Aside from one necessary clarification (see far below), it would be difficult to improve on what the New York Times, the Boston Globe, and the enrollees they interview have to say about ObamaCare.
First, from yesterday’s New York Times article, “Many Say High Deductibles Make Their Health Law Insurance All but Useless”:
But for many consumers, the sticker shock is coming not on the front end, when they purchase the plans, but on the back end when they get sick: sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage.
“The deductible, $3,000 a year, makes it impossible to actually go to the doctor,” said David R. Reines, 60, of Jefferson Township, N.J., a former hardware salesman with chronic knee pain. “We have insurance, but can’t afford to use it.”…
“We could not afford the deductible,” said Kevin Fanning, 59, who lives in North Texas, near Wichita Falls. “Basically I was paying for insurance I could not afford to use.”
He dropped his policy…
“Our deductible is so high, we practically pay for all of our medical expenses out of pocket,” said Wendy Kaplan, 50, of Evanston, Ill. “So our policy is really there for emergencies only, and basic wellness appointments.”
Her family of four pays premiums of $1,200 a month for coverage with an annual deductible of $12,700…
Alexis C. Phillips, 29, of Houston, is the kind of consumer federal officials would like to enroll this fall. But after reviewing the available plans, she said, she concluded: “The deductibles are ridiculously high. I will never be able to go over the deductible unless something catastrophic happened to me. I’m better off not purchasing that insurance and saving the money in case something bad happens.”
“While my premiums are affordable, the out-of-pocket expenses required to meet the deductible are not,” said [Karin] Rosner, who makes about $30,000 a year…
“When they said affordable, I thought they really meant affordable,” [Anne Cornwell of Chattanooga, Tenn.,] said.
And from today’s Boston Globe article, “High-Deductible Health Plans Make Affordable Care Act ‘Unaffordable,’ Critics Say”:
“We can’t afford the Affordable Care Act, quite honestly,” said Cassaundra Anderson, whose family canvassed for Obama in their neighborhood, a Republican stronghold outside Cincinnati. “The intention is great, but there is so much wrong. . . . I’m mad.”…
The Andersons’ experience echoes that of hundreds of thousands of newly insured Americans facing sticker shock over out-of-pocket costs…
“This will be an issue at least one more time in the 2016 election. It could absolutely still hurt Democrats,” said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. “Polls about the Affordable Care Act have a considerable amount of middle-income people who say either the program has done nothing for them or actually hurt them.”…
“Unfortunately, what we are headed toward now is universal crappy health insurance,” said Dr. Budd Shenkin, a California pediatrician…“It’s just not a good deal for people,” he said.
“We’re in the process of looking at going without insurance,” [Cassaundra Anderson] said, calculating that the family will be better off financially just paying the $2,000 tax penalty for not abiding by the law’s mandate. “What am I even paying these insurance people for? Why should we reenroll?”…
“I cannot get anything with this insurance. Nothing,” said [Laura] Torres, who avoids seeking treatment for her thyroid condition and high blood pressure because of cost. “I just pay my monthly payments, try to take care of myself, go to work, and hope something serious doesn’t happen to me.”…
Amete Kahsay, 53, works as a temporary warehouse packer in Columbus. The Affordable Care marketplace is her only option for health insurance. She and her husband, an airport shuttle driver, pay $275 a month for a “bronze” plan with a $13,200 deductible.
Shortly after they signed up for insurance last year, her husband rushed her to the emergency room when she experienced dizziness. The visit, which included a CT scan of her brain, cost $1,700. She paid the charge from her savings, then returned to her native Ethiopia, where care is cheaper, to consult a neurologist and seek follow-up care.
“I support Obamacare. Without it, I wouldn’t have any type of insurance. But I’m not sure it’s worth the money,” said Kahsay, a US citizen who is registered as an independent voter. “Now, unless I get very, very sick, like only if it’s life-threatening, I won’t go to the doctor. I just lay down and take a rest.”
The necessary clarification is that these people are not complaining about high-deductibles in a market system. In a market system, consumers who choose high deductibles save money on their premiums and therefore have more resources to help them pay their out-of-pocket expenses. ObamaCare, on the other hand, manages to pair high deductibles with higher premiums, stripping many people of this benefit of high-deductible plans and leaving them unable to pay their medical bills.
With two Republican presidential candidates embracing a value-added tax (VAT), it is worth looking back at the original federal debate over that bad policy idea.
Richard Nixon appears to have been the first U.S. leader to push for a VAT, which is not surprising given that he was perhaps the most statist GOP president of the 20th century. With a three-percent VAT in mind, Nixon called for new federal financing of local schools in his 1972 State of the Union address.
