If you are looking for a much more detailed version of the strategy I outlined yesterday ("Force the GOP establishment to put some daylight between themselves and the repeal-only dead-enders, then hammer them on the specifics of maintaining the parts of ACA that people love") you can read one here.

That's the thing about dead ends, they don't leave you any place to go but backwards. 

Comments

[Polifrog]

Of course the ACA, like Prohibition once was, is a dead end from which Americans wish to move forward.

According to the HHS NC ACA enrollment is running at around 160,000

Sounds great.

Of course the HHS ignores the question of how many of those 160k enrolled thus far had insurance prior to being kicked off their preferred individual plan by the ACA.

Although the data is scarce indications are that 90% of those enrolled in the ACA had insurance prior to being forced out.

And how many have paid for this insurance through the ACA? The HHS counts all those who have have chosen a plan even if they have not paid for a plan. They term this metric "enrolled", but enrollment is not the same as a paying customer. According to CNN;20% to 30% of those who have "enrolled" in the ACA have not paid. We'll go with the lower end at 20%.

====

So we can lower that initial 160k supplied by the HHS by the 20% that have not paid for their chosen plan which leaves 128K truly enrolled in the ACA  in NC.  And of those truly enrolled only 11% did not previously have insurance, about 13 thousand.

Finally we should compare that number of those enrolled to the the number of North Carolinians who have lost their insurance due to the ACA. According to the News Observer that number stands at around 473,000.

To sum up:

Since the ACA has kicked off in NC:
== 473,000 have lost their insurance due to the ACA.
== 115,220 of those then bought insurance through the ACA exchange.
== And almost 13,000 once uninsured gained insurance.

== That means 345,000 more North Carolinians are without insurance since the ACA kicked off.

None of this includes the pain of those demoted to part time work or fired altogether due to the ACA and if the current discussion among Democrats is any indication, Democrats care nothing about these newly jobless individuals.

=====

The ACA is hurting North Carolinians and ACA dead-enders do North Carolinians no favors.

[Dave Dobson]

Um, polifrog - If McCrory had allowed North Carolinians to receive the expanded Medicaid coverage that all of us are paying for in federal taxes, there would be almost 500,000 new people covered (see here: http://healthaffairs.org/blog/2014/01/30/opting-out-of-medicaid-expansion-the-health-and-financial-impacts ), with no additional cost to state budgets, and with an influx of $2.6 billion to be spent in our state. It is dishonest for anti-ACA folks to deliberately sabotage the law (and harm their fellow citizens) and then complain that the coverage numbers aren't high enough.

[Polifrog]

Hey Dave...

If the ACA were viable not only would it not be reliant upon Medicaid expansion, but the nation would be able to scale Medicaid back due to the supposed savings it was claimed the ACA would generate. One must admit that if the ACA had been able to generate the promised average savings of $2500 more people would have been able to afford healthcare and fewer would have been dependent on Medicaid. Unfortunately that $2500 as well as all the other promises surrounding the ACA were less honest than a sham-wow sales pitch.

Consider for a moment what would have happened if North Carolinians had been told years ago that at this point under the ACA that the cost of insuring 13,000 previously uninsured individuals would be 345,000 newly uninsured individuals. Then imagine if they had been told that Democrats would later come along and claim that these once self insured now uninsured individuals should have been allowed to hop aboard the expanded medicaid train and that McCrory is to blame for the ACA's failure in NC.

Yet here we are with some people calling for Democrats to grow a back-bone, to stick with their lies, rather than accept reality that the ACA is bad for North Carolina.

Americans are indeed fortunate to have governors like McCrory across America, governors who in rejecting Medicaid expansion removed from the ACA a mechanism by which the scheme's failure may have been hidden. The result has been a clearer picture of the ACA's utter failure.

It is shameful that Democrats chafe at this sort of honesty in governance. Would you have truly preferred to have been forced to expand Medicaid just to support a healthcare plan that only fills the pockets of healthcare insurers, healthcare providers, and least we forget their frequently political affiliated boardroom lackeys, via a rising tide of prices shouldered by you, me and your neighbor.

