Obama-The Carnival Huckster

For every problem, there's a cure, and President Obama will tell you what that cure is before he knows the problem. His cure, the nationalization of the health insurance industry. So what's the problem? For one, the majority of Americans do not want his cure and he will not accept that the nation will not roll over and play dead over his "plan". Why? He doesn't have a plan, he has identified the problem, as he and his liberal friends see it, not as the American public sees it. He delegated the job of designing a solution without any guidance, to that much reviled American institution called Congress. No fewer than 5 committees from the House and at least one important Senate committee, with little to no input from the Republicans.

Without leaving Obama's fingerprints on it, Obama's White House negotiated the limitation of damages the major health industry players will incur provided they hop on board the Obama express and promote his "plan". In spite campaigning on a platform to limit the level of involvement of the Washington lobbyists, the backroom arm twisting was facilitated by the very lobbyists he promised to remove from influencing legislation. To show he was going to be tough on removing costs from health care system, he turned his attention on the health insurance industry and on the waste and fraud in the Medicare and Medicaid programs. He wants you to believe that success in these two areas will pay for the new entitlement, subsidized health insurance on a sliding scale for those who claim hardship or can not afford to pay for health care insurance.

Does he think he makes sense? Now, I want to tell you, he does, because he says so. Since the advent of Medicare and Medicaid, every breathing and thinking person in America knows that there is waste and inefficiency. After all, it is a government program, the same government that brought you $1000 toilet seats and several hundred dollar screw drivers. The Amercian people know that their government is not efficient in the handling of taxpayers funds. It knows that Congress is irresponsible with managing the people's money. Every President pledges to remove waste from the government, after all it is there for the picking. Why, with all the Harvard educated geniuses that find their way into government service, have they not wrung out the savings? You know the answer. But, President Obama says he will do it, that it is a new day and we have to look forward. "Yes we can" is his motto. Do you dare to contradict the President? You bet your sweet ass you should because it is all bullshit. If it was there to the degree Obama and his minions believe, it would have been taken and corrected well before now. Nothing in his plan indicates a path to the savings, other than stripping out $500 billion from Medicare under the guise of eliminating waste. Wonder what waste he is talking about, the waste of money by paying for end of life care? How about the "unwarranted subsidies" to insurance companies who offer better coverage to seniors who opt to go to a Medicare Advantage provider, an insurance company that is paid by the government a flat rate to assume 100% of the cost of Medicare patients. The same people who have attracted a growing number of seniors to a government sponsored alternative to traditional Medicare. A plan with growing popularity amongst seniors for its superior comprehensive benefits. Is this the type of waste reduction you can believe in?

When Obama says that seniors should not listen to the scare tactics of the opposition, Should you listen? Damned right you should listen! You need to be aware of the verbal tricks and verbal slight of hand that comes from the rhetoric of the President. You need to challenge his promises. When Obama says that "nothing in our plan requires you to change what you have" you need to be aware of the grand experiment of Congress in the past when the rate to be reimbursed by the government to the Medicare Advantage providers was cut to a level that caused the providers to pull out of the program, leaving the seniors who had opted out of the traditional Medicare up a creek. The reimbursement was reduced to a level that the business was unprofitable and nobody in the industry was going to lose money just to keep the enrollment numbers up. Congress, in subsequent session, reversed the cuts and attracted the insurers back to the program.

Will it happen again? It very well could if the cuts make the program unprofitable! Will Obama and the liberal Congress care, only if the seniors remain silent. Can you afford to be quiet? No, Congress changed the reimbursement and the enrollment was reinstated because the seniors and their lobbyists AARP caused an uproar. Congressmen may be many things, but when it comes to re-election they are not stupid. Obama on the campaign trail said he favored a single payor system. If he does, he may not care that seniors who opted out of Medicare in favor of the Medicare Advantage plans will have to change back to Medicare. He may not understand that your current physician may not take you under Medicare's poor reimbursement or that you will have to change pharmacy providers because the Medicare Advantage pharmacy benefits are managed by someone else. Now, that is change we can believe in!

