take advantage of the wait-to-insure option. Such insurance would cover the costs that a patient would incur after a medical event that left no time to purchase the policies offered in the Obamacare insurance exchanges. Emergency insurance might also cover the cost of care until the “open enrollment” period for purchasing insurance at the end of each year (if political pressure does not lead to the repeal of that temporary barrier to insurance).

This type of insurance is very different from existing high-deductible policies. Given the very limited scope and unpredictable nature of the conditions that it would cover, the premium for such a policy would be very low. It would not satisfy the broad coverage requirements that Obamacare mandates, forcing individuals to pay the relatively small penalty for being uninsured and to incur the subsequent cost of buying a full policy if one is needed later. But the combination of emergency insurance and the wait-to-insure strategy would still be financially preferable for many individuals, and the number would grow as premiums are driven higher.

An interesting proposal (she said modestly). However, I think it’s illegal. As I understand it, health insurance companies are forbidden to sell any health insurance policies except the ObamaCare metallics: Platinum, Gold, Silver, Bronze, and Restricted To The Young And The Somewhat But Not Totally Poor Fake Catastrophic policies. The type of insurance policy Feldstein is describing is none of those and thus it would be illegal to sell such a policy in the United States. In other words, the problem isn’t just that an individual buying such insurance would still have to pay the fine/tax for being “uninsured”; it’s that selling such a policy is against the law.

I keep thinking I must be wrong about this because surely Greg Mankiw and Martin Feldstein must know what ObamaCare does and does not allow. But I read posts like this (Peter Suderman citing Kaiser Health News) and it seems pretty clear-cut to me:

In 2014, plans sold on the individual and small group markets will have to meet new standards for coverage and cost sharing, among other things. In addition to covering 10 so-called essential health benefits and covering many preventive care services at no cost, plans must pay at least 60 percent of allowed medical expenses, and cap annual out-of-pocket spending at $6,350 for individuals and $12,700 for families. (The only exception is for plans that have grandfathered status under the law.)

Maybe this is just Expertopia shorthand for “plans sold on the individual and small group markets will have to meet new standards for coverage and cost sharing, among other things in order to spare those purchasing them the fine/tax for being uninsured”. If so, I wish someone would say so. If that is the case, then there is no prohibition on kinds of health insurance policies insurance companies can offer so long as those who buy them are willing to be considered “uninsured” by the IRS. That would be nice to find out but I just can’t quite bring myself to believe it. (It’s very frustrating and seems a metaphor for the whole ObamaCare mess that there isn’t someone I can call or email and be assured of getting a definitive, unspun, guaranteed accurate answer to questions like these.)

On a happier note, Feldstein ends with what sounds like an endorsement of the McArdle plan. After warning that the ObamaCare unraveling that would result from the “wait-to-insure” strategy could lead to renewed calls for a single-payer system, he offers an alternative:

But it might also provide an opportunity for a better plan: eliminate the current enormously expensive tax subsidy for employer-financed insurance and use the revenue savings to subsidize everyone to buy comprehensive private insurance policies with income-related copayments. That restructuring of insurance would simultaneously protect individuals, increase labor mobility, and help to control health-care costs.

And on a lighter note, I feel moved to quote another one of my comments from that Grim’s Hall thread (emphasis added here):

Obama demonstrated conclusively during his run against Hillary Clinton that he was clueless about health care and insurance (and incapable of logic). Obamacare seems to suffer from the same flaws. It's fascinating to see how many utterly foreseeable problems are baked in the cake.

I didn’t know the half of it.

(My thanks to T99 for the title of this post.)

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* After the extended enrollment period from October 1, 2013, to March 31, 2014, ObamaCare’s open enrollment period will be from late October of each year until early December of the same year for insurance beginning the following year. Thus if I were to be hit by a bus the day after the open enrollment period ended in early December, my DI wouldn’t be able to enroll me until late October of the following year and my insurance wouldn’t kick in until January of the year after that. Unless, of course, my DI could arrange for me to experience a “life event” that would trigger an enrollment window. Getting me married off, moving me to another State, something like that.

The Bronze Age

[This post is based on what I think I know about ObamaCare. It doesn’t have links to back up my understanding because I’ve picked up and integrated this understanding from lots and lots of reading over the past month (and previously) and I can’t easily find where I read what. I may be wrong about some or all of my understanding and if so, I hope someone lets me know. I can say I’ve read everything I claim to know somewhere; however, part of the problem with ObamaCare is that even people who should know how it works and/or who claim to know how it works often seem not to. So take everything in here with a large grain of salt.]

Marc Thiessen is writing about those who are currently insured seeing their policies cancelled due to ObamaCare. He agrees with me that the penalties, at least in 2014, are too weak to force “a healthy person who does not think they need insurance” to buy a policy. He then says (emphasis mine):

So the administration needed some way to force currently insured healthy people into the exchanges. How serendipitous, then, that millions of mostly healthy people are suddenly seeing their health plans cancelled. If they cannot afford the skyrocketing prices to keep similar coverage, they have no choice but to join the exchanges. The result? A massive involuntary transfer of Americans out of private health insurance they were happy with into Obamacare plans.

I don’t think that bolded claim is correct; people whose insurance is being cancelled have other choices. They aren’t good choices but they may be better than the exchanges.

First, of course, they can elect to go without health insurance. I don’t imagine I would ever do so but for some people it may make sense. As T99 points out:

In the past, I always defined "medical catastrophe" as expensive medical treatments that would be needed for years and years, possibly for the rest of our lives, which might well be decades.  Now, a medical catastrophe is only what we may be faced with for a year of treatment, after which we can sign back up, assuming Obamacare is not repealed--and when are entitlements ever repealed?

She also talks about the options of medical tourism and of simply refusing very expensive medical treatment. Forgoing health insurance is not a path I would take but a possibility.

The second choice other than the exchanges is to buy health insurance directly from an insurance company, without going through the exchanges. With one possible exception (which I discuss next), the prices will be the same as buying through the exchanges. If someone is eligible for a subsidy, he cannot get it if he buys direct but if not, there’s no advantage to putting all that personal information into a insecure government data base - assuming you can even get it in there. Financially, for a non-subsidizable person it makes no difference to the individual or, as far as I can tell, to the insurance company if he buys direct: the premiums are the same and the direct buyers go into the same risk pool as the exchange buyers.

The third choice is the most intriguing. As I understand it, if an insurance company elects to sell policies via the exchange, the company must offer a range of policies. They have to offer a Silver policy; I believe they also have to offer a Bronze and a Gold, or possibly at least one or the other. Behind the scenes, participants in the different metals go into one big risk pool. The Silver plans are likely to attract sicker people than the Bronze plans (Silver is better coverage) so an insurance company offering a Silver plan - that is, any insurance company selling via the exchanges - must figure on a sicker pool of insured than they would see if they could offer only Bronze policies.

