Manhattan Contrarian Public Service: The Easy Solution To "Surprise" Medical Bills

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In the long list of unintended consequences of Obamacare, the latest one to attract attention is the so-called “surprise medical bill.” They have given you to think that your all-beneficent government has bestowed upon you that holy grail of healthcare “coverage.” Then you have to go to the hospital. No problem — you have “coverage.” But upon getting home you suddenly get hit with a completely unexpected bill for $2000 or $5000, or even $10,000 or more, and you are told that it is not covered by the “coverage.” What the hell is going on here?

I guess you didn’t read the fine print. The geniuses behind the design of Obamacare insisted that they could mandate both “affordable” premiums, and simultaneously third-party payment for every conceivable health issue (e.g., free birth control for eighty-year-olds). But something had to give. The remaining escape valves have turned out to be high deductibles and narrow networks in the healthcare policies. Thus, for your hospital visit, you may find that your deductible makes you responsible for the first $3000, or even $5000, of the bills. Or, even worse, you may find that even though you carefully selected a hospital that was “in network,” the doctor who treated you was “out of network,” and sends you a bill for $6000 that your “coverage” won’t pay.

This “surprise medical bill” issue has recently attracted enough attention that the Congress has swung into action. When Congress swings into action, it follows the fundamental principal that all human problems are to be solved by some kind of program, regulation, or mandate emanating from the federal government. This principal applies most particularly to solutions to those human problems that were caused by the last round of programs, regulations and mandates emanating from the federal government. And thus we have something called the Lower Health Care Costs Act, recently introduced in the Senate by Lamar Alexander (Republican of Tennessee) and Patty Murray (Democrat of Washington). Writing in the Wall Street Journal on Wednesday, in a piece titled “Get Rid of Surprise Medical Bills” (probably behind pay wall), Benedic Ippolito of the American Enterprise Institute calls the proposed LHCCA the “most consequential bipartisan health-care reform of the ObamaCare era.” . . .

As a public service to our readers and to the Congress, the Manhattan Contrarian wishes to state that there is a far, far better and easier solution to this “surprise medical bills” thing than any of the three proposals in the LHCCA. And it is a solution that is already present in existing law. The solution is, . . .

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Whatever Happened To Obamacare?

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My post of a few days ago addressed what is to me one of the oddest features of the progressive project, namely that existing government programs that were supposed to solve some social problem, but then utterly failed, just get completely forgotten — even as spending on those programs continues and indeed generally increases forever on autopilot. Meanwhile, the underlying social problem persists, and the response of the progressive politician is to cease all mention of the prior programs (and certainly never to acknowledge their failure), and instead to propose yet another new program and yet additional new spending to solve the same problem. Surely, this newly-proposed program is going to be the one that will finally work.

That prior post specifically addressed government job training programs. There were 47 of them (by one count) in 2014, when then-VP Joe Biden got the task from President Obama of finally solving the problem of inadequately-trained workers. Of course, Biden never acknowledged the disaster of the existing 47 failed programs, and instead proposed another new federal job training program and $600 million of new spending (sorry, “investments”).

And the job training situation is of course only a microcosm of the broader federal “anti-poverty” effort, where scores of programs and nearly a trillion dollars in annual federal spending never make the slightest dent in the problem of “poverty” as defined. . . .

But surely the most striking example of this phenomenon is in the healthcare area. There, all the talk among the current Democratic candidates is of finally bringing “universal healthcare” to America. . . .

But wait a minute. Whatever happened to Obamacare? Wasn’t that the be-all-and-end-all program that was supposed to bring “everyone access to medical care”? . . .

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Get Ready For The Democratic "Pragmatists"

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Yesterday the Wall Street Journal ran an op-ed with the headline “Are All Democrats Socialist? Don’t Believe the Hype.” The authors are Gregg Hurwitz and Jordan Peterson. I hadn’t previously heard of Hurwitz (he is identified as the author of a series of “thriller novels”); but Peterson is the guy who has shot to great fame in recent years as a YouTube star who advocates for leading a life of personal responsibility and hard work as the route to success. From what I had previously seen of Peterson, I had been quite impressed. With this op-ed, he just sank about 7 notches out of 10 in my estimation.

