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Posts Tagged ‘Government-run healthcare’

At the risk of understatement, Obamacare is a mess.

It’s been bad for taxpayers, bad for consumers, and bad for healthcare.

It’s even been bad for some of the special interest groups that backed the legislation. The big insurance companies supported the law, for instance, because they thought it would be good to have the government force people to buy their products.

And these corrupt firms even got a provision in the law promising bailouts from taxpayers if the Obamacare system didn’t work.

Given the miserable track record of the public sector, that was probably a crafty move.

But the companies mistakenly assumed their sleazy pact with Obama, Pelosi, and Reid was permanent. Fortunately, their Faustian bargain appears to be backfiring.

Senator Marco Rubio has led the fight to stop bailouts for the big insurance companies.

Here are some excerpts from his recent column in the Wall Street Journal.

Six years after being signed into law, ObamaCare is a costly and unsustainable disaster. …ObamaCare is also bringing out corporate America’s worst crony-capitalist impulses. The health-insurance lobby has teamed up with trial lawyers to sue the federal government—through individual lawsuits and a $5 billion class action—for not following through on a sweetheart bailout deal buried in the law. This provision of ObamaCare would have required taxpayers to bail out insurers.

But in a rare victory for taxpayers, the Florida Senator got the law changed to restrict bailouts.

My conservative colleagues and I sounded the alarm about the likelihood of a taxpayer-funded bailout of health insurers (and were mocked as Chicken Littles for it). …When it came time to pass a spending bill at the end of 2014, we succeeded in making it the law of the land that the ObamaCare bailout program could not cost taxpayers a single cent—which ended up saving taxpayers $2.5 billion. In December of last year, we came back and repeated the feat. Now I am urging leaders in both the House and Senate to make this a priority and stop the bailout a third time.

As you might imagine, there’s a counterattack by the corrupt insurance companies that conspired with the White House to impose Obamacare on the nation.

…the health-insurance companies are suing to try to get their bailout…professional attorneys from the Congressional Research Service…said that the administration’s practice of making other payments to insurers under the ObamaCare reinsurance program “would appear to be in conflict with the plain text” of the law. …Health insurers can hire all the high-paid trial lawyers they want, but they will run into a constitutional buzz saw: America’s founding document grants Congress the power of the purse… Health-insurance companies need to wake up to the reality that this…money they are fighting for, and that the Obama administration is trying to weasel a way to somehow give them, belongs to taxpayers. Taxpayers get to decide—through me and others in Congress—whether to bail them out. And the people have spoken: No, we will not bail out health insurance companies for ObamaCare’s failures.

Amen to Senator Rubio.

Let’s hope Congress continues to oppose bailouts, and let’s also hope the White House isn’t successful in somehow giving our money to the big insurance companies.

Speaking of which, here’s what Investor’s Business Daily wrote about the bailout controversy.

Right when you think Washington can’t get any worse, it does. That much was evident at a recent U.S. House of Representatives committee hearing into the Obama administration’s bailout of private health insurance companies. It’s a textbook case of government officials ignoring federal law to put special interests before the interests of American taxpayers and families.

Here’s how the mess was created…and how the Obama White House chose to respond.

Thanks to the Affordable Care Act’s labyrinthine mandates, health insurance companies have collectively lost billions of dollars on the exchanges, leading to an increasing number of them limiting their participation in or exiting the exchanges altogether. As a result, many insurers have demanded larger subsidy payments. …responding to insurance industry demands — in November the Obama administration promised to “explore other sources of funding” for payments to insurers. Yet rather than work with Congress, the administration flouted the law entirely — and in this case, that means using tax dollars to bail out insurers left on the exchanges. CMS simply decided to ignore the law.

Unfortunately, ordinary people don’t have that option.

They simply pay more to get less.

Meanwhile, Americans rightly wonder who’s looking out for them. Premiums have actually risen faster in the five years after passage of the Affordable Care Act than in the five years before, while deductibles average nearly $3,000 for the most popular exchange plans.

Isn’t that typical.

Big government makes life worse for the average person while the special interests get special deals.

Speaking of special deals, let’s look at another Obamacare rescue for a privileged group.

Bob Moffit of the Heritage Foundation explains the contortions needed to keep health insurance subsidies flowing to Capitol Hill.

…one scandal is truly bipartisan: How key administration and congressional officials connived to create, under cover of the Affordable Care Act, also known as Obamacare, special health insurance subsidies for members of Congress.

Here’s the background.

Rushing to enact the giant Obamacare bill in March 2010, Congress voted itself out of its own employer-sponsored health insurance coverage—the Federal Employees Health Benefits Program. …But in pulling out of the Federal Employees Health Benefits Program, they also cut themselves off from their employer-based insurance contributions.

Subjecting themselves and their staff to Obamacare may have been smart politics, if only to avoid the charge of hypocrisy, but that created a different problem.

Obamacare’s insurance subsidies for ordinary Americans are generous, but capped by income. No one with an annual income over $47,080 gets a subsidy. That’s well below typical Capitol Hill salaries. Members of Congress make $174,000 annually, and many on their staff have impressive, upper-middle-class paychecks. …Realizing what they had done, congressional leaders sought desperately to get fatter taxpayer subsidies in the Obamacare exchange system. …The standard excuse was that, without a special “sweetener,” a Capitol Hill “brain drain” would ensue; the best and brightest would flee to the private sector to get more affordable employment-based coverage.

Gee, it would have been a shame if the people who have screwed up public policy had to get jobs in the private sector (or, more likely, the parasitic lobbying sector).

But the law oftentimes is not an obstacle when the Obama White House wants something to happen.

…at a July 31 closed-door meeting with Senate Democrats, President Barack Obama had promised he would “fix” the mess they made of their health coverage. So, on Aug. 7, 2013, just as Congress was getting out of town for the August recess, the Office of Personnel Management ruled that members of Congress and staff enrolled in the exchange program would get Federal Employees Health Benefits Program subsidies, even though they were no longer in the program.

But how exactly did the White House evade the law?

…the Office of Personnel Management declared that Congress and staff were eligible to enroll in the Washington, D.C., “SHOP” Exchange, a health insurance exchange reserved for small businesses with fewer than 50 employees. The exchange offers special insurance subsidies to participating small businesses. The problem was, of course, that Congress is not a “small business,” at least under any clinically sane definition of the term, and no section of the Affordable Care Act provided for any congressional exemption from the ban on large employer participation in the SHOP exchanges.

By the way, as a former staffer on Capitol Hill, I do have some sympathy for the lower-level folks who didn’t create the Obamacare mess and would suddenly be in a position of having to pay all their health costs out of pocket if the law was obeyed.

But that’s not a reason to engage in legal chicanery.

As part of tax and entitlement reform, by all means let’s shift to a system where we address the third-party payer crisis by having most health care expenses directly financed by consumers (reserving insurance for large, unpredictable expenses). That new system should include all people, including politicians and their staff.

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I wrote last June about an unfortunate British guy who, after his leg was broken by thieves, was told by the government that his injury wasn’t serious enough for an ambulance.

The poor chap eventually was driven home by some cops and then had to take an Uber to the hospital.

While writing about this story, I semi-joked about what would be required to get an ambulance.

If you’re about to die, they’ll send an ambulance. But not for anything less than that.

Little did I realize that the bureaucrats would prove me wrong.

Here are some amazing excerpts from a story in the U.K.-based Telegraph.

A dying pensioner wrote a heartbreaking ‘I love you note’ to his daughters while he waited two hours for an ambulance to respond to his call for help following a heart attack. …The retired mechanical fitter… pulled a cord in his flat in Prenton in Birkenhead, Merseyside, to sound an alarm in a 24/7 emergency call centre and could be heard by the call handler shouting: “Help”. …The call handler dialled 999 but Mr Volante’s case was given a low priority by the ambulance service and paramedics took 1hr 40mins to arrive. They found him dead on his living room floor.

ronald-volante-1_3563047bIn a touching but tragic gesture, the deceased spent some of his wait time writing a note to his daughters.

A heartbreaking note was found in Mr Volante’s flat after his death, which read: “I love you Rita, I love you Deb, Dad.” This was a reference to his two daughters, Debbie Moore and Rita Cuthell.

I suppose, to be fair, that we can’t fully blame Mr. Volante’s death on government incompetence. He may have died even if the ambulance arrived in a timely fashion.

But imagine what it would be like to place a very serious call and to be treated like an afterthought.

Though the government at least offered an insincere apology, so I guess that counts for…um, nothing.

…a North West Ambulance Service spokesperson said: “The Trust would like to express its sincere condolences to Mr Volante’s family during this difficult time.

But let’s look at the bright side. If the ambulance had been on time and Mr. Volante had been admitted to the hospital, the government may have starved him to death instead.

I’m guessing a heart attack – even one where it takes you 90 minutes to die – would be preferable.

Particularly since you can’t be sure whether government-run healthcare will kill you accidentally or kill you deliberately.

P.S. Here’s my collection of horror stories about the U.K.’s version of Obamacare: hereherehereherehereherehereherehere, herehereherehereherehere and here. By the way, Paul Krugman tells us that all these stories are false. So who are you going to believe, him or your lying eyes?

P.P.S. To be fair, some screw-ups are inevitable, even in a perfectly designed healthcare system. But I would argue that horror stories are more common when the profit motive is weakened or eliminated. If you’re a Brit and you die or suffer because of crappy government-run healthcare, there’s no feedback mechanism to punish the doctor and/or hospital (or, in the above case, ambulance service). Their budgets already are pre-determined. Likewise, if you’re an American and you die or suffer because of sub-standard Medicare or Medicaid treatment, there’s presumably no effective feedback budgetary mechanism.

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Even before it was enacted, it was obvious that Obamacare was going to have a negative economic impact.

From a fiscal policy perspective, the law was bad news because all the new spending and higher taxes increased the fiscal burden of government.

From a regulatory intervention perspective, the law was bad news because it exacerbated the third-party payer problem.

Form a jobs perspective, the law was bad news because it increased the attractiveness of government dependency compared to employment.

But those were just the slap-you-in-the-face impossible-to-overlook problems.

As Nancy Pelosi infamously noted, the law needed to pass so we could know what was in it.

And the more we learn about the contents, the more evidence we find that (as shown in this poster) that more government is never the answer.

A new empirical study by scholars at Harvard and Stanford finds that “free” goodies from the government actually have a hefty price tag.

The dependent care mandate…one of the most popular provisions of the 2010 Affordable Care Act…requires that employer-based insurance plans cover health care expenditures for workers with children 26 years old or younger. …there has been little scholarly work measuring the costs and incidence of this mandate and who pays the costs of it. In our empirical work, ….we find that workers at firms with employer-based coverage – whether or not they have dependent children – experience an annual reduction in wages of approximately $1,200. Our results imply that the marginal costs of mandated employer-based coverage expansions are not entirely borne only by the people whose coverage is expanded by the mandate.

Wow, this is worse than I thought. I assumed the pejoratively nicknamed “slacker mandate” wasn’t a big issue because the types of kids getting coverage (ages 19-26) presumably had very low health expenses.

But if average wages at affected firms are $1200 lower than they otherwise would be, that’s a big hit. Maybe Pajama Boys have physical health problems in addition to their mental health problems.

Now let’s look at another higher-than-expected cost, except this time the victims are taxpayers and other health care consumers rather than workers.

Politico has a depressing story of how people have figured out how to game the system

Obamacare customers are gaming the system, buying coverage only after they find out they’re ill and need expensive care… No one knows precisely how many might be manipulating the system, but the plans say they run up much higher medical bills and then jump ship, contributing to double-digit rate increases and financial losses. Health plans also complain some customers are exploiting a three-month “grace period” — when they can keep getting subsidized coverage even if they’ve stopped paying their share of premiums.

In other words, Obamacare is so poorly designed – thanks to subsidies, mandates, and other forms of intervention – that many people can basically wait until they’re sick before signing up.

Then they incur expenses that are covered by taxpayers and/or passed on to other healthcare consumers.

There’s also another group of victims, though I confess that part of me thinks that the insurance companies deserve to suffer since they (like Big Pharma) endorsed Obamacare.

…those trends make the risk pools skew toward sicker, costlier customers — and under Obamacare, plans can no longer deny coverage to those with expensive medical conditions. That problem has been exacerbated by the large numbers of healthier people who are choosing to stay uninsured rather than shell out money for coverage.

Yup, I experience a warm glow of schadenfreude after reading that passage. But I also know that it won’t be good for the American economy and the American people if the market for private health insurance entered an Obamacare-driven death spiral.

That being said, I also don’t want them to get any bailout cash.

In any event, if the health insurance companies have a meltdown, you could bet your last dollar that the crowd in Washington somehow will blame capitalism and say that the solution is single-payer health care (even though that system is so dysfunctional it was repealed by Bernie Sanders’ Vermont and even though that system leads to endless horrors in the United Kingdom).

P.S. In the interest of fairness, I will admit that there is a group that has benefited from Obamacare.

P.P.S. Actually, there’s another group, so we can say there are two winners from government-run healthcare.

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In 2009, Paul Krugman assured his readers that government-run healthcare was a good idea, writing that “In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false.”

I guess one could argue that the determination of “scare stories,” like beauty, is in the eye of the beholder.

But if I was writhing in agony on a street because of a broken leg, I wouldn’t be happy with a healthcare system that told me I didn’t need an ambulance.

And if I was part of a system that rewarded hospitals for letting old people die, I might be tempted to say that was a scary system.

Moreover, I would be understandably irked if my I was stuck with a system for healthcare that treated patients with callous disregard.

But if you’re wealthy and well-connected, then perhaps you don’t think these results are scary because you know you’ll always be able to jump the queue in a government-run system and get good treatment for yourself.

In any event, it’s not just the healthcare system that’s scary on the other side of the Atlantic.

A report in the Telegraph paints a grim picture of dental care in the United Kingdom

Dental health standards are falling to “Third World” levels in parts of England because of a crisis of access to NHS treatment, more than 400 dentists claim today.In a letter to The Telegraph, a coalition of professionals from across the country argues that the system is “unfit for purpose” with millions of people seemingly going for long periods without even seeing a dentist, or ignorant of basic dental hygiene.The signatories accuse successive governments of hiding the problem behind a veil of spin and denial. They point to official figures showing large numbers of primary school children having to be admitted to hospital to be treated for serious tooth decay and other dental problems, many of which, they say, could be easily prevented.

