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

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’

Avik Roy At Forbes: ‘How Many Healthy People Are Signing Up For Obamacare? The White House Won’t Say’

Full piece here.

Healthcare.gov is working better now, but the full spin is still on.  Of those new enrollees:

What we need to know is: What is the breakdown of enrollees by age? What percentage have chronic conditions like Type 2 diabetes, high cholesterol, and high blood pressure? This is the kind of data that can help us compare the pool of enrollees in the exchanges to the normal U.S. population.

It’s almost certain that, so far, this enrollment data is not encouraging. Because if it was encouraging, CMS would have released it.’

Politically and ideologically, money and career-wise. some folks will keep pushing until it sticks.

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’

From Arnold Kling: ‘Notes From A Health Care Implementation Discussion’

Full post here.

Read the whole list.  Here’s the final note:

‘The scenario for Obamacare’s death is that the insurance companies “defect” by leaving the exchanges or raising rates to unacceptable levels. As Obama’s personal political strength weakens, the “defect” scenario becomes more plausible’

Out on the political streets, we’ll see what happens.

Fom a previous post of Kling’s:

Down the road, someone is going to get the shaft. It could be my neighbor, it could be me, or it could be both of us. That is, people who are relying on the unfunded systems–public sector pensions, Social Security, and Medicare–might find their benefits cut. Or people who are relying on personal savings could wind up having those savings taxed away in order to address the shortfalls in the public systems. Or all of us could have our savings eroded by inflation, from which we may not be able to protect ourselves.’

There will need to be a reckoning of some sort, and our politics can rarely make such changes efficiently and effectively (for many good, and some not so good reasons).  Perhaps with the obvious public failure of Obamacare, more of the American public will become aware of these challenges we face as a nation.  We’ve been getting diminishing returns for a while, now.

Perhaps…

Kling’s axes which he’s proposed to better understand political philosophies and/or ideologies, which I’ve copied/pasted from elsewhere:

‘Conservatives use a civilization vs barbarism axis.

Libertarians use a coercion vs freedom axis.

Liberals use an oppression axis to view the world – oppressed vs oppressor.’

Food for thought.

Kevin Williamson, at the National Review, and his new book:  ’The End Is Near, And It’s Going to Be Awesome: How Going Broke Will Leave American Richer, Happier, and More Secure.’

Walter Russell Mead’s theory, in part, posits that liberalism 4.0 needs to become 5.0 and start to creatively solve the problems we’re faced with, including globalization, the decline of manufacturing and industry, and the rise of technology.  The ‘blue’ model is behind the times:

Epstein on Obamacare’s Moral Blindnessthe 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’

Megan McArdle At Bloomberg: ‘Obamacare Shouldn’t Have Been Managed Like A Campaign’

Full piece here.

Good piece, and quite fair-minded:

‘Democrats have been complaining — loudly and repeatedly — that Republican opposition tactics on the Affordable Care Act are unprecedented. This is true, but not for the reasons that Democrats are telling themselves. No political party was ever foolhardy enough to pass such a big bill, with such sweeping consequences for so many people, without the support of a majority of their countrymen and at least a few members of the opposite party. Once they had done this unprecedented thing, the unprecedented reaction was predictable — and indeed predicted by myself and others’

Do you remember the town-hall meetings and heated debates?  There was principled opposition from the get-go.

From The Health Care Summit, Paul Ryan lays out his case:

——————————–

Arnold Kling graded the summit.  In electing Obama for a second-term, and rejecting the ideas presented above, enough Americans elected to find out just what this bill is going to mean for their bottom-lines.

Richard Epstein, libertarian law & economics thinker, looks pretty prescient on what the law’s specific challenges are and how it wasn’t likely to succeed, certainly not by now, but perhaps never in some of its aims:

‘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’

Sounds reasonable to this blog.

But politically feasible? Probably not.

The Obama team is huddled down in its bunker, still trying to make all of this work, and whatever happens, many of the President’s ideological bedfellows and political supporters really want it to work.  Failing that, I’m counting on them to push solutions that line-up with their ideological goals.

