Obama Math

Health care reform is supposed to guarantee health insurance to roughly 36 million Americans over the next 10 years at a cost of $1 trillion or more.

In simple terms, that is $100 billion per year for 10 years. That averages out to just under $2800 per individual per year . . . IF you believe their numbers.

So how does Professor Obama score on his math abilities so far?

According to Reuters, the Obama administration has spent (or invested, depending on your perspective) $158 billion to create or save 640,329 jobs.

Ignore for the moment that not all of those were real jobs created or saved. Some were only temporary jobs that lasted a few weeks. Some were not jobs at all but rather the money was spent to give raises to people who already had jobs. And it was recently reported that Columbus schools spent $145,000 to rent banquet halls and conference rooms in "high end" hotels to train existing teachers on how to teach.

This in spite of the fact they own 120 buildings that are designed for . . . teaching.

They are also spending $1.4 million to pay speakers for this 3 day session.

But back to the jobs created or saved.

640 thousand jobs.

$158 billion.

That's $246,000 per job created or saved.

Total compensation earned by the average payroll employee during October, on an annualized basis, was $59,867. If the government had simply used the funds awarded so far to pay for a year’s worth of labor, that would have paid for 2.6mn jobs!

So much for government efficiency.

Will someone please tell me how a government that spends that much money to save or create so few jobs will suddenly become an efficient machine at delivering quality health care for all at a lower cost than what we have now?

History to Sen Reid: "Um, no."

For our readers that may not have already seen this, here's Sen Harry Reid (D-BS) opining that Republicans who oppose ObamaCare are akin to folks that opposed an end to slavery, women's right to vote and civil rights legislation [ed: we're just surprised he left out the heartbreak of psoriasis, as well]:



Apparently, Sen Reid failed 7th grade history, else he would have known that Abraham Lincoln was himself a Republican, that it was the Republican party which first pushed for women's suffrage, and it was the GOP which advocated civil rights legislation, despite heavy Democrat opposition.

No gold star for you, Harry.

More (Un?)Intended Consequences

One of the major problems we'll likely face if a national health care scheme is adopted is a shortage of primary care docs. Actually, we already face such a shortage, but ObamaCare threatens to exacerbate and extend it:

"... the bill may exacerbate the difficulty some Americans already have in finding a doctor ... Even without an insurance expansion, the American Medical Association estimates the country will be short 85,000 doctors in primary care, cardiology, oncology and general surgery by 2020."

For right-brainers:


When the demand for services (i.e. tens of millions of newly insured folks, using primarily someone else's money) increases, if the supply (health care providers) doesn't match, then you're going to have shortages. Pretty simple economics.

Wonder if anyone in DC ever studied that?

(Un?)Intended Consequences: More Mammography Monkeyshines

Talk about a roller coaster: first, the Feds decide that mammograms really aren't "all that," then they decide "well, maybe they are." Now the Golden State has decided that those women on the bottom rungs of the economic ladder don't really need them, after all:

"The eligibility age for state-subsidized breast cancer screening has been raised from 40 to 50 by the California Health and Human Services Agency, which will also temporarily stop enrollment in the breast cancer screening program."

This is a state-funded initiative that had previously helped poor women to pay for this important (or not) cancer screening. It's particularly troublesome because "[m]ore than 50 percent of the women we give breast exams and mammograms to are in their 40s ...The majority of our current breast cancer survivors are women in their 40s.”

That's a pretty large swath of females that just got thrown under the health care bus. As we've noted before, while insurers can't arbitrarily decide whether or not to pay for certain procedures (and face sanctions, arbitration or lawsuits if they try), the gummint has the ultimate decision-making power: if they decide you're not going to get needed care, then you're not going to get needed care.

