Insurance companies get insurance too

The New Neo Posted on by

Well, well, well. Another case of needing to pass the bill to find out what nuggets were hidden in its deep recesses:

If an exchange plan’s performance varies in either direction by more than 3 percent, it either collects a subsidy from federal taxpayers via the Department of Health and Human Services to recoup part (50 to 80 percent) of further losses, or it has to kick back a similar share of the excess profit.

Ideally, the money kicked back by profitable health plans can cover the subsidies for plans that lose. But unlike with the other two R’s, there is no legal requirement that the numbers balance or limit on what can be paid.

So imagine that we do enter a “death spiral” situation in which a large number of exchange health plans lose big and very few turn sizable profits…taxpayers potentially face a multi-billion dollar bailout of health insurers for losses outside the corridor.

Insurers are therefore safe. Politicians who back Obamacare may not be. If insurers’ costs do rise to the level that they require a taxpayer bailout, they will also be announcing massive hikes to their insurance premiums for calendar 2015.

This news may not get the widespread publicity it deserves unless the death spiral begins. But if it does, watch out.

It’s understandable that insurance companies wouldn’t want to go into this untried, untested experiment without this sort of assurance that they wouldn’t lose their shirts. Obama had to give it to them because he needed them aboard once he knew that neither single payer nor a public option could pass. And so this unstable alliance was born.

Interpreting the election results…

The New Neo Posted on by

…is somewhat of a fool’s errand.

People will use the results to say they send all sorts of messages. “See, a very conservative Tea Party candidate loses.” Or “See, a more moderate candidate wins.”

I don’t think that’s what they say at all. I think elections turn only somewhat on the stated political principles and stands of the candidates. The deciding factors are always something about people’s reactions to the candidates themselves on a more gut level, and other issues such as money and ads, and the demographics of a particular state.

In the Virginia race, the Republican civil war—among RINOs and soc-cons and libertarians—has been activated, big time. “The establishment didn’t go to bat for Cucinelli and that’s why he lost” (see this excellent post by Ace for some reflection on that argument). And while “The libertarians are at fault in Virginia; they took votes from Cucinelli” may indeed be true, one of the hallmarks of libertarians is always going to be their fierce independence from the GOP and their “plague on both your houses” attitude, which all too often ends up electing those with whom they are least simpatico (see this for a fuller discussion).

New York City is New York City, somewhat of a law unto itself. It will reap what it sows, and I don’t think the results there have much national significance, although they are sad for my hometown, which seems determined to commit economic suicide and to reverse all the gains of the last two decades in fighting crime. Here’s the mayor-elect De Blasio:

To maintain that greatness and to ensure that our brightest days are ahead of us, we must commit ourselves to progressive ideas that will lift us all.

Ah, yes; progressive ideas are well-known for being a rising tide that lifts all boats. De Blasio’s campaign was a very model of class warfare, PC condemnation of stop-and-frisk, and cluelessness on how to work with an Albany that is almost certain to oppose him. Should be interesting.

But before you can give De Blasio’s victory an interpretation like, “liberals are getting further and further to the left,” you have to look at Christie’s enormous victory in neighboring New Jersay. It proves my point, I think, which is that candidates’ personalities matter, not just their philosophies. Christie has a straight-shooter, man-of-the-people demeanor that people find really appealing. In New Jersey it has enabled him to transcend the usual categories. And before you say “What are you talking about, Christie’s no conservative,” let me just say that by New Jersey standards he’s an ultraconservative.

Cristie has the gift of seeming to be (and perhaps even actually being) the kind of person I was surrounded with where I grew up, a neighborhood that was heavily Italian and heavily working-class, and where people were very much in your face and called it like it is (and were pretty quick with the humor, as well). So to me, Christie’s like home.

The first time I ever saw him speak, I knew he was a great politician, a natural. Don’t knock it; it’s important, and very very very rare in Republicans. A lot of you will be mad at the media for building Christie up and “shoving him down your throat.” You also may not like his emphasis on working with Democrats, although it’s not just good politics, in a state like New Jersey it’s absolutely essential for any Republican. But I know much better than to try to talk anyone into anything with Christie; just watch and judge for yourself.

