Wednesday, January 02, 2019

How Donald Trump Is Radically Reforming Obamacare

In the face of congressional inaction, the Trump administration has set out to reform Obamacare by executive order. The reforms stretch the boundaries of what many thought was possible without an act of Congress. Although some changes are still in the comment period (before the rules become formalized), the Trump reforms in some ways are more radical than Obamacare itself.

Personal and portable health insurance. The United States has a long history of encouraging health insurance at the place of work. Premiums paid by employers avoid federal and state income taxes as well as the Social Security (FICA) payroll tax. By contrast, unless they get Obamacare subsidies, most Americans receive no tax relief if they buy health insurance on their own.

Unfortunately, group insurance is not portable. When people leave their job, many must turn to individually purchased health insurance instead. This is the primary source of the “pre-existing condition” problem. Before Obamacare, insurers in the individual market could and did deny coverage to people with expensive health conditions, although Wharton health economist Mark Pauly finds that the instances of this were rare.

So why not let employees have insurance they can take with them from job to job and in and out of the labor market? This idea is highly popular in public opinion polls. But under the Obama administration, employers who did this could be fined as much as $100 per employee per day, or $36,500 per employee per year – the largest fine in all of Obamacare.

The Trump administration is proposing to get rid of those fines and actually encourage the purchase of individually owned insurance, using employer funds, through something called a Health Reimbursement Arrangement (HRA). Small businesses are allowed to do this as a result of the 21st Century Cures Act, passed in 2016. Trump is now proposing to allow employers of any size the same opportunity.

Given the sorry state of the individual market in most places, why would employers and their employees find this option attractive? Because of other Trump reforms.

In addition to broadening the scope for Association Health Plans earlier in the year, the administration announced last Thursday that  states will have the ability to (1) create risk pools and/or risk reinsurance in order to bring down premiums for average buyers, (2) create defined contribution accounts (combining Obamacare subsidies with other money) from which families can select health insurance that better meets their needs, (3) use Obamacare money to create a new and different system of subsidies and (4) create new insurance options, including non-qualified health plans.

Then on Monday, that administration released Reforming America’s Healthcare System Through Choice and Competition. This is the first time any administration has explicitly acknowledged that the most serious problems in health care arise not because of market failure, but because of unwise government policies; and it is the first time the federal government has committed to the idea of liberating the medical marketplace. In many ways the document is very similar to ideas I first proposed in Regulation of Medical Care: Is the Price Too High? (Cato: 1980)

I’ll have more to say about these policy changes in future posts.

The Treasury department believes as many as 10 million people will obtain individually owned insurance through their employers under the new rules. Harvard Business School’s Regina Herzlinger thinks the number could be much higher than that.

Tax fairness. The latest Trump executive order goes a long way toward eliminating unfairness in the tax code. For example, an above-average-income family would be able to obtain individually owned insurance with the same tax advantages as group insurance.

Below-average-income families have the opposite problem. Since these families pay no income taxes, their only tax subsidy at work is the avoidance of the payroll tax. This is well below the subsidies available in the Obamacare exchanges. Going forward, these families will be able to use employer money to obtain subsidized insurance in the exchanges. (But there will be no double dipping – it’s one subsidy or the other.)

A flexible savings account. More than 30 million Americans have a Health Savings Account, allowing them to manage some of their own health care dollars. These accounts are rigidly constrained, however. Because of an across-the-board high deductible and other requirements, most health plans sold in the Obamacare exchanges are not HSA-compatible.

HRAs, by contrast, can wrap around any health insurance plan and are available to pay for expenses insurance doesn’t pay for. Employer deposits to HRAs would give employees access to the full range of products available on the individual market. Money not spent on premiums would be available to pay other expenses, including deductibles and copayments.

Insurance tailored to family needs. Obamacare tries to force low-income families to buy the wrong kind of insurance. If a low-income couple has the misfortune to have a million-dollar premature baby, Obamacare insurance will pay the hospital the million dollars. But under some plans, the couple must pay the first $7,000 of medical expenses out of their own pocket. That’s great for hospitals, but it does almost nothing to help the family.

