Does locking people into dependence expand choice?

original article: How Government Paid Leave Restricts Parents’ Choices
January 21, 2020 by Georgi Boorman

“People say, ‘I just need to organize my life like this and make the right choices,’” Claire Cain Miller quoted from feminist author Kirsten Swinth in The New York Times recently. “Nobody’s saying, ‘I’m making choices in an impoverished world.’” The article for the New York Times’ “The Upshot” purports to examine the challenges parents face in balancing work and child-rearing.

Cain Miller operates from the premise that the United States — one of the wealthiest countries in the history of the world — is “impoverished” in parental choices. From the author’s view, parents’ limited options are due to institutional policy deficiencies, such as a lack of government-provided parental leave, meager paid leave from employers, and “gendered expectations.” If it weren’t for these “structural limitations,” the implied argument goes, American parents would face a rich selection of choices for work-life balance.

What the NYT used to say about the minimum wage

original article: The Right Minimum Wage: $0.00
January 14, 1987

The Federal minimum wage has been frozen at $3.35 an hour for six years. In some states, it now compares unfavorably even with welfare benefits available without working. It’s no wonder then that Edward Kennedy, the new chairman of the Senate Labor Committee, is being pressed by organized labor to battle for an increase.

No wonder, but still a mistake. Anyone working in America surely deserves a better living standard than can be managed on $3.35 an hour. But there’s a virtual consensus among economists that the minimum wage is an idea whose time has passed. Raising the minimum wage by a substantial amount would price working poor people out of the job market. A far better way to help them would be to subsidize their wages or – better yet – help them acquire the skills needed to earn more on their own.

Corrupting Christianity and distorting history to justify communism

original article: There is no ‘Catholic case for communism’
July 25, 2019 by Rev. Ben Johnson

On Tuesday, America magazine published an apology for Communism that would have been embarrassing in Gorbachev-era Pravda. “The Catholic Case for Communism” minimizes Marxism’s intensely anti-Christian views, ignores its oppression and economic decimation of its citizens, distorts the bulk of Catholic social teaching on socialism, and seemingly ends with a call to revolution.

While author Dean Detloff claims to own Marxism’s “real and tragic mistakes,” he downplays these to the point of farce. He admits, without elaboration, that “Communism in its socio-political expression has at times caused great human and ecological suffering.” That seems a rather anodyne way to describe decades of imperialism, censorship, and torture; the Gulag archipelago, reeducation camps designed to eradicate the victim’s entire personality, and the systematic industrial slaughter of 100 million people (and still counting in North Korea, China, and Cuba).

In this America essay, the plight of Communism’s victims is reduced to the level of “ecological suffering.”

The left seems to prefer demonizing the right to confronting the facts

original article: Why The Left Smears Conservatives Instead Of Engaging Their Ideas
May 8, 2019 by David Weinberger

“Get your facts first, and then you can distort them as much as you please.”—Mark Twain

The left routinely distorts conservative ideas, but it is not always clear whether their misrepresentations are deliberate or simply due to unfamiliarity with conservative thought.

Consider, for example, the left’s characterization of supply-side economics as “trickle-down economics” or “tax cuts for the rich.” Despite having been shown to utterly defy the facts, politicians and media continue arming themselves against these caricatures with invincible ignorance.

Socialism ethically compromised

original article: Unitarian leftist: Socialism is not ethically superior to capitalism
April 26, 2019 by REV. BEN JOHNSON

Socialism has made a resurgence in this generation, not least because of its deceptive moral appeal. Secular Millennials join liberal priests, pastors, and rabbis in saying that profits corrupt, unequal outcomes are immoral – and perhaps even Jesus would have been a socialist. Yet numerous people, secular and faithful, have weighed collectivism in the balance and found it wanting.

One of the people who found socialism ethically inferior to capitalism came from an unlikely source: the Unitarian Church.

