The Washington Post reports:
The Supreme Court may have declared that the government can order Americans to get health insurance, but that doesn’t mean they’re going to sign up.
Nowhere is that more evident than Oklahoma, a conservative state with an independent streak and a disdain for the strong arm of government…
When it comes to health insurance, the effort to sign people up isn’t likely to get much help from the state. Antipathy toward President Obama’s signature health‐care overhaul runs so deep that when the federal government awarded Oklahoma a large grant to plan for the new law, the governor turned away the money — all $54 million of it.
The idea that the federal government will persuade reluctant people here to get insurance elicited head‐shaking chuckles at Cattlemen’s Steakhouse…
But some in Oklahoma aren’t so sure the population here will be easy to persuade, especially if the state government continues to condemn “Obamacare.”
“If we’re not being cooperative and all the rhetoric is hostile, then that’s going to be a real barrier to providing information to people,” said David Blatt, director of the Oklahoma Policy Institute, a state policy think tank. “There’s a lot of important outreach that needs to happen before January 1, 2014, and it’s going to be extremely difficult to do that when you have state leaders standing there saying, ‘Over our dead bodies.’ ”
Resistance remains strong in other states as well, with some governors promising to opt out of parts of the law.
Wait until states find out that they can block ObamaCare’s employer mandate just by refusing to create an Exchange.
In the Inland Empire, an economically depressed region in Southern California, President Obama’s health care law is expected to extend insurance coverage to more than 300,000 people by 2014. But coverage will not necessarily translate into care: Local health experts doubt there will be enough doctors to meet the area’s needs. There are not enough now.
Other places around the country, including the Mississippi Delta, Detroit and suburban Phoenix, face similar problems…
Moreover, across the country, fewer than half of primary care clinicians were accepting new Medicaid patients as of 2008, making it hard for the poor to find care even when they are eligible for Medicaid. The expansion of Medicaid accounts for more than one‐third of the overall growth in coverage in President Obama’s health care law.
But isn’t the important thing that they’ll have a piece of paper that says “health insurance”?
I’m a bit late to this party, but Senate Minority Leader Mitch McConnell ® was of course right to tell Fox News’ Chris Wallace last weekend that the federal government should not pursue universal coverage:
Wallace: In your replacement [for ObamaCare], how would you provide universal coverage?
McConnell: Well, first let me say the single best thing we can do for the American health care system is to get rid of ObamaCare…
Wallace: But if I may sir, you talk about “repeal and replace.” How would you provide universal coverage?
McConnell: …We need to go step by step to replace it with more modest reforms…that would deal with the principal issue, which is cost…
Wallace: …What specifically are you going to do to provide universal coverage to the 30 million people who are uninsured?
McConnell: That is not the issue. The question is, how can you go step by step to improve the American health care system…
Wallace: …If you repeal ObamaCare, how would you protect those people with pre‐existing conditions?
McConnell: …That’s the kind of thing that ought to be dealt with at the state level…
McConnell would have seemed less evasive and could have stopped Wallace in his tracks had he said, “We will not pursue universal coverage because that causes more people – not fewer – to fall through the cracks in our health care sector.”
Michael Cannon, director of health‐care policy at the libertarian Cato Institute, formed the “Anti‐Universal Coverage Club,” whose members “reject the idea that government should ensure that all individuals have health insurance.” This attitude is now the norm within the Republican Party, even if it is rarely acknowledged so starkly.
Dear Republicans: You’re welcome.
Donald Berwick may have mastered the science of health care management and delivery. (I for one would jump at the chance to enroll my family in the Berwick Health Plan.) But his recent oped in the Washington Post shows he has yet to absorb the lessons that economics teaches about government planning of the economy, such as through ObamaCare.
Berwick, whom President Obama recess‐appointed to be administrator of the Centers for Medicare & Medicaid Services (CMS), sets out to defend ObamaCare from a fairly devastating critique by Robert Samuelson a few days earlier. Berwick responds, in essence, nuh‐uh:
I saw how this law is helping tens of millions of families and is finally putting our health‐care system on the right track…I have seen how improving care can reduce costs dramatically.
Berwick fails to see the world of difference between those two statements. Yes, in his private‐sector work, Berwick has helped hospitals save more lives, kill fewer people, and save money in the process. I’m pretty sure he has saved more lives than I ever will.
But all he saw from his perch at Medicare’s helm was people happy to receive checks from the government, and a bunch of well‐meaning bureaucrats setting goals. He did not see the costs imposed by those subsidies. As for goal‐setting, this one sentence captures it all:
The CMS, for example, has set ambitious goals to reduce complications that, if met, would save 60,000 lives and $35 billion in just three years.
If. Met. A recent Congressional Budget Office review of Medicare pilot programs showed that Medicare bureaucrats set goals all the time. They never achieve them.
Berwick’s claim that ObamaCare “cracks down hard on waste and fraud” because “Last year the government recaptured a record $4 billion” is even more ridiculous. The official (read: low‐ball) estimates are that CMS loses $70 billion per year to fraud and improper payments. The best evidence suggests that wasteful spending approaches $200 billion per year in Medicare alone. All that money that comes from you, John Q. Taxpayer. Berwick knows all these things. Yet he thinks you should be impressed that recovering a measly $4 billion is the best the government has ever done.
Berwick would never tolerate such willful blindness, shoddy reasoning, and (surprise!) poor results if it were his own money on the line. Which is exactly the point. In a free market, people spend their own money. At Medicare, Berwick spent, and ObamaCare continues to spend, other people’s money.
That is the main reason why markets are smart and government is stupid. And why otherwise smart people like Berwick can afford to keep their eyes shut.
I, for one, was not surprised to read that Medicare payments for non‐existent medical services are ending up in Cuban (read: government‐controlled) banks. Nor that “accused scammers are escaping in droves to Cuba and other Latin American countries to avoid prosecution — with more than 150 fugitives now wanted for stealing hundreds of millions of dollars from the U.S. healthcare program, according to the FBI and court records.”
In fact, I have been wondering for some time when we would see evidence that foreign governments have been stealing from Medicare. The official (read: conservative) estimates are that Medicare and Medicaid lose $70 billion each year to fraud and improper payments, a result of having almost zero meaningful controls in place. That’s practically an open invitation to steal from American taxpayers. Kleptocratic governments — and other organized‐crime rings — would be insane not to wet their beaks.
In this National Review article, I explain how easily it could happen:
Last year, the feds indicted 44 members of an Armenian crime syndicate for operating a sprawling Medicare‐fraud scheme. The syndicate had set up 118 phony clinics and billed Medicare for $35 million. They transferred at least some of their booty overseas. Who knows what LBJ’s Great Society is funding?
I also explain how these vast amounts of fraud aren’t going to stop without fundamental Medicare and Medicaid reform. Give the National Review article a read, and tell me if you share my suspicion that Medicare is bankrolling other governments.