Healthcare Spending Limits, a Step Way Too Far

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So, while Rhode Islanders go about their lives, here’s what they’re paying state government officials to think about, as reported by Richard Salit:

To curb the rising cost of health care, Rhode Island should cap how much is spent statewide by insurers, hospitals and doctors and consider ways to hold them accountable when they surpass annual targets, according to a panel convened by Governor Raimondo.

And what’s needed to oversee the development of such a cap — and a slew of other ongoing efforts to reduce health care costs and improve quality of care — is a new Office of Health Policy to establish and implement goals, the group says. 

Those were among the key recommendations included in a final report released on Tuesday by the Working Group for Healthcare Innovation, which the governor formed last summer.

Democrat Governor Gina Raimondo created the working group via executive order, and I addressed the economic illiteracy of its goal back in July, but people really need to contemplate what it is the state is seeking to do, here.  Put it plainly: People in the government want to tell Rhode Islanders how much they can spend on their own healthcare.

Oh, they’ll spin it.  They’ll say that their goal is really to limit what people who provide healthcare can charge Rhode Islanders and that they’re planning to get the best minds looking for miracle delivery methods that will ensure that everybody gets all the care they could possibly want “realistically need” while paying providers fairly for their services, but the basic fact remains the same.  What they want to do is limit how much Rhode Islanders can spend on their own healthcare.

That’s not all.  No, this isn’t some individual limit for each of us; it’s a collective limit for all of us.  So, when they expand Medicaid rules to accept even childless, able-bodied adults, those extra services have to be deducted from the total.  When they then expand the services available through Medicaid to include transgender operations, that money not only comes out of taxpayers’ wallets, but out of our shared healthcare total. And when prices go up and the powerful labor unions in the state lobby and fight successfully to hold on to their disproportionately generous benefits (perhaps with the help of binding arbitration), that much more of the squeeze will have to come out of everybody else’s share.

In the name of helping us, what government officials hope to set up is a system in which all of us must invest non-healthcare money in the buying of political influence in order to secure a fair (or less unfair) cut of the healthcare that the government allows to happen in the state.

It’s getting less and less hyperbolic to suggest that we’ve reached the point at which pitchforks on Smith Hill are justified.  Any government officials who would take steps toward this goal should be forced out of office, whether they have to be voted out, fired, or impeached.

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R.I. Center for Freedom & Prosperity: 2015 RI Report Card on Competitiveness Confirms Status Quo is Failing Rhode Islanders

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The grades are out, and once again the status quo fails on the 2015 RI Report Card on Competitiveness. When will the political class learn that their way is simply not working to reach their stated goals? If Rhode Island is to reform its way of conducting business, our elected officials must learn to place less trust in government-centric programs for every problem. We will never improve our state’s employment situation unless we adopted the need reforms that will allow Rhode Islanders to empower themselves to achieve their hopes and dreams. The 2015 report card decisively demonstrates the wreckage that decades of liberal policies have wrought upon our state.

The 2015 RI Report Card shows how Rhode Island’s political class continues to cater to special insiders, while depriving other Rhode Islanders of the opportunity for upward mobility, educational opportunity, and personal prosperity. In the major categories, Rhode Island was graded with two F’s, seven D’s, and one C. The two categories with F grades are Infrastructure and Health Care; the seven D’s are Business Climate, Tax Burden, Spending & Debt, Employment & Income, Energy, Public Sector labor, and Living & Retirement in Rhode Island; while Education received a C-. Among the 52 sub-categories evaluated, Rhode Island received 19 F’s, 24 D’s, 5 Cs, 3 Bs, and just one lone A.

These unacceptable grades should be a wake-up call to lawmakers that a government-centric approach is not producing the social justice and self-sufficiency that Rhode Islanders crave. By burdening the public with policies that discourage work and a productive lifestyle, the status quo is failing the people of our state. On the 2015 RI Report Card on Competitiveness, the Ocean State received “Ds” in the major categories of Jobs and Employment, and in Tax Burden. We must learn to trust in our people and remove the tax and regulatory boot of government off of their backs by advancing policies that empower the average family with choices, that reward work, and that grow the economy.

Only free market policy will transform the Ocean State by advancing policies that empower the average family with choices, that reward work, and that grow the economy. We can no longer tolerate Rhode Island falling further behind. The Center will continue to work tirelessly to promote policies like sales tax reform and school choice in order to help our fellow Rhode Islanders by unleashing their potential. We encourage you to help spread the word about the failing grades the status quo in Rhode Island received this year. You have power to change the Ocean State into a place where everyone can prosper. Thank you.

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Letting Bureaucrats Regulate Impossible Complexities

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Two concepts from an unsigned editorial in today’s Providence Journal beg for juxtaposition.  It’s about a proposed Care New England and Southcoast Health System merger.  First:

To be sure, regulators should carefully weigh what the new organization’s market share is apt to be in any number of areas, from primary and obstetrical care to cardiac facilities. How would the proposed merger affect Lifespan, currently Rhode Island’s largest hospital system, and presumably its chief competitor? How would it affect smaller entities such as the still independent South County Hospital?

Next:

The changes under way in health care are complex, and at times seemingly beyond the grasp of even health-care experts.

