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It Isn’t Easy Being Green
December 14, 2012 | 31 comments
The Right Prescription
The Supreme Court May Have Saved Lives
The most underreported story of the summer.
Here’s the most underreported story of the summer. When the Supreme Court ruled on the Affordable Care Act (ObamaCare) it inadvertently liberated millions of people who were going to be forced into Medicaid. Now they will have the opportunity to have private health insurance instead. What difference does that make? It could be the difference between life and death.
A Congressional Budget Office (CBO) report last week said there are 3 million such people. The actual number could be several times that size. But first things first.
Imagine that you are the head of a family of three, struggling to get by on an income, say, of $25,000 a year. You’ve signed up for your employer’s health plan because you want your family to get good health care when they need it. But that takes a big bite out of your paycheck — $250 a month.
When you first heard about the president’s health plan, you heard him say that if you like the plan you’re in you can keep it. That was good news. You also believed the whole point of the reform was to help families like yours get health insurance if for some reason you had to seek insurance on your own.
Now get ready for some surprises. The first will be an announcement that in another year or so your employer’s health plan will no longer be available to you. The reason: plain economics. People at your income level will qualify for as good or better health insurance in a new health insurance exchange. And almost all the premium will be paid for by the federal government. Most people like you would rather have higher wages than a health plan that duplicates what you can get almost for free, your employer will reason. So in order to compete for labor, your company will have to give prospective employees the compensation package they most want. And your employer will be right.
Then there will be a second surprise. Under the new rules, if you are eligible for Medicaid, you can’t get private insurance in the exchange. Further the health reform law is designed to force the states to raise the income level for Medicaid. If your state complies, someone with your income will be eligible for Medicaid and you won’t be allowed in the exchange!
Now if you were a resident alien, the rules are different. Since they don’t generally qualify for Medicaid, immigrant families at your income level can get subsidized private insurance in the exchange. But alas, you’re a citizen. So this option isn’t open to you.
Now let’s say you are under the impression that Medicaid is second rate insurance and you remember that your employer promised to pay more in wages once your health benefit is gone. What about using the higher wages from your employer to buy private insurance outside the exchange?
Now get ready for the third surprise. There isn’t going to be any market for private insurance outside the exchange — at least not for you. The insurance companies are going away. The brokers are going away. The market is going away.
Now for the final surprise. The only option open to you under the Affordable Care Act is Medicaid! Why should you care? Because your initial impression is correct. Medicaid is second rate insurance.
In most places Medicaid patients have a terrible time finding doctors who will see them and facilities that will admit them. That’s why so many of them turn to community health centers and the emergency rooms of safety net hospitals for basic medical care. Medicaid enrollees turn to emergency rooms for their care twice as often as the privately insured and even the uninsured. In fact, if you’re trying to get a primary care appointment, it appears your chances are better if you say you are uninsured.
In the future, things are likely to get worse. Here’s the latest from Kaiser Health News:
Sixteen states impose a monthly limit on the number of drugs Medicaid recipients can receive and seven states have either enacted such caps or tightened them in the past two years, according to the Kaiser Family Foundation… Mississippi has a limit of two brand-name drugs. In Arkansas adults are limited to up six drugs a month.
Study after study has found that patients on Medicaid have worse outcomes than patients with private insurance. With respect to cancer care, outcomes are much better if you have private insurance, but there does not seem to be much difference between Medicaid and being uninsured. Health blogger Avik Roy summarizes other studies that find that Medicaid patients do no better and sometimes worse than the uninsured. Additional evidence is supplied by Scott Gottlieb.
But now a rescuer has appeared on the scene. The U.S. Supreme Court has ruled that the federal government can’t force the states to expand their Medicaid programs. If your state doesn’t, then you can enter the exchange and get private health insurance after all. Right? Maybe.
Letter to the Editor View all comments (56) | Leave a comment
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Aristocat| 8.6.12 @ 6:57AM
You lost me at "hello". Who's going to pay for all this ? What happens to Medicare when they take $500 Billion out to pay for this monstrosity? Will it result in government dependents moving into Democrat states that love Obamacare, and out of states that "would prefer not to", as Bartleby would say....
benny havens| 8.6.12 @ 7:21AM
Presently, the government can’t handle, control or maintain the excessive waste and abuse existing in the healthcare system it has already created for citizens 65 and older.
