Source of Obamacare Woes: Economic Ignorance

It seems that every day new revelations emerge regarding the Affordable Care Act (ACA).  Supporters of the ACA are now starting to distance themselves from it as we hear reports of insurance companies dropping subscribers, households subscribing on the exchanges in unexpectedly low numbers and insurance costs higher than promised. Even the liberal New York Times ran an op-ed piece entitled “Obamacare, Failing Ahead of Schedule.”  Earlier this week President Obama vowed that, “I’ve run my last political campaign, but I’ve got one more campaign in me and that’s making sure that this [APA] law works.” The goal of the ACA, according to the White House’s website, is that it puts into place “comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices.”

Why this apparent disconnect between the law’s intentions and how it is actually playing out in recent months? Let’s take a step back and look at some basic indisputable facts.  Any introductory economics textbook will tell you that it is a fact of life that resources are limited.  There are only so many physicians, clinics, MRI machines, and other health care assets available at any given time.  Genesis 3:17-19 indicates that scarcity is a condition of our fallen humanity. No government can legislate it away any more than King Canute could order the tide to stop coming on the shores of England.  The only two ways to mitigate the scarcity (but not eliminate it) are to increase the supply of these resources over a period of time or to use existing health care resources more efficiently.

Health and Human Services Secretary Kathleen Sebelius states that the basic economic goals are increased access to health care and reduced costs while at the same time maintaining quality.  Increased access includes using the existing health care resources to meet the new demand from the newly insured.  This places a greater burden on the health care system and leads to higher costs.  Pushing down one end of the seesaw simply makes the other end go up.  The reform shifts the responsibility of bearing the costs from one person to another. That is why the individual mandate that everyone must have coverage or be fined is a lynchpin to the entire program.  It needs the contributions of healthy individuals who use few medical services to keep the insurance fund solvent. By the way, this approach relies on demand-side economics, where health care usage is increased in the hopes that supply will respond.  However, the reform does little to encourage a greater supply to come forth. Elementary economics demonstrates that reliance on the demand side to fix problems always leads to higher prices. Given the reality of scarce resources and cost shifting, are the headline news of increased insurance premiums for many surprising?

In fact, instead of increasing the availability of medical services, Obama’s policies threaten to make them less accessible. According to the Catholic Health Association of America, about 13 percent of nonfederal short-term hospitals are Catholic institutions. The US bishops went on record that they will not comply with the HHS contraception mandate and if Catholic health institutions follow their lead then the loss of these facilities as the IRS fines them out of existence would place an even greater stress on the remaining health care resources.  Again, simple supply and demand indicates that costs must rise under Obama’s program.

What about the promised cost efficiencies to lower costs?  Our first indication of efficiencies under the new system—the issues with the federal health care website in spite of the fact that private companies have successfully used the technology for years—is not encouraging.  The British experience of socialized medicine is instructive here.  One of the lessons that came from the National Health Services is summed up in “Gammon’s Law.”  As Dr. Max Gammon explains it, when researching the NHS he discovered that the growth of a bureaucracy “involves the progressive displacement of productive activity by non-productive and often counterproductive bureaucratic activity.”  It is important to note that he draws a distinction between administering a program, which is guiding and facilitating it, and bureaucracy, which is implementing rigid rules that stifle individual initiative.

Perhaps more than any other pope, John Paul II understood bureaucracies and inefficiencies since he suffered through decades of communist rule.  His teaching on human dignity and its connection to work and productivity are relevant here.   The Genesis account of the fall indicates that the call to creativity still exists even as we struggle against the natural world.

Using language echoing Gammon’s Law he warned that the welfare state, “… leads to a loss of human energies and an inordinate increase of public agencies, which are dominated more by bureaucratic ways of thinking than by concern for serving their clients, and which are accompanied by an enormous increase in spending” (CA, 48).

In contrast, economic freedom and a market properly oriented toward the common good would allow workers to respond to the call to creativity and produce new resources and wealth.  By mandating the terms of the insurance contracts the ACA hampers the free exchange between subscribers and insurance companies.  This reduces the incentive for companies to sell products that best meet the needs of the insured.  As John Paul puts it, individual initiative in the market encourages “the ability to foresee both the needs of others and the combinations of productive factors most adapted to satisfying those needs that constitutes another important source of wealth in modern society” (CA, 32).