[Dave Dobson]

Polifrog, how about we make a deal. Why don't we let enrollments complete and the law actually take effect before we throw around half-baked and incomplete statistics? Then we can see whether the actual outcomes are good or bad.

In the meantime, how about we not turn down $2.6 billion in aid from the federal government that would help half a million of our fellow citizens be able to get health care, and probably 1000 of them per year not die for lack of it. McCrory's policy is hurting the state's economy and killing its citizens. All you can come up with is that he's standing on principle, a principle shared by very few of the poor people to whom he's denying coverage?

Once again, you can't honestly deride it as a failure (a) before it has even begun, and (b) if you're actively sabotaging it.

You asked what my solution is - I would have preferred single payer national healthcare paid for through taxes. The ACA is a compromise - it retains some of the structural inefficiencies and some of the coverage gaps of the previous system, although it covers many more people at lower cost.

What is your solution to cover the nation's uninsured and keep costs from rising 10% a year? If you don't like the ACA, you should address the problems it's trying to solve with a better solution.

[Polifrog]

That's a good point about the statistics. They do not represent the law and are bound to change.

Had the law been enforced as written rather than delayed by the executive then the cost of ensuring each individual who had been uninsured prior to the ACA would be much higher than 27 individuals forced out of health insurance by the ACA.

Of course the delays in regard to the ACA are temporary and when they run their course that 27 who lose their insurance so that one other individual may gain health insurance will most assuredly rise.

So, you are right to note that the numbers will change over time.

That said, I take issue with something else you said:

I would have preferred single payer national healthcare paid for through taxes.

What is single payer?

We all recognize the market breaking nature of monopolies in which a single supplier supplies many consumers. Likewise most of us recognize the market breaking nature of a monopoly's antithesis, a monopsony, in which exists a single consumer amid multiple suppliers.

If one recognizes the danger of a monopoly, one should also recognize the inherent danger of a monopsony or what you call "single payer".

When someone calls for "single payer", they could just as well be calling for "single producer". Each are as damaging to a market as the other.

====

What is your solution to cover the nation's uninsured and keep costs from rising 10% a year? If you don't like the ACA, you should address the problems it's trying to solve with a better solution.

I prefer solutions based on American virtue, that amalgamation of individualism and science better known as the Enlightenment.

For example, one solution to our health-care difficulties could have been to require healthcare insurance payments to be paid not to healthcare providers, but to the purchasers of health insurance. This simple requirement would have shifted the power of consumerism to the individual who would benefit from shopping their healthcare wisely. Additionally this would have put market pressure on healthcare providers and costs would have fallen for all of us including the poor who would have found healthcare as well as healthcare insurance more affordable.

Simple ... a stroll next door without running around the government block.

[Dave Dobson]

By single payer I mean a national health service similar to what they have in Canada and many European countries, where all citizens are covered for standard treatments and specialists. I wouldn't outlaw private doctors or insurance plans for people willing to pay more for additional coverage, and I would expect that non-standard or optional procedures (e.g. elective plastic surgery, homeopathy, acupuncture) not be covered by the national system.

This does not create a "monopoly" any more than having a government-controlled military or fire department or public roads creates a monopoly. Monopsonies are not necessarily bad if they're properly administered, and we have many of them in place already - military, public works, public education, etc. It is correct to say that single-payer is anti-competitive to some degree (though hospitals could still compete on efficiency, quality of care, and customer service grounds). However, the current system is hardly competitive in a traditional capitalist sense - individuals typically do not know, pay, or understand the fees paid to hospitals, which are often assessed after treatment is already provided, and hospitals charge wildly different prices based on people's insurance coverage.

Also, more fundamentally, health care isn't something that should be treated like a consumer good like a TV or a motorcycle. Everyone ought to have a right to life-saving medical treatment regardless of ability to pay (remember life, liberty, and the pursuit of happiness?), and the private market does not provide that and has not provided that to tens of millions of citizens. Imagine a world where the firemen drive up and ask for $2000 before they put out your burning house, and drive away if you can't pay, or where you have to pay $5000 to get the police to investigate a robbery at your house. These are fundamental rights, and providing them through a free-market system has ceased working long ago except for those fortunate or wealthy enough to have good insurance.