The whole editorial treats the merger as if it’s a question of public policy about government agencies, rather than the operation of private organizations.  I find myself wondering, once again, what long-running government program instills the Providence Journal editorial board with such confidence in regulators’ ability to behave as an executive board for an industry that seems “beyond the grasp of even health-care experts.”

That shouldn’t be a new question.  It’s a basic, long-standing part of the intellectual economic discussion whether human beings can possibly collect and process enough information to make economic decisions on anything but the most narrow, direct, and personal questions.  Another basic consideration in the economic discussion is that the more decision-makers are insulated from consequences, the less care they’ll take and the less competence they’ll display.  Giving “regulators” and the general public (as represented, here, by a newspaper editorial board) power to make economic decisions for both the providers and consumers of health care is many steps too far.

With Rhode Island as an excellent case study, the United States of America needs to get out of the weeds of private industry and turn its attention to the harder questions of social belief and policy.  It’s a lot easier superficially to decree that everybody should have access to “quality, affordable health care” and then push the blame for failure around to interested parties and supposed experts than it is to answer the deep questions — especially when the solution for that failure is always to give the interested parties and supposed experts more power.

The deep questions to which I refer are those such as: What level of health care is “a right”?  How does that right interact with individuals’ personal responsibility?  Who pays for that level of health care?  Who gets to balance that cost against other possible uses of scarce resources?

Simplistic declarations about rights, with the responsibilities handed off to unaccountable bureaucrats, absolve individuals and communities of responsibility.  This lesson has become too obvious to miss in a country whose elite president indulges in endless rounds of golf and multi-million-dollar family vacations while education insiders prattle about needing more money for their own special interests and editorial boards blithely hand our freedoms over to Ubermensch regulators.

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Learning from Rhode Island’s Long Trend of Health Insurance Burdens

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To some extent, Rhode Island has been immune to the cost increases against which so many Affordable Care Act (ACA) skeptics have rightly warned since the act became law in 2010. The state had already freely opted to inflict on its people most of the harm that Obamacare has brought to other states. The increases are starting to catch up with Rhode Island health insurance consumers, nonetheless, and in ways that aren’t captured by just comparing premiums.

The Ocean State has long led the nation in the number of health insurance mandates, driving up costs. Limits on rate variation for people in different groups were already in place. The expansion of eligibility rules for Medicaid was of less import in Rhode Island because the only change left to make was to offer benefits to able-bodied adults without children.

Even the danger of scaring off insurers wasn’t much of an issue, because Rhode Island’s burdensome regulations had made the state a near monopoly for Blue Cross Blue Shield until UnitedHealth won a state government contract, making it effectively a two-company market.

As the Rhode Island Association of Health Underwriters put it, in 2004, “Over the past few years, a number of private health insurance carriers have left the state. This has severely limited the number of health insurance product choices residents and business owners in Rhode Island have, and it has also caused a dramatic rise in health plan costs, which even exceed the high health insurance rate jumps that people in other states have experienced.”

Although other states have done some catching up with the ACA, Obamacare and Rhode Island’s health benefits exchange, HealthSource RI, have not succeeded in lowering costs. As a silver lining, though, the experience may be teaching Rhode Islanders the financials of health insurance — mainly that premiums aren’t the only way for insurance to cost more.

Continue reading on Watchdog.org.

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Transgender Medicaid: Empty Show or Unknown Cost

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Answers took some days to receive and to clarify, but I’ve been meaning to follow up on this Richard Salit article in the Providence Journal:

Rhode Island is now among a handful of states that has expanded its Medicaid benefits to include medical care for transgender people, including mental health treatment, hormone therapy and sexual reassignment surgery.  

The policy change, announced a week ago, is being hailed by lesbian, gay, bisexual and transgender advocacy groups, who say the benefits should now be offered by private insurers as well.

I asked spokespeople for the state how much the change is projected to cost, and the answer, in a word, was nothing.  More specifically:

In its proposed rules for Nondiscrimination in Health Programs and Activities, the US Department of Health and Human Services states that it expects [these expanded benefits to] impact a very small segment of the population, and will have minimal impact on the overall cost of care and on health insurance premiums.

This determination is based on a study in California that found that covering transgender individuals under California’s private and public health insurance plans would have an insignificant and immaterial economic impact on costs (based on evidence of low use and the relatively small transgender population).

We do not have cost estimates specific to Rhode Island’s Medicaid’s program.

Overall, it looks like the goal is more to pressure insurers to make the same change as part of a political effort to define transgender operations as a human right, meaning that a failure to pass along the cost for these rare treatments to everybody else through the cost of regular medical care would be discrimination.

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Mandate Has No Effect: Spinning Heads on HPV Vaccine

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The latest news out of the Rhode Island government-media spin machine is that “HPV vaccination rate ‘extremely encouraging’,” as Richard Salit’s Providence Journal article puts it.  The lede or secondary headline was: “First year vaccine is required for seventh graders.”

It’s enough to make a well-informed Rhode Islander scream at the computer, tablet, or dead-tree newspaper.  Readers may recall that the HPV vaccine became controversial in Rhode Island because the state government presumed to make Rhode Island one of only two states to mandate inoculation against the sexually transmitted disease and the only one to do so by regulatory fiat.

