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1

Dissembling on HealthSource Tax

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This Kathy Gregg article on Governor Gina Raimondo’s reaction to poll results showing a new HealthSource tax to be hugely negative should not slip through the cracks.  The results of the poll found 63% opposed to the tax and only 27% in favor.  Here’s Raimondo:

“It’s out of my hands. I can’t say we are not going to have the health exchange,” Raimondo told reporters Thursday, the morning the poll results were released.

“Obamacare is what is is, the Affordable Care Act is there. I had nothing to do with it. [But] we have to implement it … and pay for it. And what I tried to do is present a proposal to the General Assembly which would put the least amount of cost on business owners for the maximum amount of benefit.”

Well, no.  It’s not out of her hands.  Handing it over to the feds means that “we” — i.e., the state government — are not paying it.  True, either way, Rhode Island health care customers will be paying the bill, but the distinction between the state and federal governments is not immaterial, not the least because of the games government officials are playing with the numbers.

“So we can either give it to the federal government or we can do it,” Raimondo said, again characterizing her proposal as one that “makes sure we run it in Rhode Island at a cost which is equal to or lower than the federal government.” …

In calendar year 2016, House fiscal staff advised lawmakers the new surcharge — that Raimondo describes as a “health reform assessment” — would be 4.74 percent for individuals and 0.98 percent for small businesses. During the next fiscal year, which begins on July 1, 2016, individuals would pay an extra 3.76 percent, and small-employers 1.05 percent to raise $11.2 million.

Kathy Gregg compares this with a 3.5% federal fee that would raise $8.6 million, but that isn’t an apples-to-apples comparison.  The federal 3.5% is applied to plans in the exchange and then spread out to all health care customers with similar plans.  In other words, the effective rate for the to people actually paying would be much lower.

The HealthSource tax, by contrast, starts with the budget for the exchange and then applies its 4.7% and 1.0% fees to all plans.  In the federal case, the federal government carries all of the risk for cost overruns, because its fee is set by law.  In the state case, the state government carries all of the risk, and the director of HealthSource can just adjust the tax as she sees fit.

I’d also take issue with the assertion that “business owners” are hurting and need that lower rate.  Are individual health consumers not hurting, or are they just not organized enough to be a political problem?

3

The HealthSource Tax and Federal Subsidies

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Coverage of Governor Raimondo’s proposed new tax on health insurance premiums strikes me as highly misleading:

… most individuals who buy their insurance through HealthSource would find the tax, since it would be rolled into the premium, covered by their federal premium tax credits, said [HealthSource Director Anya Rader] Wallack. Of the roughly 30,000 Health-Source customers, 88 percent qualify for the credits.

“So the bulk of individual customers won’t be paying the premium assessment; the federal government will instead be paying it,” Wallack said.  

Those who obtain coverage directly from insurers or don’t qualify for the credits wouldn’t gain that tax advantage.

If we’re particular about the use of language, then Wallack’s statement is simply not true.  In a recent WatchDog article, I estimated that the 3.8% HealthSource tax on all individual and small group premiums in the state would have to be 9.1% if it were calculated based only on the plans sold through the exchange.  That suggests that about 60% of all plans subject to the tax do not receive subsidies because they are sold outside of the exchange.

According to the latest enrollment data, 12% of Rhode Islanders who are buying insurance through the exchange also receive no subsidies.  That means that only 37% of all people on whom the tax would be levied receive federal assistance for their premiums.

I’ve asked for clarification as to whether it’s actually true that the the federal subsidies will go up to cover the insurance tax.  I didn’t think so, but with Obama as president the rules of government can change without notice, so let’s assume that charging the tax as part of a premium will indeed increase subsidies.  That’s still not the whole story.

Premium subsidies are calculated as a cap that a person would pay for the second cheapest “silver” plan on the exchange (the “benchmark” plan), as a percentage of income.  An individual who makes $10,000 a year is under the poverty level, so that would cap his annual insurance premium for a silver plan at 2% of income, or $200.  Let’s say the benchmark plan is $2,500.  The individual would pay the $200 and receive a subsidy of $2,300.

According to estimates, the new HealthSource tax would make the hypothetical benchmark plan $2,595.  So, the low-income individual would still pay the $200, but receive a subsidy of $2,395.

