Coyote Blog

Kevin Drum thinks it is an insight to his readers that the insurance companies are a source of support for President Obama in keeping Obamacare alive.  And perhaps it is a surprise.  After all, most of the anti-insurance company rhetoric was for the progressives, who are always fired up for any endeavor they think will punish a private corporation.

The rest of us understand that of course the health insurance industry is all for Obamacare. For them, this is the greatest bit of crony legislation in history. For all the Administration rhetoric, essentially the US government has required that every citizen buy their product, and subsidizes many of these purchases with taxpayer money. Corporatism is rampant nowadays, a bipartisan affliction, but ethanol is that only other industry I can think of that has been granted this ultimate crony grail of subsidies combined with a requirement to purchase  (though maybe ethanol wins because, at least for cellulosic ethanol, there is actually a mandate to purchase a product that does not even exist).

Politicians frequently argue by anecdote.  I don't generally find this compelling -- after all, one can find an anecdote about just about anything among 300 million people.

But for those who do believe that an anecdote proves their case -- doesn't a reversal of fortune within that anecdote then disprove their case?  How can a particular person's experience be entirely generalizable, and then suddenly not be so when the facts change?

Back in October, Sanford had written a letter to the White House to share her good news. The 48-year-old single mother of a teenage son diagnosed with ADHD had just purchased what she considered to be affordable insurance on the Washington state exchange....

Her heartfelt letter made it to the President's hands and then into his October 21 speech.

"'I was crying the other day when I signed up. So much stress lifted.'" Obama said, reading from Sanford's letter.

The president said Sanford's story was proof, despite the technical problems with the healthcare.gov website, that the Affordable Care Act was working....

But then, after Obama mentioned her story, Sanford started having problems. Sanford said she received another letter informing her the Washington state health exchange had miscalculated her eligibility for a tax credit.

In other words, her monthly insurance bill had shot up from $198 a month (she had initially said $169 a month to the White House but she switched plans) to $280 a month for the same "gold" plan offered by the state exchange....

Last week, Sanford received another letter from the Washington state exchange, stating there had been another problem, a "system error" that resulted in some "applicants to qualify for higher than allowed health insurance premium tax credits."...

The result was a higher quote, which Sanford said was for $390 per month for a "silver" plan with a higher deductible. Still too expensive

A cheaper "bronze" plan, Sanford said, came in at $324 per month, but also with a high deductible - also not in her budget.

Then another letter from the state exchange with even worse news.

"Your household has been determined eligible for a Federal Tax Credit of $0.00 to help cover the cost of your monthly health insurance premium payments," the latest letter said.

Hospitals are required to treat everyone who shows up at the door, which results in a substantial amount of uncompensated care that hospitals must spread into their rate structure for other patients (and which also gives the lie to the syllogism that being uninsured means one does not have access to health care).

Supposedly, the PPACA was going to eliminate all these costs.  Actually, it does not eliminate these costs, it just changes who subsidizes them.  Currently, other hospital patients (and their insurers) subsidize this care.  In the PPACA medicaid expansion, some of this subsidy would shift to taxpayers  (whether the actual amount of costs subsidized would go up or down depends on your assumptions as to whether the Feds or the hospitals are better at managing them).

But hospitals think they might have found a third approach.  By law, insurance companies cannot legally turn down any applicants, particularly through the exchanges, based on their health condition.  So why not have the hospital (or its non-profit Foundation) buy policies for its perennially most expensive uncompensated patients?

US hospitals are exploring ways to buy “Obamacare” insurance plans for their sickest and poorest patients as they strain under the weight of tens of billions of dollars in uncompensated costs from the uninsured.

...The controversy is another reminder of the complexity of the US healthcare system, where hospitals are forced to pay about $40bn a year in so-called “uncompensated care”. People who are not insured go to emergency rooms because they cannot legally be turned away, and often hospitals bear the brunt of the costs.

“Hospitals are considering it,” says Mindy Hatton, general counsel of the American Hospital Association, the hospital lobby group. “Hospitals shouldn’t be on the front lines delivering preventive care that patients should be receiving in a clinic or doctor’s office. That doesn’t make sense for anyone.”