Before there was Obamacare, fast food workers often had limited benefit insurance – paying, say, the first $25,000 or $50,000 of medical expenses. This kind of insurance gave them easy entry into the health care system, although the cost of rare, catastrophic events was shifted to others.

Fast food workers tend to be among the 28 million people who are currently uninsured. Many of them are turning down Obamacare insurance – whether offered by an employer or in an exchange.

Under the new executive order, however, their employers can deposit up to $1,800 in an Excepted Benefit HRA, from which employees can purchase all types of primary care, including phone and email consultations, Uber-type house calls, the services of walk-in clinics, etc. They could also take advantage of the next option.

Free market health insurance. Historically, “short-term, limited duration” health plans have served as a bridge for people between jobs or migrating from school to work. They are not subject to Obamacare regulations and they can charge actuarially fair premiums. Although they typically last up to 12 months, the Obama administration restricted them to 3 months and outlawed renewal guarantees beyond that.

The Trump administration has now reversed those decisions, allowing short-term plans to last up to 12 months and allowing guaranteed renewals for up to three years. The ruling also allows the sale of a separate plan, called “health status insurance,” that protects people from premium increases due to a change in health condition should they want to buy short-term insurance for another 3 years.

By stringing together these two types of insurance, people will likely be able to remain insured indefinitely, with plans that look like a typical employer plan. The expected number of enrollees ranges from 1.9 million ( Medicare’s chief actuary) to 4.3 million (Urban Institute).

Yet as long as people are free to choose insurance that meets individual and family needs and as long as it is fairly priced, I think the real number will be even higher.



The Demo Degradation of American Patriotism

The greatest threat to the First Amendment and freedom of the press is the Leftmedia.
“Patriotism is as much a virtue as justice, and is as necessary for the support of societies as natural affection is for the support of families.” —Benjamin Rush (1773)

In a non-contextual defense of the mass media, I often see cited the following quote: “Where the press is free and every man able to read, all is safe.”

While I believe Thomas Jefferson was correct in that assessment, in context he was referring to an institution that would live up to the high journalistic standards expected of a “free press,” as well as a people who would be able to make decisions based on sound analysis rather than soundbites.

Jefferson also offered this observation on the press: “Newspapers … serve as chimneys to carry off noxious vapors and smoke.” In 1805, Jefferson wrote, “During the course of administration, and in order to disturb it, the artillery of the press has been leveled against us, charged with whatsoever its licentiousness could devise or dare.”

Ominously, he added, “These abuses of an institution so important to freedom and science are deeply to be regretted, inasmuch as they tend to lessen its usefulness and to sap its safety.”

And given the propagation of “fake news” by the contemporary media, Jefferson was downright prophetic: “The press is impotent when it abandons itself to falsehood.”

The prevalence of press partiality had been noted by Benjamin Franklin years earlier. In 1789, ahead of deliberations for our Bill of Rights, he wrote, “If by the liberty of the press … it means the liberty of affronting, calumniating and defaming one another, I, for my part, own myself willing to part with my share of it.”

In every era since our founding, some journalists have upheld the high standards expected of a free press. However, most have abused their positions, aligned their reports with their personal perspectives and allegiances, and presented their opinions as facts. This abuse of the free-press privilege is, as Jefferson noted, “deeply to be regretted.”

Moreover, such abuse in the modern era of mass media and social media platforms is very dangerous to the future of constitutional Rule of Law and the Liberty it enshrines.

For much of the last half-century, collusion between the Democrat Party and its propagandistic press corps has led to the institutionalization of media malpractice — an abject betrayal of the First Amendment.

Our Founders clearly intended the assurance of freedom of speech and the press to be among the most significant checks on centralized governmental power. But by the late 20th century, the press had become the primary empowering agent of statists who supported the central government’s exponential (and extra-constitutional) growth.