[Hat Tip: Gateway Pundit]

Oy Canada - Early December Edition

One of the most significant problems with gummint-run health care is that, just as with most things the government touches, red tape and stringent rules often lead to broken - or at least in this case damaged - hearts:

"An elderly woman with a cane and a heart condition was told to bring her husband into a Nova Scotia hospital on her own or call 911 after he suffered a heart attack 10 metres [32 feet] from the facility's front door"

Not only did the hospital turn her away, they told her that they'd only treat hubby if he arrived by ambulance, for which she'd be charged. But of course, Canadian health care is free, right?

In fairness, my experience with American hospitals is that those arriving by ambulance are almost always bumped ahead of those who arrive by private transport; still, requiring such seems a bit Big Brotherish.

Just another example of what we may be in for.

Rocks, Hard Places, The Maverick and The Bus [UPDATED]

One of the ways its proponents plan to fund ObamaCare is by making severe cuts to Medicare [cf: Paying Paul]. The thinking is that, by throwing Grandma (and, of course, Grandpa) under the bus, "we" can better afford to pay for health care for, well, the grandkids.

One Grandpa who objects to this transfer is Sen John McCain (R-Maverick), who has proposed an amendment that would "stave off Medicare cuts and approved safeguards for coverage of mammograms and other preventive tests for women." The amendment was defeated along an almost party-line vote, with two (presumably elderly) Democrats voting with The Mav.

What's ironic is that another long-serving senator recently characterized any cuts to Medicare as "immoral." That would be Doc Harry Reid (D-BS). What a difference 4 years and an election or two makes.

[Hat Tip: PowerLine]

UPDATE: One of the (perhaps) unintended consequences of the ObamaCare cuts to Medicare is the availability of home health care:

"Bertha G. Milliard greeted the nurse who had come to check her condition and review the medications she takes for chronic pain, heart failure, stroke and dementia ... Ms. Milliard, 94, said those visits had been highly effective in keeping her out of the hospital. But the home care she receives could be altered under legislation passed by the House and pending on the Senate floor as Congress returned to work this week."

Ooops.

Turns out, home health care (which is one of the most cost efficient forms of care delivery) takes a "disproportionate" hit under ObamaCare. And since seniors are more likely than younger folks to actually receive care in this manner, it's going to hit them "disproportionately," as well.

Poor Grandma: thrown under the bus, and no home health aide to nurse her back to health.

ForeSee-able Consequences

We've long advocated increased consumer involvement in health care. When folks have "skin in the game," they tend to be more careful and discerning shoppers, which in turn can help drive down costs. A vital part of this "consumer empowerment," though, is the availability of certain tools. And one of the most important, and effective, tools is the internet. Over the past few years, we've seen various players in the health care game make increased use of the 'net, often to great effect.

For example, a lot of (perhaps most) insurance carriers have numerous features on their websites for their insureds to track claims, check availability of providers, get cost estimates, that kind of thing. But how does one measure the effectiveness of these tools?

ForeSee Results (FSR) is a company that measures customer satisfaction with vendors' websites. It publishes the American Customer Satisfaction Index (ACSI), which includes many different companies across many different sectors. Because health care is such a hot topic right now, they thought it would be interesting, and instructive, to see how different segments of the health care sector stack up. For insurers, the picture isn't pretty:

But what does this graph really mean?

To find out, we recently interviewed the president and CEO of FSR, Larry Freed. Mr Freed was kind enough to share with us the results of the survey, as well as some intriguing insights about it.

InsureBlog: Thanks for speaking with us, and for sharing your findings with our readers. What's the point of the ACSI?

Larry Freed: It's a measure of how satisfied customers, users, are of different companies' websites. We look at 700 to 800 different sites across the specturm, from retail sales to government agencies, and then look to see how they compare with others in their sector.

IB: Okay, so what does "customer satisfaction" really mean in this context?

LF: It's about how the customer perceives the company's technology: is it helpful, easy to navigate, is there adequate help available? We believe that a happy customer is a loyal customer, and this helps our clients determine how well they're doing in that regard.