This is insurance companies' worst nightmare, of course.  It would not take very much of this sort of thing to trash the whole insurance market.

The Administration response to all this has been typical of its behavior through the whole PPACA implementation.  In general their approach to all new problems has been to:

1. Make it clear that it hadn't really thought very deeply or completely about important implementation issues
2. Make snap implementation decisions to tactically deal with one problem only to find they had created new problems
3. When everything gets really messy, claim broad dictat-by-press-release powers it is not clear the law actually gives them

In this case, the Administration was faced with questions from Representative Jim McDermott.  He asked if exchange-sold health plans were considered Federal Qualified Health Plans (QHP) under the law.  If so, he pointed out that several of the things the Administration had discussed (e.g. allowing insurers to offer monetary inducements to customers who maintained good health habits) could be illegal under anti-kickback provisions.

As usual, it was pretty clear the Administration had no answer.  Or more accurately, had five different answers from five different people and agencies.  Kathleen Sebelius wrote back to McDermott that no, exchange sold plans were not QHP's and so the anti-kickback law did not apply.  This tactically solved McDermott's issue.  But it created large new issues, since it is the anti-kickback law that would have prevented hospitals from buying exchange plans for their most expensive patients.  If exchange plans are not QHP's, then hospitals considered that buying such plans was now legal.

All Sebelius has been able to do to temporarily quiet this mess has been to claim vague and unlimited powers to regulate virtually any behavior related to the exchanges.  Like Obama, she believes her press releases have force of law.  But in fact, even if she does have the claimed regulatory power, she actually has to go through a rules-writing process before any such rules can take effect.   These are structured, drawn out affairs with long delays for public comment.  This is the type of thing she needed to be doing 18 months ago.

Well, so much for the implicit gag order Obama has had on the insurance companies.  Bet we will find out a lot more interesting details about the exchange rollouts now.

[T]he White House has its own idea to stop the bleeding: Allow insurers to renew existing plans in 2014 (which means they could continue into 2015) while forcing them to send Landrieu-like letters explaining why their plans don’t conform to the Affordable Care Act’s standards.

This doesn’t really ensure anyone can actually keep their plan — which means it also doesn’t affect premiums in the exchanges. But it makes it easier for Democrats to blame insurers for canceling these plans. And it perhaps makes it easier for the White House to stop congressional Democrats from signing onto something like Landrieu or Udall.

The insurance industry is furious. They’ve been working with the White House to get HealthCare.Gov up and running and they’ve been devoting countless man hours to dealing with the problems and they’ve been taking the heat from their customers over canceled plans, and now the Obama administration wants to make them into a scapegoat.

“This doesn’t change anything other than force insurers to be the political flack jackets for the administration,” an insurance industry insider told Evan McMorris-Santoro. “So now, when we don’t offer these policies, the White House can say it’s the insurers doing this and not being flexible.”

This is like telling GE to reintroduce 100 watt lightbulbs on thirty days notice, and then blaming them if they don't do it.  Or as I tweeted earlier,

Obama telling insurers they can reinstate plans is like my wife telling me to take the exit we passed two miles ago @instapundit @mfcannon

— Coyoteblog (@Coyoteblog) November 14, 2013

 Update:  Left rallying around Obama, spreading the word that cancellations are all the insurance companies' fault.  I am SO glad I am not affiliated with a political party such that I would feel the need to embarrass myself to support some flailing politician on my team.

The Left has been calling cancelled policies "sub-standard" for months now.  For three years Obama's own folks were estimating that over half of individual policies would have to be cancelled due to the law, and in fact they purposely wrote the regulations narrower to invalidate the maximum number of policies.  But now cancellations are the insurance companies' fault??

Via the WSJ:

President Barack Obama said Thursday that insurers will be able to continue health-insurance coverage next year for current policy holders that otherwise would be canceled under the new health-care law....

"Insurers can offer consumers the option to renew their 2013 health plans in 2014 without change, allowing these individuals to keep their plans," a senior White House official said, previewing Mr. Obama's announcement. These consumers will be given the opportunity to re-enroll, the official said, essentially extending the so-called grandfather clause in the 2010 health overhaul that allowed people to keep their plans if they were in place before the law passed.