A 1972 Congressional Quarterly article examined Nixon’s VAT. (The first link when you Google “richard nixon vat congressional quarterly”). The article reveals that the administration looked fondly on a VAT because of its large revenue-raising potential—both for funding schools and for funding a general expansion of the welfare state:
Two major reasons were apparent for the Nixon administration’s consideration of a value added tax. The first was the condition of federal finances.
The budget for fiscal year 1973, which the President sent to Congress Jan. 24, included a five-year forecast showing that in fiscal 1977 the only surplus funds foreseeable would result from a proposed increase in Social Security taxes. Projected costs of existing and proposed programs were expected to absorb all revenues from existing taxes and other sources. This meant that no new programs could be inaugurated without new taxes to finance them or reduction of existing programs to release funds. Though initially pledged for education, revenues from an expanding value added tax might provide future funding for other programs.
The second reason was the situation in public schools and school districts.
Occupational licensing is supposed to protect consumers against people who would practice a trade without the proper qualifications. In the first Supreme Court case on the question, Dent v. West Virginia (1883), the Court held that government may require people to be trained and educated before taking up the medical profession, because “such regulations” help “secure” the public “against the consequences of ignorance and incapacity as well as of deception and fraud.” But, the Court warned, if states impose licensing requirements that are not aimed at protecting “the general welfare of [the] people,” those restrictions “can operate to deprive one of his right to pursue a lawful vocation.”
But Dent was decided before the advent of “rational-basis scrutiny,” the rule under which courts today typically ignore violations of the right to earn a living. Under today’s law, state governments are given extremely broad power to limit economic freedom in whatever way lawmakers or unelected bureaucrats think best. That raises a crucial question—one on which the federal Courts of Appeals are now divided: may government restrict economic freedom, not to protect the public, but solely to protect the private benefits of a preferred group of people? Does such “mere protectionism” qualify as a “legitimate state interest” under the lenient “rational basis” rule?
The Open Government Partnership is an “international platform for domestic reformers committed to making their governments more open, accountable, and responsive to citizens.” Shortly after the OGP’s creation, in my November 2012 study, “Grading the Government’s Data Publication Practices,” I gave the OGP unenthusiastic praise. It appeared to substitute meetings about open government with actual forward motion on the government transparency that President Obama promised in his first presidential race.
But an important commitment emerged late last month from the “Third Open Government National Action Plan for the United States of America.” The plan includes “a wide range of actions the Administration will take over coming months to strengthen, deepen, and expand upon” U.S. open government efforts. Among them (at the bottom of page 10) is the commitment to develop a machine-readable government organization chart.
The lack of a machine-readable government organization chart has been an emphasis of mine in writings and speeches since at least 2012. The Washington Examiner’s Mark Tapscott cited my quest for one in a favorite article calling me a “digital Diogenes.”
Having access to data that represents the organizational units of government is essential to effective computer-aided oversight and effective internal management. Presently, there is no authoritative list of what entities make up the federal government, much less one that could be used by computers. Differing versions of what the government is appear in different PDF documents scattered around Washington, D.C.’s bureaucracies. Opacity in the organization of government is nothing if not a barrier to outsiders that preserves the power of insiders—at a huge cost in efficiency.
The promise to produce a useful organization chart is not self-delivering, of course, and there are ways that this commitment could go off the rails. But the phrasing of the commitment suggests understanding of what a well-published digital organization chart is.
The General Services Administration and National Archives Office of the Federal Register will “capture agencies’ organizational directories as machine-readable raw data in a consistent format across the U.S. Federal government.” That suggests to me that the relationships among agencies, bureaus, and program offices (to use one nomenclature) will be represented in a consistent manner government-wide. Each sub-unit of government must have a unique identifier that embeds its relationship to its parent, like the identifiers in this document published by the National Institute of Standards and Technology in 2008. We’re not talking about a flat digital phone book.
It is not clear whether this commitment is a commitment of the Obama Administration to make this the authoritative organization chart. Obviously, an org chart that doesn’t accurately represent and guide the government’s own actions is not much of an org chart. But if the White House (i.e. OMB) and other important actors such as the Treasury Department (which cuts the checks) rely on and use this machine-readable government organization chart, then we will really have something. That will raise the pressure on Congress to make its processes more transparent by referring to agencies and their sub-units in legislative documents using the same identifiers.
I’ll report here on the success or failure of the project. The national action plan does not give a definitive timeline or deadline, but it does speak of action on its commitments in terms of “months.”
In this installment of positive news, we look at tiny 3D cameras that could revolutionize brain surgery, a new way of growing large quantities of red blood cells and progress in the fight against Leukemia.