Now, we know what Obama has said should bethe direction of the solution. His disdain for the health insurance industry is clear, they are the villains, the cause of the high costs of the health care and the leaders of the inflationary acceleration over the last decades. They caused the medical care inflation index to be two to three times the consumer inflation index. They are the greedy ones who kick insureds off the list at the time of most need, the ones who rate based on age and sex, that charge varying rates based on sex and age, and health experience of the individual or the community. Horrors! How could they do that?

Insurance is an underwriting game, a game that takes into consideration variables that attempt to quantify the risk so that a premium can be charged on some rational basis that relates to their expected medical loss ratio, the ratio of payout to premium, or simply, the expected costs of reimbursing providers for providing care. That the costs reflect experience and other actuarial algorithms related to risk and timing of incurred claims versus incurred and unreported claims does not make the setting of price irrational, arbitrary, or capricious as you would interpret from the remarks by Obama. That each state has an insurance commission and are members of the National Association of Insurance Commissioner (NAIC) is not recognized by Obama. Each state abides by the standards established by the rules of the state and the NAIC in formulating regulations that govern all manner of insurance. It should not be interpreted as a loose system that needs the assistance of the Federal Government. It is highly regulated and Obama would upset the delicate system of insurance regulation based on State insurance underwriting standards and would abandon sound actuarial standards of risk management in what he has proposed.

Worse, Obama would nationalize health insurance, applying price controls on many of the elements essential to understanding the risk as an insurance provider, eliminating, in fact outlawing age and sex cohorts, experience-rating standards, prohibit pre-existing conditions as a risk factor, arbitrarily cap out of pocket expenses, remove life time caps. The Federal Government would set the rules and regulate the industry. Then, he would force the insurance providers to compete against a government subsidized not-for-profit option that he claims will have lower administrative costs, lower executive compensation, and more efficiency than the companies that provide coverage now, including the many fine Blue Cross and Blue Shield plans that are currently not-for-profit and cover many of the citizens who could not access group coverage without the BC/BS plans?

Obama says he wants competition to keep the insurance companies honest. This is ok if the competition was on a level playing field with like competition, but with the government establishing an agency-like health care entity with an implied government guarantee, doesn't sound a great deal like Fannie Mae and Freddie Mac, with all the benefits of Congressional tampering and politics as usual tramping on private enterprise. We all know how well Fannie Me and Freddie Mac worked out. Can we risk our health system to such antics?

How many companies will survive this competition? Who knows, but if history is any example, many will just cease to exist or merge creating even bigger behemoths and less competition. It means that the estimated number of 5% of the population is seriously understated. As Obama said, there is nothing in his plan that will require you to change your insurer if you are happy with the insurer. He also says, there is nothing that will require businesses to change the coverage for the employees. What he does not say is what happens if the employer, who makes an economic decision and who finds his costs have increased because of the new limits on underwriting such as out of pocket caps and pricing controls, mandated coverage, and other limits placed on his plan. If the cost is higher than the penalty to pay for not providing health insurance coverage, he may make an economic decision. Either drop and pay the penalty or raise his costs without any offset. Which way do you think he will go?What happens if some insurers simply change their business model, refusing to lose money on each subscriber? You lose, and the taxpayer loses.

Now, most large businesses no longer purchase "indemnity" plans, rather, they have switched years ago to what is called "ASO" plans, health coverage where the larger employers self-insure, contracting with insurance companies who bring a network of providers, negotiated prices, information systems for claims processing, consultation on plan design, etc, but not insurance. This is true of the large employers, but encompasses employers as small as 500 employees. The insurance companies charge a few per subscriber, but take no risk. The employer takes the risk and funds the medical expenses, accruing unknown medical expenses. Under Obama's plan, how will they know what their risk is and will they be able to charge the employees and the dependents enough of a contribution, together with the employers portion, so that the health care costs do not become a surprise? With much uncertainty in the calculation, employers will be motivated to find the cheapest care.