The central assertion of the op-ed is that the “social media warriors” and explicit advocates of socialism, like Alexandria Ocasio-Cortez and Ilhan Omar, who might seem to be the current stars of the Democratic Party, are not actually “representative” of its views. Rather, we should look to the views of those Democrats, here characterized as “quieter pragmatists,” who won the Congressional seats gained by the party in the last election. Among the 2020 candidates for President, our authors state that “voters would do well” to look to the “passionate moderate voices” ascending in the party. Like who? They name two: Pete Buttigieg and Amy Klobuchar.

Are any of the Democratic candidates, and most particularly Buttigieg and Klobuchar, fairly characterized as “pragmatists” or “moderates”? . . .

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Is New York's "Safety Net" A Success?

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One of the many specialized publications here in New York is something called “Crain’s New York Business.” As its title suggests, Crain’s covers mostly the affairs of the business community, although from time to time it also dabbles in political and policy matters. Sometimes it even has some sensible things to say. And sometimes not.

This week’s issue of Crain’s is dominated by a cover story titled “The State of Inequality: A Program for Every Problem.” The article has the byline of Crain’s head editor Greg David (although I doubt he actually wrote it — it’s not his usual style at all). It purports to be a review of the state of the “safety net” and its many subsidiary programs here in New York, together with, to some degree, a comparison of same to similar programs in certain other states (Georgia, Texas, Washington).

This lengthy piece is a serious embarrassment to Crain’s. It could not be worse if they simply had published verbatim a pile of campaign propaganda fed to them by a Cuomo or a de Blasio — which may very well be what this actually is. I’ll first take you through what the article says, and then I’ll go over a few of the elephants standing around here that they have somehow missed.

The basic theme of the piece is that New York has the most extensive array of social safety net programs in the country, and THEY’RE WORKING !!!!!! And how do we know that THEY’RE WORKING !!!!! ? Because we have followed the basic journalistic technique of interviewing some of the beneficiaries of the programs, and some of the bureaucrats who run the programs. And, remarkably, those people are unanimous in declaring the great success of the programs that they benefit from and/or administer. QED! Now, has anyone thought to maybe go out and collect some data as to, for example, how New York compares to other jurisdictions in actually reducing poverty, or reducing income inequality, or (in the case of medical programs) extending life expectancy? Of course, you will not find any of that in this article. . . .

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Goodbye To Obamacare

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Obamacare!  It was supposed to usher in a new era of healthcare nirvana.  Universal "coverage"!  Better health!  "Bending the cost curve"!  "Affordable" care!

Have you noticed that you haven't been reading much about Obamacare recently?  Yes, there was a blip of press mentions last year, when the Republican Congress was making some failed attempts at full repeal of the Act.  (See my coverage here from September 27, 2017.)  And since then, mostly radio silence.  So, was universal "coverage" in fact achieved?  And, what happened with the health results?  And with the famous "cost curve"?  I'll bet you don't know.  Could it be that the press just doesn't report things that are unfavorable to the official narrative?      

And now, rather suddenly, it looks like Obamacare may be on its last legs.

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In The Progressive Vision, Dictatorship Is Never Far Below The Surface

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It seems that the favorite causes of the progressive left -- the two biggest at the moment being fighting "climate change" and establishing universal health "coverage" as a "human right" -- have been running into some roadblocks lately.  On the "climate" front (I put "climate" in quotes because none of this has much if anything to do with the actual climate) President Trump withdraws the U.S. from the Paris accords, appoints climate skeptics to key administration positions, and sets about dismantling various Obama-era regulatory restrictions on fossil fuels.  Abroad, China, India and others race to build coal plants, while the UN itself admits that even under its worst-case scare tactic models the implementation of the Paris accords would have little to no measurable effect on the climate.  On the universal health "coverage" front, Obamacare continues its slow inevitable decline, while multiple states (Colorado, Vermont, California, New York) that have flirted with "single payer" systems in the past couple of years have backed off when the enormous costs became evident.  What's a good progressive to do?