The Church presents a very different view of the nature of the human person and of economic reality than is assumed in the ACA.  The Act is based on the premise that the solution to problems of health care access is to slice the proverbial pie of a fixed size differently so that some will receive more.  Because of limited resources this implies that others will receive less.  The increased bureaucracies, stifling of creativity in addressing problems, and the loss of religious health care institutions would shrink the pie over time.

In contrast to the ACA’s static perspective the Church offers a more dynamic understanding of the economy.  God gave us the dignity to reflect His infinite creativity.  We have the intelligence to live out the call to create new goods and services, including those needed for health care.  In other words, made in God’s image we have the ability to increase the size of the pie.  The historical evidence is on the Church’s side when we look at the tremendous growth of market-based economies over the past few centuries.  President Obama will probably run one more campaign to make the ACA law work.  However, even the president of the United States cannot stop the tide from coming in.

Emil B. Berendt

By

Emil B. Berendt is Assistant Professor of Economics in the Business School at Mount St. Mary's University in Emmitsburg, Maryland. He earned his doctorate in economics at City University of New York.

  • Bob

    The Affordable Care Act is going to need a far great number of physicians over the next decade. From a CBS news website:

    “Right now, there is already a shortage of 20,000 doctors nationwide, and with healthcare expansion, plus increasing population, there will be a need for about 52,000 primary care doctors by 2025.”

    The problem will be exacerbated by the fact physician salaries are dropping (some projections are that doctor pay will drop by 16% in 2014.) And medical school costs continue to steadily rise. Many physicians are already discussing early retirement. Where (and how) are we going to get 52,000 top academic students to enter the medical field for a life of six figure med school debt, mediocre pay and 50 patient a day workloads?

    • tom mcmorrow

      Doctors can be brought into this scheme from China, Pakistan, India and the Caribbean by the millions.

      • Lee Anne Bruce

        But what does that do to the people who live in those countries?

  • Ford Oxaal

    The road to hell is paved with good intentions, and in this case, the unwillingness of the Obama people to listen to the other sides of this issue. No, the stupid, big, dumb communist way is the best way, they think. In defense of people wanting to change the system, their are a lot of jokers in the deck (big money, big lobbyists). Anyway, it seems to me and others, maybe in part Obama, that the very notion of “health insurance” is an idea doomed to failure, because unlike in the case of fire insurance, the thing being insured is nebulous, and not always desired. Fire safety is almost always highly desired. “Health” is not always truly desired — let’s face it, people like their potato chips and soda and television — they — we — like to play with matches — all the time. We like eating, even at the expense of becoming overweight. So at one end of health insurance are the clients who regularly abuse the system by starting fires on a regular basis. At the other end are the people who regularly enable the firestarters by prescribing whatever expensive tests and medications their clients need to maintain their chosen ‘lifestyle’. The guy in the middle, the insurance guy, laughs all the way to the bank. So why not a voucher system everyone pays into through tax, with 20% cash back each year for not using the system? You build up credits if you are healthy, and you enjoy some of the credits in this life in the form of cash back. When you die, your credits go into the pool. Every *citizen* gets catastrophic. Nobody gets cadillac from an American company — necessary to keep the jokers out of the deck (health “insurance” becomes illegal). In a certain number of years, everyone is on cadillac because the system spirals upward. I guarantee that somewhere in this country, their lurk the people who could tune a system like this to be fabulously successful. There could be charitable donation of credits to people who are out of credits using Internet, fine grain “voting” technology. Maybe the Obama plan just clears some of the bigger jokers from the deck.

    • LarryCicero

      So you want to replace “the guy in the middle” with a government bureaucrat?

      • Ford Oxaal

        No, you pay “cash” for what you get. Guy in the middle is gone.

        • LarryCicero

          “So why not a voucher system everyone pays into through a tax”- who is going to be the administrators? Is not what you are suggesting already available in what is called a HSA, only that you want it to be government that runs the program?

          • Ford Oxaal

            (The government already runs anything having to do with money in case you hadn’t noticed!) I’m saying build in normal market competition — a system where I can shop for the best value “imaging” service, for example — I can do this as a taxable citizen, not as an employee, not as someone enrolled in some plan. Now, I have some freedom back — some corporate drill thrall cannot hold me hostage to my insurance plan. The government’s role would be to back up the “currency” like they do now. So completely decouple the health services industry from your employer or from any insurer. Take those two layers out. Let health commerce flow. The subsidy would be the same for all citizens — no needs testing. If any group of Senators “raids the pool” they commit a treasonous act and are hung.

