Archive for the ‘Health Care’ Category.

LOL, Going to See a Lot of These

Got this from some Republican group (the "virtue" of being a libertarian is that I get bipartisan spam).

Tim Bishop = ObamaCare 

Bishop Has Been a Co-Conspirator in the Disaster That is ObamaCare; It’s Time for Him to Apologize For This Colossal and Expensive Mistake 

WASHINGTON – Today, in a rambling press conference, President Obama admitted he “fumbled” the ObamaCare rollout. And the president even warned of more problems to come.

Tim Bishop has been a vocal ObamaCare supporter from the beginning—voting for the bill in 2010 and giving the president a blank check on ObamaCare time and time again. Now that the law is becoming more of a disaster every day, Bishop needs to answer for the higher premiums and canceled plans facing families in his district.

Didn't even know who this dude was until I checked (US Representative from NY, apparently).  I expect to see a lot of this.  At least for now.  Things can change quickly.  After all, just 30 days ago the Republicans were supposedly on the ropes from self-inflicted wounds vis a vis the shutdown.  Now, no one even remembers it.

WOW! Incredible Contradiction in October Exchange "Enrollment" Report

I have not seen anyone notice this yet, but perhaps it is just because I have obsessed over the pathetically bad Commonwealth Fund survey whose findings were demolished by the numbers in the October report (here and here).  Well, it turns out, the October report actually proudly highlights the Commonwealth Funds report,  and quotes this line from the Commonwealth Fund in Appendix D:

Of those who have visited the Marketplace, 21 percent enrolled in a plan.

WTF are you doing including this survey finding in a report that essentially makes a laughing stock of this very finding?  Let's review what numbers we have in the October report:

  • From our chart here, the people covered by a "clicked" plan (sorry, but that is their circumlocution, not mine) were 106,185  (note this is generous because it is not actual enrollments, which will be less)
  • From the same chart, the people who were found eligible for Medicaid were 396, 261 (note this is generous as this is not actual enrollments, which will be less).
  • Finally, from the same source are total web visitors times 1.78  family members per visitor (to make our ratio apples to apples) of 47,840,217.  See here for further explanation of why this calculation is necessary

This gives us a percentage of web visitors of 1% that managed to do something kindof sortof close to enrollment.

This demonstrates just how insane the 21% figure is from the deeply flawed Commonwealth study.  So why in the hell is the Obama Administration quoting it as authoritative in their report?  Do they think anyone is dumb enough to use the 21% figure instead of the 1% figure?  Is this just providing ammunition to political hacks who want to spin the story in Obama's favor?  Did the Administration or possibly OFA actually pay for that study?

The only effect including that 21% number has on me is to say that Obama likely has a bigger problem -- If 21% of visitors THINK they enrolled and less than 1% actually did so, aren't a lot of people in for a rude shock?

Verbal Gymnastics and the Enrollment Report

I did not want this to get lost -- in an Enrollment report that used the word "enroll" or some variant 229 times, the one thing the report was missing was the actual number of people who had enrolled.  On the Medicaid side, the report said how many had been found eligible but not how many had enrolled.  On the private side, the best we get is this, which is just a classic of the political art:

106,185 (10 percent) of the 1,081,592 total Marketplace plan eligible persons have already selected a plan by clicking a button on the website page.

The obvious language would have been "106,185 enrolled in a plan" or "bought a plan."  But it does not say this, despite the fact that the Obama Administration certainly has the relevant number.  What this means is that 106,185 people ... OK, a quick aside.  It is not actually 106,185 people being successful on the web.  This is the number of people who would be covered in plans "clicked on" by visitors.  The total number of clicks is well under this -- likely something like 60,000, if the ration of 1.78 persons per application holds from the other numbers in the report.  So this is the number of people covered in something like 60,000 plans that visitors did the equivalent of putting in the online shopping cart but may not yet have paid for.

Well, maybe the number paid is really close to 106,185.  Hah!  I can disprove that quite simply:  We were not told the number.  QED it sucks.

Insurance Companies Got Thrown Under the Bus Today. And They Know It.

Well, so much for the implicit gag order Obama has had on the insurance companies.  Bet we will find out a lot more interesting details about the exchange rollouts now.

[T]he White House has its own idea to stop the bleeding: Allow insurers to renew existing plans in 2014 (which means they could continue into 2015) while forcing them to send Landrieu-like letters explaining why their plans don’t conform to the Affordable Care Act’s standards.

