Crumbling Institutions of the Left - Government Run Healthcare

Government run and funded healthcare is having a bad year.  The Affordable Care Act (ACA) has not delivered on its promise to insure all Americans, with 75% of those previously lacking insurance still lacking.  I also think that the situation might actually be worse, since I don't trust surveys in the social sciences.  Meanwhile, VA healthcare is no longer touted as a model of care for all.

In Virginia, Republicans have shown how principled opposition to Medicaid expansion can be popular and helpful to the state's finances.  

In January a poll by the Wason Center for Public Policy at Christopher Newport University found that 38% of Virginians opposed the Medicaid expansion. By late April, 53% were against it.

Meanhwile, Medicare is being slowly changed by the semi-free market of Medicare Advantage plans.

Austin Frakt, writing in the NYT, says that Newt Gingrich's 1995 prediction that medicare would wither on the vine if people were allowed to choose subsidized private insurance is turning out to be correct.  From the article. 

No matter the reason, what’s clear is that Medicare Advantage is a strong and growing program, despite recent moderation in government subsidies. As Medicare Advantage grows, traditional Medicare necessarily shrinks and its influence on the American health care system weakens. If the trend continues, policies, including those in the Affordable Care Act, designed to use traditional Medicare as a tool to reshape health care delivery for all Americans may become less potent. Is there a tipping point at which traditional Medicare ceases to matter?

Meanwhile, the GOP is eventually going to have to provide some positive alternatives to the ACA.  There are no shortage of good ideas, see my proposals here.  Reason's Nick Gillespie steals some of these ideas (which I stole from John Mackey).

Memorial Day Reflection - Socialized Medicine for Veterans

As we reflect on the service of Americans who gave their lives in war this Memorial Day, I also reflect on the care given those who sacrificed a great deal and must now depend upon the Veterans Administration to treat their service related injuries.  You can read for yourself about the scandal of longer and longer wait times; and the lying about those facts.  Boiled down to its essentials, the scandal is about rationing care through wait times and lying about rationing care and those same wait times.  Bernie Sanders, self avowed socialist and chair of the Senate VA committee, essentially admitted to the first part by saying that there weren't enough resources to provide care.  News flash - When the Government provides goods and services we always seem to run out.

This goes to the heart of the larger issue.  Democrats have always claimed they were the party you should elect to run government competently.  But the government has grown so vast and complex, it is impossible to do so.  Obama's surprise at finding each new scandal in his administration is almost understandable, given the federal government's vast size. But the solution must come from getting government smaller, and definitely shedding its role as direct provider of services.

With regards to veterans, we clearly need to provide them with insurance alternatives to allow them to make use of private sector medicine.  They deserve to be freed of the incompetent monopoly provisioning of health care by the federal government. John McCain has said that he will make such a proposal.  Count on the left to oppose this move.  They have touted the VA as a model for single payer in the past.  To allow out-sourcing would undermine their arguments for socialized medicine, as Krugman calls the VA system in the linked article.

Reason.com gives a great synopsis what passes for "success" in the VA's socialized medical system.

How could a bloated government bureaucracy achieve such low-cost success? As we found out recently, it's by quietly sticking veterans on a waiting list and putting off their treatment for months—sometimes until the patients are far too dead to need much in the way of expensive care. Which is to say, calling it a "success" is stretching the meaning of the word beyond recognition.

On this Memorial Day, although a time for reflection about those who have died; we should support the living veterans as well, by prising their health care from the monopoly of the federal government.

What You Should Be Reading

• KTCat equates moral relativism Houston Astro fandom.  Read it, it makes sense.
• Left Coast Rebel has great hashtag for Obama on the VA scandal.
• For Memorial Day, I am embedding one of the greatest speeches for the occasion ever given, by Ronald Reagan, of course. (The text of a different but great speech here.)

A Whimper not A Bang - ACA Quietly Repealed by Sebelius

So this is what victory over the Affordable Care Act looks like.

