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The Band-Aid Presidency

bandaid

 

Last night, in the most classic way imaginable, the Obama administration dumped a 800 lb of coal into the stockings of liberal America on the eve of the Christmas holiday.

The Administration announced that any person who had their health insurance cancelled late this year are no longer obligated to legally abide by the individual mandate, the central taxation component of the Affordable Care Act.  Additionally, these same people could satisfy the mandate requirement by purchasing catastrophic insurance alone, which previously was not considered sufficient to satisfy the mandate requirements.

The argument that the administration is making is ironic in so many ways.  They argue that the individual mandate, arguably the most important cog to the workings of Obamacare, is a ‘hardship’ to millions of Americans.  Furthermore, they are arguing that because of this hardship, they will simply delay that part of the law.

Think about the legality for a second:  President Obama is issuing a hardship exemption for something the Supreme Court has defined…as a tax.

Can you imagine the fun a Republican President can have with that power?

Let us also remember that this invalidates virtually every Democrat and liberal argument against a deal to avert October’s congressional shutdown.  Let us not forget that Senators Ted Cruz and Mike Lee put a proposal on the table to avert the shutdown if the administration simply agreed to a 1 year delay to the individual mandate.  Yesterday, Barack Obama did just that…proving that much of his stance on the shutdown was political theater, nothing more.

In the larger picture, this type of policy change largely defines the entire Obama Presidency. The pattern is as follows:  Obama and liberals propose a policy that, any common sense would tell you, cannot function in the real world. They pass this policy, often distorting the facts to the American public to get their support.  Once passed, they all of a sudden realize the idiocies contained in their plan, and rush to distance themselves from the plan they were recently advocating.  Once the policy becomes active, they realize that reality is more powerful than ideology, and thus, look for any and all ways to get themselves out of the mess they created.   And they use every ‘Band-Aid’ measure possible to cover-up the mess they have created.

The Band-Aids are piling up, and it does not only refer to health care.  Look no further than foreign policy this.  Obama’s Syria ‘Red line’ policy is a perfect example.  Obama talked a good game, but then realize that there was no way to enforce his red-line in the real world.  He quickly ran away from that policy, only to end up with a policy that, ironically, strengthened the power of a man Obama said was ‘evil’, Bashar Assad.

If you want to go further back, the Obama stimulus often had many of these characteristics as well. They passed statutes for ‘shovel-ready’ projects, and later realized there was no such thing.  They then pumped out the money, regardless of effect, to lackluster consequences.

Think of the fallacy of this latest Band-Aid on Obamacare.  The administration is arguing that they have imposed a hardship on at least 5 million Americans who lost their health insurance because of Obamacare.  So, to help these people, they are going to exempt them from the individual mandate.  However, these same people argued during the shutdown that any delay of the individual mandate would be catastrophic to the functionality of the entire ACA system.

Furthermore, the hardship claim is dubious.  Is Obama actually saying that it is more a hardship for people to lose their insurance and have to purchase it on his own exchange, than the hardship of forcing the previously uninsured to dig deep in their pocketbooks to purchase that very same insurance on the exchanges?  He is saying the previously uninsured have no burden of hardship as well?

Another liberal fallacy also dies: the argument that these were ‘substandard’ insurance policies.  Obama has now stated it is o.k. for people to move to catastrophic insurance, when the majority of this cohort had comprehensive insurance prior to Obamacare coming into effect.  In other words, Obamacare diminished  the quality of health insurance plans in America, and Obama is not legitimizing that change.

Each of the policy changes are chinks in the armor of Obamacare; that armor is now thin and rusting. This is a virtual universal delay of the individual mandate for 2014, no matter how liberals spin it.  They will never politically be able to argue that those that lost their insurance because of Obamacare bear more hardship than the uninsured do, and thus, they will be forced to exempt all Americans.  Ted Cruz wins the policy debate.

Even worse, this fixes nothing long-term.  This is a classic Obama ‘Band-Aid’.  Sure, it theoretically stops millions of people from being required to pay approximately $95 in tax penalty this April. But the real issue is not the tax, but the health care exchange.  By exempting all of these people, the administration makes the entire insurance system much less financially stable.

Insurers who were already dubious of the administration’s competence on this are now outright furious at being lied to, time and again.  They fear this will further push the risk portfolios of their insurance plans to the extreme, and thus, will increase their costs. That further increases cost pressures on health insurance premiums across the board, increasing costs for everyone. The Obamacare upward bending of the cost curve continues.

The ‘Band-Aids’ are all for show.  Ultimately, the problem is that the law itself was inherently broken.  These temporary measures actually fix nothing in the system. They are a political attempt at cover.  But nobody can protect Democrats from the onslaught of public anger that is going to arise when they realize what the ACA does, when the Band-Aids finally come off.

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Freedom Of Speech Is Bigger Than The 1st Amendment

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The latest in our litany of free speech debates comes to us courtesy of…Duck Dynasty?

Well, will wonders never cease.

For background:  the patriarch of the Duck Dynasty family, Phil Robertson, made controversial remarks about homosexuals in the most recent edition of GQ magazine. In response, A&E television has suspended Robertson indefinitely.

Now, the character of his remarks, or if they were really offensive or not, does not interest me all that much.  It is a matter of personal opinion, and let us leave it at that.