What about the people who have been responsible and purchased individual policies, joined community HMOs, bought indemnity plans who now see their cost go up with the uncertainity of underwriting? Will they keep their own coverage or will they capitulate and drop coverage and buy the cheaper plan? undoubtedly, there will be many who change plans to the government plan and probably will have to change doctors because their doctor will not accept the reduced reimbursement the government plan will pay.

That is why it is disingenuous of the President to sell his plan as if there will be minimum disruption to the existing system. This is why it it not credible for the President to stand there and lie to the American public and misrepresent the damge his plan will have to the safety and security of our healthinsurance we currently have. A health system that is working for 85% of the people, the people who favorably rate their existing coverage. Be honest, Mr. Presidnet, tell the people you really want a single payor system. Quite trying to sell them an elixir when you know it is just snake oil! Any other words, no matter how eloquently delivered, are just words, just words, you know!

We know the health system can be improved, can be held more accountable for outcomes, and should provide health care to American citizens who can not afford health insurance with out some help, either with tax credits or vouchers do to incomes to large to qualify for Medicaid, but not enough to pay for Health coverage. We should mandate enrollment of all eligible children in CHIP and SCHIP programs as a condition for the continuation of welfare payments or food stamps. We can change eligibility for Medicaid to provide health insurance to the most needy. We do not need to upset the entire system working for 85% of the people for the 10 to 12 million who need a hand in affording health care. We do not need some grand experiment with a public option, we already have public options, and they are not very efficient nor cost effective, because they are government programs. We do not need another entitlement that will be bankrupt in 40 years. We need some common sense solutions that we can all get behind. We need a bipartisan consensus, not a partisan plus 1 or 2 solution.

Obama's Little Engine That Could

Let's get one thing straight from the beginning: America's health care is too expensive, too over-utilized, uneven in delivering a quality product, and too damned dependent on the Federal government for over half of it's revenues and, for most of the rest, the business community continuing to provid health insurance as a benefit to their employees.

Moreover, many people are left without access to health care insurance through their own neglect, either by failing to enroll their children, who would otherwise be covered by Children's Healthcare programs in existence, and recently extended by the CHIPS program extension in the Stimulus package and in various add-0n features of the flurry of bills passed in the first one-hundred days of the Obama presidency. Yes, there are people who can not afford health insurance and are not provided health insurance through their employer or do not meet current thresholds for assistance, "the working poor". There are also people who could afford health insurance but decline to allocate the money to buy it.

Included in the group of un-insured is the demographic age group spanning the 18 year olds to 35 year olds, who often eschew health insurance. Of course there are a multitude of illegal aliens who are without health insurance, in spite of have employment, that daily tax the health care providers with unpaid bills. There are older adults who choose not to buy health insurance that add to the number of people who are un-insured.

That a nation as rich as America can not figure out how to assure every citizen has the opportunity to be insured against the risk of disease speaks more to the will of a nation than the ability of that nation. It also audibly cries out the need for honesty in the debate.

The populists politicians sound convincing as the assess the blame for this sorry state of affairs. It is the rich corporations who pass on to much cost to the employees and paternally dole out health care benefits at an alarming increase in cost to their employees, all for the sake of profit for their rich shareholders. Big Health insurers are blamed for being profiteers. Opposition parties are cast as fear mongers and "mobs" when they loudly rally to protect the health insurance they have from falling into government hands. "The party of 'no', is the rallying cry of those pushing for radical reform.

Few would argue against a serious attempt to improve access to health care, to make it more inclusive, to be less expensive for the insurer, the sponsor, and the insured, for "cost" are different for each stakeholder. Imperfect terms lead to imperfect interpretations. One man's cost (the insurance company or the government's cost) becomes another's benefit. If we move to reduce the cost of services covered by the government or the insurance company, it has to be taken out of someone's hide. In the case of the insurance company, it means either less service covered for the beneficiary or more out-of-pocket costs to the beneficiary. Simple!