However, that varies with with income and with the plan.  For an individual making a little over 2.5 times the poverty level (around $30,000), the $2,500 benchmark would start to approach his cap.  Maybe he’d receive some subsidy for the tax, but not all of it.

Moreover, the federal subsidy of the tax in the example would be held at $95.  A gold plan at $3,500 would bear a tax of $133, which is $38 higher than the government subsidy would be.  According to the enrollment data, this dynamic would affect all of the 13% of customers who bought gold plans and some portion of the 65% who bought silver plans.

In other words, “the bulk of individual” insurance customers would be paying the full tax, and a significant number more would pay at least some of it.*

 

* The phrase in quotation marks should be “the bulk of individual and small group.”  See here for explanation.

5

HealthSource and Defrauding of Taxpayers

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Ted Nesi reports that HealthSource RI — the state’s ObamaCare health benefits exchange — wouldn’t accept two lower-cost plans from Neighborhood Health.  Even on its surface the decision is an outrageous scam:

A Kaiser Family Foundation analysis, which originally included the two Neighborhood plans rejected by HealthSource, suggested they would have lowered the average premium for HealthSource’s second-cheapest mid-tier plan by 14% in 2017. Instead that number will only decrease by 0.5%, according to HealthSource.

But HealthSource officials said their decision was driven by the federal formula for premium subsidies, which are provided to about 90% of the Rhode Islanders who buy insurance through the marketplace.

In other words, Rhode Island officials didn’t want prices to go down too much because they want to force federal taxpayers (ultimately through debt) to pay $17 million more for Rhode Islanders’ health care than they ought to.  The openness with which “HealthSource officials” admit this shows they believe Rhode Islanders are happy to have their government stealing on their behalf, but some of us aren’t so immoral.  As a side benefit to local government agents, the after-tax cost of the exchange’s average health plan would have gone up 42% if they didn’t rig the market, making the exchange look even worse in the public eye.

And that’s not all.  Earlier this month, we learned that Neighborhood initially set its prices too high because its inexperience in the market left the organization no good basis by which to set prices.  So, they ended up refunding $2 million to members, probably with much of it simply a transfer of money taken from taxpayers as subsidies.

In summary, Neighborhood Health, which was arguably more like a quasi-public welfare agency before ObamaCare, overcharged its customers from the start, which forced us all to pay more in subsidies in our capacity as United States citizens.  It then refunded a chunk of the excess to its members, none to taxpayers.

Now, state government officials have refused to allow Neighborhood to charge less for plans in order to steal more money from taxpayers.  This action may very well result in another big transfer of wealth to Neighborhood members through another refund next year.

And on it will go.  If a private organization behaved like this, politicians and pundits would be declaring it scandalous.

7

Transfer to Medicaid “Main Driver” of HealthSource Decline

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Rhode Island’s Affordable Care Act (“ObamaCare”) health benefits exchange lost 5,027 members (18.6%) as of the December 31 deadline for open enrollment.  Officials largely blame the withdrawal of UnitedHealthcare’s plans:

HealthSource RI said in a statement that the “main driver” of the enrollment decline was the departure from the market of UnitedHealthcare, which HealthSource RI estimated insured roughly 1,400 exchange customers in 2016.

One source of lost customers was more significant, however: Medicaid.  A HealthSource spokesperson tells the Current that “about 1500 individuals who had [qualified health plan] coverage at the start of Open Enrollment have since been determined eligible and enrolled in Medicaid.”  A request for the number of Medicaid recipients who went the other way — losing the taxpayer-funded welfare benefit and signing up for a paid (if taxpayer subsidized) plan — had received no reply as of this writing.

healthsource-enrollmentlossbysource-2016

Since the beginning of HealthSource RI and the related Unified Health Infrastructure Project (UHIP), the RI Center for Freedom & Prosperity has warned that the system was designed to draw Rhode Islanders toward welfare benefits and dependence on government.  From the beginning, new Medicaid enrollment has far exceeded the numbers of Rhode Islanders who have used the exchange to purchase insurance.

These decisions and results have been a significant part of Rhode Island’s drop to 48th in the country on the Center’s Jobs & Opportunity Index (JOI) and to 39th on the index’s Freedom Factor, which is the ratio of jobs and employment to reliance on welfare programs.

