ObamaCare Worse Than Medicaid??

 

Medicaid is the worst healthcare insurance anyone can have. Everyone knows that. Doctors are paid so little to see Medicaid patients that most refuse to accept them. Healthcare outcomes have been shown time and again to be worse than any other kind of healthcare insurance. The Oregon Healthcare Experiment, an ongoing study since 2007, has repeatedly found that Medicaid patients are no better off than those who have no insurance, especially when it comes to controlling blood pressure and diabetes.

So it comes as a shock when someone makes the claim that ObamaCare can be worse than Medicaid! But that’s exactly what John C. Goodman, acclaimed healthcare economist and founder of Health Savings Accounts (HSAs), recently stated in The Wall Street Journal.

Goodman’s argument is that the best hospitals and doctors are now refusing to accept ObamaCare exchange plans while still accepting Medicaid in some cases. For example, consider Houston’s MD Anderson Cancer Center, named America’s best cancer-care hospital by U.S. News & World Report in 13 of the past 16 years. The hospital’s website says it doesn’t accept a single private health insurance plan sold on the ObamaCare exchange in Texas, but it does take Medicaid.

In Minnesota, the world-renowned Mayo Clinic, once cited by President Obama as a model for the nation – withdrew from the ObamaCare exchanges in 2016. In New York, Memorial Sloan Kettering is now off limits for every exchange plan sold in New York. Both hospitals are open to some Medicaid patients, though Mayo’s CEO has predicted publicly that Medicaid patients may eventually have to stand in line behind privately insured peers.

We all remember when Obama promised healthcare insurance for everyone and “if you like your doctor you can keep your doctor.” What kind of healthcare insurance was he talking about? Most of us believed it would resemble the employer-provided plans that most Americans enjoyed before ObamaCare. Goodman says, “Who imagined that the only products available would be more limited than Medicaid?”

How did we come to this?

When ObamaCare was introduced to the nation in 2014, it looked a lot different from today. Blue Cross of Texas as it was initially sold on the ObamaCare exchange looked a lot like most employer plans. Coverage extended to every hospital in the Dallas-Fort Worth area, including the prestigious University of Texas Southwestern Medical Center. But after sustaining huge financial losses trying to work within the ObamaCare regulations and pricing structures, the insurer pulled back on benefits and treated the UT Southwestern Medical Center as an out-of-network hospital.

That meant patients who chose to go there faced steep out-of-pocket expenses on top of rising high deductibles. The following year UT Southwestern was excluded from the plans entirely. This process of elimination of the best hospitals, and doctors, has been repeated around the country. Large insurers, including Aetna, Humana, and UnitedHealth Group have withdrawn from the marketplace for ObamaCare patients in most locations.

That doesn’t mean Medicaid is getting any better. In June, the Dallas Morning News published a year-long investigation into Medicaid in Texas. The paper uncovered hundreds of cases in which “essential medical care was delayed, denied or not delivered to people with critical health needs.”

The Fundamental Problem

The ObamaCare system of insurance is a broken model. The fundamental problem, says Goodman, is community rating. This requires insurers to charge the same premium to all comers regardless of their health status. “This gives insurers an incentive to seek healthy buyers and avoid sick ones. Since healthy people tend to pick the cheapest plan, and sick buyers are much likelier to look carefully at coverage details, plans with low premiums and narrow coverage networks are suited to attract the healthy buyers insurers want.”

Something called “risk adjustment” was supposed to compensate insurers for the expensive patients but it has failed to deliver as promised. Goodman says, “The program’s administrators don’t always assess risk properly. When ObamaCare’s risk adjustment undercompensated insurers, they passed along the cost to certain patients through higher out-of-pocket charges, according to a 2016 study by Harvard and University of Texas economists. Insures also have an incentive to spend not a penny more on the plans than the risk-adjusted compensation they get for enrollees, meaning such plans tend to offer restrictive coverage.”

The Individual Mandate was supposed to force Americans to purchase health insurance they didn’t want just to subsidize the high cost of coverage for sicker patients. Although it was upheld in a controversial decision by the Supreme Court, it was weakly enforced and provided little incentive to purchase expensive, poor coverage. Millions of healthy patients refused to enroll and the Trump administration finally eliminated the mandate in 2017.

It is obvious that Congress needs to do something about this healthcare train wreck. When even dreadful Medicaid is better than ObamaCare, you know the train is off the track.

Global Warming: A Tale of Two Opposing Views

 

No wonder we’re all confused. When two different observers draw opposite conclusions from the same facts, it’s hard to know whom to believe.

This year marks the 30th anniversary of the testimony of NASA scientist James E. Hansen before the Senate Committee on Energy and Natural Resources in 1988. Hansen painted a dire picture of the future due to global warming and expressed his “high degree of confidence” in a “cause-and-effect relationship between the greenhouse effect and observed warming.”

Hansen laid out three possible scenarios for the future:

  • Scenario A – called “business as usual” – assumed the accelerating emissions growth typical of the 1970s and ‘80s. He predicted the earth would warm 1 degree Celsius by 2018.
  • Scenario B – set emissions lower, rising at the same rate today as in 1988. He called this outcome the “most plausible” and predicted it would lead to about 0.7 degree of warming by 2018.
  • Scenario C – set constant emissions beginning in 2000 – which he deemed “highly unlikely” – and predicted temperatures would rise a few tenths of a degree before flatlining after 2000.

 

These are the facts from his testimony in 1988. How did things turn out 30 years later? Which Scenario actually happened? Depends upon whom you read.