His verdict? Socialism “is the necessary outcome, not of religion but of irreligion,” he said. Redistribution of wealth slows moral development and creates evils worse than capitalism.

How a committed socialist gave up the faith

original article: The Bolivarian God That Failed
February 1, 2019 by Clifton Ross

The day after Venezuela’s National Assembly voted to declare its president, Juan Guaidó, interim President of the Republic, I received a text from a former friend. “If the U.S. topples Vz [Venezuela],” he wrote, “I will hold you responsible.” I would have been happy to accept this responsibility had I done anything important enough to deserve it. But the idea was absurd and he knew it. If the Venezuelan regime falls—and I hope that it does—it won’t even be possible to credit (or blame) the United States. It is the Venezuelan people who finally are taking their destiny in hand and rejecting an intolerable status quo.

What happens when no one asks whether insurance is really a good way to deal with health care costs?

original article: How Obamacare Hurts Millions Of Americans By Robbing Peter To Pay For Paul
May 10, 2017 by Scott Ehrlich

In my prior article, I tried to outline the pre-existing condition issue. I concluded the amount of people potentially affected by this issue ranged somewhere between 500,000 and 1.9 million and, due to political reasons, it is much likelier to be on the lower end of that spectrum.

So for this article, I will use 1 million people as my number. Based on this data from Avalere, it’s a pretty sensible estimate, if you only count states that are solely Republican-run and therefore likely to seek a waiver.

This 1 million people are adults covered by the individual market, at the moment largely through the federal exchanges. People on group insurance are not affected by pre-existing conditions laws, as those plans do not do individual underwriting. People in government insurance such as Medicaid, Medicare, and Tri-Care are guaranteed issue upon meeting certain conditions. Children under 19 who aren’t covered by Medicaid are covered by the Children’s Health Insurance Program, which has no pre-existing condition exclusions. Futher, people in Maine, Massachusetts, New Jersey, New York, Vermont, and Washington have state laws that mandate guaranteed issue.

So our at-risk people are made up of the remaining 7 million or so people in the other 45 states who choose to self-insure, have pre-existing conditions that stop them from getting insurance, have states granted waivers under the American Health Care Act (AHCA, if it passes Congress in its current form), and have failed to keep continuous coverage.

Assuming your eyes glazed over a quarter of a way through that sentence, that shows just how many safety nets one has to fall through to be at risk of being denied coverage at the market rate, or any rate, for pre-existing conditions. Recall that just because someone has a pre-existing condition or is denied by an insurance company for one, doesn’t mean he will be denied by all. So that is why my numbers are lower than many others being reported.

Let’s Pin Down How Much These Folks’ Health Care Costs

So let’s go with that 1 million number, which is still a lot of people needing help. What can we do with them? That is the challenge. When enrolling a random assortment of 1 million Americans in a pool, theoretically about 27 percent could have some sort of ailment requiring immediate treatment. Depending on the mix of other people, it’s possible to make that pool actuarily sound.

But high-risk pools don’t work that way. In that pool, 100 percent of enrollees have pre-existing conditions. Therefore, it’s impossible to provide them insurance and keep a stable pool. You can’t insure someone for a condition he already has any more than you can insure a house that is already on fire or a car that has already crashed. There is no ability to pool risk.

So this group of people is very expensive to cover, as they are already sick and use a lot of health care. Average costs in the PCIP federal high-risk pool, the one the Affordable Care Act set up as a bridge to the exchanges, averaged more than $32,000 per enrollee per year. Based on those numbers, at 1 million enrollees, we’d be looking at more than $32 billion annually in costs for high-risk people. That $8 billion that got Rep. Fred Upton to vote yes on House Republicans’ Obamacare tweaks? That would cover only three months of expenses at full enrollment.

If the entire amount appropriated in AHCA were applied to pre-existing conditions, a whopping $123 billion, we’d only have enough to make it through four years if that cost were accurate.

