Friday, November 29, 2013

Obama Rescued?

Can he survive the healthcare onslaught?

A follow-up to my recent in depth look at the problems besetting Obamacare finds me indebted to the Sunday Times again this week.

In a editorial by Andrew Sullivan, the difficulties facing the President are analysed and prognostications proposed.

He starts out by reminding us that second-term crises are not new. Reagan, Nixon, Clinton and Dubbya all suffered from malaise in their second term. What seems to be different is the fact that Obama has painted himself into a corner with his own mouth (pardon the chillingly daft mixed metaphor) by promising that people can keep their healthcare plans if they like them. They cannot and if your plan does not meet minimum standards then you have to get a new one.

Question is – can Obama recover?

Nixon, of course, could not. His crime? He lied to the people. Is Obama any different? Categorically? Possibly? Inadvertently? The answer rather depends on you political persuasion.

Sunday Times: “The first issue is indeed healthcare. He is attempting something transformative and immensely difficult in the American context, even though every other developed country has long since passed the threshold of universal care.
Americans, after all, are a conservative bunch – and no-one likes to feel as if their health, of all things, is being jeopardised by a law that Obama need never have passed. Many will see their premiums rise. If the federal website isn't fixed, more and more people are going to go nuts as the “computer says no”.
If confidence collapses, the critical cohorts of young people may not join the system, tipping it into an insurance death spiral, in which there are too many sick people enrolled and not enough healthy people to balance them out. . . . .
If he succeeds, then, it will be by the skin of his teeth, and the odds of him clawing back to more than 50% approval are low. But it's worth remembering that the healthcare law has been declared dead several times. It was never expected to pass the Congress in 2009, which was already grappling with stimulus for the Great Recession. It survived – just – but then nearly collapsed again as the Republicans seized the late Ted Kennedy's Senate seat and the votes were suddenly in question. After that the Supreme Court, in a surprise decision, upheld it. The law is close to being zombie – dead but still alive, and staggering ominously forward.”

Can the Republicans kill it? Hard to do up against the Presidential veto.

Moreover the Republicans have yet to propose any kind of alternative except a return to the status quo – which has very little support. Even now in the law's darkest hour there does not seem to be anywhere near a majority for repeal – according to the Sunday Times.

Back to the Sunday Times: “For all those currently without adequate healthcare provision it will be a godsend. For those whose plans are randomly cancelled or changed just when they need them most it will offer peace of mind.”

Second-term Presidents are always looking to their legacy. Obamacare is going to be this President's legacy like it or not. He has no fall-back position – he must make it work.

Wednesday, November 20, 2013

Follow the Money

Money talks and bulls*** walks - Larry Stoner.

I have been racking my brain trying to remember the origin of the phrase, “Follow the Money”. Finally, I succumbed and looked it up on the ubiquitous Google. Very fittingly, in view of the real topic of this post, the quote is from the film All the President's Men – a doc-u-drama about Watergate. And the moral of the Watergate saga? When a President starts telling lies then he's in real trouble.

So, the Sunday Times this week has an article,Healthcare “lie” leaves Obama under siege, which says quite precisely that the President has lied and he's in real trouble!

President Obama -  either through carelessness, malice, incompetence or downright deceit has been forced to backtrack quickly on the Affordable Care Act (Obama-Care).

Instead of a spirited defence of his policy the President admitted he had “fumbled the ball” by unveiling a healthcare reform website beset with technical glitches.

“Yet he failed to address a more fundamental problem: millions of people had been told their existing health plans were being cancelled – despite having been promised 29 times during the battle to introduce the Affordable Care Act that ''if you like your insurance plan you can keep it''. - Sunday Times.

55% of Americans believe that he flat-out lied. Evidence that White House officials knew that millions of self-employed people would lose their existing plans, but hid this fact so that “Obamacare” could pass.

Given a chance before the media to “man-up” and admit the untruths the President resorted to a tangle of legalese instead. He ain't fooling anyone really. Hiding behind an inept administration is not going to placate those who don't like Obamacare at all and are now as happy as pigs in poop!

Without having to do anything, the President has handed them a bonus – an own goal of monumental proportions.

Under real pressure from Democrats who face mid-term elections next year, the President caved in. He announced that health insurers could extend by a year policies due to be cancelled because they did not comply with the new law.

Golly, thanks Mr President!

Just weeks after the Republican's were taking most of the flak for the government shut-down Obama throws them a life-line.

The Sunday Times thinks, “Obama's biggest challenge is that as problems mount there will be a clamour to modify the law in Congress. If they open this up for any congressional revision whatsoever, it'll be pretty much gutted. There is a good chance of it being overturned now.”

A respected polling organization believes given that Obama has more or less admitted lying getting back the trust of the people is going to be extraordinarily difficult – if not impossible.

“Joe Trippi, a veteran Democratic strategist, said he believed Republicans were afraid of Obamacare being successfully implemented because it would then become part of the fabric of the state, like the 1960's welfare programs Medicare and Medicaid, for the elderly and poor respectively.” - Sunday Times.

Another commentator said that he did not believe that the President had lied but that he had been “blissfully ignorant of the truth because it suited his political purpose.”

If that's the most charitable explanation then it really is pretty lame indeed.

So, where does this leave us and where do we go from here?

Back to the top, I'm afraid, “Follow the Money”.

Ask yourself – why were millions of people being told that their existing health plans were being cancelled?

