Obamacare’s serious weaknesses driving even strong supporters away

Commentary by James H. Shott

Although Sen. Max Baucus (D-Mont.) only recently acknowledged that the health care reform bill he helped create – the Patient Protection and Affordable Care Act (ACA), also known as Obamacare – is a “train wreck,” most Americans suspected that at its creation.

Things are so bad that President Barack Obama, trying to prevent some of the disastrous results, did something he is not allowed by the U.S. Constitution to do: postpone implementation of part of the law by suspending the employer mandate until 2015 and leaving the rest of the law intact. The Executive Branch of our government is obligated to enforce the laws – all of them, and all of each of them – and does not have the power to choose which ones, or parts thereof, it will enforce.

The House of Representatives passed two measures delaying the employer and individual mandates for one year, with 35 and 22 Democrats respectively joining in those efforts, which Mr. Obama has curiously threatened to veto.

And more recently, one of Obamacare’s most devoted groups of supporters has jumped ship. In a letter to Democrat Congressional leaders, Teamsters union president James Hoffa, and the presidents of two other unions, said this: “Right now, unless you and the Obama Administration enact an equitable fix, the ACA will shatter not only our hard-earned health benefits, but destroy the foundation of the 40 hour work week that is the backbone of the American middle class.”

The law has already encouraged some employers to trim their staffs to fewer than 50 full-time employees to avoid the expense of the mandate, and in other cases to decide against providing insurance altogether, and pay a much cheaper fine.

Nevertheless, Mr. Obama declared last week that "the law is working the way it was supposed to for middle-class Americans,” and criticized House Republicans for trying to dismantle it.

Polling data from five different polling organizations from mid-May through July 13 shows continuing disfavor among Americans, with the disparity of opposition-to-support running from as little as 5 points to as much as 15 points, and the Real Clear Politics average of the five polls at 10.2 points.

According to the Gallup poll from late last month, 42 percent say that in the long run the law will make their family's healthcare situation worse, and only 22 percent say it will make it better. And 47 percent believe the law will make the healthcare situation in the U.S. worse, while only 34 percent say it will make it better.

Republicans also are criticized for offering no alternatives while trying to dismantle the measure. “Three years after campaigning on a vow to ‘repeal and replace’ President Barack Obama’s health care law, House Republicans have yet to advance an alternative for the system they have voted more than three dozen times to abolish in whole or in part,” Sunday’s editorial in The Washington Post complained. That ignores, however, H.R. 3400 - Empowering Patients First Act, introduced in 2009 before Republicans campaigned for and won control of the House.

And now there is another, H.R. 2300 – the Empowering Patients First Act of 2013. Its principal sponsor is Rep. Tom Price (R-Ga.), who sponsored H.R. 3400, and he has credentials for health care issues matched by few in the Congress. Rep. Price is also Dr. Price, a physician who actually delivered and understands patient care.

This measure allows patients, families and doctors to make medical decisions, not Washington, DC. That is an excellent place to begin improving health care. What a shame that wasn’t the driving factor behind the ACA.

“You can get folks covered, you can solve the insurance challenges, and you can save hundreds of billions of dollars in this health care system,” said the physician/Congressman, “all without putting Washington or health insurance companies in charge of those decisions that ought to be between patients, and families and doctors.”

How can H.R. 2300 – a bill of only 249 pages, less than a tenth the length of the monstrous Obamacare bill – accomplish this?

Rep. Price describes it as comprehensive legislation under which “every single American has the financial feasibility to purchase the coverage they want, either through tax deductions, or credits, or advanceable credits or refundable advanceable credits so that they can purchase the coverage they want for themselves or their families, not what the government forces them to buy.”

He says further that everyone owns their own coverage, like a 401k plan, so if they change their job or lose their job, they take their coverage with them, and it allows all of those with pre-existing conditions to pool together, giving them the purchasing power of millions so that no one person’s adverse health status will change the cost for anyone else, including that one person.