Thirty years ago, Americans somehow survived on less than 30 minutes of national news in the evening and whatever could be gleaned from the newspapers the next morning.

Today, however, media outlets inundate the airwaves and the Internet with hyperbolic news banners and alerts, ad nauseam, in order to secure market share and ad revenue for their 24-hour news-recycling operations. (Trump’s troubles are major Leftmedia revenue generators, but no conflict of interest there…)

And print outlets, though believing themselves superior because they must be read rather than watched, are actually no better. Communally, the MSM’s “journalists” have become shills for leftist ideology.

The net result is more than a degradation of the First Amendment — it is a systemic degradation of American Patriotism.

There is a distinct division between conservatives and leftists in regard to patriotism and optimism, and the constant drone of depressive Leftmedia indoctrination is the most significant factor accelerating that division. Anti-American sentiments inevitably emerge when Leftmedia outlets select and frame the news in such pessimism, but good news does not sell. Moreover, the deeply dispirited denizens of The New York Times, The Washington Post, CNN, MSNBC, NPR, and other outlets dole out depressing perspective to an increasingly depressed audience.

Recent polling indicates that Democrats are substantially less “proud to be American” now than when Gallup began its longevity polling on this question almost two decades ago. In 2013, during the height of the Obama years, 56% of Democrats were “extremely proud.” Today, just 32% are proud. “Liberals” are even less proud of our national heritage, down to only 23%.

Notably, this division didn’t begin with Donald Trump’s surprise 2016 defeat of Barack Obama’s presumed successor, Hillary Clinton. The Demo slide began during Obama’s second term, only accelerating after Trump’s election.

Recently, New York’s inherited governor, Andrew Cuomo, captured this depressive despair when broadcasting his views: “We’re not going to make America great again. It was never that great.”

The political disparity between those with hope versus those who despair, and the decline in “happiness” and increasing sense of isolation, are arguably the results of contrasting political visions for our future.

The arrogant Leftmedia has, for decades, viewed grassroots Americans as a “basket of deplorables,” in Clinton’s words.

But the Left certainly has high regard for its MSM brethren. In a recent CNN op-ed by Notre Dame “ethics” professor Joseph Holt, he declared that the press is our “protector” and insisted, “We thank soldiers for their service because they devote themselves to protecting our freedoms, and we should. But we should also thank the media for the same reason — especially when the stakes have never been higher.”

What Holt and his ilk fail to realize is that the Leftmedia’s rhetoric is largely responsible for our nation’s epidemic of “Trump Derangement Syndrome” and the resulting transition from civil discourse toward civil war.

In fact, so deranged are today’s Demo constituents that 57% of them now view socialism favorably. Just two years ago, 56% of Democrats viewed capitalism favorably. This alarming shift is the direct result of being dumbed down by leftist socialism deniers and their Leftmedia enablers, as evident in the emergence of absurd socialist candidates.

How can it be that so many of our fellow Americans have forgotten their history? How can so many of them believe that socialism is freedom-friendly?

Years ago, an author whom I hold in high esteem, C.S. Lewis, declared, “I never read the papers. Why does anyone? They’re nearly all lies, and one has to wade thru’ such reams of verbiage and ‘write up’ to find out even what they’re saying.”

Similar wisdom abounds.

G.K. Chesterton wrote, “Journalism is popular, but it is popular mainly as fiction. Life is one world, and life seen in the newspapers another.”

In his essay “The American Press,” Mark Twain, a newspaper reporter early in his career, wrote, “There are laws to protect the freedom of the press’s speech, but none that are worth anything to protect the people from the press. … It seems to me that just in the ratio that our newspapers increase, our morals decay. The more newspapers the worse morals. Where we have one newspaper that does good, I think we have fifty that do harm.”

That notwithstanding, the Leftmedia colluded last week to protest Donald Trump’s introduction of “fake news” into the popular lexicon. This nationwide editorial “day of rage” was nothing more than a criticism of Trump for consistently calling out Leftmedia lies. Editors decried what they insist is Trump’s attack on freedom of the press, but make no mistake: The greatest threat to the First Amendment and freedom of the press, and to Liberty itself, IS the Leftmedia. Its relentless assault on Trump is eroding public confidence in the press.