As you might expect, the bureaucracy claims everything is just fine.

NHS England denied that there is a crisis…a spokeswoman for NHS England insisted: “These claims are wrong – more patients are getting the dental care they need, and 93 per cent of people got an NHS dental appointment when they wanted one in the last 24 months.”

But the numbers tell a different story.

NHS figures show that almost half the adult population of England (48 per cent) and a third (31 per cent) of children have not seen a dentist within two years. Crucially almost 62,500 people are admitted to hospital in England per year because of tooth decay – three quarters of them, or 46,400, children. …“The NHS dental system in England is unfit for purpose,” the dentists wrote. “Far from improving, the situation has worsened to such an extent that charity groups normally associated with providing dental care in Third World arenas now have to do so in England.

None of this sounds very good, though let’s acknowledge that the dentists in the U.K. are an interest group that presumably wants to get a bigger slice of government money.

So they presumably would have an incentive to exaggerate the downside of British dental care.

But this underscores the problem with government takeover of a sector. Instead of a system of voluntary and beneficial exchange, you suddenly have a zero-sum, third-party-payer-driven system where consumers, providers, and taxpayers suddenly have an incentive to squabble.

P.S. For other U.K. “scare stories,” see herehereherehereherehere, here,hereherehere, here, hereherehere, herehere, here and here.

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I feel compelled to comment on the Supreme Court’s latest Obamacare decision, though I could sum up my reaction with one word: disgust.

  • I’m disgusted that we had politicians who decided in 2009 and 2010 to further screw up the healthcare system with Obamacare.
  • I’m disgusted the IRS then decided to arbitrarily change the law in order to provide subsidies to people getting insurance through the federal exchange, even though the law explicitly says those handouts were only supposed to go to those getting policies through state exchanges (as the oily Jonathan Gruber openly admitted).
  • I’m disgusted that the lawyers at the Justice Department and the Office of White House Counsel didn’t have the integrity to say that handouts could only be given to people using state exchanges.
  • But most of all, I’m disgusted that the Supreme Court once again has decided to put politics above the Constitution.

In theory, the courts play a valuable role in America’s separation-of-powers system. They supposedly protect our freedoms from majoritarianism. And they ostensibly preserve our system of checks and balances by preventing other branches of the federal government from exceeding their powers.

To be sure, the courts – including and especially the Supreme Court – have not done a good job in some areas. Ever since the 1930s, for instance, they’ve completely failed to limit the federal government to the enumerated powers in Article 1, Section 8, of the Constitution.

The Supreme Court’s first Obamacare decision back in 2012 then took that negligence to a higher level.

Now we have a second Obamacare decision. And this one may be even more outrageous because the Supreme Court decided to act as a pseudo-legislature by arbitrarily re-writing Obamacare.

Here’s what George Will wrote about the decision.

The most durable damage from Thursday’s decision is not the perpetuation of the ACA, which can be undone by what created it — legislative action. The paramount injury is the court’s embrace of a duty to ratify and even facilitate lawless discretion exercised by administrative agencies and the executive branch generally. …The decision also resulted from Chief Justice John G. Roberts Jr.’s embrace of the doctrine that courts, owing vast deference to the purposes of the political branches, are obligated to do whatever is required to make a law efficient, regardless of how the law is written. What Roberts does by way of, to be polite, creative construing (Justice Antonin Scalia, dissenting, calls it “somersaults of statutory interpretation”) is legislating, not judging. …Thursday’s decision demonstrates how easily, indeed inevitably, judicial deference becomes judicial dereliction, with anticonstitutional consequences. We are, says William R. Maurer of the Institute for Justice, becoming “a country in which all the branches of government work in tandem to achieve policy outcomes, instead of checking one another to protect individual rights.

Here’s the bottom line, from Will’s perspective.

The Roberts Doctrine facilitates what has been for a century progressivism’s central objective, the overthrow of the Constitution’s architecture. The separation of powers impedes progressivism by preventing government from wielding uninhibited power.

Here’s how my Cato colleagues reacted, starting with Michael Cannon, our healthcare expert whose heroic efforts at least got the case to the Supreme Court.

…the Supreme Court allowed itself to be intimidated. …the Court rewrote ObamaCare to save it—again. In doing so, the Court has sent a dangerous message to future administrations… The Court today validated President Obama’s massive power grab, allowing him to tax, borrow, and spend $700 billion that no Congress ever authorized. This establishes a precedent that could let any president modify, amend, or suspend any enacted law at his or her whim.

Now let’s look at the responses of two of Cato’s constitutional scholars. Roger Pilon is less than impressed, explaining that the Roberts’ decision is a bizarre combination of improper deference and imprudent activism.

With Chief Justice Roberts’s opinion for the Court, therefore, we have a perverse blend of the opposing positions of the judicial restraint and activist schools that reigned a few decades ago. To a fault, the Court today is deferential to the political branches, much as conservatives in the mold of Alexander Bickel and Robert Bork urged, against the activism of the Warren and Burger Courts. But its deference manifests itself in the liberal activism of a Justice Brennan, rewriting the law to save Congress from itself. As Scalia writes, “the Court forgets that ours is a government of laws and not of men.”

And Ilya Shapiro also unloads on this horrible decision.

Chief Justice Roberts…admits, as he did three years ago in the individual-mandate case, that those challenging the administration are correct on the law. Nevertheless, again as he did before, Roberts contorts himself to eviscerate that “natural meaning” and rewrite Congress’s inartfully concocted scheme, this time such that “exchange established by the state” means “any old exchange.” Scalia rightly calls this novel interpretation “absurd.” …as Justice Scalia put it, “normal rules of interpretation seem always to yield to the overriding principle of the present Court: The Affordable Care Act must be saved.” …like three years ago, we have a horrendous bit of word play that violates all applicable canons of statutory interpretation to preserve the operation of a unpopular program that has done untold damage to the economy and health care system.

Now I’ll add my two cents, at least above and beyond expressing disgust. But I won’t comment on the legal issues since that’s not my area of expertise.

Instead I’ll have a semi-optimistic spin. I wrote in 2013 that we should be optimistic about repealing Obamacare and fixing the government-caused dysfunctionalism (I don’t think that’s a word, but it nonetheless seems appropriate) of our healthcare system.

This latest decision from the Supreme Court, while disappointing, doesn’t change a single word of what I wrote two years ago.

P.S. Since today’s topic (other than my conclusion) was very depressing, let’s close by looking at something cheerful.

I’ve commented before that America has a big advantage over Europe because of a greater belief in self-reliance and a greater suspicion of big government.

Well, now we have further evidence. Here’s some polling data from AEI’s most recent Political Report. As you can see, there’s a much stronger belief in self-sufficiency in the United States than there is in either Germany or Italy.

Polling data like this is yet another sign of America’s superior social capital.

And so long as Americans continue to value freedom over dependency, then there’s a chance of fixing the mess in Washington. Not just Obamacare, but the entire decrepit welfare state.

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When I criticize government-run healthcare, I normally focus on programs and interventions that distort and damage the American health sector.

So I’ve written a lot on the failures of Medicaid, Medicare, and Obamacare, as well as the counterproductive effects of the tax code’s healthcare exclusion.

But if some government is bad for the health sector, then lots of government must be even worse.

And that’s exactly what we find when we peruse stories about the British National Health Service.

Here are some excerpts from a remarkable story in the U.K.-based Independent.

A London man whose leg was broken after thieves stole his bike was forced to take an Uber taxi to the hospital after he was told that his injury “wasn’t serious enough” to warrant an ambulance. …Suffering from a broken leg and lying on the ground in agony, he called 999, only for the person on the other end to tell him to call the 111 non-emergency number as his injury wasn’t sufficiently serious for an ambulance. Eventually, three police officers picked him up and drove him home. He then had to book an Uber taxi to take him to the hospital.

Though maybe this is an example of karma.

“That is the most disappointing thing. At the time I was incredulous. I’m always a defender of the NHS but I want to know why they didn’t listen to my call properly.”

Sort of like when a defender of the IRS experiences an audit.

So how does the government defend the fact that it ignored a man with a broken leg?

In a statement to the Standard, the LAS said: “From the information given us, the patient was concious and alert and had no immediately life-threatening injuries…”

Gee, how comforting. If you’re about to die, they’ll send an ambulance. But not for anything less than that.

I guess the National Health Service sets policy based on scenes from Monty Python movies. If you just have a “flesh wound,” you’re out of luck.

Some readers may be wondering if this is an isolated example of incompetence that shouldn’t be used to indict the British system.

That’s a fair point. Indeed, there are doubtlessly similar example of malpractice in the United States (particularly with Medicare and Medicaid) and other jurisdictions where government doesn’t run the entire healthcare system.

So let’s shift to a story in the U.K.-based Telegraph that is a searing critique of the overall track record of nationalized health care.

NHS delays diagnosing and treating cancer are costing up to 10,000 lives a year, experts have warned. …Britain has one of the lowest cancer survival rates in Western Europe.  Nice said too many GPs are “guessing” whether symptoms could mean cancer, with late diagnosis responsible for thousands of deaths. … Britain is eighth from bottom in league tables comparing cancer survival in 35 Western nations, latest research shows, on a par with Poland and Estonia. …Each year, the UK has around 10,000 more cancer deaths which could have been prevented, compared with similar countries in Europe.

Hmmm…, I guess I was right in my spat with a British television host.

The (potentially) good news is that there is an effort to address this terrible track record.

For the first time, GPs will be issued with checklists of symptoms to help them spot the disease, in a bid to prevent at least half of the needless deaths. …Roger Goss, from Patient Concern, said he was surprised that doctors needed to be given such advice.  “I would be quite worried if GPs don’t know the basics of common cancers and what to look out for,” he said.  He also said that in too many areas, family doctors were under pressure to reduce the number of patients referred for tests, in order to save money.

The last sentence in the excerpt is worrisome. One of the big problems with government-run healthcare is that everybody is playing with other people’s money, and healthcare providers don’t have much incentive to be efficient or to cater to the needs of patients.

Which is, unfortunately, quite similar to the problems we have in the United States thanks to pervasive government intervention, which has caused a huge third-party-payer problem.

So I’m not overly optimistic that a new set of guidelines is going to have much effect on the quality of care on the other side of the Atlantic.

Oh, I almost forgot. Why does the title of this column include the parenthetical statement about not telling Paul Krugman about these examples of horrible results in the U.K.’s government-run healthcare system?

For the simple reason that we don’t want to burst his bubble. Krugman assured us back in 2009 that government-run healthcare was a good idea, writing that “In Britain, the government itself runs the hospitals and employs the doctors. We’ve all heard scare stories about how that works in practice; these stories are false.”

So I guess these horror stories we just reviewed are just a figment of someone’s imagination.

And I guess we have to also conclude that all the other horror stories we’ve previously shared (see here, here, herehere, herehere, here, hereherehere, here, hereherehere, herehere, here and here) also must be false.

P.S. We also have some horror stories about government-run healthcare in Sweden.

P.P.S. Though I should point out that there are good things about Sweden.

Heck, there are also good things to say about the United Kingdom.

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In the grand scheme of things, the most important development in health policy is the pending Supreme Court case revolving around whether subsidies can be provided to people obtaining health insurance from the federal exchange, even though the law explicitly says handouts are only available to people getting policies via state exchanges.

If the Court rules correctly (unlike, ahem, the last time the Justices dealt with Obamacare), it will then be very important that congressional reformers use the resulting mess to unwind as much of the law as possible.

That will be a challenge because statists already are arguing that the “only” solution is to re-write the law so that subsidies are also available via the federal government. For what it’s worth, my colleague Michael Cannon outlines the right strategy in Cato’s newly released Policy Priorities for the 114th Congress.

But let’s set aside that issue because we have a great opportunity to review another example of how government-run healthcare is a miserable failure.

Our topic for today is government-dictated electronic health records (EHRs). Dr. Jeffrey Singer is on the front lines of this issue. As a physician in Arizona, he deals with the real-world impact of this particular mandate.

And he’s so unhappy that he wrote a column on the topic for the Wall Street Journal.

Starting this year, physicians like myself who treat Medicare patients must adopt electronic health records, known as EHRs, which are digital versions of a patient’s paper charts. …I am an unwilling participant in this program. In my experience, EHRs harm patients more than they help.

By way of background, he explains that EHRs were part of Obama’s failed “stimulus” legislation and they were imposed on the theory that supposed experts could then use the resulting data to make the system more efficient and effective.

The federal government mandated in the 2009 stimulus bill that all medical providers that accept Medicare adopt the records by 2015. Bureaucrats and politicians argued that EHRs would facilitate “evidence-based medicine,” thereby improving the quality of care for patients.

But Dr. Singer says the real-world impact is to make medical care less effective and more expensive.

Electronic health records are contributing to two major problems: lower quality of care and higher costs. The former is evident in the attention-dividing nature of electronic health records. They force me to physically turn my attention away from patients and toward a computer screen—a shift from individual care to IT compliance.The problem is so widespread that the American Medical Association—a prominent supporter of the electronic-health-record program—felt compelled to defend EHRs in a 2013 report, implying that any negative experiences were the fault of bedside manner rather than the program. Apparently our poor bedside manner is a national crisis, judging by how my fellow physicians feel about the EHR program. A 2014 survey by the industry group Medical Economics discovered that 67% of doctors are “dissatisfied with [EHR] functionality.” Three of four physicians said electronic health records “do not save them time,” according to Deloitte. Doctors reported spending—or more accurately, wasting—an average of 48 minutes each day dealing with this system.

Here’s what he wrote about costs.

The Deloitte survey also found that three of four physicians think electronic health records “increase costs.” There are three reasons. First, physicians can no longer see as many patients as they once did. Doctors must then charge higher prices for the fewer patients they see. This is also true for EHRs’ high implementation costs—the second culprit. A November report from the Agency for Healthcare Research and Quality found that the average five-physician primary-care practice would spend $162,000 to implement the system, followed by $85,000 in first-year maintenance costs. Like any business, physicians pass these costs along to their customers—patients. Then there’s the third cause: Small private practices often find it difficult to pay such sums, so they increasingly turn to hospitals for relief. In recent years, hospitals have purchased swaths of independent and physician-owned practices, which accounted for two-thirds of medical practices a decade ago but only half today. Two studies in the Journal of the American Medical Association and one in Health Affairs published in 2014 found that, in the words of the latter, this “vertical integration” leads to “higher hospital prices and spending.”