So, what conclusions can we draw from all of this that are more universal?

Personalities matter.

The Democrats play dirty; be prepared for it (i.e. the libertarian challenger in Virginia was bankrolled by an Obama bundler).

Obamacare hurt McAuliffe, just not fast enough and strongly enough to make a big enough difference. If things keep going poorly for Obamacare, it will matter in a lot of races.

And Republicans will keep fighting—each other, and deflecting precious energy from the more important battle. As for me, I think William F. Buckley’s rule still makes sense: in primaries, vote for the most conservative candidate with a chance of winning. The problem is figuring out who that might be.

David Horowitz: come back to tell you all

The New Neo Posted on by

To say: “I am Lazarus, come from the dead,
Come back to tell you all, I shall tell you all”—
———–T.S. Eliot: The Love Song of J. Alfred Prufrock

David Horowitz has written a new book, although it doesn’t have much in it that’s new. It’s composed of essays Horowitz has written over the last two and a half decades. He is a chronicler of the left, with a unique perspective that comes from having been one of its leaders until the mid-1970s, and then turning right and making an announcement to that effect in 1985.

Horowitz looks back, aghast but analytical, and tries to warn of the dangers for the future. It’s as though he were attempting to expiate his own political sins by sounding a clarion call to people to recognize and pay attention to the left’s methods and goals, and to realize that the left never, never, never ever gives up, even when it might appear to do so.

The title is The Black Book of the American Left, and Scott Johnson discusses it and offers a lengthy excerpt at Powerline. This following is from the book’s introduction (but please read the entire excerpt at Powerline):

The essays contained herein describe the left as I have known it; first from the inside as one of its “theorists,” and then as a nemesis confronting it with the real¬world consequences of its actions. In all these writings I was driven by two urgencies: a desire to persuade those still on the left of the destructive consequences of the ideas and causes they promoted; and second, the frustration I experienced with those conservatives who failed to understand the malignancy of the forces mobilized against them. Most conservatives habitually referred to leftists who were determined enemies of America’s social contract as “liberals.” In calling them liberals, conservatives failed to appreciate the Marxist foundations and religious dimensions of the radical faith or the hatreds it inspired. And they failed to appreciate the left’s brutal imposture in stealing the identity of the intellectually pragmatic, patriotic, anti¬totalitarian “Cold War liberals” whose influence in American political life they began killing off in 1972 with the McGovern coup inside the Democratic Party…

The first part of my life was spent as a member of the “New Left” and its Communist predecessor, in which my family had roots. After the consequences of those commitments became clear to me in the mid¬1970s, I came to know the left as an adversary; and if sheer volume were the measure, as its principal intellectual antagonist. Some have seen an obsession in my efforts to define the left and analyze what it intends. In a sense that is true; I had left the left, but the left had not left me. For better or worse, I have been condemned to spend the rest of my days attempting to understand how it pursues the agendas from which I have separated myself, and why.

I’ll close with another fragment of poetry, from Coleridge’s “Rime of the Ancient Mariner”:

Forthwith this frame of mine was wrenched
With a woful agony,
Which forced me to begin my tale;
And then it left me free.

Since then, at an uncertain hour,
That agony returns:
And till my ghastly tale is told,
This heart within me burns.

I pass, like night, from land to land;
I have strange power of speech;
That moment that his face I see,
I know the man that must hear me:
To him my tale I teach.

Election results

The New Neo Posted on by

Here’s a thread for you to discuss tonight’s election results in Virginia and New Jersey.

Or anything else you want.

Christie’s victory was a foregone conclusion. And McAuliffe’s always seemed likely, too, although the margin was clearly shrinking. My guess is that, had the election been next week, Cucinelli might have even pulled it out.

I’ll probably have more to say about Christie and Cucinelli tomorrow.

Attitudes towards Obamacare: in the end, what it all boils down to…

The New Neo Posted on by

…may just be whether you believe health care insurance is redistributive justice, or whether you believe it’s, you know, health care insurance.