Luckily, That Cost Is Likely Overstated

Reading deeper into the report, you find that, fortunately, it may not be. Not all people with pre-existing conditions are created equally: “4.4 percent of PCIP enrollees accounted for over 50 percent of claims paid, while approximately two-thirds of enrollees experienced $5,000 or less in claims paid over the same period.” So while Avalere used the $32,000 figure, it probably vastly overstates the cost of a program like this. That’s because the people most likely to have been enrolled in PCIP would be the sickest, who need the most care immediately.

Someone with early-stage diabetes with no side effects, like myself, who may currently be tough to insure may ignore a high-risk pool like this since it costs more than I spend on treatment, while someone with advanced cancer requiring frequent doctor visits, expensive medication, and consistent chemotherapy would seek something like this out. Therefore, if the pool of 115,000 enrollees in PCIP were expanded to the 1 million people who have pre-existing conditions but couldn’t be insured, we’d likely see many more costing about $5,000 per year than the ones costing $100,000 and up.

Therefore, I prefer the number $12,000 as the cost per additional enrollee. This uses the average benefit used by a person enrolled in Medicare based on the total benefits paid divided by the total people covered. Since these people are older, sicker, or disabled and have high health utilization, I think it makes a good proxy for the sort of person likely to seek a high-risk pool who would not have jumped at the opportunity to sign up for PCIP.

Adding 900,000 people at that cost to the 100,000 people at $32,000 in PCIP gives us a total annual cost of $14 billion. That means if people in these pools were to cover about 10 percent of their own health-care expenses, the money AHCA appropriates could cover the entire affected population of the high-risk pools for the entire 10-year budget window.

This Is Still a Lot of Money

So now we’ve seen the numbers. About a million people may need help. Pooling them with the healthy has real costs to a lot of people to help a few. But we have decided as a society that we can’t just let those few suffer. Yet helping pay for their care will be staggeringly expensive. Even in my example, with this smaller pool and smaller assumed costs, we would burn through the entire pool of $123 billion in a decade. These people will still need help at the end of that decade. How do we take care of our sick population into the 2030s without busting our budget?

That is why people argue we should keep the Affordable Care Act provisions regarding pre-existing conditions, which are community rating and guaranteed issue. The benefits are obvious, as they have been blasted all over the media. People getting operations they might not otherwise have had, seeing doctors they couldn’t otherwise see, getting care they wouldn’t have otherwise received. Who would be so heartless as to take that away?

This is a classic example of concentrated and observable risk and diffuse and hard to see benefits. Remember what has happened to premiums since ACA was implemented. All these people were not covered without a cost. That cost comes out of the pockets of everyone else in the exchanges. While much harder to see, and much less heart-wrenching in a soundbite or a video or a tweet, those costs did make a difference.

Adding a few hundred dollars a month to health premiums can mean the difference between eating terrible food and eating healthy, not working out and a gym membership, scrimping and stressing over every dollar and rationing essentials which adds mental and physical health costs, or a budget that more comfortably covers your fixed expenses.

More severely, higher premiums for lower-quality policies may mean that some people who may have formerly been able to afford some form of insurance now are going without, causing exactly the sort of problem ACA was supposed to fix. To act like the days, weeks, months, and years taken off the lives of some people due to the costs ACA imposes to help others is without consequence is sadly mistaken.

When Compassion Is Cruel

Those realities aren’t purely speculative, either. Rates are rising year over year. Even with rising subsidies, the plans get more expensive to both buyers and the taxpayers. And there is no sign these rising rates will abate, as more people for whom insurance has a marginal value will choose to go without, leaving a sicker pool, causing not only rates to rise but insurance companies to lose more and more money on these policies.

That leads to insurers dropping out of markets entirely. This is why doing it the “compassionate” way has not only costs for people whose rates will rise, but also costs for those this is supposed to help, as this adverse selection will result in many of them also having no insurance options. Guaranteed issue and community rating do very little good if no one is willing to sell policies because the cost risk is too high.