"This step today is in the interest of fixing some of the challenges that have arisen" since then, the official said.

Under the plan, insurers are required to notify consumers whether their renewed plans don't include coverage that was required under the new health law, which set minimum coverage standards. They must tell consumers that new insurance options and possibly tax subsidies may be available for policies bought through online federal marketplace.

1.  The President announced this today to try to head off Congressional legislation to do the same thing.  Have we just given up on the rule of law?  Can the President unilaterally modify any law he pleases?  Shouldn't a modification in existing legislation have to come from the Legislature?  Can we just make it official and change the Constitution to say that the President can alter any legislation he wants as long as his party originally passed it?

2.  How is this even going to be possible?   My understanding is that insurance companies spend months preparing the pricing and features of their products for the next year.  The have done no preparation to offer these plans in 2014, because, you know, they were (and still are, whatever the President says in a news conference) illegal.   Its like your wife telling you to take the next exit when you are in the left lane driving 75 miles an hour in heavy traffic and the exit is about 100 yards away.  With 31 business days between now and the new year, how are they supposed to do this?  Or are they even expected to be able to do so?  Is this the President's way to blame shift to insurance companies?

Update:

Insurance source: WH fix places "onus on us even tho they know we can't" effectively extend cancelled policies given rates/logistics probs

— John Harwood (@JohnJHarwood) November 14, 2013

More from insurance industry source on WH O-care fix: "This is a joke - doesn't change anything but allow WH to blame insurance companies"

— John Harwood (@JohnJHarwood) November 14, 2013

So the October exchange data is out and the report is a bit hard to follow, in part because it dodges and weaves trying to put the best face on things.  Fortunately, I have years of experience as a corporate planner digging into numbers from division heads trying to disguise what a train wreck their results are.  So here are the numbers in a simple graphical form (click to enlarge)

Here is a simple narrative following these numbers: The exchange web sites had 26,876,527 visitors representing 47,840,217 estimated potential insured persons.  Of these, 846,184 applications have been completed covering 1,509,883 persons, of which applications covering 1,477,853 persons have been processed by the government to test eligibility.  Of these reviewed applications, 396,261 persons were eligible for Medicare or some other free program while the rest needed private coverage.  Of these, about a third were deemed eligible for a subsidy.   About 10% of those people eligible for private coverage have put a plan in their shopping cart, though it is unknown how many are subsidized and how many are not.  An unknown number have actually purchased insurance.  An unknown number of Medicaid eligible people actually have enrolled.

There are some real problems with the report's presentation.  Here are the worse issues:

• They switch back and forth between applications and persons covered by applications (which is about 1.78 persons per app.)   This is presumably a bid to make the numbers as large as possible.  All the numbers above the first one in the chart above are persons covered by applications, not applications.  As you can see, I have converted the web site visitors to this same basis so we can get an apples to apples sales funnel.  Note that this means the 106,185 number for people who have "chosen a plan" is actually a lot fewer applications, perhaps less than 60,000.
• They leave out the three numbers any reasonable person would most want to see.  How many people actually signed up and (if appropriate) paid for coverage?  Those numbers are completely missing.   How many Medicaid eligible people actually enrolled? How many of the 106,185 people covered by a plan in a shopping cart actually paid  (the shopping cart abandonment rate at private websites is about 2/3, if I remember correctly)?  And how much did these enrollments cost the taxpayer in terms of subsidies?

As bad as this report is for the administration, the truth is actually worse, as they have assiduously avoided including the numbers a reasonable person would want to see.  Without any other evidence, I have to assume that these obvious numbers were left on on purpose because they were awful.

A while back, I pointed out this poll from some group called the Commonwealth Fund.  In mid-October, on average about 15-18 days into the exchange process, they polled a group of non-corporate-insured adults (e.g. individual market or uninsured) about whether they had visited an exchange and what had been their experience.

The finding that stood out to me was that 21% of the people they interviewed that said they had visited an exchange reported that they had signed up for a policy (from the wording of the question, this probably includes both private policies and Medicaid signups).