            • LarryCicero

              In S5000A and elsewhere, Congress called the exaction a penalty- eighteen times- but if it is a tax, then what kind of tax is it? From the dissent: “[Is] this a direct tax that must be apportioned among the states according to their population[?]”

              “The subsidy would be the same for all citizens-no needs testing.” How can the subsidy be the same? Do you mean the tax? Would not the subsidy be the benefits received?

              Could decoupling from the employer be achieved by making the benefits taxable? We do not have employers insuring our homes and cars. If you wish to be rid of insurers, then you would have the patient negotiating prices directly, no middle man, and so each individual would assume the risk; Self insurance. I understand your position as making the government the middle man- the insurance man you can trust- because as you imply, the man laughing his way to the bank is guilty of greed, but the government bureaucrat is benevolent. And so you advocate a single-payer system?

              • Ford Oxaal

                What I mean on the subsidy/voucher is that you get the same credits as everyone else who is a taxable citizen, including congressmen. No privilege for the poor, no privilege for the rich — we are all in the same boat here. If you don’t use those vouchers, you get cash back up to [some percentage that works in practice as a balanced incentive without jeopardizing the pool — maybe it self adjusts] of the ones that are unused. That means you aren’t crying sick every time you feel an old age pain, or get a tick, or have an ear ache. And if you need some antibiotics, you find a clinic that affirms your hunch, and pay your $20. And it means there is competition all the way down the line. The rest of the vouchers you don’t use ACCRUE TO YOU FOR LIFE. Also you can donate a portion of your vouchers to whom you will — charitable networks would spring up. When you die, the unused vouchers go into the national pool.

                Yes, in a sense it is a form subsidized, generational self-insurance. The marketplace does the negotiating. Costs would go to a tenth of what they are now. But the government would have no part of the system except tax and refund — they would not make any decisions — their role would be strictly ministerial. Facebook like system could be used to rate providers by voting up or down, and distribute contributed vouchers.

        • Adam__Baum

          The growth of health insurance started when employers began offering it on a widespread basis to escape the wage and price controls of World War II.

          After the war, the IRS began imputing income on the value of employer paid premiums, but there was a bit of a revolt, and with the 1954 recodification of the Internal Revenue code, the Congress installed an unlimited exemption income tax (while maintaining employer deductibility). It still exists in Title 26, as Section 106.

          http://www.law.cornell.edu/uscode/text/26/106

          and with the high prevailing marginal tax rates of the day, there was a strong tax-preference for employer paid premiums over cash wages.

          There is also a problem is that there are seven requirements for what constitutes an “insurable event” and health insurance fails on several counts, most importantly, that the loss is a contingency, that it is outside the control of the insured and it is definite in amount, time and place.

          • Art Deco

            Health and life insurance differ systematically from property and casualty insurance, but you can still produce actuarially sound policies. The trouble is that insurance has been confounded with pre-paid services, covering banal expenditures at the discretion of the patient and covering things that it would be dubious to refer to as medical care. Pricing is so opaque that it cannot function as an allocative device at all.

            • Adam__Baum

              “covering banal expenditures at the discretion of the patient and covering things that it would be dubious to refer to as medical care.”
              Also known as “trading dollars”, and where a good deal of diisorder enters the system. I didn’t mean to imply that the lacking elements of “insurable events” were fatal defects. It does however complicate design and administration.
              The biggest problem is that so much expenditure is paid by a third party and it’s always easy to spend OPM.

          • LarryCicero

            Adam, how is a tax on not obtaining insurance a “taxable event”? When the “tax” is exacted do you think someone could challenge the exaction based on the type of tax being a direct tax, that is prohibited by the constitution?

            • Adam__Baum

              All I have is this:

              The is an old Latin expression:

              Judex est lex loquens: (The judge speaks the law)

              There is no rational explanation for John Roberts’ aspiration to be regarded in history with Roger Taney, but I think the implicit threats issued by the President and Senator Leahy had some bearing. He was clearly compromised in appearance, if not in fact. He knew he lose a streetfight with a guy who once made a quip about the proper response to a knife fight being to bring a gun.

              As I understand it, the Constitution authorized very limited taxation. (the proportion and enumeration types) The 16th Amendment, authorized taxes on “income” from whatever source derived, and Section 61 of the IRC defines everything as income, unless specifically excluded. How a “tax” that is conditioned on not making a purchase fits these, is beyond me.

              http://www.law.cornell.edu/uscode/text/26/61

              If we stipulate that Roberts is correct (and not just engaging in creative wordsmithing to cower to the executive and legislative branches of government), and that this is in fact a properly enacted tax, then Obamacare still should have been rejected for having started in the Senate, rather than the House.