But the larger question that arises when we have these controversies is about the nature of the freedom of speech…and I am forever perplexed at how much people fail to understand what that freedom really means.

First and foremost is confusion regarding the 1st amendment.  Why people don’t understand this really is beyond me: the 1st amendment, or in fact the entire Constitution, is about the government’s limitations in restricting the rights of free people.  The First Amendment is not relevant here in the least, unless government gets involved at some later date.

But that, in turn, does not dismiss that this is, in fact, a debate about the freedom of speech and expression.

I think the basic confusion arises in the reality that many people don’t understand the difference between Constitutional rights, and natural rights.  As stated above, Constitutional rights refer specifically to the freedoms you enjoy that the government cannot restrict or remove. Natural rights exist universally, regardless of laws, Constitutions, or governments.

Now, what bothers me most about this is not that Robertson was fired.  I fully believe A&E is in their rights to fire whomever they want for whatever reason they wish.  That is what free association is supposed to mean in a free society.  I don’t believe this is substantially different than other major dismissals of media personalities in recent days, including the firings of Alec Baldwin and Martin Bashir at MSNBC.  We can argue about the morality of each, but legally…the end result is the same.

What bothers me most is the gross hypocrisy of liberals when it comes to defining free association.  That is not to say ‘all’ liberals, but look no further than today’s Democrat Party to understand where that hypocrisy lies.

Let us compare the Duck Dynasty fiasco to another major story that has been circulating.  There have been a litany of cases, in New Mexico, Oregon, Colorado, and elsewhere, where private businesses have been told by courts that they must, under power of law and the government, do businesses with gay couples who are getting married.  The businesses include bakers, photographers, and others. These businesses had moral opposition to gay marriage, and were theoretically using their freedom of speech, religion, and free association to choose not to business when they duly chose not to.  The state, however, thought otherwise.

Both of these cases have to do with society’s understand of freedom of speech and expression.  Both, however, do not, have anything to do with the First Amendment; only that latter case is covered under the Constitution.

But it does go to show how the political Left is redefining what freedom of speech means.  For liberals today, freedom of speech means the freedom to say and do as you wish…as long as that speech is acceptable, non-offensive, and within their vision of morality.

This is why free association is such an important concept, and cannot be separated from the greater vision of freedom of speech, expression, and religion.  If you are not allowed to freely associate (or dissassociate, as the case may be), then your freedom of expression is inherently limited.  One cannot be said to have freedom if those freedoms can be taken away when a specific issue of religion, marriage, or sexuality arises.  That is by its very definition no freedom.

Furthermore, although A&E has every right to fire Robertson…let us also admit that such a firing, based on a religious belief, clearly demonstrates a lack of believing in freedom of speech.  I, for one, would not fire anyone for these beliefs, or others, as long as they don’t directly interfere with their workplace ethic.  It is hard for me to believe that A&E didn’t know that the Duck Dynasty family had some extreme social views; do they not watch their own show?  Robertson himself has said on several occasions that he would quit if the T.V. show infringed on his belief in God and freedom.  So these beliefs are nothing that should surprise the TV executives, or anyone else familiar with the show.

For A&E to now take offense shows, simply, that they are willing to accept the benefits of the Robertsons’ freedom of expression when it brings them easy money, but not willing to face the fire when that same expression is the least bit controversial.

But the mainstream media’s hypocrisy does not end there.  Let us make several comparisons.  What if Walmart decreeed that none of their employees could, publicly or privately, voice a pro-choice opinion, and if found to do so, would be fired?  What if McDonald’s decreed that no woman wearing a Hijab would keep their job?

I personally believe that all the above examples are legal, and the companies have a right to do that.  Liberals don’t, as our gay marriage example above clearly shows.  They want to dictate when companies can be forced into businesses deals, and when they cannot.  That is hypocritical to its very core.

What I believe is corporations and businesses should have every right to make decisions as they see fit, as A&E did here, and as the baker and photographer did in the gay marriage issue.  The correct public response to such behavior is to react with your dollars; individuals at every level have the freedom to associate with whomever they wish, and as such, can hurt businesses who don’t abide by our individual moral standards.

Sure, this is not a perfect system.  Some lewd people will offend others, and feelings will be hurt, families may even be damaged financially, and society will be outraged.  But the concept of freedom of speech, freedom of religion, freedom of expression, and free association don’t come free.  There is a price to everything, and this is the price we pay for freedom.  True freedom.

 

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Doctor shortage – Yes Or No? The Answer Is Yes: Absolutely.

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In an editorial in the New York Times on December 5th, Scott Gottlieb, an internist and fellow at the American Enterprise Institute, and Ezekiel J. Emanuel, a former health policy adviser to the Obama administration, argued that there is no up coming physician shortage to threaten the country in the face of the implementation of the Affordable Care Act.

I beg to differ.

Drs. Gottlieb and Emanuel are both very intelligent and knowledgeable about health care policy in this country.  And I do have the greatest respect for their expertise and their work in this arena.  However, in this case, I think they are largely deluding themselves.

First, let us stipulate that we all agree that most of the major medical associations in the U.S. fully believe a shortage is going to occur in short order, as the authors in this piece state quite openly.  Let us also stipulate that Gottlieb and Emanuel are not the first to deny there is a doctor shortage.  For example, mathematician Linda Green argued in Health Affairs journal last year there was no real doctor shortage, if you made some structural changes.  However, what we see, as we go through their logical progression, is that their assumptions face the cold, hard reality of the real world where doctors actually practice, instead of the theoretical world they seem to exist in.