What makes the Karl Marx wannabe think that he can now have a system that covers everyone and it’s going to be better?
This shows that political ideology overrules human logic. Doing the same thing over and over again and expecting a different result is the sign of someone who is not very bright.
TLP| 8.6.12 @ 7:44AM
That's all well and good.
HOWEVER..............................
In my humble opinion (and "Humble" is my middle name)we wouln't even be discussing all of these IFs, if Chief Justice Quissling, hadn't decided that his #1 JOB and Reason for Living, was to 'Insure the "Integrity" of The Court', by taking out his Red Marker, and crossing out This Word, and replacing it with That Word, while standing on his head with a Lit Cigar Up His Ass. (I still say he was GOTTEN TO, and FLIPPED)
The right thing to have done, would have been to AGREE with every single person in this Administration, from The President, all the way down to whoever's in charge of keeping an eye on his Dog (So he doesn't end up on The Barbecue Grill) that this was NOT A TAX.
That way, it would have been sent back to a Congress that wasn't in the hands of Democrat Super Majorities in Both Houses, and just MAYBE, instead of Re-inventing The Wheel, on this?
We might actually get something that doesn't require a Secret Decoder Ring and a Speed Reader, to find out what's in it.
Something that won't require an outright Bastardization of the entire process, through a Reconciliation Con Job, and a Supreme Court Justice who has, obviously, lost his Moral Underpinnings, as well as his Integrity, where his Loyalties, and his OATH, and his Job are concerned.
4sailing| 8.6.12 @ 8:06AM
You will probably like this . . .
It's Cuccinelli explaining why the SCOTUS decision was actually a win for liberty.
http://www.examiner.com/articl.....or-liberty
TLP| 8.6.12 @ 9:01AM
The Commerce Clause?
Anyone who finds Victory in Defeat, is either a Liar, a Coward, or Both.
In the end, Cuccinelli is a POLITICIAN.
So, let's put him down for - BOTH.
Occam's Tool| 8.6.12 @ 3:06PM
When I was in private practice, I would accept uninsured patients for my office if they would pay, even if I had to put them on the $5.00/month plan (which I did with a lot). I would NOT accept Medicaid for outpatient care.
Doctor Right| 8.6.12 @ 4:11PM
You're a true mensch.
Pecos Pete| 8.6.12 @ 9:40AM
Tim: "... Secret Decoder Ring and a Speed Reader, to find out what's in it."
This is the best you've ever written. Wish I had thought of it.
And the proof is in the commentary above by Mr. Goodman.
TLP| 8.6.12 @ 5:18PM
I actually thought the comment about the guy making sure that his dog didn't end up on the Grill, was my best line.
Von Mises Jr| 8.6.12 @ 8:00AM
The first deception is that major employers want to give you health insurance but will be forced by government to drop you. Crony capitalist in Fortune 500 companies were behind this plan since they wanted to offload your health benefits back to you, and this statist plan gives them the vehicle to do so.
ObamaCare is a windfall to BIG BUSINESS. The executives can afford the best health care, but you will get Medicaid.
The problem with Medicaid is that after the bureaucrats and criminals steal much of the money and the doctors receive their reimbursement, there is only $13 per one-hundred dollar office visit left after basic office expense. And for the $13 per visit, they are liable for malpractice lawsuits. So doctors will not take new Medicaid patients.
And if the states expand their Medicaid to 138% when quick research seems to indicate that GA only provides for families under $12,576 and MS at $6,371; then these states would necessarily have to raise property taxes two to four times if percentages of incomes remain constant from these incomes up to $26,344. So if property taxes in these states are estimated at $1,500 per year, they must raise them to $3K to $6K or the states go bankrupt.
I asked a couple prominent lawyers how America maintains their Federal Republic without Federalism. I believe they came to the same conclusion. We don't. We have a dictatorship from DC.
Jacob McCandles| 8.6.12 @ 10:49AM
Yep. Doctors behave very much like anyone else. They do a cost-benefit analysis of caring for Medicaid patients, and make a prudent decision so they can stay in business. So Medicaid Sally calls her doctor for an ailment, and she is sent to the ER. The cost of the ER for a given condition is 2-4 X that for outpatient care at the doctor's office. See how unintended consequences work?
