Libertarian Leanings

Leveraging The Lack of Economic Education

Casey Mulligan, professor of economics at University of Chicago, studies the impact of government decisions on the incentives and disincentives for work.  It so happens that Professor Mulligan's work had some influence on the recent CBO study that said the impact of ObamaCare would be the equivalent of 2.5 million jobs lost.

In response to the study Democrats, leftists, and their friends in the media are now claiming that job losses like this are a good thing.

Thanks to ObamaCare, we're told, Americans can finally quit the salt mines and blacking factories and retire early, or spend more time with the children, or become artists.

Funny, they didn't always think that way.  As a matter of fact, ObamaCare was projected to create jobs, not destroy them.  In 2011 David Cutler of Harvard and Harold Pollack of the University of Chicago put together a letter that was signed by dozens of left-wing economists.  The letter said that ObamaCare would boost the economy, creating 250,000 to 400,000 jobs annually.  Oopsies.

Well, maybe jobs don't matter after all.  Especially the upside is a bumper crop of new artists!  Whatever.

No matter the fallout from ObamaCare, we know one thing.  Democrats and other lefties will say it's all good.  OK, it hasn't fueled America's economic engine as advertised.  So what if economy has been in the tank for Obama's entire administration?  That's a good thing.  And if it's not good it's George Bush's fault.

Mr. Mulligan reserves particular scorn for the economists making this "eliminated from the drudgery of labor market" argument, which he views as a form of trahison des clercs. "I don't know what their intentions are," he says, choosing his words carefully, "but it looks like they're trying to leverage the lack of economic education in their audience by making these sorts of points."

Let's see how that leverage works out come November.  Sooner or later you might expect even low information voters to begin wondering about all the contradictions surrounding ObamaCare.  Maybe not.

Their Piece of the Action

Would we be better off without UPS and FedEx?  What problem would we solve if we eliminated all other carriers except the US Postal Service for delivering packages and letters?  Such a thing would create rather than solve problems.  In fact government has always opposed monopolies, except for those of its own making.  Yet there is this incessant chatter about how we should adopt a single payer plan for US health care, as if it would solve some problem.  Consider this from John H. Cochrane:

The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a "certificate of need" before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.

I always used to think that regulation of medicine and medical services was foremost for the benefit of providers, particularly the doctors.  Years ago the American Medical Association explained how it imposed limits on the number of medical school slots through its acreditation authority and why they did it.  It was to ensure the highest quality education for physicians, but it was also intended to keep physician compensation high.

A single payer system won't alleviate our shortage of doctors, and instead adds even more restrictions on medical care to the ones mentioned above by Mr. Cochrane.  But the limitations imposed by a single payer plan won't have the effect of pushing up doctors' incomes.  This is pretty obvious when you look at the way doctors are reimbursed for Medicare and Medicaid services.  They're getting stiffed.  That's why more and more are refusing to take on new Medicare and Medicaid patients, and why there is "Doc Fix" just about every time congress passes a budget. 

Think of the Affordable Care Act as the first step towards a single payer plan, which itself is a hostile takeover of an industry by the party of government.  Its purpose and the purpose of a single payer plan is to siphon off some of the billions spent on medical care and divert it into political party coffers and wallets.  Democrats are the party of government, and they want their piece of the action.