9

Speaker & OHIC: Stopping Some of the State Taxpayer’s Bleeding

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As with his pulling of Budget Article 18, another reason to praise Speaker Mattiello this week: he is not seeing why state taxpayers should be forced to step into the breach left by the drying up of federal funds.

The office responsible for protecting consumers from excessive health insurance rate increases stands to lose nearly its entire staff if the House on Wednesday approves a budget amendment passed by the House Finance Committee. The $1.03-million loss in funding for 9 of its 12 full-time staff would leave the Office of the Health Insurance Commissioner (OHIC) with only three employees …

Governor Raimondo’s budget included $1.03 million to replace federal grant funding for the nine staffers when the grant runs out on Sept. 30, but the House Finance Committee last week voted not to replace the funding. “When the money runs out the programs are off,” House Speaker Nicholas A. Mattiello said during a budget briefing last week. “Every time a federal grant expires everybody wants the funding to continue. You have a government that Rhode Island cannot afford.”

If I understand correctly (let me know if I’m wrong here), these FTE’s are in ADDITION TO the staffing of Rhode Island’s (completely useless) ObamaCare exchange, HealthSource RI. Staffing levels of this department have fluctuated somewhat but have generally suffered as the tide of federal ObamaCare funds has receded (as scheduled).

There needs to be some thought before state officials agree to implement a federal program with funds that sunset. State taxpayers simply don’t have the capacity to take on the funding of ever more, new programs.

And if the sitting Governor (in this case, Governor Raimondo) feels that the program should continue with state taxpayers picking up the tab from the lapsed federal funding, he or she should make cuts elsewhere in the budget to find that revenue, not simply heap another burden on state taxpayers.

10

Rhode Island Is Too Small to Sustain Its Obamacare Exchange, so It’s Raising Taxes

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“Insufficient scale to justify investment.  Do not pursue.”

Such was the conclusion of a 2009 report funded by the Robert Wood Johnson’s State Coverage Initiative to investigate then-Lieutenant Governor Elizabeth Robert’s plan for HealthHub RI.  This year, the first budget proposed by Rhode Island’s new governor, Democrat Gina Raimondo, provides proof that the study was right.

In 2009, the idea was to follow Massachusetts, Connecticut, and Washington in setting up a government-run health benefits exchange.  The hope (at least as publicly expressed) was that an exchange would help the state expand access to insurance while lowering the cost of health care.  Yet, members of the group conducting the study “were disappointed to learn that the development of a full exchange model, as established in Massachusetts, would not” accomplish their goals.

A few years later, with the help of the Obama Administration and a party-line vote in the U.S. Congress, creating the Affordable Care Act, otherwise known as Obamacare. Then following an executive order from Governor Lincoln Chafee, Rhode Island officials went ahead and set up exactly the sort of exchange that their report had warned them not to pursue, calling it HealthSource RI.

With the Affordable Care Act requiring federal funding to cease soon, Rhode Islanders are now finding out what “insufficient scale” actually means.

Continue reading on WatchDog.org.

11

More on Raimondo’s Outrageous Health Insurance Tax

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Kathy Gregg has more details on Democrat Governor Gina Raimondo’s proposed tax on health insurance in Rhode Island in today’s Providence Journal, and it looks increasingly outrageous.  First is a little budgeting trick.  The tax kicks in midway through the fiscal year, so on an annual basis, it’s actually twice the cost that the budget advertises:

Targeted to take effect in January 2016, the premium surcharge that Raimondo proposes would raise an initial $6.2 million of the $30.9 million the Raimondo administration is proposing to spend during the year that begins on July 1 to operate the state’s “health-insurance marketplace’’ over the next year.

Over the first full 12 months, HealthSource RI administrators anticipate the surcharge will raise $11.8 million.

And the rate is outrageous, too — above what the federal exchange would charge, for most users:

It would be assessed on the premiums of all health plans purchased in Rhode Island by individuals (at a rate of 3.8 percent) and small employers (1 percent).

As Gregg reports, that will be over $400 per year for some members.  The rate is also higher than the similar taxes in Massachusetts (2.5-3.0%) and Connecticut (1.35%).