Von Mises Jr| 8.6.12 @ 11:43AM
Perhaps it is not unintended at all. I just met a Quebecer on vacation and he reported that the 8-16 hour wait in emergency rooms had doubled.
You see the lazy socialist go to the ER to get a doctor's note so they don't have to work that week. So if you really are sick, you can't get treatment. But in the long run it saves on medical treatment for the Province and the socialist cabal gets to steal the money to boot.
snipelee| 8.6.12 @ 3:58PM
Sorry kids. Under Obamacare, doctors will be compelled to accept all comers (and whatever fees HHS deems appropriate) or lose their ticket.
Von Mises Jr| 8.6.12 @ 4:31PM
Sorry Punk, but doctors I have met have more intelligence in their rectal thermometer than you display in your arguments. They perform medicine for the love of humanity, not to exploit people as liberals do. They are very marketable and over time, no one will want to be a doctor under ObumerCare. Have you noticed that the British have had shortage of doctors and when they imported them from Third world counties some have been terrorist?
Doctors and other educated people think beyond stage one.
Bob K| 8.7.12 @ 12:24AM
They will unionize here like they did in Canada.
Intelligent Design| 8.6.12 @ 8:09AM
To paraphrase Thomas Jefferson, commerce should be set at perfect liberty, meaning a completely free-market approach to medical care and medical insurance would work best. We need far less government involvement, not more. Repeal Obamacare in its entirety.
Jacob McCandles| 8.6.12 @ 10:41AM
I basically agree ID. But we will never have a truly free market in health care, because we as a society are not prepared to deny care to anyone in need. What would happen to any other industry under these circumstances? A man has a flooded basement and calls for help ASAP. The plumber, painter, the water pumper, the carpet man, and dozens of other people are MANDATED to arrive at the scene and provide their services. Payment be damned. Pretty soon these businesses would have serious problems making a profit. Would I personally deny care to a person in need? Nope. But that's the reason free markets won't exist. That ties into the issue of the individual mandate, which we've all heard enough about.
JD| 8.6.12 @ 11:47AM
One is not "denying" anything to anyone simply because he refuses to provide it for free. That is the myth that needs to die.
Jacob McCandles| 8.6.12 @ 2:07PM
My point is that EMTALA laws mandate that the service is provided, BEFORE any contract for payment is discussed. Doctors and hospitals don't have the option of not providing (denying or otherwise) for any reason.
snipelee| 8.6.12 @ 4:01PM
Wrongo - The law only compels that care is given - by someone. Michelle O was in charge of a program designed to off-load "free riders" onto other hospitals.
CJW| 8.6.12 @ 4:59PM
This is the job of "community relations attorney" that Michele got a raise from $100,000 per year to $350,000 per year after the hospital got a million dollar earmark from Senator Obama.
Gary B| 8.6.12 @ 9:10AM
"The insurance companies are going away. The brokers are going away. The market is going away."'
Explain it to me in baby talk so I can understand it. Why in hell did health insurance companies back this pile of crap?
First, this law is bad for us; then it's good for us; then it's bad for us. It's a citizen's nightmare and a consultant's dream. If it's not repealed, it'll wrap us all around the axle. It's already half way there.
Before I die, I want to catch just one politician in a crosswalk - preferably a lying bastard Republican.
Jacob McCandles| 8.6.12 @ 10:45AM
The private industry backed the plan for the same reason the AMA backed it. They were fed a line of BS. They felt they better earn a seat at the table, then they would get a say in the outcome. But they were dealing with the devil. Most doctors, BTW, were not supportive of Obamacare. VAST majority of private Drs. were strongly against it. Obama got a bunch of government employed (university) doctors to spout his line of BS, but that's about it.
TLP| 8.6.12 @ 5:20PM
Exactly.
Gary B| 8.6.12 @ 6:17PM
Jacob: Then where are their complaints? Why aren't they saying they were tricked or blackmailed or cheated into supporting this thing? I mean, really, they have the budget to really get the word out.
I have a theory. They'd much prefer to cheat their customers than offend the government. Apparently, they serve at the government's pleasure. Is this how a free society works? Nope.
As Paul Simon said, "Get yourself free..."
Jacob McCandles| 8.6.12 @ 10:54PM
The AMA is not complaining because it is basically a left wing organization. There are other physician groups who have been very effective in communicating the evils of Ocare. These groups are private MDS primarily.