A lot of Obamacare opponents have said, “Don’t piss on my back and tell me it’s raining.”

I think it’s a lot worse than that. It’s more like, “Don’t piss on my back and tell me it’s wine.”

[NOTE: See this.]

Some of the deserving poor whom you’ll be subsidizing under Obamacare

The New Neo Posted on by

Ever since the Obamacare rollout I’ve been studying more of the details of Obamacare, including how subsidies will actually work. There’s so much information out there, so much of it shocking, that my posts just can’t keep up with my teeming brain.

I’ve probably got a hundred drafts for articles I haven’t published yet. Several of them deal with the issue I’m about to discuss, which boils down to the fact that assets are not considered when subsidies on the exchanges are determined. Family size and income, particularly line 37 of your federal income tax return, constitute the basis on which a person becomes eligible for subsidies. If your income is under 400% of the poverty level, you get them. If it’s over that, you don’t. All of that does not apply to people who already have employment-based insurance available to them; they have to play by different, more restrictive rules.

But let’s just concentrate on those without employer-based insurance who are shopping on the exchanges. When we look at them, we get anomalies like the Horsts. The Horsts have made a choice for a particular life-style—something they have every right to do—that happens to now end up qualifying them for a free ride in the new Obamacare world. And yet they might very well be asset-rich (the article doesn’t say), and they are mostly definitely highly-educated.

The Horsts didn’t make the choices they did because of Obamacare (they seem to have made the changes a few years before the law was passed), but they do get the benefits. My objection is not to the Horsts themselves. They don’t bother me at all; they’re not doing anything wrong. It’s Obamacare that bothers me. If people have major assets and are getting subsidies anyway, that bothers me. And more importantly, Obamacare opens the door to people purposely manipulating their financial situations in a big way in order to get subsidies when in fact they are fairly—or even extremely—well-to-do.

Here’s a video that could assist those who wish to change a few things in order to qualify in the future. It turns out it’s not all that hard to exploit what one might call the loopholes in the system. Be assured that it will happen. Again, this is not the fault of the people taking advantage of a law that allows them to. It is the fault of the law’s drafters [be patient; the video has been taking a longer time than usual to load, but it does load]:

Somehow I don’t think most people would be pleased if they were to find out about this.

Michelle Obama has a Halloween dream

The New Neo Posted on by

It’s that some day, children will go out trick or treating for fruits and vegetables:

First Lady Michelle Obama held a news conference last night, where she predicted that one day, children would go out on Halloween and beg for healthy food instead of candy.

No, not the Onion.

Michelle is ignoring, or trying to override, the fact that kids gravitate towards sweets even as babies. For most people the desire seems innate, a natural inclination that has some survival value.

Then again, as Katherine Hepburn’s character says to Humphrey Bogart’s in the fabulous “The African Queen”:


Progressives on a mission would often like to ignore the world as it is and make the world a better place—by their definition of “better,” of course. In this they resemble many crusaders, but crusaders would do well to take nature into consideration as much as possible. As far as sweets and children go, it might not be so nice to fool Mother Nature:

As any parent knows, children love sweet-tasting foods. Now, new research from the University of Washington and the Monell Center indicates that this heightened liking for sweetness has a biological basis and is related to children’s high growth rate.

“The relationship between sweet preference and growth makes intuitive sense because when growth is rapid, caloric demands increase. Children are programmed to like sweet taste because it fills a biological need by pushing them towards energy sources,” said Monell geneticist Danielle Reed, PhD, one of the study authors.

Across cultures, children prefer higher levels of sweetness in their foods as compared to adults, a pattern that declines during adolescence. To explore the biological underpinnings of this shift, Reed and University of Washington researcher Susan Coldwell, PhD, looked at sweet preference and biological measures of growth and physical maturation in 143 children between the ages of 11 and 15.