From what I’ve read, this will result in the cost of the Bronze plans being higher than they would be if the company offered only Bronze plans; I do not know whether this is because ObamaCare restricts the premium differences between the plans; because the subsidies are pegged to Silver plans (I can’t figure out how that would make a difference but trying to think it through makes my brain hurt so I give up early); or because it simply makes sense to the insurance company to spread the risk out across the whole pool. Anyhow, that’s the story with companies who want to sell through the exchanges: they can sell in the exchanges and out of the exchanges but they must sell the same plans both ways, and they must offer a Silver plan which drives up the rates on their Bronze plans.

However. An insurance company can choose to forgo selling on the exchanges and sell only direct. As far as I know, they must still offer only plans that meet the ObamaCare parameters. They cannot sell true catastrophic coverage or coverage without maternity benefits or coverage that makes the insured pay for a wellness visit and so on. In other words, even insurance companies who are not going to sell on the exchanges can only offer Platinum, Gold, Silver, Bronze, and Restricted To The Young And The Somewhat But Not Totally Poor Fake Catastrophic policies.

However. A company selling only outside the exchanges does not have to offer a range of metals; they can elect to sell only Platinum or only Gold or only Silver or only Bronze or, presumably, only RTTYATSBNTP Fake Catastrophic policies. If an insurance company elects to sell only Bronze policies they can reasonably anticipate that they will be selling only to healthier individuals because the Bronze policy provides the least coverage. Therefore, they can also reasonably anticipate that their insured pool will pose less risk and therefore they can offer Bronze policies at a lower premium than those insurance companies who are also offering Silver and/or Gold polices.

So a third option for someone who is currently insured and whose policy is being cancelled is to buy a Bronze policy from an insurance company that is selling only Bronze policies. Or at least to make sure his comparison shopping includes looking for such companies. He may find that a Bronze policy from a non-exchange seller is cheaper than a Bronze policy from an exchange seller and may find that to be the case even with a subsidy (depending, of course, on the size of the subsidy).

As I said, these are not great options but they are alternatives to joining the exchanges. I think having choices, even lousy ones, is always better than being trapped. If nothing else, it can cool incandescent rage down to mere white-hot anger and that has to be better for our health.

I read Robert Laszewski (without realizing who I'm reading for a while)

Somehow - I have no idea how - I ended up reading Robert Laszewski’s blog, Health Care Policy and Marketplace Review. The particular post I was directed to is entitled “The Commitment to Fix Obamacare’s Computer Systems by December 1 - Because It Can Be Done By Then or Because Is Has To Be Done By Then?” The point embedded in the title is a good one, I think: it’s awfully convenient that the date promised is the date needed to be sure people can actually get insurance as of January 1. The whole post - in fact all the posts there than I read - are worthy reading in full but there were a couple of other points I want to comment on. One has to do with delaying the individual mandate:

Some Senators, Democrats as well as Republicans, are talking about passing legislation to defer the individual mandate for as much as a year because of the computer problems. That makes some sense given the problems consumers are having. But will that legislation also appropriate money for the insurance companies that would be required to cover the sick while the healthy sit it out for a year?

I’ve said before that I don’t think delaying the mandate (really, I think, the fine/tax) will make a big difference in how many health people sign up. That is, I’m not convinced anyone would sign up simply to avoid the fine/tax. I think the problems with the rollout make it even less likely the young invincibles would sign up anyhow. I’m in the minority apparently. Peter Suderman, for example, shares Laszewski’s concerns.

Laszewski’s other point consists of two suggestions for the new ObamaCare Czar’s to-do list. One is to get the 834 transactions (the backroom transmission to insurers) cleaned up before anything else is fixed. As he points out, if system is fixed enough so that lots of people can sign up but that information doesn’t get to the insurers cleanly, there is going to be quite a mess.

His second suggestion is:

Focus on the private exchanges and health insurance companies with their own websites that still cannot connect to healthcare.gov for things like subsidy calculations. The companies have been begging for this capability from the beginning. If it had been done, they could now be serving as an effective work-around giving consumers an efficient means to get signed-up. This should have been Plan B in the first place in case the Obamacare site did not work.

I’m not quite sure what he’s saying here. Is he simply referring to giving insurance companies help telling their customers what subsidies they can get; or is he advocating letting people do the whole sign-up process with their insurance company, removing any need for anyone to ever use the ObamaCare website/exchanges? If the latter, I agree; if the former then, yes, that would reduce the anxiety for people who are looking at big premium changes and can’t figure out if they’re going to be subsidized. (Although there are free-standing subsidy calculators available on the Internet - here and here, for example. These aren’t official numbers but they are both from reputable sources so would presumably at least be in the ball park.)

The “Commitment” post went up at Laszewski’s site a few days ago. Today he posted “Mr. President: I like My Health Insurance and I Would Really Like to Keep It - Can You Help Me Out Here?”. He talks about the excellence of his current plan and reports receiving a letter telling him he cannot keep it “because my plan isn’t good enough under Obamacare rules.” The new plans he can buy have worse coverage than his current plan. And to cap it all off:

And, wait all you people telling me rate shock does not exist, it far more restricted plan costs 66% more than our current monthly premium. Mr. Rate Shock got rate shocked––and benefit shocked to boot.

Odd. This seems not to back up the claim that all of us who are losing our current insurance have sub-standard crap or the claim that if we are going to have to pay more it’s worth it because we’ll be getting more.*

Laszewski has also done a couple of interviews with Ezra Klein. In one of them, dated October 23, he makes this point:

But they have to get the backroom fixed before they open the front door. If they open the front door before that back room is fixed, you’ll have a catastrophe. People are going to be signing up and seeing their banks accounts debited multiple times, or their insurance won’t come through. The White House is meeting with insurance industry executives today, and I can tell you what they’re talking about. They say you need to get this fixed, because you’re setting us up for a real fall with our customers. They’re not going to blame Kathleen Sebelius if they walk into their doctor’s office and the doctor doesn’t know who they are. They’ll blame the insurance company. And I’m sure what the insurers are telling the White House today is we will not let you put us in that position.

I suspect the White House doesn’t care what the insurers are saying. I’ve always believed that one of the worst features of ObamaCare and yet one that has great benefit for its supporters is the involvement of the insurance companies. Large corporations, especially large insurance corporations, make great scapegoats.

*****

Notes:

* I want to say, for the record, that even if both these claims were true they would still not be valid arguments for making me buy what someone else thinks I should. I get to decide what is and is not sub-standard for me. I get to buy sub-standard crap if I really want to. I get to decide I’m willing to live with less rather than paying more. I get to go without if nothing I can buy suits me. My money, my health, my decision.

