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.]

The excuses for Obama’s lies are more revealing than the lies themselves

The New Neo Posted on by

President Obama repeatedly and brazenly lied to the American people about keeping their health insurance plans and their doctors, and now he uses sophistry and more lies to weasel out of it, adding that they should just “Shop around” for a new one if they lost the one they had.

Here’s a three-and-a-half-minute excerpt from Obama’s speech, including (at about 1:33) the part where he uses that phrase:

I was going to analyze what he said in the excerpt, but I quickly became overwhelmed by the magnitude of the task. Although it’s short, it contains so many lies, prevarications, distortions, errors, and attempts to mislead that the analysis would be novella length.

And to what point? There are those who have noticed and been offended by lie after lie after lie, and those who have either been taken in by them, are not paying attention, minimize them, excuse them, or applaud them because the ends justify the means and they agree with his ends.

Is there even one liberal talking head on TV or pundit in print who has admitted that the president flat-out lied? Is there one who hasn’t offered a convoluted excuse that should fill that person with shame but somehow does not? The only one I’ve seen so far who admits Obama lied is Douglas Schoen, and he’s hardly any sort of Democrat at all, although he still calls himself one. He opposed Obama’s 2012 run, and some time ago declared the ACA a “disaster” for the Democratic Party.
So as a Democrat, Schoen certainly has a large asterisk next to his name.

The others offer a cornucopia of excuses, proving (if there had previously been a particle of doubt) that they have given up any pretense of integrity. Smilingly, they present the official talking points, from “he didn’t know the truth when he made the promises” (despite this) to “it was an incomplete statement; what he really meant was…” to “all the canceled policies were junk and those who liked them fools, so we must make the decision for them in order to protect them from their terrible judgement” to “oh, it only affects a few people anyway.”

Obama doesn’t plead ignorance—most likely because that would be to admit error, and Obama does not acknowledge errors. His stance is basically that there was absolutely nothing he did wrong. But as you can see from the tape, he does offer his own versions of the other excuses.

This is how tyranny comes to America. Watching the smug faces behind him during the Faneuil Hall speech I sense yet again that this is a plot I’ve seen before, but with slightly different lines and characters. I’m pretty sure the worst excuse of them all would be the “we must make the decision for them” one. That thought is the base on which the tyranny rests.

Some of those nodding, smiling people around Obama while he made that speech want to take over control because they love power itself. Some are just arrogant and think they know best and can actually create a better world. Some are mere followers who bask in reflected glory and like to dance in a ring. But they all have conceded that they have the right to do this.

[NOTE: A bunch of excuses from the administration itself, especially the “incomplete statement” one: it wasn’t a lie, it was a “simplification.” Note, also, that Jonathan Gruber, MIT economist and architect of Obamacare, uses the minimization excuse: the “president’s description of it was ‘pretty low on the totem pole of political overstatements.'” Wow: “overstatement.” From an economist, yet.]

Oh, Mama: Stuck Inside of DC with the Obamacare Blues Again

The New Neo Posted on by

Ofrustrated

The inspiration is Bob Dylan’s “Stuck Inside of Mobile with the Memphis Blues Again” (you can find Dylan’s original lyrics here).

The singer for this version is Obama, of course. And I didn’t even have to change the lyrics all that much.

STUCK INSIDE OF DC WITH THE OBAMACARE BLUES AGAIN

Oh, the MSM draws circles
Up and down the block
I ask them what the matter was
But it’s all just empty talk
And the press corps* treats me kindly
And records me on tape
But deep inside my heart
I know I can’t escape
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Well, Hillary, she’s in the alley
With her pantsuits and her Bill
Speaking to some Ayers man
Who says I’ve lost my will
And I would send a message
To find out if she’s talked
But the post office has gone bankrupt
And my emailbox is blocked
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Valerie tried to tell me
To stay away from the insurance line
She said that all the insurance men
Just drink up your blood like wine
An’ I said, “Oh, I didn’t know that
But then again, there’s only one I’ve met
An’ he just smoked my eyelids
An’ took away my cigarette”
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Biden cried last week
He’s into Scotch on the rocks
But everybody still talks about
How badly they were shocked
But me, I expected it to happen
I knew it was getting surreal
When I signed the bill in the East Room
And he called it a big effing deal
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Now the senator came down here
Showing ev’ryone his gun
Handing out free tickets
To the wedding of his son
An’ me, I nearly got busted
An’ it’s really not a plus
To get caught without a ticket
And be discovered beneath a bus
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Harry Reid looked so baffled
When I asked him why he dressed
With twenty pounds of scandals
Stapled to his chest
But he cursed me when I proved it to him
Then I whispered, “Not even you can hide
You see, you’re just like me
I hope you’re satisfied”
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Now Pelosi gave me two cures
Then she said, “Jump right in”
The one was public option
The other was just exchanges’ spin
An’ like a fool I mixed them
An’ it strangled up my mind
An’ now people just get uglier
An’ I have no sense of time
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Sebelius said “whatever”
In her grilling by the Reps
When I could watch her talk for free
And then descend the Capitol steps
Now people say, “Aw come on now,
You promised!” they tease and taunt,
An’ I say, “You just know what you think you like
But I know what you want”
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

Now the bricks lay on K Street
Where the lobbyist madmen climb
They all fall there so perfectly
It all seems so well timed
An’ here I sit so patiently
Waiting to find out what price
You have to pay to get out of
Going through all these things twice
Oh, Mama, can this really be the end
To be stuck inside of DC
With the Obamacare blues again

[*Can be pronounced “press corpse” if preferred.]

