Tag: ObamaCare

Categories
free trade & free markets too much government

Doctoring, Priced

Any number of economists will tell you that medicine just has to be different from other goods and services provided on the market. They will offer elaborate theories to explain, for instance, why competitive markets won’t work for health care, and why more government is necessary, and why, in fact, today’s hospitals don’t publish their prices.

I see this mainstream “explanation” as mere apologetics, designed to justify evermore government. The truth is that medicine is “different” because legislation — at local, state, and federal levels — has made the industry different. It’s an accident of history, not something “natural” to this particular market.

But, as Obamacare further consolidates medicine under the government rubric, there appear some daring examples of non-compliance. The latest is from Dr. Michael Ciampi, of South Portland, Maine, whose family practice group has stopped accepting insurance payments of any kind, public or private.

Posting its prices on the Web, Ciampi Family Practice claims to offer substantial savings over other providers. And other benefits, too, including house calls:

Because we no longer contract with insurance companies, Medicare or Medicaid, we can be more flexible and innovative. We use technology when it helps us take better care of patients, but we refuse to use it for technology’s sake. We will not spend our visit staring at a computer screen instead of looking at you. We can also spend more time with patients than the typical provider in a “big box” medical practice. . . . We do not have physician assistants or nurse practitioners.

Ciampi is not the only (or biggest) provider to do this.

Could competition just erupt without a government-provided “solution”? Could “the market” provide the leadership medicine needs now?

This is Common Sense. I’m Paul Jacob.

Categories
insider corruption national politics & policies

Sebelius Crosses the Rubicon

Senator Lamar Alexander compares the latest Obama administration scandal to Iran-Contra . . . he says it’s “even bigger.”

One hates to continually harp on the president and his scandals, but he and his big government keep producing them. So here we go again!

Obamacare was supposed to save money. It hasn’t. And it should be no shock to learn that the plan has already overshot its budget. Its implementation budget. And Congress balked at throwing more money at the “Affordable Care Act,” perhaps on the grounds that  we can’t afford it.

So Health and Human Services Secretary Kathleen Sebelius passed around the hat to the major players in the managed medical insurance industry — the folks previously demonized by Democrats as the greedy bloodsuckers who singlehandedly caused industry price inflation — to push the plan through on a “shoestring budget.”

Trouble is, it’s not obvious that this is legal. Sen. Orrin G. Hatch called Sebelius’s private fundraising effort “absurd,” and promised to inquire about conflicts of interest.

It’s easy to see why the Republicans in the House and Senate are suspicious. Such a move rubs up against the grain of what a republic is. But I’m sure Democrats are shrugging. It is just another business-government partnership, after all.

Well, it’s not “just another.” It might end up being the biggest ever. And you have to draw the line somewhere. Ancient Romans drew the line to protect their republic at the Rubicon — which Caesar crossed, ushering in empire.

It’s not just armies that cross important boundaries.

This is Common Sense. I’m Paul Jacob.

Categories
national politics & policies too much government

Unions versus Obamacare

Former friends of Obamacare keep discovering that the law treats them as enemies.

Three years after Obama signed the Affordable Care Act, Kinsey Robinson, president of United Union of Roofers, Waterproofers and Allied Workers International, says that many provisions “were not fully conceived, resulting in unintended consequences . . . inconsistent with the promise that those who were satisfied with their employer-sponsored coverage could keep it.”

Robinson worries that members who now enjoy multi-employer health plans through the union will lose both benefits and employment as Obamacare goes into effect. Small contractors not required to offer insurance coverage under the law will enjoy an unfair bidding advantage. So he now calls for “repeal or complete reform” of Obamacare. (Let’s do the repeal, then restart with the right reforms.)

I’m no fan of unions, which have too often acted to quash competition in the labor market. But as long as unions exist, if they’re going to oppose something, let Obamacare top the list until it is gone.

No doubt many more expressions of shock and dismay await us as people discover the consequences of the law. In 2010, then-Speaker Nancy Pelosi declared that the health care bill had to be passed so we could learn what was in it; after which, free of the fog of partisan debate, we’d all come to understand at last that lumbering Big Brother is indeed our very best friend.

We’re finding out alright, we’re discovering that with friends like BB, and Pelosi, who needs fiends?

This is Common Sense. I’m Paul Jacob.

Categories
national politics & policies too much government

Free Money?

Monday, I lamented our deeply-indebted federal government’s policy towards the states: Bribery.

It busily borrows more and more money to entice our more fiscally sound state governments into dramatically expanding Medicaid spending to ever less sustainable levels. I also noted that several Republican Governors who were long opposed to Obamacare are now taking the bribes.

Wisconsin Governor Scott Walker isn’t one of them, but he appeared on Fox News Sunday to speak with host Chris Wallace, who said:

“As you well know, seven Republican governors have agreed to the expansion of [Medicaid] to 133 percent of the poverty [line] . . . And they say they’re doing it because of, if you will, free money. . . . [C]ritics say that your decision is, one, going to cost your state millions of dollars and, two, going to mean a lot of people in Wisconsin are uninsured.”