The answer is simple: dictatorship.  If these stupid plebes and Trumpers can't see the morality and the necessity of immediately establishing the progressive utopia, then this whole democracy thing just isn't going to work.  A few correct-thinking experts, armed with the full coercive powers of the state, can impose the needed progressive solutions in the blink of an eye.  What's to lose?

Often the advocacy for the dictatorship of supposed experts has proceeded by muted euphemisms.  I'm thinking, for example, of the statement by top UN climate bureaucrat (Executive Secretary of the U.N. Framework Convention on Climate Change) Christina Figueres at a press conference in February 2015 that mankind must "intentionally . . . change the economic development model" in order to stop global warming:

This is the first time in the history of mankind that we are setting ourselves the task of intentionally, within a defined period of time, to change the economic development model that has been reigning for at least 150 years, since the Industrial Revolution.  This will not happen overnight and it will not happen at a single conference on climate change…It is a process, because of the depth of the transformation.

See?  She never mentioned "dictatorship"; or, at least, she didn't use that exact word.  But more recently, the perceived need for soft euphemisms seems to have lessened.  Let's just go ahead and say it!  A couple of examples for today:

Over in Europe, prominent environmentalist Jørgen Randers (professor of "climate strategy" at BI Norwegian Business School) took to the pages of Svenska Dagblat yesterday to make an explicit call for dictatorship to solve the "climate crisis."  According to Randers, the call for dictatorship is supported by multiple "climate experts."  At his Cool It blog, Bjørn Lomborg (who fortunately seems to have the ability to read Swedish) covers the matter, and helpfully provides a translation of the key passages.  Here are the translated headline and sub headline from the Randers article:

Democracy must be suspended to solve the climate crisis.  An elite government is better than democracy -- at least if the world is to succeed in resolving the acute climate crisis, according to Professor Jørgen Randers.  Several climate experts highlight a clear model:  China's dictatorship.  

Lomborg is rather scathing in his commentary:

Look at the costs to achieve the sort of climate policies that Randers and many others are advocating. If the EU fulfills its promise of cutting emissions by 80% in 2050 (which is the most ambitious climate policy in the world today), the average of the best peer-reviewed models show that the cost would run to at least $3 trillion per year, and more likely double that – meaning $6,000 for each EU citizen per year. Of course, few will vote for that.  [MC note -- the cost could easily be a multiple of even the larger estimate.]  Moreover, asking for a dictatorship neglects one of the main reasons for democracy: how do you ensure that the dictator does what is good for you? . . .  Look at China, which unfortunately is held up by many environmentalists as a green ideal.  It gets 86% of its total primary energy demand from fossil fuels (International Energy Agency data, latest from 2014, extrapolated to 2017). How is that ultra-green?

Meanwhile, over in the healthcare arena, we have the premier British medical journal The Lancet publishing an opinion piece on November 4 by its head editor Richard Horton, making an explicit pitch for more Marxism in medicine.  The title of the piece is "Medicine and Marx."   Unlike Randers, Horton does not actually use the word "dictatorship"; but I wouldn't call his effort "euphemisms" either.  Rather, Horton writes in the old Soviet/Orwellian Newspeak, using the words those guys employed to mean (to anybody who was alive and awake) not just "dictatorship," but "totalitarian rule by jackbooted thugs."  Example:

21st-century health care [is] better investigated and interpreted through a Marxist lens. . . .   Marxism defends a set of values. The free self-determination of the individual, an equitable society, the end of exploitation, deepening possibilities for public participation in shaping collective choices, refusing to accept the fixity of human nature and believing in our capacity to change, and keeping a sense of the interdependence and indivisibility of our common humanity. . . .  Marxism is a call to engage, an invitation to join the struggle to protect the values we share.

Wow.  Could anybody alive possibly still buy this?  As to the reference in the last line to "the values we share," John Hinderaker at PowerLine comments:

What values are those? Mass murder? Totalitarianism? Rule by a criminal elite? A rigid class system in which a few ruthless and politically connected thugs prosper, and everyone else starves?

Come on, John!  Aren't those really minor quibbles when are so close to achieving the holy grail of universal health "coverage"?