Patterico's Pontifications

8/6/2010

Why ObamaCare has gaping holes

Filed under: General — Karl @ 1:50 pm



[Posted by Karl]

AoSHQ’s Dave In Texas is a bit surprised that the voluminous new healthcare law does not, in fact, define health care:

Wait until the public discovers the government is now literally determining what qualifies as “health care” in America.

That isn’t a typo. ObamaCare mandates that insurers spend a certain percentage of premium dollars on benefits, but Democrats never got around to writing the fine print of what counts as a benefit. So a handful of regulators are now choosing among the tens of thousands of services that doctors, hospitals and insurers offer. Few other government decisions will do more to shape tomorrow’s health market, or what’s left of it.

The WSJ piece just quoted is addressing what will count as medical benefits for insurance “medical loss ratios” under the new law. However, we will see a variation on the same theme when the new Health Choices Czar gets down to the business of deciding minimum levels of benefits for insurance plans to be offered through the government-created Potemkin market known as the Health Exchange.

If Dave — or anyone else — is surprised that the healthcare law does not define what health care gets financed and what does not, it is probably due to thinking that the Congressional intent was to establish healthcare policy. In reality, the Congressional intent was to pass a healthcare law assuming control over the system. One of the keys to passing ObamaCare was to buy off the “stakeholders” (interest groups) who were in a position to lobby and advertise against it — AHIP (Big Insurance), AMA, AHA, etc. Addressing issues like “what is health care” would have increased the odds of these groups fighting with each other and among themselves, contrary to the basic goal of passing a bill into law. Moreover, the flap over the US Preventive Services Task Force’s “guideline” — that women in their 40s should stop routine annual mammograms and older women should cut back to biannual exams — demonstrates why Congress would have no interest in the details of the government-defined insurance plans, where increasing numbers of people will eventually be dumped if the law gets fully implemented. The proles were already upset enough at the ruling class; Congress certainly wanted to avoid offending any constituency or group seeking inclusion of their disease, condition, or treatment in the government benefits package(s).

Indeed, Congress wanted to save those fights for later. Punting any issue likely to cause controversy keeps the Beltway carousel spinning. The interest groups already mentioned, plus those lobbying on everything to breast cancer to AIDS to chiropractic to medical device manufacturers will all be gearing up to lobby the vast new bureaucracies created under Obamacare for favorable consideration of one sort or another. Tossing the law’s hot potatoes to unelected civil servants allows Congresspeople to play the white knights, working the Rube Goldberg-esque machinery on behalf of their constituents and their donors. At the outset, this will be directed to establishing generous minimum benefits. Later, when the spiralling costs of the program produce plans for rationing care, pols will intervene to “save” valuable benefits from the bureaucratic reaper. The pols will also help steer groups to the crucial and costly counsel provided by their former staffers, to be employed at the K Street firm of “Don’t You Know Who I Am?”

In short, this process is how Congress disclaims responsibility for Leviathan it creates, as a way of squeezing money from the public to perpetuate their incumbency and their fiefdoms. It is a process Congress has honed over decades of legislation. But now that they are treading into matters of life and death, perhaps more people will see it for what it is.

–Karl

29 Responses to “Why ObamaCare has gaping holes”

  1. Another Rube Goldberg gem from our princes and princesses in congress – who’d a thunk it?

    Dmac (d61c0d)

  2. um, so we are saying that amazingly, this legislation… was not long enough?

    I think i am going to cry.

    Aaron Worthing (A.W.) (e7d72e)

  3. The National Association of Insurance Commissioners (NAIC) has been going nutty trying to come up with definitions of what should be included in the MLR calculations. Obama loves to talk about wellness programs and preventive medicine, but will those be included in MLR ratios? How about overhead costs, if so, how much? It ain’t an easy task and everybody’s got an opinion, especially the politicians in Washington who hate greedy insurance companies but have never managed a business themselves. At least starting with the NAIC, whose members have a vested interested in seeing that insurance companies stay solvent long enough to pay their claims and provide coverage to residents of their states, I think they have a better chance of getting it right than those greasy a** socialist haters in Washington.

    daleyrocks (940075)

  4. I think we should apply Judge Wagner’s rational basis test to BarckyCare, and watch it collapse.

    JD (3dc31c)

  5. JD

    um, you mean Walker, right, from the prop 8 case?

    Aaron Worthing (A.W.) (e7d72e)

  6. Yeah, my bad.

    JD (3dc31c)

  7. This sounds so much like the marketing of “pull” in Atlas Shrugged, somebody must have read it and thought it sounded like a good idea. I am not amused.

    Machinist (497786)

  8. Colonel always think
    policy with gaping holes
    made by Gaping Holes

    ColonelHaiku (d7de3f)

  9. Please …. let ObamaCare die a thousand deaths! And be denied coverage on its way to the morgue!

    10SCgal (9d2e60)

  10. It is a process Congress has honed over decades of legislation.

    That sentence should be put in bold flashing neon letters at the start of the post. This is the way Congress has worked for years–pass a grand sounding law and then pass it over to the bureaucrats to write up what the law will actually be.

    kishnevi (5ac534)

  11. kishnevi,

    You gotta save something for the kicker!