"Cheat their customers..". You are a fool. Shouldn't waste my time with children.
Gary B| 8.6.12 @ 11:19PM
Let's say you're a doctor. Whom do you fear most? Your hapless patients, who are forced to deal with whatever plan plows over them or the government, who can regulate you out of business tomorrow? Everyday consumers are on the end of this whiplash. They are the casualties. Doctors are collateral damage and right there with them. They better speak up just a little louder and fight back harder if they want to pay back their medical school loans. I'm not privy to the literature, so I haven't heard a peep.
DRA2012| 8.7.12 @ 9:49PM
I tell you what, Gary B old chum - it wasn't the Republicans that foisted this Bolshevik cr*p on our country. It was those fine truthful "Progressive" Democrats who forced this mess down our throats, even while exempting themselves and their political allies from its effects. No, this horrible monster isn't going to go away until we complete the process that was started in 2010 and finish removing anyone who voted for this horror out of office. Even so, it will still take a number of years for our medical community to recover from its side-effects.
Doctor Right| 8.6.12 @ 9:41AM
I'm sorry, but WHAT?!?!? "Saved lives"??? Are you kidding me??
The ultimate goal of the ObamaCare is to seize control of the billions of $$ spent by private citizens on healthcare and transfer that cash to the Federal Government so they can plunder it at will.
The Federal Government is NOT going to pay for anyone's healthcare...WE ARE!!! Through ever-increasing and confiscatory taxation policy that forces the producers of society to pay for the non-producing underclass of takers.
Private health insurance will be phased-out in a few years; it simply won't be profitable. At that point, the people who drafted PPACA will have achieved their desired outcome: SINGLE-PAYER.
Quality will decrease.
Wait-times for procedures will increase.
Medicine will be rationed.
Doctors will quit or retire rather than become de-facto indentured servants of the Federal Gov't.
"Death Panels" will prevail; in fact, they are unavoidable. Anytime a resource is treated as finite, it MUST be rationed.
The dirty little secret about the PPACA "healthcare reform" is that it wasn't about healthcare at all; it was about plunder.
Despite all their incessant caterwauling about "the rising costs of healthcare" and "greedy insurance companies," all the Left really wanted was to control the money.
And now that they have it, the last thing they want to do is spend it on sick people. That money is "walkin' round" money for graft and corruption.
The entire premise of this article is absurd.
JD| 8.6.12 @ 11:53AM
Read to the end of the article. The headline was a sarcastic reference to the people who will fall into the new "donut hole" on page 2 of the article. Such people will get private insurance completely paid for by the government.
Shadow| 8.6.12 @ 12:02PM
The three million saved by this change will be dwarfed by the millions on Medicare who will die because they are denied treatment by the board of leftist saving money for themselves.
Gary B| 8.6.12 @ 12:27PM
What did Milton Friedman say, "Place the federal government in charge of the Sahara Desert and in five years there will be a shortage of sand."
TLP| 8.6.12 @ 5:31PM
Indeed.
Bob K| 8.6.12 @ 9:42AM
Poor John C. Goodman does not know how governments work here in our Federal Republic!
Medicaid is not just a medical insurance program. It is a huge Federal Welfare Program administered by the individual states. If a state has a big Nursing Home Industry located within it's confines, like PA, most of the patients in those homes will get their medical care through the Medicaid program Their cases will be managed and processed by the state. These businesses will still need this money as will the Doctors who still make the rounds there.
Families that qualify for Aid to Dependent Children also qualify for Medicaid.
Families legally registered here from Mexico (or elsewhere, like India) where the family head has a full time job (or dry-cleaning business) can qualify for ADC, Food Stamps and Medicaid if the family income is low enough and when Income Tax time rolls around it will qualify for the Earned Income Tax Credit which is another Federal Welfare Program.
Does anyone really think that a private insurance program is going to take on everybody in (extended, no doubt) families like this?
When are all these people, like Goodman, who analyze policy from inside the Beltway for their own livings, finally going to realize that the entire system is broken? That none of their ideas will ever work? That the only answer is to throw these programs out and start over and never let new ones like Obama Care get started!
Mike G| 8.6.12 @ 9:43AM
When all is said and done, the pols (Dems and Repubs) are going to end up telling us that a national health care system is the only way to fix this mess that they've created. And they won't have a way to pay for that either!