Revetment

Jonathan Bernstein has a Link up at Salon called “GOP’s Obamacare conspiracy: Sabotage from the inside”. In it, he argues there are “eight ways that Republicans attempted, perhaps successfully, to undermine the ACA”. Neoneocon refers to this as “just-sad”. She’s right but there are a lot of people out there who are going to love his article.

I’ve begun to see those on the Left as firing and falling back in the ObamaCare rollout fiasco. First, they argued there weren’t really problems. When that position was overrun, they argued that it was all volume, just proof of how incredibly much Americans wanted ObamaCare. When they were forced out of that position, they fell back on the claim that the problems were frustrating rather than disastrous; I call this the “when Amazon is glitchy, it’s annoying but it’s not a big deal” stance. Being overrun by counterfactuals there, they argued that no one - no one - was more angry, more frustrated than President Obama and Secretary Sebelius. Now that position has proved to be too enraging or too ridiculous - or both - to hold back attacks, so they are rallying to their usual bunker: it’s all the Republicans’ fault.*

Bernstein’s article provides a great revetment for this last position. His claims about what Republicans did to cause this mess are incredibly vague but therein lies their value for all those who will never, ever concede that ObamaCare doesn’t seem to be working out too well. His arguments will be believed because people want, desperately, to believe them and, since the arguments are not themselves facts, they can’t be refuted by opposing facts. These arguments allow those on the Left to avoid the cognitive dissonance that would come from having to admit Obama’s one big accomplishment is a mess.

All that said, I am going to push back on one of his arguments:

Passing on state-run exchanges: With over half the states refusing to set up their own marketplaces, the job of the federal government was much larger than originally envisioned.

In what way? The legislation clearly anticipated setting up a Federally run exchange so the creation of HealthCare.gov was “originally envisioned”. I am left to assume that Bernstein thinks making the Federal exchange website handle twenty-seven States is a significantly bigger job than making it handle one State. And it may be: if you’re just handling one State you can hard-code everything. Real programmers will cringe (and probably throw up) and you’ll be in big trouble when stuff like premiums and benefits change next year, but, hey, deadlines are deadlines. However, handling twenty-seven States shouldn’t really be a bigger job than handling two States. Why? Tables.

It’s been a long time since I was writing application programs but - call me crazy - if I were designing the Federal exchange website, I’d write just one program rather than twenty-seven different ones - or twenty-seven different State pieces of one. And I’d have that one program read tables from the various States and insurance companies to get the information I needed to do my calculations and display my results. And the amount of work would be the same whether I was handling one State or all fifty-seven.

Except for testing, of course, but the kind of testing needed for multiple States is different from testing whether the data could flow through the website from beginning to end. That is, you get the system pushing data through quickly and cleanly and once that’s happening - that is, once the exchange appears to be working - you start testing specific cases for accurate output. Needing extra time to be sure the tables for each State produced accurate output might have meant the Federal exchange came up providing wrong answers - although that kind of testing actually is something you can throw extra manpower at - but it wouldn’t mean the Federal exchange basically didn’t come up at all.

So maybe I’m missing something but I’m unable to see how the lack of State exchanges had anything to do with the ObamaCare rollout crashing and burning. Unless, of course, President Obama and Secretary Sebelius and Jonathan Bernstein were delusional enough to believe they’d never have to create the Federal exchange website at all.

*****

Notes:

* There also seems to be a side skirmish of blaming Republicans because “Democrats really wanted single payer”. I would like to think this will be harder to sell since, as T99 points out, ObamaCare passed on a straight Democratic Party vote and thus could have taken any form the Democrats wanted. However, I fear even this ludicrous argument will be uncritically accepted by those whose first priority is avoiding reality.

If you like it

Senator Ron Johnson (R-Wisconsin) has announced he will introduce an ”If You Like Your Health Plan, You Can Keep It Act” bill next week. According to Senator Johnson’s press release:

One of the most important promises made by President Obama and Democrat congressional leadership to promote the Affordable Care Act was that Americans who were satisfied with their health plans could keep them.  That promise has been broken.  More than a million Americans have been notified that the plans they like with the coverage they have chosen have been canceled.  Millions more Americans will have the plans of their choice canceled in months to come.

Americans want the freedom to choose their own plans and want to be in control of their own health care.  They don’t want Obamacare destroying what they have and what they like.  They don’t want their personal choices regarding their health plans and their families’ health plans canceled by Obamacare.

The “If You Like Your Health Plan, You Can Keep It Act” will amend the law to make Obamacare live up to the promises of the politicians who sold the plan to the American public.  I will file the bill in the coming week and hope to garner support from fellow Senators of both parties who truly want to make sure President Obama honors his promise that every American has the freedom to keep his or her own health care plan.

I hope you’ll contact you Senators and Representative and ask them to co-sponsor this bill or at least support it. If you’re not sure how to contact your Congressmen, here’s how to find that information:

Find Your Senator

Find Your Representative

To me, this bill is worth supporting for two reasons. First, it’s the right thing to do for people whose current insurance has been cancelled and who will be significantly negatively affected by having to spend more and/or get less when they are left with no options but Obama-approved health insurance policies. In other words, it’s the right thing to do for people who are getting a raw deal.

Second, it asks a version of what I believe is the most important question in the ObamaCare issue, one that should be asked of the President, Secretary Sebelius, every Congressman who voted for this bill, and every one of our fellow citizens who support ObamaCare: Who the hell do you think you are, to tell me what to buy with my own money?

Jot and tittle

Oh, boy. This is a bad minute and a half soundbite. I understand that there may be more to this and that this may be an off-the-cuff answer to a question that isn’t on the video but still.

Today, John Boehner, in a press conference with other Republicans, said this:

You know, we had another jobs report yesterday.  Another, frankly, disappointing jobs report.  This economy’s not creating the jobs that the American people are looking for.  Their wages are stagnant, and part of the problem is that we’ve got the whole threat of ObamaCare continuing to hang over our economy like a wet blanket.

Employers scared to death in terms of what they have to do and what they don’t have to do, afraid to add new employees.  And, you know, when you look at the problems with ObamaCare all the focus here lately has been on the website.  Clearly there’s problems with the website, but I would argue that the problems go much further than that. 

How about the report over the last couple of days of the hundreds of thousands of Americans who are finding out that they’re going to lose their coverage because the plans they have today don’t qualify under ObamaCare.  And when you begin to look at these hundreds of thousands of people I think what you’re going to see at the end of October are more Americans are going to lose their health insurance than are going to sign up at these exchanges.  This is a very serious problem.  It’s affecting our economy.  And it’s affecting the ability of the American people to find the job that will help them take care of themselves and their families.