“In our case,” explained Walker, “we actually reduced the number of uninsured, we reduced the number of people on Medicaid and we actually saved a little bit of money.”

Wallace then asked if he feared Congress wasn’t going to live up to its end of the bargain.

“No doubt about it,” Walker responded. “Just for my cost to continue Medicaid in the state of Wisconsin, without any expansion, it cost me $644 million more in this budget. Thirty-nine percent of that is because the federal government under the Affordable Care Act and other provisions is pulling back on their previous commitments. That’s today. That’s without the expansion. . . . If Congress can’t fulfill the commitments they’ve made, I’m concerned about where they’re going to be in the future.”

Wallace then asked Governor Markell (D-Delaware), “why is it that he doesn’t trust Washington and you do?”

That question went unanswered.

This is Common Sense. I’m Paul Jacob.

Categories
national politics & policies Tenth Amendment federalism too much government

How to Surrender Freedom

When in the fight for liberty should one give up?

Never. Contrary to deterministic notions of social change, there’s nothing inevitable or permanent about any loss of our freedom.

What then should we make of the words of Daily Debate scrivener Robert Tracinski? Noting criticism of Florida Governor Rick Scott for reversing his stand against the Democrats’ health care reform package, Tracinski, also a foe of Obamacare, asserts that the battle to either repeal or block it “was effectively over with November’s election, when Democrats retained the presidency and control of the Senate.”

A bad blow is not a permanent conquest, however.

Scott’s opposition was central to his 2010 campaign for governor. As governor, he led a lawsuit against Obamacare. After the Supreme Court’s anti-constitutional decision upholding it, he said he would keep fighting by declining federal funds to expand Medicaid.

Alas, Scott has now thrown in the towel. (We don’t know yet whether state lawmakers, whose acquiescence is also required, will similarly discard their drenched terrycloth.) Proponents of greater government hegemony over the medical industry crow that all other hitherto recalcitrant governors will, in the words of David Firestone, “soon knuckle under and do exactly the same thing. . . . By investing a relatively small amount of their own money to cover the poor, states get a huge increase in federal Medicaid funds.”

You see how the bribe to the states is made. Cave in to a usurpation, and some of the apparent increased burdens will be borne not at the state level, but by the already insolvent, debt-ridden, deficit-addicted federal government.

It’s a sick system. And I’m not talking about just Obamacare.

This is Common Sense. I’m Paul Jacob.

Categories
national politics & policies too much government

Laboring for Unemployment

When you make it harder to hire people—as Obamacare does by imposing penalties on companies that fail to provide specified health insurance—you make it more unlikely that persons will be hired.

Consider the case of Automation Systems Inc., reported at National Review Online. After the economy went into a nose dive a few years back, the only way owner Carl Schanstra could keep the company alive was by slashing staff.

Automation Systems has managed to bounce back, and business is improving. Currently, Schanstra employs 37 people. He would like to hire lots more. But as soon his company employs more than 50, he’ll be socked with $40,000 in penalties and $2,000 for each additional employee. Even firms that already provide health care to employees will have to pay such penalties if they have 50+ workers and their insurance plans don’t offer as much coverage as Obamacare deems necessary.

When you must shell out $40,000 to the government—$40,000 more than all hitherto expected payout of salary and benefits—to hire your very next employee, you have a strong incentive to keep your company smaller than you might have liked. And workarounds like contracting consultants, as discussed last week, are not options for every company.

This reality may seem obvious to anyone with even modest knowledge of what it takes to create wealth and make a living. But somehow the obvious escapes the central planners in Washington.

Or maybe they just don’t care about the hardships their policies impose upon us.

This is Common Sense. I’m Paul Jacob.

Categories
free trade & free markets national politics & policies too much government

Attacking Wage Employment

I don’t know what the optimum ratio of employees to independent contractors would be. No one does. But we can be pretty certain that the current skewing of the economy towards less wage employment and more independent contracting by Obamacare is not a good thing.

You see, “one consequence” of the health reform package, writes economist David Henderson on EconLog, “is an increase in contracting out to avoid the 50-person threshold.”

Now, if there were a general shift towards part-time employment and professional contracting as a result of businesspeople and workers appraising their advantages on the open market, we’d just note this with interest or a shrug and say, “whatever the market decides.”

After all, people might substitute wage contracts for performance contracts (or vice versa) for reasons given by Nobel Laureate R.H. Coase, who figured out why firms exist at all: contracting out isn’t costless. It takes time to negotiate each deal, each task, etc. My friend Dr. Henderson will correct me, I hope, if I’m wrong, but employing labor full-time — by bundling numerous tasks together — is usually easier and cheaper than seeking out specialists and consultants for each task you want done.