Obamacare: imagology meets reality?

The New Neo Posted on by

It may well be that what’s been going on lately with Obamacare is that imagology has met reality.

Before the rollout, everything was theoretical. Even now, almost everything is a prediction and projection about what we think will happen.

But there have been a couple of realities. One is the website, even worse than its most vehement naysayers had predicted, and frustrating users in a very personal way. That has a direct effect on the credibility of those who promoted, passed, and designed Obamacare.

Another reality is the people who already perceive themselves as having been hurt by the law. Of course, a certain portion of them—and we have no idea how big or small this group will ultimately be—may be mistaken and may find in time that they actually qualify for better (or worse) insurance policies and more (or fewer) subsidies than they think they do at the moment. But they are very, very real, and they are speaking up and telling their stories.

The link at the beginning of this piece was to an article containing a relevant quotation from the book Immortality by Czech author Milan Kundera. It bears repeating:

…[C]ommunists used to believe that in the course of capitalist development the proletariat would gradually grow poorer and poorer, but when it finally became clear that all over Europe workers were driving to work in their own cars, [the communists] felt like shouting that reality was deceiving them. Reality was stronger than ideology. And it is in this sense that imagology surpassed it: imagology is stranger than reality, which has anyway long ceased to be what it was for my grandmother, who lived in a Moravian village and still knew everything through her own experience: how bread is baked, how a house is built, how a pig is slaughtered and the meat smoked, what quilts are made of, what the priest and the schoolteacher think about the world; she met the whole village every day and knew how many murders were committed in the country over the last ten years; she had, so to speak, personal control over reality, and nobody could fool her by maintaining that Moravian agriculture was thriving when people at home had nothing to eat. My Paris neighbor spends his time an an office, where he sits for eight hours facing an office colleague, then he sits in his car and drives home, turns on the TV, and when the announcer informs him that in the latest public opinion poll the majority of Frenchmen voted their country the safest in Europe (I recently read such a report), he is overjoyed and opens a bottle of champagne without ever learning that three thefts and two murders were committed on his street that very day.

…[S]ince for contemporary man reality is a continent visited less and less often and, besides, justifiably disliked, the findings of polls have become a kind of higher reality, or to put it differently: they have become the truth. Public opinion polls are a parliament in permanent session, whose function it is to create truth, the most democratic truth that has ever existed. Because it will never be at variance with the parliament of truth, the power of imagologues will always live in truth, and although I know that everything human is mortal, I cannot imagine anything that would break its power.

[ADDENDUM: Andy at Ace’s discusses some mighty fine imagology from the Atlantic.]

In other news…

The New Neo Posted on by

Obamacare has so dominated the headlines it’s easy to neglect other important news. But there’s plenty of it:

I suppose this first one in connected with Obamacare, too, but it’s a different aspect of it. The D.C. Circuit Court of Appeals has struck down the ACA’s birth-control mandate as violating business owners’ religious freedom. The case may ultimately go to the Supreme Court.

There has been a shooting at Los Angles airport in which several people were wounded (one critically) and a TSA agent killed. The shooter is reported to have been a white male who appeared to have been targeting TSA agents and who “pulled an assault rifle out of his bag, began to open fire in the terminal and proceeded to the TSA screening area.”

This is a nightmare scenario that’s not difficult to imagine, because the checkpoints for weapons are focused on preventing them from getting on an airplane, not the airport itself. Israel, needless to say, has different ways of dealing with these things.

Speaking of Israel—according to Caroline Glick, Israel needs to understand that Obama has and will lie to and betray it. A brief excerpt:

Since Obama first entered the White House, Netanyahu and his colleagues have used the term “strategic interests” as a euphemism for American pressure. By using the term in the context of the freeing of murderers, Netanyahu and Ya’alon made clear that the US has blackmailed Israel into keeping up concessions to the PLO despite the fact that the concessions demoralize the country, destabilize the government, embolden terrorists determined to murder still more Jews, and encourage Abbas to escalate his support for terrorism and his diplomatic war against Israel.

Read the whole thing.

And William Jacobson of Legal Insurrection covers the recent and depressing goings-on at Brown University.

They voted for it…

The New Neo Posted on by

…before they were against it:

Senate Democrats voted unanimously three years ago to support the Obamacare rule that is largely responsible for some of the health insurance cancellation letters that are going out.

In September 2010, Senate Republicans brought a resolution to the floor to block implementation of the grandfather rule, warning that it would result in canceled policies and violate President Barack Obama’s promise that people could keep their insurance if they liked it…

On a party line vote, Democrats killed the resolution, which could come back to haunt vulnerable Democrats up for re-election this year.