Here’s the “extremely encouraging” news:

As of Sept. 1, with data compiled on 85 percent of the seventh graders in public and private schools, 72.5 percent had received at least the first in a series of three recommended doses of HPV vaccine.

That’s pretty good, right?  Vindication for the mandate?  Not really.  Read a bit farther and do some math:

Because it’s a new mandate, the only previous Rhode Island statistic to compare that to is one from 2014 from the U.S. Centers for Disease Control (CDC). It estimated that, among those ages 13 to 17, 76 percent of girls and 69 percent of boys had the first dose of the HPV vaccine.

Average those two percentages, and you get… 72.5%.  Public school enrollment data for the 2014-2015 school year shows that there are more boys, so the overall percentage based on the two numbers given would be 72.3%, but the percentages themselves are rounded, and private schools may very well shift the balance back toward equal numbers.

In other words, the government diktat that all students must put this drug in their body changed the vaccination rate almost not at all.  It did, however, create a new precedent for the bureaucracy’s little dictators.  On the positive side, it may have sparked some enduring backlash and eroded confidence in the government, inasmuch as the number of religious exemptions for vaccines jumped from “about half a percent for the 2014-15 school year to 4.47 percent for 2015-16 year.”

Any push-back against the state government in Rhode Island is good news, as far as I’m concerned, especially when the local news media tends to simply pass along the government’s spin.

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RI Report Card: Rhode Island Government Still Failing Its People

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The RI Center for Freedom & Prosperity’s Competitiveness Report Card for Rhode Island is less of an indication of how Rhode Islanders are doing than what insiders are doing to us.

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HealthSource “Inadvertently” Doesn’t Maximize Abortion Coverage

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With HealthSource RI — Rhode Island’s health benefits exchange under the federal Affordable Care Act — currently in its open enrollment period, I’ve been looking at changes in premiums, deductibles, and such.  Although I still have to look more deeply, it’s reasonably safe to say that, in most cases, premiums went up (sometimes by double-digit percentages) and, in many cases, deductibles also went up.  That is, those who were automatically re-enrolled may soon discover that their monthly costs are going up while their total benefits decrease.

It is within that context, along with my belief that (in most cases) abortion is tantamount to infanticide, that I read Kristin Gourlay’s Rhode Island Public Radio article about “9000 Inadvertently Re-Enrolled In Plans With No Abortion Coverage,” which the International Business Times has picked up for a larger story.  I’m sure the plans in which those 9,000 people were re-enrolled included other changes, with additions and reductions in coverage, and while I understand that this is a controversial issue of substantial public debate, it bothers me that killing unborn children is treated as a major component of basic healthcare.

Based on the current enrollment demographics for HealthSource, 46% of enrollees are men and 51% are over 45 years old.  It’s not this simple, of course, but roughly speaking that means only around 8,118 enrollees are likely to be in the demographic range that would be interested in abortion coverage in the first place.  We could reasonably reduce that number by a couple thousand (at least) to account for those who are pro-life.*

Applying these percentages to the 9,000 “inadvertent” re-enrollments, only around 2,381 are likely to be applicable to abortion, anyway, reduced to fewer than 1,700 if only those who think abortion should be legal are included.  That’s around 5% of all enrollees.  It’s not inconceivable that a similar or larger number of HealthSource customers would be interested to know that they were “inadvertently” re-enrolled in plans that do cover abortion even though plans that do not are now available.

 

* I grabbed poll results from a post on RI Future, but I hesitate to apply them, here, for two reasons.  First of all, the poll was conducted on behalf of Planned Parenthood, which is the nation’s leading aborter, and the skew is obvious in the way the question is phrased.  Second, the actual opinion that produced a 71% support rate was whether the law should leave decisions up to individuals, which leaves a great deal of room for people to oppose being made to subsidize abortion through an insurance pool, much less desiring the coverage for themselves.

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All They Need’s the White House (In Some States)

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As a follow-on to my Watchdog column, this week, Megan McArdle’s thoughts on the Democrats’ electoral fate in the Obama Era raise a telling point, from a Rhode Island point of view:

Many of [ObamaCare’s] subsequent struggles have stemmed from the apparent belief that [Democrats] didn’t need down-ticket races, or public opinion; all they needed was Barack Obama sitting in the Oval Office.

Kentucky illustrates the dangers of this strategy. Most policy happens at the state and local level, not federal, something that’s easy to forget as local media outlets fail and news coverage becomes increasingly focused on national elections. Under outgoing Democratic governor Steve Beshear, Kentucky was a poster child for the success of Obamacare; under incoming governor Matt Bevin, it may well become a poster child for its failure.

Sitting here in the Democrat-run Ocean State, I’d caution McArdle not to be overly skeptical of the strategy.  Our state’s health benefits exchange (also created by questionable executive order) lived off federal funding and administrative changing of the law for development and a couple of years of operations.  Now, it looks likely to survive by being embedded in the larger Unified Health Infrastructure Project (UHIP), for which the federal government has largely paid.

HealthSource is a good example of the Rhode Island reality that, if the federal government can find a way to pay for it, state policymakers will go along.  The lesson may have limited application across a large, diverse country, but it is an indication of what the Left will strive to do with its control of the federal bureaucracy, judiciary, and whichever elective offices it can win.

For our part, Rhode Islanders should take it as a point of personal shame that our state and our liberties are so easily bought.