The Profiteers

Would you buy a used car from this man?  That was the first thing that popped into my head when I saw this picture.  It was more famously asked about Richard Nixon back in the days before Watergate.  The answer then was supposed to be, no you would not.  But with John Podesta the answer might yes, but not necessarily based on any trustworthiness.  If he lives up to a hit man reputation he has, according to the Wall Street Journal, saying no to the figurative used car risks the figurative broken kneecap.  As soon as he joined the White House staff Podesta proved out the Journal's opinion, calling Republicans "a cult worthy of Jonestown."   I guess Obama means business.  There's a lot at stake, all the more evident as state level healthcare exchange directors abandon, or are jetisoned, from the sinking ship that is ObamaCare.  Just take a look at some of these numbers. Enrollment and technical dysfunctions and security breaches akin to the 36 federal exchanges continue to beset Minnesota's operation, called MNsure. On Tuesday, April Todd-Malmlov, the exchange's executive director since 2011, resigned under political duress. The state's problems are severe—4,478 have selected a plan so far—but were not severe enough to disrupt her two-week vacation in Costa Rica late last month with her partner, James Golden, who runs the state's Medicaid program. Amid a political uproar, upon Ms. Todd-Malmlov's return she was forced out by Democratic Governor Mark Dayton. Poorly timed Caribbean R&R also sealed the fate of Rebecca Pearce last week. The chief of Maryland's ObamaCare exchange absconded for the tonier destination of the Cayman Islands as her exchange floundered. We hear it's lovely this time of year. Democratic Governor Martin O'Malley promised his state would "lead the nation" on the Affordable Care Act and he is leading Minnesota by a click or two, with 5,179 sign-ups. Maryland's performance glitches are still so atrocious that on Monday Mr. O'Malley said he's weighing a Plan B that would desert Ms. Pearce's handicraft and shift residents to the federal Healthcare.gov website. Yes, it's that bad. Out in Hawaii, Coral Andrews stepped down from her position running that state's exchange on the same day as Ms. Pearce. Fewer than 500 people have enrolled thus far in the Aloha State's exchange, despite having received $205,342,270 in federal exchange planning and establishment grants. That sounds bad unless the point of comparison is Oregon, where enrollment stood at all of 44 people at the end of November. The Beaver State's $303,011,587 in grants in hand works out to about $6.9 million a head. Enrollment since has improved to 7,597 as the state abandoned trying to fix the digital site and moved to all-paper applications and direct insurer recruitment. Rocky King, the functionary responsible for that anachronism, was placed on extended medical leave this month. What an absolute cash cow ObamaCare has been for those who signed on to implement it.  Just look at those grants:  $205,342,270 to Hawaii and $303,011,587 to Oregon to set up their state exchanges.  Not to mention the $634,000,000 for Healthcare.gov.  Software development doesn't really cost that much. As a matter of fact, you've probably heard about those private for profit websites where you can get health insurance.  They have an advantage over Healthcare.gov.  They work.  You can actually buy a policy on them. (Though if we had this to do all over again buying new insurance wouldn't be high on your list of things you'd want to do.)  There's another advantage that doesn't get much mention.  Development of the private websites didn't cost over a billion dollars like Healthcare.gov.  But let's not mix apples and oranges here.  The billions spent on ObamaCare were meant to buy more than just a website.  The real objective is to buy the power and votes to secure Democratic majorities well into the future.  Back in 2010 Obama and his cronies at the top of the Democratic party placed their bet that the tipping point was reached.  They believed they could ram ObamaCare through even though it was (and still is) wildly unpopular.  All they would have to do would be hang on until the subsidy checks hit the mail.  Then the new dependent demographic makes repeal impossible, as fear keeps the gravy train rolling. Obama isn't giving up, troubles with ObamaCare notwithstanding.  His goal of permanently co-opting federal income streams for the Democratic party is far from dead. Updated 12/21/2013.

Impervious

Did you hear Obama say the other day that he was "not informed directly" that the ObamaCare website didn't work?

Second question. (Laughter.) You were informed or several people in this building were informed two weeks before the launch of the website that it was failing the most basic tests internally; and yet a decision was made to launch the website on October 1st. Did you, sir, make that test (sic)? And if so, did you regret that?

PRESIDENT OBAMA: OK. On the website, I was not informed directly that the website would not be working as -- the way it was supposed to. Ha[d] I been informed, I wouldn't be going out saying, boy, this is going to be great. You know, I'm accused of a lot of things, but I don't think I'm stupid enough to go around saying, this is going to be like shopping on Amazon or Travelocity, a week before the website opens, if I thought that it wasn't going to work.

I suppose it's possible that nobody told him, but I think it's more likely he knew there were problems with the website, but decided to ignore them and go ahead with the October 1st rollout.  When he realized how badly he misjudged, he went to the line about how he's not that stupid.  

While there might be plenty of evidence to support you, it's generally not a good idea to disagree with Obama on that point.  For one thing you're immediately branded as racist.  That hasn't bothered Mark Steyn.

Ooooo-kay. So, if I follow correctly, the smartest president ever is not smart enough to ensure that his website works; he’s not smart enough to inquire of others as to whether his website works; he’s not smart enough to check that his website works before he goes out and tells people what a great website experience they’re in for. But he is smart enough to know that he’s not stupid enough to go around bragging about how well it works if he’d already been informed that it doesn’t work. So he’s smart enough to know that if he’d known what he didn’t know he’d know enough not to let it be known that he knew nothing. The country’s in the very best of hands.