Shopping is great for elective procedures, but it's not really an option when you're sick, or when there are limited providers for the service you want to have. Also, most folks don't have the training or background to know how to shop for many medical procedures. I don't mind visiting five or six stores for a TV, but when I'm losing arterial blood, I don't want to have to get on Yelp to find the best deals. If I'm too broke to pay market rates for my chemotherapy, I shouldn't have to die because of it.

[Polifrog]

First Democrats sold us on the the fancy that is the ACA...It didn't work.

Your solution? Sell another fancy?

It's time to grow up, Dave. Have the American sense of character to buy that which you need or, if wisdom leads you, to prepare for the eventuality that you may someday need to buy that which you need.

As for Americans, what keeps you from trusting them? Why must their healthcare dollars be spent by entities others than themselves?

When individuals are removed from the equation by Democrats not only are those individuals no longer able to affect positive change in the market but we have a real example of Democrats leading our nation to turn its backs on the Enlightenment. Individualism is empowerment yet you and the Democrat Party would diminish individualism and lead us back to the darkness that preceded the Enlightenment.

Current examples:

== Real Americans demoted to part time work due to the ACA? The Democrat reaction.. Meh.
== More Americans, neighbors, friends out of jobs due to the ACA? The Democrat reaction..Meh.
== More Americans without health insurance today than before the ACA? The Democrat reaction.. Meh.
== A president that ignores the plain language of law? The Democrat reaction.. Meh.

There is no greater darkness than the unAmerican Democrat reaction to the horror that has been the ACA.

[Dave Dobson]

Wow, melodramatic much? Sheesh. You still haven't put anything on the table that would fix any of the problems with the old system. Nothing. Neither has the national Republican party. ACA tries to fix a lot of these problems. We might quibble about methods, but the problems with the old system (preexisting conditions and uninsured Americans) were big and unsustainable. Most of the horrors you're ginning up are completely false, and for the others, the law hasn't been in place long enough yet for them even to materialize.

[polifrog]

You still haven't put anything on the table that would fix any of the problems with the old system. Nothing.

I suggested returning money to individuals so that they may influence the health market in the American tradition.

Perhaps you see that as nothing, but it is that faith in individual liberty, that faith in our American neighbors, that faith in American virtue that created the superpower our nation became. To be clear, it was not your faith in management that grew this nation, and it is your faith in management that is hurting Americans via the ACA.

It is truly sad to see so many have lost faith in their fellow Americans and as importantly, the American tradition. But I suppose that is what it is to be an unAmerican Democrat.

[Dave Dobson]

"Returning money?" What money? How much? From where? The uninsured don't pay enough in taxes to get enough "returned" to buy their own healthcare. ACA provides the mid-range poor enough money to buy healthcare on an open market - how is that different from what you're proposing? And for those who can't even afford that, they get covered via Medicaid. Except in North Carolina, where McCrory has decided he'd rather they be sick, broke, and dead, and that people in Kentucky, New York, and California will get the benefits of our tax money instead of us. You're completely inconsistent, and your "solution" is a big plate of nothing - completely detail-free and unworkable.

Also, you don't get to call me unamerican, dude. America is equal opportunity for all. America is not having a privileged class of aristocracy with inherited wealth - that's what we fought the revolution against. America is great enough not to allow businesses to profit while their workers can't afford to treat their illnesses. America is the land of opportunity, and that opportunity should be provided to all, not just the wealthy, healthy, and full-time employed.

[polifrog]

My "plate of nothing" works quite well in respect to LASIK surgery and dentistry. These are both industries that benefit from a lack of your management. Even while technology expands,prices fall and is that not how prices are expected to act in the face of technology?

Higher education and the health industry do not follow that pattern. As a result we all ... pay, the poor you so frequently reference at a greater percentage relative to income. Why do these costs not matter to you? Why not back off, channel insurance dollars to those who buy insurance rather than directly to the health industry? Why not just let the prices fall, man? Put the money back in the pockets of individuals (both in terms of lower healthcare costs and more immediately by making insurance payments flow directly to the hands of individuals) so that grass roots change may take hold and transform the healthcare industry toward the needs of individuals rather then the selfish desires of those who would manage.