This doesn’t really ensure anyone can actually keep their plan — which means it also doesn’t affect premiums in the exchanges. But it makes it easier for Democrats to blame insurers for canceling these plans. And it perhaps makes it easier for the White House to stop congressional Democrats from signing onto something like Landrieu or Udall.

The insurance industry is furious. They’ve been working with the White House to get HealthCare.Gov up and running and they’ve been devoting countless man hours to dealing with the problems and they’ve been taking the heat from their customers over canceled plans, and now the Obama administration wants to make them into a scapegoat.

“This doesn’t change anything other than force insurers to be the political flack jackets for the administration,” an insurance industry insider told Evan McMorris-Santoro. “So now, when we don’t offer these policies, the White House can say it’s the insurers doing this and not being flexible.”

This is like telling GE to reintroduce 100 watt lightbulbs on thirty days notice, and then blaming them if they don't do it.  Or as I tweeted earlier,

 Update:  Left rallying around Obama, spreading the word that cancellations are all the insurance companies' fault.  I am SO glad I am not affiliated with a political party such that I would feel the need to embarrass myself to support some flailing politician on my team.

The Left has been calling cancelled policies "sub-standard" for months now.  For three years Obama's own folks were estimating that over half of individual policies would have to be cancelled due to the law, and in fact they purposely wrote the regulations narrower to invalidate the maximum number of policies.  But now cancellations are the insurance companies' fault??

Waaaaaaaay Too Late, And I Bet Obama Knows It

Via the WSJ:

President Barack Obama said Thursday that insurers will be able to continue health-insurance coverage next year for current policy holders that otherwise would be canceled under the new health-care law....

"Insurers can offer consumers the option to renew their 2013 health plans in 2014 without change, allowing these individuals to keep their plans," a senior White House official said, previewing Mr. Obama's announcement. These consumers will be given the opportunity to re-enroll, the official said, essentially extending the so-called grandfather clause in the 2010 health overhaul that allowed people to keep their plans if they were in place before the law passed.

"This step today is in the interest of fixing some of the challenges that have arisen" since then, the official said.

Under the plan, insurers are required to notify consumers whether their renewed plans don't include coverage that was required under the new health law, which set minimum coverage standards. They must tell consumers that new insurance options and possibly tax subsidies may be available for policies bought through online federal marketplace.

1.  The President announced this today to try to head off Congressional legislation to do the same thing.  Have we just given up on the rule of law?  Can the President unilaterally modify any law he pleases?  Shouldn't a modification in existing legislation have to come from the Legislature?  Can we just make it official and change the Constitution to say that the President can alter any legislation he wants as long as his party originally passed it?

2.  How is this even going to be possible?   My understanding is that insurance companies spend months preparing the pricing and features of their products for the next year.  The have done no preparation to offer these plans in 2014, because, you know, they were (and still are, whatever the President says in a news conference) illegal.   Its like your wife telling you to take the next exit when you are in the left lane driving 75 miles an hour in heavy traffic and the exit is about 100 yards away.  With 31 business days between now and the new year, how are they supposed to do this?  Or are they even expected to be able to do so?  Is this the President's way to blame shift to insurance companies?

Update:

How To Read the Evasive October Health Exchange Numbers

So the October exchange data is out and the report is a bit hard to follow, in part because it dodges and weaves trying to put the best face on things.  Fortunately, I have years of experience as a corporate planner digging into numbers from division heads trying to disguise what a train wreck their results are.  So here are the numbers in a simple graphical form (click to enlarge)Obamacare-October-Numbers2

Here is a simple narrative following these numbers: The exchange web sites had 26,876,527 visitors representing 47,840,217 estimated potential insured persons.  Of these, 846,184 applications have been completed covering 1,509,883 persons, of which applications covering 1,477,853 persons have been processed by the government to test eligibility.  Of these reviewed applications, 396,261 persons were eligible for Medicare or some other free program while the rest needed private coverage.  Of these, about a third were deemed eligible for a subsidy.   About 10% of those people eligible for private coverage have put a plan in their shopping cart, though it is unknown how many are subsidized and how many are not.  An unknown number have actually purchased insurance.  An unknown number of Medicaid eligible people actually have enrolled.