In the editorial in the NY Times, the authors first point to the Massachusetts experiment with Romneycare as a reason that we should not believe that the doctor shortage will occur.  They state:

Take Massachusetts, where Obamacare-style reforms were implemented beginning in 2006, adding nearly 400,000 people to the insurance rolls. Appointment wait times for family physicians, internists, pediatricians, obstetricians and gynecologists, and even specialists like cardiologists, have bounced around since but have not appreciably increased overall, according to a Massachusetts Medical Society survey.

There are many problems with this statement.  First and foremost is that Massachusetts is a poor analogy for the nation at large.  Massachusetts has the highest ratio of physicians per capita (462 doctors per 100,000 individuals). The national average?  About 300.  This means that Massachusetts has approximately 50% more physicians than the rest of the country on a per capita basis.

Now, even with that built-in advantage, the state had significant access disruption.  Let us put aside the fact that between 2009 and 2011, premiums in the state rose by 9.7 percent while benefits actually decreased by 5 percent. Deductibles during that time period rose 40 percent.  What Gottlieb and Emanuel failed to mention is that there are numerous surveys from the state showing that access to physicians is becoming problematic.

These results from a survey performed by the Massachusetts Medical Society:

The telephone survey of 838 doctors conducted in February and March found that 51 percent of internists are not accepting new patients, up from 49 percent the previous year. Fifty-three percent of family physicians, the other major group of primary care doctors, were also not taking new patients.

Even for patients fortunate enough to have a primary care doctor, waits for appointments continued to be lengthy. The average wait for an appointment with an internist was 48 days, which was five days shorter than last year, but the average wait for family medicine was 36 days, a week longer than in the 2010 survey.

Patients were also waiting longer to see specialists. The average wait for gastroenterologists, obstetricians/gynecologists, orthopedic surgeons and cardiologists were all higher than a year ago, the report said.

Now, Emanuel and Gottlieb are correct that these numbers have fluctuated, but that is to be expected.  Overall, however, access to physicians in Massachusetts has worsened over the past few years.  And don’t forget: Massachusetts is America’s best case scenario in regards to physician access.

Furthermore, even if their claim that there has been no decreased accesss in Massachusetts under Romneycare is true, that still doesn’t necessarily mean anything, because of the huge discrepancy in doctor to per capita ratio stated above.  Additionally, Massachuestts had the highest rate of insured in the country.  Therefore, the number of new patients entering the system that were previously uninsured is less than anywhere else in the nation.  To use a state such as Massachusetts that is skewed so heavily to one side of the scale seems to be foolish.

The editorial authors then go on to make several unsubstantiated claims:

Innovations, such as sensors that enable remote monitoring of disease and more timely interventions, can help pre-empt the need for inpatient treatment. Drugs and devices can also obviate the need for more costly treatments. Minimally invasive procedures, like laparoscopic surgeries, can be done more quickly with faster recovery times and fewer physicians.

There is virtually no evidence, anywhere, for this.This could be true, but it would take a massive improvement in current medical treatment methodologies that cannot be foreseen, and more importantly, are unlikely to occur in the near term.  I can speak for myself, as a radiologist who performs teleradiology on a significant scale; or my wife, who is Clinical Assistant Professor at a major medical center.  Neither of us can see the kind of transformation that Gottlieb, Emanuel, or Ms. Green are suggesting.  In short, these are dreams, not practical realities.

They go on to discuss what doctors call ‘physician extenders’, such as physician assistants, nurse practitioners, etc.  These professionals certainly have a place in the ever-expanding U.S. health care system.  They also can likely serve with more autonomy than they do today, in order to decrease the workload on physicians.  Of course, that would take a dramatic change not only in how we practice medicine, but also extensive changes in the medicolegal landscape of the country.

Even without those considerations, however, what the authors fail to declare is that expansion of the use of these professionals has already been the case for several decades.  As stated by Dr. Richard Cooper in an article in the Journal of the American Medical Association in the November 13, 2013 edition (page 1932), between 1990 and 2012, the number of physicians increased by 50%, while the number of nurse practitioners and physician assistants increased by a whopping 500%.  Therefore, Gottlieb and Emmanuel are suggesting a larger expansion in the use of these professionals than has already occurred.  That kind of dramatic change is not practical, and filling the gap with a huge number of these personnel should be considered unlikely.

The one solution that is advocated by most medical studies, the expansion of medical schools and residencies, is dismissed by the authors here. But one indisputable fact is that the United States is producing far too few physicians.  This started during the Clinton era, when Medicare purposefully capped the number of residency positions funded.  This was done because the argument was that decreasing the number of residencies would push more doctors into primary care; that prediction never came to fruition. In fact, if residency programs had not been capped in 1997, and annual growth in the number of positions had continued at a historical basis, there would be no physician shortage today.

Medical schools, both Osteopathic and Allopathic, have steadily increased medical school seats since 2000.  According to Dr. Cooper, 27,000 medical graduates will be produced by 2020, a 50% increase from 2000.  This is still far too few to close the gap we suffer from today.