The findings, reported in the journal Physiology & Behavior, suggest that children’s heightened liking for sweet taste is related to their high growth rate and that sweet preferences decline as children’s physical growth slows and eventually stops

On Halloween we give out sweets because they are treats, something a bit forbidden and special. Why would children beg for fruits and vegetable instead, as the First Lady suggests? I can think of only one reason: if they’ve been deprived of them, or of food in general.

And since now I’ve got “The African Queen” on the brain, I’ve got to add this clip. Which has nothing to do with Michelle and sweets, but I like it (especially Hepburn’s masterful little chin quiver that begins at around 2:13)

[ADDENDUM: Commenter “Ann” provided a transcript of Michelle Obama’s speech. Apparently she didn’t explicitly make a Halloween reference in her remarks, although she did use the word “begging.” It was the newspaper headline that said she was referring to Halloween. The context was the date (Oct. 30).]

What Obama actually meant by “If you like your…”

The New Neo Posted on by

All is now explained.

When President Obama said, “”If you like your health care plan, you’ll be able to keep your health care plan, period” he actually meant to say “periods,” plural.

As in “…”, otherwise known as the ellipsis:

Ellipsis…is a series of dots that usually indicate an intentional omission of a word, sentence or whole section from the original text being quoted…Ellipses can also be used to indicate an unfinished thought or, at the end of a sentence, a trailing off into silence…When placed at the beginning or end of a sentence, the ellipsis can also inspire a feeling of melancholy or longing.

Obama is now filling in those missing words:

Now, if you have or had one of these plans before the Affordable Care Act came into law and you really liked that plan, what we said was you can keep it if it hasn’t changed since the law passed.

Ah, now I remember that’s what Obama said. Of course. Dummy me.

Just like I don’t remember Clementis’ hat:

Orwell wrote that “doublethink” requires a person:

“”¦to forget whatever it was necessary to forget, then to draw it back into memory again at the moment when it was needed, and then promptly to forget it again: and above all, to apply the same process to the process itself. That was the ultimate subtlety: consciously to induce unconsciousness, and then, once again, to become unconscious of the act of hypnosis you had just performed.”

World’s tallest man gets married…

The New Neo Posted on by

…and says he’s also the world’s happiest man.

I decided to post this as a feel-good story because I figured we need some relief from all-Obamacare all the time.

Then I noticed that the groom, who is from Turkey, went to the US to get the treatment that helped him:

US doctors treated Kosen’s tumor in August 2010 in the state of Virgina with a precisely targeted shot of extremely high frequency gamma rays, using a non-invasive radiosurgical device known as a Gamma Knife.

Wonder how long the US will continue to be the go-to place for medical care and medical innovation.

“You can keep it”: the lie was absolutely deliberate

The New Neo Posted on by

It’s clear:

It’s not easy to get a lie into a presidential speech. Every draft address is circulated to the White House senior staff and key Cabinet officials in something called the “staffing process.” Every line is reviewed by dozens of senior officials, who offer comments and factual corrections. During this process, it turns out, some of Obama’s policy advisers objected to the “you can keep your plan” pledge, pointing out that it was untrue. But it stayed in the speech. That does not happen by accident. It requires a willful intent to deceive…

This whole episode is a window into a fundamentally dishonest presidency. And the story gets worse. After Obama began telling Americans they could keep their plans, White House aides discussed using media interviews “to explain the nuances of the succinct line in his stump speeches.” But they decided not to do so, because “officials worried .”‰.”‰. that delving into details such as the small number of people who might lose insurance could be confusing and would clutter the president’s message.”

Keep it simple, stupid. Wouldn’t want the masses getting the wrong (that is, right) idea, especially before election time, would you?

David Cutler gets to say “I told you so”

The New Neo Posted on by

David Cutler wrote this memo on health reform implementation in May of 2010, about six weeks after Obamacare was passed. I suggest you read the whole thing, and remember as you read it that Cutler was a supporter of the ACA.