IB: What do the scores in the chart mean?

LF: Well, we consider an 80 to be a very strong (good) score. As an industry, health care averaged 75, which is very good. But that's an aggregate, and you can see that different segments have different scores.

IB: I see that. I notice, too, that the "worst" aggregate position is taken by health insurers; in fact, there's a pretty big gap between that carriers and - most surprising to me - government sites.

LF: That is interesting; in fact, and I can't tell you the names of the carriers involved, but within that cohort the scores ranged from a high of 86 to a low of 42. By way of comparison, Google and Amazon both scored 86 in their categories, so you can get a sense of what those scores can mean.

IB: So (at least) one carrier scored very high, which is good. I'm still somewhat confused, though: my experience with government sites is that they're often very difficult to navigate, heavily cluttered, just not all that use-friendly. It just seems counter-intuitive that they'd score so much higher than carriers. We're certainly no shills for the companies [ed: I mentioned our "Stupid Carrier Tricks" series], but at least in this regard, I've been fairly impressed with their sites.

LF: Well, ease of use, navigability, that kind of thing is important, but it's not the only measurement. There's also what we call the "trust factor" that plays a big part; how much credibility do you give the site, what are your expectations. Often, customers look at, say, the CDC site as very credible, which more than offsets whatever problems that might have with the mechanics of the site itself.

It's really a perception and expectation issue: if the customer goes to a site where their expectations aren't that great, the bar is pretty low so it's easy to jump. Contrasted with another site that may have a great reputation, one's expectations are higher.

IB: Like eating at Frisch's versus Ruth's Chris...

LF: Exactly. You're expecting great service at one, maybe you're pleasantly surprised by the service at the other.

IB: So what does this bode for the carriers? What do they have to do to close that gap? And is it important that they try?

LF: I think it's very important. They're sort of at a crossroads, there's health care reform legislation that's going to directly affect them, they need to be trying to improve their credibility and the value of their online presence.

I'm actually a big fan of the "42" company; they really have nowhere to go but up, and every incentive to make that happen. And these kinds of surveys are helpful in that effort. We believe very strongly that "you cannot change what you do not measure." If you don't know where you are, how do you where to go?

IB: Thanks so much for your time, Larry, and for sharing your insights.

Readers who'd like to know more about ForeSee Results should click over to their site; please feel free to leave your own thoughts and questions in the comments, and I'll forward them on.

[Special Thanks to Brandon Fibbs!]

Call it Macaroni? Er, No, It's Still a Feather.

The Congressional Budget Office issued a report November 30 prepared in conjunction with the Joint Committee on Taxation. Among other things, the report states (bottom of page 4):

"CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law."

Got it. That outcome is financially WORSE than doing nothing.

And who are the people who buy “nongroup policies”? They’re individuals. A great many of these individuals are uninsured. The uninsured are the very people who need the most help. But the Senate Bill will increase the premiums that the uninsured would have to pay to get medical insurance they already can't afford. Does this make sense?

I think even more important, the effect of the Senate Bill on medical insurance premiums tells us that the cost of medical care would also be greater under the proposed law, than under current law. That’s because the cost of insurance is driven by the cost of medical care. In other words, the Senate bill does bend the cost curve. It bends the curve UPWARD.

The November 30 report goes on to say (still on page 4):

"About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law."

The administration and Senate leadership selected this comment for their great “AHA!” on Monday – AHA!! CBO proves us right! The premium per participant will reduce under the Senate Bill!! [they said]

Sure - - after the subsidy.

So you tell me. Will it cost taxpayers more to subsidize the more-expensive medical care caused by bending the curve upward ? Or will it cost taxpayers more to subsidize the less-expensive medical care we have now? C’mon, it’s an easy question.

I’m not saying we should be satisfied with what we’ve got. What we’ve got is far too expensive and it’s far too inefficient. The current “system” not only drives people nuts, it drives doctors nuts and payers such as the government, small employers, and large employers nuts, too. We need to change it. But the Senate Bill will give us no better than we have now, at higher cost.