    Karl (12dcea)

  12. As Shirley Sherrod noted, it is racist to oppose BarckyCare.

    JD (3dc31c)

  13. Let me help…

    HEALTH CARE: getting your anal cavity scrubbed out weekly to prevent AIDS or having weekly therapy sessions to help you from molesting children.

    NOT HEALTH CARE: Heart surgery after 75.

    Got it?

    HeavenSent (ff0596)

  14. I guess you all have already seen the story about boner pills for schoolteachers:
    http://www.jsonline.com/news/milwaukee/100108249.html

    Under govt healthcare, we taxpayers will be funding acupuncture, aromatherapy, backcrackers, medical pot, homeopathy, sex reassignment, tattoo removal, and every quack talking cure imaginable. Just like with Medicare, a quarter of the invoices the govt will pay will be for bogus billings and sham appointments. It’s going to be peachy.

    gp (ba49cb)

  15. Do you just make stuff up, gp?

    Chris Hooten (c5fad1)

  16. Speaking of gaping holes ^^^

    Icy Texan (ff919d)

  17. > wanted to avoid offending any constituency or group seeking inclusion of their disease, condition, or treatment in the government benefits package(s).

    Yes, much, much better to put such decisions into the hands of unelected bureacrats who have no interest in anyone’s personal problems or issues… right?

    Go over to the IRS and tell them about your own personal woes that lead to your inability to pay your taxes… If you blubber real, real hard, they might see fit to hand you a kleenex.

    OBloodyhell (e080b3)

  18. Hold on! You’re saying the Executive Branch makes rules and definitions!?! OMG, I never knew that’s what regulations were for. I thought Congress, an omnipotent body of geniuses, crafted legislation for every eventuality and the Executive Branch just…..you know, followed orders.

    Oh, no, hold it, like almost every person who went to law school (clear throat and looks in Karl’s direction) I took Admin Law and I know about the rule-making process and how well-litigated the are is….

    No, that’s not the most offensive part of this post, since Karl notes in passing that Congress

    ossing the law’s hot potatoes to unelected civil servants allows Congresspeople to play the white knights, working the Rube Goldberg-esque machinery on behalf of their constituents and their donor

    . Of course, for a guy who works for a Government, he sure has contempt for the administrative state.

    So, here’s Karl burying the lede. To be fair, it’s still unclear he has any idea about what this legislation is about, since — again — he constantly whines about the “Government taking over healthcare” when Congress just reformed health insurance law. He knows this, but stating it in Limbaugh-esque terms is supposed to scare y’all.

    Again and for the record: the bill passed by Congress reforms HEALTH INSURANCE and not healthcare. Karl’s shock at the existence of the rule-making process only stands in stark relief to his failure to understand the basic premise of the legislation he is scared of.

    timb (449046)

  19. Lying dishonest stalkers savaging strawpeople is sooooo 2007.

    JD (3dc31c)

  20. Obloodyhell, if you want to comment on the rules, there will be a mandatory comment period. After that, there will be lawsuits to complain about the rules. After that, you can go to Congress to complain that you can’t your Viagra covered by your insurance company.

    Wow, who knew.

    Unelected people already control your health insurance and they have an inherent interest in making you receive as little of it as possible. Why you people are so frightened of government bureaucrats with no profit motives telling your insurance company to cover you versus private bureaucrats who are trying to screw you for their bonus is beyond comprehension

    timb (449046)

  21. “the bill passed by Congress reforms HEALTH INSURANCE and not healthcare”

    timb – You should inform your President and Party of that fact. They seem to feel otherwise.

    daleyrocks (940075)

  22. timb,

    Allow me to introduce you the Limbaugh-esque wingnutter Michael Kinsley:

    If the government requires insurers to accept all customers and charge all the same price, regulates all aspects of their marketing to make sure they aren’t discriminating, and then redistributes the profits to make sure that no company gets penalized unfairly, in what sense is the industry still “private”?

    Beyond that, if you have an argument that what health care gets paid for is unrelated to what health care gets provided, I would lurve to hear it. But I would guess the doctors who comment here could tell you a bit about how payment affects practice.

    As you note, I do know a bit about administrative law. Indeed, as you may not know, I wrote for the Federal Register when I was still a law student. But what I am pointing out is the difference between theory you learned in class and the actual practice. We can all watch Schoolhouse Rock to find out how a Bill becomes a law, but the real sausage-making is a lot uglier. So it is with the administrative state. And many more people know about the gap between theory and practice when it comes to Congress than about the gap that exists with respect to the administrative process, so I’m spreading the word. Frankly, I’m a little baffled that it bothers you that much.