While H.R. 2300 has the great advantage of being properly focused on patients and physicians, trying to straighten out the voluminous failures of the ACA in one bill is a Herculean feat. Obamacare needs to be repealed in total, and as soon as possible, and then Congress must undertake a sensible approach to correcting the problems of the health care system without turning it over to the government.

Cross-posted from Observations

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Foolish big-government policies continue to impede economic recovery

Economic news continues to be slightly positive, with May's numbers a mixture of good and bad.

Unemployment ticked up one-tenth, from 7.5 percent to 7.6 percent and, oddly, that isn't as bad as it seems, because 420,000 people who had dropped out of the labor force thought that the environment had improved sufficiently to start looking for work again last month. Had those folks remained on the sidelines, the rate likely would have held at a too-high 7.5 percent. However, 101,000 of those new job-seekers didn't find work, pushing the unemployment rate up.

The influx of new job-seekers, however, moved the labor force participation rate from 63.3, a 34-year low, to 63.4.

New jobs totaled 175,000 last month, a little better than the 155,000 average of the last three months, but most were low-paying jobs that are not likely to increase consumer spending. And that number is well below the number needed monthly to make real progress in lowering the unemployment rate. The Federal Reserve Bank of Atlanta's calculator shows that more than 400,000 new jobs per month will be needed to get the unemployment rate down to the full-employment level of 5.0 percent in a year, and nearly 261,000 new jobs a month to hit 5.0 percent in two years.

Four years after the $1 trillion stimulus package that was supposed to generate a 5.1 percent jobless rate, we are still a long way from that number with unemployment 50 percent higher than that. And as long as consumer confidence remains low and business uncertainty remains high, unemployment will not change much.

Businesses that scaled back workers during the recession continue operating with fewer employees, uncertain of how their costs may increase through higher taxes and costs related to health care reform, and won't hire more workers until those uncertainties are put to rest, or until there is a surge in consumer demand. However, consumers also are nervous about spending in the current economic environment, and are waiting for stability.

Last Thursday's Labor Department numbers showed that non-farm productivity, defined as output per hour of all workers, rose at a 0.7 percent annual rate in January through March, reversing the trend in the last quarter of 2012, as the economy sputtered.

One explanation for the recent pickup is that businesses saw higher demand for products and services over the winter, and that typically leads to higher wages for workers, ultimately improving living standards. However, it might also mean that employers are getting more out of their current workforce and thus have no urgent need to hire, which does not improve the unemployment picture.

On the topic of health care reform, the public has never embraced the Affordable Care Act known as Obamacare, and is even less enamored of it today, according to a new Rasmussen Reports national telephone survey.

Rasmussen found that only 41percent of the 1,000 likely voters that participated now hold at least a somewhat favorable opinion of the health care law, while 54 percent view it unfavorably. A tiny 15 percent view Obamacare very favorably, while 40 percent have a very unfavorable view of the law.

A slightly better rating appears in the new NBC News/Wall Street Journal poll, which shows that 49 percent of Americans say they believe the Affordable Care Act is a bad idea, while just 37 percent say it is a good idea. Like the Rasmussen poll, the NBC/WSJ poll had a substantial number of participants who strongly believe Obamacare is a very bad idea, at 43 percent.

These numbers reflect an increase in unpopularity since July 2012, when 44 percent of NBC/WSJ poll respondents called it a bad idea, while 40 percent called it a good one.

Some of the reasons for this unpopularity are that while the Affordable Care Act promised to lower premiums for families, regulators decided to impose a 3.5 percent surcharge on insurance plans sold through federally run exchanges. There also is a $63 fee for every person covered by employers, and a "premium tax" that will require insurers to pay more than $100 billion over the next decade. The Joint Committee on Taxation expects insurers to simply pass this tax onto individuals and small businesses, boosting premiums another 2.5 percent.