              This exactly one of those cases that causes me to hold the judiciary and the law in such contempt. I really get tired of lawyers and judges telling me the sky is green and that I don’t have a proper understanding of the deeper meaning of verdant hues.

              • LarryCicero

                Abraham Lincoln argued that what mattered was the nature of the thing. That a slave was different than hogs or cattle and could not be thought of in the same manner- thus slaves were people and could not be property.

                There is no “event” to tax. It fails in every way to try to call a penalty a tax. But, if the court has deemed it a tax, that does not mean they gave consideration to the type of tax it is. I think Justice Roberts just said they have the power to tax, but did not consider the nature of the tax. Yes, I think Roberts will be remembered much as Taney.

                • Adam__Baum

                  One point of contention. Income taxes aren’t conditioned on any event, including receipt, thanks to the “constructive receipt” doctrine. One of the first “tax dodges” was to deposit money into an irrevocable account created for the sole benefit of the recipient.

                  • LarryCicero

                    I don’t follow. Is there not an event, when there is a transfer? I work, employer cuts a check. There is your event. What, if you excuse me for not looking it up, is constructive receipt?

                  • LarryCicero

                    I looked it up. That the transfer has not been completed, but the funds were available to the recipient who chose to forgo receiving them to dodge the tax during a tax period does not mean an event has not occurred. The funds being made available is still an event.

                    • Adam__Baum

                      In reviewing what I wrote, It was defective. I should have qualified my use of the term event and I see what you were inquiring about and answered now.

  • Adam__Baum

    Obamacare is the ultimate evolution of Ropke’s “Cult of the Colossal” .
    http://www.theamericanconservative.com/repository/the-cult-of-the-colossal/

    Ironically, Ropke feuded with Hayek, who also had an insight about massive central control.

    The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design.
    -F.A. Hayek, The Fatal Conceit

    The only question is whether or not is was an exercise in hubris or deceptive method to overwhelm the existing system, create chaos and disorder using the despicable Cloward-Piven strategy.

    http://en.wikipedia.org/wiki/Cloward%E2%80%93Piven_strategy

    • Patsy Koenig

      Answer: It was deliberate. I saw numerous videos of Obama and other high-ranking govt. officials, filmed prior to the health care debate, stating their goal was a One Payer System. They definitely knew that ObamaCare is a Trojan Horse.

      • Art Deco

        That may be an ultimate goal but not their interim goal. I think you impute too much foresight to the president. The man is a performer, not a planner or administrator.

        • Adam__Baum

          But he is a schemer.

  • NE-Catholic

    Thank you, Professor Berendt for identifying that the problem with 0bamacare lies in its violation of the most basic principles of economics (and good sense.) There is, however, another aspect – 0bama proudly asserts he will launch a ‘campaign’ to fix it. His statements make clear that it will be a politically-based ‘ideological’ campaign not one focused on actually doing something constructive. He lacks the will, skill, talent, insight and experience to do anything else. His ideological co-conspirators will happily follow him down that path and continue to waste billions of taxpayer dollars to further degrade both the American economy and the healthcaer system. In addition to vast amount wasted on building the failed sign-up system, the latest news reports that $2 BILLIONS of taxpayer dollars have disappeared as unsecured ‘loans’ to groups to set up healthcare ‘co-ops’. The whole program is a cesspool of waste, corruption and political cronyism. Thanks to 0bama and those paragons of ‘Catholic’ virtue, HHS Secretary Katherine Sebelius, Nancy Pelosi, Senator Jean Shaheen, etc., etc.

  • Patsy Koenig

    The real problem is the rediculous cost of medical care; which neccessitates socialistic medical insurance, a.k.a. racketeering. The government gave the AMA a monopoly over medical care; and like every monopolist, they abused it: driving Midwives out of child birthing; making it illegal to give free medical advice without a worthless medical degree; the AMA controls what doctors can and cannot do; doctors are over-educated and under-trained; they get paid big bucks for doing nothing or for making patients sicker; most doctors supress natural remedies; and the FDA is a criminal enterprise. The government control over medicine, through the AMA and FDA, is the cause of the medical care crisis; and more government control will only make it worse.

    • Art Deco

      I do not think medical degrees are ‘worthless’ and the continuous escalation in the share of domestic product devoted to medical care post-dates the foundation of medical schools in this country by about 170 years and the foundation of the American Medical Association by just short of a century.