The Senate leadership wants to stick a feather in its cap, and call it macaroni. But CBO says not so fast. Thanks to CBO, the information before the public is now clear and settled fact. It is wrong to assert that the Senate Bill will save money, or will be “budget neutral”. It will instead cost much more than doing nothing, and will not accomplish the very things we understand are most important.

By the way, remember when candidate Obama promised a health care plan that would save every American family $2,500 a year? I’d like to know, where the heck is THAT plan?

Keeping Abreast of the Mammogram Controversy

A couple of weeks ago, we reported on a federal health panel's new recommendations regarding when and how often women should get mammograms. The panel's findings had ignited a pretty fierce firestorm among women's health advocates, and was widely denounced. Our take was that it didn't portend well for those who think that government-run health care would be such a perky idea.

Now comes news that the panel is softening its approach, opining that "screening women in their 40s should not be automatic, but should not be denied either."

But what struck me as even more disturbing was this admission by one of the panel's esteemed members:

"The recommendation about breast cancer screening for women 40 to 49 did not say what the task force meant to say. The task force communication was poor."

No kidding.

One is tempted to believe, however, that it was merely the fact that they were called out on their recommendations that caused them to backpedal; if the information hadn't been widely disseminated in both the old and new media, how many women would now be facing mammography rationing?

As we noted in our original post, this might have had even farther reaching impact, in that insurance carriers might have been encouraged to approve fewer mammograms. Fortunately, this hasn't turned out to be the case, as we see in an email notice I received yesterday from UHC:

"UnitedHealthcare Mammography/Cervical Screening Guidelines Remain Unchanged ... We consider mammography an important screening procedure, one that has resulted in the ability to detect and treat breast cancer at earlier stages of the disease and save lives."

The release goes on to note that UHC will continue to cover mammograms as recommended by its insureds' physicians, and that employers with self-funded plans may modify their plans to include this coverage if they don't already do so. What's also heartening is that the carrier notes that, "the American College of Obstetricians and Gynecologists (ACOG) recently changed its recommendations for cervical cancer screening, advocating less frequent screening for women in their 20s. However, UnitedHealthcare is not changing its coverage policy on cervical cancer screening."

Kudos to UHC.

Medicare Advantage: What's Up with That?

Inasmuch as Medicare Advantage (MA) plans are firmly in the crosshairs of ObamaCare, this video may soon be rendered moot. But since they're still alive and kicking - so far - this latest video in the Humana "Good to Know" series [ed: that's our name for them] provides a good background on what they are and how they work:

Right-wing Nutjob Casts Aspersions on ObamaCare

This is just beyond the pale. A noted hard-right senator has the temerity to claim that deficit neutrality is not part of the plan:

"Just for a second -- health care reform, whether you use a ten-year number or when you start in 2010 or start in 2014, wherever you start at, so it is still either $1 trillion or it's $2.5 trillion, depending on where you start…"

And how does this arch-conservative justify these outrageous comments?

Well, he points out, without a thought of how unlikely this might be, that all the tax increases start in Year One of "The Plan," but that expenditures don't actually occur until Year 5.

Well, if you're going to use facts and logic...

Shame on you, Senator Max Baucus, shame on you.

MassCare Coming Up Short

Over the years, we've chronicled the various pitfalls of RomneyCare (aka MassCare). Long on promises, short on delivering on those promises, it's a glimpse into the (possible) future of how a national health care system would fare. Now, though, the fit has really hit the shan:

"Six community hospitals, squeezed by the economic downturn and the Massachusetts budget crunch, are set to file a lawsuit in Suffolk Superior Court this morning seeking millions of dollars from the state for unpaid health care services."