In the case of the government's drive to reduce its costs, similar effects occur: services are reduced for beneficiries (as often happens when States experiencing cost overruns in their State Medicaid programs) or when the cost of Part B benefits increase for those enrolled in Part B under Medicare to offset the annual inflationary costs of the Medicare program. Who pays? Not the Federal Government. It is the beneficiary who pays, either in more dollar costs or in reduced covered service. In either case, the beneficiary either pays or defers service. Then there are those who take the service and leave the providers with bad debts, in which case it raises the cost to the provider, burned by the bad debt. Somebody pays and it is usually the beneficiary and the trade off is in dollars or in reduced benefits. There is no free lunch.

The liberals want government heath care and are glad to spend anyones money ecept their own to achieve this goal. The conservative like the status quo, private enterprise approach filled with incentive to make the right decision (what ever the right decision is) and take responsibility for one's own health care decisions. Now this make a lot of sense! Let people, ill equiped to make life or death decisions with little to no support but the internet and the Pharmacy industry advertisments on there favorite soap oprea. Now that is improvement!

Both major parties insist that it is possible to provide low cost, high quality health care to all regardless of financial or health status. (We usually are warned, "If it sounds to good to be true, it probably isn't). We are asked by both parties to suspend disbelief. The liberals want radical reform atany cost and ditch the existing system as a failed system. The conservatives want to find cost-savings, but take serious cost savings off the table. Neither party is willing to be honest with the American public.

During the aftermath of the recent financial meltdown and busting of the housing and credit bubbles, the politicians began to assess blame. First on the target, big business, big banks, and greedy executives. Having assigned the blame, their job was to come up with a solution: assign the government the job of preventing the abuses they identified, seek penalties against the perpetrators, raise taxes and impose restrictions on executive compensation. In short, re-regulate, for the Government is the only entity that can assure competency. We are to believe that these steps, imposed on the engines of growth, would have no unintended consequences. That there would not be a cost to somebody in all these actions. that banks would not figure out how to charge higher costs to offset punitive aspects of the government's drive to prevent financial meltdowns. They want us to believe that you can lower cost and not effect the quality of financial services.

What is scary, they want the same wrong-minded thinking applied to the one thing that trumps financial self interest, the health insurance system that pays our health care costs so we do not have to worry. Was the government successful in managing Fannie Mae and Freddie Mac. How about our perpetually bankrupt US Postal Service? Is the VA well managed, how much waste do they experience annually as a result of Congressional tampering? Are we getting our moneys worth out of all the Amtrak subsidies? Were is the return for all the taxpayer money invested in AIG? Can you think of one governmental program that would give you comfort that the Government can get health care right?

Well, they know better than that. All that talk from Obama and his White House advisers about squeezing the excess out of Medicare, eliminating the abusive practices of doctors and hospitals, ending fraud, and reducing the costs of Medicare and Medicaid to a sustainable level is just talk. Remember during the Obama campaign, we heard Obama say, in response to points driven home by the challengers, "these are words, just words". We now know what that means. The program laid out are "words, just words" lacking any substance and merely to move the populist notions ahead to a naive body of listeners ready to drink the "next kool-aid" of Obama thoughts.

Of cousre, the Republican party is no better at coming up with hyperbole. What they lack is any measure of a plan. Obama has words as his plan, since he delegated the process to Congress and has remained aloof in it drafting. Read that, provided no leadership. Republicans have only one word, "no". Like a two-year old going through the "terrible twos", they cry out "no". They have nothing else. No plan to improve access, cost, and assure quality. The Republican National Committee only today announced the "senior's health bill of rights". As usual, the tone-deaf body is proposing to be opposed to any move to trim Medicare spending or limit end-of-life care.
Nice move, Mr Steele! You too, like Obama and Congress, have taken any serious attempt to reduce the cost of the Medicare program off the table. You and the Obamaniks must still believe everything keeps rising, housing prices, the stock market, and your poll numbers. Do you believe in the tooth fairy? Why, Obama has even cozied up to the special interest groups (Big Pharma, Hospitals, and Doctor lobbyists) and cut deals that are meaningless to cost saving (the savings woud come anyway, Obama just put a floor on the damage at a pittance of what could be saved under existing law). Why, to get there vote, to enlist them in his campaign to shove a costly health reform plan down the throats of an unwilling public.

