Health

If it Looks Like Redistribution, and Acts Like Redistribution…

Redistribution: “These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking ‘socialized medicine.'”

According to the New York Times, despite best efforts by the Obama administration to argue otherwise, “the redistribution of wealth has always been a central feature of the law and lies at the heart of the insurance market disruptions driving political attacks this fall.”

Agrees Jonathan Gruber, health economist at MIT: “Americans want a fair and fixed insurance market …You cannot have that without some redistribution away from a small number of people.”

The White House sees it differently. White House strategist, David Axelrod: “Widening income inequality has, to some Americans at least, changed the meaning of redistribution. ‘The whole redistribution argument has shifted in the country because there’s a sense that a lot of redistribution has been to the top and not the bottom.'”

Americans Spend More on Healthcare But Get Less

An excellent chart from The Atlantic that highlights the nation’s irrational approach to healthcare spending: “We spend much more than any other rich country, but we certainly don’t get more for it. We get less. …. [In fact,] we spend more than four times as much as the Czech Republic does per persona, and live about just as long.”

“The problem is everybody wants the system to change, but nobody wants their corner of it to change … We can’t afford our healthcare exceptionalism.”

Americans Satisfied with Their Personal Healthcare Coverage

A Gallup “review of recent research on healthcare cost, coverage, and quality reveals that Americans continue to be much more positive about their own personal healthcare situations than about the healthcare situation nationally ….These findings may help explain why the healthcare law has never been highly popular, even before the recent troubles in implementing it; many Americans simply feel that their healthcare situation is fine as it is.”

Gallup summarizes the “five key elements of American public opinion about healthcare”:

1. Americans’ views of their own healthcare coverage are quite positive, and much higher than the ratings they give healthcare coverage in the country more generally.

2. A majority of Americans remain satisfied with the cost of their healthcare — again much higher than their satisfaction with the cost of healthcare more generally across the nation.

3. Americans are quite positive about the quality of healthcare they personally receive. Their ratings of healthcare quality nationally are less positive, but still in majority territory.

4. Most Americans do not believe that the U.S. healthcare system is in crisis, but they do think it has major problems.

5. Americans now view healthcare as the second-most-important problem facing the country.

A Long List of Problems with Obamacare Rollout

White House officials were warned early on that it would be “impossible to open a fully functioning [healthcare] exchange on October 1”, according to a the New York Times investigation. Nevertheless, the warnings were ignored and “Government officials …insisted that Oct. 1 was not negotiable.”

The investigation reveals a number of contributing factors to the troubled rollout of Healthcare.gov:

Unrealistic Goals: “The online exchange was crippled, people involved with building it said in recent interviews, because of a huge gap between the administration’s grand hopes and the practicalities of building a website that could function on opening day.”

Technical Glitches: “An initial assessment identified more than 600 hardware and software defects — ‘the longest list anybody had ever seen,’ one person involved with the project said.” As late as September, “the system failed a test of only 500 simulated users [and] the site was still down more than half the time in mid-October.”

Inexperienced Management: “The president’s signature initiative was effectively left under the day-to-day management of Henry Chao, a 19-year veteran of the Medicare agency with little clout and little formal background in computer science.”

Inexperienced Technical Management: Although CGI was selected as the prime contractor, “the Medicare agency reserved the role of general contractor, or system integrator, for itself, even though it lacked the necessary in-house software engineering resources to handle such a task.”

As “one computer expert with intimate knowledge of the project said, “Literally everyone involved was at fault.”

Two New Obamacare Delays

CNBC reports that the Obama administration has announced that two deadline extensions for the health care reform law.

“One extension gives consumers eight extra days, to Dec. 23, to enroll in Obamacare plans that kick in Jan. 1, and gives them until Dec. 31 to actually start paying for those plans. The other extension delays by one month, to next Nov. 15, the opening of enrollment for insurance beginning in 2015. That extension also will give consumers another week on the back end of that enrollment period, which now will close Jan. 15, instead of Dec. 7.”