There are some real problems with the report's presentation.  Here are the worse issues:

  • They switch back and forth between applications and persons covered by applications (which is about 1.78 persons per app.)   This is presumably a bid to make the numbers as large as possible.  All the numbers above the first one in the chart above are persons covered by applications, not applications.  As you can see, I have converted the web site visitors to this same basis so we can get an apples to apples sales funnel.  Note that this means the 106,185 number for people who have "chosen a plan" is actually a lot fewer applications, perhaps less than 60,000.
  • They leave out the three numbers any reasonable person would most want to see.  How many people actually signed up and (if appropriate) paid for coverage?  Those numbers are completely missing.   How many Medicaid eligible people actually enrolled? How many of the 106,185 people covered by a plan in a shopping cart actually paid  (the shopping cart abandonment rate at private websites is about 2/3, if I remember correctly)?  And how much did these enrollments cost the taxpayer in terms of subsidies?

As bad as this report is for the administration, the truth is actually worse, as they have assiduously avoided including the numbers a reasonable person would want to see.  Without any other evidence, I have to assume that these obvious numbers were left on on purpose because they were awful.

 

Why You Should Be Very Skeptical of Low-Sample-Size Advocacy Group Polling

A while back, I pointed out this poll from some group called the Commonwealth Fund.  In mid-October, on average about 15-18 days into the exchange process, they polled a group of non-corporate-insured adults (e.g. individual market or uninsured) about whether they had visited an exchange and what had been their experience.

The finding that stood out to me was that 21% of the people they interviewed that said they had visited an exchange reported that they had signed up for a policy (from the wording of the question, this probably includes both private policies and Medicaid signups).

I thought this seemed crazy-high.  And now new data from the Administration is confirming it.   The Administration is reporting about 106,000 "selected a plan" in October -- a very generous definition since it includes people who put a plan in their shopping cart but did not purchase it.  Not a definition of a sale that Amazon.com would ever use.    Further, another 400,000 or so were "found eligible" for Medicaid, whatever that means though it sounds well short of "enrolled."  So call it generously 500,000 people by the end of October.  The other key bit we need is that the Administration is reporting about 27 million unique visitors to these sites.  So at best we are looking at 1.9% of exchange visitors kind-of-sort-of-maybe having done something that approaches being enrolled.

This puts the Commonwealth Fund polling an entire order of magnitude off, at 21% vs. 1.9%.  And remember their survey occurred in the middle of the month, when the web site was not even working, and one can assume that successful enrollments were back-end loaded in the month.  The CF was nice enough to respond to my emails but were unable to explain the discrepancy, other than the sample size was low making the results unreliable.  So why the hell do it, and then put out a press release?

One explanation for part of the discrepancy may be in those who have created user accounts (normally a trivial task on a private site but a Herculean accomplishment on Healthcare.gov) but have not actually purchased a plan.  The Obama Administration says that there are about a million of these, so in addition to the 1.9% that put a plan in their shopping cart, there are another 3.7% that created a user account and gave the Feds enough info to assess subsidy eligibility, but who have not selected a plan.  Remember, that this was the minimum hurdle the Obama Administration originally set even to see insurance plan prices, and is still the minimum hurdle to get a subsidy quote.  It will be interesting to see the conversion rate of people once they find they are not getting free stuff from Uncle Sugar.

Even so, this only adds up to 5.6% of people who visited the exchange and had any sort of success (in most cases far short of enrollment) at all.  Way short of 21%.  Remember that we you see "studies" like this in the future.

When Hacking is Unnecesary

The Feds are claiming they know of at least one Denial of Service (DOS) attack on the Obamacare exchange.  Talk about irrelevant.   This is a site that crashes under the onslaught of about a dozen regular users.  A DOS attack could be executed by me and three of my friends just by trying to log on and create accounts.  First day exchange visitors are guilty of an unwitting DDOS attack just for navigating to the site.

I was just thinking this morning that it would have been a funny Onion article to show some average schlub with a headline that Joe Smith was being accused of a DOS attack for visiting the exchange on October 1.

Your Health Insurance Got Cancelled For These People

I had fun photoshopping (here, here) the first batch of these ads.  But now they seem to have entered the realm of self-parody, so here are some of the actual ads, without modification (source).

As a libertarian, I have no desire to grade the choices they are making.  I just don't want to subsidize them, though this seems to be the proud message of the ad campaign:  "Obamacare subsidizes bad choices and dangerous behavior".