But amid the post-rollout political backlash, last week the agency created a new category: Now all you need to do is fill out a form attesting that your plan was cancelled and that you "believe that the plan options available in the [ObamaCare] Marketplace in your area are more expensive than your cancelled health insurance policy" or "you consider other available policies unaffordable."
This lax standard—no formula or hard test beyond a person's belief—at least ostensibly requires proof such as an insurer termination notice. But people can also qualify for hardships for the unspecified nonreason that "you experienced another hardship in obtaining health insurance," which only requires "documentation if possible." And yet another waiver is available to those who say they are merely unable to afford coverage, regardless of their prior insurance. In a word, these shifting legal benchmarks offer an exemption to everyone who conceivably wants one.

Well that was weird.  The ACA individual mandate, the whole Supreme Court fight, if you recall, was about its core essentiality to the success of the law.  And now the same Sebelius, defendant in National Federation of Independent Business v Sebelius, has very quietly gutted the individual mandate. As the WSJ article quoted above points out, the longer the mandate isn't enforced, the less likely that it will EVER be enforced.  And I thought we were going to have to wait until 2017 to have a chance at repeal.

Katherine, we've got to gut this thing before the GOP can.

Republicans should publicize this ruling far and wide, declaring victory over this hated law.  Then they need to work on real health care reform, because the problems with health care that has caused the electorate to tolerate the Democrats aren't going away either.  As I have published before, here is a start:

Liberty Movement Health Care Plan (first published in 2011):

Here is the plan that John Mackey of Whole Foods proposed, my comments in italics.

1. "Remove the legal obstacles that slow the creation of high-deductible health insurance plans and health savings accounts." Patients who have skin in the game and market knowledge will reduce costs faster than any government program.
2. "Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits."
3. Allow competition across state lines.
4. "Repeal government mandates regarding what insurance companies must cover."
5. "Enact tort reform."
6. "Make costs transparent."
7. "Enact medicare reform." Medicare policies that are mimicked by the private sector are strangling the medical profession.
8. Revise tax law to make it easier to donate to those without insurance.

To expand on these points.

1. The government could help lead this effort by reforming first Medicaid, by turning it into an insurance subsidy program for the poor. But the program would require those in the program to pay a high copay until a low catastrophic cap was reached. Such a system would create a market for a system where people have more incentive to shop for best value in medical care. This system could then be applied to Medicare.
2. The next big issue is that health care is tied to employment. My first impulse is to forbid the offering of insurance through employment, but that would make a conservative social engineer, instead of a liberal one. Removing the tax advantage would at least set a level playing field. To date, the portion of employee compensation that comes in the form of employer health insurance isn't taxed as compensation. This ties employees to their companies and needlessly. You would think that liberals would be opposed to a scheme where tax policy gives corporations leverage over employees. However, I dislike schemes whereby the government imposes on employee relations, so I will settle for leveling the playing field.
3. Interstate competition is not the norm in insurance. Surely the federal government has the right to "regulate" as in "make regular" this portion of interstate commerce, by insuring that any insurance offered for sale in a state would be available in the fifty states. Increasing competition will probably be opposed by the insurance industry, but freer markets benefit consumers.
4. One size never fits all. So mandating coverage should be banned. Insurance is always tricky business, even homeowner's insurance, as Road Dawg can attest to. Along with no mandates will be the need to enforce clear language in policies and communications with policy holders. I am a libertarian, but not so naive as to believe that some insurance companies won't try to wriggle out of agreements to save money. Court is expensive for individual consumers, so regulation that enforces good practices of transparency and clarity will be necessary. But regulation should always aim for simplicity and this also needs to be part of a reform package.
5. With regards to tort reform, we have seen positive results in Texas, where access to care increased after passage of reform.
6. Cost transparency is important to enable process improvement and allow patient choice. Most people don't know the true cost of a medical visit, even after the visit is over. Here again, Medicaid reform could lead the way, by insisting that patients receive better notice and understanding of their bill.
7. Medicare policies with regards to reimbursement are arcane and lead to huge misunderstandings on what is covered and unexpected bills. Transforming Medicare to save it for those who truly need it, into an insurance subsidy scheme, will get the government out of the rule writing business and free up insurance plans to compete.
8. Allowing Americans to donate to those who need health care insurance might make little difference, but maybe not. I see lots of do-gooder millionaires wanting to pay more taxes. Maybe they could pay for poor people's insurance in the interim.