Last but not least, Dr. Singer explains that electronic health records don’t reduce errors or increase efficiency, notwithstanding the claims of advocates.

The EHR system assumes that the patient in front of me is the “average patient.” When I’m in the treatment room, I must fill out a template to demonstrate to the federal government that I made “meaningful use” of the system. This rigidity inhibits my ability to tailor my questions and treatment to my patient’s actual medical needs. It promotes tunnel vision in which physicians become so focused on complying with the EHR work sheet that they surrender a degree of critical thinking and medical investigation. Not surprisingly, a recent study in Perspectives in Health Information Management found that electronic health records encourage errors that can “endanger patient safety or decrease the quality of care.” America saw a real-life example during the recent Ebola crisis, when “patient zero” in Dallas, Thomas Eric Duncan, received a delayed diagnosis due in part to problems with EHRs.

Wow, not exactly an uplifting read.

Indeed, Dr. Singer’s perspective is so depressing that I hope he’s at least partially wrong. Maybe after a couple of years, and with a bit of luck, doctors will adapt and we’ll get some benefits in exchange for the $20 billion-plus of taxpayer money that has been plowed into this project (not to mention all the time and expense imposed on the medical profession).

But the big-picture lesson to be learned is that planners, politicians, and bureaucrats in Washington should not be in charge of the healthcare system.

Which brings us to the real challenge of how to put the toothpaste back in the tube.

Government intervention is so pervasive in the healthcare sector that – with a few rare exceptions – normal market forces have been crippled.

As such, we have a system that produces higher and higher costs accompanied by ever-rising levels of inefficiency.

Amazingly, the statists then argue that more government is the only solution to this government-caused mess. Sort of Mitchell’s Law on steroids.

But that path leads to single-payer healthcare, and the horror stories from the U.K. should be enough to show any sensible person that’s a bad outcome.

The only real solution is to restore a free market. That means not only repealing Obamacare, but also addressing all the other programs and policies which have caused the third-party payer crisis.

P.S. Just like yesterday, I want to finish a grim column with something uplifting.

Here’s a sign that will irk statists driving through one part of Pennsylvania.

Now take the IQ test for criminals and liberals and decide whether this means more crime or less crime.

If you’re having trouble with the answer, here’s a hint from Chuck Asay.

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One of the good things about working at the Cato Institute is that there’s never any pressure to put your thumb on the scale to help any political party.

Our loyalties are to libertarian principles, many of which are reflected in the Constitution, so we’re free to criticize or praise politicians based on their ideas rather than their partisan affiliation.

That’s why we criticized President Bush’s pro-centralization No Child Left Behind education scheme just as much as President Obama’s pro-centralization Common Core education scheme.

It’s also why I criticized Bush for being a big spender like Obama (indeed, Bush was a bigger spender, even for domestic programs!).

I’m giving this background because today I’m going to say something nice about Obamacare.

Not because I like the overall law, but because honesty is the best policy.

Regular readers know that our healthcare system is screwed up by bad government policy. More specifically, spending programs such as Medicare and Medicaid, combined with tax preferences and regulations that encourage over-insurance, have created a giant third-party payer problem.

Only 11 percent of health care spending in America is directly financed by consumers. The rest is paid for by taxpayers, insurance companies, and other third parties.

This has eviscerated the normal working of a competitive market. When people are spending their own money, they are careful and prudent. When they spend other people’s money, however, they are not overly concerned about cost.

As a result, we have a needlessly expensive system. And because third-party payer requires lots of administration and paper work, bad government policies also have caused absurd levels of inefficiency.

Well, there’s one small piece of Obamacare that actually is helping to mitigate this problem. The law includes a so-called Cadillac tax that caps the special tax preference for fringe benefits (if your employer provides you a health insurance policy as part of your compensation, that type of income isn’t taxed, unlike your cash wages).

And that reform is having a positive impact. Here are some passages from a Bloomberg story.

Large employers are increasingly putting an end to their most generous health-care coverage as a tax on “Cadillac” insurance plans looms closer under Obamacare. Employees including bankers at JPMorgan Chase & Co. (JPM) and college professors at Harvard University are seeing a range of moves to shift more costs to workers. …The tax takes effect in 2018, and employers are already laying the groundwork to make sure they don’t have to pay the 40 percent surcharge on health-insurance spending that exceeds $27,500 for a family or $10,200 for an individual. Once envisioned as a tool to slow the nation’s growing health-care tab, the tax has in practice meant higher out-of-pocket health-care costs for workers.

The last sentence in the excerpt, by the way, is economically illiterate.

The Cadillac tax will restrain health spending because it means higher out-of-pocket costs for consumers. They are going to have more authority and responsibility of how to spend their own money.

Think of this analogy. Will you eat more if I give you $25 to buy a meal or if I give you a pre-paid voucher for a $25 all-you-can-eat buffet?

If you’re a normal person, you’ll take the $25 cash, buy a meal for less than that amount, and save the extra money for something else.

But if you’re given a pre-paid voucher for the buffet, you’ll pig out because there’s no additional cost for consuming more items.

And the Bloomberg story includes evidence that giving consumers more control over their income is having the predicted positive effect.

The tax on Cadillac plans — named after the luxury vehicle to denote their lavishness — is one reason the growth in health-care premiums has slowed since the Patient Protection and Affordable Care Act took effect in 2010. …The tax “is having the effect that was intended, which is the cost of these plans are being reduced,” Christopher Condeluci, a former Senate Republican aide who helped design it, said in a phone interview. …Premium increases for employer-provided health insurance, which covers about 48 percent of Americans, “slowed markedly” in 31 states since 2010, the year the Affordable Care Act became law, the New York-based Commonwealth Fund reported today. Nationally, premium growth fell by about a percentage point after the law, to 4.1 percent a year on average, the report said.

By the way, I should hasten to add that I’m not happy about the way the Cadillac tax was adopted, for a major reason and a minor reason.

The major reason is that it was part of a law that is otherwise a very expensive disaster.

The minor reason is that, for reasons of both good tax policy and good health policy, I want to eliminate loopholes and tax preferences only if we can use every penny of revenue to finance lower tax rates.

And that’s exactly what you get with a flat tax, which is a system where you don’t even need a Cadillac tax because there’s no healthcare exclusion.

Under Obamacare, by contrast, the Cadillac tax limits the healthcare exclusion, but politicians used the money to finance bigger government.

Now let’s say something bad about Obamacare.

John Goodman of the Independent Institute has a column in today’s Wall Street Journal. He points out that the law is hurting many of the people it was supposed to help.

…the law is already hurting some of the people it was intended to help. By this time next year, we may find that many workers who earn within a few dollars of the minimum wage have less income and less insurance coverage (as a group) than they did before the mandate began to take effect.

How does John justify these assertions?

Because he did some real-world research, surveying 136 fast-food restaurants with 3,500 employees.

The results are not encouraging, at least for the workers.

Before 2014 about half the employees were “full time” as defined by ObamaCare; that is, they worked 30 hours or more a week. The potential cost to the employers of providing mandated health insurance to their full-time staff would have been about $7 million a year. But by the time the employers took advantage of all their legal options they were able to reduce their cost to less than 1% of that amount. The first step was to make all hourly workers part time. …workers in the survey whose hours were reduced to part time…can get subsidized insurance through an exchange, but they will be asked to pay up to 9.5% of their income for what is unattractive coverage. Some of them previously had mini-med plans, but this kind of insurance is no longer available to them. …Those few remaining full-time employees will get mini-med insurance for themselves, but they are unlikely to be able to afford coverage for any dependents they have. They will not get an ObamaCare bronze plan unless they fork over about one-tenth of their take-home pay, and they won’t be able to get bronze coverage for other family members unless they forfeit more than half their income. Out of 3,500 employees, only one that we know of got the kind of insurance that the architects of the Affordable Care Act wanted everyone to have.

One out of 3,500? Sounds like the typical success rate for a government program.

But we shouldn’t joke. It’s not funny that low-income workers are being hurt. Just like it’s not funny that young adults, retirees, and kids are being disadvantaged by Obamacare as well (on the other hand, it is somewhat amusing that politicians, IRS agents, and Harvard professors are upset about the law).

The bottom line is that an overwhelming percentage of Obamacare provisions make the healthcare system more expensive and less effective.

Yes, there are some positive effects of the Cadillac tax, but those are easily offset by all the features of the law that increase the size and scope of government.

P.S. Since I mentioned that third-party payer has messed up our healthcare system and caused prices to rise, I should point out that there are a few sectors where consumers are still in charge. And in those areas, such as cosmetic surgery and abortion, prices are falling in relative terms.

P.P.S. The folks at Reason TV put together a must-watch video on how a hospital can be more efficient and affordable in the absence of third-party payer.

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Four years ago, I put together some New Year’s Day Resolutions for the GOP.

Three years ago, I made some policy predictions for the new year.

But since I obviously don’t control Republicans and since I freely admit that economists are lousy forecasters, let’s do something more practical to start 2015.

Let’s simply look at three very important things that may happen this year and what they might mean.

1. Will the Republican Senate support genuine entitlement reform?

One of the best things to happen in recent years is that House Republicans embraced genuine entitlement reform. For the past four years, they have approved budget resolutions that assumed well-designed structural changes to both Medicare and Medicaid.

There were no real changes in policy, of course, because the Senate was controlled by Harry Reid. And I’m not expecting any meaningful reforms in 2015 or 2016 because Obama has a veto pen.

But if the Republican-controlled Senate later this year approves a budget resolution with the right kind of Medicare and Medicaid reform, that would send a very positive signal.

It would mean that they are willing to explicitly embrace the types of policies that are desperately needed to avert long-run fiscal crisis in America.

I don’t even care if the House and Senate have a conference committee and proceed with actual legislation. As I noted above, Obama would use his veto pen to block anything good from becoming law anyhow.

My bottom line is simple. If GOPers in both the House and Senate officially embrace the right kind of entitlement reform, then all that’s needed is a decent President after the 2016 elections (which, of course, presents an entirely different challenge).

2. Will there be another fiscal crisis in Greece (and perhaps elsewhere in Europe)?

The European fiscal crisis has not gone away. Yes, a few governments have actually been forced to cut spending, but they’ve also raised taxes and hindered the ability of the private sector to generate economic recovery.

And the spending cuts in most cases haven’t been sufficient to balance budgets, so debt continues to grow (in some cases, there have been dramatic increases in general government net liabilities).

Sounds like a recipe for further crisis, right? Yes and no.

Yes, there should be more crisis because debt levels today are higher than they were five years ago. But no, there hasn’t been more crisis because direct bailouts (by the IMF) and indirect bailouts (by the ECB) have propped up the fiscal regimes of various European nations.

At some point, though, won’t this house of cards collapse? Perhaps triggered by election victories for anti-establishment parties (such as Syriza in Greece or Podemos in Spain)?

While I’m leery of making predictions, at some point I assume there will be an implosion.

What happens after that will be very interesting. Will it trigger bad policies, such as centralized, European-wide fiscal decision-making? Or departures from the euro, which would enable nations to replace misguided debt-financed government spending with misguided monetary policy-financed government spending?

Or might turmoil lead to good policy, which both politicians and voters sobering up and realizing that there must be limits on the overall burden of government spending?

3. If the Supreme Court rules correctly in King v. Burwell, will federal and state lawmakers react correctly?

The Supreme Court has agreed to decide a very important case about whether Obamacare subsidies are available to people who get policies from a federal exchange.

Since the law explicitly states that subsidies are only available through state exchanges (as one of the law’s designers openly admitted), it seems like this should be a slam-dunk decision.

But given what happened back in 2012, when Chief Justice Roberts put politics above the Constitution, it’s anybody’s guess what will happen with King v Burwell.

Just for the sake of argument, however, let’s assume the Supreme Court decides the case correctly. That would mean a quick end to Obamacare subsidies in the dozens of states that refused to set up exchanges.

Sounds like a victory, right?

I surely hope so, but I’m worried that politicians in Washington might then decide to amend the law to officially extend subsidies to policies purchased through a federal exchange. Or politicians in state capitals may decide to set up exchanges so that their citizens can stay attached to the public teat.

In other words, a proper decision by the Supreme Court would only be a good outcome if national and state lawmakers used it as a springboard to push for repeal of the remaining parts of Obamacare.

If, on the other hand, a good decision leads to bad changes, then there will be zero progress. Indeed, it would be a big psychological defeat since it would represent a triumph of handouts over reform.

I guess I’m vaguely optimistic that good things will happen simply because we’ve already seen lots of states turn down “free” federal money to expand Medicaid.

P.S. Let’s close with some unexpected praise for Thomas Piketty. I’m generally not a fan of Monsieur Piketty since his policies would cripple growth (hurting poor people, along with everyone else).

But let’s now look at what France 24 is reporting.

France’s influential economist Thomas Piketty, author of “Capital in the 21st Century”, on Thursday refused to accept the country’s highest award, the Legion d’honneur… “I refuse this nomination because I do not think it is the government’s role to decide who is honourable,” Piketty told AFP.

It’s quite possible, perhaps even likely, that Piketty is merely posturing. But I heartily applaud his statement about the role of government.

Just as I applauded President Hollande when he did something right, even if it was only for political reasons.

But let’s not lose sight of the fact that Piketty is still a crank. His supposedly path-breaking research is based on a theory that is so nonsensical that it has the support of only about 3 percent of economists.

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It’s time to add to our collection of horror stories from the U.K.’s government-run healthcare system (previous examples can be found here, herehereherehereherehereherehere, here, here, here, here, here, here, and here).

What makes today’s story different, though, is that the bureaucracy not only is denying care to a small child, but also seeking to prevent the family from seeking treatment elsewhere.

Check out these excerpts from a blood-chilling story in USA Today.

The parents of a child suffering from a severe brain tumor signaled Monday they would defy efforts to force them to return to Britain, days after their family fled.

So why did they feel the need to escape a presumably civilized nation?

It seems government-run healthcare isn’t exactly on the cutting edge when it comes to life-saving treatments.

The family had fled to Spain in hopes of selling a property to obtain enough cash for a new treatment in the Czech Republic or the United States they hope will help their child. Police pursued them and issued an arrest warrant on suspicion of neglect after Southampton General Hospital realized their patient — Ashya King, 5 — was gone, without their consent. British authorities have made no apology for the warrant.

I can’t resist interrupting the main focus of the story at this point because the story then includes this line.