57

63

This has to be one of the more bizarre moments in the history of insurance.  Never before has any insurance company likely ran ad campaigns aimed at attracting the worst risks.  The irony of course is that President Obama needs to sell this to young people precisely because most of them won't use it.

Legislators Pressuring Insurance Companies to Extend The Policies That Legislators Forced to Be Cancelled

Just to prove that there is no end to the arrogance and moral bankruptcy of politicians:

Federal lawmakers and state officials are stepping up pressure on insurers to allow consumers whose coverage has been canceled in response to the health overhaul to keep their policies beyond the end of the year.

On Tuesday, one of the largest regional health plans in the nation, Blue Shield of California, said it would relax its stance on terminated policies for about 115,000 people after state regulators demanded it do so. Customers now will have until March to decide which plan to choose for 2014, a three-month extension. Because the newer plans generally cost more, the extension could save residents as much as $28.6 million on premiums, said Dave Jones, California's insurance commissioner....

The move by Mr. Jones, an elected Democrat, comes as some other Democrats are seeking ways to allow individual policyholders to keep their current health plans and to defuse the issue of canceled plans, which has become a headache for supporters of the law.

Cancellation letters are expected to be sent to as many as 10 million Americans who buy coverage directly from insurers, rather than through an employer or government program. While these individuals would have to buy new policies, regulators and lawmakers say the extensions would give them more time to shop for an affordable new plan—particularly because continuing problems with insurance exchange websites are preventing many of these consumers from finding new coverage.

This is incredible.  Senator Mary Landrieu, for example, has now introduced a bill that would reverse some of the rules that are forcing insurers to cancel policies, essentially the same bill she voted against 3-1/2 years ago.

Commonwealth Fund Thinks 21% of October Health Exchange Visitors Enrolled in A Plan. This is Either Good or Bad News for Obama

Here is a link to the study, via Information Week.  Here is the key chart:

click to enlarge

 

First, this includes people who signed up for Medicare, which is a good chunk of the state exchange signups to date.  Signing uninsured up for Medicare is meaningless, as they don't even need to be signed up to get the benefit (a hospital will enroll them if they were to come in for a visit).

Second, this is either very good news or very bad news for the Administration.

If true, which I seriously doubt, it would mean that the exchanges are a wild success.  A 21% conversion rate would be awesome even for a private retail web site, and would likely imply over a million enrollments in October.

However, there is a very good chance that in fact this is very bad news.  Since this is based on survey data, it means that 21% THINK they enrolled.  But what very well may have happened is that they eventually were successful in creating a user account, and believe that having an exchange user account means they are enrolled for insurance, which is clearly not true.

We shall see.

 

It Turns Out That Democrats Were Responsible for the Watergate Coverup

The Washington Post has a very good article on failures of Obamacare exchange implementation.  The Left is finding the article to be convincing evidence that the failures were all ... wait for it .. the Republican's fault.

Every single failure, save one, in the article (we'll come back to that one in a minute) was due to the Administration's fear of Republican criticism.  So results were hidden, bad decisions were made, and key steps were delayed until after the last election.  All because the Obama Administration appears to incredibly thin-skinned about criticism.

But blaming these decisions on Republicans and other Obamacare opponents is absurd.  One could easily say that the bad decisions made by the Nixon administration to cover up Watergate and other campaign shenanigans were driven by a fear of political reprisals by Democrats, but no one would be crazy enough to blame the Democrats for them.  It reminds me of the folks who wanted to blame failures in the Vietnam war on the anti-war movement.  But that is exactly what is going on here, and the amazing thing is just how many people seem willing to enable and support this incredible evasion.

The one other example that Republicans are supposedly to blame is latched onto by Kevin Drum, among others, quite eagerly.  Apparently, the PPACA legislation, which was written entirely by Democrats and passed without a single Republican vote, failed to actually provide financing for an enormous new organization to build and run the exchanges.  And, amazingly enough, Republicans refused to fix the Democrat's problem with the Democrat-written legislation in a law they hated and wanted repealed.  So the Obama Administration had to build the exchanges within the existing CMS organization, which botched the implementation.  And for THAT, apparently Republicans are to blame for it all.