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Obamacare Exchange in Rhode Island Limping Along in Need of More Funding

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An acquaintance investigating health insurance pricing through the website of HealthSource RI—Rhode Island’s health benefits exchange under the Affordable Care Act (ACA; ObamaCare)—became caught in one of those torturous loops people encounter on the Internet from time to time, whether by user error or a technical glitch. The various forms on the site just would not work for him.

After two-and-a-half hours on hold waiting to interact with a human being through that old-fashioned device, the telephone, the clock ran out on HealthSource’s business hours, and not wanting to remain on hold over night, he hung up and emailed his friends in frustration.

Recent news coverage makes clear that his was not a unique experience.

Continue reading on Watchdog.org.

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Giving the Game Away on Diversity Talk and “Health Equity Zones”

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It’s hard not to agree with Rhode Island Director of Health Nicole Alexander-Scott when she phrases her point of view like this:

“Like the governor, I also fully support diversity across the board in leadership levels … I love to say diversity brings strength. You have a variety of backgrounds, a variety of ideas, experiences that add new ways of accomplishing things. We’re in an age where we have to be creative, we have to be innovative, and the more diverse perspectives we have, the better we are at being able to achieve that effectively …”

Unfortunately, the context suggests that, like most liberals and progressives, she takes an extremely superficial, arguably racist view of diversity.  Providence Mayor Jorge Elorza lays it out with stunning clarity in his contribution to the Providence Journal’s “Race in RI” series.  With the paradoxical imperatives that we have to “focus on what brings us together” and declaring that people who disagree with him about the existence of “white privilege” should be written off, Elorza says he chooses to “focus on like-minded people.”

Apparently, having his biases confirmed is more important to the mayor than “a variety of backgrounds… ideas… and experiences” that brings “diverse perspectives” to the necessity of solving problems creatively.  The way to achieve diversity is apparently to make people who are substantively different disappear.

That point of clarity dovetails nicely with another, hidden within Alexander-Scott’s interview:

Using $2.7 million from the U.S. Centers for Disease Control, Rhode Island has created 11 “health equity zones” to target the root causes of poor health, including poverty, inadequate housing and lack of nutritious food and safe recreational opportunities.

Thus money confiscated from taxpayers for the purpose of disease control somehow becomes diverted to “safe recreational opportunities,” and this is just the edge of the crowbar under the bedrock of our freedoms.  “Diversity” and “equity” are wonderful principles in the abstract and defined honestly.  In the current practice, they’re manipulative buzzwords for “like-minded people” to confiscate money and consolidate power in order to buy votes and make people dependent on government.

Far from wanting healing, the people promoting these ideas need divisions and disparities to remain.

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Turning Rhode Island into the Government, LLC, State

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Rhode Island is stealing our opportunity to fulfill our potential and be self-sufficient. We’re becoming increasingly dependent on subsidies from government, jobs remain scarce, and the state’s latest programs are designed to make things worse.

Here’s one indicator of increasing dependency: From January 2007 to January 2010, the state added over 60,000 residents to the federal Supplemental Nutrition Assistance Program (SNAP; “food stamps”). Over the next three years, nearly 50,000 more joined, bringing the total to nearly 181,000.

In those few years, the state added about one-tenth of its population to the welfare program. Since then, during a supposed recovery, the number of participating Rhode Islanders hasn’t even fallen by 10,000.

During the same period, nearly 40,000 jobs disappeared from Rhode Island, and the state hasn’t quite replaced 30,000 of them. Joblessness or low pay subsidized with handouts appears to be the new normal in Rhode Island. As the crawling increase in jobs shows, we’re not achieving our role as a community to provide self-fulfilling, dignified work that allows us to support our own families.

Continue reading in the Providence Journal.

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The Demon RI’s Cult of Big Government Would Summon

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As Halloween approaches, fear not the masks and movies; fear the quiet promises whispered in press releases and incanted with mystical words like “equity,” “sustainability,” and “diversity.” The Cult of Big Government is working night in and night out to raise from the dark abyss of dangerous philosophies a demon to possess all of society and sap the human will.  Look south of Salem, to Rhode Island, where the scheme is well advanced.

In a society so comfortable that it has become discomfited by the wisdom of its ancestors, our popular myths mislead us now.  The demon will not arrive with a flash of lightning and the smell of sulfur.  It has changed the masks of racial bigotry and overt greed in which it has been spotted in the past.  Its minions have no need of the ritualistic dances of the legislature.  No virgin need be sacrificed (though virginity itself may be).  Surviving until dawn will not save the victims.

Rather, the secular clerics of the soulless cult have chosen three points in the lives of unsuspecting national villagers on which to build their citadels, disguised as places of public service, and when the triangle is fully drawn between them, all hope will be lost.

Continue reading on Watchdog.org.

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Growing Programs Versus Saving Money in Waste, Fraud, and Abuse

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A recent report from the federal Government Accountability Office noted that “improper payments” through government benefit programs have increased dramatically–by more than 300 percent from 2003 to 2014, reaching $125 million.

Eliminating “waste, fraud, and abuse” has become something of a go-to promise for political purposes, often as a hypothetical funding source for desired programs. But taxpayers should be wary of bureaucratic attempts to trim spending around the edges; tendencies will always be toward more money transferred out of their pockets.