Senate Democrats like Mary Landrieu, Jeanne Shaheen, Mark Pryor, Kay Hagan and Mark Begich ”“ all of whom voted against stopping the rule from going into effect and have since supported delaying parts of Obamacare.

The Republicans were prescient and tried to protect people—or insurance companies, anyway. The Democrats were not and/or did not. How many people will end up making these connections? Interestingly enough, though, the article appears at CNN. The MSM seems to be covering this story with greater fairness than usual—for the moment, anyway.

[Hat tip: Instapundit.]

Looking back at Obamacare: three and a half years ago

The New Neo Posted on by

I am going to post an excerpt from a post I wrote in March of 2010, two days after the ACA was passed and signed into law. I’m not doing it just to say how prescient I was. And I still don’t know exactly how this will pan out in the long run. I’m posting it to show that what’s happening now with Obamacare was not so difficult to predict. In fact, it was rather easy.

Here you go:

…[T]his bill affects people’s lives in the most intimate way possible””their access to health care””and (despite promises to the contrary) the majority of them are concluding that it will ultimately take away from them more than it will give. They judge that it will take not only more money from them, but their present access to medical choice, something most are quite satisfied with now. They calculate that it will take away the high standards of medicine and particularly medical innovation they have come to expect in this country. And it may even take away the country’s solvency, already highly compromised.

All this has been done by the government without their consent””unless you believe that, once an election has occurred, anything that government chooses to do is by definition done with the people’s consent, even if the government’s plans had been misrepresented before the election.

Arguments that Obama campaigned and was elected on this particular bill are ludicrous (worse than ludicrous: transparently duplicitous). The centerpiece of his campaign was a new bipartisanship and transparency, and some general sort of health care reform was going to be part of it. But the specific provisions of this bill (including, for example, the individual mandate, which he had explicitly disavowed) most certainly were not, nor was this process of bill passage. His most oft-stated promise””that you could keep your current health plan if you like it””has become another joke (unless you understood that the promise came with an expiration date of a year or two).

No, there has never been another bill like it. Historical. The comparisons to Social Security or Medicare are laughable as well. Yes, there was some opposition to both among conservatives of the time. But they were very much minority voices and did not carry the day even within the Republican Party. Both bills were hugely popular with large majorities of Americans, and passed with overwhelming bipartisan support in Congress. No one had to go out afterwards to “sell” them like a snake-oil pitchman; they had already sold themselves.

The process by which the bills passed was the normal one, as well. And, more importantly (even though we see the enormous fiscal costs now), they were mostly seen at the time as “win-win” situations by the American public. Nearly everyone paid into them and everyone would be getting something out of them, and for the vast majority of Americans they did not replace better benefits that were already in place.

In contrast, the current bill is seen as taking from the many to benefit (theoretically, at least) the few, as threatening mightily to endanger the economy of the entire country, and was rammed through against the will of the American people. That’s the sort of “historical” we could have done without.

Big F-ing deal, indeed.

I got a bit of a chill reading that, I must say. And it’s not even Halloween anymore.

Another deadline looms…

The New Neo Posted on by

…and the Obama administration and the Democrats may not be able to finesse this one:

According to an Affordable Care Act timetable established by administration officials, early next October insurance companies will announce their new menu of health care plans for the ACA marketplaces — plans that may be more varied and numerous than those offered this year, but that almost certainly will come with higher prices.

The likely price hikes will hit the individual and small-business insurance markets only weeks before Election Day on Nov. 4, 2014.

“What genius came up with that timetable?” asked one key Democrat, who declined to be quoted by name because he is involved in private White House talks.

Democratic senators and their political advisers have been lobbying the White House and the Department of Health and Human Services to push back the next “open season” date until after the election, to no avail.

The concern about the 2014 timetable highlights a fundamental political reality of Obamacare: The success or failure of the program depends largely on the kindness of strangers — the insurance companies — and whatever happens in the marketplace, for good or ill, will be ascribed to President Obama and the Democrats, since Republicans refused to vote for the law or cooperate in efforts to make it work.

Obama may come to regret dissing the insurance companies.

He may come to regret a lot of things. Of course, he could postpone the announcement date till after the election—but even low-information voters might start to get a mite suspicious.

[ADDENDUM: Scary stuff. Well, it is Halloween.]

Those “junk” health plans

The New Neo Posted on by

Bob Laszewski describes his old health insurance plan, one of those cancelled ones that the administration is referring to as junk. And he also describes the plans he could get to replace it.

Read the whole thing, and see which you think is junk. The question for the Obama administration is: how many of the people can you fool, how much of the time?

It becomes increasingly clear why the ACA’s implementation was delayed till long after the 2012 election. It wasn’t just to game the CBO, it was to con the country. So I’ll add to the question above: how many of the people can you fool, how much of the time, and for how long?

[NOTE: See also this. Hat tip: Mrs Whatsit.]