      • Adam__Baum

        MD’s are not worthless, but in the future, we are likely to have fewer encounters with licensed physicians, you are more likely to see a PA (Physician’s Assistant) or CNRP (Certified Registered Nurse Practioner) operating under the supervision of a Doctor. This has been happening for some time, even prior to Obamacare.

        This leads to the question: Have the requirements to obtain the degree and the license been in the interest of the patient or the profession. If they are essential, why can others engage in diagnosis and treatment?
        There’s also an interesting difference between MD’s and DO’s, and MD’s were very hostile to Doctors of Osteopathy at one time.

        http://en.wikipedia.org/wiki/Osteopathic_medicine_in_the_United_States

  • Watosh

    Prof. Bennet notes that the contributions of healthy individuals who use few medical services to keep the insurance fund solvent. Precisely, that is the essence of all insurance after all. No the young generally do not need the medical care that the old require, so the argument is why make them pay into the system. Well, in case anyone hasn’t noticed the young eventually get old, in which case they will then benefit.

    Don’t get me wrong Obamacare is a horrible bill, even if it did not require payment for services that we Catholics object to. Hey it was designed by a Republican, Conservative think tank, The Heritage foundation a few years back in order to derail Democrat health care plans, and of course it was first implemented by a Republican Governor, Mitt Romney, in Massachusetts, so what can expect of such a plan. The Obamacare version was largely written by the health care insurance industry and big pharma. By the way the administrative costs of administering medicare, is much, much less than the administrative costs of private health care insurers.

    Then their is the lament, “I don’t want the government to tell me what medical care I can receive.” Those who make this complaint seem oblivious to the fact that private health insurance companies have always told their insurers what medical treatment the health insurance company would pay for. And since the CEO’s and the top management of private insurance companies are paid for increasing the profitability of the private health insurers, they have an incentive to deny health care coverage to their subscribers. That is an economic fact.

    Again Obamacare is terrible. The Republicans were stupid to shut down the government and by so doing distract attention from the mess that the opening of Obamacare was. Actually Obamacare is a gift for the Republicans as it will probably bring them a lot of votes as time goes on and the dissatisfaction grows. The only good thing about it is that it might result in the defeat of Hillary Clinton whom the Democrats are grooming to run for President. The bad news is that this means a Republican will become President.

    Now if anyone wants to learn something about economics, I recommend John C. Medaille’s fine book “Toward a Truly Free Market,” based on Catholic economic teaching.

    • Art Deco

      Hey it was designed by a Republican, Conservative think tank, The
      Heritage foundation a few years back in order to derail Democrat health
      care plans, and of course it was first implemented by a Republican
      Governor, Mitt Romney, in Massachusetts, so what can expect of such a
      plan.

      No, the Heritage Foundation floated some position papers over the period running from 1987 to 1994 by an analyst named Stuart Butler which included individual mandates. We are talking about a sketch a few pages long, not a meticulously designed ‘plan’, much less a finished piece of legislation.

      http://www.heritage.org/about/staff/b/stuart-butler

      As for Gov. Romney, he faced a situation which had two salient features: 1) he had to work with a Democratic legislature which had been responsible for the evolution of the Massachusetts market in health care finance; and 2) the market for household medical insurance was in the process of imploding because of state mandates and perverse incentives incorporated into the law. Romney’s reforms rendered that market more respective of incentives and choice, not less. Working politicians often do not get to choose their starting square.

    • Adam__Baum

      “Precisely, that is the essence of all insurance after all. ”

      Not quite. You pay a premium which reflects the aggregate risk your particular cohort (a group of similarly situated individuals) incurs.

      Just as it’s not fair to charge the understandably high premiums that are required to service a cohort of inexperienced 16 y.o. male drivers driving a modified “pocket-riocket” to an experienced 40 y.o., married female driving a modest midsize, unmodified sedan, you can’t stick 25 year olds with the premiums required to service 75 year olds.

  • slainte

    The nexus between the actual market value of a service provided to a patient by a doctor/hospital and the illness treated has been skewed by years of governmental intervention, legislative mandates, and subsidies.
    A friend some years ago had a gall bladder removed; a simple, routine procedure with no complications performed with some form of laser that spared him from actual surgery…..cost billed to his insurance company $30,000.
    There is a disconnect between the actual market value of the service (its complexity), the time value of the doctor, the actual cost to the hospital, and what is actually billed the patient and/or his insurer. Services provided should be aligned with actual provider fees and costs using the competitive markerplace.