One thing that is misleading, I believe, is spokeswoman Maria Tocco’s explanation that, per federal law, “a premium assessment has to be levied this way, as premiums must be the same inside and outside the Exchange for the same products.”  As I explained yesterday, the governor’s proposed language imposes the rates based on market, not plan.  In other words, the governor is taxing all plans whether or not they are offered in the exchange.

I imagine she’s doing that because the rate they’d have to charge in order to follow the method of the federal exchange and still pay for HealthSource would have made Rhode Islanders eyes pop (and further prodded the exodus of productive people from the state).  As healthcare expert Sean Parnell estimated for an article I wrote, last year, applying the federal rate to Rhode Island’s exchange would generate around $5 million.  Roughly speaking, Raimondo’s tax is more than twice as costly, so if it were structured like the federal fee, the rate would have to be up to nearly 8%.

Obviously, more plans and more people means a lower rate.  That’s why Massachusetts and Connecticut can charge less even though their exchanges cost more.  But none of this is news.  The RI Center for Rhode Island has long been saying that Rhode Island’s market is simply too small to justify its own health benefits exchange.

Even agents of the state of Rhode Island admitted this, back when they were free to be honest.  Last June, I quoted from a 2009 report reviewing the lieutenant governor’s proposal for an exchange like HealthSource.  Their conclusion back then?  “Insufficient scale to justify investment. Do not pursue.”

What’s changed that has a supposedly financially savvy governor touting this as economic development?  Perhaps that they think they can get away with it, now.

12

Beware: The Health Exchange Premium Fee Is a Simple Tax

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With publication of the legislation enacting Governor Raimondo’s budget, as House bill 5900, some of the details left ambiguous in standard budget documents can be checked.  One of the more disconcerting is the supposed “fee” assessed on health insurance premiums in the state.

The budget presentation avoids naming what the “fee” is, but the talk and reportage during and after last night’s speech by the governor presented it as a fee structure similar to the way the federal government pays for the federal health benefits exchange.

Reviewing the legislation makes it clear that this is not the case.  The new revenue stream for HealthSource RI is simply a tax.

As I explained during the last legislative session, the federal exchange fee works like so:

  • Health insurers are assessed a 3.5% fee on the premiums of plans sold through the exchange.
  • They are not permitted to charge different prices for the same plan on or off of the exchange.
  • Therefore, the price of the fees must be spread across all people who purchase that particular plan, whether on or off of the exchange.

According to the governor’s legislation, the new health insurance tax would work very differently:

  • HealthSource will determine its budget for the year.
  • That total will be allocated to the small employer market and the individual market in proportion to each market’s participation in the exchange.
  • The insurer will increase all premiums in each market by the percentage necessary to generate the necessary money.

One consequence of this different method that must appeal to our progressive governor is that it shifts the tax burden toward Rhode Islanders with more-expensive plans.  No matter what the proportion of bronze, silver, gold, or whatever plans on the exchange, the tax is a flat percentage on all plans, so people buying more-expensive plans will pay more.

A consequence that surely appeals to the state’s government-first establishment is that there’s no escape from the tax.  It doesn’t matter whether insurers participate in the health benefits exchange or not, and it doesn’t matter if they sell different plans on or off of the exchange.

But the most important consequence is that this fee is completely unrelated to actual usage of the exchange.  Again, it’s just a tax, collected via health insurance plans.

According to the governor’s budget, HealthSource will cost $30.9 million to operate next fiscal year, but $24.7 million of that is still coming from the feds.  You don’t have to agree with me that the Obama administration is breaking the law by continuing to pay for state exchanges to understand that the operating costs of HealthSource are guaranteed to grow by leaps and bounds, as federal involvement tapers off.

In other words, nobody who cares about Rhode Islanders or the local economy should want to cross this particular Rubicon.  Once this new tax is law, all bets are off.  The success or failure of the exchange becomes immaterial.  The General Assembly never has to face the heat for increasing taxes.  The bloated government start-up company that is HealthSource RI becomes just another factor driving up the costs of Rhode Islanders’ insurance.