That is why, whichever way you lean politically, both the ACA and AHCA seem to be just a band-aid. Neither are sustainable, needing significant federal money pumped into them to survive. ACA will need it to subsidize the cost of policies to get healthy people to sign up while also subsidizing the losses insurance companies suffer in an effort to keep them on the exchanges when they don’t.

AHCA will need massive continued subsidies to fund high-risk pools, all as health-care gets more individualized and potentially more expensive. This is in addition to the increasing burden Medicare will put on state and federal budgets as baby boomers retire and live to a ripe old age, while higher birth rates among poorer Americans, in addition to ACA expansion, should cause a massive increase in Medicaid spending.

This is why any comprehensive health insurance reform is doomed to fail. Americans want great quality care at cheap prices that is abundantly available. At best, we can get two of those three. At worst, we get very expensive plans that provide very little real health care for the most vulnerable while making things worse for everyone else. That is why our efforts should focus on ways to provide better health care for everyone, increasing the size of the pie of good-quality, available health care rather than locking in the worst parts of our current system and merely fighting about who should pay for them.

crisis, culture, economics, government, health care, legislation, nanny state, public policy, reform, regulation, spending, tragedy, unintended consequences

Confusion between care and insurance guarantees costs will rise

original article: When Replacing ObamaCare, Remember Health Insurance Isn’t Health Care
March 7, 2017 by WILLIAM M BRIGGS

Big Louie whispers to you, “Say, Mac. The fix is in. The Redskins are throwing it to the Browns. It’s all set. Guaranteed.”

“No, kiddin’, Louie?”

“I’m tellin’ ya. Now listen. I want you to bet me the Skins win.”

“Wha…? But you just told me ….”

“You aren’t paying attention. What’s wrong with you, Mac? You want trouble? I said the Skins will lose and you will bet they’re going to win. Now gimme sixty bucks that says the Skins will win.”

“Hey! You don’t have to be so rough …”

“Say, these twenties are new! Considerate of you. Listen. Don’t be so glum. You’re contributing to a good cause: me.”

Flawed anthropology leads to flawed economics

original article: We’re all Dead: How J.M. Keynes – And His Critics – Went Wrong
June 29, 2016 by Liz Crandell

“Critics of John Maynard Keynes were so determined his economics were wrong that they allowed Keynes to dictate the terms of the debate,” says Victor Claar, professor of economics at Henderson State University, in his Acton University lecture. He continues to describe Keynes flawed anthropology with respect to classical economists and the Great Depression. Key observations of human nature include the principles of work, property, exchange, and division of labor. We can survive and prosper, take ownership of our work, support and rely on each other through exchange, and specialize in exchange at an opportunity cost. Furthermore, these observations are linked to moral imperatives.

Obamacare Premium Hikes Expected in 2017

original article: Get Ready for Huge Obamacare Premium Hikes in 2017
April 21, 2016 by Eric Painin

Amid rising drug and health care costs and roiling market dynamics, the spokesperson for the nation’s health insurers is predicting substantial increases next year in Obamacare premiums and related costs.

Without venturing a specific percentage increase, Marilyn Tavenner, the president and CEO of America’s Health Insurance Plans (AHIP), said in an interview with Morning Consult that the culmination of market shifts and rising health care costs will force stark increases in health insurance rates in the coming year.

“I’ve been asked, what are the premiums going to look like?” she said. “I don’t know because it also varies by state, market, even within markets. But I think the overall trend is going to be higher than we saw previous years. That’s my big prediction.”

If Tavenner is right, Obamacare will jump dramatically—last year’s premium for the popular silver-level plan surged 11 percent on average. Although Tavenner didn’t mention deductibles, in 2016, some states saw jumps of 76 percent, while the average for a 27-year-old male on a silver plan was 8 percent.

