ACA

Two Wednesday Links-Roger Scruton & Megan McArdle

/ chr1 / Leave a comment

Roger Scruton at The New Criterion: ‘Populism, VII: Representation & the people:‘

‘All this has left the conservative movement at an impasse. The leading virtue of conservative politics as I see it is the preference for procedure over ideological programs. Liberals tend to believe that government exists in order to lead the people into a better future, in which liberty, equality, social justice, the socialist millennium, or something of that kind will be realized.’

Is there a global conservative movement or moment happening right now?  Different people, as parts of different and sometimes competing traditions have different things to conserve…

Megan McArdle at Bloomberg: ‘Best Health-Care Plan For Republicans?-Wait‘

‘A plan based on these ideas may, to be sure, end up covering fewer people than Obamacare currently does. But then Obamacare may end up covering fewer people than Obamacare currently does, because it seems to be slowly strangling the individual market.’

One goal was to get various poor and sick people as permanently ensconced and dependent on a vast expansion of federal authority as possible (or Medicaid, for now, while raiding Medicaid).  Don’t mind the rotten deal and bad incentives for many other people that came about (rising health-care costs were unsustainable, after all).

If this meant a vast expansion of money, politics, and power into your life, limiting policy options, limiting many doctors’ freedom to serve you locally and directly, well, it was for your own good.

You see, the designers of the ACA have the knowledge, moral virtue and ability to make everyone’s lives better.  Their principles are universally true, and descriptive of a future they can predict with as much accuracy as a formula predicts the probabilistic path of a particle.  Hard choices, scarce resources, and basic human suffering are mostly a thing of the past.

Health-care is a right derived from these true principles, the knowledge to design the ACA just a matter of implementation now….

What was that again?

Ah yes, money, politics, and power.

Megan McArdle At Bloomberg: ‘A Sign That Obamacare Exchanges Are Failing’

/ chr1 / Leave a comment

Full piece here.

‘Molina’s losses suggest that instead of stabilizing, the exchanges are getting worse. There is no way to fix Obamacare without fixing the pool so that younger, healthier people buy insurance.’

For the most part, there’s no way to induce younger, healthier people into a system working against so many of their interests except by force of law and punishment; force which was barely concealed by particularly daft and short-lived political promises.

Pools of risk must deal with reality, and if you start from the idea of health-care as a right to be promised and guaranteed by a group of people in charge of government (claiming to speak for all People), rather than starting from the idea of health-care as a resource to best be distributed by price signals and market forces; by individuals making hard choices and sacrifices for themselves and their loved ones, then you’re more likely to get worse outcomes.

There’s also probably no way to really get the people who designed this law, the people who have pretty high IQ’s, trained at many of the best schools, to ever really examine the beliefs and principles that likely led to such failures, because that’s not how most people, most of the time, really operate.

More politics, and more people fighting over more politics to come…

Epstein on Obamacare’s Moral Blindness, the Obamacare Quagmire, and Watching Obamacare Unravel.

Still Looking For Alternatives-Charlie Martin At PJ Media: ‘Obamacare vs. Arithmetic’

Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’…Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Hard Decisions Regarding Obamacare And More Signs Of The Times

/ chr1 / Leave a comment

In response to Megan McArdle’s piece: ‘Republicans Should Save These 3 Unpopular Parts Of Obamacare.‘

Via The Goldwater Institute: ‘Where The Right Shouldn’t Go Wrong On the ACA‘

‘The usually spot-on McArdle misses the mark this time.

It is no exaggeration to say that, because it is immune from judicial, executive and legislative review and oversight, IPAB is the most dangerous consolidation of unchecked government power in American history. That is why it should be a top priority in ACA repeal efforts.’

Meanwhile, A. Barton Hinkle at Reason has a few suggestions:

‘Obamacare tries to solve the problem of pre-existing conditions the Rube Goldberg way: Make insurers cover individuals no matter what, then guard against people buying coverage only once they get sick by forcing everybody to purchase a policy through the individual mandate—an unprecedented expansion of government power.’