The case has riveted Britain, which is proud of a health service that offers universal care.

Maybe Brits are proud of their NHS, which would be a poor reflection on the collective IQ of the nation, but it certainly doesn’t offer universal care.

Unless, of course, you include neglect and torture in your definition of care.

Now back to our main story.

…the saga has…raised volatile questions of how much power authorities should have in interfering in some of the most sensitive of questions — and whether it has the right to insist that treatment dictates be followed. …Television images have shown the Kings being loaded into a Spanish squad car in handcuffs. When asked by the BBC on their views, the couple told the reporter they are just trying to help their child. …The family has criticized Britain’s health care system, saying he has a serious tumor that needs an advanced treatment option called proton beam therapy and that it wasn’t being made available to him. …Unlike other types of cancer treatment, it doesn’t indiscriminately kill surrounding healthy tissue, so there could be fewer long term effects.

But fear not. If little Ashya can somehow hold on until 2018, maybe the bureaucrats will be able to help.

Britain’s health department announced in 2011 it will build two treatment centers to make proton beam therapy available in London and Manchester from 2018. Until those facilities open, Britain will pay for patients eligible for the therapy to go to the USA and Switzerland for treatment. It wasn’t immediately clear why health care officials didn’t make this option available to Aysha.

As a parent, I know I would break the law if faced with the same situation.

It’s outrageous and disgusting, though, that such laws even exist.

P.S. I don’t mean to pick on the United Kingdom. We also have horror stories about government-run healthcare in the United States.

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When government suppresses the free market and takes over the healthcare sector, you get some really odd results.

Consider these stories from Sweden:

 A man sewing up his own leg after getting frustrated with a long wait.

The government denying a wheelchair to a double amputee because the bureaucrats decided his impairment might not be permanent.

Speaking of amputations, an unfortunate man was put on such a long waiting list that his only treatment, when he was finally seen, was to have his penis removed.

Today, we’re going to augment that list. But not with another story from Sweden, which is actually a much better country in terms of public policy than most folks realize.

Instead, we’re going to look at some great moments in government-run healthcare in both the United States and the United Kingdom.

Our first story is from the Chicago Tribune and it deals with Medicaid and Medicare spending.

But we’re not going to look at the aggregate data. Those numbers are very sobering, to be sure, and you can click here and here to learn more about that problem.

Instead, we’re going to drill down into the details and get some up-close evidence of why the programs are so costly. Simply stated, providers learn how to bilk the government.

A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions. Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.  And then there was this: The sessions were often being performed by obstetricians and gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled. So Medicaid began cracking down, and spending plummeted after new rules were implemented.Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows. Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total. Among the highest billers for group psychotherapy in Illinois were three OB-GYNs and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.

Some of the specific examples are beyond belief. Keep in mind as you read the next passage that there are only 365 days in a year, and only about 261 workdays.

Of the Illinois OB-GYNs billing for group psychotherapy, Dr. Josephine Kamper had the highest number of sessions. She was paid for 10,399 sessions in 2012, at a cost to Medicare of $207,980. …Another OB-GYN, Lofton Kennedy Jr., billed for 9,154 group psychotherapy services. He declined to comment. The third-highest-billing OB-GYN, Philip Okwuje, charged Medicare for 8,584 group therapy sessions.  

Illinois isn’t the only place where taxpayers are getting ripped off.

A Queens, N.Y., primary care doctor, Mark Burke, was paid for more sessions than anyone else in the country — 20,841. He accounted for nearly one in every six sessions delivered in the entire state of New York in Medicare, separate data show. He did not return messages left at his office. Another large biller was Makeba Gordon, a social worker in Detroit. She was reimbursed for nearly 5,000 group therapy sessions for her 26 Medicare patients, an average of 190 each. She also billed for 2,820 individual psychotherapy visits for the same 26 patients, who allegedly would have received an average of 298 therapy sessions apiece in 2012. Gordon could not be reached for comment.

And I’m sure you won’t be surprised to learn that the bureaucracy in Washington doesn’t seem overly worried about this preposterous waste of money.

Aaron Albright, a spokesman for the U.S. Centers for Medicare & Medicaid Services, said in an email that Medicare has no policy regarding which physicians may perform group psychotherapy. During such sessions, “personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction, insight, and support,” according to rules set out by one of Medicare’s contractors.

The second story comes from the United Kingdom.

Regular readers know that the government-run healthcare system in the United Kingdom is an ongoing horror story of denied care, sub-standard care, and patient brutality (click here to see some sickening examples).

You would think the U.K.’s political class would respond by trying to use money more effectively.

You would be wrong. The bureaucrats somehow have decided that tax monies should be used to finance a sperm bank, even though private sperm banks already exist.

Here are some excerpts from a report in the Daily Mail.

Britain is to get its first NHS-funded national sperm bank to make it easier for lesbian couples and single women to have children.For as little as £300 – less than half the cost of the service at a private clinic –  they will be able to search an online database and choose an anonymous donor on the basis of his ethnicity, height, profession and even hobbies. …The National Sperm Bank will be based at Birmingham Women’s NHS Foundation Trust, which currently runs an existing NHS fertility clinic and recruits sperm donors from the local population. Funded by a £77,000 Government grant, the bank will be run by the National Gamete Donation Trust (NGDT) which this year received  an additional £120,000 of public money to organise egg and sperm donation.

Some have criticized the initiative because it will purposefully increase the number of fatherless children.

…the move – funded by the Department of Health – is largely designed to meet the increasing demand from thousands of women who want to start a family without having a relationship with a man. Critics last night called it a ‘dangerous social experiment’ that could result in hundreds of fatherless ‘designer families’. …Ms Witjens rejected suggestions that children suffer adverse consequences from lacking a father figure. …Ms Witjens pointed to the removal of the reference to a ‘need for a father’ in the Human Fertilisation and Embryology Act, when taking account of a child’s welfare when providing fertility treatment.

I’m sympathetic to the argument that children do best in conventional households with fathers, but my main reaction to this story is that government shouldn’t try to either penalize or subsidize unconventional households.

And a government-sponsored sperm bank definitely falls into the latter category.

But I’m not surprised. Governments love to squanders other people’s money, and the U.K. government has considerable expertise (if you can call it that) in this regard.

Heck, the U.K. healthcare system is even financing boob jobs. But we’re not talking about reconstructive surgery for women who had mastectomies. They pay for breast augmentation for women who claim “emotional distress.”

Though maybe the U.K. government deserves a special prize. It developed a giveaway program that was so convoluted that nobody signed up to take the money.

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Last September, I shared a disconcerting video showing an unfortunate young woman getting her OB/GYN exam from a very creepy version of Uncle Sam.

Well, you’ll be pleased to know that “Creepy Uncle Sam” does not discriminate. In this video, a young man faces the unpleasant experience of getting his prostate checked.

Kudos to Generation Opportunity for putting together such clever videos.

But I think their most recent video is a true masterpiece. It manages to showcase almost all the bad features of Obamacare in a short, amusing, pithy form.

And if you like videos that make fun of Obamacare, here are some other examples from the archives.

*The head of the National Socialist Workers Party finds out he can’t keep his health plan.

*Young people discover that they’re screwed by Obamacare.

*Remy of Reason TV sings about the joy of part-time work.

*A cartoon video imagines a world where buying coffee is like buying government-run healthcare.

*One of the biggest statists of the 20th century is angry that the Obamacare exchanges don’t work.

Let’s close with a good cartoon from Ken Catalino.

And whatever the government says Obamacare costs, you can feel confident (albeit depressed) that the real cost will be higher. Especially if you’re also counting non-fiscal costs such as fewer jobs.

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I thought TARP was the sleaziest-ever example of cronyism and corruption in Washington.

The Wall Street bailout rewarded politically well-connected companies, encouraged moral hazard, and ripped off taxpayers. Heck, it was so bad that it makes the sleaze at the Export-Import Bank seem almost angelic by comparison.

But I may have to reassess my views.

One of the provisions of Obamacare allows the White House to give bailouts to big health insurance companies. You’re probably wondering why these big firms would need bailouts. After all, didn’t Obamacare coerce millions of people into becoming involuntary customers of these companies? That should give them lots of unearned profits, right?

But here’s the catch. The President wasn’t being honest when he repeatedly promised that Obamacare would reduce premiums for health insurance. And since the Democrats don’t want consumers to get angry about rising costs (particularly before the 2014 elections), they want health insurance companies to under-charge.

Avik Roy of Forbes explains in greater detail how the White House is coercing health insurance companies to limit premium increases before the mid-term elections. Here are some excerpts.

Hidden in the midst of a 436 page regulatory update, and written in pure bureaucratese, the Department of Health and Human Services asked that insurance companies limit the looming premium increases for 2015 health plans. But don’t worry, HHS hinted: we’ll bail you out on the taxpayer’s dime if you lose money. …The White House is playing politics with Americans’ health care—and they’re bribing health insurance companies to play along. The administration’s intention is clear: Salvage the 2014 midterm elections. …Technically, the regulations don’t force health insurance companies to tamp down their premium spikes. But the White House isn’t asking nicely. …Under Obamacare, insurers are so heavily regulated that they have to play nice with the bureaucrats who call the shots. …If insurance companies don’t give in, regulators have powerful ways to make life hard for them. A shrewd CEO doesn’t need to look far to see what might happen if his company opts out.

But before you feel sorry for Big Insurance, remember that these corrupt companies supported Obamacare and fully expect to get bailed out by taxpayers. Here are some blurbs from an article last month in the Weekly Standard.

Most Americans don’t think it’s their job to bail out insurance companies who lose money under Obamacare, but that’s exactly what’s poised to happen. Obamacare’s risk-corridor program — which President Obama has been using as a slush fund to placate his insurance allies and keep them quiet about his lawlessness — shifts financial risk from insurers to taxpayers. According to the House Oversight Committee, health insurers expect Obamacare’s risk corridors to net them nearly $1 billion, at taxpayer expense, this year alone. …It was a win-win that would boost Obamacare in its early days — to the benefit of those who’ve gained extraordinary power at the expense of Americans’ liberty, and of those whose product has become mandatory for Americans to purchase.

In other words, we have a stereotypical example of Mitchell’s Law. Government screws up something, and then uses that mess as an excuse to impose more bad policy!

This Lisa Benson cartoon is a perfect summary of what’s happening.

P.S. If you’re in the mood for some dark humor, here’s the federal government’s satirical bailout application form.

P.P.S. Switching to a different topic, it’s time for me to rectify a mistake. When I first created the Moocher Hall of Fame last year, I didn’t include the “Octo-moocher” as a charter member. After all, having 14 kids while living on the dole didn’t seem particularly noteworthy.

But now we’ve discovered that she could afford her kids. She just wanted other people to pick up the tab.

Octomom Nadya Suleman pleaded no contest Monday to a single count of misdemeanor welfare fraud for failing to disclose income she was receiving from videos and personal appearances while collecting more than $26,000 in public assistance funds to care for her 14 children.

This may not be as impressive as the deadbeat who got handouts while living on a $1.2 million yacht, but still worthy of membership.

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I wrote a few weeks ago about the hidden economic damage of Obamacare, particularly the harm to the job market.

Today, let’s get further depressed by looking at the ever-worsening fiscal damage of the law.

Here’s some of what Chuck Blahous of Mercatus wrote about this costly new entitlement.

The ACA was enacted in 2010 with the promise of reducing the federal budget deficit while expanding health insurance coverage. Nearly lost amid the recent press cheerleading over ACA enrollment figures is that this promise has disintegrated, and now no one…can say how much fiscal damage the ACA will ultimately cause. …CBO currently estimates that the ACA’s coverage provisions will cost the federal government $92 billion a year by FY2015. This is roughly 0.5 percent of projected U.S. economic output for 2015, well exceeding the relative costs of Social Security and Medicaid at similar points in their histories. (The amount falls just short of the proportion of GDP absorbed by all of early Medicare.) Worse, the federal fiscal position was far weaker when the ACA was passed than when Social Security, Medicare, and Medicaid were created.

That’s bad news, but things will get even worse in coming years.

Troubling though the ACA’s startup costs are, they represent only the tip of the fiscal iceberg that will be the fully phased-in law. CBO projects that its annual costs will hit $200 billion by FY2020, or nearly 0.9 percent of GDP. Yet this assumes that lawmakers will be content to allow the ACA’s health insurance subsidies to grow more slowly than low-income beneficiaries’ health care costs, as the law now stipulates. Thus there is every reason to believe that the ACA’s eventual costs will far exceed initial estimates, as happened with Social Security, Medicare, and Medicaid. …Also unclear is whether the ACA’s reinsurance and “risk corridor” provisions will produce unexpected federal budget costs; these provisions were included in the ACA to protect insurers… the Obama administration continues to promise both participating health insurers and taxpayers that they will each be protected from loss under the risk corridor provisions.

The potential bailout for insurance companies is bad news for taxpayers, but it’s even more upsetting for moral and practical reasons.

The big insurance companies got into bed with the White House, figuring it was a good idea for the federal government to coerce Americans into buying their product. As far as I’m concerned, they should swallow heavy losses.

But in Washington, there’s rarely a downside for doing the wrong thing. Instead, this could be like TARP. A reward for bad behavior.

By the way, it’s not just policy wonks who are concerned about the fiscal burden of Obamacare. According to Roll Call, the Congressional Budget Office has – for all intents and purposes – given up trying to estimate the fiscal burden of the legislation.

For Democratic lawmakers who were hesitant to sign onto the sweeping 2010 health care law, one of the most powerful selling points was that the Affordable Care Act would actually reduce the federal budget deficit…the answer to that question has become something of a mystery. In its latest report on the law, the Congressional Budget Office said it is no longer possible to assess the overall fiscal impact of the law. That conclusion came as a surprise to some fiscal experts in Washington and is drawing concern. …In a little-noticed footnote to a report issued in April, “Updated Estimates of the Effects of the Insurance Coverage Provisions of the Affordable Care Act,” the CBO wrote that it and the Joint Committee on Taxation “can no longer determine exactly how the provisions of the ACA that are not related to the expansion of health insurance coverage have affected their projections of direct spending and revenues.”

Translated into plain English, Obamacare is a budgetary black hole.

If only somebody could have predicted that this would happen. But actually, many people did. The history of entitlement programs is that they are bad news in theory and even worse news in reality.

Indeed, even I warned that Obamacare was going to be a bigger fiscal nightmare than originally predicted, as seen in this video.