NASA’s 3D Camera Could Improve Brain Surgery
Tiny 3D cameras developed by NASA may revolutionize the way doctors practice brain surgery. A device, known as MARVEL (short for Multi-Angle Rear Viewing Endoscopic Tool), is a 0.2 inch diameter camera that is attached to an endoscope - a snaking instrument used to examine the inside of the human body. NASA officials claim that MARVEL could make brain surgery quicker and cheaper, with less recovery time required. Before this technology can reach the operating room, the team needs to develop prototype for the FDA’s approval.
Scientists Have Found a Way to Make Red Blood Cells
The global blood supply remains in a state of constant shortage, a precarious situation for patients undergoing intensive surgery. Promisingly, a group of scientists have discovered a new way of producing large quantities of red blood cells, which perform the critical oxygen-ferrying duties of blood. The scientists identified a particular gene within stem cells and modified it so that these stem cells mature into red blood cells in greater numbers.
These Are the Genes Linked to Aging
New research has pinpointed 1,500 genes responsible for human aging. Scientists examined blood samples amongst 14,983 aging adults of European ancestry, and measured levels of RNA—the genetic product that our genes produce when they’re active. One caveat to these finding is that while individuals with Hispanic or Native American ancestry largely matched these markers, the RNA crossover dropped to only 27 percent in populations with African ancestry.
New Kind of ‘Designer’ Immune Cells Clear Baby’s Leukemia
A baby in London has been cleared of a previously incurable form of Leukemia thanks to an experimental cell therapy that creates ‘designer immune cells.’ After all other treatment options had failed, the doctors injected the baby with genetically edited cells in a tiny 1-milliliter intravenous infusion. The therapy works by adding new genes to healthy immune cells known as T-cells. The T-cells are rendered invisible to a powerful leukemia drug that would usually kill them and reprogramed to only fight leukemia cells.
The Hill reports the Senate GOP is trying to decide how much of ObamaCare to repeal via the budget-reconciliation process:
[Senate Majority Leader Mitch] McConnell only needs 51 votes instead of the customary 60 because he is moving the repeal measure under a special budgetary process known as reconciliation. The downside of the strategy is that that package can only include provisions designed to impact the budget deficit.
As a result, popular parts of the law, such as the prohibition against discriminating against pre-existing conditions and allowing young adults to stay on their parents’ health plans until age 26, cannot be included.
First of all, ObamaCare’s most enduring myth is that its pre-existing conditions provisions are popular. This myth is based entirely on misleading poll questions that ask about only the (presumed) benefits of those regulations. When pollsters ask about not only the benefits but also the costs of those regulations, 2-to-1 public support flips dramatically to 5-to-1 opposition. Second, that last part is a matter of debate, not fact.
As the Heritage Foundation’s Paul Winfree and I explain (in The Hill, as it happens):
A full-repeal bill…would recognize that ObamaCare creates a single, integrated program of taxes and subsidies that work in concert to expand coverage, and would eliminate that entire program as a whole. Its primary effect would be budgetary. According to the Congressional Budget Office (CBO), full repeal would eliminate $1.7 trillion of spending and “would reduce deficits during the first half of the decade.” Retaining ObamaCare’s spending cuts would ensure that repeal reduces deficits in perpetuity.
With respect to the opinion, held mostly by Democrats, that The Hill portrays as fact, we write:
Opponents will try to argue that repealing ObamaCare’s health-insurance regulations (e.g., community rating) would have only an incidental effect on the budget. Yet those regulations are merely part of that larger, integrated program to expand coverage: community rating taxes the healthy to subsidize the sick; the individual mandate enforces those transfers by making part of that implicit tax explicit; additional regulations further enforce that implicit tax; explicit premium subsidies reduce those implicit taxes, and supplement the implicit subsidies, for low-income taxpayers; and the employer mandate imposes an implicit tax on workers that both reduces and offsets direct spending on premium subsidies.
Every relevant authority has held these provisions were designed to create a single, integrated program of taxes and transfers, and has rejected attempts to isolate those regulations from other parts of that program.
Winfree and I then cite former Senate Majority Leader Harry Reid (D-NV), former House Speaker Nancy Peolosi (D-CA), the Obama administration, and the Supreme Court, all of whom fell over themselves to argue that those regulations are part of a single, integrated program. As a result:
To treat ObamaCare’s health-insurance regulations as separate from that larger scheme is to renounce the Supreme Court’s King ruling and everything ObamaCare’s authors have said about how the law works. It would amount, to quote the Obama administration, to “seizing on isolated phrases [and] giving them a meaning divorced from statutory context [to] advance a radically different conception of the Act’s operation.”
Thus, “Congress may repeal those regulations via reconciliation just as it can repeal rules regulating any other government spending Congress zeroes-out through that process.”
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