  • hombre111

    I demand my right to medical care that costs two to three to four times more than the same care in other countries like Canada and in Europe, and leaves millions upon millions without any care except an emergency room. It is truly right and just that the biggest cause of American bankruptcy is a catastrophic health bill. Yes, my fellow Americans, this should be the ideal for all!

    • Adam__Baum
      • LarryCicero

        I am reminded of a story, if I remember it right, where a community had a fee for the fire department. If you didn’t pay it they would not put out the fire if your house was burning. We don’t have complaints about people being refused treatment, but about not being able to afford it. If you demand that a doctor work without payment, that you have a right to his labor, are you not violating his natural right to the fruit of his labor? Should the fire department all be volunteer? And what about those who built the firetruck? The water to put out the fire? The next thing you know, some bishop somewhere will be demanding that water should be free because it is a gift from God. Oh, we heard that, never mind.

      • hombre111

        I lived under Canadian healthcare for six months. See Watosh, below, for the best reply to this whole discussion.

        • Adam__Baum

          Great, you’ll know how to go back.

        • me

          I lived under British healthcare for 4 years. Disgusting to say the least. Do you know that more British women die of breast cancer than any other country in Europe, even Eastern Europe? That’s because they don’t have access to mammograms until they turn 60 years old… Ain’t that great.

    • Bob

      All the top medical device and pharma/biotech research, innovation, and clinical development done in the world is done in the United States. All the major upfront costs of these miracle cures and inventions are born by US academic centers and companies. The world benefits from our incredible inventions. Because Europe and Canadaian healthcare systems put a cap on costs (and they cap and ration treatment for patients) they negotiable lower prices from US pharma/device/biotech companies. Therefore, the brunt of research and development costs is passed on to the open markets of the US.

      But make no mistake; Canada and Europe cap costs and ration healthcare. You get what you pay for in life. You want cheap healthcare, you’ll get cheap healthcare. You’ll get a generic med, when you need brand. You won’t get surgery from the Harvard med grad, you’ll have surgery from the Med School of Ghana. . An example I see is Roswell Cancer Center, a top cancer center in Buffalo. Take a drive through the hospital’s parking garage and notice all the Canadian license plates. Whe Canadians get cancer, they go south of the border because they’d like to live longer and know where to get the best cancer care.

      So tossing out ridiculous, uneducated sarcasm only makes you

      • hombre111

        I strongly doubt American medicine is more costly because of all the research. American medicine is more costly because big pharma is allowed to charge what the market will bear.
        When Canadians get cancer and can afford it, they sometimes go south of the border. Like any system, Canadian medicine has its limitations. But they live longer than we do and have healthier lives. The same is true in Europe.

        • Adam__Baum

          Then again, your doubts aren’t founded on anything other than your distorted statist lens. Having doubts based on that, and no experience or education in the matter is just ignorant cynicism.

    • Bob

      And make noooooo doubt, hombre111, rationing is coming with the Affordable Care Act, see the Forbes article below. The article mentions medical care rationing and cost containment as a fact for the British healthcare system. If you require major cancer care or heart surgery in the next several years hombre, under the ACA you’ll be treated statistically from a spreadsheet. Instead of bypass surgery, you’ll get a stent. Instead of starting your cancer treatment with the latest VEGf inhibitor, you’ll get the older med that costs less and is less effective and has greater side effects:
      http://www.forbes.com/sites/paulhsieh/2012/10/03/get-ready-for-obamacares-medical-rationing/

      • hombre111

        As I noted above, rationing of medical care is already a fact of life if you are poor. Met a despairing woman whose uterus was dropping out of her body cavity. Too young for medicare, she had no insurance. The doctors demanded the thousands of dollars it would take up front. Got into touch with my personal charity sources, including St. Vincent DePaul and the Knights of Columbus. We finally worked it out. But lots of others are in her shoes, without hope and without help. But then, the poor are invisible, their current desperation doesn’t count. I agree, Obama Care, which tried to bow to private enterprise, is a mess. What we really need is a single payer system modeled after Canada and Europe.

        • Bob

          And the single payer system will tell the ill 65 year old “your medical care expense is reaching its maximum. Our actuary tables tell us you only have two years to live, and you’re expensive so we’re cutting you off. Goodbye.”

        • Adam__Baum

          You can keep repeating the lie that care is being rationed for the poor, but it is not. Having been a part of the MA fiscal apparatus I’ve forgotten more about this subject than you will ever know.