Earlier this year, the Congressional Budget Office said that 7 million people will likely lose their employer coverage thanks to Obamacare — nearly twice its previous estimate. The CBO said that number could be as high as 20 million.

And in December, state insurance commissioners warned Obama administration officials that the law's market regulations would likely cause "rate shocks," particularly for younger, healthier people forced by Obamacare to subsidize premiums for those who are older and sicker.

Combined with the other liberal policies that have caused the recovery to stall for four years, the unpopular federal takeover of health care deepens uncertainty for businesses and raises insurance and health costs for consumers. Then there is Obamacare's planned involvement of the IRS.

A stagnant recovery and pain and suffering are what happens when the narrow ideological dreams of the ruling elite take precedence over addressing the real needs of Americans.

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Rubio's immigration legislation is Obamacare on steroids

Rubio’s immigration legislation is Obamacare on steroids

 

Americans should get ready for the newest affliction from Washington D.C. This time it is in the form of immigration legislation. As porous as our borders are presently, this monstrous legislation will enable a deluge of immigrants to flow into this country. Marco Rubio, a Republican Senator from the Great State of Florida, is spearheading the push to move this legislation forward. Commercials have already appeared noting this legislation as a cure-all to all the prior failed immigration laws and policies that preceded it. Three decades ago one of our best presidents, Ronald Reagan, made a concerted effort to stem the flow of illegals from south of the border, it failed. Since then a hodge-podge of remedies have been attempted to bring sanity to the immigration process. They also failed. Senator Rubio has been all over the media touting the virtues of his program that disadvantages American citizens over their illegal counterparts. A version of this pending legislation is revised weekly to keep current with its critics’ analysis. Volumetrically, this bill contains 867 pages with references to more waivers, exemptions and exceptions per page than its big brother, Obamacare. For complexity it contains a dazzling array of tenets that could baffle the most rational mind. With such a variety of paths to by-pass the restrictions in the core bill, one can only extrapolate that it was deviously prepared this way for a reason. According to reports, Rubio claims border control will improve, more sensible approaches to the illegals already on our soil will come into being and future arrivals will be given an easier path to citizenship. From closer inspection of this newest offering from Congress, the antithesis will occur. Illegals will be able to bring their families here with much less effort than before, potentially doubling and or tripling their present numbers. Management of the borders are taken out of the hands of those who perform these heroic actions, and given over to government lackeys to do as they choose. We are told by Rubio that; entitlements will not be available to illegals, that fines will be paid by those who have trespassed on our soil and this illicit populous will be able to stay in this nation with multiple conditions of their heads. Once you absorb this surrealistic presentation, a normal mind would come to the same conclusion as his or her  brethren, that Rubio is full of chicken feathers. This monster should not pass either house of Congress or anywhere near yours. Trillions is the price tag for a legislation that is doomed to fail like its predecessors. Conservative media voices are already lining up to support this egregious bill without understanding its true nature. In the event there is any sensibility left in Congress, this legislation, in its present form, should be defeated and buried in the landfill from which it originated. Rubio is being disingenuous with the American Public concerning the contents of his legislative initiative. As a result, his political career will suffer tremedously. His elementary approach to this complex issue displays he is not ready for primetime. Mark Davis, MD, President of Healthnets Review Services, www.healthnetsreviewservices.com. platomd@gmail.com. Author of Demons of Democracy and the forthcoming book, Obamacare: Dead on Arrival, A Prescription for Disaster. Manager of the group on LikedIn, Government in Transition: join, comment and debate some of the finest minds.

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Did you slip and fall into your garbage can? There’s a code for that!

The Affordable Care Act has forced insurance costs higher, encouraged many employers to bail out of providing health plans for their employees or cut employees or reduce hours to below the full-time threshold to avoid the higher costs, and has unleashed thousands of pages of new regulations. But intrepid federal bureaucrats charge ahead with even more requirements for providers, one of which is a revamping of the codes used to identify the medical services that providers use to bill insurers.

