In a recent piece in The New Yorker a physician who also is a writer bemoans the fact that anyone is opposed to the ACA[1]. He starts off with the obligatory sob story of some poor unemployed person who no longer has insurance and gets ill, at lease this person appears to have a biopsy on some "pre-malignant" disorder. Then the poor guy gets the bills. Surprise.
He then states concerning the roll-out of the ACA:
How this will unfold, though, depends on where you live.
Governors and legislatures in about half the states—from California to New
York, Minnesota to Maryland—are working faithfully to implement the law with as
few glitches as possible. In the other half—Indiana to Texas, Utah to South
Carolina—they are working equally faithfully to obstruct its implementation.
Still fundamentally in dispute is whether we as a society have a duty to
protect people like Paul Sullivan. Not only do conservatives not think so; they
seem to see providing that protection as a threat to America itself.
That is the way the law was written by the Democrats. One
should not blame those who did not even vote for the law. Secondly, and this is
the first sob story part of his piece, if someone loses their job, they still
have home and auto insurance. No auto insurance no car registration, no
driving. No home insurance and some may default on their mortgage and get the
home repossessed. So why let health insurance lapse. Because people assume they
will be taken care of on someone else’s dime. It does not always work that way.
So find a job, any job, and get two or three to survive. Some of us have been
there.
Then he bemoans:
Obstructionism has taken three forms. The first is a
refusal by some states to accept federal funds to expand their Medicaid
programs. Under the law, the funds cover a hundred per cent of state costs for
three years and no less than ninety per cent thereafter. Every calculation
shows substantial savings for state budgets and millions more people covered.
Nonetheless, twenty-five states are turning down the assistance. The second is a
refusal to operate a state health exchange that would provide individuals with
insurance options. In effect, conservatives are choosing to make Washington set
up the insurance market, and then complaining about a government takeover. The
third form of obstructionism is outright sabotage. Conservative groups are
campaigning to persuade young people, in particular, that going without
insurance is “better for you”—advice that no responsible parent would ever give
to a child. Congress has also tied up funding for the Web site, making delays
and snags that much more inevitable.
The state exchanges will also entail Medicaid expansion. Why? After all the Feds are paying. Well first where do the Feds get the money, simply from us. Second, and this is critical, the Fed support is but for a short while. Then the States must pay. That is excessive. Especially since in some states they are doubling or tripling the Medicaid roles. Take New Jersey, there will almost be a tripling of the roles. Now it is not as if they are not getting care, just go to any ER. But now it gets loaded onto private insurance fees. Taken out of corporate and individual coffers. But when the size triples, it will be all out of the remaining taxpayers pockets, along with the sizeable subsidies. Imaging getting a subsidy even if your income is just shy of $100,000!
And he continues:
And he continues:
Some states are going further, passing measures to make
it difficult for people to enroll. The health-care-reform act enables local
health centers and other organizations to provide “navigators” to help those
who have difficulties enrolling, because they are ill, or disabled, or simply
overwhelmed by the choices. Medicare has a virtually identical program to help
senior citizens sort through their coverage options. No one has had a problem with
Medicare navigators. But more than a dozen states have passed measures
subjecting health-exchange navigators to strict requirements: licensing exams,
heavy licensing fees, insurance bonds.
Is there any concern in the above statement? Should states
just allow anyone to “assist” people in selecting how to spend money on 18% of
the economy? The navigator program is open to massive fraud and corruption. The
navigators need de minimus training and can put themselves forth as experts and
who knows what they will do. We regulate attorneys and accountants and even
hair dressers. People will be making tremendous personal and financial decisions
on getting insurance. We regulate those who purvey home and auto and life
insurance. But this writer seems to consider it some evil to regulate the
purveyors under the ACA. Why? Do we trust Government agents any more than
others? Just look at the IRS. Argument ended. As for the Medicare program,
first we paid for it, second we keep paying for it, third, there is no navigator,
there is one program, and fourth it delimits my choice of physicians.
So what is wrong with the ACA? I started this blog in late
2008 recognizing two things. First that the economy was in a mess and not a
single academic economist had a clue. A few admitted it but most such as the
gnome from the South kept mouthing off as to what should be done. The classic
case is the Romer curve, predictions that were not even close, even now! And
that person is still teaching on the state dole. Second, was the issue of Health
Care? I complained about Hillary Care in the early 90s and when I saw train
wreck number two approaching I again was concerned.
In my opinion Health Care should be as follows:
1. Universal coverage. Everyone needs to have it.
2. Commercially available. Insurance entities should market
it nationally.
3. Provide catastrophic coverage only by mandate. You get
terminal cancer, a stroke, massive MI, you are covered. You have a cold, it is
your dime. You can always buy more insurance, but the law must not mandate some
full package. That includes birth control.
4. Individual purchases and after tax dollars. That is
correct, just like your home and auto insurance.
5. Government subsidies for the lower incomes. That means
poor folks. Poor because they cannot find a job. Not poor because they just
like hanging out at mom’s through their 20s and 30s.
6. Penalties for lifestyle risks. Smoke and you [pay more,
Obese and you pay more. Drugs and you pay more.
7. No Government control. The Government can require it, as
a tax if you will, but they get no information, provide no regulations, and
demand no specific performance.
Simple. As we have shown this can be done today with a lower
expenditure than we have now for everyone.
The author ends with:
This kind of obstructionism has been seen before. After
the Supreme Court’s ruling in Brown v. Board of Education, in 1954, Virginia
shut down schools in Charlottesville, Norfolk, and Warren County rather than
accept black children in white schools. When the courts forced the schools to
open, the governor followed a number of other Southern states in instituting
hurdles such as “pupil placement” reviews, “freedom of choice” plans that
provided nothing of the sort, and incessant legal delays. While in some states
meaningful progress occurred rapidly, in others it took many years. We face a
similar situation with health-care reform.
I guess every Democrat needs to bring in racism, it seems to be part of the Party rant. No one’s
rights are in dispute here. All have a right to buy health care. No one is
denied health care because of sex, race, and religion. No group is being barred
from hospitals. This in my opinion is just a classic cheap shot. Making this the same as racism is akin to calling a person a Nazi. It is both out of place and destroys the logic of the argument, if ever there was any. It now seems almost obligatory to rant in this manner. Frankly it dilutes whatever argument one may have.
The problem is that we need health care reform, we need
universal health care but the Government as controller is the worst of a bad
set of options. The regulations resulting from the Law are minion. They are
confusing, some contradictory, and a great financial and unnecessary burden. Is
this segregation? Hardly. It is the people speaking out against something
jammed down their throats.
It would be nice if some of these academics and physicians had a modicum of financial acumen. Just a little bit.
It would be nice if some of these academics and physicians had a modicum of financial acumen. Just a little bit.
Posts
