Patterico's Pontifications

10/7/2009

ObamaCare: A FAIL from sea to shining sea

Filed under: General — Karl @ 7:36 pm



[Posted by Karl]

The story of large-scale government takeovers of healthcare in America is the story of consistent failure.

Don’t take my word for it. Take the word of ObamaCare cheerleader Ezra Klein, who wrote in 2007 about how state attempts at government-controlled health care failed time and again — in Washington state, Hawaii, Tennessee and Oregon (I have added links for more detailed looks at some of these failures). While differing in the details, the stories shared common elements — skyrocketing premiums, driving out private insurers, “unexpected” floods of people into the public system, and ultimately rationing and benefit cuts.

Klein missed similar tales from Maine (x2), South Dakota and Kentucky, where mandates drove almost all insurers out of their respective states (something to remember when liberals complain about the lack of competition in health insurance markets).

Klein also missed the failure of insurance exchanges in Texas, Florida, North Carolina and California. Cappy McGarr, the chairman of the Texas Insurance Purchasing Alliance from 1993-95, writes:

If Congress now creates new exchanges, as seems increasingly likely, it must prevent this phenomenon by setting two national rules: Insurers have to accept everyone and have to charge everyone the same rates regardless of health status.

Such rules would force insurers to spread risk. But enforcement would also be difficult. Every aspect of health insurance — from the rules for underwriting and setting premiums to the marketing of policies — would need to be monitored stringently to prevent companies from steering all bad risks to the exchanges. (Emphasis added.)

Requiring insurers to accept everyone (“guaranteed issue”) and charge the same rates (“community rating”) will cause insurance premiums to skyrocket, perhaps double. For all of the Democratic rhetoric about how ObamaCare will promote choice, it is clear that the point of the exchanges is to reduce choice. Jon Kingsdale, who runs the Massachusetts exchange, is more honest about the need for the exchanges to reduce choice.

Speaking of Massachusetts, Klein’s 2007 piece was excited about the then-new government takeover there, but noted that the state might be a special case because it had one of the lowest uninsured populations in the country, a wealthier-than-average population, and a pre-existing tax to fund it. Those exceptional factors would seem to make it a bad model for ObamaCare, even it if worked — but of course, it does not work as advertised. In 2009, we discover a program ripped by everyone from the CATO Institute to the left-wing Institute for America’s Future. Average health care premiums in the state are rising faster than the national average, people are choosing to pay the fines instead, wait times for care are rising, and even 13% of the insured have to forego care because it is so expensive. As in Oregon, the government is already headed toward rationing care. Yet analysts agree that the proposals now crawling through Congress are close to those already increasing costs and decreasing quality care in the Bay State.

The liberal response to this record of failure has been to claim that it shows that the government takeover of healthcare must be national in scope — a “no exit” approach that again flies in the face of Democratic claims about preserving choice and competition. The fact that Medicare and Medicaid are in sad financial straits themselves bothers them no more than the failure of all their other healthcare efforts.

Stranger still, the politicians considering voting for ObamaCare miss some of the obvious political lessons to be drawn from these failures. For example, in Washington state, following a citizen’s revolt, control of the state House switched from 65 Democrats and 33 Republicans to 61 Republicans and 37 Democrats, and Democrats were reduced to a one seat margin in the state Senate. Democrats from Washington state also lost the most seats in the US Congress in 1994, including House Speaker Tom Foley. In Tennessee, a tax revolt over funding TennCare ended at least 16 years of GOP control of the governorship. Previously, when Congress passed the Medicare Catastrophic Coverage Act in 1988, a citizen’s revolt forced Congress to repeal the law by huge margins before it went into effect.

The old saying defining insanity as doing the same thing over and over, but expecting a different result, comes readily to mind.

–Karl

25 Responses to “ObamaCare: A FAIL from sea to shining sea”

  1. Hawaii is an excellent example of the effect of a “public option.” The state provided a subsidized children’s coverage for those who couldn’t afford private coverage. Seven months later, the state dropped the program. Why ? The parents all dropped private coverage and went for the state subsidized program. It, of course, went broke and, after seven months, they cancelled the program. Hawaii can’t print money; the feds can.

    Mike K (2cf494)

  2. And yet it seems Republicans are caving. I don’t think politicians are capable of learning long-term lessons when all they think about is short-term re-election. That’s why I favor term-limits that makes everyone a lame duck after a few years.

