But the underlying fallacy — the failure to notice that things must add up — is, in my experience, the single greatest source of economic error. Politicians routinely promise to make medical care or housing or college educations more widely available by controlling their prices; economists routinely scratch their heads and ask where the extra doctors or houses or classrooms are going to come from. You can no more speed up the line for medical care by lowering prices than you can speed up the deli line by handing out tickets.
Notes from the Golden Orange
EppsNet Archive: Healthcare
In Britain, even though they’re already paying for the National Health Service, six million Brits — two-thirds of citizens earning more than $78,700 — now buy private health insurance. Meanwhile, more than 50,000 travel out of the U.K. annually, spending more than $250 million, to receive treatment more readily than they can at home.
The conversation below took place more than four years ago — June 23, 2009 — at a congressional hearing on Obamacare. The topic was the keep-your-coverage promise, and the participants were Christina Romer, then chair of the Council of Economic Advisers, and Rep. Tom Price, who is also a doctor.
The conversation plays out like one of those word puzzles where you start out with one word and change one letter at a time to get a completely different word. Watch Romer’s responses on keeping your coverage go from “Absolutely” to a stammering “I’d have to look at the specifics.”
It’s also yet another reminder of what a pig in a poke Obamacare was. Even the people advocating for it had no idea what was in it.
REP. PRICE: You also mentioned, as other folks have, that the president’s goal — and it’s reiterated over and over and over — that if you like your current plan or if you like your current doctor, you can keep them. Do you know where that is in the bill?
MS. ROMER: Absolutely. And things like the employer mandate is part of making sure that large employers that today — the vast majority of them do provide health insurance. One of the things that’s —
REP. PRICE: I’m asking about if an individual likes their current plan and maybe they don’t get it through their employer and maybe in fact their plan doesn’t comply with every parameter of the current draft bill, how are they going to be able to keep that?
MS. ROMER: So the president is fundamentally talking about maintaining what’s good about the system that we have. And —
REP. PRICE: That’s not my question.
MS. ROMER: One of the things that he has been saying is, for example, you may like your plan and one of the things we may do is slow the growth rate of the cost of your plan, right? So that’s something that is not only —
REP. PRICE: The question is whether or not patients are going to be able to keep their plan if they like it. What if, for example, there’s an employer out there — and you’ve said that if the employers that already provide health insurance, health coverage for their employees, that they’ll be just fine, right? What if the policy that those employees and that employer like and provide for their employees doesn’t comply with the specifics of the bill? Will they be able to keep that one?
MS. ROMER: So certainly my understanding — and I won’t pretend to be an expert in the bill — but certainly I think what’s being planned is, for example, for plans in the exchange to have a minimum level of benefits.
REP. PRICE: So if I were to tell you that in the bill it says that if a plan doesn’t comply with the specifics that are outlined in the bill that that employer’s going to have to move to the — to a different plan within five years — would you — would that be unusual, or would that seem outrageous to you?
MS. ROMER: I think the crucial thing is, what kind of changes are we talking about? The president was saying he wanted the American people to know that fundamentally if you like what you have it will still be there.
REP. PRICE: What if you like what you have, Dr. Romer, though, and it doesn’t fit with the definition in the bill? My reading of the bill is that you can’t keep that.
MS. ROMER: I think the crucial thing — the bill is talking about setting a minimum standard of what can count —
REP. PRICE: So it’s possible that you may like what you have, but you may not be able to keep it? Right?
MS. ROMER: We’d have — I’d have to look at the specifics.
“I am not a crook.” — Richard Nixon
“Read my lips: no new taxes.” — George H.W. Bush
“I did not have sexual relations with that woman, Miss Lewinsky.” — Bill Clinton
“If you like your plan, you can keep it.” — Barack Obama
When President Obama said that he could provide health care to millions without taking any health care away from people who have already got it, he had no chance of being believed. The statement was absurd on its face. This is a law of arithmetic: If you invite a bunch of friends to share your lunch, there’s going to be less lunch for you. Everybody understands that. . . .