Currently, there about 18,000 such codes and one might be fooled into believing that is enough. But the devoted folks who get paid to generate new codes have been hard at work revamping the code system and the new list contains nearly 8 times the former number, checking in at 140,000 medical codes. The feds reason that more specific information is needed to adequately communicate what doctors and hospitals do for their patients, as well as what patients may have done to require a visit to a provider.

New codes describe precisely what bone was broken, or which eye was blackened, and tell insurers whether your injury occurred in, for example, an opera house, an art gallery, on a squash court, or in one of nine locations in and around a mobile home.

Some of them push the limits of propriety. Code R46.1 is for "bizarre personal appearance," while code R46.0 is for "very low level of personal hygiene." Others tell insurers whether an injury caused by walking into a lamppost was the "initial encounter," or a "subsequent encounter."

There is a group of codes that clarify whether you were injured while sewing, ironing, crocheting, doing handcrafts, knitting, or my personal favorite, playing a brass instrument. (Brass players are now churning out imaginative scenarios for how these injuries might have occurred.) There is also a code indicating that a patient's injury occurred in a chicken coup.

Speaking of birds, there are 72 codes for patients who have run afoul of these creatures, and being bitten by a parrot has a different code than if said parrot flies into you, or if you are bitten or flown into by a macaw or a goose. There are nine different codes for each of the six different species of bird.

The folks that developed the system—generally known as ICD-10, for International Classification of Diseases, 10th Revision—say "the codes will provide a more exact and up-to-date accounting of diagnoses and hospital inpatient procedures, which could improve payment strategies and care guidelines," and their use is scheduled to be required in two years. Pat Brooks, senior technical adviser at the Centers for Medicare and Medicaid Services explains that "It's for accuracy of data and quality of care."

As a side note, healthcare reform, known more commonly as Obamacare, is deemed so important that the furloughs that befell air traffic controllers did not extend to Obamacare regulators and code generators, according to Gary Cohen, director of the Center for Consumer Information and Insurance Oversight, who said that his office has not cut its workers’ hours and pay as a result of the automatic budget cuts that went into effect in March. This information should help convince doubters that the pain of the sequester is a conscious political choice of the administration, and not a requirement of the sequester.

While federal bureaucrats are busy, busy, busy improving the healthcare system with mountains of new regulations and charge codes, some of the people who actually provide care are taking different approaches, some of them good, and some not.

A recent Deloitte Center for Health Solutions survey of over 600 doctors reveals that 6 in 10 may retire earlier than they had planned, and will do so in the next three years, due to the effects of the Affordable Care Act on how they practice medicine.

Further, many providers will leave the private sector to work for hospitals or accountable care organizations, and others are fighting back against massive government interference in the doctor-patient relationship by reverting to an older direct primary care model that eschews health insurance in favor of fee-for-services, such as an office visit for $20 or a house call for $100. Some offer a membership plan where patients pay a set fee per month for physician services.

Getting away from health insurance, government regulations and other requirements reduces costs substantially, allowing doctors to provide services at affordable prices, and has the further advantage of allowing doctors to escape "assembly line medicine," all of which may benefit the relationship between providers and patients. In contrast to Obamacare, this is a real improvement in the system.

Finally, even supporters of this Rube Goldberg-like contrivance are starting to realize its boundless weaknesses. Senator Max Baucus, (D-Mon.), one of the Affordable Care Act’s designers and strong backers, told Health and Human Services Secretary Kathleen Sebelius during a Senate committee hearing that he sees "a huge train wreck coming down."

It's a shame Sen. Baucus and the other blind supporters didn't do their homework before the measure passed the Congress, and save the country much pain and suffering. But perhaps it’s not too late to reverse course.