“The second extension means that many consumers may not see the premium prices for plans until after congressional elections in early November 2014. But administration officials said the delay will give insurers more time to evaluate their first-ever experience offering coverage on the government-run individual plan exchanges, and set their prices accordingly for the next year to reflect that.”

A Redistribution of Wealth Under Obamacare

James Oliphant contends that Obamacare technical glitches have revealed deeper, more structural problems: “The curtain has been yanked back to expose the ungainly reality that lies at the very heart of the program: Very simply, under the Affordable Care Act, there are winners and there are losers. And there were always going to be. That fact, even more than the star-crossed rollout, may be the more enduring political threat to Obamacare.”

“In the traditional entitlements, just about every taxpayer eventually becomes a “winner,” but under the ACA that may never happen. In that way, the law is more of a direct wealth transfer.”

Politically, the Obama administration can’t admit that the only way for the program to be successful is “that there would need to be a transfer of wealth—from the young to the old, from men to women, from the healthy to the sick. That to raise the floor, you had to lower the ceiling.”

Oliphant warns: “The simple truth is that the Affordable Care Act is, from a certain point of view, either a finely tuned machine whose parts have to work in an almost orchestral fashion for it to produce the wellspring of results that have been promised, or an infernal, jury-rigged contraption that could collapse from the smallest series of stresses.”

How the 'Nuclear Option' Impacts Obamacare

The Senate’s decision to invoke the ‘nuclear option’ has a number of healthcare related implications.

According to National Journal, “the Senate’s rules change will likely make it much easier for President Obama to fill the Independent Payment Advisory Board, or IPAB—a 15-member panel tasked with slowing the growth in Medicare spending.”

“GOP critics oppose the IPAB largely because it puts the power to set Medicare payments in the hands of unelected experts. Supporters say that’s exactly the point: Congress lacks the political will to actually make meaningful cuts …  Obama will likely be able to fill the board and move ahead with one of the most significant cost-control measures in his signature health care law—if he wants to.”

According to Ezra Klein, “one important effect of Thursday’s change in the Senate rules: … It makes it easier for the government to hire good people, and makes it easier for them to fire bad people.”

“That’s not to say any of them will be fired. But the constant use of the filibuster against political appointments made it extraordinarily difficult for the White House to fire anyone because they didn’t know whether they’d be able to appoint a replacement — or, if they could appoint a replacement, who Republicans would actually accept.”

Chart of the Day

— The Council of Economic Advisers has a new report finding that health care spending is growing at the slowest pace on record. This chart shows the average annual growth rate of health spending on private insurance, Medicare, and Medicaid from 2000-2007 (in blue), 2007-2010 (in red), and 2010-2013 (in green).

“The fact that the health cost slowdown has persisted so long even as the economy is recovering, the fact that it is reflected in health care prices – not just utilization or coverage, and the fact that it has also shown up in Medicare – which is more insulated from economic trends, all imply that the current slowdown is the result of more than just the recession and its aftermath.  Rather, the slowdown appears to reflect ‘structural’ changes in the United States health care system.”

What Americans Now Think About Obamacare

Digging into the results from a new Washington Post-ABC News poll about Americans’ reactions to the Obamacare rollout, Scott Clement outlines his top six findings:

  1. Obamacare opposition is rising. It’s now at a record high of 57 percent.
  2. Americans hate the individual insurance mandate. Almost two-thirds oppose this requirement with 53% ‘strongly’ opposing.
  3. Even more say the mandate should be delayed due to Web site problems. 71% say the government should delay health insurance requirements.
  4. But people like the employer insurance mandate. The employer mandate garners 85% from Democrats; 56% from Independents; 29% from Republicans
  5. Obama’s a bad manager, but not a liar. In general, most (56%) say Obama is not a good manager, don’t detect intentional deception (52%).
  6. Can the law be salvaged? Americans are split down the middle at 49% on whether the government can recover from early problems or whether it’s doomed to fail.