    Karl (12dcea)

  23. So one fifth of six percent of the population supposedly has children (how many were from prior marriages or relations with the opposite sex the know it all Judge somehow fails to note). So to placate one percent of the population the Judge craps in the face of more than ninety percent of the remainder. Once again another poor choice of judges from Bush I has haunted this nation for many years and will do so for years to come.

    eaglewingz08 (83b841)

  24. I just remembered that the WSJ piece quoted in the post also addresses the linkage of payment and practice:

    More notable is that people partial to ObamaCare but largely outside of politics are coming to understand the mess Congress has created. To wit, much of health care’s intellectual energy is moving toward a concept called the “accountable care organization,” which would replace today’s fragmented delivery system of mostly solo practitioners with teams of doctors and hospitals working together. These integrated groups would manage and coordinate care, use more information technology and try to improve treatment quality for chronic disease and complex conditions.

    Yet “it isn’t easy to draw a bright line, or even a fuzzy line, between traditional health services and some of the more innovative coordinated models,” says Mark McClellan of the Brookings Institution and a leading accountable care proponent. The new model would rely on many tools that aren’t strictly medical, like, say, a checkup or a CT scan.

    For example, how to classify a program to double-check doctors orders to avoid one of the unnecessary surgeries that kill some 12,000 people every year? Or counseling, calls, emails and other types of case management to make sure patients comply with their diabetes regimen? Or investments in electronic medical records? Obviously these programs aren’t the same as an O.R. visit, but they still cost money, often a lot of it, and many insurance programs pay or are starting to pay for them.

    The possibility that these will be written out of the MLR definition is feeding a growing unease about politics shaping medicine more than it already does. The California Association of Physician Groups, the largest U.S. accountable care trade group, recently protested that a narrow MLR ruling “would create a disincentive for plans to contract with our members and undercut the coordinated care model.”

    Health Integrated, a respected medical consulting firm, urged regulators “to avoid discouraging or inadvertently extinguishing the successful innovation that (so frequently) arises only from a plan’s ability to try new ideas.” Even North Dakota’s Democratic Rep. Earl Pomeroy, who voted for the bill, argues that tight MLR regulation “could have a chilling effect on future innovative programs.”

    Karl (12dcea)

  25. can we contend that health cares
    they don’t clarify
    are a bloody farce?

    I could really use a drink right now

    happyfeet (19c1da)

  26. Karl – timb just wants to stalk you and adds no value as usual. Creepy he is.

    daleyrocks (940075)

  27. Comment by timb — 8/7/2010 @ 10:36 am
    Hold on!
    — Hold your breath. Keep holding it until i say “stop”.

    You’re saying the Executive Branch makes rules and definitions!?! OMG, I never knew that’s what regulations were for.
    — That’s what “signing statements” are for. You know, those things that lefties screeched about whenever the previous administration dared to issue one.

    I thought Congress, an omnipotent body of geniuses, crafted legislation for every eventuality and the Executive Branch just…..you know, followed orders.
    — Replace “Congress” with “HuffPo” and “Executive Branch” with “timmah” . . . and drop the “I thought”, since they thought for you.

    Of course, for a guy who works for a Government, he sure has contempt for the administrative state.
    — Of course, for a guy that always wants the government to DO SOMETHING, you sure have contempt for the minimalist administrative state.

    Again and for the record: the bill passed by Congress reforms HEALTH INSURANCE and not healthcare.
    — And reforming the insurance will have no effect whatsoever on the type and level of care that is provided? Start breathing again; the lack of O-2 is starting to show.

    Icy Texan (be7dba)

  28. Do you just make stuff up, gp?

    Comment by Chris Hooten

    No, I think he has been hanging around the California legislature for the past thirty years and watching how health care legislation is written.

    Timb, I really don’t think you have any qualifications in this area that we should pay attention to. Other than your DNC lifetime donor card, I mean.

    When legislators start to decide what health care to include in coverage, they make the most amazing decisions. I’ve watched it since 1978.

    The Competitive Medical Plan (CMP), later known as HMO or PPO, is the previous incarnation of the “accountable care organization.” These are bureaucracies and are the only system recognized by other bureaucracies.

    It would not occur to a bureaucrat to say that the Medicare plan will pay $40 for a mammogram for an eligible member. I wonder if Timb knows that 10% of breast cancer occurs in males and would he include males in the rules for mammograms?

    If Medicare did make such a determination, women could decide to pay what the market rate was for mammograms. I have previously mentioned that a friend of mine, a radiologist, was investing in a chain of mammography clinics to be placed in shopping malls. They would be staffed by a tech and a clerk. The patient would pay a flat fee, at the time they were discussing $100, and would be mailed the report. Insurance, under pressure from feminist groups no doubt, began to pay for mammograms and the cash clinic idea went away. Now that the cash competition is gone, the rules are starting to tell 40 year old women they don’t qualify.

    It’s an old story.

    Mike K (d6b02c)

  29. > Why ObamaCare has gaping holes

    Oh. my. The mind boggles at all the possible responses to such a straight line.

    ….head…..

    ….exploding….

    ….must…
    …c-c-contain…
    …MIRTH!….

    BOOM!!!!!!

    OK, NOW you’ve done it. Now I need to get my brain repaired, you bastard!!

    :oP

    IGotBupkis (e080b3)


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