This Eric Allie cartoon doesn’t focus on the fiscal problems of Obamacare, but it’s worth sharing because the entire law is a mess.

Too bad the American people are the guinea pigs for this experiment in statism.

Wouldn’t it be nice if instead we had the freedom to experiment with market-based healthcare?

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Obamacare resulted in big increases in the fiscal burden of government (ironically, it would be even worse if Obama hadn’t unilaterally suspended parts of the law).

The legislation increased government spending, mostly for expanded Medicaid and big subsidies for private insurance.

There were also several tax hikes, with targeted levies on medical device makers and tanning beds, as well as some soak-the-rich taxes on upper-income taxpayers.

These various policies are bad news for economic performance, but the damage of Obamacare goes well beyond these provisions.

Writing for Real Clear Markets, Professor Casey Mulligan of the University of Chicago explains that Obamacare contains huge implicit tax hikes on work and other forms of productive behavior.

…can we begin to take seriously the idea that the fiscal policies and regulations hidden in the Affordable Care Act are shrinking our economy? …Politicians and journalists use the term tax more narrowly than economists do, but the economic definition is needed to understand the economic effects of the ACA. …Withholding benefits from people who work or earn is hardly different than telling them to pay a tax. For this reason, economists refer to benefits withheld as “implicit taxes.” What really matters for labor market performance is the reward to working inclusive of implicit taxes, and not the amount of revenue delivered to the government treasury… The ACA…is full of implicit taxes. Many of them have remained hidden in the “fog of controversy” surrounding the law and their effects excluded from economic analyses of it.

In other words, his basic message is that the government reduces incentives to be more productive and earn more money when it provides handouts that are based on people earning less money.

Indeed, click here to see a remarkable chart showing how redistribution programs discourage work.

And speaking of charts, here’s one from Professor Mulligan’s article, and it shows the nation’s largest tax hikes based on what happened to the marginal tax rate on working.

Wow. No wonder we’re suffering from a very anemic recovery.

Professor Mulligan elaborates.

During a period that included more than a dozen tax increases, the ACA is arguably the largest as a single piece of legislation, adding about six percentage points to the marginal tax rate faced, on average, by workers in the economy. The only way to cite larger marginal tax increases would be to combine multiple coincident laws, such as the Revenue Acts of 1950 and 1951 and the new payroll tax rate that went into effect in 1950. Even with these adjustments, the ACA is still the third largest marginal tax rate hike during the seventy years. …Let’s not be surprised that, as we implement a new law that taxes jobs and incomes, we are ending up with fewer jobs and less income.

By the way, other academics also have found that Obamacare will lure many people out of the workforce and into government dependency.

The White House actually wants us to believe this is a good thing, as humorously depicted by this Glenn McCoy cartoon.

But rational people understand that our economic output is a function of how much labor and capital are being productively utilized.

In other words, Obamacare is a mess. It’s hurting the economy and should be repealed as the first step in a long journey back to market-based healthcare.

P.S. Mulligan’s chart also re-confirms that unemployment benefits increase unemployment. Heck, that’s such a simple and obvious concept that it’s easily explained in this Wizard-of-Id parody and this Michael Ramirez cartoon.

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Since I’ve already created a Moocher Hall of Fame to acknowledge the strangest and most reprehensible examples of government dependency, it’s occurred to me that there also should be a Bureaucrat Hall of Fame to highlight the government employees that have figured out how to most successfully rip off taxpayers (and here are some good candidates for charter membership).

But what if an entire bureaucracy was eligible?

The paper pushers at the Veterans Administration sure have figured out how to milk the system. Check out these excerpts from Associated Press report.

Nearly 80 percent of senior executives at the Department of Veterans Affairs got performance bonuses last year despite widespread treatment delays and preventable deaths at VA hospitals and clinics, a top official said Friday. …Workers at the Phoenix VA Health Care System — where officials have confirmed dozens of patients died while awaiting treatment — received about $3.9 million in bonuses last year, newly released records show. The merit-based bonuses were doled out to about 650 employees, including doctors, nurses, administrators, secretaries and cleaning staff.

This is such an outrageous waste of money that even the politicians who created it feel it should be criticized.

Rep. Jeff Miller, R-Fla., chairman of the House Veterans Affairs Committee, said the VA’s bonus system “is failing veterans.” Instead of being given for outstanding work, the cash awards are “seen as an entitlement and have become irrelevant to quality work product,” Miller said. Rep. Phil Roe, R-Tenn., said awarding bonuses to 80 percent of executives means that the VA was setting the bar for performance so low that “anybody could step over it. If your metrics are low enough that almost everybody exceeds them, then your metrics are not very high.” Rep. Ann McLane Kuster, D-N.H., said the VA suffered from “grade inflation, or what (humorist) Garrison Keillor would refer to as ‘all of the children are above average.'” Kuster and other lawmakers said they found it hard to believe that 80 percent of senior employees could be viewed as exceeding expectations, given the growing uproar over patients dying while awaiting VA treatment and mounting evidence that workers falsified or omitted appointment schedules to mask frequent, long delays. …Miller, the panel’s chairman, noted that in the past four years, none of the VA’s 470 senior executives have received ratings of minimally satisfactory or unsatisfactory, the two lowest ratings on the VA’s five-tier evaluation system.

But the real lesson is that government simply doesn’t work very well

Or let me rephrase that. Government works very well…but only if you’re a politician, lobbyist, contractor, bureaucrat, or some other insider who has figured out that “the public sector” is a great way to obtain unearned wealth.

If you’re a taxpayer, by contrast, you get the short end of the stick (I was thinking of another analogy, but decided to keep things clean).

And if you’re someone – like a veteran – who is relying on government, then you’re in a very unfortunate position (sort of like the person in the other analogy that crossed my mind).

The main thing to understand is bureaucrats respond to incentives. And when you have government programs with no bottom-line reason to  deliver efficiency and good service, we shouldn’t be surprised that we get bloated payrolls and absurd compensation packages.

This video explains that it’s a government-wide phenomenon.

And to close out today’s column, here’s a Steve Kelley cartoon about Forrest Gump and the VA.

P.S. Don’t let politicians and interest groups get away with claiming that “inadequate funding” caused the VA scandal.

P.P.S. And grit your teeth because the government-run veterans health system is a good predictor of what we’ll all experience if the government-run Obamacare system is fully implemented.

P.P.P.S. Don’t forget that bonuses for poor performance are standard operating procedure in Washington. The bureaucrats at the IRS have been rewarded with extra cash notwithstanding all the scandals.

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The statists are claiming Obamacare is now a success.

Needless to say, I think this is a laughable assertion. Indeed, I shared a very clever graphic from Ted Cruz to help explain why it’s hardly a big achievement to destabilize the insurance market and then coerce and/or bribe some people into using Obamacare.

More recently, I debunked the claim that government-caused inefficiency in the current healthcare system somehow is an argument for a single-payer system.

But I’m getting tired of kicking the dead horse of government-run healthcare. As time passes, it will become increasingly apparent that Obamacare is making things worse rather than better.

So I’d rather enjoy some laughs by sharing some Obamacare cartoons.

Let’s start with this Nate Beeler gem about Obama “succeeding” after the goalposts were moved.

Reminds me of this funny cartoon from Gary Varvel.

And speaking of Varvel, he doesn’t seem to think that Obamacare will become more popular over time.

It’s amazing that some people think this botched system is a success. Let’s call it the soft bigotry of low expectations.

As Lisa Benson illustrates.

And if you agree that Obama is being graded on a curve by a biased press, the Glenn McCoy cartoon in this post also will make you chuckle.

And since I just mentioned Glenn McCoy, here’s his contribution today. Same theme as Varvel, and just as funny.

Last but not least, we have the award-winning Michael Ramirez.

I’m surprised, by the way, that I don’t see many cartoons using the Titanic analogy. Perhaps my memory is fading, but I think this cartoon from Eric Allie is the only other time that a ship heading toward an iceberg has appeared on my blog.

P.S. Since I’m a big advocate of reducing the burden of government spending, this chart from Mercatus is definitely worth sharing.

It shows the huge amount of fraud and waste in many government programs.

But remember that we don’t want to shrink the federal government because of waste, fraud, and abuse.

We want Washington to be smaller because we respect the Constitution and think it’s wrong to trap people in government dependency.

And, needless to say, the easiest way to make matters worse is to acquiesce to higher taxes. That would give politicians an excuse to spend even more money and surely kill any chances of meaningful entitlement reform.

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I’ve observed, reported, mocked, written, and explained that Obamacare is a cluster-you-know-what.

So I’m rather bemused and frustrated by the latest pro-Obamacare spin that the law is a “success” because there are now 7 million people who have picked a plan.

There are lots of reasons for normal people to have a what-the-expletive-deleted response to this declaration of victory. For instance:

The goal of Obamacare was to insure the uninsured, yet that number has barely budged, so why is the Administration allowed to move the goalposts to something far more modest?

Obamacare also was supposed to lower premiums by $2500 and allow everyone to keep their plans and their preferred providers, so what happened to those goals?

And why should we even believe the White House spin when we have no idea whether people who have picked a plan have actually paid for that plan?

Moreover, what’s so impressive about getting some people to sign up for plans when they can get something that’s subsidized by taxpayers or other consumers?

But here’s an image put together by Senator Cruz’s office that may be the best – and certainly most amusing – look at the Administration’s supposed “achievement.”

Obamacare Broken WIndows

Amen. People are being both coerced and bribed to sign up for Obamacare, in many cases after the law forced the cancellation of plans that they liked.

So why are we supposed to applaud the fact that a small fraction of the population has chosen the only possible option?

That’s the same mentality that allows politicians to brag about our “voluntary” tax system. As if any of us send our hard-earned money to the crooks in Washington for any reason other than the fact that otherwise we would get arrested.

P.S. Since I commented on our acquiescence to the IRS and our “voluntary” tax system, I will admit thatWashington Tax I’m amused and chagrined by this poster. It’s minimized since it uses a sometimes-inappropriate synonym for wimps.

P.P.S. Since this post was about the “broken window” theory of Obamacare, let’s make sure to give ultimate credit to Bastiat, who came up with the original broken windows analogy (as captured by this cartoon mocking Keynesian economics).

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I spoke yesterday to the Memphis Economics Club about America’s looming fiscal crisis, and I did my usual song-and-dance routine about potential Greek-style chaos in the absence of genuine entitlement reform.

But I confess I was stumped when, after the speech, someone from the audience asked me what was going on with Obamacare.

I can pontificate at length about why government intervention has screwed up our healthcare system, and I can wax poetic about the need to restore market forces both with tax reform and with significant changes to Medicare and Medicaid.

But I was asked to speculate about the Obama Administration’s strategy, and I didn’t know what to say other than they’re in panic mode and they’re arbitrarily changing or ignoring the law based on short-term political imperatives.

To get an idea what I’m talking about, here’s what the Wall Street Journal opined.

Liberals say they believe in a living Constitution, and apparently they think the Affordable Care Act is a living document too. Amid one more last-minute regulatory delay, number 38 at last count, the mandate forcing nuns to sponsor birth control is more or less the only part of ObamaCare that is still intact. On Tuesday evening, the Health and Human Services Department announced that the six-month open enrollment period for ObamaCare insurance that began in October 2013 and was supposed to end on the last day of March would be extended indefinitely. …The expanded enrollment period was slipped into a legal crevice related to “exceptional circumstances” signing up such as natural disasters including “an earthquake, massive flooding, or hurricane.” …By the way, as part of this delay HHS will make no attempt to verify real enrollment problems and will instead rely on what the agency calls “the honor system.” No one will be asked why they need an extension. …This pattern of dishonesty and political improvisation has come to define ObamaCare, which is the law for some people, sometimes, except when it isn’t. Nothing HHS claims can be trusted, and little that the President of the United States promised about his signature law has turned out to be true.

Well, I must confess that I (sort of) agree with part of what the White House is doing. Obamacare has been a natural disaster.

Building on this theme, Abby McCloskey and Tom Miller have a column in the WSJ with a blunt message about the mandate.

The individual mandate has failed. After a last-ditch effort with President Obama himself encouraging “young invincibles” to sign up before the deadline, …the White House announced that people who applied for coverage on the federal health-insurance exchange will have until mid-April to finish the paperwork. …The individual mandate had the least effect on those it was supposed to encourage to gain coverage—the uninsured. … Goldman Sachs analysts estimate that about one million uninsured Americans will sign up for the ObamaCare exchanges before open enrollment ends. For perspective, that’s about 2% of the 48 million uninsured. A larger share of the exchange enrollees is likely coming from people whose previous coverage was canceled (due to other ObamaCare rules) or those who found a somewhat better deal for exchange coverage (due to much more generous low-income subsidies).

Wow, just 2 percent of the uninsured. That’s a high failure rate, even by government standards.

At this stage, the only good response is to laugh.

So let’s enjoy some Obamacare cartoons, starting with this gem from Glenn McCoy.

Reminds me of my quip about Syria and Obamacare, which even got noticed by Rand Paul!

Here’s Chip Bok having some fun with the government’s disgusting enforcement mechanism.

Brings to mind this flying monkeys cartoon.

Here’s McCoy again, this time mocking the left’s claim that we should be happy about the people who have lost their jobs because of Obamacare.

This Michael Ramirez cartoon is a classic. I especially love the eyes (a talent that Ramirez often exploits).

Needless to say, the White House’s disregard of its own law is largely driven by a desire to avoid election-day backlash, which is why this Gary Varvel cartoon is a good way to close today’s collection.

P.S. If you have a strange yearning to watch me predict the collapse of the western world (basically the same topic of my speech in Memphis), here’s a recording of my recent speech to the Center for Political Studies in Denmark.

And if you get bored with more than 60 minutes of my supposed wisdom, you can skip the rest of the video and look at the real highlight of my trip to Copenhagen, the “welfare state party ship.”

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Obamacare may not be good news for taxpayers or consumers, but let’s look at the bright side. At least the law has generated some superb political humor, including funny videos.

*The head of the National Socialist Workers Party finds out he can’t keep his health plan.

*A creepy version of Uncle Sam wants to know about your sex life.

*Young people discover that they’re screwed by Obamacare.

*One of the biggest statists of the 20th century is angry that the Obamacare exchanges don’t work.

We have another addition to this amusing collection. This cartoon video employs lots of snark to expose the illogical underpinnings of Obamacare.