As a matter of simple mathematics, erroneous payments can increase for one of two reasons: Either the size of the program grows, or the error rate increases. If a strategy for reducing the error rate results in a much larger program, then it will wind up costing more money. The State of Rhode Island is on the cusp of proving this principle.

Continue reading on Watchdog.org.

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The Giant Preschool in Health Equity Zones

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“Health equity zones” are the latest euphemism hiding an ultimate end of our liberties and control over our own lives.

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Ted Almon’s Self-Serving Op-Ed Hypocrisy

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Depending how you feel about corporate executives’ using government and the news media to manipulate the public and line their own pockets, you’ll either be impressed or disgusted with a recent op-ed in the Providence Journal penned by Claflin Co. CEO Ted Almon.  Either way, you have to admit that it takes more than a healthy dose of (let’s be polite) audacity for him to accuse other people of “paid… agitprop” when his company has received tens of millions of dollars from the government agency that he’s defending and stands to receive tens of millions more.

In this regard, Ted Almon’s Claflin Co. is a veritable poster company for a system of government run by insiders and for insiders, selling government handouts at others’ expense.

Anybody who thought Almon’s essay defended the Department of Veterans Affairs based on principle should consider that, in fiscal year 2015 (last October through this September), Claflin did over $16 million of business with the VA.  That was up from about $14 million the year before and has been on a more-or-less steady increase since at least 2008, when the total was less than $3 million.

Claflin’s interest in the VA is likely to grow, considering that, as of March, the company had a five-year contract with the agency for “hospital equipment and related services.”  Naturally, Claflin is a private business, so its financials don’t appear to be immediately available to the general public, but it’s a safe bet that government healthcare spending represents a growing portion of its revenue.

Indeed, Almon has actively advocated for an expanding role for the state and federal governments in the provision of healthcare, up to and including testimony before the General Assembly.  (In case you’re wondering, no, he’s not registered as a lobbyist on the Secretary of State’s Lobby Tracker.)  No doubt, he likes his company’s chances of capturing a sizable portion of that business.

With this knowledge, it’s difficult not to laugh when reading Almon declare that, “to function efficiently,” free markets “require very transparent value propositions and broad competition.”  And it’s difficult not to cry when the consummate insider goes on to insist that competition in his industry will only “drive up costs rather than reducing them.”

To the contrary, competition alleviates the challenge of “very transparent value propositions,” because it becomes in companies’ interest to deliver more value for lower prices in order to capture market share, at least when there isn’t a government-managed cartel.  What’s driving up costs in healthcare is the disconnect between the payment and the consumer.  Almon’s government-centric approach makes that disconnect bigger, not smaller, and relies on the good intentions of politicians and corporations.

Of course, nobody should believe that the CEO of a private company sincerely wants less competition for the reason that it will lower prices.  If you’re willing to take Almon’s word on his economically absurd claims, I’ve got ownership papers for a chest of golden government stethoscopes at the bottom of Narragansett Bay that I’d happily sell you for a fair price.

 

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A Quick Thought on Controlling Healthcare Costs

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Rhode Island Hospital is apparently “eliminating nearly 200 positions and shutting down an early intervention program for developmentally disabled children” due to budget constraints.  My first hypothesis would be to blame this on ObamaCare and Rhode Island’s embrace of both the health benefits exchange and the Medicaid expansion, but I don’t have the time to become as intimately familiar with the specifics of this decision to prove it.

However, I would suggest that anybody who thinks the loss of these jobs and services is a terrible development should remember that Governor Raimondo’s strategy for bringing down costs is to impose a cap on healthcare spending within the whole state.

People who prefer top-down planning by the government tend to believe that the plans will always include the things they treasure or prioritize, and of course the central planners are happy to let people believe that… until it stops being true.

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Another Third-of-a-Billion Dollars Goes Toward Dependency

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Cost overruns for the state’s Unified Health Infrastructure Project (the “dependency portal”) should bring public scrutiny to the dangerous policy that the project seeks to implement.

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Trump, Carson, and the Conservative Intelligentsia

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During impromptu commentary on the Dan Yorke Show, today, responding to breaking news that Donald Trump had pledged to support the Republican candidate whoever it might be, I mentioned that, prior to the announcement, Fox News had flashed poll results (by accident, I think) that showed Ben Carson beating Trump in a head-to-head.  Understandably splitting his attention for the show, Dan hadn’t seen it, but I was right:

Carson has the best favorability rating in the field at 67 percent positive and 6 percent negative. That’s an improvement from 45 percent positive and 10 percent negative from before the first debate.

He’s the only Republican who would beat Trump in a hypothetical head-to-head match-up, according to the poll. Carson would thump Trump 55 percent to 36 percent if the two were to square off.

Also while we were off the air, Trump made a statement that he would go for full repeal of ObamaCare.  As much as I support that step, both Dan and I had to laugh at Trump’s bravado.  He simply said he’d work to repeal the law and replace it with something better and cheaper.  If a reporter had asked for details, The Donald no doubt would have pushed back the challenge, “Do you doubt that I can do that, punk?”

That specific issue has beguiled Republicans and conservatives for years, as they’ve stammered in the face of the policy question, “What will you replace it with?”  Two points on this.

