Tag: ppaca

Interview with John Goodman on How to Replace ObamaCare

Last year, the Cato Institute held a forum on John Goodman’s latest book on health reform, A Better Choice: Healthcare Solutions for America (Independent Institute, 2015). Goodman founded and was the longtime president and CEO of the National Center for Policy Analysis. The Wall Street Journal calls him “the father of health savings accounts,” and he is currently president of the Goodman Institute for Public Policy Research and a senior fellow at the Independent Institute. Video of the book forum is available here.

I posted a lightly edited transcript of my interview of Goodman, which did a good job of highlighting the differences among ObamaCare opponents, in three parts:

For more on the three schools of ObamaCare opponents, see Cato’s previous book forum on Philip Klein’s Overcoming Obamacare: Three Approaches to Reversing the Government Takeover of Health Care (Washington Examiner, 2015).

Hillary Clinton’s Answer On Rising ObamaCare Premiums

As the number of people enrolling in ObamaCare Exchanges is falling below the Obama administration’s targets, Hillary Clinton faced a tough question at a town hall meeting in Ohio on Sunday night. Theresa O’Donnell, a Democratic-leaning voter complained that ObamaCare caused her family’s health insurance premiums to double from $5,880 per year to $12,972 per year. “I would like to vote Democratic, but it’s costing me a lot of money,” O’Donnell pleaded. “I am just wondering if Democrats really realize how difficult it’s been on working-class Americans to finance ObamaCare.” The audience applauded O’Donnell, showing once again that, really, not even Democrats like ObamaCare.

John Kasich’s ObamaCare Duplicity

Ohio governor and GOP presidential hopeful John Kasich says he opposes ObamaCare. Yet somehow, he has managed to embrace the law in every possible way. He wanted to implement an Exchange, even if it was clearly unconstitutional under Ohio law. He denounced the Medicaid expansion’s “large and unsustainable costs,” which “will just rack up higher deficits…leaving future generations to pick up the tab.” Then he went ahead and implemented it anyway. Worse, he did so unilaterally, after the Ohio legislature passed legislation prohibiting him from doing so (which he vetoed). When Republican legislators and pro-life groups filed suit to stop him, Kasich defended his power-grab all the way to the Ohio Supreme Court. 

Kasich’s defense of his record on ObamaCare has been…less than honest. Just one example: in a town hall meeting in South Carolina last night, Kasich railed against how ObamaCare increases the cost of health care at the same time he boasted he has constrained Medicaid spending in Ohio. In fact, Kasich’s unilateral Medicaid expansion not only increased the cost of Medicaid to taxpayers nationwide, but according to Jonathan Ingram of the Foundation for Government Accountability, it “has run $2.7 billion over budget so far [and] is set to run $8 billion over budget by 2017.” 

For more examples of Kasich’s ObamaCare duplicity, see my new four-part (yet highly readable!) series at DarwinsFool.com:

 

How David Brooks Created Donald Trump

Donald Trump, David Brooks (Credit: AP/John Locher/Nam Y. Huh/Photo montage by Salon)

The ugliness of this year’s presidential race makes The New York Times’ resident erstwhile conservative David Brooks wistful for Barack Obama. The irony is that David Brooks, Barack Obama, and their respective tribes bear much of the responsibility for the rise of Donald Trump.

“I miss Barack Obama,” Brooks laments, because “over the course of this campaign it feels as if there’s been a decline in behavioral standards across the board.” Brooks cites Hillary Clinton’s emails and some other stuff, but everyone knows he’s talking about The Donald. “Many of the traits of character and leadership that Obama possesses, and that maybe we have taken too much for granted, have suddenly gone missing or are in short supply. The first and most important of these is basic integrity. The Obama administration has been remarkably scandal-free.” By the time he’s done, Brooks upgrades Obama’s integrity to “superior.”

We all have difficulty seeing our blind spots. That’s why we call them what we call them. But Brooks’ obliviousness here is awe-inspiring.

Donald Trump has risen to the top of the GOP presidential field by appealing to resentments stoked by both political tribes. Even Brooks is even doing it, right there in his column.

Trump is riding resentments Obama has stoked by ruling as an autocrat. Rather than accept that voters elected a Republican Congress for the purpose of restraining his ambitions, Obama famously boasted he can act without Congress, because “I’ve got a pen and I’ve got a phone.”

He has repeatedly circumvented the democratic process and he knows it, as when he boasts, “I just took an action to change the law.” When challenged, he tries (with some success) to intimidate courts into writing tortured opinions in his favor. Still his executive overreach has been on the losing end of more unanimous Supreme Court rulings than either of his two immediate predecessors. Even allies admit he plays fast and loose with the rule of law.


When a president doesn’t play by the rules, he is telling his political opponents their votes don’t matter. That breeds resentment.

Ted Cruz, PolitiFact, ObamaCare & Jobs

I have two posts up at Darwin’s Fool on ObamaCare’s impact on jobs. In one post, I critique Politifact’s ruling that GOP presidential candidate (and Iowa caucus winner) Sen. Ted Cruz (TX) is a liar for claiming that ObamaCare is a job-killer. An excerpt:

In their rush to label Ted Cruz a liar, PolitiFact ignored economic theory, ignored economic consensus, ignored problems with the evidence they had amassed, ignored that some of the evidence they collected supports Cruz, ignored reams of anecdotal evidence, and dismissed Congressional Budget Office projections based on nothing more than a subjective and arbitrary distinction PolitiFact themselves invented.