Dr. Cooper in his JAMA article pleads for consensus among policy advisors.  He states the following:

To do nothing ignores the powerful economic and demographic trends and leaves future generations to ponder why they and their loved ones must experience illness without access to competent and caring physicians.

Drs. Gottlieb and Emanuel do a disservice to the medical community by distorting the realities of the demographics involved among the physician community of the United States.   We will very likely need far more physicians than they project, and most experts believe that a shortage of 200,000 physicians by the year 2020 is very likely. Depending on wishful thinking and technological advances that cannot even be seen by the most acute vision imaginable is not a thoughtful policy position; it is a Hail Mary.  The government must quickly come to terms with the major disaster that awaits us if we do not respond to this looming health care problem.

 

Links:

http://www.nytimes.com/2013/12/05/opinion/no-there-wont-be-a-doctor-shortage.html

http://www.forbes.com/sites/scottgottlieb/2013/12/05/obamacare-wont-create-a-doctor-shortage-but-that-doesnt-mean-youll-have-ample-access-to-physicians/

http://www.census.gov/statab/ranks/rank18.html

http://www.mass.gov/chia/docs/r/pubs/13/ar-ma-health-care-market-2013.pdf

http://www.wbur.org/2011/05/09/doctors-survey

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/01/15/doctor-shortage-what-doctor-shortage/

http://content.healthaffairs.org/content/32/1/11.full

http://jama.jamanetwork.com/article.aspx?articleID=1769903

 

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Obama On Obamacare: Honesty Is NOT The Best Policy

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This weekend showed the mendacity of the Obama Administration on the continued debacle of the rollout of the Affordable Care Act.

Saturday was the deadline that Obama himself proclaimed for full functionality of the Healthcare.Gov website.  We were told, all last week, that the government was working day and night to achieve ‘success’.  And then Sunday morning, Voila!  The White House proclaimed they had achieved their goals.

Except for one problem:  the reality is that the website is far from fixed.

First, the metrics that the White House themselves have used for ‘success’ has been slowly been moving downward since Obama made his proclamation in early October.  At first, it was that 80% of applicants could complete their insurance purchasing process through the website.  Then, it was that 80% of people could actually complete the application on the website, and have the process completed in steps unrelated to the internet (paper applications, for example).  Now, the criteria is that at 80% of people can sign on to the website.  They no longer even discuss completing the process.

Even more laughable is that HHS states that they have achieved their goal of the website being up and running 90% of the time.  Let us put aside the fact that 90% success of a website is pathetic; what is even worse is that 90% is noninclusive of downtime from scheduled maintenance that the website requires almost daily.  So when the website isn’t down for fixes..it is functioning at 90%.  Not much of an achievement.

“Healthcare.gov on Dec. 1 is night and day from where it was on Oct. 1,” Jeff Zients, who was brought in to oversee fixes to the troubled Obamacare website, declared during a Sunday conference call.  That may be true, but that doesn’t mean we have achieved any level of success.

Furthermore, when HHS was specifically asked by Washington Post Health Care blogger Sarah Kliff whether their problem with the 834 forms (essential data necessary to insurers to complete the purchasing process) have been solved..they refused to answer.

My contacts in the insurance industry have said that there have been small improvements, but overall, the problems persist.  So much so, the insurance industry put out a statements stating that although the website has improved, major problems remain, and are nowhere near to fixed.

Today the White House was proclaiming that 100,000 people have signed up to Obamacare in November, claiming another victory.  Again, this can only be considered a victory if you wear rose-colored glasses.  Yes, it is better than the 26,000 sign ups in October, but a fraction of the 800k expected in November.  At the current pace, Obamacare would need approximately 56k purchasers a DAY to achieve their goal of 7 million by the end of March.

The White House would be better served by admitting the truth.  Admission of the faults in the program such as that the entire program is running well behind schedule, and needs to be delayed, and that the website may need to be rebuilt are simple realities that the public may be willing to forgive.  The administration seems to be unwilling or unable to make such an honest assessment, either because of political or practical realities.  But trying to fool the American people that any of these metrics are any type of ‘success’ is likely a level of mendacity that will only lead to failure.

 

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Hunger Games Catching Fire: Movie Review

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The much anticipated sequel of last year’s hit The Hunger Games arrives just in time for Thanksgiving…and delivers just like a holiday movie should.

Katniss (Jennifer Lawrence) returns home after her victory in the Hunger Games, only to find her world turned upside down.  As the saying goes, you can’t go home again. While she must continue to act as if she is in love with Peeta (Josh Hutcherson), as she did during the Games, she clearly has feelings for her long time best friend Gale (LiamHemsworth). But her life is not the same; she is now wealthy because of her winnings, living in opulence while the rest of District 12 remains in squalor.

As part of their victory, Katniss and Peeta must go on a ‘victory tour’ of the 12 districts of the nation of Panem.  We learn quickly that their victory in the Games has set of a chain of events that will have ramifications for the country, and their own lives.  The pair have unintentionally ignited a slow, burning hatred for the leadership of the dictatorial nation…with Katniss as the symbol of how to rebel against the system.

President Snow (Donald Sutherland) decides that he has had enough of this love crossed pair, and uses the the Quarter Quell (the 25th anniversary of the Hunger Games, which always has a special ‘spin’ to it) in order to rid himself of both problems, as he throws both of them back into the arena for another fight to the death.