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A national tragedy: We are learning what is really in Obamacare

Many thanks to former Speaker Nancy Pelosi for jamming the Patient Protection and Affordable Care Act through the House of Representatives so that finally the people could  "find out what is in it, away from the fog of controversy," as Ms. Pelosi so famously said two years ago. This unintentional revelation of what goes on in Ms. Pelosi's mind came in the heat of the battle between the liberal Congress and the American people, a majority of whom opposed this first step in a government takeover of our healthcare system. The American people lost that battle.

Of course, now that the odious gunk contained in the Affordable Care Act, now affectionately known as "Obamacare," has started oozing out, even the people who voted to approve the measure now realize how little they knew about it when the vote was taken.

Searching President Barack Obama's florid promises for a truthful statement about all the wonderful things the ACA would do for us is more challenging than Diogenes' trying to find an honest man.

Like your doctor? You can keep your doctor. Nope!

Like your insurance? You can keep your insurance. Nope!

It will lower costs. Nope!

After all the broken promises, there are also some new goodies in Obamacare:

There are 18 new taxes, estimated at about $800 billion, that will mostly affect America's middle class. And inflation, the cruelest tax on the poor, will increase as businesses find their operation burdened with added costs brought about by higher taxes and onerous government mandates, and pass those costs along to the consumer in the form of higher prices.

Obamacare will add $6.2 trillion (That's "trillion" with a "t"!) to the long-term deficit, according to the Government Accountability Office.

Medicare providers will be expected to continue to provide services despite a cut of $716 billion in payments. Added bureaucracy will make applying for health care even more burdensome than it already is; worse than that, an estimated 7 million people will lose their employer-provided health insurance; and worse yet, thousands of workers will find their hours cut or will lose their jobs entirely.

Just what we need: another government mandate that keeps unemployment unacceptably high.

Opponents of Obamacare warned that forcing companies employing 50 or more full-time workers to buy health insurance for their employees would result in a loss of jobs overall, and many full-time workers would have their hours reduced below the 30-hour weekly threshold. Even though the employer mandate does not go into effect until next January, employers are required to track worker's hours for up to 12 months prior to that, meaning that job and hours cuts have already begun so that employers can escape the $2,000 per-worker fine for uncovered employees, or have to bear the even higher costs of providing health insurance to full-time workers.

So, rather than increasing the number of employees getting insurance from their employers as advertised, Obamacare has instead caused employees to have their hours reduced, or cost them their jobs entirely.

These decisions are being made by more than a few businesses. The International Franchise Association finds that 31 percent of franchisees plan to cut staff to avoid Obamacare’s 50-employee mandate, and a study by Mercer consulting firm found that half of businesses that don’t presently offer health insurance plan to reduce employee hours to avoid Obamacare’s penalties.

The food industry has been particularly hard hit, including: Kroger, Wendy's, Red Lobster, Olive Garden, Burger King, McDonalds, KFC, Taco Bell, and Papa John's Pizza. Also affected are government workers across the nation, for the same reasons.

If not keeping your doctor or your insurance policy if you wanted to is not bad enough, or if thousands of Americans losing the jobs or having their hours reduced to less than 30 a week isn't bad enough, how about thousands of doctors taking down their shingles? According to a survey from the Deloitte Center for Health Solutions, 6 in 10 physicians said they expect many of their colleagues to retire earlier than planned in the next 1 to 3 years.

Another 55 percent of doctors surveyed believe many of their colleagues will cut back on their hours because of the way medicine is changing, and 75 percent believe the best and brightest may not consider a career in medicine, up from 69 percent in 2011.

How could the smartest man ever to inhabit the Oval Office have been so desperately wrong? Curious people want to know: Did Barack Obama just not have a clue about what the law that now bears his name would actually do, or did he deliberately deceive people about what it would do in order to gain their support for it?

There is a faction that firmly believes that if people lose their private sector insurance coverage, or can't afford it, that is precisely what Mr. Obama wants, thus making his dream of a single-payer government healthcare system a reality.

So, will our public servants act to relieve us of this Obomination? They should remember that there are Senate and House elections in 2014. And so should we.

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