13

Some 2015 Predictions (HealthSource and RhodeMap)

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Filling in for Matt Allen on WPRO, last night, Jay Martins asked me to call in with predictions (and warnings, really) about HealthSource RI and RhodeMap RI.  Here are my notes for the call:

HealthSource

When commentator Avik Roy was looking for the perfect quotation to summarize Vermont’s aborted flirtation with single-payer healthcare in Forbes magazine, he picked Raimondo’s choice to lead HealthSource RI, Anya Rader Wallack. What she said was: “We can move full speed ahead…without knowing where the money’s coming from.”

That pretty much sums up the strategy with HealthSource RI, too. They leapt into this thing expecting the money just to materialize, and it didn’t.

The ironic problem is that Wallack’s primary job this year will be figuring out where the money’s coming from.

Prediction:  There will be some dramatic hearings and political battling with House Speaker Nicholas Mattiello (D, Cranston), but ultimately, the government insiders like HealthSource enough — mostly as a stepping stone to our own attempt at giving government all control over healthcare — that they’ll give him something substantial that he wants as a trade. What that’ll be may be the most important answer we’ll get in the next six months.

 

RhodeMap

We can only hope that this will be a big story.  RhodeMap’s going to be more interesting than HealthSource in its way. What we’re going to see are:

  • Local pro-RhodeMap/Smart Growth activists trying to get on local planning boards
  • Stealth legislation and ordinances to give planning boards more authority
  • Other stealth legislation and ordinances to push forward RhodeMap principles, which have a lot of money and insider and activist support behind them.

The big questions are:

  • How strongly cities and towns will push back
  • How insiders in the state and federal government will ultimately thwart those towns and anti-RhodeMap activists that manage to gain local traction — whether regulation, legislation, judicial hearings, or politically undermining them
  • Whether the general public’s interest (and outrage) can be maintained

Eminent domain is definitely a flash point that will grab the public’s attention, and despite assurances, RhodeMap does open the door for it, but there are many lower-grade tools in the central planners’ toolbox.  First, they’ll work on pressuring property owners through taxes, zoning, regulation, and general government harassment, all of which will offer property owners the escape hatch of devices like transfer of development rights.  (That’s when a property owner sells somebody, possibly the government, the rights to develop his or her land, which he or she technically continues to own and the buyer transfers that right in order to develop land somewhere else.)

Only if none of that works will they move forward with property takings, which isn’t likely to happen in 2015.  The targeted property owners will be outraged, but mainstream journalists don’t tend to care about individual property owners when it’s the government that’s harassing them, so the question is whether those with eyes to see will manage to weave together the bigger story and get the public to pay attention to it.

14

HealthSource, RhodeMap, and the Way Government Plans

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You may have seen Ian Donnis’s report that Governor-elect Gina Raimondo intends to replace Christine Ferguson as the head of HealthSource RI, Rhode Island’s ObamaCare health benefits exchange:

The leading candidate to replace Ferguson is Anya Rader Wallack, the president of Arrowhead Health Analytics in Fall River, Massachusetts, and a former policy director and deputy chief of staff for former Vermont governor Howard Dean. Rader Wallack declined comment when contacted by RIPR.

Ms. Rader Wallack may now have the dubious distinction of making an embarrassingly telling comment even before she’s taken office in Rhode Island.  Avik Roy quotes her in Forbes, in an article about the (inevitable) collapse of Vermont progressives’ single-payer-healthcare fantasy:

If there’s one quote that sums up the whole episode, it’s the one from Anya Rader-Wallack, declaring that “we can move full speed ahead…without knowing where the money’s coming from.” Green Mountain Care attempted to offer Vermonters more generous coverage than they currently had, but couldn’t figure out how to convince doctors and hospitals to accept pay cuts, nor workers to accept tax hikes.

That quote sums up HealthSource RI’s story pretty well, too.  As reported on the Current, Ferguson chose not to follow through with a more-detailed projection of its likely effects on the local healthcare market, and the consequences for HealthSource and the state budget could be devastating.

But this is how an organization (in this case, government) plans when everybody making decisions profits simply by being active and bears no real personal risk for failure.  It’s also how people plan when they feel like they can always take other people’s money and pass laws to force people to behave as the plans require.  We see this with RhodeMap RI, too, especially with its Growth Center plans, which have explicitly drawn purposes for land that the government does not own (and whose owners have not been consulted).