Such is the story of politics, of course, but this blog has specifically objected to the forced redistribution, the aim to nationalize and perhaps socialize medicine, and the ambitious undertaking to fundamentally redefine the relationship all Americans have with their government.

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’

Richard Epstein At The Hoover Institution: ‘Watching Obamacare Unravel’

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’

Richard Epstein At The Hoover Institution: ‘The Obamacare Train Wreck’

Full piece here.

Click through for analysis on specific provisions of the ACA:

‘Republicans are howling to repeal and defund Obamacare. As a policy matter, that is surely the correct move. But as a political matter, the prompt repeal of Obamacare is just not going to happen over the uncompromising opposition of a Democratic president and a Democratic Senate. So, if the first-best solution is not possible, more modest fixes for Obamacare are in order until Republicans start winning elections’

Epstein looks pretty prescient on what the law’s specific challenges are and how it wasn’t likely to succeed, certainly not by now, but perhaps never in some of its aims:

‘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’

Sounds reasonable to this blog.  There are solutions out there to rising health-care costs.

These aren’t just computer glitches, but rather deep and serious challenges that likely won’t be fixed anytime soon.  I’m reminded of Solyndra, which showed an almost childlike understanding of the private sector and childlike faith in political coalitions guided by rather Left-Of-Center idealism to throw taxpayer money at the industries which were desired to succeed.  Long on speeches, short on delivery.  Lots of politics.

Tech start-ups which actually do succeed (and most don’t) throw a lot of talent and energy balls-to-the-wall to try and solve specific problems to make some process that people engage in now simpler and easier.   These problems can be very complex and challenge the best minds who are under intense deadlines to use their capital well.  There are no guarantees in this high-risk, high-reward activity which can be the work of a lifetime amidst intense competition.  The path is littered with near misses and spectacular failures.

It’s not as easy as it looks.

So, how much politics was involved here?  Avik Roy makes the case a little more starkly:

‘The answer is that Obamacare wasn’t designed to help healthy people with average incomes get health insurance. It was designed to force those people to pay more for coverage, in order to subsidize insurance for people with incomes near the poverty line, and those with chronic or costly medical conditions.’

You won’t just be paying more for your own insurance, you will be forced to buy other people’s insurance, induced into then kept by force in a system of political wrangling where politicians and certain favored interests and coalitions control the money supply much more than they do now.

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’

Richard Epstein At The Hoover Institution: ‘Watching Obamacare Unravel’

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’

Ross Douthat At The NY Times: ‘Yes, Liberals Won’

Full piece here.

‘If Roberts set conservatism up for future high court victories yesterday, in other words, it was because he proved himself a deft politician and a careful custodian of his own credibility, not because the details of his decision fundamentally shifted constitutional interpretation to the right.’

Sunday politics.

Related On This Site:   A Few Health Care Links: “The Individual Mandate Survives As A Tax”Ilya Somin At Volokh: ‘Of Silver Linings And Clouds’

The Roberts long-view theory, more here from Paul Rahe, or just the Supreme Court staying out of politics?

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’

William Saletan and Ross Douthat At Slate: ‘Liberalism Is Stuck Halfway Between Heaven And Earth’

Douthat’s The Grand New PartyRoss Douthat At First Principles: ‘The Quest for Community in the Age of Obama: Nisbet’s Prescience’

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Ilya Somin At Volokh: ‘Nonlegal Arguments for Upholding the Individual Mandate’

Full post here.

Somin takes on a few of the claims by supporters of the individual mandate.  Such is politics, of course, and perhaps more so as of late:

‘Both parties give short shrift to constitutional limits on federal power because judicial deference has created a political culture in which almost anything goes. More careful judicial scrutiny of Congress’ handiwork might lead Congress to start taking the Constitution seriously again. That result that should be welcomed by conservatives, libertarians, and liberals alike.’

Perhaps.  Comments are worth a read.