So when the President said he could expand the availability of medical care while allowing everyone else to keep the care they’ve got, it was like saying he’d take us for a tour of England in his rocket ship. It had absolutely no chance of being believed, and therefore, it seems to me, does not count as a lie.
It counts instead as an expression of contempt for the many entirely reasonable people who tried to point out that it is not within a President’s power to suspend the laws of arithmetic.
That expression of contempt was arguably pretty contemptible, and arguably as contemptible as a lie. And of course he’s compounding it by trying to tell you with a straight face that everyone who has to switch health plans will end up with “better” plans that allow them to consume even more medical care. I could give you some pretty striking counterexamples among people I’m personally close to, but there’s no need for that, since anyone who grasps basic arithmetic can see that the president’s words cannot be true. But speaking untruths is not enough to make him a liar. For that, he’d have to speak plausible untruths, and he has too little respect for the American people to bother coming up with any.
Cindy Vinson and Tom Waschura are big believers in the Affordable Care Act. They vote independent and are proud to say they helped elect and re-elect President Barack Obama.
Yet, like many other Bay Area residents who pay for their own medical insurance, they were floored last week when they opened their bills: Their policies were being replaced with pricier plans that conform to all the requirements of the new health care law.
Vinson, of San Jose, will pay $1,800 more a year for an individual policy, while Waschura, of Portola Valley, will cough up almost $10,000 more for insurance for his family of four. . . .
Covered California spokesman Dana Howard maintained that in public presentations the exchange has always made clear that there will be winners and losers under Obamacare. . . .
“Of course, I want people to have health care,” Vinson said. “I just didn’t realize I would be the one who was going to pay for it personally.”
The general point is that a positive right to health care – no matter how splendid you hold that right to be and no matter how lovely is the provision of that right – requires that its recipients receive at others’ expense the services to which these recipients have a ‘right.’ Someone (or a multitude of someones) must supply those services whose recipients self-righteously insist be supplied as a matter of ‘right.’ This fact is undeniable and inescapable.
Note that – although undeniable and inescapable – this fact does not by itself establish a case against treating health care as a right. But recognizing this reality does reveal certain potentially ugly aspects of all this ‘rights’ talk about health care – namely, to exercise your ‘right’ to health care requires that someone else be forced to serve you. Someone else must not merely refrain from interfering in your life and business. Instead, that someone else must be obliged to exert positive effort to help you – and not because you make it worthwhile for that person to exert that effort on your behalf, but because the government will ultimately execute him or her if he or she refuses to supply you with that to which you have a positive ‘right.’
I’m aware that such positive “rights” strike many people as being evidence of a highly progressive and especially civilized and caring society. They strike me as being quite the opposite: evidence not only of economic ignorance, but of collectivized and mutually destructive predation camouflaged with a pretty mask and falsely scented with absurd oratory.
Well buddy when I die throw my body in the back
And drive me to the junkyard in my Cadillac
Say goodbye to that $500 deductible insurance plan and the $20 co-payment for a doctor’s office visit. They are likely to become luxuries of the past. . . .
Then blame — or credit — the so-called Cadillac tax, which penalizes companies that offer high-end health care plans to their employees.
You’re probably thinking: “So what? I don’t have a high-end health care plan. I’m a working stiff. Let the Wall Street fat cats pay their Cadillac tax.”
Actually, because the plan cost that triggers the Cadillac tax is not indexed for inflation, Bradley Herring, a health economist at Johns Hopkins Bloomberg School of Public Health, estimates that as many as 75 percent of plans could be affected by the tax over the next decade.
The hospital where Abbey Bruce, a nursing assistant in Olympia, Wash., worked, for example, stopped offering the traditional plan that she and her husband, Casey, who has cystic fibrosis, had chosen. . . .
She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.
