Monday, February 22, 2016

Ignorance Is Bliss


The United States is a true super power. We have wealth, power, and almost unlimited resources. What we lack, what we desperately need, is more intellectual honesty. There is no reason to believe that that is going to change anytime soon.

The debate that led up to the passage of the Patient Protection and Affordable Care Act (PPACA or Obamacare) in 2009 and 2010 was filled with undeliverable promises and sugar-coated fantasies. This blog called out several Democrats by name. And a lack of intellectual honesty seemed pretty bad until we got the debates of 2011, 2012, 2013, 2014, 2015, and now 2016. We have replaced blather with cynicism.

The cynic knows what he is attacking is safely out of reach and what he is proposing wouldn’t really work. It doesn’t matter. It is the House of Representatives voting to repeal Obamacare 60+ times. It is our nation’s most cynical politician, Senator Ted Cruz, shutting down the government in effort to call more attention to himself.

The cynic understands the issue. The ignorant does not. We have devolved to ignorance, an entirely fact-free discussion of an important issue such as our health care and 20% of our economy. This is far more dangerous. And for that we must thank super salesman Donald J. Trump.

We may all have our own opinions about whether Mr. Trump knows what he is talking about when he tackles immigration, national defense, or taxation. But I feel compelled to speak up when he invades my territory, the delivery of paid access to our health care system.

Anderson Cooper conducted town hall meetings with all six Republican candidates on CNN last week. When asked about the PPACA and health care, Mr. Trump agreed to the need for mandates before he moved to his usual self-aggrandizing answer about his large crowds and standing ovations. I was impressed simply because the word mandate means something and his acceptance meant that he might be paying attention to this issue. That impression was short-lived.

Donald Trump appeared on CNN again on Sunday. Jake Tapper interviewed Mr. Trump on The State of The Union. Here is the entire interview. Mr. Trump, fresh off his South Carolina victory, quickly backtracked on mandates. He must have been briefed on the official talking points. Though he kept on detouring to how great his plan will be and that he will make sure that sick Americans aren’t dying in our streets (a real concern), he decided that he really doesn’t like mandates and he wants to eliminate state lines. Watch the interview. Words matter and it was clear that he had no idea what any of the terms meant.

Republicans cite the Tenth Amendment almost as often as the Second. But States’ rights seem to be unimportant when it comes to insurance regulations. Eliminating state lines and having insurers sell wherever they’d like might have some eventual benefit, might, but certainly nothing in the short run.

This blog has discussed the individual mandate numerous times. We all understand that people won’t purchase car insurance unless required. Health insurance is no different. If we want to have guaranteed issue and cover preexisting conditions, we need to have everyone participating. Even the GOP 1993 plan incorporated mandates, mostly because it was a real plan.

So what was Mr. Trump talking about? Nothing! What is the Trump plan? There is none. His gut instincts might have him embracing the core values of Obamacare or its ancestor, the Republican’s 1993 plan, but he hasn’t bothered to learn the details. This isn’t a lack of intellectual honesty. This isn’t cynicism. This is simply ignorance. He doesn’t know anything about Obamacare. One can only hope that a President Trump will.

He may appear angry, but Donald Trump is a really happy guy. Damn near blissful.


Thursday, February 4, 2016

Time For A Little Firesign Theater


The real name for this post would have been How Can You Be in Two Places at Once When You're Not Anywhere at All. The link to the 1969 Firesign Theater album will let you listen to the album while you continue to read this post. Of course, if you are of a certain age, I’ve already lost you…

How can you be two places at once? How can you appear to advocate for something while you spend all of your time and energies undermining that very same thing? This being Health Insurance Issues With Dave, smart money says that this is probably about health insurance and the companies that sell it.

The major insurers want you to know that they are here for you. Ask them. They’ll tell you. The major insurers litter their public pronouncements and email communications to their agents with words like commitment and partnership. Companies such as Aetna, Cigna, Anthem and UnitedHealth Care want you, the American public, to know that they are committed to their partnership with the American people and are ready to deliver their product through the federal exchange, the state exchanges and whatever platform available to them. You can hear the Battle Hymn of the Republic playing in the background as you read the emails, the fruit of the labors of their overworked PR departments.

And this would be wonderful if it were true. But, of course, it isn’t. There would be a huge uproar if the largest insurers abandoned the exchanges. Terrible publicity. Government officials and the heads of the exchanges would all blast the insurers as bad corporate citizens and incompetents. Plus, drop out of the market and they can’t get back in for five years. So the insurers needed to find a backdoor.

The solution is to stop paying the agents. Anthem, Aetna, Cigna, UnitedHealth Care all hope that by not paying the agents during the Special Enrollment Period we will place our business with those companies who will. Sure that may push all of the clients to one or two companies from February till December, but it won’t be them. And what would happen if all of the companies stop paying the agents, so that none of us can afford to spend the hours of time necessary to match Americans to the appropriate policy and insurer? NOTHING! No one with any authority would ever notice that thousands of Americans were even more unhappy than usual with their health insurance.

The insurers are losing millions of dollars on policies written on the exchanges. The Special Enrollment Periods are being abused. The federal exchange is not enforcing the rules. Fixing the problem is an option. It would take a lot of work and require the building of trust between the exchanges and the insurers. Removing the incentive to do our jobs is easier but terribly cynical. But Congress attempted to repeal the Patient Protection and Affordable Care Act (PPACA or Obamacare) for the 60+ time last week. What is more cynical than that? So who is going to notice one more act of self-serving cynicism?

The insurers will continue to say one thing publicly and do the exact opposite privately. But like Nick Danger, we are lost on the wrong side of the album and you really can’t be two places at once.