brainiac conspiracy

Another Light Blogging Day

As some of you know, my old individual health-insurance plan was canceled at the end of December due to noncompliance with the Goldberg Act. I still have dental insurance with the same carrier, however, and yesterday I received a letter from them, telling me that as a courtesy they were enrolling me in their Pediatric Dental Care plan for an extra $6 a month---even though I have never requested this plan because I don't have any fucking children. Anyway, I've wasted another half day trying to get them to stop stealing my money, so until I return, here, have another Goldberg video.

---Baron V

More Fake Freedom

Sure, it's great that everyone now has access to health care---or at least, cannot be denied health care. But what happens when you live in an area where there are few if any health-care providers? That's yet another dilemma that the Goldberg Act doesn't solve, and people who live in the poorest parts of rural America---where a sizable majority of the population is poor and elderly, and where access to public transit is minimal or nonexistent---are going to find that the promise of universal health care rings rather hollow when you can't get to a real-life doctor. There were policy fixes for this that could have been incorporated into the law---allowing nurse-practicioners to perform more doctoral functions, or loosening visa requirements for foreign-born doctors, or increasing federal aid to medical schools to admit more students---but one or more of the "stakeholders" objected, so the problem wasn't solved. Then again, that was to be expected when the task of fixing America's health-care mess was outsourced to the same people who created the mess in the first place.

---Baron V

The Stupidest Thing You Will Read This Year

I know, this is from an op-ed in the Wall Street Journal, but it's hard to believe that anyone still believes this nonsense anymore. Even harder to believe is that anyone with an advanced degree would believe this nonsense at all. But apparently, people do:

We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. We'll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service . . . Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.

Because deregulation worked so well the last time we tried it.

Oh, and good luck convincing people to take on $100 grand in student-loan debt so they can pursue a career in medicine that pays $9 an hour. And those untested prescription drugs you're importing from China should be a hit with consumers, too! So as noted, stupidest thing of the year.

---Baron V

Could Have Warned Them

That attempting to fix a broken system by outsourcing policy to the same people who broke the system in the first place was not the smartest idea our 11-dimensional Zen masters could have schemed up. The fact that they are still inventing policy on the fly, four years later, would tend to suggest that they know they've a major problem on their hands. Those midterms are gonna be a laff riot, no?

---Baron V

More Free Stuff For The Richies

Continuing from the previous post, if I could wave a magic wand, I'd personally make health care free at the point of delivery for everyone, not only for New England families who bring in $100 grand a year, because everyone pays too much money for health care in this country. There's a policy tool that could accomplish this, of course, and the Times would be performing an important service to its readership if some reporter would interview some health-care economists and ask them how much the Chapmans---and the rest of us--- would save if we booted private insurance and covered them through Medicare. I'm willing to bet it would be a nice chunk of change!

---Baron V

Make Health Care Free For Rich People

The New York Times is a decent paper, with plenty of talented writers, but they have this irksome habit of recycling the same human interest story over and over: Specifically, where they talk to some affluent Northeasterners and discover just how hard it is to get by on only a six-figure salary:

“We are just right over that line,” said Ms. Chapman, who is 54 and does administrative work for a small wealth management firm. Because their plan is being canceled, she is looking for new coverage for her family, which includes Mr. Chapman, 55, a retired fireman who works on a friend’s farm, and her two sons. “That’s an insane amount of money,” she said of their new premium. “How are you supposed to pay that?”

Eight hundred a month to cover a family of four? Don't know what the cost of living is like in New Hampshire, but out here in California, that would be a pretty good deal. Either way, only in the pages of the Times---and maybe the Post, too---would households with incomes of a hundred grand a year be considered a part of America's beleaguered middle class.

(Via.)

---Baron V

Still Not Getting It

Whether it is a fair characterization or not, the Goldberg Act is perceived by a majority of the public as liberal Democratic social legislation, and if it fails, it is a disaster for liberalism in general and Team Democrat in particular. The 11-dimensional Zen masters in the White House have had four years to game out every possible scenario that could result from the law, and the fact that they are still making policy changes on the fly suggests that either (a) they haven't done their jobs, or (b) the law is unworkable in its present form. The good news is, there are, and have always been, alternatives!

---Baron V

Death Panels

Surprise surprise, they actually do exist!

In February 2012, Deutsche Bank completed the first longevity transaction that relied on third-party investors, a 12 billion euro swap with Aegon NV, a Dutch insurer. Aegon paid Deutsche Bank a fee to assume some of its pension risk. The bank then sold the risk to investors, who receive a floating payment from Deutsche Bank based on how quickly pensioners die relative to an index derived from Dutch population statistics.