“My husband didn’t choose to be born this way,” Ms. Bruce said. The union representing her, a chapter of the Service Employees International Union, has objected to the changes. Her employer, Providence Health & Services, says it designed the plans to avoid having employees shoulder too much in medical bills and has reduced how much workers pay in premiums.
ObamaCare proponents say the Cadillac tax is bringing down employer (not patient) costs as planned.
Cynthia Weidner, an executive at the benefits consultant HighRoads, [said] that the tax appeared to be having the intended effect. “The premise it’s built upon is happening,” she said, adding, “the consumer should continue to expect that their plan is going to be more expensive, and they will have less benefits.”
Key takeaway: Pay more. Get less.
I hate to say I told you so, so instead I’ll say say an insincere thank you to Obama and all the delusional fuckers who voted for this goddamn law.
Health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers.
That headline should not read “DESPITE new health law,” it should read “BECAUSE OF new health law.”
But we were going to get things for free! We were promised better things at a lower cost!
In my day, most of the citizens were farmers or merchants or tradesmen. They lived by their hands and their wits. They had horse sense and they knew when they were being sold a bill of goods.
Of course, that was before television.
Americans today are unfortunately rather stupid. Most of them don’t know anything about economics, science, history, government . . . as George Carlin says, “Think of how stupid the average person is, and realize half of them are stupider than that.” George is here in heaven now. He breaks me up, he really does.
Your president and Congress have decreed that every American will have health insurance whether they want it or not. They have further decreed that a lot of Americans will not have to pay for their own health insurance, which means that the cost of their health insurance has to be paid by the rest of you. That’s one reason why your health insurance premium is going up.
Another reason your premium is going up is the “guaranteed issue” provision. “Guaranteed issue” means that no one can be denied health insurance because of pre-existing conditions.
Funny story: My friend Paul Epps, his wife has an insurance agency in Southern California. It’s an area that’s susceptible to wildfires in the summer months. When a fire breaks out, people who live near the fire actually call this woman wanting to buy a homeowners policy.
Of course, she doesn’t sell it to them. Insurance companies are a little bit smarter than that.
Buying a homeowners policy when your house is already on fire is analogous to “guaranteed issue” health insurance: Hello, I’d like to buy some health insurance. Oh by the way, I have cancer, but the doctors think that with lengthy and expensive treatment, I have a chance to pull through.
This is not even insurance anymore. Insurance is something you pay for now to protect against the risk of having to pay a lot more later. In these cases, there IS no risk. The bad news has already happened. It’s a dead loss for the insurance company and they have to spread the cost of that loss to other policyholders. That’s another reason your premium is going up.
This isn’t even economics, folks, it’s just common sense.
A slight minority of Democrats (48%) say the government should be extremely or very involved compared to 13 percent of Republicans. Non-whites (47%) are more likely than whites (25%) to say the government should be very or extremely involved in finding solutions to the country’s obesity problem.
My fellow Americans —
The country doesn’t have an obesity problem. If you’re obese, that’s your problem, not the country’s problem, and you bear the costs of it, financial and otherwise.
Some people might argue that obesity causes an increase in public health costs. That is untrue.
Think about it. If you die in your 40s because you’re too fat, you have saved us all a lot of money, to the extent that your healthcare costs are borne by the public. If you’d maintained a normal weight and lived to be 80, you’d still have end-of-life medical expenses, plus an additional 30 years of expenditures in between.
For those who want a solution to the “obesity problem,” I offer two:
- Eat less.
- Exercise more.
Got that, fatso?
If [Affordable Care Act] implementation goes as intended and widespread utilization and automation are achieved, providers could save about $11 billion per year.
You really can’t dispute something as vague as that but it does raise a number of questions:
- What does it mean for thousands of pages of legislation affecting the entire healthcare industry as well as every man, woman and child in America to go “as intended”? It’s a circular argument. If it goes as intended, we save $11 billion. If we don’t save $11 billion, it didn’t go as intended.
- Is “widespread utilization and automation” part of going “as intended” or is that a separate thing?