Patrick J. Michaels and Ryan Maue of The Cato Institute write their opinions in The Wall Street Journal. They say the winner is Scenario C. Global surface temperature has not increased significantly since 2000,(emphasis mine) discounting the larger-than-usual El Nino of 2015-16. Assessed by Mr. Hansen’s model, surface temperatures are behaving as if we had capped 18 years ago the carbon-dioxide emission responsible for the enhanced greenhouse effect. But we didn’t. And it isn’t just Mr. Hansen who got it wrong. Models devised by the United Nations Intergovernmental Panel on Climate Change have, on average, predicted about twice as much warming as has been observed since global satellite temperature monitoring began 40 years ago.”

They say Hansen was also wrong about his claims that hurricanes would get stronger and they would cause increasing amounts of damage. He said tornadoes would also get stronger but they say National Oceanic Atmospheric Administration (NOAA) data suggests the opposite.

In a 2007 case on auto emissions, Hansen testified that most of Greenland’s ice would soon melt, raising sea levels 23 feet over the course of 100 years. Michaels and Maue say, “Subsequent research published in Nature magazine on the history of Greenland’s ice cap demonstrated this to be impossible. Much of Greenland’s surface melts every summer; meaning rapid melting might reasonably be expected to occur in a dramatically warming world. But not in the one we live in. The Nature study found only modest ice loss after 6,000 years of much warmer temperatures than human activity could ever sustain.

On the other hand, Seth Borenstein, writing for The Associated Press, claims an entirely different interpretation of the data. He says, “Thirty years later, it’s clear that Hansen and other doomsayers were right. Earth is noticeably hotter, the weather stormier and more extreme. Polar regions have lost billions of tons of ice; sea levels have been raised by trillion of gallons of water. Far more wildfires rage.”

Borenstein claims the world’s annual temperature has warmed nearly 1 degree and the temperature in the U.S. has gone up even more – nearly 1.6 degrees.

Two totally different points of view from observations of the same data.

What are the backgrounds of these different writers?

Seth Borenstein is a journalism professor for New York University and a science writer for The Associated Press.

Patrick J. Michaels has a PhD in ecological climatology from The University of Wisconsin – Madison. His doctoral thesis was entitled Atmospheric anomalies and crop yields in North America. He is a senior fellow in environmental studies at The Cato Institute.

Ryan Maue has a PhD in meteorology from Florida State University and was awarded a National Research Council postdoctoral associateship at the Naval Research Lab in Monterey, California where he focused on global weather prediction and verification. He is also a research meteorologist and adjunct scholar at the Cato Institute.

Who is correct? Their scientific credentials should help you decide.

Healthcare Reform Under Trump

 

President Trump promised to repeal and replace ObamaCare with something better. Democrats, and three Republicans, have prevented that achievement thus far. But there is much to celebrate, nevertheless.

The Individual Mandate has been eliminated, attached to the Tax Reform bill that passed in 2017. No longer must Americans purchase a health insurance policy or pay a tax penalty. They once again have the freedom to purchase insurance or not.

The Trump administration has also permitted more low-cost “limited duration” insurance plans, extending their eligibility up to 365 days and making them renewable. This has allowed more Americans to afford health insurance.

The Labor Department recently announced new rules to govern Association Health Plans (AHPs), which will allow small businesses to enjoy the same benefits of lower premiums and economies of scale as large businesses have always enjoyed. (ObamaCare Relief for Small Business)

Dr. Scott W. Atlas, senior fellow at Stanford University’s Hoover Institute, says the next step should be to expand and improve Health Savings Accounts (HSAs). HSAs allow people to set aside money tax-free to pay for health expenses. But they also serve an important function in lowering healthcare costs. They put consumers directly in charge of their healthcare purchases, which drives competition, which lowers prices for everyone.

The problem in healthcare is that most consumers never actually see the price of what they’re purchasing. Most healthcare bills are paid by third-party payers such as your healthcare insurance company, Medicare, or Medicaid. Patients are mostly aware of just the co-pays and deductibles they pay directly. This separates consumers from the real costs and lowers incentives for them to save money. Healthcare providers, doctors and hospitals, don’t have to compete on prices.

But HSAs change all that. They give patients the incentive to save money (their money), by finding the best price for their health care purchases. This creates competition, fosters transparency in prices, and increases quality while lowering expenses.

Atlas says outpatient nonemergency care forms the bulk of healthcare expenditures and therefore is amenable to price-conscious purchasing. Almost 60% of all health expenditures for privately insured adults under 65 and almost 40% of the elderly’s expenses are for outpatient care, according to a 2012 report from the IMS Institute for Healthcare Informatics. Prices rapidly decrease when patients pay out-of-pocket for procedures like Lasik corrective vision surgery and MRI or CT scanning. Data from MRI and outpatient surgery confirm that prices fall almost 20% when patients are motivated to shop around.

How effective are HSAs at lowering expenses?

Spending reductions averaged 15% annually, according to a 2015 National Bureau of Economic research paper, when workers were given high-deductible plans. When HSAs were added to the high-deductible plans, savings increased to up to 30%. These reductions occurred without harming patients’ health.

By the end of 2017, there were at least 22 million HSAs in the U.S., up 11% year-over-year. These accounts benefit middle-income families as well as high-income families. Median household income for HSA holders is $57,060, and two-thirds earn less than $75,000 per year.

Currently these HSAs are tied to specific insurance deductibles, which limits their usefulness. To maximize consumer power on prices, Atlas recommends Congress remove restrictions on full HSA participation by seniors on Medicare. Motivating seniors, the biggest users of healthcare, to seek value is crucial to driving prices lower.

Personally, I have had an HSA account for years, but was saddened to learn that I could no longer add to the account when I turned Medicare eligible. This is a counterproductive restriction that makes no sense if we want to lower healthcare costs.

The keys to lowering costs are competition and consumer incentives to compare prices to find the best value for their healthcare dollar. HSAs are a great way to achieve both.