This is, in many ways, a transition movie, and as such, you view the characters quite dramatically different in the beginning of the movie compared to the end.  Katniss is fully a different person, with a different fate and expected future, at the end than you foresaw at the end of The Hunger Games.  We no longer can see a happy future for her, but only misery and more conflict and pain. As such, this movie does a nice job showing that transformation, and setting up the last book, which will be made into two separate movies.

I will have to say I enjoyed this movie more than the first.  First and formost, this was always my favorite of the three books. But Director Francis Lawrence has made a darker and more energetic film, that gives us more an innate feel of what the characters are going through, and the largeness of the issues that are revolving around our main characters.

This movie is as highly recommended as the first movie, and for me personally, was more enjoyable.  This series is shaping up quite nicely.

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Kennedy Assassination, 50 Years Ago Today

JFK-and-Jackie-in-Dallas

I was born a decade after John F. Kennedy was assassinated in Dealey Plaza on November 22, 1963.  My knowledge and understanding of Kennedy’s life of course then comes through the prism of his death, more than his life.

That is largely how the mythos around Kennedy exists to this day: a liberal icon, whose life in ‘Camelot’ was the ideal that all politicians live up to.

We, of course, know this not to be the case today, if we are students of history.  Camelot was largely a post-mortem creation of the Kennedy inner circle, expanded and inflated to greater than life in his death.

His family life was far from perfect.  His political beliefs were scattered, and liberals forget that Kennedy supported what in today’s day and age would be steadfast conservative principles such as low taxes, low federal spending, and a strong worldwide U.S. military presence.

I think some conservatives take it too far; Kennedy was no conservative, but he would not easily find a home in the present Democrat Party either. I mean, truly, what Democrat today would feel comfortable saying this out loud:

“The federal government’s most useful role is … to expand the incentives and opportunities for private expenditures. … [I]t is a paradoxical truth that tax rates are too high today and tax revenues are too low and the soundest way to raise the revenues in the long run is to cut the rates now.”

He would be run out of every progressive group known today.

We also today forget that it was Kennedy that started the Vietnam War.  There has been decades of debate on whether Kennedy would have expanded the war as Lyndon B. Johnson did. Robert F. Kennedy seemed to think so. RFK himself stated before his death that JFK had no intention of pulling out of Vietnam.

But all of these political realities, including ones we have not spoken of (Bay of Pigs, Cold War, Civil Rights) pales in comparison to Kennedy’s death.

Kennedy ultimately died at the hands of an extreme leftist progressive communist, something that we tend to forget today.  Some liberals today want to blame the right-wing of that day, which is plain silly and easily dismissed.

Lee Harvey Oswald was a devout left-wing extremist, who converted to communism, even going so far as defecting to the Soviet Union.  In April 1963, Oswald attempted to shoot Edwin Walker, a retired U.S. Army general, as he sat at a desk in his dining room. Walker was a leading member of the John Birch Society, a right-wing group. That is not the actions of a right-winger; it is the actions of just the opposite.

Maybe it is most fair to say that Kennedy was just another victim of the Cold War. Of course, that reality didn’t suit the liberal intelligentsia of the time.  As James Piereson writes in his brilliant book Camelot and the Cultural Revolution, many of the liberal icons of the era chose to purposefully distort history, and make JFK’s death about civil rights, and not the Cold war.

Of course, the confusion of who actually was resonsible for Kennedy’s death, the murder of Oswald himself, the Warren Commission and the innumerable conspiracy theories that have been created and continue to arise to this day just muddy the waters of the reality of the historical moment even more.

This will continue to be debated forever.  The death of a leader does that to a nation.  But on a societal note, I somewhat understand the profound effect that the JFK assassination had on that generation.  I thought I understood it to some effect by seeing what I thought were life changing events such as the Challenger disaster, or the fall of the Berlin Wall. But 9/11 was transformative in a way that none of those were, and most  likely 38 years from now will have more impact on our lives than the JFK death has for us today.  I wonder if my children will view 9/11 as some distant historical footnote, as in many ways I view Kennedy’s assassination.

But, past the historical and political spin, this was a life of an American war veteran and hero, a man who valiantly served his country, and was taken from the American people in a horrible manner.  Whatever else you think of Kennedy, we should embrace the portions of his life that added to the American nation, and value them for what they were.

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What Really Worries Democrats About Obamacare

 RTX12UJY

Ignore the media, and the liberal spin.  There is one simple political reality:  Democrats across the board are extremely worried about the Affordable Care Act, and its effect on the 2014 elections.

I have quite a few connections to staffers and other behind-the-scenes people in the Democrat Party.  Talking to them, there is a consensus: they are in trouble.

Some of them fully believe that Barack Obama, Kathleen Sebelius and the rest of the President’s administration can right the ship, and some make the Obamacare system functional enough to please the public.

Most, however, don’t believe anything of the sort.

There is a reason for this:  for all the bluster and hot air about the Obamacare website debacle, that is the least of the worries for liberal supporters of the health insurance reform plan.  In fact, the failure of the website may actually be hiding some of the more pernicious aspects to the health care law.