The plan for Middletown, for example, makes the particularly chilling suggestion that government operatives should include private commercial property in its planning “because properties on that side of the road may redevelop before the town-owned property does,” and the government needs to “send a message about the desired character of future development.”

Ultimately, that may be the secret to the illusion that we can simply assign ever-greater responsibility in our society to government, and the really smart people who take government jobs will simply figure out the best way to accomplish their goals.  Like novelists, they plan out a plausible reality, and where they write themselves into a corner, they assume that some literary device, some mix of regulatory demands and money confiscation, will solve the problem.

When the author’s power is infinite and the consequences for failure are borne by others, there really isn’t a reason to find evidence that a scheme will actually work.  Full speed ahead!… until the crash, followed by a new six-figure job in another state.

19

“Spotlight on Spending” Report: Where Have You Been All of My (Political, Taxpaying) Life?

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Fine, tell me I need to get a life. But it is not an exaggeration to say that the “Spotlight On Spending” report compiled by the R.I. Center for Freedom & Prosperity and released Tuesday made my year.

Rhode Island currently has the eight highest local and state tax burden. While this is up from sixth highest, it is clear that we continue to spend beyond our means and our ability. Yet we’ve been told repeatedly – sometimes explicitly (thank you, Rep Tanzi); usually more subtly by the substance of the budget itself that emerges from the end of the legislative session – that there is nothing left in the state budget to cut. The “Spotlight On Spending” report resoundingly contradicts this.

22

Costs upon Costs with HealthSource-Related Data

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Government spin and incomplete reportage of HealthSource RI’s results leave Rhode Islanders with little understanding of how short the health benefits exchange will be of covering its expenses or how much greater the Medicaid handouts will be than projected.

23

RI Center For Freedom & Prosperity: “State Cannot Afford Operation of HealthSourceRI”

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As readers may know, ObamaCare RI, a.k.a., HealthSourceRI (funny that they had to give it a different name), was created via Executive Order by Governor Chafee with federal funds that disappear next year. HealthSourceRI has turned into the consummate bloated, expensive and unnecessary governmental bureaucracy without even accomplishing one of its important claims of increasing […]

24

HealthSource RI really is the perfect RI government program.

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Consider:

Christine Ferguson, executive director of HealthSource RI, suggested the state could look to a tax or fee, as some states that run their own exchanges have done.

But it could also use a combination of direct state aid, advertising revenues, grants and “strategic partnerships” with other agencies and nonprofit groups to help offset costs.

Only in government is it possible to plan to figure out how you’re going to pay for a $25-30 million annual operation after having spent several times that to set it up.

And right on cue comes the voice of the leftist labor unions:

Another advisory board member, Patrick Quinn of the Service Employees International Union, which represents nurses and other healthcare workers, suggested Rhode Island could impose a tax on soda, or assess a fee on not-for-profit health-care providers that pay “outrageous” salaries to their executives.

Of course! An expensive new government program is the perfect opportunity to impose nanny-state values and redistribute wealth.

No wonder people are giving up on Rhode Island.

25

Investing taxpayer money to give it away.

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Along with the federal government’s roll-out of the bad news surrounding enrollment in the health benefits exchanges of the Affordable Care Act (ACA; aka ObamaCare), HealthSource RI has published a more-complete picture of Rhode Islanders’ use of the site.

Basically, of the 4,405 “processed applications,” 73%, or 3,213, are Medicaid recipients, meaning that they were “shopping” for a welfare program that’s free to them. Of the remaining 1,192 presumably-paying customers (although many will likely be mostly or partially subsidized by federal taxpayers), only 267 have fully enrolled — that is, they’ve made the first payment indicating that they’ve actually purchased the plan.

As shown on the chart that I’ve posted on the RI Center for Freedom & Prosperity’s site, that works out to $371,268 in U.S. taxpayer-funded grants to get the exchange working per enrollment.

As she might be expected to do, HealthSource director Christine Ferguson puts a positive spin on the results, saying that “the Medicaid piece is a great, smashing success.” Make it easy for people to get something for free, I guess, and you’ll have takers.