Unlike Steyn, I think Obama's miscalculation is not stupidity.  As we read further down in Obama's press conference I think it becomes obvious that Obama's faith in his own brilliance is blinding.  Look at this admission he offered up in the guise of humility.  

What we're discovering is that part of the problem has been technology, hardware and software, and that's being upgraded. But even if we get the -- the hardware and software working exactly the way it's supposed to with relatively minor glitches, what we're also discovering is that insurance is complicated to buy. 

Well, OK.  Admitting to making such a discovery it this late stage may have been stupid.  Just imagine yourself in private industry as the sponsor of a large IT project, one that's been taking three years to get off the ground, and when it finally debuts as a production system it's a complete disaster.  Now imagine yourself explaining to the stakeholders that you've just now come to realize that the business is... well, it's complicated.  

Since you're not Obama you'd have been expected to know, not only that it's complicated, but how complicated and how your system was designed to address such complexities.  Not knowing is not doing your job.  Somehow, Obama is oblivious to what his belated realization really means.  

If it has only recently occurred to him that buying insurance might be complicated, it's pretty clear that he hasn't given a thought to what else might be complicated about insurance.  How about the complications involved in devising an insurance plan and putting together all of the managerial, technical, and financial resources so that premiums can be collected, claims can be paid, customers and the company can be protected from fraud, and it can continue in business?  Failing to consider all of the possible complications is not stupidity, it's arrogance.  It's the absolute conviction that he, Barack Obama, knew all that he needed to know. 

Baby steps, I suppose.  At least he's acknowledged that there was this one time something he didn't know.  But even though he admits that it turned out, after all, to be important, I doubt that he thinks that he, Obama, should be expected to have understood it beforehand — somebody beneath him, maybe, though to inform Obama directly might be asking too much.

For the sake of perspective, it's important to note that Obama's goal has always been the transformation of America.  By comparison ObamaCare is somewhere down the list of priorities.  So the healthcare website doesn't work?  That can be fixed.  It's just a tool for implementing ObamaCare as ObamaCare itself is just a step towards the ultimate transformation of America.  Obama's goal is for America to be a utopian paradise.  He remains impervious to any argument that it would be the world's first, after hundreds of years of attempts.  There have always been these complications, you see.  But Obama remains confident.  He's smartest guy in the room and he means to pull it off.  What could possibly go wrong?

Speaking of Disingenuous

Lawrence Summers has written a column for the Washington Post on the Immediate lessons from health-care reform.  You'll be shocked, shocked to learn that the root cause of ObamaCare's disastrous October 1st rollout is none other than the Republican party. Oh, he concedes there are other factors.  The "dismal track record of the implementation of large-scale information technology initiatives," unexpected obstacles, lack of oversight, and maybe we can throw in some unrealistic expectations.  But opposition to Obama is Summers' real concern, the one that he says is a threat to democracy no less.

These are old truths that those responsible for implementing Obamacare should have heeded. Yet fairness requires recognizing the equally important, and in some ways more fundamental, factor behind the problems implementing Obamacare: the systematic effort of the president’s opponents to delegitimize and undermine the project.

To begin with, there is very little that's legitimate about ObamaCare.  Resistance to ObamaCare was so intense that the healthcare reform bill was passed without a single Republican vote.  The people of Massachusetts, in an all too rare showing of good sense, elected a Republican, Scott Brown, to the Senate seat once held by the sainted (in progressive circles) Ted Kennedy, himself a champion of universal healthcare entitlement.  Brown campaigned on the promise that he would be the 41st Senate vote against the Obama's healthcare reform bill.  When that promise carried the special election, Congress broke its own rules so that the the bill could be passed without Brown ever getting the opportunity to vote against it.  "Deem and pass" was the gimmick they used.

After laying the groundwork for a decisive vote this week on the Senate's health-care bill, House Speaker Nancy Pelosi suggested Monday that she might attempt to pass the measure without having members vote on it.

Instead, Pelosi (D-Calif.) would rely on a procedural sleight of hand: The House would vote on a more popular package of fixes to the Senate bill; under the House rule for that vote, passage would signify that lawmakers "deem" the health-care bill to be passed.

