Obama

Obamacare, the Wisdom of Rose Wilder Lane, and Why Nancy Pelosi Was Sort of Right

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The “Affordable Care Act,” aka Obamacare, seems to be full of surprises.  For example, it seems that many Americans are being forced onto Obamacare exchanges where most plans provide only local medical coverage…a bit of a problem for people who travel, change jobs, or have vacation homes.  To take another example, this Washington Post article says Obamacare may make it impossible for people living in American territories (such as Guam and the Northern Mariana Islands) to purchase health insurance policies at all. “Unexpected!” results of Obamacare seem to be almost daily news.

These surprises especially strike those ordinary Americans who are the targeted users of Obamacare, of course…but  also, they seem to strike many of the creators of the program. Some members of the government classes, of course, simply lied about Obamacare’s effects…first and foremost this is notoriously true of Obama himself. But I also feel sure that there are many among those CongressCreatures who voted for this 2000-page bill who have been genuinely surprised by some or many of its outcomes. It is simply not possible to clearly predict in advance the effects of a piece of legislation so all-encompassing, so verbose, and so quickly pushed through.

Rose Wilder Lane, still at that point a Communist, visited the Soviet Union in 1919. After she explained the benefits of central planning to a disbelieving village leader, he shook his head sadly and said:

It is too big he said too big. At the top, it is too small. It will not work. In Moscow there are only men, and man is not God. A man has only a man’s head, and one hundred heads together do not make one great big head. No. Only God can know Russia.

Indeed, one hundred or one thousand or ten thousand heads together in the form of CongressCreatures or health care bureaucrats did not suffice to make one great big head that would fully grasp the implications of Obamacare. Nancy Pelosi was sort of right when she said “But we have to pass the bill so that you can find out what is in it”…she should have carried it further and said: “We have to pass the bill so that we can find out what’s in it.”

It is precisely this difficulty in predicting the outcomes of sweeping change, on a society-wide scale, that makes such sweeping and radical change something to be usually avoided..and when indeed necessary, to be conducted with caution and careful forethought. British statesman and political philosopher Edmund Burke made this point eloquently and famously. Nothing could be more anti-Burkean than Obama’s statement on October 30, 2008: “We are five days away from  fundamentally transforming  the United States of America.”

After coming to realize that the defects of Communism are inherent and not just due to problems with one particular implementation of it, Rose Wilder Lane also became convinced that:

Centralized economic control over multitudes of human beings must therefore be continuous and perhaps superhumanly flexible, and it must be autocratic. It must be government by a swift flow of edicts issued in haste to catch up with events receding into the past before they can be reported, arranged, analyzed and considered, and it will be compelled to use compulsion. In the effort to succeed, it must become such minute and rigorous control of details of individual life as no people will accept without compulsion. It cannot be subject to the intermittent checks, reversals, and removals of men in power which majorities cause in republics.

Note how this comment ties in with the Obama administration’s tendency to adjust the healthcare insurance program via quick and arbitrary administrative rulemaking, rather than via the legislative process. RWL would say that this kind of behavior is inherent in a program intended to establish government control over vast swaths of society.

She also notes that:

Nobody can plan the actions of even a thousand living persons, separately. Anyone attempting to control millions must divide them into classes, and make a plan applying to these classes. But these classes do not exist. No two persons are alike. No two are in the same circumstances; no two have the same abilities; beyond getting the barest necessities of life, no two have the same desires.Therefore the men who try to enforce, in real life, a planned economy that is their theory, come up against the infinite diversity of human beings. The most slavish multitude of men that was ever called “demos” or “labor” or “capital” or”agriculture” or “the masses,” actually are men; they are not sheep. Naturally, by their human nature, they escape in all directions from regulations applying to non-existent classes. It is necessary to increase the number of men who supervise their actions. Then (for officials are human, too) it is necessary that more men supervise the supervisors.

…and discusses the temptations of power to a leader who believes in expansionist government:

If he wants to do good (as he sees good) to the citizens, he needs more power. If he wants to be re-elected, he needs more power to use for his party. If he wants money, he needs more power; he can always sell it to some eager buyer. If he wants publicity, flattery, more self-importance, he needs more power, to satisfy clamoring reformers who can give him flattering publicity.

 

Selected Posts from 2013, continued

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A Winter’s Tale. An appropriate post given today’s temperatures.

Saint Alexander of Munich. Alexander Schmorell,  a member of the anti-Nazi student resistance group known as the White Rose, has been canonized by the Russian Orthodox Church Abroad.

Deconstructing a Nazi Death Sentence. The transcript of the verdict passed by the “People’s Court” on members of the White Rose provides a window into the totalitarian mind.

Despicable.  US Secretary of State John Kerry, speaking in Istanbul,  compared the victims of the Boston Marathon bombing to the nine Turkish activists killed by the IDF as they tried to break Gaza’s naval blockade.

Appropriate Reading and Viewing for Obama’s Surveillance State.

Six Hundred Million Years in K-12.

Some 3-D Printing Links.

Aerodynamics, Art History, and the Assignment of Names.

My health care posts from 2013

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David has a good idea. I often read the archives of my personal blog to see how I did in forecasting the future or understanding the present. A major concern of mine is, of course, health care and what is happening. When I retired from surgery after my own back surgery, I spent a year at Dartmouth Medical School’s center for study of health care. My purpose was to indulge an old hobby. How do we measure quality in health care ? I had served for years on the board of a company called California Medical Review, Inc. It was the official Medicare review organization for California. For a while I was the chair of the Data Committee. It seems to have gone downhill since I was there. First, it changed its name in an attempt to get more business from private sources. Then it lost the Medicare contract.