First of all, there’s no focus here. He starts off talking about the bad job report and ObamaCare being part of the reason for that. Then he skips to the website and then to people who have insurance but whose policies are being cancelled because they don’t meet ObamaCare standards. And then it’s back to the economy and jobs. Both the ObamaCare damper on job creation and the currently insured being dis-insured are problems and I’m glad Boehner is talking about both of them. But jumbling them together undercuts the impact of each. Talk about jobs; then talk about dis-insuring.

Second, where are the props? Obama wheeled out a handful of people for his “NBD on the URL” talk the other day. Where are Boehner’s business owners who are not hiring? Where are the (legions of) currently insured who are being dis-insured? I know all this touchy-feely stuff is the realm of the Left but trust me - having a few thousand of those of us whose insurance was cancelled stacked up behind Boehner would have been more effective than some vague numbers.

Third, Boehner appears to think that the currently insured being dis-insured because of ObamaCare is “affecting the ability of the American people to find the job that will help them take care of themselves and their families.” I hate ObamaCare with a passion and would happily blame it for everything from crabgrass to moldy tile grout, but I just can’t figure out the connection between having my individual health insurance policy cancelled and not being able to find a job. Now, maybe this was a verbal eliding and he was really moving from Topic C (dis-insurement) back to Topic A (bad jobs report) and didn’t intend to imply a causal connection. If so, he should have at least taken a very long breath between “very serious problem” and “[i]t’s affecting”.

Fourth, I have this sinking feeling that Boehner doesn’t actually understand what he’s saying, that he’s just repeating talking points he’s been handed and is sort of saying them because he knows he’s supposed to be ticking off points. I don’t think this is unique to Boehner. I think most of the people in Washington spouting off about ObamaCare are pretty clueless. I also believe that the whole ObamaCare issue is now strictly about political posturing and not at all about good policy. But it doesn’t give me a lot of hope that the Republicans are going to mount an effective campaign to take advantage of the ObamaCare rollout fiasco.

I like John Boehner, in that visceral sort of way that one likes or dislikes public figures. But I’m not holding out much hope that he and his Party are going to rescue us from one jot or tittle of ObamaCare.

(Great. I looked up “jot” and “tittle” to make sure I was spelling and using them correctly and found the use of them to mean “the smallest bit” comes from a Bible verse:

For verily, I say unto you, till heaven and earth pass, one jot or one tittle shall in no wise pass from the law till all be fulfilled. (King James Version, Matthew 5:18)

Looks like we’re stuck with ObamaCare till the end of time.)

Chit-chat

My husband was poking around in the songs he’s downloaded to the hard drive over the years and started playing this one to demonstrate a feature of our Mac. I really like it and thought it might make a nice change of pace in the midst of all my ObamaCare rhetoric:

Lero-Lero from the album Lero-Lero by Luisa Maita

The link is to Maita’s website which has the following description of this song:

“Lero-Lero” is a slang term that translates as an informal, aimless conversation. A deconstructed samba about two friends from a ghetto on the outskirts of São Paulo who have each other’s backs whenever trouble arises.

No matter where we come from, that’s a good sort of friend to have - and to be.

Enjoy!

Perception and politics

Related and somewhat counterposed to, the discussion on my recent “Reason and compassion” post is this paragraph from a blogger over at Ace of Spades (emphasis mine):

Allah had a post last night saying Ted Cruz is rejecting the "let it burn" approach to ObamaCare. Watch the clip at the end of the post, I'm not sure where Cruz stands on this. Yes, he rejects the notion that the GOP should try [and] profit politically from the suffering ObamaCare is imposing. That's just basic politics. You don't win votes by calling people idiots for voting for this and then say, "now you must suffer". What Cruz doesn't do in that quote (though he may later) is what Rubio does...suggest an affirmative course of action to make ObamaCare "better".

In the Allah post he references, there’s this (emphasis again mine):

Imagine if HHS fixes the front end of the site, so that people can now easily register and enroll, but the back end of the site remains a complete mess, with insurance companies forced to try to process tens of thousands of garbled enrollments in December. People who signed up, especially those with preexisting conditions, will be eager to have their coverage take effect in January. “All we need is $100 million to fix the back end and get this coverage flowing,” O might say. What’s the compassionate play at that point? It’s almost unimaginable that the GOP would appropriate the money and acquiesce in funding Obama’s boondoggle; on the other hand, even if the money is withheld in the name of pressuring Obama to delay the law for awhile, there may be thousands of sick enrollees who’ve already made financial plans based on the expectation of coverage. (This, of course, was precisely the reason Cruz wanted the law stopped before it started. Once people become dependent on the program and its subsidies, it becomes very hard to undo.) So what’s the play then? Dig in, refuse the appropriation, and tell Obama to figure out a way to clean up his own mess, even if that means chaos for the sick and/or an industry death spiral? That would be, essentially, LIB [Let It Burn] in action. It’d be all Obama’s and the Democrats’ fault, but that doesn’t solve the problem of how to spare people a lot of suffering from their stupidity and incompetence.

This is the dilemma for Republicans especially and for conservatives more generally: How do Republicans refuse to make what appear to be minor concessions to “fix” ObamaCare without looking like they’re the bad guys? Allah is correct when he says chaos and destruction in the insurance industry would be “all Obama’s and the Democrats’ fault”. He’s wrong, however, if he thinks most of the voting public would see it that way. What they’d see (or, rather, believe) is that all that’s needed to fix things is a little tweak here and there - and the Republicans are refusing to co-operate because they’d rather see people suffer.

It seems to me Republicans (and conservatives) have two choices. One is to refuse to help “fix” ObamaCare. If they’re going to take that route, they need to be able to explain what the end game is. To use Allah’s example, they have to finish this explanation:

We are not going to appropriate $100 million to fix the back end so those people who think they’ve signed up for health insurance can actually get it in a timely fashion. The reason we’re not going to do it is because we believe the exchange problems prove what we’ve said all along: the Federal government has no business being in the health insurance sales business and we want the government out of it immediately. We understand our refusal will result in the people who think they’ve signed up for health insurance not getting it and in insurance companies having tens of thousands of fewer customers (and millions of dollars less revenue) than they planned on.
{Pick one of the following concluding statements to conclude this explanation:
1) This will not be a problem.
2) This will be a problem but we’re not going to address it because you idiots “will never learn [your] lessons about statism unless [you’re] forced to suffer the consequences of statist policies.”
3) This will be a problem but we’re not going to address it because [fill in the blank].
4) This will be a problem and we will address it by [fill in the blank].
5) Thank you for your attention.}

I don’t see this first choice - refusing to help “fix” ObamaCare - as a winning political strategy but I could certainly be wrong.