    DRJ (7fbae6)

  3. Good post Karl.

    I wonder if folks like Myron and bored again will ever acknowledge the health care reform experiments already tried in so many states and the after effects as they pimp for their favorite bill. They always seem to ignore that we’ve tried most of the shit being floated by the Dems before and they can see what happens if they want to take a look. Shoot, you even provide a bunch of links to make it easy for them.

    daleyrocks (718861)

  4. Racist

    JD (3e97b4)

  5. DRJ,

    If the GOP is caving, how is Erickson the only person with the story? Indeed, how would caving serve the re-election prospects of almost all of the GOP Senators? Does anybody think the Senate GOP is sufficiently competent to keep their cave-in a secret from everyone but a single blogger?

    Erickson may believe he is reliably informed. I will too — when I see other people with the story, preferably with names or some description of the sourcing.

    Karl (246941)

  6. Karl,

    I have no idea what’s true anymore, primarily because I don’t trust many people in Washington. They may be decent people on a personal level but their principles are easily skewed. Take George H.W. Bush — a nice guy who I think meant it when he said “Read my lips” — who nevertheless broke his vow for reasons that made sense at the time. Washington makes it easy to compromise principles everyone swears they would never compromise.

    DRJ (7fbae6)

  7. I just look at what a clusterf*ck the “Cash for Clunkers” program was to get an idea of what Obamacare will look like.

    Both are programs roughly cobbled together and pushed through without a lot of forethought towards the actuall implementation and maintenance, all to address some perceived “crisis.”

    The Cash For Clunkers actually made things worse, because now dealerships aren’t making mission for the next few months becuase they sucked all their buyers forward. Ooops. No one seemed to think of that.

    I suspect there will be a lot more “Opps, no one thought of thats” with Obamacare as well.

    Steve B (5eacf6)

  8. “…in 1988, a citizen’s revolt forced Congress…”

    Who can forget those terrifying images of vicious crowds chasing the benevolent Chairman of the Ways & Means Cmte through the streets of Chicago…Ah, those were the days!

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  9. DRJ: I read the same post over at RS, and I think the reports of Republicans caving are greatly exaggerated. But yeah, I agree, it’s hard to tell what’s true anymore. What bothers me is that I know that’s the way the politicians want it.

    I do think there will be one last big push for a real public option before Congress passes some version of the bill with a very weak public option-like addendum that, as I’ve heard it put, will be “caveated to death.” I also wouldn’t put Snowe’s trigger off the table, as a way to appease those of us to the left on reform.

    Daley: There is no doubt previous attempts at the state level have not worked well on the funding side — I would not argue otherwise. The programs have been popular, though.

    I guess where we part is that I think the funding can be worked out with a little bit (or maybe a lot!) of ingenuity. Medicare and Social Security, we are finding now, have not been worked out fully on the funding side either. But no one takes that as a cue to abandon either.

    And one of the great joys of this debate for me has been watching Republicans zealously defend Medicare, a program they once vigorously opposed. It puts a smile on my face. Bold prediction: Down the road, maybe after we’re gone and nobody can say I wasn’t right, there will be Republicans defending universal coverage. Hey, I can dream. :)

    Every other western nation has found a way to extend universal care, and for cheaper than what we pay with our spotty care. That doesn’t make sense to me.

    Are the people in France that much smarter than us? They think they are, but I don’t think so.

    I guess I think the U.S. can do nearly anything it sets its mind to.

    But I sort of agree with Seinfeld. Maybe it’d have been better if we hadn’t put a man on the moon. Then our seeming lack of competence/ideas in other areas would make sense. :)

    Folks Like Myron (aka Myron) (6a93dd)

  10. BTW, I would add that, if we had better life expectancy outcomes, that would be a stronger case for keeping the current system in place. But, we don’t. We’re in the 30s. That’s not good enough for me. Even Israel is ranked 10. You can’t get more stress than what they’re dealing with — literally beset by enemies on all sides.

    But they do have universal coverage.

    Folks Like Myron (aka Myron) (6a93dd)

  11. Myron – Popularity means what exactly? Funding is a rather large portion that has yet to be addressed in any substantive way. But Barcky won’t sign anything that is not deficit neutral. He promised.

    JD (78047c)

  12. The best example is Los Angeles County King-Drew Medical Center.

    Michael Ejercito (6a1582)

  13. Steve B: Your view of Cash for Clunkers is extremist. It was generally considered a qualified success. Far from a “clusterf**k,” though I love that word (I live in a military town) and would never object to its copious use.

    The cash incentives for homes also seems to be working well and will probably get extended.