My one complaint with this video, though, is that it merely scratches the surface.

Yes, Obamacare is a cluster-you-know-what, but there are many other government programs and policies that cause inefficiency and high costs

Here’s some of what I wrote on this topic back in 2009, starting with an explanation of how government intervention in the tax code has distorted the insurance market and turned it into an inefficient form of pre-paid healthcare.

Insurance is supposed to be for unforseen major expenses, such as a heart attack. But our gold-plated health plans now mean we use insurance for routine medical costs. This means, of course, we have the paperwork issues discussed above, but that’s just a small part of the problem. Even more problematic, our pre-paid health care system is somewhat akin to going to an all-you-can-eat restaurant. We have an incentive to over-consume since we’ve already paid. Except this analogy is insufficient. When we go to all-you-can-eat restaurants, at least we know we’re paying a certain amount of money for an unlimited amount of food. Many Americans, by contrast, have no idea how much of their compensation is being diverted to purchase health plans.

I then ask readers to contemplate what car insurance would look like if government also intervened in that market. Or to think about the consequences if insurance for houses also was subject to government-caused distortion.

Imagine if auto insurance worked this way? Or homeowner’s insurance? Would it make sense to file insurance forms to get an oil change? Or to buy a new couch? That sounds crazy. The system would be needlessly bureaucratic, and costs would rise because we would act like we were spending other people’s money.  But that’s what would probably happen if government intervened in the same way it does in the health-care sector.

The best way of fixing the mess in health insurance, for what it’s worth, is a flat tax. This is because the “healthcare exclusion” is repealed and compensation in the form of fringe benefits is taxed at the same (low) rate as other forms of income.

This presumably will end the incentive for gold-plated Cadillac health plans since workers – once the playing field is level – will prefer a greater amount cash compensation. So health plans gradually will be scaled back so they offer genuine insurance.

This video from the Center for Freedom and Prosperity offers a good explanation.

You also should watch this Reason TV video that shows a real-world example of how prices fall and the system is more efficient when consumers are in charge of healthcare.

For the same reason, I also recommend this story from North Carolina, as well as this example of capitalism from Maine.

It’s also worth noting that there are a few tiny parts of our healthcare system where markets are allowed to operate and consumers are in charge of spending their own money, and in these areas – such as cosmetic surgery, laser eye surgery, and abortion (regardless of whether you approve or disapprove) – we find stable prices and rising quality.

Free markets work…when they’re allowed to function.

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The President’s main “accomplishment” has been such a disaster that I wonder whether it’s time to feel sorry for Obama.

And if you looked in the dictionary for a definition of Schadenfreude, you might find a picture of me reading a story exposing more evidence that Obamacare isn’t working.

Heck, I’ve even shared Hitler parody videos (two of them!) mocking the law.

But to paraphrase Mae West, there’s no such thing as too much of a good thing.

Today, we’re going to look at the opinions of two experts, both of whom expect further bad news for Obamacare.

Here’s some of what Michael Tanner, my Cato colleague, wrote for the New York Post.

…“the State of ObamaCare” is growing ever more troubled. For starters, it’s falling far short of the goal of universal coverage. …just 1.5 million have actually completed the ObamaCare checkout, including payment. Worse, surveys indicate that less than a third of those enrolling were previously uninsured. …Even using the most optimistic reading of these figures, fewer than 11 percent of uninsured Americans have gotten coverage because of the ObamaCare law; most likely, fewer. This is what we’re getting for the $2.7 trillion that ObamaCare will cost over the next 10 years? Plus, we should subtract the roughly 500,000 Americans who, by the White House’s own count, have lost insurance because of ObamaCare.

And Mike expects things will get worse over time.

…that’s just the tip of the iceberg, because those policy-killing rules will hit another part of the market over the course of this year — namely, the “small group” market, where employers now buy health policies that cover about 78 million Americans. Many of those with cancelled plans will ultimately end up with similar, if more expensive, employment-based policies, but some are likely to simply wind up uninsured. …Then there’s the bad news about who is enrolling in ObamaCare plans — or rather, who isn’t: not enough of the young and healthy folks that the program needs to overpay for insurance so as to offset the costs of covering older and sicker people. …Oh, and a Reuters survey finds that new enrollees are also less healthy than ObamaCare’s designers hoped, too. Humana, one of the nation’s largest insurers, reports that so far enrollment in its exchange-based plans has been far “more adverse than previously expected.”

Megan McArdle of Bloomberg is similarly unimpressed with how Obamacare has developed.

Enrollment is below expectations: According to the data we have so far, more than half of the much-touted Medicaid expansion came from people who were already eligible before the health-care law passed, and this weekend, the Wall Street Journal reported that the overwhelming majority of people buying insurance through the exchanges seem to be folks who already had insurance. Coverage is less generous than many people expected, with narrower provider networks and higher deductibles. The promised $2,500 that the average family was told they could save on premiums has predictably failed to materialize. And of course, we now know that if you like your doctor and plan, there is no reason to think you can keep them.

But it’s going to get worse, she writes.

The Barack Obama administration is in emergency mode, pasting over political problems with administrative fixes of dubious legality, just to ensure the law’s bare survival — which is now their incredibly low bar for “success.” Although the fixes may solve the short-term political problems, however, they destabilize the markets, which also need to work to ensure the law’s survival. The president is destroying his own law in order to save it.

The article has lots of detail, but here are a few highlights of the bad things that already have happened.

Obamacare’s exchange facility was conceived as a “three-legged stool”: guaranteed issue, community rating, mandate. …Take one away, and the whole thing is in danger of collapsing. Unfortunately, whenever someone has voiced discontent with the way things are going, the administration has taken a hacksaw to another leg. …some folks who had policies they liked before were being forced to drop them and buy new policies they didn’t like so much. That caused an outcry, followed by an emergency grandfathering rule. Other major emergency fixes include…A one-year delay of the employer mandate…Numerous extensions of enrollment and payment deadlines…Changes in the rules governing the “risk corridor” programs that cover excess losses at insurers.

And here are the bad things that Megan expects will happen in the future.

…the worst is yet to come. Here’s what’s ahead…2014: Small-business policy cancellations…Summer 2014: Insurers get a sizable chunk of money from the government to cover any excess losses. When the costs are published, this is going to be wildly unpopular…Fall 2014: New premiums are announced…2014 and onward: Medicare reimbursement cuts eat into hospital margins…Spring 2015: The Internal Revenue Service starts collecting individual mandate penalties…Spring 2015: The IRS demands that people whose income was higher than they projected pay back their excess subsidies…Spring 2015: Cuts to Medicare Advantage…Fall 2015: This is when expert Bob Laszewski says insurers will begin exiting the market if the exchange policies aren’t profitable…Fall 2017: Companies and unions start learning whether their plans will get hit by the “Cadillac tax,”…January 2018: The temporary risk-adjustment plans, which the administration is relying on to keep insurers in the marketplaces even if their customer pool is older and sicker than projected, run out…Fall 2018: Buyers find out that subsidy growth is capped for next year’s premiums…I expect that the administration is going to issue “temporary” administrative fixes for most of the law’s unpopular bits — just as it has so far. That’s not going to get any easier as midterms and then a presidential election creep closer.

Wow. If I was a Democrat politician, I would not be overly happy at that list – particularly since Obamacare already has caused several dozen involuntary retirements from Congress.

And if I was a partisan Republican, I would get down on my knees every day to give thanks because Chief Justice John Roberts was willing to disregard the Constitution to keep Obamacare alive.

But since I’m a humble policy wonk who simply wants to protect and restore economic liberty, I’m just glad that there’s growing recognition that Obamacare is a turkey that needs to be repealed. No wonder I’m getting more optimistic with each passing day.

Let’s close with a couple of new Obamacare cartoons.

Using an image that will cause many of us to wince, Glenn Foden manages to combine Obamacare and the NSA spying scandal.

Obamacare Cartoon Tampa 2

Hmmm…I think the images in this example of NSA humor is more pleasurable.

And here’s Henry Payne mixing Obamacare and movie awards.

Obamacare Cartoon Tampa 1

This post has focused on Obamacare’s failings, so let’s close with an acknowledgement that it’s hard to beat something with nothing.

That’s why reformers need to advocate the types of policies that would undo decades of intervention and re-introduce market forces to the healthcare system.

This video from Reason TV is  a great introduction to that topic.

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The title of today’s column may not make much sense if you’ve never watched The Producers, a 1960s Mel Brooks comedy featuring Gene Wilder and Zero Mostel, but you’ll soon see the connection.

That’s because we’re going to laugh at Obamacare, otherwise known as the gift that keeps on giving, and Hitler is part of our satire.

The President’s ill-fated takeover of the healthcare sector has been a complete cluster-you-know-what for the left. It’s not only helped make the American people far more skeptical of big government, it’s also generated some first-rate political humor.

We’ve had everything from Pajama boy abuse to clever political cartoons, all of which has helped turn government-run healthcare into a punch line.

I think Obamacare videos are particularly effective, whether they’re based on sex or mockery, and one of my favorites, from last October, featured the former Fuehrer of Germany’s National Socialist Workers Party.

Now we have a second example of Hitler Obamacare parody, and it is equally funny. It appears that a national socialist shouldn’t rely on the promises of an American quasi-socialist.

One of my favorite parts, which takes place about three minutes into the video, is the reference to Sandra. I assume that’s a clever dig at Ms. Fluke, the female version of Pajama Boy. If it was unintentional, then it’s merely serendipity.

But the whole video is amusing, including the references to the corrupt waiver process that has exempted many unions from provisions of Obamacare.

Heck, the humor assault on the President’s main “accomplishment” is so brutal that I sometimes – when sharing cartoons mocking Obamacare – can’t help but talk about a spirit of Schadenfreude and I also wonder whether it’s time to feel sorry for the President.

Maybe I’m becoming a softie.

P.S. If you like Hitler parody videos, here are two more that are worth viewing.

Here’s Hitler learning about Europe being downgraded.

And here’s the Fuehrer finding out that Scott Walker prevailed in his fight against government bureaucrats in Wisconsin.

But if you want a serious video about Obamacare, you can click here and watch me pontificate about why government-run healthcare is a fiscal nightmare.

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Welcome Instapundit readers. To augment the depressing and worrisome message in this post, I suggest you read this article showing how we can restore market forces to our government-dictated healthcare system.

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I hate to dredge up bad memories so early in a new year, but we need to remind ourselves of the awful TARP bailout of 2008.

Our financial system had gone out of whack because of bad monetary policy from the Federal Reserve and unsustainable housing subsidies from Fannie Mae and Freddie Mac.

Some financial institutions gambled on the government’s misguided policies and got caught with their pants down when the bubble burst.

But rather than let those companies fail and use the sensible and non-corrupt “FDIC resolution” method to recapitalize the banking system, we got a taxpayer-to-Wall-Street bailout.

Or, from the perspective of the big banks, they got a very good return on their campaign contributions (read Kevin Williamson if you want to get upset about this disgusting form of cronyism).

Well, as Yogi Berra might say, it’s deja vu all over again.

Except now the fat cats lining up at the Treasury door are the big health insurance corporate titans. They got in bed with the White House to push Obamacare and now they’re worried about losing money now that it’s becoming more apparent that the American version of government-run healthcare doesn’t work any better than the British version.

Charles Krauthammer warns us about what may happen in his Washington Post column.

…there’s a Plan B. It’s a government bailout. Administration officials can’t say it for political reasons. And they don’t have to say it because it’s already in the Affordable Care Act, buried deep. First, Section 1341, the “reinsurance” fund collected from insurers and self-insuring employers at a nifty $63 a head. (Who do you think the cost is passed on to?) This yields about $20 billion over three years to cover losses. Then there is Section 1342, the “risk corridor” provision that mandates a major taxpayer payout covering up to 80 percent of insurance-company losses.

At this point, you may be wondering why there’s bailout language buried in the Obamacare legislation.

The simple answer is that politicians always love to accumulate power, and the insurance industry probably lobbied very hard to get this back-door access to our money.

But maybe the White House knew that Obamacare would be unstable and they needed a bailout option to keep the system from totally unraveling. Particularly when it seems that the Obama Administration is arbitrarily changing the system every other day.

First, it postponed the employer mandate. Then it exempted from the individual mandate people whose policies were canceled (by Obamacare). And for those who did join the exchanges, Health and Human Services Secretary Kathleen Sebeliusis “strongly encouraging” insurers — during the “transition” — to cover doctors and drugs not included in their clients’ plans. The insurers were stunned. Told to give free coverage. Deprived of their best customers. Forced to offer stripped-down “catastrophic” plans to people age 30 and over (contrary to the law). These dictates, complained an insurance industry spokesman, could“destabilize” the insurance market.

So what does all this mean? It’s not good news for Big Insurance.

Shrinking revenues and rising costs could bring on the “death spiral” — an unbalanced patient pool forcing huge premium increases (to restore revenue) that would further unbalance the patient pool as the young and healthy drop out. End result? Insolvency — before which the insurance companies will pull out of Obamacare. Solution? A huge government bailout. It’s Obamacare’s escape hatch. And — surprise, surprise — it’s already baked into the law.

This sounds depressing, but Krauthammer suggests that there could be a way of derailing a bailout before it begins.

…the GOP needs to act. Obamacare is a Rube Goldberg machine with hundreds of moving parts. Without viable insurance companies doing the work, it falls apart. No bailout, no Obamacare. Such a bill would be overwhelmingly popular because Americans hate fat-cat bailouts of any kind. Why should their tax dollars be spent not only saving giant insurers but also rescuing this unworkable, unbalanced, unstable, unpopular money-pit of a health-care scheme? …Do you really think vulnerable Democrats up for reelection will vote for a bailout? And who better to slay Obamacare than a Democratic Senate — liberalism repudiating its most important creation of the last 50 years. Want to be even bolder? Attach the anti-bailout bill to the debt ceiling. That and nothing else. Dare the president to stand up and say: “I’m willing to let the country default in order to preserve a massive bailout for insurance companies.” …Who can argue with no bailout? Let the Senate Democrats decide: Support the bailout and lose the Senate. Or oppose the bailout and bury Obamacare.

I hope his political judgement is correct, though I suspect the statists (and their echo chamber in the media) would portray any effort to amend the debt limit as a sore-loser attack on Obamacare.

But if it’s a simple no-bailout message, perhaps that would be sufficiently popular to overcome the political establishment. As Krauthammer points out, the legislation could be very simple: “Sections 1341 and 1342 of the Affordable Care Act are hereby repealed.”