Hospitals are generally taking major hits as their reimbursement rates continue to fall. In this case, the Bay State's much-touted health care initiative has left them reeling with lower reimbursements and unpaid bills. Of course, that's a direct result of the program's own struggles to control costs.

Adding fuel to the fire is the fact that the half-dozen plaintiffs are among those truly at the bottom of the rung:

"[H]ealth care providers known as “disproportionate share hospitals,’’ institutions at which at least 63 percent of patients ... are covered by public insurance plans such as Medicaid or Medicare."

That last is important: "covered by public insurance plans." It doesn't seem much of a leap to substitute "public insurance plans" with "Public Option," and a whole new can of worms becomes accessible. Whom do the hospitals sue when it's the Feds?

RELATED: Over at Ace of Spades, an intriguing discussion of health care as "supply side" driven. This insight is worth more than a passing thought:

"In the US system, there is a theoretically unlimited amount of health care available, you just have to be willing to pay for it.

You've just the nailed the fatal flaw of the Democrat's health care reform; it isn't reform at all, it's simply more regulation ... real reform would involved increasing the supply of doctors, medicines, and hospitals. ObamaCare does just the opposite, it focuses entirely on demand." [italics in original]

Definitely food for thought.

HR 3961 - you need to know about it [Bumped to Top]

[Welcome OpenCongress readers!]

[ed: I've bumped this to the top of the page because it's important. To quote P J O'Rourke: "If you think health care's expensive now, just wait 'til it's free."]

H.R. 3961 passed the House last week by a vote of 243-183. This bill was formerly a part of HR 3962 “Obamacare”. Here’s a link to the voting by Yea and Nay, by Democrat and Republican, and by Not Voting.

This bill would block the 21 percent cut in Medicare reimbursement to physicians, scheduled to take effect in January 2010. The bill would instead increase physician payments in 2010 based on the Medicare economic index, and implement an entirely new formula for 2011 and after. That’s a pretty big swing – minus 21% to plus something. So it has a significant cost. This bill was scored by the Congressional Budget Office as costing about $210 billion when it was part of Obamacare. So the House leadership, bless their hearts, seeking to reduce the cost of Obamacare, just made it go away. Like magic, the cost of Obamacare was reduced by $210 billion. But like reality it's back as HR 3961. I think this illustrates how governments - anyway our government – anyway most of our Representatives - pretend that charging us more is really a savings. It’s also a pretty good insight into how gullible they think we are.

Wait, there’s more.

The bill would entitle physicians to more than a 20% increase in Medicare reimbursements relative to CURRENT LAW.

Why the capital letters? Because, when CMS calculates the Medicare premiums each year, it can take only the CURRENT LAW into account. Based on current law, “the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium.” 15% is a whopping increase for Medicare Part B.

But if physicians will become entitled to 20% MORE in 2010, the 2010 Part B cost will be higher than CBO projected and that means premiums are too low even after that whopping 15% increase. The Part B premiums for 2010 need to be a lot higher. Would that happen? Heck no, it’s too late in the year to change the premiums. So the government (that means the taxpayers) would eat the entire additional cost. Medicare participants won’t pay higher premiums than already announced. That is, in 2010 they won’t. But come 2011, CMS will again calculate the Part B premiums, taking into account the new physician reimbursements, and Seniors will suffer another whopping increase to their Part B premiums.

Now go back to the link again. See that reference to “pay-as-you-go budget rules” in the top paragraph? That means this bill is not funded. So its cost adds to the US deficit.

Oh yeah, about the voting on HR 3961:

242 of the 243 yea votes were Democrats.

172 of the 183 nay votes were Republicans.

Scroll down, yeah keep on scrolling, keeeeep on, until you reach “Not Voting”

There you find the name of NANCY PELOSI. Third in line for President, exercising her precious right . . . NOT to vote. What th- ??

Please don't you be like Nancy. Stand up for something constructive. Tell your senators what you think of this Bill. Call their offices. They're probably not all that busy this week anyway.

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