The prospect of more widespread use of such investment vehicles, collectively dubbed death derivatives, concerns some regulators, who see in this fledgling market a resemblance to earlier financial innovations that turned toxic [...]

Some regulators are concerned about potential weak spots such as a lack of open market pricing. Since only a handful of insurers, reinsurers and banks are active in the market, risks over time could become concentrated. Losses would probably hit most firms at the same time.

A cure for cancer, for example, may not be celebrated at the investment banks and other institutions that had assumed longevity risk. They would face catastrophic losses as pension plans around the world simultaneously confronted the prospect of participants living years longer than envisioned.

There is literally nothing these compulsive gamblers won't throw money at. Heaven forbid that governments should ever consider the possibility that certain types of trades be banned outright. I mean, given everything we've learned about the way they conduct business, I think it's safe to assume that they will rig the longevity market the same way they've rigged all the others. Only this time, people might not only pay for it with their fortunes but with their lives. Really not good!

---Baron V

Fear of The Unknown

As a rule, you can expect a fair amount of it any time liberal social legislation is being debated, so the latest public reaction to the Goldberg Act is not at all surprising. As an alternative, however, just think of what the reaction would be if you told those same people that they didn't have to worry about purchasing health insurance because, you know, they're already covered. Bet they'd like it a lot better!

---Baron V

No One Could Have Possibly Predicted

That America's job creators would have used the Goldberg Act as a convenient excuse for offering shittier health-care coverage to their employees. Team Democrat, I'm looking at you!

(Via.)

---Baron V

Hump Night Music Blogging

Because our government is like a Roach Motel: Incompetents crawl in, and they never crawl out.

---Baron V

An O-Care Success Story

Regular visitors to this site know that your humble blogger is no fan of the Goldberg Act, basically because I'm no fan of private insurance companies. I still have doubts about the law's long-term efficacy, i.e., its ability to bend down the health-care cost curve, but for what it's worth, it does help people who qualify for Medicaid and/or the subsidies. In my case, I just enrolled in an individual Silver PPO plan at Covered California---it took about ten days but they finally approved me---that's costing me half of what my previous crappy Bronze plan did, with zero deductible, lower copays for doctor visits and prescription drugs, and only a couple grand in out-of-pocket costs. Of course, I couldn't afford this plan were it not for the generous subsidy, and if I make more money next year (and I'd better, or I'll be sleeping on Wilshire Boulevard), I'll have to return some of the that subsidy to the IRS next year. But I'll deal with that if and when it happens. For now, I'm impressed.

Update (2:35 pm): As a public service I should mention that while Covered California is a reasonably user-friendly experience (depending on the time of day), it's not perfect, and the information it displayed regarding my doctor's network coverage was completely bassackwards. So be sure to call your doc before you enroll in a plan.

---Baron V

The Ideological Divide

Sure, if the Goldberg Act succeeds, it will be a plume in the cap of Team Democrat and a black eye for Republicans. If the act fails, the opposite. But while the future of Act may or may not be a death knell for one of these teams, what's maddening is how the debate over the Act has been transformed into a metaphor for what constitutes "liberalism" and "conservatism" in this country. By "liberalism", we mean that if we place a few restrictions on insurance companies while promising them 40 million new customers, somehow the free-market fairies will work their competitive magic and drive down costs for everyone, even though---as someone more knowledgeable than our political leaders reminds us---it has never happened before: In other words, the kind of neoliberal corporatism that has led to the impoverishment of millions of American workers and massive wealth transfers to the rich.

Conversely, by "conservative", we mean outlawing medical malpractice suits, abolishing Medicaid, privatizing Medicare, and allowing insurance companies to peddle junk policies across state lines, which doesn't form a coherent policy outlook but which pisses off liberals: In other words, the kind of Randian cultism that has provided a moral basis for the existence of America's billionaire class---and which as an added bonus has turned a sizable percentage of the adult-age population into a gang of confused and paranoid zanies. While there is indeed a divide of sorts between these two warring factions, one thing they unwittingly agree upon, apparently, is on the justness of a destructive and predatory economic order that is gradually transforming the nation into a shinier version of Mexico with more cable channels. Yes, one side decries income inequality, but neither side will do a damn thing about it.

So what we really mean when we talk about "liberals" and "conservatives" now is, compassionate capitalism vs. cruel capitalism. But it hardly matters whether our leaders tell us "This is going to hurt me a lot more than it's gonna hurt you" or "Suck this, bitch" when they're punishing us. The problem is, they're punishing us for no reason, and that's what's got to change.

---Baron V

Because They Can

It's why the health care is still too damn expensive:

“Lucentis is Avastin---it’s the same damn molecule with a few cosmetic changes,” said J. Gregory Rosenthal, a Toledo ophthalmologist who, outraged by the price, co-founded a group called Physicians for Clinical Responsibility to protest its use. “Yet Americans are paying a billion dollars every year for no good reason---unless you count making Genentech rich.”