This meant that the original Senate healthcare bill, passed before the special election that sent Brown to the Senate, was accepted unchanged by the House.  Deeming the Senate bill passed meant that there was no separate House version to be reconciled with the Senate bill in conference committee, which meant the Senate would not have to vote on it again.  Had there been such a vote, ObamaCare would have been dead.  Scott Brown's vote would have given Republicans enough for a successful filibuster.

Funny how the democratic process is a threat to democracy when progressive power grabs are at stake.  Noticeably missing from Summers' analysis something more threatening to democracy — the word "keep," as in "If you like your healthcare plan, you can keep your healthcare plan.  Period."  If Obama, as the CEO of an insurance company, made a claim so deliberately and demonstrably untrue, he would very likely be spending the rest of his life in prison.  But let's leave aside the fraud part of it.  Obama's dishonesty reveals his absolute certainty that the American people would never agree to this healthcare mess that was foisted upon us — solely by the Democratic party.  Obama knew he had to lie about it.  He knew there was no other way to get it through.

Four years ago in September — the date was September 12, 2009 — about a half million people gathered for a peaceful demonstration against the healthcare law in Washington D.C.  Even though the healthcare reform law was still in the proposal stage, resistance to it was intense. 

We see more Tea Party predictions coming true.  in response progressives like Summers argue that opposing Obama's policies is more than just racist.  It's a threat to democracy as well.  Summers believes that Republicans should simply drop all opposition to it.  To do otherwise unpatriotic and undemocratic.

It is disingenuous for those who stood ready to turn any regulatory detail into an attack ad to profess outrage when guidance was not provided during an election campaign. It is hypocritical for those who held up confirmations of key officials with responsibility for managing federal health-care programs and whose behavior deterred many people from coming into government to lash out at the incompetence of government management. And it is indefensible to refuse to appropriate money to carry out a program and then attack it for being under-resourced.

Talk about disingenuous.  A Republican attack on ObamaCare for being underfunded?  Quite the opposite, it's way overfunded from the Republican perspective.  Underfunded would be the best thing about it.

There is a danger here that goes far beyond delays in access to health insurance. The risk is of a vicious cycle in which poor government performance leads, on the one hand, to overly bold promises of repair and, on the other hand, to reduced funding and support for those doing the work. This generates unmet expectations and disappointment, setting off the cycle anew. In the end, government loses the ability to deliver for citizens and citizens lose respect for government. Our democracy is the loser.

I see no threat to democracy from the recognition that government can't do everything.  Citizens may lose respect government, not because of an inability to deliver but instead because government is intruding to much.  The greater threat to democracy in America is ObamaCare itself and the lies that are repeated trying to justify it.

Obama’s premeditated, repeated, nationally televised lies about the “Affordable Care Act” are integral, indeed essential, to his presidency and to the workings of the US government. The outcome of two national elections depended on it.

Even more significant is his contention that he never said what he said, and that what he said was true anyhow. In interpersonal relations, such a contention is an insult that makes civility impossible; because to continue to treat with someone who makes such affronts is self-degradation of which few are capable. In political life, such an insult is a declaration of war.

The greater threat to democracy is posed by a party whose political goals are more important than the truth.  That's been the Democratic party for these last twenty years.

Holding Down Cost?

No.  David Cutler hails the success of ObamaCare.  It's a success, he says, because it is slowing the increase in Medicare costs.

The Affordable Care Act is a key to the underlying change. Starting in 2010, the ACA lowered the annual increases that Medicare pays to hospitals, home health agencies and private insurance plans. Together, these account for 5 percent of the post-2010 cost slowdown. Medicare payment changes always provoke fears — in this case, that private plans would flee the program and that the quality of care in hospitals would suffer. Neither of these fears has materialized, however. Enrollment in private plans is up since the ACA changes.

In reality, ObamaCare is simply a refusal to pay for Medicare services.