Hard choices will have to be made, choices which may quite literally mean death, or a sooner death, for some people than otherwise would occur.

Yet, in a world of scarce resources, these decisions are being made every day, and this blog believes if you want the greatest number for the greatest good, you must treat health care like the market it is, getting the incentives right and letting as many individuals (you and me) negotiate those hard choices with as many market and price signals as possible.

Once health-care becomes a ‘right,’ it becomes a sacred cow to be slowly milked by people who claim to have the knowledge to milk that cow, but whose claims to knowledge, I don’t believe, can negotiate reality beyond the political and economic influence they seek and the often ideological lights which guide them.

This failure of design will fail more spectacularly in the long-run, and lead to more suffering.

On that note, I don’t necessarily dream of a world of old W.A.S.P. establishment types making the important decisions which affect my life; nepotistic, clubby, but hopefully honorable and capable of broader sacrifice beyond their spheres of belief and interest.

I would just rather have the guys out on the golf-course swapping stories, finding camaraderie and making subtle judgments about each other’s characters to have the right incentives, having to serve customers and do right by their families when possible.

You know, be held to their own past decisions and frankly, not to have too much power.

Let’s spare everyone the bullshit of having any individuals be inherently any better or worse by their status as a group-identity member.

That way lie(s) fiefdoms and Balkanization.

On that note, I would rather as few people as possible getting rich solely through politics, but some signs are not good.

Culturally, I suspect many are drifting towards ideals that will retrench some of the old government/big business connections found throughout the boomer generation, but now with the standard-issue European secular humanistic ideals and their discontents playing a more important role.

Please tell me all the ways I’m wrong, here:

I keep putting up this quote from Ira Stoll:

‘Indeed, if there is a single fact that sums up the state of American political economy at the present moment, it is this: the Boston office building once home to Inc. Magazine and Fast Company, which chronicled and celebrated small and fast-growing businesses, is now the headquarters of a publication called “Compliance Week.”’

Two Links On Obamacare: Megan McArdle & Ricard Epstein

/ chr1 / Leave a comment

Megan McArdle from December 5th, 2016:

‘For Obamacare’s critics, of course, allowing the exchanges to collapse under their own weight might be politically preferable to passing a bill that can then be blamed for the inevitable denouement. Republicans are now discovering the unhappy truth first learned by the Obama administration: Talking about what you’d like to do with America’s convoluted health-care system is a lot easier and more enjoyable than actually doing it.’

Richard Epstein revisits some of his original predictions, and explains his reasoning as to why the exchanges would inevitably collapse.

In order to implement the ACA, you first must control markets, making deals with the insurance companies to get them in by offering taxpayer (other people’s) money and promising them captive consumers and competitive advantages. This will centralize and bureaucratize the health-care industry and naturally continue many of the market distortions in place. Then you must force younger, healthier people into involuntary arrangements which often work against many of their interests.

Political influence and populist sentiment are the main levers in pursuit of your vision of a better society.

Of course, if much of your identity is dependent upon a political ideology and moral belief system which promises equality and fairness through redistribution of the ‘fixed economic pie’, then these details are post-hoc…your fight is righteous and your enemies the cause of most if not all failures of policy design.

Previously: Charlie Martin here:

‘Whatever solution we look for though, the really important point is this: the whole basis of Obamacare, the notion that we can have more people, getting more benefits, and pay less, is just impossible. The arithmetic doesn’t work. And if you think that’s “unfair,” I’m sorry.’

Epstein on Obamacare’s Moral Blindness, the Obamacare Quagmire, and Watching Obamacare Unravel.