The story of Genentech’s two drugs, Lucentis and Avastin, began with a scientific marvel---a breakthrough in biology that, thanks to the vast budgets of U.S. entitlement programs, has produced enormous financial returns.

Those profits have yielded benefits. By paying for such drugs without regard to cost, the Medicare system has helped stimulate investment in medical research that contributes to the development of more lifesaving technologies.

But the flow of cash also pushes up the health-care costs that are projected to deplete federal budgets. For while Genentech has aggressively marketed the more expensive drug and sought to restrict the use of the cheaper one, critics say, Medicare has been powerless to do anything but pay up.

It should be duly noted---once again!---that the Goldberg Act does absolutely nothing to rectify this since the profiteers and middlemen who extract billions of dollars from our health-care system were permitted to write the law. This sure was worth losing the House of Representatives over, now, wasn't it.

The fact remains: You want to drive down health-care costs, you drive down health-care costs. Anything other approach only invites never-ending ransom payments to a pharmaceutical extortion racket.

---Baron V

Welcome To Our World

Hate to say "I told you so", but, like, I told you so:

Veteran House Democratic aides are sick over the insurance prices they’ll pay under Obamacare, and they’re scrambling to find a cure.

“In a shock to the system, the older staff in my office (folks over 59) have now found out their personal health insurance costs (even with the government contribution) have gone up 3-4 times what they were paying before,” Minh Ta, chief of staff to Rep. Gwen Moore (D-Wis.), wrote to fellow Democratic chiefs of staff in an email message obtained by POLITICO. “Simply unacceptable” [...]

[T]he premiums for gold-level Aetna HMO plans in D.C. cost an average of $684.40 per month for a 55-year-old. A similar plan would cost an average of $287.11 for a 27-year-old. The gold-level CareFirst HMO plans have an average premium of $573.07 for a 55-year-old---more than double the $240.41 average for 27-year-olds. That’s before the federal employee contribution toward the premium.

None of this needed to happen, and there is a very simple cure. But it would have required political leadership that was willing to tell insurers that since they're not needed in the UK or in Sweden or in The Netherlands or in Canada, they're not needed here, and that they should find some other products to insure. It would have required telling hospitals and doctors that billing their patients $500 for a stitch or $10,000 for a 15-minute colonoscopy were no longer permissible. It would have required telling pharmaceutical companies that they would need to negotiate prices of their products with the government as they do everywhere else. It would have required, in a nut, genuine political courage to push back against the profiteers, rent-seekers and middlemen who are bankrupting the country, and to push for legislation that would have benefitted patients and consumers first. But obviously, we don't have that kind of political leadership in America.

These people carried the water for Team Democrat, and now they're getting their just rewards. Pardon me if I have trouble manufacturing any sympathy for them.

---Baron V

Circular Logic

Missed this gem from yesterday:

If you still don’t like Obamacare---and I know you don’t---even though it’s built on market-based ideas of choice and competition in the private sector, then you should explain how, exactly, you’d cut costs, and cover more people, and make insurance more secure. You owe it to the American people to tell us what you are for, not just what you’re against. That way we can have a vigorous and meaningful debate. That’s what the American people deserve. That’s what the times demand. It’s not enough anymore to just say we should just get our government out of the way and let the unfettered market take care of it---for our experience tells us that’s just not true.

But too much of our private health-care system is an unfettered market. Even if insurance companies are now required to cover some routine services and can only extort a certain percentage of our income, hospitals can still charge whatever they want because they can. Physicians can still charge whatever they want because they can. Pharmaceutical companies and device manufacturers can still charge whatever they want because they can. And the Goldberg Act does squat about it. It simply shifts the costs around. Those "market-based ideas of choice and competition" the President touts are the leading cause of personal bankruptcy in America, and have been for years. They need to be dynamited, not held up as some noble example to follow.

---Baron V

Fixing a Website is Easy

What's not easy is convincing people to purchase a product they don't think they need:

While a majority of uninsured people surveyed by Gallup---63 percent---say they intend to enroll in the health exchange, 28 percent said they would not enroll and would instead pay a fine [...]

People who don't sign up for insurance by the end of March will have to pay a fine. The fine in 2014 is 1 percent of the person's income or $95, whichever is higher. The maximum penalty for a family is $285.

Another poll on Wednesday indicates a majority of young people disapprove of the healthcare law. Less than a third of 18- to 29-year-olds say they’re likely to sign up for ObamaCare, according to a survey done by Harvard University’s Institute of Politics.