The second choice is to help “fix” ObamaCare. The “help” the AoS blogger is talking about is Marco Rubio proposing a delay in the individual mandate. (It actually sounds like what he wants to delay is the fine/tax which is sort of but not quite the same thing.):

He [Rubio] said it would be "prudent" to delay the requirement on individuals to buy health insurance -- set to kick in early next year -- until users can consistently access the main website.

"How are you going to go after people next year ... if the thing you're forcing them to buy isn't available to buy?" he asked, saying the site is "not working."

Rubio's plan would delay the mandate until the Government Accountability Office certifies the system is "up and running and effectively working for six months, consecutive." 

There are two problems with this kind of “help”. First, it doesn’t address the actual problem, which is not “I’m worried about paying the fine/tax” but rather “I can’t buy health insurance”. Second, it doesn’t advance the cause of getting rid of - or at least weakening - ObamaCare.* If the Republicans really want to help - as opposed to looking like they're helping - they need to think of something that will address the problem of people not being able to reliably buy health insurance and will also loosen some of the nuts and bolts of ObamaCare. I’m sure (well, hopeful) there are some smart people in the Republican Party who can come up with something but here’s one suggestion: Let people buy health insurance, including the subsidized kind, directly from insurance companies, without going through the exchanges.

There’s no question this will help fix people’s inability to buy health insurance on both the front (website is a hunk of junk) end and the back (insurance companies not getting usable info) end. It would be hard for the Democrats to oppose because it both sounds and is perfectly reasonable; the point is to get people health insurance, not to feed some giant government data base, right? So why not let people buy direct from insurance companies which have lots of experience in selling insurance; have working websites; and are already set up to handle the whole subsidy thing since they’re supposed to be taking feeds from the ObamaCare website?

The “See Plans and Prices in Your Area” capability in HealthCare.gov will show me all the insurance companies in my area that are offering policies so I know who to talk to. At least one of them, Horizon Blue Cross Blue Shield, took my age and sex and showed me all the possibilities - subsidizable and not - in about a nanosecond. Heck, it even has a comparison capability. And if I want to compare policies across insurance companies, I gather esurance.com will do that (although I’ve never used it). We could sweeten the deal for insurance companies by changing the percent they’re allowed to devote to administrative overhead from 20% (if I remember correctly) to 25% - and sweeten the deal for Democrats by bringing that percentage down one point at a time over the next four years (finally sticking at 21%) as the insurance companies get the tools in place to handle the subsidizable policies from beginning to end.

Yes, the next four years. This is not an "until ... the system is ‘up and running and effectively working for six months, consecutive’” change; this is a permanent change. The Feds can, of course, get HealthCare.gov running and if people eventually like it better they can certainly use it.** But being able to buy direct from insurance companies is forever. And part of the deal would be a full accounting of how much HealthCare.gov has already cost us and how much it costs us to fix - as it’s happening, not ten years from now. Say, a report every week.

And, in exchange for graciously agreeing to save the Democrats’ bacon, the Republicans should ask for something. Nothing too big, nothing that looks business friendly (like getting rid of the medical device tax), nothing that looks ideological (like removing birth control as a required coverage item). Something that looks small, something that ordinary people will like.

My choice would be allowing anyone who wants to to buy true catastrophic health insurance (high deductible, no carve-outs for paid-for preventive care) and not be fined/taxed for being insufficiently insured. I’d want to look at some numbers first, though; if it’s not pretty cheap and it’s not a good thing for insurance companies it may not be worth asking for. It can be framed as something good for those currently insured now cancelled who are suffering from sticker shock and those currently uninsured who are doing the same. After all, if they’re too rich to qualify for a subsidy they’re rich enough to carry a high deductible. Right?

Catastrophic insurance is my thing both personally and policy-wise.*** If it’s not yours, well, here’s something I’d really like to see: getting rid of the ObamaCare requirement that employers provide their employees with health insurance. Now, that’s bigger and can look both business-oriented and, if not strictly ideological, at least Running Dogs Of Capitalism Crushing The Masses-oriented. However, it could be sweetened with a requirement that employers who are currently providing health insurance can stop doing so if they give each employee who is currently getting health insurance a raise equal to the amount the employer pays for that employee’s health insurance (plus maybe some percent). Then add in the ability for individuals to take their health insurance premiums off their taxes (I would have thought ObamaCare did this but I can’t find anything that says it did). And point out that these moves:

1) Probably give the less well-off more disposable income since they get a pay raise; can get subsidized health insurance; and can take whatever they do spend on health insurance off their taxes;
2) Probably means we end up with more healthy people in the individual health insurance pool;
3) Gets rid of the ObamaCare deformations of hiring (like the 50-employee threshold and the 30-hour full-time definition); and
4) Gets rid of the problem of employers with religious objections to some of the insurance requirements - they can just pay their employees more and let them go buy their own insurance.

All of these moves - allowing people to get subsidies without using the exchanges; making true catastrophic health insurance count as “insured enough”; not requiring employers to provide health insurance - loosens the Federal government’s grip on health insurance. It’s certainly not a repeal of ObamaCare but it changes the structure enough to make further movement toward a better system easier.

Plus, it should give the Republicans some political credit. And, as a bonus, these changes might actually help some people who need it.

*****

Notes:

* There’s a third problem which is that if getting rid of the individual mandate actually makes a difference in who buys health insurance (I’m not convinced it would) then the chaos and death spiral Allah talks about would become more likely. This would advance the goal of getting rid of ObamaCare but it could very well also leave the private insurance industry in a shambles. Maybe Republicans are willing to risk that to get rid of ObamaCare but what happens if there is no viable private health insurance industry when the dust settles? Then again, maybe Democrats like that idea because it will lead to a demand for true government insurance. Or maybe Democrats don’t like that idea and they’ll be smart enough to never agree to delay the individual mandate/tax/fine because they know that would destroy ObamaCare.

** As an added bonus, I’d really like it if this fix could include language along the lines of:

People can buy health insurance direct from insurers, without going through the exchanges, and still get ObamaCare subsidies, regardless of whether their State has established its own exchanges or relies on the Federal exchange. The language of the Affordable Care Act that prohibits Federal subsidies for insurance bought in a State without its own exchange still stands. If you live in a State that didn’t set up its own exchange, you can only get Federal subsidies if you buy your health insurance direct from an insurance company.

I imagine the way to sell this language would be to dig out the reasoning that resulted in the prohibition on subsidies when using the Federal exchanges and wave it around, insisting that the original argument is still valid (I have no idea what it could have been) and, at the same time, also insisting that this new fix corrects a grievous injustice.

This should pretty much eviscerate the Federal exchanges.