Still Looking For Alternatives-Charlie Martin At PJ Media: ‘Obamacare vs. Arithmetic’

Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’…Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Freedom To Choose-Megan McArdle At Bloomberg: ‘A ‘Tweak’ To Fix Obamacare? That’s A Red Flag’

/ chr1 / Leave a comment

‘A ‘Tweak’ To Fix Obamacare? That’s A Red Flag‘

McArdle:

‘So if all we need to do is persuade Republicans to abandon their objections to Obamacare, and possibly their own electoral futures, in order to bail Democrats out of the mess they created, then we’re all going to be living with these problems for a very long time.’

I’m guessing that when a political actor’s ideas are such that political and legislative authority are more likely to become both means and ends, those who do not share the same moral sentiments driving such means and ends will become more bitterly blamed for any failures of design.

One can even sympathize with the sentiment behind the ACA while recognizing many fundamental problems it has tried to address, to say nothing of the sad, grubby politics involved in its passage.

As I see it, during the past eight years, political and legislative authority have become much more easily incentivized in each one of our lives.

Gaining and exercising political power is currently justified by those in power as necessary to correct past injustices, within the moral commitments of common causes which unite against these injustices, towards presumed liberation (many ‘-isms’ are providing the moral, intellectual and ideological glue to hold political coalitions together long enough to wield the power that got the ACA passed).

Previously: Charlie Martin here:

‘Whatever solution we look for though, the really important point is this: the whole basis of Obamacare, the notion that we can have more people, getting more benefits, and pay less, is just impossible. The arithmetic doesn’t work. And if you think that’s “unfair,” I’m sorry.’

Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Richard Epstein At The Hoover Institution: ‘The Obamacare Quaqmire’

From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”…Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’…

Alternatives to Obamacare, Red & Green Nuttiness-Some Links

/ chr1 / Leave a comment

-Tyler Cowen’s post from 2009:  ‘What Should We Do Instead Of The Obama Health-Reform Bill‘

Richard Epstein looked pretty prescient on what the law’s specific challenges are:

‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily’

Avik Roy summed his thoughts up nicely:

‘Any serious health reform program—left, right, or center—would involve some disruption of our existing health-coverage arrangements. What makes Obamacare such a deeply flawed piece of work is not that it disrupts our existing arrangements, but that it disrupts those arrangements by forcing people to buy costlier coverage.’

The force is exactly the problem for folks concerned about the politicization of money, the expansion of authoritarian bureaucracy driven by activists into ever more corners of American lives.

You know, something that works.

What comes next isn’t exactly clear…

As for my own conspiratorial suspicions, I expect an influential cohort, if not an editorial majority of the NY Times to soon resemble that of Britain’s ‘Guardian‘ (that’s Vanguardian to you, you neoliberal bourgeois sell-out).

Here is a Guardian headline tumblr page to help clarify: So.Much.Guardian.

Jezebellians writing about the NY Times have discovered a plot:

https://twitter.com/shaneferro/status/768177207122493440

Do I make any predictions?

Predictions require knowledge I don’t actually have and committing to a standard to which I could actually be held.

I simply brace myself for these things ahead of time, and invite you into a confederacy of predictive anticipation, dear reader.

–

From Jill Stein’s Green Party page…the whole nutty thing seems pretty red:

It’s time to build a people’s movement to end unemployment and poverty; avert climate catastrophe; build a sustainable, just economy; and recognize the dignity and human rights of every person. The power to create this new world is not in our hopes; it’s not in our dreams — it’s in our hands.

I can’t speak to Britain’s Green Party, but neither can anyone else apparently.  Via David Thompson: ‘Incredibly Awkward Interview With Natalie Bennett.’

A train-wreck on the air with a lot of coughing.  If some Britons aren’t engaged in the magical and doomsday cult thinking of back to nature utopianism, they’re apparently channeling that magical thinking into the Green Party political platform of free houses and money-tree utopianism. Good to know.

Megan McArdle At Bloomberg: ‘Aetna’s Retreat From Obamacare Is More Than It Seems’

/ chr1 / Leave a comment

Full piece here.

