Wednesday, October 15, 2014

Obamacare and the Aims of Progressivism

Greg Scandlen notes the provision of health care, historically, has been an arena populated in America by a host of civil society institutions. These institutions were purposefully displaced by government over the course of the past century:

These associations were formed by working class men and women from all ethnic groups. In some cases they owned and operated their own hospitals. They also provided schools and orphanages for the children of deceased members, sickness funds for members who were unable to work, relocation assistance to help workers go where the jobs were, and moral support to families in times of trouble.

In the early 20th Century, these organizations came under attack by the Progressive Movement, which opposed self-help as interfering with the preferred dependency on and loyalty to the State. The Progressives also disparaged traditional values such as thrift, which got in the way of an economy ever more dependent on consumer spending. One leader of the Progressives is quoted as arguing in 1916 that, “Democracy is the progress of all, through all, under the leadership of the wisest.” The idea that common workmen could provide for their own needs was offensive to those who thought only an educated elite could order the affairs of society.

Greg writes at length about this subject in a new paper from the Citizens’ Council for Health Freedom. The widespread provision of charity care and service was also a major factor – which has again been crowded out by government in the form of Obamacare:

As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t.

The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage.

If a patient is eligible to purchase subsidized coverage through the law’s online marketplaces but doesn’t sign up, should hospitals “provide charity care on the same level of generosity as they were previously?” asks Peter Cunningham, a health policy expert at Virginia Commonwealth University.

Most hospitals are still wrestling with that question, but a few have gone ahead and changed their programs, Cunningham says.

The online charity care policy at Southern New Hampshire Medical Center in Nashua, for example, now states that “applicants who refuse to purchase federally-mandated health insurance when they are eligible to do so will not be awarded charitable care.”

The same rule disqualifies aid to those who refuse to apply for expanded Medicaid, which New Hampshire lawmakers voted to extend, beginning Aug. 15.

Little wonder that, given this type of crackdown on the charity care side of things and the expanded promise of coverage to new Medicaid recipients, hospitals are seeing another Emergency Room spike:

Experts thought if people bought health insurance through the Affordable Care Act, they would find a private doctor and stop using hospital emergency rooms for their primary care.

Well, more people have health insurance. But they are still crowding into emergency departments across the nation.

An online study by the American College of Emergency Room Physicians found that nearly half of its members have seen a rise in visits since Jan. 1 when ACA coverage began. A resounding 86 percent of the physicians said they expect that number to continue growing.

In Philadelphia, emergency room visits were 8 percent higher in June than in November 2013, according to the Delaware Valley Healthcare Council, which collects data from 70 percent of the region’s hospitals.

“We find that when people don’t have health care, there is a degree of pent-up demand,” said Alex Rosenau, the ER physicians’ group and an ER doctor in Allentown. “People finally feel like they can go get medical care once they have some insurance.”

The spike in emergency room visits isn’t totally surprising. Rosenau said when Massachusetts enacted its own health care reform in 2006, everyone predicted the newly insured would find a private doctor. Instead, emergency departments saw a 3 to 7 percent increase in volume.

“Insurance does not equal access,” said Rosenau, adding that his group believes everyone should have access to care. “They know when they go to the emergency department, they are going to be seen.”

Complicating the matter is the growing shortage of primary care physicians. People who have never had a private doctor may have trouble finding one. So they continue to rely on emergency rooms.

It’s almost as if the crowding-out effects of government can have negative or unanticipated ramifications, particularly when they impact and warp the decisions people make about their lives.



Liberating the Poor from the Medicaid Ghetto

Medicaid is a massive federal-state entitlement program desperately in need of reform. Its mission is to provide health care to the poorest of the nation’s poor ... and thus the poor have the most to gain from positive reform efforts, says Peter Ferrara, a senior fellow for The Heartland Institute and author of a new Heartland Policy Brief, “Liberating the Poor from the Medicaid Ghetto.”

According to the Centers for Medicare and Medicaid Services, which administers Medicaid, federal and state government spending for the program will total $6.56 trillion between 2013 and 2022. Medicaid is already the biggest line item in state budgets, and Medicaid spending will continue to grow, especially in the states that extended the reach of their programs under the Patient Protection and Affordable Care Act. (About half the states enacted the Medicaid expansion provided for under Obamacare, while half did not.)

Ferrara notes the absurdly high-cost Medicaid program delivers tragically low-quality care. Hospitals and physicians resist taking Medicaid patients because the program reimburses providers only about 60 percent of their costs associated with delivering care. “Medicaid patients face difficulties in obtaining timely, essential health care, suffering from adverse health as a result,” Ferrara writes.

As he has done in previous installments of his entitlement reform series of Policy Briefs, Ferrara urges modernizing Medicaid by block-granting the federal government’s share of funding to the states. He writes:

The unwillingness of health care providers to accept Medicaid patients because of the program’s shamefully low reimbursement rates could be addressed by extending to Medicaid the 1996 reforms of the Aid to Families with Dependent Children (AFDC) program. ... Each state would be free to use the funds for its own redesigned health care safety net program for the poor in return for work from the able-bodied.