For fifty years your managed solutions have driven up healthcare costs when technology should have been driving costs down and the ACA is making it worse before our eyes.

As to calling you unAmerican. I didn't. I simply noted that Democrats define themselves as unAmerican. Our Constitution represents American virtue yet Democrats reject so very much of it.

The 1st Amendment -- for decades Democrats have define down the individual right to religious expression to the point that government individuals are no longer allowed to express their personal religious beliefs.

On free speech Democrats can not bring themselves to support the right of the Kochs and Art Pope to engage in free speech. Even you reflexively say,

...you don't get to call me unAmerican, dude.

How does such a statement even come from an American?

On assembly Democrats can not bring themselves to support the American liberty to act collectively and speak as one voice via incorporation. What is more American than private citizens acting in concert to affect change in governance? What is more unAmerican than to reject that?

The 2nd Amdendment -- for decades Democrats have attempted to redefine the American virtue of individual power toward a communal power of the state. Doing so is an unAmerican affront to individualism and the Enlightenment in which individualism is rooted.

On and on it goes. Mention American virtue to a Democrat and they, in all seriousness, will ask, "What is American virtue as they dive into moral relativism."

The simple reality is that Democrats have lost their sense of American virtue, they have lost their belief in the individual and have in so doing rejected the Enlightenment.

But whether you are personally a Democrat, that is up to you. Define yourself as you wish.

[Fred Gregory]

Poli

Yup it is sad that so many Democrats have lost faith in American traditions and their fellow citizens

The ( partisan Democrat ) host of Meet the Press ( can't bear to speak his name ), repeatedly, on air mangles a quote of Senator Rubio ( " He called the budget deal unAmerican" ) Then apparently when the screams from backstge were heard the big dummy unseriously corrected him self while chuckling. Sheesh !

Who you calling unamerican , Stretch ?

[polifrog]

Fred

It seems that Piers Morgan is stepping down at CNN. He claims that America grew tired of him when, in fact, it was he who never embraced American virtue.

It seems that Democrats found his unAmericanism so very vanilla, so very akin to their own brand of unEnlightenment that they did not tune in. His best ratings seem to have been a result of the few Americans left in America challenging his erudite nuttery.

Perhaps CNN has learned that they and the Democrats for which they provide a podium are each better off when those giving voice to their shared unAmericanism do not sound like FDR, Kennedy or the King of England speaking down to the colonies.

[Fred Gregory]

Hagan v. Hagan or The worst-planned presser in political histoy

"I have no idea how Democratic Sen. Kay Hagan's news conference could've been worse except had she lit a baby bunny on fire while stomping on the American flag.

The junior Senator from North Carolina filed for re-election yesterday in Wake County. The media was all there, as her campaign obviously alerted them to the event. This is pretty standard. It makes for good video to have the pol surrounded by friends, family, and supporters as they sign the paperwork and everyone cheers.

But it seemed to escape Hagan and her camp that after she signs the papers she'd need to actually talk to the media"

Viseos of the event ( disaster ) in the link

[polifrog]

Yes, Fred.

Hagan, an ACA deadender, definitely found herself in a self crafted cul-de-sak of Americans made worse off by her callous support of Dave's "manged-care" (aka the ACA) over healthcare.

[Fred Gregory]

UPDATE: WAPO 3/6/14

Health insurance marketplaces signing up few uninsured Americans, surveys say

"The new health insurance marketplaces appear to be making little headway so far in signing up Americans who lack health insurance, the Affordable Care Act’s central goal.

A pair of surveys released on Thursday suggest that just one in 10 uninsured people who qualify for private health plans through the new marketplace have signed up for one — and that about half of uninsured adults has looked for information on the online exchanges or plans to look.

Taken together, the snapshots shown by the surveys provide preliminary answers to what has been one of the biggest mysteries since HealthCare.govand separate state marketplaces opened last fall: Are they attracting their prime audience? "

[Andrew Brod]

Another snapshot, with perspective.