So here is a timeline of the largest hurdles  the supporters of Obamacare face over the next twelve months:

 

November through December 2013

The enrollment numbers for the first month were terrible, and that is unlikely to dramatically change any time soon.  Initial numbers stated the total enrollment nationwide for October was a meager 50,000 or so.  That is less than 1/10th of 1% of the total necessary to keep the system sustainable.

Obamacare defenders will try to spin that the tens of thousands added on to the Medicaid system as a sign of success, but even people not familiar with the ACA understand it is easy to give away free stuff; It is another thing entirely to get Americans to pay their hard-earned money into the system, when that system may not provide them any great benefit in the near term.

The website functionality is going to be an ongoing challenge as well. President Obama and HHS Secretary Kathleen Sebelius both promised that the website would be working by the end of November.  That now appears to be another ‘incorrect promise’ and frankly, most IT experts I talk to would be surprised if the system is up and running before February.

Website Security will be an issue as this process continues as well. Consumer Reports and others already warned Americans that they should wait until major fixes in the security loopholes were corrected. On 11/19/13, there was testimony that the website places user data at “critical risk” despite recent government assurances it is safe to use.   Several security experts have predicted a large-scale breach in security. Imagine millions of Social Security numbers, credit card numbers, along with IRS tax data and health data being breached.

Amazingly, the entire ACA Payment system also has to be built, after three years.  There is no system at present to transfer funds from the Federal government to the states or to insurers.  And even more shocking? On November 18th, the head of the IT for the ACA admitted that at least 30% of the ENTIRE IT INFRASTRUCTURE still needed to be constructed.

To compound matters, the system also has a nonfunctional subsidy calculator.  What does this mean?  Right now, they are only estimating individuals expected subsidies.  However, if the estimate is incorrect and over estimates your subsidy, you could be liable for hundreds or thousands of dollars more in premiums next year.  This would be problematic in the best of situations.

To compound this problem, the administration is trying to shunt customers to private insurance websites, as a ‘work around’ for  the broken Federal exchange.  The problem is, it is technically against the law for purchases outside of the exchanges to receive federal subsidies.  What happens if a legal entanglement results in those subsidies to be ultimately rejected?  Customers could be in for a real disaster if they agree to purchase insurance, only to find they are not eligible for subsidies.

 

January through June 2014

The first problem is one I have already written about:  Obama will have to break his promise that If you like your doctor, you can keep your doctor.  This promise could never have held true in the market that Obamacare creates, because as predicted, many of the policies purposefully eliminate expensive and elite institutions.

I personally have been booted off of several health care plans because of a cancer center I work at.  I know many doctors stating similar experiences at elite institutions such as Memorial Sloan-Kettering Cancer Center, Mayo Clinic, Cleveland Clinic, and other prestigious institutions. The most famous case was a cancer patient in California who wrote an editorial in the Wall Street Journal, and who could no longer see her oncologists and other treating physicians, because the California exchange had no policies that would include all of her physicians.

The next major debacle will be the surprise of high deductible payments. The majority of the policies being sold are the cheaper ones on the exchanges; the so-called Bronze and Silver plans.  The average yearly deductible, after paying your premium for these policies, is around $5,000.  There is a high degree of variability, but on average these are high deductible plans.  What will happen the first time there is a sick child, and a $5,000 deductible stands between that poor family and a life saving procedure?

One interesting twist will be the use of Obamacare Navigators.  This was a program the administration started to ‘guide’ customers through the process.  Sounds great.  Except for one problem:  many of the Navigators were not appropriately screened, and there has already been a fair amount of fraud in this group of government workers. Undercover videos of Navigators telling customers to defraud the government have already surfaced, and I am sure you will see dozens of those as time goes on.

 

July through September 2014

This is actually when the rubber meets the road.  By this point, no matter how incompetent the administration’s IT experts are, virtually everyone that wants to have insurance should have insurance.  The website problems, even if they still persist, should no longer be relevant.

The first question that will arise is how many people chose to pay the penalty?  For many of the lowest income persons, a penalty of $95 was all that was required to opt out; with the high expense of many plans, a fair number of people will choose this option.

More important is the ratio of healthy individuals compared to sick ones in the exchanges.  For the exchanges to survive, they require a very high ratio of healthy people buying in, in order to subsidize the rest of the population.  Recent data from Kentucky (supposedly a liberal success story) shows that the ratio of healthy to sick is closer to 1:4 than the close to parity required for financial sustainability.

What happens if this does not occur?  Insurers will enter the oft talked about ‘death spiral’.  They will be required to raise their future premiums in 2015, because the cohort of patients in their insurance pools are less healthy, and thus, more expensive to treat.  The death spiral occurs as young, healthy persons realize that the increased costs of their insurance is not worth it, and opt out…further increasing the ratio of sick persons in the insurance pools, and further increasing costs.  This is the scenario that most scares Obamacare proponents.

The irony of all this is this presumes that the individual mandate  is not delayed.  Right now, the Upton and Landrieu bills sit in Congress, and Obama has announced his executive order to ‘fix’ the problem of policy cancellations.  The more delay of the individual mandate, either by legal methods or presidential signature, the more likely it is that insurers will have costlier insurance pools that will drive up premium costs moving forward.

The next problem is how this huge new population of insured patients will be treated by a system that is already overburdened.  A doctor shortage very well could arise.  Something similar, but to a lesser scale, occurred during Romneycare’s implementation in Massachusetts.  Massachusetts was more prepared than most states, as it has the highest ratio of doctors to patients in the country.  Even then, access to physicians, especially specialists, was restricted substantially.  Now imagine the states with low doctor to patient ratios, and you can imagine the complications that could arise.