Of course, beyond the just bizarre "buck stops anywhere but here" mentality, there are other problems with this logic.  First, it is hard to believe that a brand new greenfield organization run entirely by Obama's policy folks and completely without any systems experience would have done better than an organization that at least has some health care systems experience.  Further, would the schedule really have been aided by having to start an entirely new organization from scratch?  Finally, it is clear from the article that a large part of the reason for moving the work to CMS was not just money but a desire to avoid transparency, to bury and hide the work.  Even had the financing mistake** not been made, one gets the sense that Obama might have buried the effort inside CMS anyway.

In fact, this is the overriding theme from the entire article.  Every decision made for the Obamacare implementation seemed to be driven by political expediency first, avoiding transparency and accountability second, and actual results last.  It is well worth reading yourself to see what conclusions you draw.

 

** I am not entirely convinced it was a mistake.  Remember, the Democrats were scrambling to make the PPACA seem budget neutral.  They might easily have left out key bits of financing they know they needed, thinking they could hide the appropriation later.   A plan that died when Scott Brown was unexpectedly elected.

 

Low Information Senator

I have understood for years that politicians are power-hungry, irresponsible, ego-driven, and not nearly as bright as the image they like to project.  But some people still seem to trust them, even at times idolize them.  Post-Obamacare, how is that even possible.  Check out this interview with Senator Feinstein.

SCHIEFFER: The president said in the beginning that one thing was that if you liked the health care program you had, you could keep it. We now know there was debate within the administration before he said that as to whether that was actually a promise that could be kept. Should the president not have made that statement?

FEINSTEIN: Well, as I understand it, you can keep it up to the time — and I hope this is correct, but this is what I’ve been told — up to the time the bill was enacted, and after that, it’s a different story.  That part of it, if true, was never made clear.

You have heard the term, "low information voters" but this is the low information Senator.  Either that, or she is the dumbest liar on Earth.  She seems to have no idea what is actually in the most substantial piece legislation she has helped to pass in the last 10 years.  And as spin goes, this has to be the lamest.

Politicians Lie By Default. They Lie Even When The Truth Is Easy To Check. Haven't We Figured That Out Yet?

Via Reason's Hit and Run

In the opening days of Obamacare’s October 1 launch, federal officials touted high web-traffic numbers, but repeatedly refused to provide enrollment data for the federally facilitated exchanges.

On October 3, White House spokesperson Jay Carney, pressed for enrollment numbers, said, “No, we don’t have that data.” On October 7, in an appearance on the Daily Show, Health and Human Services Secretary Kathleen Sebelius repeated the claim when questioned about enrollment: “I can’t tell you,” she said, “because I don’t know.”

But that simply wasn’t true—at least not during the first few days.

Leaked meeting notes from high-level war room briefings inside the federal health bureaucracy on October 2 and October 3 report that federal officials were aware of the exact number of federal enrollees on the first and second days in which the exchanges were running.

And, as seemed likely at the time, it turns out that the numbers were very, very low.

According to the notes, which were released by the House Committee on Oversight & Government Reform and taken from daily briefings in the Center for Consumer Information and Insurance Oversight, the federal office directly in charge of the exchanges, there were just six successful enrollments across the 36 federal exchanges on launch day.

A friend by the way sent me this stat:  Of the 5 million first day exchange visitors, more will be hit by lightening this year than successfully enrolled that day

Kathleen Sebelius's Testimony on Web Site Difficulties Now Posted on YouTube

More Totally Bogus Obama Excuses

Here is his new excuse for his "you can keep your health insurance" promise being broken.  It is -- wait for it, you will never guess -- insurance companies' fault.

"One of the things health reform was designed to do was to help not only the uninsured but also the under-insured," Obama said. "And there are a number of Americans, fewer than 5 percent of Americans, who've got cut-rate plans that don't offer real financial protection in the event of a serious illness or an accident.

"Remember, before the Affordable Care Act, these bad apple insurers had free rein every single year to limit the care that you received or used minor pre-existing conditions to jack up your premiums or bill you into bankruptcy."

This is absurd.   Kaiser Permanente cut zillions of policies.  Are they a bad apple?  My policy was cut by Blue Cross / Blue Shield of Arizona.  Are they some fly-by-night cut-rate insurer?

The Meaning of "Period"

Frequently, in selling Obamacare, President Obama and Administration officials said that if you like your health insurance you can keep it, period.