Ferrara notes Congressman Paul Ryan (R-WI) included Medicaid block grants in his 2012 and 2013 budgets, and generally “[s]upport for such fundamental entitlement reform is now mainstream within the Republican Party.” He writes, “The current Medicaid system is so disastrous that those who support it cannot realistically be seen as caring about the poor. Their opposition to reform exposes a radical, impractical, counterproductive ideology to which they are wedded because it maximizes their power.”



On Halloween, Dems will be Haunted by their ObamaCare Pasts

Like the grim reality of death, there's no escaping Democrats' support for ObamaCare.

There's been considerable speculation over whether ObamaCare would manifest itself as a major election issue this year, in light of the media's focus on Ebola and the turmoil in the Middle East. Well, any doubt that ObamaCare still matters can be put to rest, with the announcement that 13 states and the District of Columbia will be sending out hundreds of thousands of insurance cancellation notices by the end of October, mere days before the November 4th elections.

This has got to be worrying for Senate Democrats up for reelection, whose support for the Affordable Care Act that is the cause of these cancellations will surely not resonate well with voters.

In tight races across the country, Democrats may now see their earlier words come back to haunt them. For example, in Arkansas, incumbent Senator Mark Pryor is on record referring to ObamaCare as "an amazing success story." How Pryor can defend this claim as thousands more Americans get thrown off the insurance rolls is anybody's guess.

In Colorado, as Mark Udall tries to beat back a strong challenge from Republican Cory Gardner, he will have to bear the consequences for repeating the now-infamous lie: "If you have an insurance policy you like, doctor or medical facility that provides medical services for you, you'll be able to keep that doctor or that insurance policy."

In Louisiana, where Republican challenger Bill Cassidy is gaining ground against Mary Landrieu, the Democratic Senator will have to defend her claim that ObamaCare would drive down insurance costs for families and businesses.

Only one of these Democrats seems to have the sense to run from the president's signature policy, Bruce Braley in Iowa, who has referred to ObamaCare as a "big failure." It's clever political posturing, but rings awfully hollow in light of Braley's repeated refusal to vote for repeal or defunding of the law as a Member of the House of Representatives. It's just another substanceless campaign statement that makes Braley look like an empty suit, blowing feebly in the direction of the political winds.

In fact, all of the above Democrats supported ObamaCare, not only with their words, but with consistent, repeated votes to make sure the law continues to wreak havoc on the country's medical system.

As more Americans lose their health insurance in the days and weeks before the elections, Democrats are going to find it increasingly hard to hide to from their abysmal voting records.



We Need Good Preachers Before We Get Good Government

In his 1798 letter to the officers of the First Brigade of the Third Division of Massachusetts’ Militia, America’s second president, John Adams, made a famous observation about the U.S. Constitution: "We have no government armed with power capable of contending with human passions unbridled by morality and religion. Avarice, ambition, revenge, or gallantry would break the strongest cords of our Constitution as a whale goes through a net. Our Constitution was made only for a moral and religious people. It is wholly inadequate to the government of any other.”

Noting its limited scope and enumerated powers, Adams argued such a founding document would adequately govern given the personal and civic decorum and the decency of the citizens of the United States. Flip that coin over to understand that without the absolutes of right and wrong woven into the tapestry of a moral and religious people, an overreaching and excessive government would follow.

Dial the clock forward to 2014 America -- the nation devoted to the god of me, myself and I, rather than the Hand of Providence of earlier years. Consider the cries of discrimination, intolerance and even racism, when societal standards of what is right, decent and good are most perfectly summed up by the bumper sticker, “WHATEVER!”

This cultural casserole of conscience shuns “a moral and religious people” and heralds the governing elites who view their intellect as superior to the weak leaning on the crutch of faith and religion. These 21st century elites openly mock the belief in and reverence of the Judeo-Christian Deity who endows His creation with unalienable rights, demands personal responsibility, shows love and mercy through community benevolence and charity, and has a dim view of laziness, lying and corruption.

Yet a society composed of individuals who subscribe to honesty, individual discipline and industriousness, mutual respect of persons and property, along with a measure of good will and charity, is a free people. Such a society will enjoy Liberty driven not by external lists and constraints of law, but by internal goodness and the “Golden Rule.”

As we navigate the path toward the elections of 2014 and 2016, we ask this: Instead of winning the argument and exacting policy, isn’t the more bountiful fruit to sustain our Constitution’s limited government enjoyed by winning hearts and minds to live a life of faith?

Which brings us to former Arkansas governor and TV personality Mike Huckabee. Following last week's Supreme Court refusal to hear cases on same-sex marriage, Huckabee vowed he would leave the Republican Party if the fight against same-sex marriage and abortion did not continue as a primary political plank of the party. It's not the first such declaration from those of faith who seek higher office or lead in an elected position.

Yet a “house divided will not stand.” The nation's Mike Huckabees should be cautious in abandoning the political vehicle that most frequently and effectively opposes the party whose membership voted God out in the 2012 Democrat National Convention.

Isn’t it even more critical in this cultural battle that those of the Judeo-Christian faith season their environs by being the “salt of the earth” rather than taking their 50-pound salt block into isolation?

In using John Adams’ observation to inform our center-right pursuits, fiscal restraint and discipline, economic success and might, along with a populace of individual accountability and productivity, are more likely when our Judeo-Christian God informs our politics and drives our conduct.

One might say John Adams was observing that good preachers precede good government.



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