That doesn’t even take into consideration that many physicians are likely to opt out to the largest expanding health care insurance program in the country:  Medicaid.  Already in states like New York, about a third of doctors have opted out.  Many physicians, especially those tied to hospitals, cannot opt out.  But this decrease in available primary physicians to handle this huge new number of Medicaid patients (who are among the sickest and poorest patients around) could be a disaster, and there is no short term solution to this problem.

 

October through December 2014

This is where all the real excitement occurs.  Let us assume some how, some way, Democrats have survived the year without any major catastrophes, and are holding their head above water as the midterm elections come.  There are several huge hurdles still remaining. 

The first, and largest by far, will be the kicking in of the employer mandate. Remember that this mandate was supposed to occur this year; however, because of the completely broken and unworkable system, Obama delayed it (outside of legal bounds no less).  But the employer mandate is the crux of the entire system; the majority of Americans get their insurance through their employer, and insuring this mandate is vital to that majority.

The problem arises in the fact that in the same way that millions are losing their private insurance plans today, even a greater number of employees are likely to either lose their plans or see drastic changes next year.  This was predicted by the Department of Health and Human Services as far back as 2010.  Now is when that change kicks in.

Furthermore, millions of small business owners will have to decide whether to pay for insurance, or send their employees into the exchanges; the same exchanges that are so far struggling to handle the volume and load.

For employers that are going to continue their insurance plans, another problem: they will likely get notices from insurance companies that the plans they currently purchased no longer exist.  Sound familiar?  And insurers will, under Federal law, have to do that a minimum of 60 days before cancellation, meaning…the beginning of November, at the very latest.

And, remember the ‘death spiral’ we discussed above?  If insurers face that hurdle, they are likely to raise rates across the board.  Here is the biggest problem of all: for all the talk about these changes affecting only the people on the exchanges, if and when a ‘death spiral’ or anything like it occurs, costs will rise for everyone.  That means increased premiums for businesses, which will likely be passed on directly to employees.  Some employers will also likely choose the easy option, which is shifting their employees to the exchanges.

And all this will be announced just weeks before the election.

 

After all of this, you begin to understand why those that truly understand the steps necessary in the next year to implement the full-scale of the Affordable Care Act are worried.  Right now, we are seeing the tip of the iceberg: gross incompetence in establishing a website for entry into this behemoth government monstrosity.

But once you enter this behemoth, you start to understand that there are numerous interweaving and interconnected cogs that will need to work relatively smoothly, or the system as a whole will flounder.

That doesn’t even tell the political story.  Every week, if not daily, there will be a story about individuals who are being harmed by the ACA.  Those stories will drown out any of the positive stories, because we know that ultimately the media highlights the negative.  As stated above, when a child or young mother is denied life saving treatment because of restrictions placed upon them by Obamacare, who takes the blame?

Liberals are trying to circle the wagons, to keep sustainable political support for the plan, in the hopes that the Obama Administration can fix the problems in short order.  But as you can see above, there is no simple fix.  Many of the ‘problems’ with Obamacare are inherent to the system that Democrats devised.  These were intended results.  How do you fix the plan, when it is the intent of the plan that is the problem in the first place.

So batten down the hatches, America…it is going to be a bumpy ride.

 

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Gettysburg Address Sesquicentennial

Lincoln Gettysburg Address2

150 years ago, today:

Four score and seven years ago our fathers brought forth on this continent, a new nation, conceived in Liberty, and dedicated to the proposition that all men are created equal.

Now we are engaged in a great civil war, testing whether that nation, or any nation so conceived and so dedicated, can long endure. We are met on a great battle-field of that war. We have come to dedicate a portion of that field, as a final resting place for those who here gave their lives that that nation might live. It is altogether fitting and proper that we should do this.

But, in a larger sense, we can not dedicate — we can not consecrate — we can not hallow — this ground. The brave men, living and dead, who struggled here, have consecrated it, far above our poor power to add or detract. The world will little note, nor long remember what we say here, but it can never forget what they did here. It is for us the living, rather, to be dedicated here to the unfinished work which they who fought here have thus far so nobly advanced. It is rather for us to be here dedicated to the great task remaining before us — that from these honored dead we take increased devotion to that cause for which they gave the last full measure of devotion — that we here highly resolve that these dead shall not have died in vain — that this nation, under God, shall have a new birth of freedom — and that government of the people, by the people, for the people, shall not perish from the earth.

Abraham Lincoln
November 19, 1863

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Democrats To America: We Lied, But You Should Apologize

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What a hilarious dynamic you now have in the Democrat Party.

The civil war I described earlier is between two, diametrically opposed views.  One is the Obama Progressive Idealistic wing: they will push Obamacare, no matter what.  If there is absolute, positive evidence that the program doesn’t work, it wouldn’t alter their belief that their plan must be enacted fully.  Reality matters little to this wing of the party; they simply are fanatical idealogues.

