25.10.16

THE OBAMACARE COLLAPSE IS WELL UNDER WAY.

Family members are reporting the bad news from their exchanges.  I'm still on the State of Illinois's dime, but that may not be all good, as the state continues to play cash flow games with reimbursements, and local practitioners have been requesting advance payment from state employees.  It's the nasty late October surprise we anticipated.  Whether Mr Trump will be able to make any political hay out of it remains to be seen.  I suspect that his complaints about employees in his companies getting bad news from the exchanges is going to be spun as more evidence of stinginess, in this case relying on temporary and part-time workers.  Insurers are saying enough and walking away, and the plan you had last year may no longer be available this year.  (The efforts by the national government to bend the cost curve are driving physicians out, but that's a separate matter.)  "Normal disruption," a bureaucrat says, and yet there are hundreds of thousands of people experiencing normal disruption in Florida and North Carolina, both battleground states.  That disruption is concentrating minds ahead of the election.
“Without any significant statutory and regulatory changes on the federal and state levels, we may face the crisis again,” said North Carolina Insurance Commissioner Wayne Goodwin, a Democrat who’s up for election this year. “There needs to be a wholesale re-evaluation by leaders in Washington.”
The insurance reform has accomplished two things that its framers probably didn't anticipate, which offer potential for improvements in working lives, once the dirigiste impulse goes away.  By requiring employers to cover only full time employers, defined as thirty hours or more a week, the law has broken the tie between employment and health insurance, and it might lead to new thinking about whether a forty hour work week ought to be the standard for all time.  Now, if we had proper markets, including interstate sales of insurance, we might have something resembling functioning exchanges, not the current muddle.  More markets in insurance, not less.  More markets in medical services, as well.  You really can't talk about "bending the cost curve" until there's something resembling price discovery at work.  But don't expect Mr Obama (or Mrs Clinton) to get that.
Obama believes that only comprehensive insurance policies are real insurance. Conservatives generally believe, by contrast, that people should be free to buy cheaper policies that protect them only from financial catastrophes arising from their health needs.

It’s a difference that leads to others. Obama says that people who are having trouble buying insurance on Obamacare’s exchanges should receive more generous subsidies. The conservative alternative -- relax the regulations that make the insurance unaffordable for them -- is unacceptable to him because it would be a retreat from comprehensiveness.

All of the president’s shows of open-mindedness include similar caveats. He noted that Obamacare allowed state experimentation. But that experimentation is allowed to proceed only if the experiments promise to end with at least as many people having coverage that is at least as comprehensive as what Obamacare delivers. A policy that resulted in more people having catastrophic coverage wouldn’t qualify.
Catastrophic coverage, plus health savings accounts, plus greater commercial freedom for routine procedures are more likely to bend the cost curve than any comprehensive reform. And yet, Mrs Clinton continues to push for her Conrail option.

Who says the gods of politics don't have a sense of humor.  Let's suppose that the Democrat-Media-Academic Complex is correctly anticipating a Hillary win in two weeks, with a sympathetic House and Senate.  They'll own the revelation of the two lies in the Patient Protection and Affordable Care Act, and they'll own the Conrail option, or something more European.

For a preview of what something more European would look like, contemplate Colorado's Amendment 69.  (Yeah, I'm having impure thoughts, involving suckitude, but let's stay on topic.)  It's currently a referendum, thus in proper Jeopardy fashion, the proposal is in the form of a question.
Shall state taxes be increased $25 billion annually in the first full fiscal year, and by such amounts that are raised thereafter, by an amendment to the Colorado Constitution establishing a health care payment system to fund heath care for all individuals who primary residence is in Colorado, and in connection therewith, creating a governmental entity called ColoradoCare to administer the health care payment system; providing for the governance of ColoradoCare by an interim appointed board of trustees until an elected board of trustees takes responsibility; exempting ColoradoCare from the Taxpayer's Bill of Rights; assessing an initial tax on the total payroll from employers, payroll income from employees, and nonpayroll income at varying rates; increasing these tax rates when ColoradoCare begins making health care payment for beneficiaries; capping the total amount of income subject to taxation; authorizing the board to increase the taxes in specified circumstances upon approval of the members of ColoradoCare to contract with health care providers to pay for specifics health care benefits; transferring administration of the Medicaid and children's basic health care funds for Colorado to ColoradoCare; transferring responsibility to ColoradoCare for medical care that would otherwise be paid for by workers' compensation insurance; requiring ColoradoCare to apply for a waiver from the Affordable Care Act to establish a Colorado health care payment system; and suspending the operations of the Colorado health benefit exchange and transferring its resources to ColoradoCare?
That's everything you need to know about single payer.  You start with some kind of tax increase to get it started, then set up a committee to determine when and by how much taxes must be increased, and who gets classified as rich and subject to further fleecing.  At the national level, a Hillary presidency with a Democrat Congress is likely to continue the myth of cutting costs, just watch the bond markets, if you can stand it!

Single payer within one state, however, is going to face the same problem socialism in one Germany or one Korea faces: the productive people are going to opt out, until they get fenced in.  "Can single-payer work in an individual state or does it really require a national program?" That ducks the more important question, which is, How expensive will health care be when the national government picks up most of the tab?

In two weeks, we'll know who gets to manage this policy failure.

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