McArdle:

‘Insurers cannot simply go on eating those losses forever. They certainly won’t do so for free. Unless the exchanges get a rapid infusion of healthier customers who pay substantial premiums without using much care, insurers are going to keep pulling out of the areas where they are losing money. Or at the very least, they will demand benefits from the government to make it worth their while to stay.’

Sigh.

As previously posted:

Pascal Emmanuel Gobry here.

‘One ray of sunshine might be an involuntary heightening of the contradictions: The structure of the Affordable Care Act, by removing health care decisions even further from consumers, all but ensures that costs will escalate even faster. At some point, most employers in America will only be able to afford catastrophic health insurance for their employees. If and when that irony busts onto the scene, perhaps real consumer dynamics will emerge, and perhaps America will stumble backward into a Singapore-style system.’

Or it might make this country stumble into the single-payer model after those who wrote the law ridiculously stretched the truth in order to sell it to the American people.

Sally Pipes has had experience with this kind of thing in Canada.

Once you make a scare economic good a ‘right,’ you’re just fighting over who controls the good, which, in most cases, leads to less for a vast majority, and the most advantage for those who need your money most in order to gain political power and influence.

Charlie Martin from a while ago:

‘Whatever solution we look for though, the really important point is this: the whole basis of Obamacare, the notion that we can have more people, getting more benefits, and pay less, is just impossible. The arithmetic doesn’t work. And if you think that’s “unfair,” I’m sorry.’

Related On This Site:  Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’…Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Richard Epstein At The Hoover Institution: ‘The Obamacare Quaqmire’

From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”…Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’…

Two Sunday Obamacare Links-Free Lunches

/ chr1 / Leave a comment

From The Economist:

‘Yet the share prices of America’s five biggest health insurers—UnitedHealthcare, Aetna, Humana, Cigna and Anthem—have all roughly tripled over the past five years. The big insurers have been consistently and highly profitable (see chart).’

Regulation has some winners, but it’s probably not you…

Megan McArdle on a serious problem with health-insurance:

‘Bankruptcy is terrible. But you’d probably pay a lot less for bankruptcy insurance than you would for insurance that actually made you healthier.’

Of course, this is the whole point of insurance…paying into a pool of risk to cover the losses if/when you face trouble.

The main problem with the ACA for people who think like me, is that coercion is used to round up everyone into a system that’s poorly, if not fatally, designed.

Free-lunches are on the menu, and we’re all now forced into a pact that pays for them with horrible cost/benefit ratios.  If you already think there’s enough spending and taxation, regulation and back-room dealing in D.C….this law ain’t for you either:

‘You can’t really blame Obamacare for the fact that the most “affordable” insurance offers rather scanty coverage for the average user. Though of course, you can blame the law’s architects for overpromising. They should have been more honest, with themselves and with voters, about the limits of what they could actually do. But of course if they had been, the law probably would never have passed.’

Addition:  Avik Roy summed it up nicely:

‘Any serious health reform program—left, right, or center—would involve some disruption of our existing health-coverage arrangements. What makes Obamacare such a deeply flawed piece of work is not that it disrupts our existing arrangements, but that it disrupts those arrangements by forcing people to buy costlier coverage.’

There are other ways to be on the ‘right-side of history,’ if what’s important to your identity is being a moral person during a time of identity politics.

We can all do better.

Still Looking For Alternatives-Charlie Martin At PJ Media: ‘Obamacare vs. Arithmetic’

Avik Roy At Forbes: ‘Democrats’ New Argument: It’s A Good Thing That Obamacare Doubles Individual Health Insurance Premiums’…Megan McArdle At Bloomberg: ‘Health-Care Costs Are Driven By Technology, Not Presidents’

Related On This Site:    From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”…Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’…Peter Suderman At The WSJ: ‘Obamacare And The Medicaid Mess’…From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Some Sunday Obamacare Links

/ chr1 / Leave a comment

Megan McArdle at Bloomberg: ‘Obamacare Insurers Are Suffering. That Won’t End Well.‘

As to the recent noise made by UnitedHealth:

‘That said, strategic positioning is obviously far from the whole story, or even the majority of it. UnitedHealth really is losing money on these policies right now. It really is seeing something that looks dangerously like adverse selection.’