My favorite paragraph in Felice Freyer’s Providence Journal article, though, is this one:

Among those buying private insurance, Ferguson said that Rhode Island has exceeded the first-month target of 890, which was set by the federal government but not previously revealed. (Of the 1,192 who are buying insurance, 267 have already paid their premiums, which are due Dec. 15.)

Beware previously unrevealed goals, especially when it’s not clear when the federal government actually defined “enrollee.” One wonders where that goal — which is exactly 75% of the actual number (to the nearest ten) — came from.

In August, Spokesman Ian Lang told me that the exchange “anticipates” enrolling at least 70,000 people by the end of next year. Even if that includes Medicaid recipients (which wasn’t clear), they’re not on track to make it.

26

Number Games to Lock Us In to Government Medicine

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The General Assembly’s budget looks likely to impose a brand new HealthSource tax on all Rhode Islanders who buy individual or small-group health insurance in the state. Whatever the numbers can be made to show, the scene will surely darken in years to come.

28

Learn the Lesson, Rhode Island: Doctor Shortage

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It’s anecdotal, to be sure, but add Ellen Lenox Smith’s letter in the Providence Journal to the evidence that Rhode Island has a worsening doctor problem:

Just last week, I had an appointment with my pulmonologist, who shared that out of the four doctors in his practice, only two are now left. This poor doctor is expected to take on the work of the two that are now gone along with his original patients, and they are not intending to replace those gone. I am so concerned that he will decide it isn’t worth it and leave, too.

This is not the type of medicine he planned of doing: overstretched, overtired and not able to care for his patients in the manner he was first hired to do.

Rhode Island imposes a high number of mandated coverages on health insurance, driving up the cost.  We’ve pushed nearly one-third of our population into Medicaid.  And our laws are restrictive when it comes to occupational licensing, regulations, and taxation.

This environment of massive government control puts a lot of pressure on the prices that providers can charge customers, which has an effect on how much time they can afford to spend with them, meaning that the job may not be what they wanted it to be.

We need to learn this lesson, because ideological and motivated activists are trying to push our state even farther down this road.  Market forces allow us to match up the things that people want done (and can afford) on one hand and the things that other people are willing to do (for an income they are willing to accept) on the other.

Messing with that freedom-derived balance means that something else is determining who gets what from whom.  Then, the incentives of politics will make it more beneficial to promise the moon to the getters at the expense of the providers.  Even if the current providers tough that out and don’t cross the border, we’ll inevitably see fewer new ones as time goes forward, and everybody will suffer.

29

Government’s Interest in Promoting Itself

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Tom Ward of the Valley Breeze offers an important warning for anybody hoping to keep an eye on their government and its successes and failures:

There’s a shift coming in local and state news coverage, and it’s not a good one. You’ll need to train yourself to spot real news done by independent journalists at newspapers and TV stations, from public relations – propaganda, really – done by the growing legions of writers employed by political officials or state agencies. What’s more annoying? Taxpayers are paying for the one-sided press, whose writers tow “the company line,” whether that company is a school department, mayor’s office, or state agency.

My question? Why are taxpayers forced to pay for this? Readers should ask themselves, “Who benefits?”

For some politicians in office, it becomes impossible to tell where their taxpayer-funded “communications” staffs end and their campaign machines begin.  Perhaps even more insidious, though, is the use of taxpayer funds to promote the use of government as a solution for all problems versus other alternatives.

Researching school choice a few years ago, I was struck by the degree to which government schools’ advantages extended beyond the no-direct-cost funding model to the point of having promotional apparatus.  The state, especially, has professionals dedicated to the promotion of the public system, from announcements of innovations to promotion of individual teachers.

With some variation in form and emphasis, this applies across government.  Police and fire departments promote their community services; welfare agencies (including HealthSource RI) advertise their offerings; and on and on.

To some extent, this is natural and good.  Communities should want broad comfort with the local police department, for example.  When government becomes as big and all-encompassing as it has, however, its self-promotion can flip an emphasis on using its coercive power only when necessary to presenting it as the ideal solution in all cases.

30

On Losing the PawSox

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Losing the PawSox seems mainly to be a worry of RI’s decision-making elites, but the best thing Rhode Island could do is to make it clear that it has decided to get back to basics and get itself onto a better path.

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