Related On This Site: Charles Fried and Randy Barnett among others, testify as to the constitutionality of the Affordable Care Act (Nearly 3 hrs, but likely worth your time.  You can skip to the parts you’d like)……Randy Barnett At Volokh: ‘My Answers to Questions Posed by Senators Durbin and Sessions’…Wasn’t it the executive branch with too much power…not the legislative?: Eric Posner At Volokh Replies To Comments The Straussians are not too happy with that view, as the comments suggest:  From Volokh: Harvey Mansfield Reviews ‘The Executive Unbound’

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’

Originalism vs the ‘living constitution?” George Will Via The Jewish World Review: ‘True Self-Government’A Few Thoughts On Robert Bork’s “Slouching Towards Gomorrah”

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From AEI: ‘Study: ‘Obama Healthcare Reform Raising Costs, Forcing Workers Out Of Existing Plans’

Full post here.

Well, some people behind the Affordable Care Act want to get to single payer, that’s no doubt true.

You also need young, usually healthy people (usually without much money) to pay into the system to subsidize the old, the sick and the poor.  Right now, 2.5 million of those young people have been added to their parents’ plans for a longer period of time, but eventually they will be siphoned in.  I believe one of the primary goals of the Affordable Care Act is to fundamentally change the relationship between nearly every American and their government, bending it more toward the progressive political and moral vision of “shared sacrifice” and collectivist principles of organization which require another entitlement program which won’t ever pay for itself.  This is nothing new.

Some will get access to health care who didn’t have access before, and others will pay for them.  Some insurance companies will gain a lot of new customers (but they must play the game right and tithe the overseers and check the political winds more than they do now).  Some reasons for rising healthcare costs will be addressed (longer life spans, technology and prescription drugs) and many other won’t, and new ones will pop up.

The people who make decisions though, and where the money comes from, and where it goes, and what principles govern our politics and lives, our health, health care, and health insurance will change drastically.

Here are a few quotes posted before on this site:

Pournelle’s Iron Law of Bureaucracy:

‘Pournelle’s Iron Law of Bureaucracy states that in any bureaucratic organization there will be two kinds of people”:

 First, there will be those who are devoted to the goals of the organization. Examples are dedicated classroom teachers in an educational bureaucracy, many of the engineers and launch technicians and scientists at NASA, even some agricultural scientists and advisors in the former Soviet Union collective farming administration.

Secondly, there will be those dedicated to the organization itself. Examples are many of the administrators in the education system, many professors of education, many teachers union officials, much of the NASA headquarters staff, etc.

The Iron Law states that in every case the second group will gain and keep control of the organization. It will write the rules, and control promotions within the organization’

and two quotes from Henry Hazlitt:

“The art of economics consists in looking not merely at the immediate but at the longer effects of any act or policy; it consists in tracing the consequences of that policy not merely for one group but for all groups.

and

“The first requisite of a sound monetary system is that it put the least possible power over the quantity or quality of money in the hands of the politicians.”

My two cents.

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’

Reason Via Youtube: ‘A True Tale of Canadian Health Care: ‘Why Some Patients Need To Go To The U.S. For Surgery

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From The New England Journal Of Medicine Via CATO: ‘The Constitutionality of the Individual Mandate’

Full video here. (~15:00 min)

Jack Balkin and Ilya Somin debate aspects of the Affordable Care Act.

Related On This Site:  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’

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Peter Suderman At Reason: ‘RomneyCare: Nope, Still Not Working’

Full post here.

‘So insurance coverage has increased, but largely thanks to tax-funded subsidization. Yet that’s created problems too: As more people got coverage, the system has struggled to keep up with increased demand for services. Uncompensated care, frequently cited as the justification for ObamaCare’s mandate, has remained expensive as emergency rooms have been flooded. And we’re not even getting into the cost overruns.’

Reason also interviews Canadian Sally Pipes who thinks Obamacare is mostly a foot in the door to single-payer, and what that could mean.

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

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