I still think it’s crucial to advocate that the ACA, poorly written and hastily passed with one-party consent, is a law designed to plan over 1/6 of the American economy from one location, taking money earned by some and redistributing that money (time + labor) to others by way of a huge bureaucracy, politicians, and other interested parties.

The things you might dislike about health-care access now, in all probability, will increase: Huge networks, murky billing and rising prices.  Some people will have access to care they previously didn’t but with awful cost/benefit outcomes.

We’ve taken many of the failures of the old system, the employer-based, jerry-rigged one, and vastly expanded Medicaid on top of it. This has also taken much choice, incentive, and opportunity away from the hardest working people, while trying to give the hardest working people’s stuff to the people who have less stuff.

This blog believes there’s no such thing as a free lunch.

The promises made reeked at the time (bending the cost-curve downwards), and a lot of numbers were tossed around to sway public opinion, and get the thing passed.

Such promises cannot possibly be met, and when they’re not, it’s reasonable to expect the people who made the promises will be all too happy to then regulate, ration, and control the system they’ve built, and huge parts of the economy, the political economy, and our lives.

They have the knowledge to do so, as far as they’re concerned.

Jim Pethokoukis quotes Robert Laszewski:

‘When are Obamacare apologists going to stop spinning the insurance exchange enrollment as some big victory that is running smoothly? Yes, Obamacare has brought the number of those uninsured down — because of the Medicaid expansion in those states that have taken it and because the poorest people eligible for the biggest exchange subsidies and lowest deductibles have found the program attractive. But that Obamacare has been a huge failure among the working class and middle-class — not to mention those who make too much for subsidies and have to pay the full cost for their expensive plans–has once again been confirmed.’

Previously: Charlie Martin here:

‘Whatever solution we look for though, the really important point is this: the whole basis of Obamacare, the notion that we can have more people, getting more benefits, and pay less, is just impossible. The arithmetic doesn’t work. And if you think that’s “unfair,” I’m sorry.’

Everyone equally more miserable, really:

Still not a right:  From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?…A Few Health Care Links-03/18/2010…Peter Suderman At The WSJ: ‘Obamacare And The Medicaid Mess’…From KeithHennessey.Com: ‘How To Repeal Obamacare’

Megan McArdle At Bloomberg: ‘A Few More Arguments Against Obamacare’

/ chr1 / Leave a comment

Full piece here.

A thoughtful piece:

‘This is not a tedious rehash of my reasons for opposing Obamacare, though two years in, perhaps such a rehash is due. If it is, I will provide it in a different post. This is just a post on why I don’t think that the argument for Obamacare can rest very securely on the argument that we are simply cleaning up some ugly negative externalities, in much the same way that we do with noise ordinance and anti-pollution laws. That is not what we are doing, and if it were, we wouldn’t be doing it’

You don’t have to be libertarian to find some of Richard Epstein’s suggestions…reasonable:

‘As I have noted before, there is only one type of reform that can make progress in meeting the three goals of a sensible health care system: cost reduction, quality improvements, and public access. That reform requires massive deregulation of the many market impediments that are already in place. Lower the costs, drop the excessive mandates, and thin out administrative costs, and people will flock back to the system voluntarily.’

Related On This Site: From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’From If-Then Knots: Health Care Is Not A Right…But Then Neither Is Property?… From The New Yorker: Atul Gawande On Health Care-”The Cost Conundrum”…Sally Pipes At Forbes: ‘A Plan That Leads Health Care To Nowhere’…From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’