JD| 8.6.12 @ 12:08PM
That is exactly the plan. It has been all along. The key is what it's always been - misdirecting blame for the mess. At every step, they say "The problem is that the system is too private; we need more government." Adding more government makes it worse, of course, but they're still able to sell the same line.
Sjccoach| 8.6.12 @ 10:56AM
Once again a CINO at American Spectator tries to convince people that a loss is a win. We lost. Justice Robert is either a coward or was blackmailed into changing his position. There articles defending him are getting very tiresome.
JD| 8.6.12 @ 11:51AM
You misunderstand the article. It's sarcasm. It describes the many ways that people will lose under ObamaCare, as well as one way that a bunch of poor people will fall into an inadvertent loophole and make out like bandits (thus the headline).
The problem here is that when all of these things come to pass, Democrats will blame the Right for all the problems. That's been our biggest problem all along - Democrats make a mess, but they succeed (through their media) in blaming Republicans.
Boar Hunter| 8.6.12 @ 1:00PM
Thats exactly why Romney is the perfect candidate...for the Democrats.
JD| 8.6.12 @ 1:28PM
It's a sad catch-22. Electing Republicans occasionally allows the liars to blame Republicans for all the problems. On the other hand, electing nothing but Democrats speeds disaster.
It would be nice if the public could learn reality without being forced to see it the hard way.
TLP| 8.6.12 @ 5:42PM
If you have an ALTERNATIVE PLAN, please let us in on it.
Otherwise, you're Strategy of Pummeling Romney, for not being the Republican's answer to JESUS CHRIST, isn't helpful.
I know you think you're being Cute?
But you sound like a Dumbass.
JD| 8.6.12 @ 12:09PM
All of the bad things written in this article and in the comments will come to pass, and Democrats and their media will ensure that the public blames Republicans. The "solution" will be nationalized healthcare. That's been the plan all along.
snipelee| 8.6.12 @ 4:06PM
The "plan"" is also to fully unionize the heath care system.
Louisiana Joe| 8.6.12 @ 2:26PM
I am sorry but I just can’t bring myself to blame Roberts for not saving us from ourselves. Everyone knew in November 2008 that if Obama was elected with a Democrat House and Senate that we would get socialized medicine. This should not be a surprise. Instead many Republicans were just too disgusted to vote for traitor John so they showed their disgust by staying home. Boy-o-boy did you show McCain. Now you have five trillion in new debt, two new commies on the Supreme Court, and socialized medicine. It is not Robert’s job to save us. We got the government we deserved, now what are you going to do about it? Have you sent a check to Romney? Have you sent a check to Freedom Works or any other conservative pac? Are you even registered to vote or are you just going to sit around with your computer and complain?
Occam's Tool| 8.6.12 @ 3:10PM
LJ:
Multiple checks sent to Romney. I'm the local Republican Precinct Captain. Checks sent to Cravaack and Bachmann (I'm from Minnesota). Voted for McCain. Plan to vote for Romney and send more money in October to all 3 candidates mentioned. (Do not believe Bills has chance against Klobuchar---wanted Pete Hegseth---Paulbots predominated---will vote for Bills, but essentially weak candidate)
RAM| 8.6.12 @ 2:39PM
Forgive me if this is simplistic or something, but:
If the Supreme Court had thrown out ALL (100.00%) of Obamacare, which was within its grasp if Chief Justice Roberts hadn't wimped out, wouldn't that have been the more ideal result for this year?
Gary B| 8.6.12 @ 3:30PM
Simple is good but bad for consultants. Complicated is bad but good for consultants. Also, complicated makes it much easier to grant waivers to contributors and to camouflage payments to cronies.
Occam's Tool| 8.6.12 @ 3:17PM
Roberts screwed up bigtime. The reason I do not support the Death Penalty except for the most open and shut cases (Aurora, Arizona) is that I do not trust 99% of attorneys to be able to pour piss out of a boot even with a map and instructions. The vast bulk of attorneys wouldn't have lasted a day in Med School. The vast majority of MDs could have completed Law School in their sleep (Take me, for instance. 33 ACT, 1420 SAT, 4.0 in non-science classes, Magna Cum Laude Biology grad TCU.).