We have heard the clear message from a majority of Americans. They don't like the snake oil Obama is selling. They want to know the truth. They want a debate, not a freight train, Yet, Obama and the Obamanik elites want to dismiss the voices of the rabble as the bable of a mob. Un-American mobsters to boot.

Yet, we have the Obamaniks and Congress hell-bent on pushing health care reform, including a public option (the White house handlers have banned the real term Government option). They believe that Choice and Control (they have also banned the use of the real term Competition when describing their plan). The plan they envisage will result in Quality, affordable healt care (The White House has also banned the true description "Universal coverage).

You get the drift? Words, just words used to manipulate the debate and keep the naive public in the dark by choosing words that the public likes and confirmed by focus groups and polls of words that describe the plan, well chosen words to obfuscate, manipulate and deceive. But don't worry, our friends at the loyal Republican opposition have their own obfuscating words. "Patient-centered health care" is substituted for "Private/free-market health care", "health care is seriously toubled and needs serious reform" is used instead of "health care is a good system but still needs tweaks". The list goes on and anyone interested can read more about this on the Wall Street Journal Part A article entitled "Obama Allies Find Words Fail Them". Health care reform by the polls, now that is change we can believe in!

When you think about a government designed program for health care reform, we should all keep in mind these simple phrases: Amtrak, Fannie Mae/Freddie Mac, AIG, USPS. Each a creation of government planning gone wrong. Each a financial disaster. Can we trust them with 17 % of our GDP? With out more conscientious debate, more open and honest dialog with the American public, we are on a collision course for a major train wreck with 17% of our GDP and trillions of dollars in deficits you and me, the taxpayers, will have to pay. That would eliminate most of the artificial savings targeted by the current plan, not to mention the increase tax that a growing number of Americans will pay to adopt a poorly thought out plan.

We must insist on a careful and thoughtful debate. We need to assess the health care system in its entirety. Do we wreck a system that is working for 85 % of the people in order to solve the problems of access for a yet undetermined number of un and under insured people. What do we do to strengthen the existing health care insurance system, make it affordable, lower costs, and improve quality outcomes that would fund the access for those who need a hand in buying health insurance and mandating those who can afford insurance, but chose not to buy it. Can this be done by providing incentives, negative or positive, that incorporates the many Democratic and Republican ideas being offered, but ignored by the Obamaniks.

Can we face the need to rein in health care costs to make the system affordable and turn a deaf ear to the lobbyists? Can we understand that this will have to be a shared sacrifice by all, not just a taxing exercising aimed at the rich?

With a more open debate, an informed public, and a slower pace, yes we can achieve change. Yes we can achieve improvements. But we can not tax our future generations and leave them with trillions of dollars of debt in the name of progressive (liberal) ideology. We can not accept the status quo in the name of conservative ideology. the answer is always at the mean.

At the entrance to Zhong He Dian at the Forbidden Palace, Beijing, is an inscription written by Emperor Qianlong. It reads, "the Way to Heaven is profound and mysterious and the way of mankind is difficut. Only if we make a precise and unified plan and follow the doctrine of the mean, can we rule the country well". This was written around 1627. It is a lesson our leaders would be wise to follow. For surely, as we hear the rhetoric from the liberals on the fringe of American society, a couse of action that bypasses customary legislative protocal in an attempt to ram through radical reform, is surely a road to a train wreck. If the Obama administration truely wants to govern well, they are heading on the wrong track to nowhere. The American people know that. Hopefully they will learn that, too.