Tag Archives: regulation

The Uselessness of Obamacare

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Here’s another example of the ineffectiveness of the Obama administration—of government generally—as a business manager. HHS’ Office of the Inspector General conducted a review of ObamaMart’s performance last fall and early winter—from October through the end of December—although it didn’t include four ObamaMart centers that chose not to comply with the IG’s request for information.

As of the first quarter of 2014, the Federal marketplace [ObamaMart] was unable to resolve about 2.6 million of 2.9 million inconsistencies because the CMS eligibility system was not fully operational. It was unable to resolve inconsistencies even if applicants submitted appropriate documentation.

Moreover,

These inconsistencies pertained to citizenship, national status, and lawful presence; income; and employer-sponsored minimum essential coverage.

These are things that determine whether a citizen must buy a government-approved health plan, and if so whether that citizen is eligible for taxpayer subsidy for the premiums.

And there’s this [emphasis added]:

[ObamaMart] was capable of resolving more than 330,000 inconsistencies with Social Security number, non-employer minimum essential coverage, incarceration status, and whether the applicant is an Indian. However, during the same reporting period, the Federal marketplace reported that it had actually resolved only about 10,000 such inconsistencies, or less than 1 percent of the total.

The thing isn’t even capable of collecting quality control data.

[ObamaMart] could not determine the number of applicants who had at least one inconsistency. Rather, the Federal marketplace reported unique inconsistencies, and it could not determine the corresponding number of applicants because one applicant could have more than one inconsistency. As a result, it was not possible at the time of our evaluation to determine the extent to which inconsistencies are distributed across applicants in the Federal marketplace.

Marketplaces also reported that data on inconsistencies may be overstated. Some marketplaces reported that failures with eligibility systems allowed applicants to submit multiple applications. In these instances, each application could be processed and cause the same inconsistencies to occur and be counted.

There were a number of examples; I only excerpted the one.

Just wait until tax time next April when these failures will come home to roost. Who’s got the government-approved plan? Who’s (still) eligible for taxpayer subsidy? Who owes the government a refund because he wasn’t eligible for that taxpayer subsidy, or wasn’t eligible for so much? Not even the Shadow knows.

But the ones who’ll be hurt the most will be the little guy, barely making ends meet and forced to buy a plan he neither needed nor wanted, and the little guy who must pay back the subsidy for which he wasn’t actually eligible.

Organizational Failure?

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Dr Roy Marokus, who currently serves in private practice…said veterans’ appointments were cancelled so VA medical providers could attend the two-day conference. Medical providers at the VA Medical Center in Oklahoma City, where Marokus briefly worked, and providers at all other VA medical centers in the Veterans Integrated Services Network [VISN 16, which includes VA facilities in Oklahoma, Arkansas, Mississippi, Louisiana, and parts of Missouri , Texas, Alabama, and Florida], attended the conference.

A review of the paperwork handed out during the conference showed topics included advice on how to plan a party and asked the medical staff to explore, “What Color is Your Personality?”

“Veterans waiting for appointments got pushed back for two days,” Marokus said. “In human costs, you have all these veterans. Why was that conference needed?”

And this, in VISN 22, which includes parts of California and Nevada:

Another veteran took issue with the filming of the TV show Grey’s Anatomy, which takes place at the Sepulveda VA Ambulatory Care Center. The filming encompasses the entire second floor of the facility.

Gary B, who asked for his last name to be withheld due to a pending 1151 claim [such a claim is for death or disability “as if service-connected”—including VA medical malpractice] with the VA, said aside from the limited care for veterans, the show’s trailers are an inconvenience for veterans.

“They take up the whole parking lot,” he said.

And there is this incident:

A Veterans Affairs nurse who spent 28 years at the embattled agency’s facility in Albany, NY, says when she came forward to report abuse including stolen drugs [including 5,000 vials of morphine from a locked drawer(!); the vials were refilled with saline solution and replaced] and mistreatment of patients, her supervisors turned on her instead of trying to fix things.

The patient abuse and the VA’s response to her calling it out include this:

…she reported that doctors had restrained a patient for seven hours in violation of VA rules. Now she has been banished to an office cubicle, stripped of her nursing duties and supervisory role and faces a 30-day suspension without pay.