*** I think the best way to control health care costs is to make people pay for their own health care insofar as they are able. Catastrophic health insurance means I’ll be careful about just nodding when my doctor says, “Let’s do an X-ray, an MRI, a blood test, and send you off to this neurologist.” I’m going to pay for all that until my insurance kicks in so I’m likely to say, “Do we really need to do all that because my knee hurts? Could we just, like, you know, first try me on some of that 500mg Naproxen that costs $5 for 20 tablets?” So I’ve just saved thousands of dollars and, if the Naproxen doesn’t do it, I can go back to my doctor and have a long conversation about which one of the things he wants to do next is most likely to be helpful.

At the same time, I don’t think people should be unable to get health care because they run out of money. The trick is to make what I have to pay hurt enough so I’ll only spend it if I really need to. That’s why I favor a variant of the McArdle plan. McArdle talks about catastrophic health plans where the deductible is a percent of a person’s income, say 15% or 20%; my variant is that the percent increases as income does. If we just say “20% of income” as the deductible, someone making $20,000 is going to find that hurts enough to make her careful; someone who makes $1 million is not. Yes, this is redistributionist.

I call ObamaCare

I called the ObamaCare number yesterday afternoon. (In case you’re thinking of doing the same, that number is (800) F1UCKYO). Unlike all the people Tweeting about being asked to call back or being referred to the website, I got through to an actual human being almost instantly.

I asked for information on buying insurance through the exchanges. He asked if I’d set up an account online. I said I hadn’t, that I was wondering if I could apply over the phone or if the representative could mail me a paper application. He said that he could mail me a paper application but that even so at some point I’d have to go online to create an account.

I was about to ask what people without computers were supposed to do (they do exist) when he offered me another option: I could go to a center and speak with someone in person who would help me. I expressed interest and asked that he tell me where the nearest center was. The following dialogue ensued:

Representative: What is your phone number?

Me, thinking: Hmm. There are these things called “cell phones” these days so anyone who uses phone number rather than zip code as a proxy for location is stupid. Then again, I have read that the Obamacare system is 20-year-old technology. What the heck. He probably already has my phone number. In fact, this is the 21st Century - he must have that. Maybe he’s just trying not to be creepy with the whole Big Brother is watching thing.

Me: 555-555-5555. [No, not really. I actually give him my real phone number.]

Representative: Can I have your last name?

Me, thinking: Wait. What?

Me: Why do you need my last name to tell me where to find the nearest service center?

Representative: I need your last name and first name. The system won’t let me proceed unless I enter it.

Me, thinking: Enter it where? What system? WTF?

Me: No, thank you. Not interested. Bye.

And thus endeth my interface with the ObamaCare phone system. Please don’t bother to tell me that Representative was wrong, that I can enroll over the phone or by paper or find a service center without giving my name. I’m well aware Representative may be wrong. But you go to ObamaCare with the Representative you have, not with the Representative you want. If he is wrong, that’s not an argument that ObamaCare is better than it appears from my experience; it’s an argument that ObamaCare is worse.

I’ve have resolved to not go near any part of the ObamaCare exchanges (online, phone, or service center - assuming I could find one) until November. The anniversary date on my current policy isn’t until the Spring so I have some time.

In somewhat happier news, I’m pretty sure I can buy health insurance directly from my current carrier, without going through the exchanges. At first glance, it looks like I can get a policy that will cost about the same as the one I have now but with much higher out-of-pocket costs. I cannot tell you how thrilled I am about that. Seriously thrilled about knowing I won’t have to choose between using the exchanges and going without coverage. Sarcastically thrilled about getting less for my money.

Realism and compassion

Over at NRO, David French has written a post entitled “The Tea-Party Plan to Delay/Defund Obamacare Was Not Only More Realistic, It Was More Compassionate”:

Not only did the tea-party plan have a chance, it was far less cynical and far more compassionate than the Republican alternative. The Republican alternative to the tea-party plan boils down to this: Let the people suffer (also called ”let Obamacare implode”), then they’ll come to us, we’ll win a [bunch] of elections over several cycles, then we’ll make it better. 

Well, step one is working (if that’s the right word to use). People are suffering. Over the weekend, NBC News reported that 460,000 Americans in just two states (California and Florida) face insurance-plan cancellations as they’re being driven to the non-functioning exchanges. That’s ten times more people facing cancellations in just two states than have (allegedly) enrolled in Obamacare plans nationwide.

Imagine being a middle-aged man or woman, staring at a cancellation notice, and desperately trying to sign up for new insurance through a website that doesn’t work. How would you feel?

I don’t have to imagine - I am staring at a cancellation notice and at a website that doesn’t work. And all the Republican glee about how bad the roll-out has been is making me, what’s the word, oh, yeah - bitter.

You know who else gets this? Ezra Klein, of all people:

A lot of liberals will be angry over this post. A lot of conservatives will be happy about it. But it's important to see the Affordable Care Act as something more than a pawn in the political wars: It's a real law that real people are desperately, nervously, urgently trying to access. And so far, the Obama administration has failed them.

I hate ObamaCare with a passion. If someone sat down to deliberately design a crummy health insurance plan, ObamaCare would be the result. But we’re stuck with it. We might have been able to kill it somewhat gracefully even a month or two ago; we might, possibly, have been able to kill it in the past two weeks; but now it’s too late. It’s certainly the case that the long-term effects of letting it survive are going to be unfortunate (to say the least) but by now the short-term effects of killing it are too visible to allow us to drive a stake through its heart.

And you know what else? The Republican plan, as outlined by French, isn’t going to work. There just aren’t that many people who are going to suffer from ObamaCare or who would suffer if it imploded. I think about three Left-leaning friends who consider ObamaCare the bee’s knees. One of them is on Medicare; one of them gets health insurance through a retirement package; and one of them gets health insurance from an employer. None of those people are going to suffer from ObamaCare, at least not anytime soon and never in any direct way. Any consequences they feel from ObamaCare or from an ObamaCare implosion are down the road (certainly past the 2014 elections) and will be explained away as the result of something else (Republican obstructionism being the most likely candidate).

I don’t expect Republicans to help fix ObamaCare: the Democrats created it, they own it. But I do expect the Republicans to stop doing touchdown dances at the news that their fellow citizens can’t buy health insurance. At least fake a little compassion. And if you could manage to suggest an alternative - a simple alternative - to letting people suffer, that would be nice, too.

Now this is scary

Here’s a website where someone is methodically debugging the problems with HealthCare.gov:

Is There A Problem Here?

I find this kind of detailed, plodding, apolitical demonstration of the software failing much scarier than articles that rant and rave about the problems.

(The “Is There A Problem Here?” site looks at all kinds of software fails. The link I provide selects for the posts about problems with HealthCare.gov.)