Lumetra, which lost a huge Medicare contract last November, is changing its name and its business model as it seeks to replace more than $20 million in lost revenue.
The San Francisco-based nonprofit’s revenue will shrink this year from $28 million last fiscal year, ending in March 2009, to a projected $4.5 million, CEO Linda Sawyer told the Business Times early this week.
That’s in large part because it’s no longer a Medicare quality improvement contractor, formerly its main line of work. And in fact, the 25-year-old company’s revenue has been plummeting since fiscal 2007, when it hit $47 million.

I see no sign that it is involved with Obamacare which is being run from Washington with a state organization that seems no better run than the parent organization.

Beginning Jan. 1, 2015, the Affordable Care Act no longer will provide federal grants to fund state health exchanges. In addition, California law prohibits using the state’s general fund to pay for the exchange.

Anyway, for what it is worth, here are the links to the 2013 health posts.

The Lost Boys

Alternatives to Obamacare.

Why the Obamacare Site Isn’t Working.

Where Healthcare May be Going.

Conservatives Invented the Mandate; say the Democrats.

A Critical Insight.

A Rolling Catastrophe.

Why Health Care is in Trouble.

Where Do We Go Now ?

Building the Airplane During Takeoff.

The Procurement / Bureaucracy Excuse, and the Drive for Expanded Presidential Power

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President Obama has been unwilling to admit that the problems with the Obamacare roll-out might suggest that he needs to work on improving his management skills. Instead, he has chosen to blame the complexities of government bureaucracy, and in particular the complexities of the government procurement process–all matters that have seemed to be rather surprising to him–and this view has predictably been echoed by some in the pundit class.

I have several thoughts on this matter:

1) It is not yet clear to what extent the Obamacare systems problems are a function of too much bureaucracy in the procurement process versus too little bureaucracy in that process as employed in this specific case. In particular, were Serco and CGI and other key contractors selected based on the robot-like processes of the Federal procurement system…or was heavy political influence involved? I don’t think we know yet.

2) A good workman understands the limitations of his tools and materials. We wouldn’t think much of a civil engineer who designed a high-traffic-carrying bridge without paying close attention to the load-bearing characteristics of the steel girders and cables used; nor would we think much of an architect who designed a house in which a family was investing much of their financial net worth without considering the weather resistance of the wood and other materials he was specifying. Shouldn’t Obama, before embarking on a plan to greatly increase the Federal Government’s role in healthcare, have seriously considered the characteristics and limitations of the tools and materials that he was using–the Federal agencies and their policies and procedures–for this purpose? He stands convicted out of his own mouth for not performing this basic level of due diligence.

3) Whatever the encumbrances of the Federal bureaucracy–and yes, we all know they are significant–nothing prevented Obama from taking a more serious and responsible executive role in supervising the roll-out, and/or putting effective people in key leadership positions. Can there be any doubt that if a person of the quality of General Bernard Schriever, for example, had been put in control of the technology and paperwork process implementation, the odds of success would have been considerably better?

4) Most important: Obama and his media/academic sycophants refuse to understand the inevitable limitation of government micromanagement.  I’ve previously quoted Peter Drucker:

Whether government is “a government of laws” or a “government of men” is debatable. But every government is, by definition, a “government of paper forms.” This means, inevitably, high cost. For “control” of the last 10 per cent of any phenomenon always costs more than control of the first 90 per cent. If control tries to account for everything, it becomes prohibitively expensive. Yet this is what government is always expected to do.

The reason is not just “bureaucracy” and red tape; it is a much sounder one. A “little dishonesty” in government is a corrosive disease. It rapidly spreads to infect the whole body politic. Yet the temptation to dishonesty is always great. People of modest means and dependent on a salary handle very large public sums. People of  modest position dispose of power and award contracts and privileges of tremendous importance to other peopleconstruction jobs, radio channels, air routes, zoning laws, building codes, and so on. To fear corruption in government is not irrational.

This means, however, that government “bureaucracy”— and its consequent high costs—cannot be eliminated.  Any government that is not a “government of forms” degenerates rapidly into a mutual looting society.

(I’m confident Professor Drucker would agree that whether the forms are paper or electronic makes no difference at all in this context.)

As I also noted earlier: the expansion of government into all aspects of human life leads to increasing inefficiencywhile the increasing frustration with bureaucracy results in a widespread demand to “make government more responsive” by giving more discretionary authority to administrators and to their political superiors. This is exactly what we are seeing with Obamacare, with the emphasis at present being on an increase of discretionary authority for the political superiors of the administrators. This, in turn, must result in a government which is not only a looting society (Obamacare waivers or special privileges for politically-well-connected groups, for example)  but increasingly a tyranny. Yet at the same time, there will still be enough baroque proceduralization (selectively enforced) to ensure high levels of inefficiency and very high government administrative costs. And the discretionary authority–the movement away from a Government of Laws and toward a Government of Men–must create widespread uncertainty and, consequently, equally widespread economic damage.

 

Obamacare, the Scrooging

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People signing up for Obamacare are being robbed by the government. This time it’s not metaphorically, like when your perfectly satisfactory insurance plan is made illegal and all the compliant plans are more expensive and have worse terms but literally. People are having their accounts debited improperly during the Christmas season. And because it is being done by the government, there is little recourse to sue due to sovereign immunity and, of course, those most injured haven’t the money to hire representation anyway. I think Pope Francis calls it ‘despoliation of the poor’.

Double debits, wrong day debits, wrong amount debits, these are all standard hazards with any sort of Electronic Funds Transfer (ETF) system. There’s nothing particularly new about these issues. It’s all part of the back end errors that those dastardly Republicans have been hyperventilating about and Democrats have been pooh poohing for weeks now.

You never know when Tuttle will turn into Buttle in one of these systems. But what’s in a name?

Merry Christmas

Cross posted: Flit-TM