First, perhaps Trump’s prime attraction is that Republicans think he might just get away with what Democrats and progressives get away with as a matter of course (because they own the media, the academy, and every other institution that might call them on their nonsense).  Then-Speaker of the House Nancy Pelosi famously said that the public would know the details of ObamaCare after it had become law.  That is, until it was already law, the Democrat position was essentially that they were going to do healthcare better and cheaper.  “Do you doubt our intentions, fascist?”

I sincerely want conservatives to articulate their policies, because they are smart and make more sense than progressives’ hopey-changey fairy tales, but from a practical perspective — really — why should a pre-primary candidate feel like he has to offer a detailed plan?

Second, if Trump continues to dominate the Republican field (with the exception of Carson, depending how you look at it), I hope he and conservative thinkers will find a way to work together.  If he were to concede their expertise and put his braggadocian stamp of approval on their policy proposals — changing “Do you doubt that I can do that, punk?” to “Are you gonna say I don’t know a good idea when I see one, kid?” — he could not only advance the correct policy, but also prove that maybe he is a savvy executive and wouldn’t sink the nation with his ego.

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Inappropriate Attitude Toward Government Dictats

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As one analyzes Rhode Island government, it becomes clearer and clearer that the basic problem is ultimately one of political philosophy.  Granted, the political philosophy of Rhode Island conveniently serves those who have a personal interest in government power, but what I’m suggesting is that special deals and tyranny aren’t entirely imposed on an unwilling public.  The corruption has filtered into the culture.

One particular strain of this corruption is visible in the controversy over the Department of Health’s unilateral bureaucratic mandate that all children going into the seventh grade (boys or girls; public or private school) must be vaccinated against a sexually transmitted disease.  Consider this, from Linda Borg in the Providence Journal:

In the first of several public information forums, Dr. Nicole Alexander-Scott, director of the Department of Health, emphasized that no one wants children to miss school and said her office wants to work with parents who have “strong feelings” about the vaccine. She said the vaccine is mandatory because the state wants to reach as many students as possible, noting that Rhode Island already has the highest rate in the country for vaccinating youths against HPV.

Forcing people to put drugs into their children’s bodies just because the “state wants to reach” them is entirely inappropriate.  This begins to approach Brave New World levels of inappropriateness, wherein there are no parents, really, and school is just the government’s way of molding people into the kind of citizens whom the government wants them to be.

Most importantly, note the complete inversion of the appropriate relation of families to the government:  The government has no strong feelings about the vaccine — as evidenced by the fact that it didn’t bother to go through a rigorous process of persuading the people’s representatives — but for parents to push back on it, they must have strong feelings.  The default is what the government wants.

Jane Dennison, a Barrington pediatrician (who no doubt offers vaccines as a profitable product to her patients), sides with the government, saying, “The health department is not trying to cram this down your throats,” but it clearly is.  They’re coming at us with a fist full of it, and only those who push back avoid having it thrust upon them.

My family may or may not go forward with HPV vaccines, but I’ve already filled out the exemption forms.  We have to push back on these infringements on our rights.

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HPV Vaccine Mandate the Tip of Big Money Insider Interests

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Following the money around the Rhode Island Dept. of Health’s decision to require all Rhode Island seventh graders to be vaccinated against a sexually transmitted disease reveals the big-money game of politics and government health.

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Rhode Island’s ‘Ouroboros’ approach to economic development

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At the request of third graders from an elite Newport private school, lawmakers in Rhode Island this year declared the American burying beetle to be the official state insect. The designation is appropriate not only because the Ocean State is one of the few that still can claim the bugs as residents, but also because the species feeds on and breeds in carrion — i.e., “the decaying flesh of dead animals.”

If Rhode Island legislators are looking for ideas for next year, the Ouroboros should be a candidate for the official state economic symbol. Historically, the mythical snake eating its own tail has been emblematic of renewal and self-creation, but Rhode Islanders may finally answer its greatest mystery: What happens when the snake finishes?

Rhode Island’s strategy of subsidizing every step in the economic chain has a similar circular feel.

Continue reading on Watchdog.org and then… return for this bonus ending, only on the Ocean State Current:

Despite a one-month increase of 1,100 jobs in “education and health services,” the total number of jobs located in Rhode Island decreased by 300, in June, after a longer-term trend of slowed growth, and the latest economic development controversy is the shift of a local star start-up company, Teespring, to Kentucky, after that state provided $2.5 million in tax incentives while Rhode Island officials had no interactions with its executives.

Bugs that require carrion to survive must live in a world of living animals.  Somebody has to pay for expanded government programs that provide services to beneficiaries of other government programs.  Otherwise, the economy will ultimately become a central-planning head with nothing left to eat.

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Intrusive Agences Sloshes Billions Around for ObamaCare

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I just came across this letter from IRS Commissioner John Koskinen related to his July 17 presentation to Congress on the tax implications of ObamaCare for last tax year.  I’m sure there are broad points that could be made with some investigation, about the additional expense of premiums, about likely increases next year, and so on.  On the fly, though, a couple of impressions are worth making.

First is how inappropriate it is for this to be the purview of the Internal Revenue Service.  It’s bad enough that the agency is empowered to take our money away and to collect all sorts of personal information in the process. Now our healthcare is mixed up with it.  This is an agency that targets people for audits if they give to the wrong kind of non-profit.