Suddenly, as of yesterday they are arguing that there were actually all sorts of implicit asterisks to this promise.  The exact meme is still evolving retroactively, but the favored excuse is to say that of course this promise only applied to "real" insurance, "real" being defined as having the features the President thinks the policy should have  (this despite the fact that the promise very clearly defines insurance suitability based on the customer's, not the President's, preferences -- he said if you like your insurance, not if I like your insurance).

But what strikes me is the word "period."  This word adds no extra detail to the promise.  The only point to including it is to emphasize that this is the entirety of the promise, without any additional disclaimers or elaborations necessary.   By saying "period", Obama was saying that there were no asterisks, no hidden small print.

SopranoCare

Via the Daily Caller:

The White House is pressuring insurance companies not to speak publicly about Obama administration policies that could eliminate the existing health insurance plans of millions of Americans.

The administration made “clarifications” to the 2010 Affordable Care Act after it was passed that have already wiped out hundreds of thousands of existing health plans.

“Basically, if you speak out, if you’re quoted, you’re going to get a call from the White House, pressure to be quiet,” said CNN investigative reporter Drew Griffin on Anderson Cooper 360 Wednesday night. Insurance companies executives, Griffin said, ask heads of consulting firms not to criticize the Obamacare rollout debacle publicly.

“They feel defenseless before the White House P.R. team,” Griffin said. “The sources said they fear White House retribution.”

Prior to the Obamacare rollout, insurance companies issued warnings to the White House about the possibility of mass cancellations, which the administration ignored.

As has become usual of late, Jay Carney channels Ron Ziegler with this absurd answer.  Apparently, the fact that insurance companies are still engaged in routine conversations with their customers proves they have not been silenced from publicly criticizing Obamacare.

White House press secretary Jay Carney, however, waved off the allegations.

“That accusation is preposterous and inaccurate,” Carney said. “Plus, it ignores the fact that every day, insurance companies are out talking about the law, in large part because they are trying to reach new customers who will now have new, affordable insurance options available from providers through the new marketplaces.”

The Real Health Insurance Shock Is Coming Next Fall

Obviously, the whole Obamacare implementation is in disarray.  Some of this I expected -- the policy cancellations -- and some of it I did not -- the horrendous systems implementation.  But I actually thought that most of this would be swept under the rug by a willing media.

What I really expected was for the true shock to come next fall.  And I think it is still coming.  I believe that despite rate increases, insurers are likely being overly optimistic about how much adverse selection and cost control issues they are going to have.  As a result, I expected, and still expect, huge premium increases in the fall of 2014.

Why?  The main benefit of Obamacare is for people who cannot afford health insurance but want it, and for people who are very sick and have lost their insurance.   Obamacare is a terrible plan as implemented because it futzes with virtually everything in the health care system when a more limited plan could have achieved the same humanitarian coverage goals.

Anyway, one reason Obamacare is so comprehensive is that it is based on a goal of cost control for the whole system.  Unfortunately, most all of its cost control goals are faulty.  From Megan McArdle, in an amazing article covering a huge range of Obamacare issues:

But I think it’s also clearly true that the majority of the public did not understand this. In 2008, the Barack Obama campaign told them that their premiums would go down under the new health-care law. And the law’s supporters believed it.

Q. Obama says his plan will save $2,500 annually for my family. How?

A. Through a combination of developing efficiencies in the system, expanding coverage to all Americans, and picking up the cost of some high-cost cases. Specifically:

-- Health IT investment, which will reduce unnecessary and wasteful spending in the health care system. Examples include extra hospital stays because of preventable medical errors and duplicative diagnostic tests;

-- Improving prevention and management of chronic conditions;

-- Increasing insurance industry competition and reining in the abusive practices of monopoly insurance and drug companies;

-- Providing reinsurance for catastrophic cases, which will reduce insurance premiums; and

-- Ensuring every American has health coverage, which will reduce spending on the “uncompensated” care of uninsured people who end up in emergency rooms and whose care is picked up by institutions and then passed through higher charges to insured individuals.

The part about reinsurance was always nonsense; unless it’s subsidized, reinsurance doesn’t save money for the system, though it may reduce the risk that an individual company will go broke. But the rest of it all sounded entirely plausible; I heard many smart wonks make most of these arguments in 2008 and 2009. However, it’s fair to say that by the time the law passed, the debate had pretty well established that few to none of them were true. “We all knew” that preventive care doesn’t save money, electronic medical records don’t save money, reducing uncompensated care saves very little money, and “reining in the abusive practices” of insurance companies was likely to raise premiums, not lower them, because those “abuses” mostly consist of refusing to cover very sick people.