Here’s an excerpt from Cutler’s Wiki entry to establish the basics of his resume. Note that he had served the Clinton administration, so he knows more than many professors how the executive branch of the government works—or doesn’t work, as the case may be:

David Matthew Cutler is the Otto Eckstein Professor of Applied Economics at Harvard University. He holds a joint appointment in the economics department and in Harvard’s Kennedy School of Government and the Harvard School of Public Health. He graduated from Harvard College, summa cum laude, with a degree in Economics, and then joined the Harvard faculty after receiving his Ph.D. in Economics from the Massachusetts Institute of Technology in 1991. He served in the administration of Bill Clinton and was the senior health care advisor to Barack Obama.

Now read the following excerpt from Cutler’s memo to fellow Harvard economics professor Larry Summers, back when Summers was an official member of the Obama administration (which Cutler never was). Remember, this was sent about six weeks after Obamacare was passed:

The second major task of reform is to set up and run insurance exchanges. I am not encouraged by what is occurring there either. Running exchanges is a collaborative process. As just one example, the person who ran the Commonwealth Connector in Massachusetts estimates that he had 500 town meetings to discuss reform, the equivalent of 17,000 meetings nationally ”“ and this was in a state where two-thirds of people, along with insurance companies, supported reform. The person newly appointed to head the insurance oversight office has a reputation as an insurance bulldog, not a skilled facilitator. Remember that most people will get their information about reform from their doctor and their insurance agent. If you cannot find a way to work with hesitant states and insurers, reform will blow up. I have seen no indication that HHS even realizes this, let alone is acting on it.

My guess is that they’d rather blame Republicans and insurance companies for not co-operating.

Cutler continued:

Above the operational level, the process is also broken. The overall head of implementation inside HHS, Jeanne Lambrew, is known for her knowledge of Congress, her commitment to the poor, and her mistrust of insurance companies. She is not known for operational ability, knowledge of delivery systems, or facilitating widespread change. Thus, it is not surprising that delivery system reform, provider outreach, and exchange administration are receiving little attention. Further, the fact that Jeanne and people like her cannot get along with other people in the Administration means that the opportunities for collaborative engagement are limited, areas of great importance are not addressed, and valuable problem solving time is wasted on internal fights.

But it’s hard for Obama to appoint someone who might appear to know more about something than he does, although every now and then I suppose he bites the bullet and does it. Whether Obama thinks anyone actually knows more than he does about anything is another question.

Cutler went on to make a number of specific suggestions about re-organizing the effort. But the gist of it all was this:

You need to bring in people who share the President’s vision and who know how to manage health care or other complex operations. These people then need to interact with existing agency personnel to make reform happen.

That seems rather—elementary. Doesn’t it? And yet apparently it was not being done. No wonder Cutler sounds so urgent. He was seeing people trying to set up one of the most complex organizational and policy operations the government has ever undertaken, and appointing people to do it who had virtually no experience in anything of the sort.

But after all, that’s pretty much what the American people did when they elected Obama.

[NOTE: This is also a must-read. Except for the obligatory “the Republicans frightened the administration into mucking up the rollout,” it’s both informative and devastating. And since it’s in the WaPo, some of Obama’s supporters might actually read it and be alarmed.]

Oh, those greedy, grasping insurance companies…

The New Neo Posted on by

…with their junk policies before Obamacare came along and fixed it for you.

From an article in the WSJ by Edie Sundby, who suffers from gallbladder cancer and yet has outlived her original dire prognosis by years:

Since March 2007 United Healthcare has paid $1.2 million to help keep me alive, and it has never once questioned any treatment or procedure recommended by my medical team. The company pays a fair price to the doctors and hospitals, on time, and is responsive to the emergency treatment requirements of late-stage cancer. Its caring people in the claims office have been readily available to talk to me and my providers.

But in January, United Healthcare sent me a letter announcing that they were pulling out of the individual California market. The company suggested I look to Covered California starting in October.

You would think it would be simple to find a health-exchange plan that allows me, living in San Diego, to continue to see my primary oncologist at Stanford University and my primary care doctors at the University of California, San Diego. Not so. UCSD has agreed to accept only one Covered California plan””a very restrictive Anthem EPO Plan. EPO stands for exclusive provider organization, which means the plan has a small network of doctors and facilities and no out-of-network coverage (as in a preferred-provider organization plan) except for emergencies. Stanford accepts an Anthem PPO plan but it is not available for purchase in San Diego (only Anthem HMO and EPO plans are available in San Diego).