          Where it is being rationed, although not explicitly is among the elderly.

          Last year my, almost centenerian grandmother reached the end of what was for the most part, a long and vital race. After a fall and hospitalization, her previously mild dementia accelerated and she exhibited a common symptom of it, refusing to eat. She lost 25 pounds in six weeks, and having been moved to a nusing home, I asked the staff what they proposed to do about the weight loss. One nurse responded “you could get a feeding tube, but that would just prolong the inevitable”. I decided that to avoid any potential ramifications to my grandmother, I’d pass on my initial impulse, which was to say “you don’t look like you miss many meals, why should she?”.

          You can bet that the IPAD will make those decisions in the future by issuing binding treatment protocols and an aggressive, informed and vigilant grandson will be of now value. The aged and infirmwill run a version of Logan’s Run, so the state can direct resources to min richer veins of electoral gold.

    • Bob

      The year is 2017, Dr. Sally Smith, oncologist: “We’ll, Mr. Hombre111, we’ve got sad news to inform you that you have progressive small cel lung cancer that has metastacized. Interestingly, there is a brand new TKI on the market that can give you a 90% chance of a cure and living another 30 years. But we inputted your vital statistics (age, current healthcare costs and burdens, salary) into our ACA calculator and looks like you only qualify for 50 year old, inexpensive methotrexate, which will give you a 30% chance of living another 3 years with many side effects. You’ve lived long enough, don’t you think Mr. Hombre111? So go have a nice weekend and we’ll get ya started on methotrexate on Monday!”

      • hombre111

        This kind of rationing is already happening. If you are poor and can’t afford insurance, many a doctor will demand the money up front. Start planning a funeral.

        • Bob

          A Catholic hospital by its very decree does not turn away the poor.

          But the rationing, utilitarian ACA will deliver different cancer care to the 65 year old versus the 30 year old.

        • Adam__Baum

          It is illegal to refuse care in every jurisdiction I am aware of.

        • Deacon Ed Peitler

          You have no idea about the poor’s access to health care. If you did, and have worked in hospitals like my wife and have for a combined 80+ years, you would know that the poor have better access to healthcare than most. And you would see firsthand how the poor know how to work the system. They might even give you a few tips on how to get premier treatment for that hypothetical small cell carcinoma you have.Bob talked about. By the way, i wish you good health.

          • hombre111

            Dear Deacon Ed,
            First, congratulations for working in hospitals. And if the poor, who get to wait for hours upon hours in emergency rooms, get better healthcare than most, you are simply proving Obama’s point. Americans get less after paying much, much more.

            • Adam__Baum

              Better that it’s unavailable to all, instead of of waiting for hours for care, you wait for months or years wondering if you’ll get care or death.

        • Guest

          Which planet?

    • Art Deco

      I demand my right to medical care

      And your right to be free from Sacred Tradition, Sacred Scripture, and the Magisterium; and your right to be free from the authority of your bishop; and your right to abuse your parishioners with Marty Haugen music…

      • hombre111

        Hmm. Ad hominem and apples vs. oranges arguments usually add up to a poor case, when it comes to the issue at hand.

        • Adam__Baum

          It’s not an “ad hominem”. You have a long record of dismissing doctrines you find personally unpalatable. The suspicion of your fidelity to orthodoxy comes from a clear and lengthy public record.

    • therain

      I pray for people like you, misguided and uninformed.

  • tom mcmorrow

    The professor implies this is all incompetence. The costs quintuple, abortions increase, the massive debt doubles in 8 years, the middle class is humbled, the likes of Sebelius define life and death, and a “proletariat” rewarded. The leftist noose is tightening. Everything’s on schedule. Huzzahs for the Democratic Party.

  • WRBaker

    It seems obvious that the old “New Math” now reigns supreme!

  • nick2001

    I have a hard time understanding how reliance on pure market forces will work when it comes to health care. Certainly, no one could blame insurance companies for refusing to cover older, sicker (or even younger and sicker) applicants when it might curtail their bottom line. If left to pure market forces, no one except for the healthy would be welcome to the insurance market at reasonable prices.
    Health insurance is not the same as property insurance. We generally have ways to become safer drivers, build better and safer homes, etc. However, when it comes to our health, we are often at the mercy of indifferent forces. I know we can all eat better and exercise more. But even then we are still at risk of accidents or genetic diseases. No one disputes that infants are born with all kinds of medical defects and abnormalities. If given a choice, would any for-profit insurance company take on a newborn with congenital defects?
    If insurance is an answer, it must be paid by all and it probably requires a single-payer system where profit is taken out of the picture. Insurance only works when the pool is large and everyone needs to pay into the system. Insurance for medical needs is different from every other type of insurance where we have a higher level of control over the risk of loss.
    If insurance is not the answer, there will be many individuals who cannot pay–even if the price of medical care is normalized to market driven pricing. What is the answer for these folks. Don’t we owe it to each other to share this risk?