The result?  Many of these things that supposedly reduced costs actually increase them.  So if you think the shock is high now, wait until next fall.  We will see:

  • Rates going up
  • Less choice, as insurers pull out of many local markets
  • Narrowing of doctors networks, and reduced choice in doctors
  • Companies dropping health care and dumping workers (and retirees if they can get away with it) into the exchanges and Medicare.

The Arrogance of Obama, and Obamacare

So I guess the Left has hit on its favored meme in response to the millions of insurance cancellations.  From Obama to Valerie Jarrett to any number of bloggers, the explanation is that the cancelled policies were "sub-standard".  We may have thought we liked them, but it turns out we were wrong.  Deluded in fact.

These folks -- despite not knowing my income, my net worth, my health situation, my age, my family size, my number and age of kids, my risk adversity, my degree of hypochondria, my preventative care habits, my diet, my lifestyle, my personal preferences and priorities, or any details about my insurance policy that I spend many hours analyzing and cross-comparing -- have decided they know better than I what health insurance I should want.

My plan was not substandard.  I graduated magna cum laude in engineering from Princeton and was first in my class at Harvard Business School.  I spent hours shopping for my coverage and was fully satisfied with my resulting policy.  Many of the aspects of my policy that cause Obama to call it "sub-standard" -- lack of mental health care, lack of pediatric dental care, lack of maternity care, lack of free contraception, a higher than average deductible -- were my preferences.  I got what I wanted.

More expensive, more highly featured products are not necessarily "better".  A Mercedes is not necessarily the best car choice for a middle class buyer just because it has more features than his Taurus.  Would Obama tell that person his Taurus is "sub-standard" and force him to pay for a Mercedes? If not, why the hell is doing the exact same thing but with health insurance OK?

From his speech today, via Bryan Preston

When Obama came to that section of his speech when the line usually falls, he went with a new spin. If you’ve lost your healthcare thanks to his law, he wants you to know that you were just “under-insured.” Because he says so.

“One of the things health reform was designed to do was to help not only the uninsured but also the under-insured,” he said.

“If you had one of these substandard plans before the Affordable Care Act became law, and our really liked that plan, you are able to keep it. That’s what I said when I was running for office.”

“But ever since the law was passed, if insurers decided to cancel or downgrade these substandard plans, what we said, under the law, is you have got to replace them with quality, comprehensive coverage,” he said, “because, that, too, was a central premise of the Affordable Care Act from the very beginning.”

Update:  ugh

Screen shot 2013-10-30 at 9.12.14 AM

Update #2:  Yesterday I said the time seemed right for the Left to pick a meme to explain the insurance cancellations and then give the media its marching orders.  David Firestone of the NYT has gotten the memo

The so-called cancellation letters waved around at yesterday’s hearing were simply notices that policies would have to be upgraded or changed. Some of those old policies were so full of holes that they didn’t include hospitalization, or maternity care, or coverage of other serious conditions.

Republicans were apparently furious that government would dare intrude on an insurance company’s freedom to offer a terrible product to desperate people.

“Some people like to drive a Ford, not a Ferrari,” said Marsha Blackburn of Tennessee. “And some people like to drink out of a red Solo cup, not a crystal stem. You’re taking away their choice.”

Luckily, a comprehensive and affordable insurance policy is no longer a Ferrari; it is now a basic right. In the face of absurd comments and analogies like this one, Ms. Sebelius never lost her cool in three-and-a-half hours of testimony, perhaps because she knows that once the computer problems and the bellowing die down, the country will be far better off.

So you see the talking points as the media gets their orders.  1.  All policies that were cancelled were sub-standard.  2.  People will be better off with more expensive policies, even if they are too dumb to konw it.

My policy was perfectly fine.  I was not tricked.  I am willing to bet I am at least as smart as David Firestone.  I am positive I am smarter than Barrack Obama.  And yet my policy was cancelled.

What Obama Meant When He Made His Health Insurance Promise

I thought this is a great description of what Obama really meant

And folks, the opponents of my plan are trying to scare you. But if you like your health insurance the way it is, and if I like your health insurance the way it is, then you can keep it.