Research required. I tried. I really tried. I managed to get to the .gov website which has simply oodles and oodles of information. So many oodles that it gave me a headache. I tried to research with Google searches outside the .gov network. Not entirely successful.

Forbes Thought Of The Day

“ Every time we have an election, we get in worse men and the country keeps right on going. Times have proven only one thing and that is you can’t ruin this country even with politics. ”
— Will Rogers

Aside from the brilliant Will Rogers quotation the best explanation which ordinary folk might be able to understand is in the Forbes article above.

I especially like this bit I have extracted from the Forbes article:

“Of course, let us not forget that candidate Obama campaigned for years promising that Obamacare would reduce the cost of family health insurance by an average of $2,500 a year. But instead of going down, the cost of health insurance has shot up. More Calculated Deception? How could anyone think that mandating slews of additional benefits that health insurance would have to provide, in addition to requiring insurers to issue new coverage to everyone at standard rates no matter how sick and costly when they first applied, would do anything but raise the cost of health insurance sharply?”

Follow the Money! I repeat, Follow the Money.

Even a little common sense should have made the voters realise that extending quality healthcare to millions of folks who previously didn't have it was going to cost big bucks.

(You can make a very good case for the voters being very stupid, but politicians are not in the business of pointing this out to their electors – for very good reasons.)

Nevertheless, that's the system.

How about, just for a change we follow the cash. Data from the WHO (World Health Organisation) - BTW if you think the WHO is a communist plot please stop reading now and go and resume digging your bunker.

In the more than 10%-ers of spending as a percentage of GDP we have Belgium, Bosnia-Herzegovina, Burundi, Canada, Costa Rica, Cuba, Denmark, France, Georgia, Germany, Greece, Kiribati, Lesotho, Liberia, Micronesia, Nauru, Netherlands, New Zealand, Niue, Palau, Moldova, Rwanda, Serbia, Sierra Leone, Switzerland, Tuvalu and USA.

Interesting? If we exclude the “minnows” whose large spending can be due to some very odd factors, we have Belgium, Canada, Denmark, France, Germany, Netherlands, New Zealand, Switzerland and the USA.

Is this some kind of exclusive club we should all aspire to join?

I'm not so sure.

Looking at a countries health spending as a proportion of all spending the USA (22.4%) is eclipsed by the Solomon Islands (23.1%) and Samoa (23.4%). Colombia is on the list at (20.1%) and Andorra comes is at a whopping 21.3%.

The USA spends 17.9 % of it's GDP on healthcare – the UK spends 9.6%.

What can we learn from these raw statistics – if anything?

Do you think the healthcare in the Solomons is about as good as the US?
Do you think the healthcare in Samoa is a bit better?
Do you think that Columbian healthcare is actually quite good?
Are the Andorrans among the most blessed folk on earth for healthcare?
Is the healthcare in the US twice as good as the UK?

I've got a “no” on all of the above. I may be wrong, but I'm from Missouri and you are going to have to show me.

I get very annoyed with folks using percentages to “prove a point”. Stop letting the stats blind you and answer a simple question – 10% of not a lot = ?? (if you said “not a lot” you are correct!)

You cannot use stats or mathematics to realistically analyse the cost of healthcare.

Why? Because the cost of healthcare is a bottomless pit. Putting it another way – the cost of healthcare in any society is going to increase as people live longer, new drugs and treatments become available (as drug companies try to recoup their costs by charging massive amounts for drugs which may (for example) provide an extra year of poor quality life for cancer sufferers), more and more people expect more and more from the system and the working (tax-paying) population decreases for simple demographic reasons.

In the Eastern Daily Press we have a senior Conservative politician saying much the same as I.

Anne Widdicombe is not a left-wing loonie. She has impeccable conservative credentials (for a British politician that is).

In the article, The NHS cannot do it all warns ex-minister, her main point is, “The NHS is not going to survive until the end of the century in the form that we know it. We've got to be grown up and recognise that.”

She goes on, “I wish people would stop thinking the NHS can deliver all it – it can't. It has never been able to provide everything and never will. The NHS is limited. It is limited in time and money. People have just got to accept that. It is no good looking for perfection in everything.”

She goes on, “We can only do what we have the resources to be able to do.

She pointed out (as I have already pointed out) hospitals never used to provide cancer care services like chemotherapy and radiotherapy as they do now. Every time they deliver one thing, another demand is put upon them. The demands are soaring towards infinity, so you will get pockets of extremely bad practice.”

She says, politicians are “frightened” of acting (Obama take note!!) because of the huge emotional attachment between the public and the NHS. (US readers do not switch off here – the kind of emotional attachment she is talking about is exactly the same as the attachment folks have for their healthcare plans – no matter how misguided. The President is rightly being pilloried for trying to break that attachment.

From a safe distance, it looks like human nature is at the root of Obama's problems. The folks who are attached to their plans are the self-employed, I believe. The Affordable Health Care Act sees some of these plans as not very good. Why? Well if you are self-employed and cost is your raison d’etre you are unlikely to have opted for a (perceived) expensive plan when you have the choice of a cheaper one. Can't really blame them.

Unless your view is that it is just irresponsible for some folks to effectively opt-out of Affordable Care – knowing full well that if the stinky-stuff hits their fan they will want someone else to pick up the pieces.

In the Western industrial societies, healthcare may be too important to let individuals irresponsibly opt-out. How we square the circle with individual freedom will tax the brains of the best of us.