Politics

Where health care may be going.

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UPDATE: I posted this as much for myself as for others to read. Today, Peggy Noonan weighs in. In case this is behind the paywall, here is her conclusion.

Even though it’s huge, and those who are reporting the story every day are, by and large, seasoned and have seen a few things, no one seems to know how it will end. Because it’s new territory. Does anyone believe the whole technological side can be fixed quickly? No. The president may eventually accept a brief delay in implementation—it is almost unbelievable that he will not—but does anyone think that the economics of the ACA, the content as set out and expressed on the sites, will flow smoothly, coherently, and fully satisfy the objectives of expanding health-insurance coverage while lowering its cost? You might believe that, but early reports of sticker shock, high deductibles and cancelled coverage are not promising. Does anyone think the president will back off and delay the program for enough time not only to get the technological side going but seriously improve the economics? No. So we’re not only in the middle of a political disaster, we’re in the middle of a mystery. What happens if this whole thing continues not to work? What do we do then?

This is the Titanic, folks.

I have watched the failed rollout of Obamacare this past three weeks and wondered where it was going. I have some suspicions. There is a lot of talk about delaying the individual mandate, as Obama did with the employer mandate. Megan McArdle has a post on this today. I think it is too late to fix or delay Obamacare.

With Nov. 1 storming toward us and the health insurance exchanges still not working, we face the daunting possibility that people may not be able to sign up for January, or maybe even for 2014. The possibility of a total breakdown — the dreaded insurance death spiral — is heading straight for us. The “wait and see if they can’t get it together” option no longer seems viable; we have to acknowledge that these problems are much more than little glitches, and figure out what to do about them.

She has already described the insurance death spiral. I think it is here.

Am I exaggerating? I know it sounds apocalyptic, but really, I’m not. As Yuval Levin has pointed out, what we’re experiencing now is the worst-case scenario for the insurance markets: It is not impossible to buy insurance, but merely very difficult. If it were impossible, then we could all just agree to move to Plan B. And if it were as easy as everyone expected, well, we’d see if the whole thing worked. But what we have now is a situation where only the extremely persistent can successfully complete an application. And who is likely to be extremely persistent?

Very sick people.

People between 55 and 65, the age band at which insurance is quite expensive. (I was surprised to find out that turning 40 doesn’t increase your premiums that much; the big boosts are in the 50s and 60s.)
Very poor people, who will be shunted to Medicaid (if their state has expanded it) or will probably go without insurance.

Levin points out: It is now increasingly obvious to them that this is simply not how things work, that building a website like this is a matter of exceedingly complex programming and not “design,” and that the problems that plague the federal exchanges (and some state exchanges) are much more severe and fundamental than anything they imagined possible. That doesn’t mean they can’t be fixed, of course, and perhaps even fixed relatively quickly, but it means that at the very least the opening weeks (and quite possibly months) of the Obamacare exchanges will be very different from what either the administration or its critics expected.

The insurance industry is already reacting to Obamacare and this will quickly become irreversible. This article is from September.

IBM, Time Warner, and now Walgreens have made headlines over the past two weeks by announcing that they plan to move retirees (IBM, Time Warner) and current employees (Walgreens) into private health insurance exchanges with defined contributions from employers.

The article calls it “maybe a good thing” but that supposes the exchanges will function. What if they don’t for a year or more ? What will health care look like in November 2014 ?

What happens next — as we’ve seen in states such as New York that have guaranteed issue, no ability to price to the customer’s health, and a generous mandated-benefits package — is that when the price increases hit, some of those who did buy insurance the first year reluctantly decide to drop it. Usually, those are the healthiest people. Which means that the average cost of treatment for the people remaining in the pool rises, because the average person in that pool is now sicker. So premiums go up again . . . until it’s so expensive to buy insurance that almost no one does.

Will that be apparent a year from now ? I’m sure the administration, and the Democrats, will do almost anything to avoid that. What can they do ? They’ve already ignored the law to delay the employer mandates. It’s too late to delay the individual mandate because individual policies are being cancelled right now.

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Global Warming and Cooling.

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I have been frustrated by the antics of the AGW alarmists. Scientific American, for example, has lost whatever reputation it once had for objective science. (pdf) In an another example, the actions of Michael Mann should make for an interesting discovery in his suit against Mark Steyn.