Sorry, it's true. There may be brilliant attorneys, as there are savage Wolverines, but I have no respect for the vast majority of attorneys I have met, and the ones I have met who I like and respect tend to despise the profession. In short, the most brilliant attorney I know is brilliant because he was a brilliant infantry battalian commander and a field grade officer, not because he is a lawyer. He would agree with me, and he was the former Chief of Instruction in Rule of Law at the Army War College.
Doctor Right| 8.6.12 @ 4:14PM
Your righteous indignation is a joy to behold.
Occam's Tool| 8.6.12 @ 3:18PM
Sorry, I digressed. My point is that I do not trust attorneys and judges with life and death responsibilities. Most are too immature and lazy.
Occam's Tool| 8.6.12 @ 3:18PM
Ram---completely correct, sir.
JD| 8.6.12 @ 4:06PM
And now we see that the Sihk shooter was a white supremacist. Note the headlines:
Fox News: Shooter was a white supremacist
CNN: Shooter was far-right
There is nothing conservative about white supremacist movements. Never has been. CNN's terminology is patently false, yet it's reaching a lot of eyeballs right now.
This is the same type of lying that we'll see on the subject of this article's results.
atilla| 8.6.12 @ 5:54PM
WE ARE ALL CONSIDERED EQUAL UNDER THE LAW.....NO PROBLEM!
BUT, WHEN YOU CAN'T PAY YOUR BILLS IT THEN BECOMES UNDER THE AUSPICES OF CHARITABLE ORGS., FOR EXAMPLE, THE TAX EXEMPT RELIGIOUS ORGANIZATIONS OR THE CIVIC ORGS OR ANY OTHER ORGANIZATION THAT WANTS TO HELP.
IT IS NOT, UNDER ANY CONDITION, THE RESPONSIBILITY OF THE GOVERNMENT TO HELP THESE PEOPLE.
IT IS IMMORAL AND UNCONSTITUTIONAL TO TAKE MONEY FROM AN EARNER TO GIVE TO ANOTHER PERSON...IT IS JUST THEFT, NO OTHER WORD FITS.
THERE SHOULD BE NO, AND I REPEAT , NO DIGNITY IN TAKING FROM YOUR NEIGHBOR TO SURVIVE.
IN THE 70'S THEY THOUGHT THAT IT WAS, BUT IT IS JUST CRIMINAL THIEVERY.
IF YOU LIKE TO EAT, GET A JOB.....IF YOU LIKE A ROOF OVER YOUR HEAD, GET A JOB, ETC....
I KNOW THAT JOBS ARE HARD TO FIND, BUT THAT IS ONLY THE CASE UNDER OBAMAS REGIME.
HIS REGIME HAS PREVENTED JOBS EXPANSION AND ENERGY EXPANSION.
IF YOU WANT YOUR JOBS BACK AND YOUR LIFE SAVINGS BACK, VOTE THIS BUM AND HIS ILK OUT OF OFFICE.
VOTE CONSERVATIVE, THEY MEAN BUSINESS.
WITH LOVE AND COMPASSION,
GENE HAUBER AKA ATILLA
atilla| 8.6.12 @ 6:02PM
THE SUPREME COURT'S DUTY AND ITS ONLY DUTY IS TO DETERMINE THE CONSTITUTIONALITY OF LAWS PASSED IN THIS COUNTRY.
THEY ARE NOT HERE TO HELP POOR PEOPLE STEAL FROM THE EARNERS WHO PAY THE TAXES.
THAT IS THE RESPONSIBILITY OF TAX EXEMPT ORGANIZATIONS LIKE RELIGIOUS ORGS, CHURCHES ET AL, AND CIVIC ORGS.
STOP THE GRAND LARCENY COMMITTED BY THE GOVERNMENT IN THE NAME OF THE "POOR".
atilla| 8.6.12 @ 6:09PM
BY THE WAY.......
WHERE IS THE HOLY OF HOLY'S OF THESE BLEEDING HEARTS, ON THIS VERY APROPO SUBJECT.......CHARLES DARWIN?
WHO SHOULD SURVIVE?.......THE GIVERS OR THE PERENNIAL THIRD OR FOURTH GENERATION WELFARE RECIPIENT TAKER? HUH, HUH, HUH?
I'M WITH THE TAXPAYER. DUH!