Second is how the billions just slosh around in government.  With two-thirds of the estimated number of Americans expected to file claims related to the “premium tax credit” having done so:

  • $10 billion was paid out in health insurance subsidies (3.2 million taxpayers; $3,125 average).
  • $780 million more was paid out after claims on tax returns (1.3 million taxpayers; $600 average).
  • $1.3 billion was taken back from taxpayers who’d received subsidies (1.6 million taxpayers; $800 average).
  • $1.5 billion was taken from taxpayers who had to pay the penalty for not having insurance (7.5 million taxpayers; $200 average). (The percentage of income used to calculate this penalty doubles in the current tax year.)

The IRS will now be sending collection letters to  710,000 Americans with a “reminder” that they have to file, along with “correspondence” to another 760,000 who filed tax returns without the ObamaCare form.

Beyond its attempt to take over healthcare across the country, this law is an excuse for government intrusion and redistribution of income.

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Governor to Suspend Economics by Decree

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On the tropical island of Rhod Ah, Chief Rai Mondo has convened a council of the Elders to craft words by which to decree that the island’s active volcano will no longer erupt.  Said the chief, through a translator:

Right now, if you own a business on Rhode Ah Island or if you’re anybody who lives here, the lava has been encroaching on your life every single year.  It’s unaffordable.  It puts a burden on islanders who just want to go about their lives.  It makes it so other people don’t want to come here and makes it harder for us to get anything done.  The whole point of this decree is to say, “Hold on.  We can’t sustain that.  Let’s bring the amount of volcanic activity down.”

OK, that’s not the story.  Actually, Governor Raimondo has convened a “Working Group for Healthcare Innovation” with the central mission of figuring out how to place “a cap on both public and private health care spending.”  The model state, Massachusetts, ties health care spending to the state economy, but according to Providence Journal reporter Jennifer Bogdan, “some suggested that the Massachusetts law did not provide a strong enforcement mechanism for sticking to those targets.”

This is a terrible, terrible idea, and it’s backwards in the both the sense that it seeks to decree a plug at the output-side of an essentially natural process (economics) and in the sense that it’s retrograde, like a laughable island dictatorship.  The Massachusetts experiment has not run its course, yet, and there’s always room for spin, but this September article from the Boston Globe shows hints of the problems that one should expect:

Partners spokesman Rich Copp said costs grew faster than expected in 2013, but that over time Partners will reduce costs by delivering more coordinated care in lower-cost community settings instead of its big academic hospitals, Massachusetts General and Brigham & Women’s. Partners is trying to acquire community hospitals north and south of Boston. …

… The annual estimates are an outgrowth of the state’s landmark health care reforms, which sought first to expand insurance coverage and later to control costs — among the highest in the nation. …

… Doctors at UMass Memorial Health Care decreased spending 1 percent for some patients, while the doctors group Atrius Health had a decrease of 3 percent for others.

Something and someone is driving the spending.  A top-down decree to control spending will not necessarily target the people and incentives that create the spending, but those that the people at the top want to target.

At the end of the day, such caps create incentive for consolidation and quotas, less choice, and increasing transfer of costs (which will continue to grow) to those in preferred groups or roles in the market and from everybody else.

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Planned Parenthood and the Racket of “Non-Profit”

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Unless you get your news strictly from mainstream news sources, you’ve probably caught wind of the undercover video in which a top Planned Parenthood doctor discusses harvesting human organs from aborted babies while munching on lunch and drinking red wine.  It’s pretty gruesome stuff, including the pro tip of using ultrasound to ensure that the doctor’s forceps don’t “crush” valuable organs that clients have selected from the menu.  (That’s a word Dr. Deborah Nucatola actually uses, but in context, she might mean a menu of affiliates around the country that will harvest the organs for the trafficking company.)

For the most part, the mainstream media appears to be waiting to report the story until it can be spun in a pro-Planned Parenthood, anti-conservative/GOP way, but online defenders of the abortion provider have characterized it as an almost altruistic activity of a bunch of non-profits using medical waste to develop medical breakthroughs.  Of course, to the pro-lifer, that doesn’t make the practice any less disturbing, and other parts of Dr. Nucatola’s dialogue raise questions about legality (such as using partial-birth techniques for a better harvest).

Watching the full footage of the interview used for the report, it becomes clear that the defenders’ focus isn’t on the practice, but on a different way of talking about business.  The Planned Parenthood affiliates, Nucatola says, just want “to break even” or, if they can “do a little better than break even,” then they can put that money back into the practice.  But “break even” means paying everybody’s salary.  It means expanding.

Putting the money back into the practice means increasing the amount of activity, which is a salable point for donors and grant-givers.  Moreover, Planned Parenthood is engaged in political activity.  If the sale of baby body parts can contribute resources to expenses that the non-profit and activist wings share, then the activists can use their dedicated resources for other things.  Money is fungible, and the ways in which large organizations can move it around are plentiful.

A very telling part of the discussion comes at around minute 8 of the full footage, when the ostensible buyers initially ask about pricing.  Nucatola doesn’t describe it as a process of calculating expenses to make sure that no profit is made.  Rather, she talks about setting a price that would be defensible if the abortionist were audited.  In other words, this isn’t a moral distinction.  The restrictions on profiting from the killing of unborn children are just a regulatory consideration in setting the market price for organs.