In the other post, I offer a compilation of media reports about employers who have eliminated jobs or switched to part-time hiring. 

Obamacare’s Low Enrollment Numbers Also Show Why Exchange Coverage Will Get Worse

The Obama administration has released the numbers from the 2016 open enrollment period for Obamacare’s health insurance exchanges. The Congressional Budget Office had already downgraded its enrollment projection for 2016 from 21 million to 13 million. The news is actually just slightly worse: only 12.7 million enrollments, a number that is likely to shrink over the course of the year. Naturally, the administration declared success because enrollments exceeded the 10 million it had predicted back in October (thereby confirming speculation it had deliberately low-balled that prediction so it could later declare victory in spite of what it knew would be terrible enrollment numbers). Yet most observers overlooked what may be the worst news of all: evidence suggesting significant adverse selection in the Exchanges.

The administration reported that 70% of those who re-enrolled for 2016 shopped for a better plan, while 43% switched plans. The administration spun this as a positive, as evidence that Obamacare is expanding choice.

In reality, those numbers mean the vast majority of enrollees were dissatisfied enough with their Obamacare coverage to look for a better option , and a near-majority were so dissatisfied with their premiums or their coverage that they switched to what they hope will be a better plan. Most importantly, such widespread plan-switching is strong evidence of the type of adverse selection that is already eroding Obamacare’s promise to the sick , and could cause the exchanges to collapse.

The Biggest Loser In The Democratic Debate Wasn’t Hillary or Bernie, It Was ObamaCare


Hillary Clinton and Sen. Bernie Sanders participate in a Democratic primary debate in Charleston, South Carolina, on Jan. 17, 2016.

In their final debate before they face Democratic primary voters, Hillary Clinton and Bernie Sanders traded sharp jabs on health care. Pundits focused on how the barbs would affect the horse race, whether Democrats should be bold and idealistic (Sanders) or shrewd and practical (Clinton), and how Sanders’ “Medicare for All” scheme would raise taxes by a cool $1.4 trillion. (Per. Year.) Almost no one noticed the obvious: the Clinton-Sanders spat shows that not even Democrats like the Affordable Care Act, and that the law remains very much in danger of repeal.

Hours before the debate, Sanders unveiled an ambitious plan to put all Americans in Medicare. According to his web site, “Creating a single, public insurance system will go a long way towards getting health care spending under control.” Funny, Medicare has had the exact opposite effect on health spending for seniors. But no matter. Sanders assures us, “The typical middle class family would save over $5,000 under this plan.” Remember how President Obama promised ObamaCare would reduce family premiums by $2,500? It’s like that, only twice as ridiculous.

Clinton portrayed herself as the protector of ObamaCare. She warned that Sanders would “tear [ObamaCare] up…pushing our country back into that kind of a contentious debate.” She proposed instead to “build on” the law by imposing limits on ObamaCare’s rising copayments, and by imposing price controls on prescription drugs. Sanders countered, “No one is tearing this up, we’re going to go forward,” and so on.

Such rhetoric obscured the fact that the candidates’ differences are purely tactical. Clinton doesn’t oppose Medicare for All. Indeed, her approach would probably reach that goal much sooner. Since ObamaCare literally punishes whatever insurers provide the highest-quality coverage, it therefore forces health insurers into a race to the bottom, where they compete not to provide quality coverage to the sick.  That’s terrible if you or a family member have a high-cost, chronic health condition—or even just an ounce of humanity. But if you want to discredit “private” health insurance in the service of Medicare for All, it’s an absolute boon. After a decade of such misery, voters will beg President (Chelsea) Clinton for a federal takeover. But if President Sanders demands a $1.4 trillion tax hike without first making voters suffer under ObamaCare, he will over-play his hand and set back his cause.

The rhetoric obscured something much larger, too. Clinton and Sanders inadvertently revealed that not even Democrats like ObamaCare all that much, and Democrats know there’s a real chance the law may not be around in four years.

During the debate, Sanders repeatedly noted ObamaCare’s failings : “29 million people still have no health insurance. We are paying the highest prices in the world for prescription drugs, getting ripped off…even more are underinsured with huge copayments and deductibles…we are spending almost three times more than the British, who guarantee health care to all of their people…Fifty percent more than the French, more than the Canadians.”

Sure, he also boasted, repeatedly, that he helped write and voted for the ACA. Nonetheless, Sanders was indicting ObamaCare for failing to achieve universal coverage, contain prices, reduce barriers to care, or eliminate wasteful spending. At least one of the problems he lamented—“even more [people] are underinsured with huge copayments and deductibles”—ObamaCare has made worse. (See “race to the bottom” above, and here.)

When Sanders criticized the U.S. health care system, he was criticizing ObamaCare. His call for immediate adoption of Medicare for All shows that the Democratic party’s left wing is simply not that impressed with ObamaCare, which they have always (correctly) viewed as a giveaway to private insurers and drug companies.

Clinton’s proposals to outlaw some copayments and impose price controls on prescription drugs are likewise an implicit acknowledgement that ObamaCare has not made health care affordable. In addition, her attacks on Sanders reveal that she and many other Democrats know ObamaCare’s future remains in jeopardy.

Seriously, does anyone really think Clinton is worried that something might “push[] our country back into that kind of a contentious debate” over health care? America has been stuck in a nasty, tribal health care debate every day of the six years since Democrats passed ObamaCare despite public disapproval. Or that Republicans would be able to repeal ObamaCare over President Sanders’ veto?