Via Consumer Reports via Instapundit

Playing with premiums

Via Patterico (I think via Ace of Spades but can’t find the post again), I found a Subsidy Calculator (“Premium Assistance for Coverage in Exchanges”). The Calculator was developed by Kaiser and lets me enter some minimal information - State, zip code, annual income, number of people enrolling and their ages - and tells me what the premium will be for a Silver plan and what subsidy I can expect. It also tell me what a Bronze premium and subsidy would be. The FAQ section associated with the Calculator does warn:

Does the calculator provide definitive estimates of what people will pay under the health reform law?

No. The calculator is intended to illustrate how families in varying circumstances may be affected by the tax credits and limits on age rating included in the law. Premiums will vary from region to region and based on assumptions insurers make in setting premiums. In addition to what people would pay in premiums, they would also have out-of-pocket expenses for cost sharing (e.g., deductibles and coinsurance), which in some cases would be subsidized based on income. In addition, there are many other factors that could increase or decrease how much people pay, including efforts to make the health care system more efficient and additional revenue measures to finance the federal cost of reform.

So take the numbers with a grain of salt. However, assuming the resulting numbers are at least in the ballpark, this is very helpful and, for me, reassuring . If the calculator is correct then, in New Jersey, my annual premium for a Silver plan is going to be about what I’m paying now. I would have to see one-to-one comparisons of co-pays, deductibles, and maximum out-of-pocket numbers; and I would have to see how limited the in-network pool of providers is to determine if the plans are comparable; but at least I can relax about having to spend a gazillion dollars more than I’m spending now to get some kind of coverage.*

It’s interesting to use the calculator to play around with different income levels and see what happens. My premium is always $8,093 but subsidies change - sometimes a lot - and Medicaid eligibility adds another wrinkle.

If I enter my income as $46,000, my subsidy is $0; I pay $8.093.

If I enter my income as $45,000, my subsidy is $3,818; I pay $4,275. Making $1000 less saves me almost $4000 in health insurance costs.

If I enter my income as $44,000, my subsidy is $3,913; I pay $4,180. Now making $1000 less saves me less than $100 in health insurance costs.

If I enter my income as $34,000, my subsidy is $4,903; I pay $3,109. Making $10,000 less saves me $1,010 in health insurance costs.

If I enter my income as $24,000, my subsidy is $6,507; I pay $1,587. Making $10,000 less saves me about $1,600 in health insurance costs.

If I enter my income as $14,000, my subsidy is $7,813; I pay $280. Making $10,000 less saves me about $1,300 in health insurance costs.
At this level, I’ve started getting Medicaid notices:
If my State expands Medicaid to everyone under 138% of the poverty level, I can go into Medicaid.
If my State doesn’t expand Medicaid to everyone under 138% of the poverty level, I can buy subsidized coverage through the exchanges.
I assume (although it is not said explicitly) that if my State expands Medicaid, I can still buy coverage through the exchanges but
i will not be subsidized. I’ll be too poor for subsidies.

If I enter my income as $4,000, my subsidy is $0; I pay $8,093. Making $10,000 less costs me $7,813 in health insurance costs.
It’s not that simple, of course. The problem here is that my annual income is below 100% of the federal poverty level. That means I either go into Medicaid (if my State allows it) or I buy an unsubsidized policy through the exchanges. There is apparently no scenario in which I can buy subsidized coverage through the exchanges. I’m really too poor for subsidies.

The calculator also sometimes informs me that:

Because Bronze level coverage would cost more than 8% of your household income, you may instead opt to purchase catastrophic coverage. With a catastrophic plan, you would pay out-of-pocket for most health services until you reach the annual limit on cost sharing ($6,350 in 2014). However, preventive services are covered with no cost sharing required.

As far as I can tell, I start getting this message once I report an income below 100% of the poverty line. I had heard that only young people could buy catastrophic** coverage but according to the “Notes” section below the calculator:

The law also makes available a catastrophic policy for young adults and those exempted from the requirement to obtain insurance due to affordability. Catastrophic plans are less comprehensive and have a lower premium than other coverage. Eligibility to purchase catastrophic coverage is reflected in the calculator, when applicable. Premium subsidies may not be applied to catastrophic coverage.

So a very useful tool, both for me personally and for beginning to understand how this is all supposed to work. Thanks, Kaiser.

*****

Notes:

* I do still have to worry about whether I can get into the exchanges to register and about whether I'm willing to give the government all that information. Sometime next week I'll talk to Blue Cross/Blue Shield about whether I can buy direct from them and skip the online exchanges.

** Catastrophic-ish actually. My understanding is that even the "catastrophic" policies pay for some preventive care.

Designer health policy

Via Ace of Spades, I found this essay on Obamacare at The Federalist. Clear, concise, nicely balanced.

Read the whole thing but here’s an appetizer:

Three years after enactment of the law, CMS decided to finally ask the question: just who are these poor wretched uninsured people and what are they looking for? One might think they would have inquired about this before enacting a remedy, but there you have it.

Note to self

In thinking about a recent comment to one of my posts, I went looking for something I’d written. I did so by searching for the word “profaned” and, to my surprise, I found two old posts that contained that word. Who knew?

I re-read both of them and decided to drag them into the present, for my sake rather than for anyone else’s. When I spend too long in the Doomsday Predictor that is the political part of the Internet and find myself believing that all is lost, most people are idiots, and “they” are a waste of fresh air and sunshine, I need to remind myself of what I wrote, of what I believed and, truly, still believe.

So here they are, not in the order they were written but in the order in which they make sense to me today:

Raindrops on roses

The best things

Obamacare giveth - but first it taketh away

I don’t know if I never knew Obamacare contained this provision or just forgot about it (like I forgot about the nutritional labeling provision):

Gold, the co-founder, said that without a $112 million federal loan through Obamacare, CoOportunity would have difficulty growing to the size where it can spread risks and costs among enough people to succeed.

The loan gives the company the financial backing it needs to begin selling policies and paying claims, and is due to be repaid to the federal government. The Affordable Care Act contained $6 billion in loans to establish other cooperatives around the country.

Because the new law requires insurers to spend 85 percent of premiums from large-group policies on health care claims, he said, it's almost impossible for a publicly traded health insurance company to pay its administrative costs and still make a profit that appeals to investors.

“You don't see for-profit companies starting in the insurance business any more,” Gold said. “That's why the ACA seeded nonprofit cooperatives to provide competition in a market that's increasingly less competitive.”

So if I understand this correctly, the architects of Obamacare knew the law would reduce competition and decided to correct for that by providing government money to create new competition. They deliberately destroyed what little was left of the sellers’ side of a market in health insurance then tried to artificially recreate it. Is it just me or is this slightly insane?