Some Empirically Determined Pipeline Benefits

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A study prepared by the SMU/Cox’ Maguire Energy Institute for the Consumer Energy Alliance has some interesting data from the Keystone XL leg that connects Cushing, OK, with Nederland, TX (built because it’s a purely domestic leg and so did not require President Barack Obama’s personal approval). The figure below presents a map of the pipeline and some proposed adjuncts to it. The Gulf Coast Project is the section of the Keystone XL pipeline project that connects the two towns, and it was open for business last January, so the empirical data are current.Keystone-System-Map

Here are some of the short-term benefits of the project’s work and a couple of longer term benefits:

  • $2.3 billion in private-sector investment
  • 11 million+ hours of labor completed by 4,844 American workers
  • 50+ contracts with US manufacturers and companies that built the pipeline and associated equipment, spread across the country: Arkansas, California, Georgia, Indiana, Kansas, Louisiana, Maryland, Michigan, Minnesota, Missouri, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, and Texas
  • manufacture of 485+ miles of high-strength, advanced oil pipeline (36-inch diameter) and associated equipment: thousands of pieces of equipment used to build transformers, meters, electric motors, cabling and electrical equipment; piping assembling and structural steel for supports; etc
  • 2.25 million barrels of new oil storage capacity at Cushing
  • 6 modern pump stations

Some broader results of the pipeline:

  • pumped $3.6 billion into the Texas economy, $2.1 billion into the Oklahoma economy
  • boosted local tax revenues by millions of dollars
  • Prague, OK: “doubled our city sales tax receipts”
  • full RV parks from the construction effort contributed as much as $8,000 a month in electricity fees alone to the municipal utility
  • tax revenue available—and used—to improve education, local infrastructure, and public services
  • Local restaurants, hotels, and businesses experience a significant boos

This table summarizes the overall economic impact of the project:

  Oklahoma Pipeline Impacts Texas Pipeline Impacts
Total Economic Activity $2,143,364,856 $3,638,561,905
Labor Income $1,041,174,418 $1,696,054,834
Employment (person years) 15,852 26,924
Total Taxes $72,384,852 $144,992,343
Indirect Business Taxes $50,339,639 $112,533,584
Direct Business Taxes $22,045,213 $32,458,759

Many will argue that most of these effects will disappear in a few years, even as soon as the pipeline builders leave. Since the results are temporary, why bother, especially given the risks of an oil pipeline? Leaving aside the fact that pipelines are safer than trains for transporting oil and natural gas, ask the folks who’ve gotten these “temporary” fiscal results whether they think any of it was “worth it.”

In Which I both Agree and Disagree

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…with a Supreme Court decision. In Mccullen v Coakley, the Supreme Court unanimously struck down a Massachusetts law that placed a mandatory 35 foot buffer zone around abortion clinics within which anti-abortion protests were prohibited. The purpose of the law, to allow women wishing an abortion unfettered access to the clinic, was met, but overbroadly, according to the court.

That’s the part with which I agree. If we’re going to argue as I have in the past that “free speech zones,” like those on too many college campuses, unconstitutionally restrict free speech, then so does the other side of that coin: non-free speech zones. Either we have free speech in this country, or we do not.

But Chief Justice John Roberts, writing for the Court, displayed a sad misunderstanding of that right of free speech. In his rationale for striking Massachusetts’ law, Roberts wrote

McCullen explained that she often cannot distinguish patients from passersby outside the Boston clinic in time to initiate a conversation before they enter the buffer zone.

And [emphasis added]

As explained, because petitioners in Boston cannot readily identify patients before they enter the zone, they often cannot approach them in time to place literature near their hands….

But this ignores the other person’s (here, the woman seeking the abortion) free speech right to choose what conversation she will hear, especially when that unwanted conversation is directed at her and not, from the public square, to no one in particular (and so equally to everyone). Roberts’ thesis also ignores the intended recipient’s free speech right not to have materials pressed on her without her prior consent.

I disagree with Roberts’ rationale.

In the end, an opinion founded on bad law is itself a bad opinion, even if it reaches the right conclusion.

Status of Obamacare Six Months In

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The preliminary results are not promising. And unsurprising.

Among those health-law marketplace enrollees who have seen a doctor or other health-care provider in the first quarter of this year, around 27% have significant health issues such as diabetes, psychiatric conditions, asthma, heart problems or cancer, the data show. That is sharply higher than the rate of 16% for last year’s individual-consumer market over the same time frame, according to the data[.]

It is also more than double the rate among people who held on to their existing individual policies; among those enrollees, the rate was 12%.

This was well understood and predicted from the jump by those (not only on the right) who viewed the matter objectively rather than through the lens of must-pass because it’s the Progressive thing to do.

Look for sharply higher premiums this summer and fall.