    I guess I’m saying that there are better examples of government incompetence. The VA comes to mind, though it works well for some people, others not so much.

    Folks Like Myron (aka Myron) (6a93dd)

  14. Funding is a rather large portion that has yet to be addressed in any substantive way.

    JD: You’re aware of the CBO report, correct?

    Folks Like Myron (aka Myron) (6a93dd)

  15. Folks like Myron keep claiming that life expectancy is an indictment of our health care insurance system.

    But that’s been debunked so often that you’d think they would give up repeating it.

    No, they don’t give up. Because fraudulent arguments are their core arguments.

    SPQR (26be8b)

  16. Funding is a rather large portion that has yet to be addressed in any substantive way.

    JD: You’re aware of the CBO report, correct?

    Or were you speaking specifically of the public option?

    Folks Like Myron (aka Myron) (6a93dd)

  17. SPQR: Yes, silly me, I will cling to the “fraudulent” claim that living longer is a sign of good health.

    Myself and doctors, who by a firm majority, support a bill with a public option.

    Folks Like Myron (aka Myron) (6a93dd)

  18. Yes, silly me, I will cling to the “fraudulent” claim that living longer is a sign of good health.

    It is also a sign of avoiding death by accident or homicide.

    Michael Ejercito (6a1582)

  19. Myron – Life expectancy. In order to compare life expectancy you have to know how the base data is treated. How do the data collectors handle deaths very early in life? If a child is born three months premature and dies the next day in the US they are counted as a live birth and are figured into life expectancy. In many countries they would not be, some countries ignore all deaths among infants below a certain arbitrary age.
    If I figure the average life expectancy of a man who lives to be 70 and an infant that dies as he is born I get an average of 35. If i figure the life expectancy of a man who lives to be 70 and an infant that dies as he is born (but ignore the infants data point) I get an average of 70.

    Have Blue (854a6e)

  20. Polls show that as many as 45% of Doctors would retire rather than work in a system dominated by a government run option.

    Have Blue (854a6e)

  21. I guess where we part is that I think the funding can be worked out with a little bit (or maybe a lot!) of ingenuity. Medicare and Social Security, we are finding now, have not been worked out fully on the funding side either. But no one takes that as a cue to abandon either.

    So we can’t work out Medicare and SS funding but the new program’s funding can be worked out.

    And one of the great joys of this debate for me has been watching Republicans zealously defend Medicare, a program they once vigorously opposed. It puts a smile on my face. Bold prediction: Down the road, maybe after we’re gone and nobody can say I wasn’t right, there will be Republicans defending universal coverage.

    So what were the Republicans claiming about Medicare back then? That the cost would explode the budget, among other things.

    Opponents claim Obamacare will increase costs, reduce choice and result in rationing. So what’s Myron’s response? The Republicans support Medicare now.

    So what should we conclude based on Myron’s flow of logic? That Obamacare will increase costs, reduce choice, result in rationing and that Republicans will be supporting it by then. And that will make him happy.

    Gerald A (138c50)

  22. Which CBO report? The one that states there will be unsustainable deficits or the one that uses the ficticious Medicare cuts?

    JD (45da85)

  23. Yes, silly me, I will cling to the “fraudulent” claim that living longer is a sign of good health.

    You are not being merely silly, Myron. You are being dishonest. Life expectancy is not strongly correlated with universal health insurance – which is the claim you deceptively intend to make.

    And you know this. This is not an accidental distortion on your part from ignorance. You actually know you are being dishonest, Myron.

    SPQR (26be8b)

  24. “I guess where we part is that I think the funding can be worked out with a little bit (or maybe a lot!) of ingenuity.”

    Myron – One of the great joys for me in this debate is reading the comments of progressives such as yourself who are obviously uninterested in digging into the details of how these programs will actually work. Your blythe dismissal of funding as an issue which can be worked out later is a classic symptom of a belief that the government (a public option) will solve all our problems and has an endless supply of money or will take enough away from other people to pay for what it needs to accomplish. Funding is an issue central to reform, since it involve costs after the bill is passed. The examples we have seen show the provisions which the Democrats are pushing actually lead to higher prices for health insurance, less choice, and ultimately rationing, things which Obama pledged to avoid. By ignoring the examples already in place you are turning a blind eye to what is likely to happen and showing you are fundamentally unserious about actual reform.

    There is a reason people here do not take you seriously Myron. It’s because you do not take the issues seriously yourself and just repeat surface level talking points your read on other blogs.

    daleyrocks (718861)

  25. But he has good intentions.

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