The real thing

A couple of my local grocery stores have started selling Coca-Cola sweetened with sugar rather than high fructose corn syrup (HFCS). They put it on the “Mexican Foods” aisle and bill it as “a little taste of home”. I finally tried a bottle this past week. Oh, my. It’s very different and very good. Sweeteners aren’t just sweet: they actually have flavors of their own and I like the way sugar tastes much better than the way HFCS tastes. As for artificial sweeteners, in my opinion those are best not even mentioned.

Unfortunately, that little taste of Mexico is pretty pricey compared to my usual American Coke. The Mexican Coke was on sale for a dollar per single-serving bottle. I can buy a single-serving can for about 17 cents if I find it on sale and I can always find it on sale. I do wish we could straighten out our weird sugar laws and get back to sweetening stuff made in this country with sugar again. The jury is still out on whether sugar is better for my weight than HFCS but there’s no question it’s better for my taste buds.

Django Unchained

I watched Django Unchained last night. I have to admit I came to it reluctantly. I put it in our NetFlix DVD queue quite a while ago for a number of reasons: I loved Django (and really liked its surreal offspring, Sukiyaki Western Django); Unchained has Franco Nero (the original Django) in it and I appreciated the homage (and the eye candy); and it’s a Quentin Tarantino movie (no more need be said). However, after seeing Lee Daniels' The Butler this past summer, I worried that Django Unchained would be the same sort of heavy-handed, treacly, hectoring, sentimental mess, so I kept sliding it down in the queue. I should have known better. We are, after all, talking about Tarantino.

Django Unchained is utterly unsentimental, clear-eyed, and matter of fact. There is no one pontificating on the evils of slavery; there are no heroes trying to save the world. There is simply the reality of slavery, presented as an integral part of the movie, neither air-brushed out nor shoe-horned in; it just is. That presentation of slavery as part of the warp and woof of the time, as wallpaper, unremarkable yet always there in the smallest details, makes the horror of it impossible to put out of ones mind. This movie doesn’t lecture us; it doesn’t have to.

Among Tarantino’s movies, Django Unchained reminds me most of From Dusk Till Dawn. Both movies begin with violence as a way of living but human violence, in a sense understandable violence. Both then enter a world of horrific violence, utterly evil violence, a world beyond human comprehension: vampires in From Dusk, slavery in Unchained. And both have truly remarkable bloodbaths, although that hardly distinguishes them among Tarantino’s movies.

Django Unchained is both an astonishingly powerful movie and a surprisingly good one. I can’t imagine Tarantino is going to win any serious awards for this film but he should.

Government is a trust

... and the officers of the government are trustees. And both the trust and the trustees are created for the benefit of the people. - Henry Clay

Ace is writing on the Park Service shenanigans during the shutdown (emphasis in original):

Obama does not own the military, the government, or the national parks, media. Obama instead is the trustee of these things -- but is required to oversee them for the benefit of their true owners, the American People.

Here are some other things a trustee cannot do: [snip]

And he definitely, definitely may not block the beneficiary from enjoying the property held in his name to coerce the beneficiary to pay him more for his services as trustee, or to give more freely to charities the trustee favors.

Read the whole thing.

Living in a company town

T99 has been on a roll over at Grim’s with her posts on the ways the Administration is implementing the shutdown to make it as unpleasant as possible for the citizenry. One of her recent posts concludes with the best paragraph I’ve read on these kinds of tactics:

Frankly, the whole business underscores what a bad idea it is to get used to freebies from the feds.  Anytime they're in a bad mood, they can restrict access to make a point.  We should be working on making them as unessential as possible.

Tell me again which side is crazy

I can’t claim to be totally objective but I’ve gotta say that Harry Reid sounds like a vicious lunatic:

DANA BASH: You all talked about children with cancer unable to go to clinical trials. The House is presumably going to pass a bill that funds at least the NIH. Given what you’ve said, will you at least pass that? And if not, aren’t you playing the same political games that Republicans are?

HARRY REID: Listen, Sen. Durbin explained that very well, and he did it here, did it on the floor earlier, as did Sen. Schumer. What right did they have to pick and choose what part of government is going to be funded? It’s obvious what’s going on here. You talk about reckless and irresponsible. Wow. What this is all about is Obamacare. They are obsessed. I don’t know what other word I can use. They’re obsessed with this Obamacare. It’s working now and it will continue to work and people will love it more than they do now by far. So they have no right to pick and choose.

BASH: But if you can help one child who has cancer, why wouldn’t you do it?

REID: Why would we want to do that? I have 1,100 people at Nellis Air Force base that are sitting home. They have a few problems of their own. This is — to have someone of your intelligence to suggest such a thing maybe means you’re irresponsible and reckless.

while Eric Cantor sounds like a reasonable man - or at least a reasonable politician:

... over the next several days the House will pass bills to:

1. Reopen the NIH and ensure that all patients have access to clinical trials (passed 254 to 171 with the support of 25 Democrats) [snip]

These sweet-heart deals where the law [Obamacare] applies to some but not others; where unions, politicians,  and big business get special breaks but working middle-class families and small businesses are left to suffer is unacceptable.

The Williamson Rule

From an interview Kathryn Jean Lopez did with Kevin D. Williamson (emphasis mine):

LOPEZ: Why is it important to consider politics and government — Barack Obama and the NYPD officer — one and the same?

WILLIAMSON: All politics is force. It’s more obvious when you are dealing with the police and the military, because they carry guns. But those guns are used only to enforce policies mandated by people who do not carry guns themselves. My general rule is: If you are not willing to put a gun to your neighbor’s head over the issue, then you should not be willing to vote to have somebody else put a gun to your neighbor’s head over the issue. Which puts cowboy-poetry festivals, getting monkeys high on cocaine, and other government-sponsored shenanigans into a very different perspective.

I don’t have anything in particular to hang on this; I just think the Williamson Rule is a useful lens through which to view proposed policies. However much I may like a proposed government activity, is it important enough to me to put a gun to someone’s head to implement the activity? If not, then maybe I need to think again before asking the government to do just that.

Pacific Rim

I saw Pacific Rim this past July. I liked it so well I was tempted to interrupt my blogging hiatus just to write about it. It was the perfect summer movie: Pretty people, terrible monsters, heroic sacrifice, driving music, incredible special effects, even a little love story. What's not to like?

You can find all kinds of clips from the movie on YouTube and I think I’ve gone through about twenty of them. There are variations on the theme music from the movie in most of them but this one is my favorite:

Pacific Rim Main Theme

Starting at about 23 seconds in this sounds, for a few minutes, like the version of the theme used when we first see the brothers taking Gypsy Danger out. At which point in the movie I sat straight up and laughed in pure delight.

I’m hoping the powers that be are clever enough to release the DVD before Christmas so it can go on my list for Santa.