In one way, I almost wish that Justice Roberts hadn't changed his mind at the last minute, and had voted to strike down the Goldberg Act. It would at least have forced Team Democrat to acknowledge the obvious flaws in the law. For one, the most logical way to guarantee universal access to health care is not to compel people to enroll when they don't perceive a need for care but to automatically enroll them at birth so the health care is available to them whenever they eventually need it. Because as it stands now, it's becoming pretty obvious that the people who are flooding the exchanges are people with pre-existings and people like myself---too young for Medicare but old enough to have potentially serious health concerns---while the youngs and the healthies are staying away. If that's the case, it means financial armageddon for those of us who are enrolled in 2015. But I guess we shouldn't worry much about it because Team Republican would never use that against us in an election season.

---Baron V

Of Course They're Going to Lie About it

Because we already know that they lie about everything:

[A] national Republican group will hit 12 Democrats–all running in Senate elections next year–over changes to Medicare.

The National Republican Senatorial Committee will highlight Wednesday the candidates' support for the federal health care law, better known as Obamacare, and what Republicans call $717 billion in cuts to the popular entitlement program that guarantees health insurance to seniors.

Democrats defending the program, however, say the changes aren't cuts, but savings of projected costs of Medicare over the next 10 years.

You know what would really lower Medicare costs? Enrolling everyone in Medicare! because right now, only old people can enroll in it, and old people get sick more often and consume more health care than non-old people. And besides lowering health-care costs and providing every citizen with peace of mind, it also preempts the crazies and charlatans from leveling charges of Medicare cuts against you. It's like this: how can you argue that Team Democrat is cutting Medicare when they just expanded the program to cover everyone? So, smart policy, and smart politics, too!

But for this to ever happen, we would need a Democratic party that was smart enough to avoid Republican traps, and forget about trying to wrestle the mantle of "fiscal responsibility" away from them. They've never cared about that in the least, and they'll only use Team Democrats' frugality as a political cudgel to club them like baby seals when election time rolls around. In other words, expand Medicare and expand Social Security, and raise taxes to pay for it. Republicans and billionaires won't like it, but most voters will. And you need voters to win elections!

(Via.)

---Baron V

Why They Gouge Us

Because they can:

A day spent as an inpatient at an American hospital costs on average more than $4,000, five times the charge in many other developed countries, according to the International Federation of Health Plans, a global network of health insurance industries. The most expensive hospitals charge more than $12,500 a day. And at many of them, including California Pacific Medical Center, emergency rooms are profit centers. That is why one of the simplest and oldest medical procedures closing a wound with a needle and thread typically leads to bills of at least $1,500 and often much more.

At Lenox Hill Hospital in New York City, Daniel Diaz, 29, a public relations executive, was billed $3,355.96 for five stitches on his finger after cutting himself while peeling an avocado. At a hospital in Jacksonville, Fla., Arch Roberts Jr., 56, a former government employee, was charged more than $2,000 for three stitches after being bitten by a dog. At Mercy Hospital in Port Huron, Mich., Chelsea Manning, 22, a student, received bills for close to $3,000 for six stitches after she tripped running up a path. Insurers and patients negotiated lower prices, but those charges were a starting point.

The main reason for high hospital costs in the United States, economists say, is fiscal, not medical: Hospitals are the most powerful players in a health care system that has little or no price regulation in the private market.

Rising costs of drugs, medical equipment and other services, and fees from layers of middlemen, play a significant role in escalating hospital bills, of course. But just as important is that mergers and consolidation have resulted in a couple of hospital chains like Partners in Boston, or Banner in Phoenix dominating many parts of the country, allowing them to command high prices from insurers and employers.

In most other industries, antitrust legislation would be invoked, the mega-hospitals broken up, and their executives charged with price-fixing. And in any other developed nation, these procedures would cost the patient nothing at the point of delivery, and the government would regulate pricing and billing. But of course we must never be allowed do any of these things because it would be too "disruptive". So the rent extraction and medical bankruptcies will continue, and thanks to the Goldberg Act, a greater share of the total cost burden will now be shouldered by taxpayers. This is worse than a policy failing--- by legitimizing profiteering on sickness and human misery, it's a moral failing as well.

---Baron V

Not Rocket Surgery

One could have predicted---easily!---that the Goldberg Act, and its companion Website, would work poorly and inefficiently. That's because the policy foundation at the heart of the Goldberg Act originated with a bunch of people who believe that government inherently works poorly and inefficiently, and who intentionally craft legislation to confirm their ideological bias. There is an easy fix for this, and all it has ever required is the political will to eliminate the middlemen who drive up health-care costs for everyone while providing nothing of value in return. But if you're going to rely on policy that was drawn up by people who want to sabotage liberal government, then you shouldn't be surprised if your liberal government gets sabotaged. That was the point all along.

---Baron V