Despite the constant political rhetoric that Medicare payment reductions affect only providers and not beneficiaries, funding cuts for Medicare services will directly affect those who depend on those services. If Obamacare’s major reductions are implemented by Congress over the coming decade, seniors’ ability to access Medicare services will surely diminish. In fact, the Medicare Trustees project that the lower Medicare payment rates would cause 15 percent of hospitals, skilled nursing facilities, and home health agencies to become unprofitable by 2019, and this percentage would reach roughly 25 percent in 2030 and 40 percent by 2050.[2]

This means that seniors would have an increasingly difficult time accessing care. As the Trustees explain:

Medicare’s payments for health services would fall increasingly below providers’ costs. Providers could not sustain continuing negative margins and would have to withdraw from serving Medicare beneficiaries or (if total facility margins remained positive) shift substantial portions of Medicare costs to their non-Medicare, non-Medicaid payers.[3]

Fewer Plan Choices

In addition to the provider payment reductions, Obamacare significantly reduces payments to Medicare Advantage (MA) plans by an estimated $156 billion from 2013 to 2022.[4] About 27 percent of all Medicare beneficiaries are enrolled in MA plans, a system of regulated and private plans competing against each other as an alternative to traditional Medicare. MA plans are attractive to beneficiaries because they offer more generous and comprehensive coverage than traditional Medicare by capping out-of-pocket costs and offering drug coverage.

This claim that healthcare costs are being contained is nonsense, but the administration really has no choice.  They simply can't stop lying about ObamaCare and expect it to survive.  But this brings us to the cost of administration lies.  Andrew McCarthy writes that a CEO who deceives consumers as Obama has deceived the American people would be guilty of a serious federal felony.  

‘If you like your health-care plan, you will be able to keep your health-care plan. Period.” How serious was this lie, repeated by Barack Obama with such beguiling regularity? Well, how would the Justice Department be dealing with it if it had been uttered by, say, the president of an insurance company rather than the president of the United States?

Fraud is a serious federal felony, usually punishable by up to 20 years’ imprisonment — with every repetition of a fraudulent communication chargeable as a separate crime. In computing sentences, federal sentencing guidelines factor in such considerations as the dollar value of the fraud, the number of victims, and the degree to which the offender’s treachery breaches any special fiduciary duties he owes. Cases of multi-million-dollar corporate frauds — to say nothing of multi-billion-dollar, Bernie Madoff–level scams that nevertheless pale beside Obamacare’s dimensions — often result in terms amounting to decades in the slammer.

It doesn't matter that Obama's fraud can be proven.  It's an inescapable fact.  There is just no chance that Obama will be impeached, prosecuted, or in any way made to pay a penalty for what under the laws that the rest of us live under would be a federal crime.  Laws are not for Obama, or the rest of the ruling class for that matter.

The Perfect Obama Supporters

Yesterday ProPublica carried a story under the headline Loyal Obama Supporters, Canceled by Obamacare that told a familiar story.  Somebody, happy with their healthcare insurance policy, found that they couldn't keep it, contrary to Obama's promise — a promise that he punctuated with the word, "Period." 

Hammack recalled his reaction when he and his wife received a letters from Kaiser in September informing him their coverage was being canceled. “I work downstairs and my wife had a clear look of shock on her face,” he said. “Our first reaction was clearly there’s got to be some mistake. This was before the exchanges opened up. We quickly calmed down. We were confident that this would all be straightened out. But it wasn’t.”

...

This plan was ending, Kaiser’s letters told them, because it did not meet the requirements of the Affordable Care Act. “Everything is taken care of,” the letters said. “There’s nothing you need to do.”

The letters said the couple would be enrolled in new Kaiser plans that would cost nearly $1,300 a month for the two of them (more than $15,000 a year).

Lee Hammack and his wife JoEllen Brothers may be shocked and disappointed, but they can find consolation in their rescue from a bad-apple insurance company — Kaiser Permanente.

“Remember, before the Affordable Care Act, these bad-apple insurers had free rein every single year to limit the care that you received, or use minor preexisting conditions to jack up your premiums or bill you into bankruptcy. So a lot of people thought they were buying coverage, and it turned out not to be so good.”

The new Kaiser policy will cost Hammack and Brothers more than twice as much as the one they had, but the couple believe they can adapt.  If Hammack can reduce his income to under about $62,000, which for a family of two would four times the federal poverty level, he can qualify for subsidies that could reduce his premiums to zero.   He’s giving it serious consideration.  He can take a lower salary or contibute more to his retirement account.

In spite of all that Hammack and his wife keep faith in Obama and ObamaCare.  

“We’re not changing our views because of this situation, but it hurt to hear Obama saying, just the other day, that if our plan has been dropped it’s because it wasn’t any good, and our costs would go up only slightly,” he said. “We’re gratified that the press is on the case, but frustrated that the stewards of the ACA don’t seem to have heard.”