- Assuming that implementation does go as intended and widespread utilization and automation are achieved, the best we can say is that providers “could” save “about” $11 billion per year? Could they save more? Less? Break even? Could they lose $11 billion? It’s meaningless speculation.
- Can anyone remind me of a large-scale government program that went “as intended” and saved everyone a lot of money?
- Why, despite all evidence to the contrary, do people continue to believe that government can successfully engineer social aspirations?
In other news, if my plan to grow wings on pigs goes as intended, it could revolutionize the way we export bacon.
These things never go as intended. They can’t possibly go as intended. There are always unintended consequences. I can’t implement a policy in my own house and have it go as intended and there’s just two people and a dog.
I asked the friend who called the NEJM article to my attention what going “as intended” means in the context of the ACA and he said, “I think it means legislators don’t muck with it too much.” What does “muck” mean? What does “too much” mean? We could go on and on . . .
David Henderson says — accurately, I think — that Mitt Romney’s “47 percent” remarks can be paraphrased as “People who are dependent on government will vote for the candidate who credibly (to them, at least) promises to keep the programs that have created that dependence.”
Do you think President Obama disagrees with that? He doesn’t.
If you think he does, please see The Life of Julia on the president’s web site. It lays out a “typical” woman’s cradle-to-grave dependence on government assistance and describes how Obama will keep those programs going while Mitt Romney won’t.
The most insulting thing about it is that as you read about Obama funding this and Obama funding that, it sounds like he’s doing it all out of his own goddamn pocket. What a prince!
There’s no acknowledgement that Obama is taking from some and giving to others, and that all of Julia’s “free” stuff is paid for by me and people like me out of money earned by our own labor.
And we are struggling. We’re putting a kid through college, my wife has had an expensive medical condition, our home equity has plummeted, the roof leaks, my car is long overdue for new tires . . . there are unplanned expenses . . . next month, something else will break. That’s life.
As part of our middle-class existence, we pay a five-figure annual federal income tax bill. We pay for Julia’s babysitters, education, health care, etc., and Obama takes the credit. Not even a “thank you.” If we could keep even a fraction of that money, maybe we could afford to pay our own education and health care costs.
How about acknowledging that for every Life of Julia there’s a Life of Paul and presenting their stories in juxtaposition to show how, as with any policy, some people are better off and some people worse.
|Life of Julia||Life of Paul|
|As she prepares for her first semester of college, Julia and her family qualify for President Obama’s American Opportunity Tax Credit—worth up to $10,000 over four years. Julia is also one of millions of students who receive a Pell Grant to help put a college education within reach.||As they go into debt to pay for their own child’s college education, Paul and his wife are required to pay for Julia’s college tuition as well.|
You see the idea? Let’s try another one . . .
|Life of Julia||Life of Paul|
|Julia decides to have a child. Throughout her pregnancy, she benefits from maternal checkups, prenatal care, and free screenings under health care reform.||Paul’s wife is diagnosed with a life-threatening medical condition. Although they have health insurance, which they pay for themselves, there are deductibles, co-pays and out-of-pocket expenses, as well as the financial implications of his wife’s inability to work. They receive no government assistance, which is fine, but their financial woes are compounded by the fact that they are also required to pay for Julia’s “free” medical care.|
The money being used to buy the votes of millions of Julias out there is not coming exclusively or even primarily from unnamed “millionaires” on “Wall Street” . . . it’s coming from “middle class” “hard-working Americans” on “Main Street” who are struggling.
- Progressive = Liberal
- Investing = Spending
- Choice = Abortion
- Bodies = Abortion
- Healthcare = Abortion
- Who they love = Gay marriage
Remember, we’re supposed to be worrying about skyrocketing health-care expenses. Doubling the number of wellness visits and free pills sounds great, but who’s going to pay for it? There is a liberal dream that by mandating coverage the government can make something free.