And a footnote: While the Leftmedia elite were ranting about their First Amendment rights, according to research by the Freedom Forum Institute, fully 40% of Americans can’t name a single one of the five rights enshrined in our First Amendment. And 36% could only name one.



Trump Uses Obama’s Own Home Against Him in Brilliant Border Wall Argument

To anyone with a sliver of logic rattling around in their brains, the importance of border security should be readily apparent.

It wouldn’t be an exaggeration to say that one of the biggest reasons President Donald Trump won the 2016 election is because border security was one of his biggest campaigning points.

Despite the fact that it’s so logical and clearly something many Americans want, leftists have long had some inexplicable problem with anything involving border security or a potential wall.

The liberal actor Peter Fonda was slammed as a “domestic terrorist” by the National Border Patrol Council for incendiary comments he made about the men and women who try to enforce border security.

Late night “comedian” Jimmy Kimmel basically equated Americans who supported border security to uneducated meth addicts.

The lunacy of the left truly knows no bounds. But amid the hysteria, Trump noticed something that leftists like Fonda, Kimmel and former President Barack Obama might have a hard time explaining.

“President and Mrs. Obama built/has a ten foot Wall around their D.C. mansion/compound,” Trump tweeted on Sunday. “I agree, totally necessary for their safety and security. The U.S. needs the same thing, slightly larger version!”

Say what you will about Trump, but his expertise when it comes to subtle trolling is undeniable.

From saying “I agree” with the Obama’s for their fence to his very deliberate use of the word “slightly,” this is a brilliant way for Trump to flip the script on leftists.

But trolling aside, Trump raises a point that many of these leftists and elitists will have a hard time explaining.

So many of them live in lavish mansions and gated communities and have the gall to attack Trump’s border wall? What, exactly, is the purpose of gates and walls for their homes? Security and safety, two of the biggest things Trump has argued for through his border walls.

To be clear, I’m not condemning leftists and elitists for having these walls. They can do what they want with their property, and if walls help them secure and protect their loved ones and belongings, more power to them.

I’m condemning their rank hypocrisy for not wanting that same level of security and protection for America as a whole.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCHPOLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated),  a Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

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1 comment:

Robert said...

The increasingly common stories of the Leftmedia deliberately lying and deceiving reminds me of a tirade that the legendary baseball manager Sparky Anderson uttered, apparently as the Reds manager in the 1970's, when after an interview with a newspaper, the headline of the story was deliberately chosen to make him look bad. While it was on the air, the Jim Healy show had the entire audio of the tirade. These days, however, the audio apparently cannot be found, but some sites do have a transcript of what he said:

Anderson: You know, well, but I don't give a shit, you know. To me, I don't care what the fucking headline says. Whoever's writing the fucking story better control the headline, then. That's a lot of bullshit. I don't need to come in this town, and be made to look like a fucking fool. And I'm not going to buy that bullshit. So they can stick it in their fucking ass I don't really give a shit about nothing. I think its horseshit when fucking people will call you and you trying to be right with people and you pick up a fucking paper and its total bullshit. Now I don't think you have to do that. If you're gonna shoot right with fucking writers and be good to them and everybody else, and then the cocksucker's gonna turn around and fuck you, I don't think its right. Now I'll tell ya they can stick it in their ass as far as I'm concerned. I mean it. Now, that's, that's the way I'm gonna be. I say this, I've always been fair with fucking writers. And when the son of a bitch is gonna be that fucking way, fuck, I don't, you know I don't give a shit about it. I'll be honest. They can take it and stick it in their fucking ass, do whatever they want to do. That's the way I feel. But I got people here too you know and when my fucking brother in law calls you up and says "What the fuck are you doing?". Its a fucking joke that you have to come home and have fucking bullshit like that. That's all I got to say.

Gee, you think he was upset about being lied about?