They may have bought into Obama's lies:  First that they could keep their insurance, "Period," and second that what he had always said was they could keep their coverage if the policy didn't change.  Or they might think being lied to is fine when the cause is Obama's idea of social justice.

ProPublica doesn't say if either Hammack or Brothers have given any thought to what other conclusions might be drawn from their plan to reduce income and qualify for subsidies.  Theirs is only a small drain on the treasury, the reduced tax revenue as a direct result of the couple's lower taxable income along with the higher spending for this brand new insurance premium subsidy. 

As we all know, a financial hit on the treasury is never a problem for progressives like Hammack and Brothers, or for ProPublica either.  There is no spending problem, according to enlightened folks such as they, only a revenue problem that will be solved when those greedy bad-apple insurance executives and employees can be made to pay their fair share in taxes. 

Oh, and by the way, what becomes of the employees of those bad-apple insurance outfits like Kaiser?  The ones who support the individual market that ObamaCare was designed to eliminate?  No problem.  Time Magazine assures them that ObamaCare is having no impact whatever on jobs.  Never mind that actual company surveys say quite the opposite.

More Workers Will See Their Hours Cut: “Some employers will minimize the number of newly eligible employees by cutting back on hours for at least a portion of their workforce – 11% of all large employers say they will do so.”

Progressives see no connection between our continued feeble economic growth and the regulatory burdens imposed by Obama and ObamaCare.  In reality our slow growth has a negative impact on tax revenue and all this new spending is going to pile up the debt, But I can see it now.  Any attempts to even slow down the spending increases, never mind cut into the debt, will have Hammack and Brothers villifying the Republicans for threatenting their health care subsidy.  That would be the one they would never have needed had it not been for ObamaCare.

Something We Already Knew

According to Dr. John Noseworthy, President and CEO of the Mayo Clinic:

Obamacare does nothing to link doctors' fees to their performance and reduce health-care costs, the head of the Mayo Clinic told CNBC on Friday.

From the tone of the article, I get the sense that Dr. Noseworthy would be content with a single payer system, but that system won't do anything to control costs either.  Ever heard of "the doc fix?"

For the past decade, Congress has passed a series of patches to prevent doctors who treat Medicare patients from seeing their reimbursements drastically cut. Each time, lawmakers grumble and talk about getting something permanent in place so they can end this detested exercise. And every year, they wait until the last minute and hastily patch it, only to repeat the routine.

The way government typically seeks to reduce Medicare costs is to stiff the doctors.  As a result triple the number of doctors abandoned Medicare in 2012 as in prior years.

CMS said 9,539 physicians who had accepted Medicare opted out of the program in 2012, up from 3,700 in 2009. Some 685,000 doctors were enrolled as participating physicians last year, said CMS, which has never released annual opt-out figures before.

Since this is not going to change under ObamaCare — at least it won't according to Dr. Noseworthy — we can expect greater shortages of doctors and services, especially for elderly patients and especially with regard to end-of-life care. 

The administration also cited research by Dr. Stacy M. Fischer, an assistant professor at the University of Colorado School of Medicine, who found that “end-of-life discussions between doctor and patient help ensure that one gets the care one wants.” In this sense, Dr. Fischer said, such consultations “protect patient autonomy.”

Opponents said the Obama administration was bringing back a procedure that could be used to justify the premature withdrawal of life-sustaining treatment from people with severe illnesses and disabilities.

Section 1233 of the bill passed by the House in November 2009 — but not included in the final legislation — allowed Medicare to pay for consultations about advance care planning every five years. In contrast, the new rule allows annual discussions as part of the wellness visit.

Elizabeth D. Wickham, executive director of LifeTree, which describes itself as “a pro-life Christian educational ministry,” said she was concerned that end-of-life counseling would encourage patients to forgo or curtail care, thus hastening death.

“The infamous Section 1233 is still alive and kicking,” Ms. Wickham said. “Patients will lose the ability to control treatments at the end of life.”

Democrats ridiculed the notion of "death panels" which they "reasoned" away by claiming that this end-of-life counseling has nothing to do with death panels.  Why the very idea is ridiculous.  Except that the death panel argument is really about ObamaCare's IPAB, Independent Payment Advisory Board.

For instance, one program that is up for debate is Medicare’s Independent Payment Advisory Board, or IPAB. IPAB was created in 2010 following the implementation of President Obama’s Patient Protection and Affordable Care Act, and is a fifteen-member Government agency tasked with reducing Medicare costs while retaining quality of care.