Here’s a good mandate: Let’s mandate that every time a government official says that the government is going to “help” some category of voter, he or she has to say who they are going to hurt in the same sentence. Because it has to be someone.
I work for a healthcare organization. In the lunch room today was one of those cylinders full of caramel corn and cheese corn that turn up everywhere around the holidays.
This one had a note attached: Compliments of your colleagues at the American College of Chest Physicians.
Are caramel corn and cheese corn good for cardiac health? They’ve gotta be terrible, right?
Beware of chest physicians bearing gifts!
CARDIOLOGIST: Who referred you to our office?
PATIENT: I saw your name on a container of cheese corn.
CARDIOLOGIST: Ha ha, yeah, those things pay for themselves a million times over in stents and angioplasties.
I can make a firm pledge. Under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.
There must be some mistake then because I just got an email from our accounting department stating that effective January 1, 2011, over-the-counter drugs will require a doctor’s prescription when an FSA claim for reimbursement is submitted.
That doesn’t even make sense. Of course I don’t have a prescription for OTC drugs. Why would I pay a doctor to write me a prescription for something that I can just walk into Walgreen’s and buy it?
Hi Doc, I’ve got a terrible cold so I just stopped by to drop a $30 co-pay and get a prescription for some Nyquil.
And if I can no longer pay for ibuprofen, aspirin, cough/cold medication, etc., with pre-tax dollars through my FSA, that makes my taxes go up. Did I mention that I earn less than $250,000 a year?
They came first for the smokers with last April’s increase in the cigarette tax from 39 cents a pack to $1.01 (even for smokers making less than $250,000), and I didn’t speak up because I wasn’t a smoker.
Then they came for the tanners with the 10 percent tanning bed tax (no exemption for tanners making less than $250,000), and I didn’t speak up because I wasn’t a tanner.
Then they came for me and by that time no one was left to speak up . . .
WASHINGTON — President Barack Obama told voters repeatedly during the health care debate that the overhaul legislation would bring down fast-rising health care costs and save them money. Now, he’s hemming and hawing on that.
Many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government.
That would dismantle the employer-based system that has reigned since World War II. It would also seem to contradict President Obama’s statements that Americans who like their current plans could keep them. And as we’ll see, it would hugely magnify the projected costs for the bill, which controls deficits only by assuming that America’s employers would remain the backbone of the nation’s health care system.
Hence, health-care reform risks becoming a victim of unintended consequences.
We have to pass the bill so that you can find out what is in it.
Experience hath shewn, that even under the best forms of government those entrusted with power have, in time, and by slow operations, perverted it into tyranny.
My fellow Americans —
This is a glorious day in our great nation! No, I’m not referring to that tragedy of a health care bill, which I’ll get to in a moment. I’m talking about Free Pastry Day at Starbucks! Who doesn’t enjoy a tasty scone with his morning coffee?
Now, on a more somber note . . .
Goodbye, representative democracy! Farewell, consent of the governed!
President Obama today signed into law a far-reaching measure that will affect everyone living in these United States, now and in the future. It is opposed by most of the country and it is now law.
I would never have believed that the government I helped to establish would one day engage in this kind of forced sodomy against its own people.
We know what is right and we will do it, regardless of whether you want it done to you or not.
If Karl Marx were here, he would no doubt make a case for trading off liberty in favor of whatever it’s called when a centralized authority redistributes your income in the interest of “equality.” If you know even a little bit about American history, I guess you know which side of that fence old Tom Jefferson is on.
Switching from politics to economics: People with insurance use more health care resources than people without. Put another stitch in my head, doc! I’ve got insurance!
If more people have insurance, it will increase the demand for health care, which in turn will increase the price.
Now imagine that everyone has insurance. I got your health care reform right here: We’re going to drive the price of health care through the roof, then spend a titanic amount of money helping poor people afford it.
I have no (proven) living descendants and for that I say — Thank God! The next generation of Americans is going to be crushed under the burden of paying for this misguided vision of government.
Yours in sadness and in hope,