The warning to consumers from Tavenner, the former administration official who headed the Center for Medicare and Medicaid Services (CMS) and oversaw the disastrous launch of HealthCare.gov, the Obamacare website, comes at a time of growing uncertainty about the evolving makeup of the Obamacare health insurance market. With many insurers struggling to find profitability in the program, the collapse of nearly half of the 23 Obamacare insurance co-ops and this week’s announcement that giant UnitedHealth Group intends to pull out of most Obamacare markets across the country, anticipating future premiums and copayments is largely risky guesswork.

https://w.graphiq.com/w/AeuX4gyiI5?wmode=transparent

Type of Plan Selected Among Those Enrolled in an Obamacare Marketplace Plan | HealthGrove

Premiums for the current 2016 season rose on average by 8 percent over the previous year, with 12.7 million Americans enrolling for coverage and government subsidies, according to CMS. Federal officials stress that the average rate doesn’t tell the whole story, and that in many cases after consumers shop around for the best price and government subsidies are applied, the actual premium increase is lower.

The Department of Health and Human Services did a study looking at what consumers were estimated to pay based on initial filings compared to what they actually paid. The study found that last year, the average cost of Obamacare marketplace coverage for people receiving tax credits went from $102 a month to $106 per month, a 4 percent change — despite warning from some of double-digit hikes.

Tavenner’s prediction may well be an opening gambit in the negotiations between the industry and insurance regulators about the 2017 premiums. As Morning Consult noted, many insurers have begun submitting opening bids on raising their premium rates and copayments, which will then be reviewed by the government and finalized this fall.

With a major presidential and congressional election looming this fall, the administration is doing all that it can to tamp down fears of major hikes next year in Obamacare insurance premiums and related out-of-pocket costs. Benjamin Wakana, a Department of Health and Human Services spokesperson, said on Thursday that changes in health care insurance rates are “not a reliable indicator” of what typical consumers on average will pay. “Marketplace consumers would do well to put little stock in those initial numbers,” he said in an email.

But Tavenner outlined several factors that she could put considerable pressure on premium prices next year. Those include:

• A general rise in the nation’s health care tab. Overall, U.S. health care spending grew by 5.3 percent in 2014 – reaching an historic level of $3 trillion, after years of relative cost stability. Medical costs rise from year to year and will certainly affect the next round of premium hikes.
• Soaring prescription drug prices. Insurers as well as government health care programs have been struggling to keep pace with rising drug prices, especially newer specialty drugs to treat the Hepatitis-C virus and cancer. Pfizer Inc., Amgen Inc., Allergan PLC and other companies have raised U.S. prices for scores of branded drugs since late December, with many of the increases between 9 percent and 10 percent, according to the Wall Street Journal .

• The combination of market forces and limitations imposed by the Affordable Care Act will put enormous pressure on insurers to up their premiums. Under the law, there is a cap on insurers’ profits, companies are obliged to insure anyone regardless of their general health or pre-existing conditions, and the insurance plans must be structured in a certain way that often lead to losses.
• Finally, two of three federal “risk mitigation” programs created under Obamacare are due to expire in 2017. Those programs were set up to protect insurers from huge, unexpected losses from providing health insurance on the Obamacare exchanges. UnitedHealth and other major insurers have found it difficult to accurately anticipate their costs in providing coverage to sicker or older Americans, and set premiums that were inadequate to cover their risks. Without those programs to fall back on, many companies likely will seek to jack up their premiums.

“It’s kind of a myriad of factors,” Tavenner said in predicting rising premium costs. “It’s not one factor.”

Clare Krusing, director of communications for AHIP, said in an interview on Thursday that health insurance companies “are working through” these factors right now in setting rates for the coming year and deciding whether to participate.

“Plans are just beginning to file their rates, and it’s a long process with state and federal regulators, until those are approved,” she added. “Certainly plans are going to evaluate market conditions and regulatory approvals, and that will all impact their participation overall” in Obamacare.

bureaucracy, crisis, economics, government, health care, legislation, medicine, nanny state, public policy, reform, tragedy, unintended consequences