Seriously, this is how Jay Carney explains it

White House press secretary Jay Carney on Tuesday said President Obama's claim that all Americans could keep their health insurance plans under the new health law deserved a “fuller explanation,” acknowledging millions of consumers would not keep their current coverage.

After the passage of Obamacare, the president has repeatedly insisted that if any individual likes their health care plan, they could “keep it.”

Carney on Tuesday added a crucial caveat to that promise, saying Americans could keep their insurance if the plan is “still available.”

This is absolutely absurd.  The whole meaning of the "If you like your health insurance..." promise was that the government would not ban your current policy, that the program was simply about adding options for the uninsured, not reducing options for the insured.  Now Carney was saying, as if we all should have known, that what Obama meant was that you can keep your policy as long as we don't ban it.

 

 

White House Still Promising That I Can Keep My Health Insurance

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Seriously, I don't have to change a thing!  Web site here, at least until they decide to hide it.

WhiteHouse.Gov Still Lying about Keeping Your Health Insurance

This was on the White House web site at 5:30 EST today, October 29, 2013.  Look at the second to last paragraph.  You can click to enlarge.

click to enlarge

 

In case you can't read it, here is just that paragraph full size

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I am as cynical as one possibly can be about politics and this even amazes me.

Why The Administration Could Not Delay the Exchanges, Even When They Clearly Did Not Work

I think it is now clear why the Administration could not delay the exchanges, even when Republicans essentially cast them a lifeline during the budget debate by trying to delay the mandate by a year:  I think the Administration knew that a massive wave of insurance policy cancellations were already in the mail, and that the recipients of these letters would be facing huge price increases for their policies.

It is telling that the one thing you are NOT hearing from Administration officials in response to the policy cancellations is surprise.  If they were surprised, they would be yelling stuff like, "what the hell are those insurance companies doing?"  They knew this was coming, and you get the sense they were grimly bracing for it to be made public, hoping that perhaps their friends in the media would not make a big deal about it.

The minimum requirements on health plans that is driving these cancellations cannot at this point be cancelled.  Or, put more precisely, they could be cancelled but the act would be meaningless, because insurance companies have no way to suddenly go back to the old policies and pricing.  It takes too much planning to work out their product line and they can't just switch back on a dime.

So the huge wave of cancellations and price increases in the individual market was unstoppable.  That being said, the Administration has to be able to offer an alternative, and the only one they have is the hope one might get his or her new policy subsidized by other taxpayers.  But that is only possible through the exchanges.  So that had to be allowed to go forward and made to work, somehow.

There is no fix to this mess.  This is an avalanche that was loosed three years ago and cannot be stopped.

Who the HELL is Jay Carney to Tell Me My Health Insurance Policy is "Sub-Standard"?

Via Bloomberg

The health-care law eliminates “substandard policies that don’t provide minimum services,” said Jay Carney, a White House spokesman, in response to the cancellations. The “80-plus percent” of Americans with employer plans or covered by government programs are unaffected.

I chose my policy very carefully, and don't think it is "sub-standard" because it does not include pediatric dental care for two people in their fifties.  This is the worst consumer dis-empowerment that I can remember in my lifetime.

And I totally agree with this

Now an effective levy of several thousand dollars on the small fraction of middle class Americans who buy on the individual market is not history’s great injustice. But neither does it seem like the soundest or most politically stable public policy arrangement. And to dig back into the position where I do strong disagree with Cohn’s perspective, what makes this setup potentially more perverse is that it raises rates most sharply on precisely those Americans who up until now were doing roughly what we should want more health insurance purchasers to do: Economizing, comparison shopping, avoiding paying for coverage they don’t need, and buying a level of insurance that covers them in the event of a true disaster while giving them a reason not to overspend on everyday health expenses.

If we want health inflation to stay low and health care costs to be less of an anchor on advancement, we should want more Americans making $50,000 or $60,000 or $70,000 to spend less upfront on health insurance, rather than using regulatory pressure to induce them to spend more. And seen in that light, the potential problem with Obamacare’s regulation-driven “rate shock” isn’t that it doesn’t let everyone keep their pre-existing plans. It’s that it cancels plans, and raises rates, for people who were doing their part to keep all of our costs low.

With my high deductibles, I am actually out shopping every day on health care prices and I can tell you from my experience that if everyone did so, we would see a reversal of health care inflation.  More here