The other cohort is the Pragmatic ‘Do and Say Anything to win elections’ wing of the party.  This was most famously led by Bill Clinton, but now numerous Democrats that are (SURPRISE!) up for re-election next year have joined as well. Mary Landrieu, Kay Hagan, Mark Begich, and moderates such as Joe Manchin belong in this group.  They believe they must placate the angry American electorate first and foremost. What is ironic is this group doesn’t care about the success or failure of the ACA either; they simply want to do enough to get 50.1% of the vote next year.

And in the middle is the rest of America.

Americans feel betrayed.  They never truly supported the Affordable Care Act, but a majority of them trusted Barack Obama enough that they gave him the benefit of the doubt; that, more than anything explains Obama’s re-election.  The benefit of the doubt on the economy, on foreign affairs, and yes…on Obamacare.

That trust is now broken.

Look no further than the recent polling from numerous agencies.  Trust in Obama has collapsed entirely.  On most issues, Republicans are more trusted; remember, this was the party who a few weeks ago was less liked than many venereal diseases.  Obama is doing worse than that.

And what has Obama and Democrats done to respond to Americans discovering they have been lied to?  Basically, they blamed…everyone but themselves.  The list is long.

It was Republicans fault for not working with Democrats; even though the GOP correctly and appropriately predicted the problems that have now occurred.

It was the fault of the media, for not spinning more.

It was the fault of contractors, who failed to do their job, as if government oversight wasn’t the administration’s responsibility.

My favorite? It was the fault of average Americans. Why?  Because they were foolish or stupid to believe the lie in the first place.

If you think I am exaggerating, simply go read some of the ‘elite’ liberal columnists out there. This last excuse actually has become common place among the liberal intelligentsia.

The quandary that liberals are in leaves them between a rock and hard place.  Either they can follow their fanatical ideology, and fight for the Affordable Care Act, even though more and more evidence is coming to light that the plan cannot achieve the major goals set for by Obama himself.  The alternative is to pass something like Landrieu’s Senate plan, allowing people to keep their current health plans; that would blast a hole in the central tenet of Obamacare, which is to redistribute health care dollars from the healthy to the sick.

I actually agree with many liberals:  no amount of running away from Obamacare is going to save Democrats this time. They own this, in totality.  Ultimately, the only thing that would save them would be a competent rollout of the remainder of the system, which at this point seems highly unlikely.

Which means, when the 2014 election rolls around, we can truly see who deserves to be delivering, and receiving, apologies.

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The Early Stages Of A Democrat Civil War

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An interesting dynamic is brewing in Congress among Democrats, and with the White House in the middle, as their circular firing squad on Obamacare continues.

Greg Sargent of the Washington Post as well as other liberals have pointed out that Sen. Mary Landrieu’s Keeping the Affordable Care Act Promise Act , which is a various of Republican Rep. Fred Upton’s Keep Your Health Plan Act, is forcing the hand of Democrats in the House of Representative.

Landrieu’s plan is going to be hard for Red State Democrats to ignore.  Poll numbers on Obamacare are plummeting as the Administration’s incompetence becomes more apparent.  Sen. Kay Hagan’s vanishing lead in North Carolina will only hasten to increase the pressure on these vulnerable Senators.  Furtherm0re, even relatively safe liberals like Jeff Merkley of Oregon have signed on to Landrieu’s plan, showing the political pressure Democrats are under.

For the House, who has always been more steadfast in their support of President Obama, this puts them between a rock and a hard place. Most House Democrats are in safer districts than their Senate counterparts, and thus can afford to hold the line. But how much pressure is too much?

This builds an interesting dynamic of triangulation for the White House.  They need to balance the needs of their liberal allies in the Senate, while still making the political choices palatable to their friends in the House.

But this becomes more difficult by the day.  Again, from Sargent:

A senior Democratic aide tells me opposition to the Upton plan will be increasingly difficult to maintain among House Dems if the administration doesn’t offer a workable fix of its own. The aide adds the need to maintain House Dem opposition has been made more urgent by another problem: Senate Dems (the latest being Dianne Feinstein) supporting their own politically expedient “fixes” that could also undermine the law.

“Now that Feinstein has broken off, that makes it even more important that House Democrats stay together as much as possible — to keep Senate Ds from caving,” the senior Dem aide says. But the aide adds, in a reference to this week’s House action: ”We need an administrative fix that works before the vote.”

This puts all the pressure on Obama; but his choices are slim.  Delaying the individual mandate is actually very bad policy now (I personally oppose the Upton plan for a myriad of reasons). Obama cannot do that and not make the systemic problems worse.  There is no Presidential order that will give people their insurance back to them.  And the other legislative fixes are nonstarters either in the House or Senate.

So one of two dynamics shape up: one, the Senate passes Landrieu’s bill, and House Democrats are left fighting a losing fight against the Upton bill, in which case they will have to defend voting against this bill to the public.

The second option is that House Democrats fold, and Obama is forced to veto this bill, in which case all the blame falls upon him, after he just promised he would do ‘everything imaginable’ to fix the problem.

Either way, there isn’t any safe harbor for Democrats on this issue.  They are fooling themselves that any of this will  protect them from the wrath of the American voter if the ACA fails as incredibly as events so far have shown. From a political standpoint, I think at this point they would be better served to circle the wagons and defend their progressive policies.  But the panic instinct among politicians is so profound, they must appear like they are doing something productive, even when the target of their attacks are members of their own party, or their own President.

So the Democrat circular firing squad continues.

 

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