    • Art Deco

      Agreed. The provision of medical care, custodial care (of the infirm, the addled and insane, the orphaned), legal services, schooling, and the issue of various natural monopolies and public amenities require supplements of greater or lesser dimension to pure commercial exchange. (So of course our government takes to subsidizing agribusiness, real estate development, extractive industries, grocery purchases, gas and electric service, phone service, and rental housing).

    • Adam__Baum

      “If insurance is an answer, it must be paid by all and it probably requires a single-payer system where profit is taken out of the picture.”.

      You seem not to understand that profit is NEVER taken out of the picture. Have “single payer” system and there will be legions of bureacrats enacting and enforcing petty rules that justify their existence. Worse, they will be able to do so with impunity. That’s the whole point of the idea of Gammon’s law.

      • nick2001

        Profit has nothing to do with bureaucratic inefficiencies. But if you want to look at how a efficiently (or inefficiently) a single payer system works, it may be fair to take a look at administrative costs incurred in the current Medicare system. It is widely recognized that Medicare has lower administrative costs than private insurance plans.
        And let’s remember that single-payer is not the same as socialized medicine. Health providers would not be forced into becoming government employees and a private “gap” insurance market could still thrive–much as it does in the current Medicare system.
        .
        According to the Kaiser Family Foundation (and other respected studies), administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue.

        Insurance industry-funded studies exclude private plans’ marketing costs and profits from their calculation of administrative costs. Even so, Medicare’s overhead is dramatically lower.

        Medicare administrative cost figures include the collection of Medicare taxes, fraud and abuse controls, and building costs.
        And we still need to answer this question–If we operate in a purely market driven system, who will assume the costs of caring for that newborn with congenital abnormalities? How we answer that question may define who we are as a society. Are we in this together as brothers and sisters or is it every man for himself?
        . .

        • Adam__Baum

          “But if you want to look at how a efficiently (or inefficiently) a single payer system works, it may be fair to take a look at administrative costs incurred in the current Medicare system. It is widely recognized that Medicare has lower administrative costs than private insurance plans.”

          I am a former medicare and medicaid auditor, so my understanding of those programs, quite frankly exceeds yours, including the fact that it is designed to be cross-subsidized by commercial plans. Additionally, people over 65 incur patient care costs many times what people under 65 do, so OF COURSE administrative care costs are lower as a percentage.

          “And let’s remember that single-payer is not the same as socialized medicine.”

          Given that “socialized medicine” is something of a nebulous term, it’s difficult to make fixed assertions, however single-payer would be one variant of what is referred to as “socialized medicine”.

          If you want to discuss this after you bone up a bit and get your agoraphobia treated, fine.

          • Benjamin Warren

            Anyone supporting tyrannical medicine is a threat to civil society and ought to be threatened with excommunication immediately. St. Thomas Aquinas condemned tyranny twice, St. Augustine condemned tyranny once, and the natural law condemns it daily on lewrockwell.com. You cannot be Catholic and support any American political movement after about 1865!
            The answer is to completely deregulate medicine, and for the rich and middle class to be paternalistically generous _on their private initiative_. When general physicians are not required to study Shakespeare (or even organic chemistry) medical costs will come way down. Anything else will turn us into Cuba.

  • thebigdog

    One of the biggest problems with ObamaCare is that the left truly believes that the work is done in the classroom and that the real world application is a mere detail.

    Apart from the truth, the greatest asset of conservatism is the complete failure of liberal policies when the are implemented.

  • therain

    It’s sad the liberals are trying to take the best medical care in the world and turn it into the worst, but that’s what they do. They take the good, and hope and change and fundamentally transform it into bad, evil and waste.

  • Shrdlu42

          Hmm, let’s see now, based on your religion you believe “Obamacare” is a false idea that must be ended. So, those of us who don’t share your religion, and believe it’s false, clearly should believe “Obamacare” is fine.

          See the kind of “fun” which arises when you mix Church and State, Religion and Politics!

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