Let’s close today’s post with some good Obamacare cartoons. We’ll start with Eric Allie’s amusing look at how the White House is measuring success.

Obamacare Cartoon Jan 2014 1

Nice gimmick, huh? You pass a law that destroys people’s existing insurance policies, then you claim victory when some of them sign up for more expensive Obamacare insurance.

Next we have Nate Beeler welcoming the new year.

Obamacare Cartoon Jan 2014 2

Chip Bok’s cartoon is somewhat optimistic in that he’s suggesting that Obamacare may unravel.

Obamacare Cartoon Jan 2014 3

And Gary Varvel mocks the moving goalposts of Obamacare.

Obamacare Cartoon Jan 2014 4

Lisa Benson congratulates the President for winning Politifact’s Lie of the Year Award.

Obamacare cartoon Jan 2014 5

Michael Ramirez hints that the President may not be in a position to enjoy his multi-million dollar Hawaiian vacation.

Obamacare Cartoon Jan 2014 6

Last but not least, Scott Stantis warns us that Obamacare violates the Hippocratic Oath about doing no harm.

Obamacare Cartoon Jan 2014 7

P.S. Under no circumstances should you feel sorry for the insurance companies. As I noted the other day, they endorsed Obamacare and actively lobbied for its passage. They deserve every bad thing that might happen to them.

P.P.S. It’s hard to find much humor in this situation, but perhaps this funny “bailout application” could be updated to make it easier for big insurance companies to rape and pillage taxpayers.

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Not counting humor-oriented pieces such as this and this, it’s been nearly a month since I’ve written about Obamacare.

To make up for this oversight, today we’re going to look at a way out of the Obamacare mess.

But the goal isn’t simply to repeal the President’s bad policy. That merely gets us back to where we were in 2009. We need to figure out how to restore market forces to healthcare, and that means undoing decades of misguided government intervention.

Fortunately, we have a roadmap thanks to John Cochrane, a Cato adjunct scholar and Professor at the University of Chicago. Writing in the Wall Street Journal, he explains how radical deregulation is the right approach.

He starts with an essential point that “settled law” doesn’t mean unchangeable law.

…proponents call it “settled law,” but as Prohibition taught us, not even a constitutional amendment is settled law—if it is dysfunctional enough, and if Americans can see a clear alternative.

And he points out that Obamacare will get worse over time.

This fall’s website fiasco and policy cancellations are only the beginning. Next spring the individual mandate is likely to unravel when we see how sick the people are who signed up on exchanges, and if our government really is going to penalize voters for not buying health insurance. The employer mandate and “accountable care organizations” will take their turns in the news. There will be scandals. There will be fraud. This will go on for years.

But the law won’t collapse on its own. Indeed, its failures will be used as excuses for even more government.

Yet opponents should not sit back and revel in dysfunction. …Without a clear alternative, we will simply patch more, subsidize more, and ignore frauds and scandals, as we do in Medicare and other programs.

So what should be done?

Professor Cochrane points out that the healthcare system isn’t a free market now and it wasn’t a free market when Obamacare was imposed.

Instead, it’s one of the most heavily government-controlled sectors of our economy.

The U.S. health-care market is dysfunctional. Obscure prices and $500 Band-Aids are legendary. The reason is simple: Health care and health insurance are strongly protected from competition. There are explicit barriers to entry, for example the laws in many states that require a “certificate of need” before one can build a new hospital. Regulatory compliance costs, approvals, nonprofit status, restrictions on foreign doctors and nurses, limits on medical residencies, and many more barriers keep prices up and competitors out. Hospitals whose main clients are uncompetitive insurers and the government cannot innovate and provide efficient cash service.

He then explains how a market could operate – if it was allowed.

A much freer market in health care and health insurance can work, can deliver high quality, technically innovative care at much lower cost, and solve the pathologies of the pre-existing system. …We’ll know we are there when prices are on hospital websites, cash customers get discounts, and new hospitals and insurers swamp your inbox with attractive offers and great service. …Only deregulation can unleash competition. And only disruptive competition, where new businesses drive out old ones, will bring efficiency, lower costs and innovation.

If this sounds familiar, it may be that you watched this video from Reason TV on market-based hospitalization. And if you haven’t, you should!

Cochrane writes that deregulation will enable the “creative destruction” that brings progress in other parts of the economy.

We need to permit the Southwest Airlines, Wal-Mart, Amazon.com and Apples of the world to bring to health care the same dramatic improvements in price, quality, variety, technology and efficiency that they brought to air travel, retail and electronics. …Health insurance should be individual, portable across jobs, states and providers; lifelong and guaranteed-renewable, meaning you have the right to continue with no unexpected increase in premiums if you get sick. Insurance should protect wealth against large, unforeseen, necessary expenses, rather than be a wildly inefficient payment plan for routine expenses. People want to buy this insurance, and companies want to sell it. It would be far cheaper, and would solve the pre-existing conditions problem. We do not have such health insurance only because it was regulated out of existence.

Needless to say, Obamacare is the opposite of a free market. It assumes that you solve government-created problems by adding additional layers of government.

The Affordable Care Act bets…that more regulation, price controls, effectiveness panels, and “accountable care” organizations will force efficiency, innovation, quality and service from the top down. Has this ever worked?

Cochrane has the right diagnosis and right cure, but that’s the easy part. The real challenge is implementing the policies that would restore a functioning market.

That requires reforms to Medicare and Medicaid, not only to save money for taxpayers, but also because those are some of the steps that are needed if we want market forces to bring down the cost of healthcare.

Health care liberalization also means a flat tax, not only for the pro-growth impact of lower tax rates, but also because it gets rid of the internal revenue code’s healthcare exclusion, thus ending the distortion that encourages over-insurance.

It means state-by-state battles to get rid of regulations, mandates, and other forms of intervention that hinder competition and markets.

They say that even long journeys begin with a single step. That’s true, but it’s also important to walk in the right direction.

That hasn’t happened in recent decades, so it’s time to scrub the slate clean. We need free markets, not more government. We need more consumer sovereignty, not more third-party payer.

Since I’m a sucker for good political humor, we’re going to close with a great Michael Ramirez cartoon. As you can see, there’s a reason why he won my political cartoonist contest. Indeed, if I ever do another contest, this could replace his award-winning “Julia” cartoon.

Pajama Boy Move Out

It’s almost enough to make you feel sorry for Pajama Boy.

Maybe somebody should fix him up with Julia. I’m guessing they wouldn’t even know how to reproduce without intervention, handouts, and subsidies, so that would be an additional way of improving the gene pool.

And it would offset the reproductive advantage of the bureaucracy.

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On Thanksgiving, I shared a bunch of cartoons mocking the national turkey known as Obamacare.

One of those cartoons, by Robert Ariail, mocked the President for repeatedly lying when he said we could keep our health insurance plans if we liked them.

Well, we have more humor using that theme.

And if you like these images and cartoons, you can keep them!

Our first example (which arrived in my inbox, so I don’t know who deserves the credit) will be familiar to fans of the original Star Wars trilogy.

Keep It Image 2

Next we have a Lisa Benson cartoon, which would have been a good addition to a Thanksgiving cartoon collection.

Keep It Cartoon 1

Here’s a cartoon from Gary Varvel and it shows a group that is now terrified because of Obama’s deceit.

Keep It Cartoon 2

As a matter of fact, there already is evidence that many politicians did lose their jobs back in 2010 because of Obamacare.

It would be nice if more of them were punished next year.

Last but not least, we have some doggies that are a bit troubled by a version of Obama’s big lie.

Keep It Image 3

If you need more Obamacare humor, you can enjoy various cartoons, videos, and jokes by clicking here, here, hereherehereherehere,hereherehereherehereherehereherehereherehere, and here.

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I’ve periodically used “Schadenfreude” to describe my feelings about certain issues.

“Time for another tax hike!”

Maybe this makes me a bad person, but I’ve openly admitted to a perverse sense of happiness at the misfortune of others when, for instance, France’s class-warfare tax policy backfired because successful taxpayers emigrated.

And I’ve expressed similar amusement when writing about Europe’s fiscal crisis and the whining of statist politicians.

But the Obamacare disaster gives me a steroid-fueled feeling of Schadenfreude. As a matter of fact, we need to augment that term with another phrase just to capture what’s happening.

So what’s a good option? Well, according to Wikipedia, “Desert /dɨˈzɜrt/ in philosophy is the condition of being deserving of something, whether good or bad.”

That’s where we get the phrase “just deserts,” and that’s exactly what Obamacare supporters are getting as their cherished scheme for government-run healthcare blows up in front of our eyes.

I’m not the only one who is enjoying this moment in history. Here’s some of Jonah Goldberg’s unabashedly snarky column in National Review.

To paraphrase Oscar Wilde, you’d have to have a heart of stone not to laugh at the unraveling of Obamacare. …If you can’t take some joy, some modicum of relief and mirth, in the unprecedentedly spectacular beclowning of the president, his administration, its enablers, and, to no small degree, liberalism itself, then you need to ask yourself why you’re following politics in the first place. Because, frankly, this has been one of the most enjoyable political moments of my lifetime. …Indeed, not since Dan Rather handcuffed himself to a fraudulent typewriter, hurled it into the abyss, and saw his career plummet like Ted Kennedy was behind the wheel have I enjoyed a story more.

Isn’t that a marvelous excerpt, particularly the comment about the “beclowning of the president”?

But Jonah’s just getting started.

In every tale of hubris, the transgressor is eventually slapped across the face with the semi-frozen flounder of reality. …in the modern era, comeuppance-for-the-arrogant is more often found in comedies, and the “rollout” of Healthcare.gov has been downright hilarious. …Indeed, the whole law is coming apart like a papier-mâché yacht in rough waters.

I don’t even know what “orcs” are, but this next passage does a very good job of nailing Obama for arrogantly refusing to negotiate when the President probably had the most to gain from a delay!

During the government shutdown, Barack Obama held fast, heroically refusing to give an inch to the hostage-taking, barbaric orcs of the Tea Party who insisted on delaying Obamacare. …But we didn’t know something back then: Obama desperately needed a delay of Healthcare.gov. In his arrogance, though, he couldn’t bring himself to admit it. The other possibility is that he is such an incompetent manager, who has cultivated such a culture of yes-men, that he was completely in the dark about the problems. …This is how you know we’re in the political sweet spot: when the only plausible excuses for the administration are equally disastrous indictments.

Jonah also has some great commentary about the role of other Administration flunkies.

The president may now claim that he knew nothing, but he must have wondered why Henry Chao, Healthcare.gov’s chief project manager, set the bar of success at sea level last March: “Let’s just make sure it’s not a Third World experience.” At this point, it could only be more of a Third World experience if Healthcare.gov required enrollees to pay with chickens. …every day Jay Carney looks even more like a little boy who put on his dad’s suit. You have to wonder what goes on in his mind, as a former journalist, when he tells his former colleagues that “the American forces have been completely destroyed with minimal Iraqi casualties.” (Oh, wait, that was Baghdad Bob. I get them confused.) And what about Dan Pfeiffer going on the Sunday shows to insist that no American should believe his or her lying eyes? …the website will get better. It could hardly get worse, short of a finding that it causes irritable bowel syndrome.

Speaking of Jay Carney, Jonah says that the President’s spokesman has reached the point where “the musky stench of fear, sweat, and urine wafting from the podium makes it hard for all but the true believers to put much stock in his words.”

Jonah then makes the very serious point – in a very amusing way – that Obamacare was deliberately designed so that millions of people would lose their old coverage.

Five million people — and counting — have lost their health insurance, despite the president’s years of “you can keep your plan” promises. The president has apologized, sort of. He says he’s “sorry” that people have found themselves in a bad situation because of “assurances” he made. But no one has lost their insurance because of the president’s assurances, they’ve lost their insurance because of the president’s law. If a captain has the lifejackets filled with cement, his assurance that “you can keep your lifejacket” is only half the crime.  Obama knew the lifejackets wouldn’t work. …Millions more will eventually lose the insurance they like because of Obamacare, according to the administration’s own internal estimates. The cancellations aren’t a bug, they’re a feature, and the president lied about it over and over again.

So what’s the bottom line? Jonah is reveling in the moment.

…as a political and ideological matter, this is beyond fantastic. For years we’ve been told that Democrats were more “reality-based,” that “facts have a liberal bias,” in the words of Paul Krugman, and that if they could just have their way, they could fix all of our problems. No one represented this arrogant promise more than Barack Obama himself. But, with an irony so rich it would be made of Corinthian leather if it was a car seat, the only way he could get his signature legislation passed was to baldly and brazenly lie about it, over and over and over again. He created a rhetorical cloud castle where no one would lose his insurance, every family would save thousands of dollars, and millions of the uninsured would suddenly get coverage. Anyone who doubted this was called a fool or a liar, or even a racist.

Let’s add to our amusement with some cartoons, starting with one from Glenn McCoy.

Obamacare Snakes Cartoon

Next is one from Michael Ramirez.

Obamacare Lying King Cartoon

We’ve already seen some humor with that theme, but I wanted to share the Ramirez cartoon because he does such a great job capturing Obama’s imperious demeanor.

Next we have Nate Beeler who makes a very serious point in a very funny manner.

Obamacare TNT Cartoon

Eric Allie shows how the President’s lapdogs are trying to rationalize this train wreck.

Obamacare Truthers Cartoon

Last but not least, Henry Payne summarizes the website mess while suggesting that’s just the tip of the iceberg.

Obamacare Website Goof Cartoon

If this hasn’t exhausted your interest in Obamacare humor, you can enjoy various cartoons, videos, and jokes by clicking here, here, here, herehere, here, here, here, here, here, here, here, here, here, here, here, and here.

*Several people have asked whether it should be “just desserts.” That was my initial inclination, but I went with the single-S approach based on Wikipedia. Suffice to say, I’m not sure which approach is correct and I’ve certainly made mistakes before. But if this is a goof on my part, at least it’s a lot smaller than the $16 trillion error I made on national TV.

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When I wrote a few days ago about the “Continuing Obamacare Disaster,” I didn’t realize I was understating the problems with the President’s boondoggle scheme.

Now that the law’s been passed and implemented, the American people are finally finding out what’s in it (per Nancy Pelosi) and they’re not happy.

Indeed, they’re so unhappy that our overseers in Washington are scrambling to mitigate the political fallout.