Today, I find a nice discussion of global warming and cooling over the past epoch. The Greenland ice cores are, or should be, the gold standard of temperature measurement. For example.

Summary:
Records of past temperature, precipitation, atmospheric trace gases, and other aspects of climate and environment derived from ice cores drilled on glaciers and ice caps around the world. Parameter keywords describe what was measured in this data set. Additional summary information can be found in the abstracts of papers listed in the data set citations.

Now, to the data.

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The Shutdown

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Since I am a Department of Defense contractor, examining military recruits. I expected that we would not be called to come in after Monday but I worked Tuesday and was told they expect no slowdown. Of course, maybe they won’t pay us but that is still in the future.

UPDATE: Today is the 8th and I have been called again for tomorrow.

So far, the shutdown seems to be working with the assistance of Democrat verbal and active mistakes. I always thought Gingrich fumbled the ball in 1995. This time, the GOP strategy of passing small directed bills to fund popular programs, seems to be working. Certainly the Democrats like Harry Reid and the National Park Service are helping all they can.

Washington politicians may have the time to debate how to fund the government, now that their pig-headedness has shut it down, but the nation’s World War II veterans don’t.

“World War II veterans are dying by the hundreds every day,” says Fred Yanow, of Northbrook, Ill., who spent 1942-45 in the Pacific theater as an Army private. “It’s a shame that they don’t care about World War II veterans when so many of them are dying off.” The 16 million men and women who wore their nation’s uniform in the so-called “Good War,” from 1941 to 1945, are leaving for eternal R&R at the rate of 650 a day.

Which Washington politicians ?

Harry Reid ?

Claire McCaskill had some clever comments.

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Lese-Majeste

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(Sorry, no history post today – just too much going on and I am too steamed about this particular First Amendment issue. It seems that in the eyes of certain parties, our current president may not be mocked by the peasants.)

That useful concept (thank you, the French language for putting it so succinctly!) is defined “as an offense that violates the dignity of a ruler” or “an attack on any custom, institution, belief, etc., held sacred or revered by numbers of people.”Well, it appears that our very dear current occupant of the White House is certainly held sacred by a substantial percentage of our fellow citizens. How else to account for the perfectly earsplitting howling from Missouri Democrats and the usual suspects over a rodeo clown wearing an Obama mask to yuck it up before the crowd most of whom seem to be laughing their heads off. All but the desperately sensitive, who breathlessly insisted that it was just like a KKK rally, practically. The rodeo clown’s name apparently is Tuffy Gessling; his supporters, and those who, as a matter of fact, support the rights of a free citizen to mock authority figures of every color and persuasion, have set up a Facebook page. He’s also been invited by a Texas congressman to come and perform the skit at a rodeo in Texas.

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The Drug War

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My sentiments on the whole drug question have been influenced by some experience with the medical aspect of the problem. Drugs are slipping out of any control due to developments in synthetic variations of older substances that stimulate brain chemistry, sometimes in unknown ways. The traditional drugs, if we can use that term, are also slipping out of control with Mexican drug wars replacing the Columbian cartels even more violent than their predecessors.

What about marijuana ? It is widely used by the younger generation and, while I do think there are some harmful consequences, especially in potential schizophrenics, the fact is that the laws are widely ignored and do little good and much harm. First, what about the link to psychosis ?

Epidemiological studies suggest that Cannabis use during adolescence confers an increased risk for developing psychotic symptoms later in life. However, despite their interest, the epidemiological data are not conclusive, due to their heterogeneity; thus modeling the adolescent phase in animals is useful for investigating the impact of Cannabis use on deviations of adolescent brain development that might confer a vulnerability to later psychotic disorders. Although scant, preclinical data seem to support the presence of impaired social behaviors, cognitive and sensorimotor gating deficits as well as psychotic-like signs in adult rodents after adolescent cannabinoid exposure, clearly suggesting that this exposure may trigger a complex behavioral phenotype closely resembling a schizophrenia-like disorder. Similar treatments performed at adulthood were not able to produce such phenotype, thus pointing to a vulnerability of the adolescent brain towards cannabinoid exposure.

This suggests that adult use may be less harmful.

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