So if I go with a health-exchange plan, I must choose between Stanford and UCSD. Stanford has kept me alive””but UCSD has provided emergency and local treatment support during wretched periods of this disease, and it is where my primary-care doctors are.

Before the Affordable Care Act, health-insurance policies could not be sold across state lines; now policies sold on the Affordable Care Act exchanges may not be offered across county lines.

Edie’s dilemma is not just about premiums being lower or higher pre- and post-Obama; it is about physician and hospital availability, which will affect people who buy on the exchanges, because (at least as far as I can determine) the vast majority of the exchange policies limit choice to doctors and hospitals in approved networks. And in many places the networks are far more restrictive than people’s policies were before.

As yet, most people have no idea about this consequence of Obamacare; it is the Obamacare boot (in more ways than one) that has yet to drop. So far I can’t recall seeing a piece from a pro-Obamacare pundit that factors it in or deals with it at all. However, I’m almost certain that if and when they do get around to acknowledging the phenomenon, they—and President Obama—will blame it (once again) on the insurance companies doing the limiting, and claim they’re doing it just to greedily maximize their take above and beyond what’s needed (although why this behavior should suddenly have taken such a jump post-Obamacare, and why many companies wouldn’t want to offer more choices than their competitors, and thus attract more customers, I don’t know).

But Obama and his progressive supporters will almost undoubtedly use their stock response that any and all negative post-Obamacare changes are not the result of Obamacare itself but are instead opportunistic grabs by the insurance companies wishing to screw customers still further. For Obama to ignore the math of how the insurance business actually works—that you can’t add coverage to a policy without increasing costs to the consumer, or limiting coverage in another area of that policy—is okay with many of his supporters, who don’t seem to understand the way insurance works, as well.

And if everything bad about Obamacare can be blamed on greedy insurers, the next step, of course, is to eliminate those insurers from the equation by going to public option or single payer. Public option drives out private insurers somewhat more slowly than single payer, but it tends to get there all the same.

I’ll close by reproducing here a response to Sundby’s piece from a commenter named Michael Kaiser (can’t figure out how to give a direct link to the comment, but it’s one of the earliest, on page 1 of the comments to the article):

No offense guy, but you have gotten much more than you have deserved. Over a million dollars spent on care at multiple world-class providers. And now you actually are complaining that you can not keep it all forever? Situations like yours are at the core of what is wrong with our healthcare system and our planet as well. We can not afford to keep everyone alive and well fed, etc. forever no matter what. Furthermore, end-stage care makes up a disproportionate amount of medical dollars spent. How much more do you think society–and ultimately it is society–should spend to try to keep you in the 2%?

Aside from its intense mean-spiritedness, it shows a complete lack of understanding about how insurance actually works. Health care insurance has come so far from its basic roots that I suspect he may even genuinely not understand the simplest principles of insurance; hard to tell. But look for attitudes like his to become more and more prevalent and more frequently voiced: if you get something, you are by definition taking it away from me and you don’t deserve more than I get.

In this, as in so many many other things, we can hardly do better than to turn to the words of Winston Churchill. For “socialism” you can substitute “progressivism” if you wish:

Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.

[ADDENDUM: Excellent posts here and here by Ace.]

[ADDENDUM II: And Think Progress jumps in with the inevitable “She didn’t lose her insurance because of Obamacare, she lost it because of the insurance company” defense, thus missing one of the most important points of Sundby’s article (not that I think they really missed it; I think they purposely distorted it). Her problem is that the exchanges limit the doctors and hospitals that people can go to much more than most older policies do, and this is true whether you had a policy that was canceled (as Sundby did) or are coming to the exchanges for other reasons. She is warning people that money isn’t the only thing that will change about coverage, it’s access and choice.

The White House’s Dan Pfeiffer approvingly cites the Think Progress article. No surprise there, either.]