The Wall Street Journal opined today on the meaning of President Obama’s announcement.

In a major political reversal, the President announced at a surprise press conference that he is suspending the regulations that he now admits are the reason that millions of health insurance plans have been terminated. …Now these mass cancellations are proving to be unpopular, and Democrats are panicking, so Mr. Obama is offering a temporary stay of execution.  …There is less reprieve here than Mr. Obama claims. It’s hard to un-cancel insurance. The rules Mr. Obama is repudiating were written in 2010, and insurers have been adapting to them for years. They will now have to scramble to revive the policies they can while throwing all of their actuarial assumptions out the window. The faux reprieve also lasts for only one year and applies only to anyone who was covered in 2013.

But even that’s not the full story. Here’s more of the editorial.

The burden will also now fall on state insurance commissioners to decide if they want to try to reapprove old plans, or something similar to the outlawed products. But even the insurers that want to exercise this option will need to resuscitate plans in a mere six weeks. The first they heard about the President’s “fix” was at the press conference. …Such regulatory rewriting is also probably illegal. The Administration claims it has “enforcement discretion” to suspend the regulations. But like the employer mandate Mr. Obama also delayed for a year, their hard start-dates are defined in the statute—January 1, 2014. The black-letter law of the Affordable Care Act does not say the rules apply whenever they are politically convenient.

Megan McArdle also thinks the White House is brazenly disregarding legal requirements.

The administration is not changing the rules, just declining to enforce them against the insurers. This is becoming a pattern: Obama’s position on the law seems to be that it’s his law, and therefore the law is whatever he and his appointees say it is. That’s dangerous for all sorts of reasons.

I’ll be less polite and say that the President is acting like America is a banana republic and he’s the tinpot dictator who can arbitrarily decide the law.

Keep this going and we’ll eventually be Argentina.

Though maybe this isn’t a bad thing. If I can somehow magically become President, I can use the Obama precedent to suspend bad tax law and to unilaterally decide to shut down a bunch of wasteful government departments.

Returning to the real world, Veronique de Rugy gives us a very important reminder in the Washington Examiner that this mess was entirely predictable because of the inherent incompetence and inefficiency of government.

Washington is missing the bigger picture of what the rollout glitches represent. That’s the much deeper problem of government intervention in general. …government-program incentives tend to favor interest groups instead of rewarding success or punishing failure in the same way as the market. …In sum, the problem with the Obamacare rollout is…that government institutions themselves are inherently prone to bad decision-making, often choosing the interest of politically favored groups. …In fact, we can expect these types of negative consequences when the government intervenes in any market — not just health care. For proof, look no further than the flawed government policies that distorted the health care system and prompted the push for Obamacare in the first place.

The final sentence is spot on. Our healthcare system was dysfunctional when Obama took office. But it was screwed up because of government intervention. So Obama’s plan to add another layer of government was a very painful example of Mitchell’s Law.

In reality, you don’t solve government-caused problems with more government.

But this brings us to the big issue of what happens next. The statists will argue that the failure of Obamacare means we need single payer healthcare, which means the government has full control of everything, like in the United Kingdom.

Needless to say, that would be a disaster. More spending and more taxes would be one obvious consequence, but it would also mean that politicians and bureaucrats would decide who lives and who dies. Stalin UK HealthIf you think that’s an exaggeration, check out this horror story (as well as the other examples linked in the third paragraph).

For those of us who care about both taxpayers and good healthcare, we need to use the Obamacare meltdown as a springboard to push for policies that will actually make the system work better.

I actually wrote back in April that Obamacare wouldn’t work and that this would create precisely this opportunity. But making a prediction is the easy part (especially since I never remind people of the times when I make inaccurate predictions). The hard part is pushing the right policies and convincing the American people that we have the right ideas.

I’m a think tank wonk, so I’ll simply list the good policies.

As part of fundamental tax reform, we need to phase out the healthcare exclusion in the tax code – a perverse policy that encourages grotesque waste, inefficiency, and featherbedding in most parts of the medical industry.

We also should reform Medicaid and Medicare to help address the part of the third-party payer crisis caused by the direct government intervention.

If you want to get an idea of how a genuine market-based system would operate, watch this superb video from Reason TV. If you want more examples, here’s a report from North Carolina on free-market healthcare in action and here’s a similar story about capitalist healthcare in Maine.

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When I talk about people being “screwed” by Obamacare, I’m generally referring to taxpayers who will bear a heavier fiscal burden and consumers who will pay more to get less.

But maybe we need to use a more elastic definition because some Obamacare proponents are using sex as a selling point to trick young people into buying over-priced insurance through exchanges.

Chris Moody of Yahoo! News reports that subsidized birth control is the focus.

From the folks who brought you the “brosurance” campaign that promotes the affordable care act comes a new line of ads aimed at reminding young women the new law will subsidize their birth control. The online ads were created by two nonprofit groups, the Colorado Consumer Health Initiative and Progress Now, to encourage young people to enroll in the exchanges.

And the ads are not exactly subtle. Here’s an example, presumably modeled after the “got milk?” campaign.

Birth Control 1

As an unmarried male, I theoretically should support anything that makes females easier to obtain, but instead this ad campaign is disconcerting on several levels.

1. I don’t like government either promoting sex or discouraging sex. Simply stated, it’s not their business. Though if some group wants to discourage sex by making it less enjoyable, then linking it to government might work like magic.

2. I don’t like the absurdity of using insurance for routine medical expenses. We don’t use auto insurance for oil changes and we don’t use homeowner’s insurance to repaint the dining room. The same principle should exist for health insurance, with policies only covering large and unexpected bills. That’s how a genuine market works, but Obamacare will take us farther down the path of third-party payer, which means more inefficiency and rising costs.

3. And I don’t like Obamacare, so it goes without saying that don’t like anything of the law’s features. The one time I wrote something nice about Obamacare, I included so many caveats that I’m pretty sure I preserved my anti-Obamacare virginity.

But it’s not just the Colorado Obamacare exchange that is linking sex with Obamacare. The private sector also is getting involved.

Sugar daddies are using government-run healthcare to go after young women.

Here’s a blurb from a report by the local CBS station in Dallas.

The online dating website Seeking Arrangement is launching the new campaign in Dallas, targeting young and healthy women who are now set to pay higher health insurance premiums under the recently launched Affordable Care Act. The new law is projected to increase insurance prices by an average of 41 percent next year, the website states. They want to offer women a “sweeter” plan. Seeking Arrangement suggests that women use their service to connect with a “sugar daddy” who can offset some of the new healthcare related costs. The website has earned a reputation for urging female college students and single mothers to meet men who are willing to offer money and expensive gifts for companionship.

The website is even posting a billboard.

sa-billboard

As I wrote above, I don’t think it’s government’s job to interfere with the decisions of consenting adults regarding sex. But I’m old-fashioned enough to think that it’s wrong if the government makes the healthcare system so convoluted and expensive that young women are encouraged to seek out rich older men merely to deal with the higher costs of Obamacare.

Some readers may joke that I might feel differently if I was rich rather than merely old, but we libertarians are a purist bunch. I don’t want to benefit from state intervention. Heck, I’ve already said I’d be happy to get rid of the mortgage interest deduction in the tax code, even though I’m a beneficiary.

P.S. Since we’re on the topic of sex and government-run healthcare, here’s what Mark Steyn wrote about pornography and government-imposed health rules.

P.P.S. Don’t forget that Obamacare allows taxpayer-financed Viagra for sex offenders.

P.P.P.S. And I’m sure we’re all delighted that the government wants a database about our sex lives.

P.P.P.P.S. Our British cousins already link healthcare and sex, with government-provided breast augmentation as well as taxpayer-financed sex trips to Amsterdam.

P.P.P.P.P.S. Remember Sandra Fluke, the 30-yr. old college student who whined that birth control wasn’t being subsidized? Well, you can remember her ignoble role and enjoy some laughs with this great Reason video, this funny cartoon, and four more jokes here.

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It seems there’s a cottage industry of people in America devoted to making parody videos about one of the world’s most evil statists. And some of them make very strong points about public policy.

Here’s Hitler learning about Europe being downgraded.

And here’s the Fuehrer finding out that Scott Walker prevailed in his fight against government bureaucrats in Wisconsin.

Well, the clever folks at the Powerline Blog have added to this stellar collection. Watch as the leader of the National Socialist Workers Party learns about the failure of Obamacare.

I give this two thumbs up, five stars, and whatever else signifies a good job.

The parts about Bidencare and Hillarycare are delightfully vicious. And DC insiders will be amused by the jab at the Heritage Foundation for concocting the mandate in the first place (to be fair, Heritage has atoned for that sin by becoming one of the leading critics of Obamacare).

To augment the Hitler video, let’s share some great new Obamacare cartoons, starting with one from Henry Payne.

Obamacare Cartoon Oct 2013 3

And here’s the always clever Michael Ramirez.

Obamacare Cartoon Oct 2013 2

Last but not least, Lisa Benson weighs in with a good depiction of Obamacare’s launch.

Obamacare Cartoon Oct 2013 1

The bad news, if we can be momentarily serious, is that Obamacare’s failure is the predictable result of bad policy based on bad economics. But failure doesn’t mean the law blows up and disappears. Legislation will be required to undo the damage, which is why it’s good that some lawmakers continue to fight.

In the meantime, it’s our healthcare system – which was already messed up by government to begin with – that’s incurring the damage. Which makes this bit of humor that arrived in my inbox funny…but in a very dark way.

Obamacare Explanation

P.S. If you want to enjoy some more Obamacare humor, click here, here, here, here, here, here, here, here, here, here, here, here, and here.

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Back in 2009, before Obamacare, the United States had a healthcare system that was plagued by excessive government intervention, which led to a third-party-payer crisis and massive inefficiencies.

Perversely, the President thought the way to solve these problems was even more intervention, even though lots of people were warning that additional government spending and added intervention would make a bad situation even worse.

Now that it’s 2013 and Obamacare is being implemented, it seems (what a surprise!) that critics were right.

Allie Obamacare CartoonAmazingly, even the New York Times is being forced to acknowledge that Obamacare is turning into a typical government cluster-you-know-what.

…the chief digital architect for the Obama administration’s new online insurance marketplace, told industry executives that he was deeply worried about the Web site’s debut. “Let’s just make sure it’s not a third-world experience,” he told them. Two weeks after the rollout, few would say his hopes were realized. For the past 12 days, a system costing more than $400 million and billed as a one-stop click-and-go hub for citizens seeking health insurance has thwarted the efforts of millions to simply log in. The growing national outcry has deeply embarrassed the White House, which has refused to say how many people have enrolled through the federal exchange.

Not exactly the launch the President was hoping for, huh? Eric Allie’s cartoon is a much more accurate portrayal of what’s happening.

And contrary to what the White House is claiming, the problems go way beyond opening-day glitches.

“These are not glitches,” said an insurance executive who has participated in many conference calls on the federal exchange. Like many people interviewed for this article, the executive spoke on the condition of anonymity, saying he did not wish to alienate the federal officials with whom he works. “The extent of the problems is pretty enormous. At the end of our calls, people say, ‘It’s awful, just awful.’ ” Interviews with two dozen contractors, current and former government officials, insurance executives and consumer advocates, as well as an examination of confidential administration documents, point to a series of missteps — financial, technical and managerial — that led to the troubles.

Benson Obamacare CartoonBy the way, notice how people don’t want to speak on the record, presumably because of concern about vindictive persecution by the Obama Administration. By itself, that should be a huge story.

But let’s stick with the coverage of the Obamacare disaster. As you can see, the Lisa Benson cartoon is right on the mark.

…just a trickle of the 14.6 million people who have visited the federal exchange so far have managed to enroll in insurance plans, according to executives of major insurance companies who receive enrollment files from the government. And some of those enrollments are marred by mistakes. Insurance executives said the government had sent some enrollment files to the wrong insurer, confusing companies that have similar names but are in different states. Other files were unusable because crucial information was missing, they said. Many users of the federal exchange were stuck at square one. A New York Times researcher, for instance, managed to register at 6 a.m. on Oct. 1. But despite more than 40 attempts over the next 11 days, she was never able to log in. Her last attempts led her to a blank screen.

But it’s not just the people trying to obtain insurance that are having an unpleasant experience.

The people who already have insurance are experiencing Obamacare sticker shock.

A North Carolina newspaper reports on bad news for health insurance consumers in the Tarheel State.

The Buncombe County resident, who along with her husband is self-employed, had been buying a policy from Blue Cross and Blue Shield of North Carolina. The couple paid $341 a month for a policy with a $10,000 deductible. Recently, Campbell, 53, got a letter informing her that her plan was not compliant with the Affordable Care Act and would no longer be available. It suggested a new plan with an $11,000 in-network deductible and $843 monthly premium. …John Wingerter, director of health insurance information services at the Council on Aging of Buncombe County, says he’s gotten at least a dozen calls from people who say their rates have increased dramatically.Some have said their rates have doubled or more than doubled.

Bok Obamacare CartoonAnd the Albuquerque Journal reports on some unfortunate people in New Mexico who have been victimized by Obamacare.

Robert Hare was happy with his insurance. So were Gregory Rothrock and his family. Yet, their insurance must change, and it will cost them more money. …Hare said his individual plan now costs him $87 a month and has a $5,000 deductible. The new plan will cost $211 and includes benefits, such as maternity coverage, that are required by the ACA but which Hare doesn’t want. …As for Rothrock, depending on which of the three levels of coverage he chooses, coverage for his family of three could be as much as 360 percent more costly.

Hmmm…I thought Obamacare was supposed to bring insurance rates down?!? And didn’t the President promise that people could keep their plans?

Does this mean – gasp! – that the folks in Washington have been lying to us!?!

The Chip Bok cartoon above is an amusing – and disturbing – look at what’s happening.

And when you add it all up, this Glenn Foden cartoon is a good summary of what we’ve been saddled with.

Foden Obamacare Cartoon

Which explains why I’m glad some lawmakers are still fighting Obamacare, even though they face very difficult odds.

P.S. If you want to enjoy some more Obamacare humor, click here, here, here, here, here, here, here, here, here, here, here, here, and here.

P.P.S. If you want to know how to restore a functioning market-based healthcare system, this video from Reason TV is must watching.

P.P.P.S. If you want to know where Obamacare will probably take us, peruse the horror stories about the U.K. system linked at the bottom of this post.

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