The debate over IPAB has been fierce, and both Republicans and a number of prominent Democrats have come out against the panel. However, despite this, President Obama, in making his requests for the 2014 budget, has  proposed that the Independent Payment Advisory Board’s authority only be increased.

If we’re trying to pass a budget, we want to make sure that we’re funding programs that work–and IBAP unequivocally doesn’t.

IPAB takes the Medicare decision-making process away from doctors and away from Americans’ elected representatives in Congress and gives it to an unelected, unrepresentative and unaccountable advisory board. This panel is flawed and unethical–but it has total authority to make decisions regarding Medicare funding, how to implement spending cuts within the Medicare program, and how to allocate medical services.

Further, IPAB jeopardizes the quality of medical treatments and services for Medicare beneficiaries: proponents of IPAB argue that the program will improve care by reducing costs, but  in reality, by advising such reduced spending per capita, IPAB can actually result in the denial of certain medical treatments, limiting services for seniors and Americans with disabilities.

With nothing in ObamaCare that will drive costs down, the solution will be refusal to pay.  Obama and the Democrats repeatedly promised that nobody is going to be denied treatment.  And we can keep our health insurance policies too, if we like them. 

Picking The Right Losers

Advocates of Social Justice explain that the problem with capitalism is that there are "winners and losers."  Here is Dr. A.W. Frank of the University of Calgary arguing the importance of studying Marxism.

[I]t was Marx who first showed, with a drama that captured the world’s attention, that capitalism is about producing winners and losers; that’s what a capitalist economy is designed to do.  And Marx establishes a fundamental task of social science as figuring out the conditions that lead to some people being winners and others being losers.  Thus Marx continues to set a large part of the social scientific agenda.

How is it that we still have so many out there who think capitalism is about producing winners and losers.  Capitalism doesn't choose anything.  People choose, if they're fortunate enough to live in a capitalist society.  It's the opposite in the socialist model where individuals are not permitted to choose.  But guess what:  Socialism still has its winners and losers.  It's just that somebody else gets to pick them.  In this case, it's Barack Obama.

Although recent criticism of the healthcare law has focused on website glitches and early enrollment snags, experts say sharp price increases for individual policies have the greatest potential to erode public support for President Obama's signature legislation.

"This is when the actual sticker shock comes into play for people," said Gerald Kominski, director of the UCLA Center for Health Policy Research. "There are winners and losers under the Affordable Care Act."

Gerald F. Kominski, Ph.D. is a Health Services Professor at UCLA Kaiser Permanente Center for Health Equity.  The L.A. Times provides no context for the professor's comment about ObamaCare picking winners and losers.  Is it a flaw in ObamaCare, or is he outlining strategy?  Based on his biographical information, I'm inclined to think the latter. 

Dr. Kominski received his Ph.D. in public policy analysis with a concentration in health economics from the University of Pennsylvania in 1985, and his B.A. in chemistry from the University of Chicago in 1978. He teaches classes in advanced research methods, health economics, and cost-effectiveness analysis. His research focuses on evaluating the costs and cost-effectiveness of health care programs and technologies; improving access and health outcomes, particularly among ethnic and vulnerable populations; and developing models for estimating health expenditures and forecasting population health.

First we apply the sticker shock.  That starts the destruction of the private insurance market.  And finally we move to single payer.  Rejoice.  The tragic injustice that results when people choose their own insurance policies is remedied by ObamaCare.  

Period!

What could be more emphatic than that?  

"If you like your health care plan, you will be able to keep your health care plan. Period.  No one will take it away. No matter what."

No matter what!  That was Barack Obama selling ObamaCare.  As we contemplate our buyer's remorse, we can be reminded of the words of Nancy Pelosi.

“But we have to pass the bill so you can find out what is in it, away from the fog of controversy.”

There are some, I suppose, who believed Obama meant it when he said, "Period," although it's difficult for me to imagine.  Gullible seems such an inadequate description, especially now that we're finding out "what is in it."

Four sources deeply involved in the Affordable Care Act tell NBC NEWS that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a “cancellation” letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience “sticker shock.” 

...

Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.”  

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them. 

Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”

Obama knowingly lied about healthcare reform.  Period.  But, why should anybody be surprised about that?