In recent years we’ve seen a rise in consulting professionals, in part because the Internet has reduced the costs associated with working from a distance. But today’s switch to independent contractors (as well as to part-time employment) is a result of Obamacare raising the cost of keeping full-time employees. Of course businesses will seek to . . . economize.

And we know such substitution is suboptimal because people are doing it under duress, the threat of force behind Obamacare.

This is Common Sense. I’m Paul Jacob.

Categories
government transparency national politics & policies

The Latest Legislative Land Mine

The most prescient thing ever said about the Patient Protection and Affordable Care Act, commonly called Obamacare, was articulated by then-Speaker of the House Nancy Pelosi: “we have to pass the bill so that you can find out what is in it.”

The medical reform package is quite the hodgepodge. Actually reading the whole thing makes taking on Middlemarch, War and Peace, and In Search of Lost Time a course of light entertainment.

The latest revelation from its thousands of pages? A passage prohibiting doctors from asking their patients questions about guns in the home.

The Washington Post reports that many gun control groups are incensed at the power of the NRA to limit their ability to “collect information”:

Physician groups and public health advocates say the cumulative effect of these restrictions undercuts the ability of the White House and lawmakers to make the case for new laws, such as an assault-weapons ban, in the face of opponents who argue that there’s no evidence such measures are effective. Advocates for regulating guns lament that reliable statistics are limited in part because physicians and health researchers who could track these patterns are being inhibited.

Considering the quality of previous doctor-led sociological studies into gun usage — and really, this is not a medical problem but a complex, society-wide issue far beyond the competence of medical training to comprehend — the prohibition might really best be described as a defense of scientific method.

But the big issue here is not the politics of “research.” It’s that a health care reform package passed nearly three years ago contains hot potatoes such as this, and we are only discovering them now.

Nancy, you were all too disastrously correct.

This is Common Sense. I’m Paul Jacob.

Categories
responsibility too much government

Is Pregnancy a Lifestyle Disease?

Two stories courtesy of Reason’s Hit and Run startled me into thinking about the strange issues that come up when you put government in charge.

Peter Suderman covered another Supreme Court review of Obamacare, featuring Liberty University’s claim that Congress overstepped its authority in mandating employer coverage of specific insurance features, and that the contraception/abortion mandate violates religious freedom.

Then I scrolled down to read Rachel Moran on one conservative British MP’s daring call for “patients suffering from so-called ‘lifestyle diseases,’ such as type II diabetes, [to] pay for their own prescriptions rather than claim free or subsidized drugs.” The Tory MP has a point:

[W]e have got to have an affordable system that rewards individual responsibility. If you want to have doughnuts for breakfast, lunch and dinner, fine, but there’s a cost.

Trouble is, as we learned last Saturday, the whole point of the modern welfare state is to take away folks’ responsibility by removing negative consequences, the costs, from risky behavior.

Here in America, we’re headed that direction. The responsibility for one’s own contraceptive purchases is being shifted (by the Democrats’ healthcare reform law) from individuals and couples to employers, via government — putting the monetary burden onto all citizens, via higher insurance payments.

The religious freedom aspect of the constitutional challenge is a red herring. More basic? Individual freedom and personal responsibility. But those aren’t exactly guaranteed in the Constitution, and politicians haven’t found a way to get elected in enough numbers on the issue of returning responsibility back into the system.

So we’re left in a world where it makes perverted sense to call pregnancy a “lifestyle disease.” And subsidize its prevention.

This is Common Sense. I’m Paul Jacob.

Categories
ideological culture

Predictable Prescription

President Obama loves a laugh line he uttered during his convention speech and is now on tour with it, using it to stoke up his campaign whistle stops.

Obama told us that Republican policy amounts to this: “Have a surplus? Try a tax cut. Deficit too high? Try another. Feel a cold coming on? Take two tax cuts, roll back some regulations and call us in the morning.”

Obama is correct that tax cuts don’t magically cure behemoth deficits or leviathan debt. And, frankly, Republicans are often as loathe as Democrats to cut — really cut — government spending.

But it’s not as if Obama were the Lone Ranger when it comes to hacking away at the federal octopus, constantly proposing only balanced budgets and demanding shutdowns of federal agencies and programs. No. Obama, like so many in DC, demands ever higher spending, ever higher taxes, ever more regulations — as exemplified by Obamacare. The president demonizes as Darwinian dastards all who support even vanishingly small reductions in projected increases in spending.

If the GOP plays a one-note tune of tax cuts, ad infinitum, the Democrats’ have their own long-playing record spinning around and around: the idea of government as the solution to every problem. But whatever “fiscal irresponsibility equivalence” exists between Republicans, who want to cut taxes in the face of trillion-dollar a year deficits, and Democrats, who want to keep spending more, the underlying issue remains whether we need more government or less.

Take less government, less spending, lower taxes, and call me on election morning.

This is Common Sense. I’m Paul Jacob.