The “non-profit” aspect may provide legal cover for an immoral activity, but motivation is separate.  The fact that no shareholders draw a direct profit from investments isn’t much of a distinction.

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One Piece of the Health Care Solution Puzzle

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From time to time people who are inclined to support heavy government involvement in healthcare will ask me what the alternative is.  My answer has been a system that disengages health insurance from employment, drives down the cost of insurance, and creates incentive for people to make prudent decisions and spend wisely.

Basically, the law would end existing incentives to route health insurance through places of employment and ease mandates to make high-deductible plans that really are insurance, rather than health management programs, more feasible.  With that done, opening up the insurance market across state lines would be no problem.  To compete and to manage their own costs, insurers might throw in things like a free check-up every year, but the idea would be that the purpose of their service is to manage risk, like car insurance, not to negotiate every detail of a person’s medical consumption.

To fill in the gap, everybody would get health savings accounts into which anybody concerned could put money — the people themselves, their employers, the government (for low-income people), and charities.  It would be tax free and would be an asset that could (maybe) be spent in retirement or at least passed down.

I bring this up because a bill for Achieving a Better Life Experience (ABLE) accounts passed both chambers of the Rhode Island General Assembly, this session.  Basically, it would create accounts for blind and disabled Rhode Islanders that the state would manage and into which any supporters could put money.  As designed, the system probably has more government involvement than needed, but the concept seemed familiar.

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Sides in the New Health Care World

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This one article is too little evidence for sweeping statements, but there’s a telling thread throughout it.  The basic news is that health insurance companies in Rhode Island are looking for a big increase in premiums, even though the plans on offer are requiring more and more out-of-pocket spending.

What’s interesting, though, is the attitude of Health Insurance Commissioner Kathleen Hittner:

… Hittner’s staff is still reviewing the proposals, and the commissioner was reluctant to characterize how this year’s requests stack up to previous years.

“It’s difficult to say,” said Hittner, explaining that because of the many changes brought about in recent years by the Affordable Care Act, “it’s like comparing apples to oranges.”

“What our job is now,” she said, “is to look at these rates and make sure we have received all of the assumptions made by the carriers and make sure these rates are reasonable.” …

“People like to point at the insurance companies, but it’s not all about the insurance companies,” Hittner said. “It’s all of the other things that go on with what we want in health care and the way it’s delivered.”

Notice how…

  1. We can’t compare these prices to those pre-ACA, because that would be “apples to oranges,” even thought the ACA was sold on the grounds that it would lower prices.
  2. It’s all about “what we want” in the way health care is “delivered.”

The government and the insurance companies are now completely on the same side.  The insurance companies want money, and the government wants to keep and expand its new health care powers.

This is exactly the dynamic that citizens should want to avoid, because it will result in higher prices, inferior results, fewer options, and less freedom.

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No Weapon Formed Against Us Shall Prosper

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Looking at current events, it’s tempting to be discouraged, but in the trials of a church in Charleston we can find inspiration to wipe discouragement away.

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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.

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Civil Disobedience Against the Many Ways to Dictate Rules

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Elizabeth Price Foley quotes the following from a Wall Street Journal column by Daniel Henniger:

Barack Obama, channeling decades of theory, says constantly that the traditional system has failed. He said it in his 2011 Osawatomie, Kan., speech: “It doesn’t work. It has never worked.” He has attacked Congress repeatedly as a failed institution, teeing it up for mass revulsion just as he did the 1%.

With Congress rendered moribund, the new branch of the American political system is the federal enforcement bureaucracy. The Department of Health and Human Services’ auto-revisions of the Affordable Care Act are the most famous expressions of the new governing philosophy. But historians of the new system will cite the Education Department’s Office for Civil Rights’ 2011 “Dear Colleague” letter on sexual harassment as the watershed event.

I’m currently going through all of the legislation on the table in the General Assembly, and two observations stand out (as usual):

  1. Our elected officials really do believe that it is their role to micromanage life in this state.
  2. As bad as that is, worse still is the latitude that they are increasingly giving to appointed bureaucrats to do the same.

An example that I’ve heard from multiple directions, lately, is the still-new mandate that all seventh grade students (public or private school) must be vaccinated against human papillomavirus (HPV) — a sexually transmitted disease.  This isn’t like the flu or chickenpox, which students can catch and spread simply by attending school.  The Dept. of Health has crossed into a new territory of rationale, assuming the authority to instruct parents to put a drug in their children based on studies of long-term health risks, rather than immediate danger.

The bureaucracy has done so with the permission of extremely broad legislation, which states that students are required to show proof that they have “been immunized against any diseases that may from time to time be prescribed by regulation of the director of health.”  There is a religious exemption form, but that only mitigates the reality that freedom has been flipped.  Instead of the government attempting to persuade parents to make a particular decision, they’re requiring parents to actively notify the government of their decision in the other direction.

Charles Murray’s notion that Americans need to begin a regimen of deliberate civil disobedience against the bureaucracy seems wiser by the day.  There doesn’t appear to be anything about filling out the exemption form that precludes a parent from actually going forward with the vaccine, so it should become a matter of course among parents, and we should all look for other ways to thumb our nose at people who think they have authority over us, but shouldn’t.

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