I thought this seemed crazy-high.  And now new data from the Administration is confirming it.   The Administration is reporting about 106,000 "selected a plan" in October -- a very generous definition since it includes people who put a plan in their shopping cart but did not purchase it.  Not a definition of a sale that Amazon.com would ever use.    Further, another 400,000 or so were "found eligible" for Medicaid, whatever that means though it sounds well short of "enrolled."  So call it generously 500,000 people by the end of October.  The other key bit we need is that the Administration is reporting about 27 million unique visitors to these sites.  So at best we are looking at 1.9% of exchange visitors kind-of-sort-of-maybe having done something that approaches being enrolled.

This puts the Commonwealth Fund polling an entire order of magnitude off, at 21% vs. 1.9%.  And remember their survey occurred in the middle of the month, when the web site was not even working, and one can assume that successful enrollments were back-end loaded in the month.  The CF was nice enough to respond to my emails but were unable to explain the discrepancy, other than the sample size was low making the results unreliable.  So why the hell do it, and then put out a press release?

One explanation for part of the discrepancy may be in those who have created user accounts (normally a trivial task on a private site but a Herculean accomplishment on Healthcare.gov) but have not actually purchased a plan.  The Obama Administration says that there are about a million of these, so in addition to the 1.9% that put a plan in their shopping cart, there are another 3.7% that created a user account and gave the Feds enough info to assess subsidy eligibility, but who have not selected a plan.  Remember, that this was the minimum hurdle the Obama Administration originally set even to see insurance plan prices, and is still the minimum hurdle to get a subsidy quote.  It will be interesting to see the conversion rate of people once they find they are not getting free stuff from Uncle Sugar.

Even so, this only adds up to 5.6% of people who visited the exchange and had any sort of success (in most cases far short of enrollment) at all.  Way short of 21%.  Remember that we you see "studies" like this in the future.

I had fun photoshopping (here, here) the first batch of these ads.  But now they seem to have entered the realm of self-parody, so here are some of the actual ads, without modification (source).

As a libertarian, I have no desire to grade the choices they are making.  I just don't want to subsidize them, though this seems to be the proud message of the ad campaign:  "Obamacare subsidizes bad choices and dangerous behavior".

This has to be one of the more bizarre moments in the history of insurance.  Never before has any insurance company likely ran ad campaigns aimed at attracting the worst risks.  The irony of course is that President Obama needs to sell this to young people precisely because most of them won't use it.

Just to prove that there is no end to the arrogance and moral bankruptcy of politicians:

Federal lawmakers and state officials are stepping up pressure on insurers to allow consumers whose coverage has been canceled in response to the health overhaul to keep their policies beyond the end of the year.

On Tuesday, one of the largest regional health plans in the nation, Blue Shield of California, said it would relax its stance on terminated policies for about 115,000 people after state regulators demanded it do so. Customers now will have until March to decide which plan to choose for 2014, a three-month extension. Because the newer plans generally cost more, the extension could save residents as much as $28.6 million on premiums, said Dave Jones, California's insurance commissioner....

The move by Mr. Jones, an elected Democrat, comes as some other Democrats are seeking ways to allow individual policyholders to keep their current health plans and to defuse the issue of canceled plans, which has become a headache for supporters of the law.

Cancellation letters are expected to be sent to as many as 10 million Americans who buy coverage directly from insurers, rather than through an employer or government program. While these individuals would have to buy new policies, regulators and lawmakers say the extensions would give them more time to shop for an affordable new plan—particularly because continuing problems with insurance exchange websites are preventing many of these consumers from finding new coverage.

This is incredible.  Senator Mary Landrieu, for example, has now introduced a bill that would reverse some of the rules that are forcing insurers to cancel policies, essentially the same bill she voted against 3-1/2 years ago.

Here is a link to the study, via Information Week.  Here is the key chart:

First, this includes people who signed up for Medicare, which is a good chunk of the state exchange signups to date.  Signing uninsured up for Medicare is meaningless, as they don't even need to be signed up to get the benefit (a hospital will enroll them if they were to come in for a visit).

Second, this is either very good news or very bad news for the Administration.

If true, which I seriously doubt, it would mean that the exchanges are a wild success.  A 21% conversion rate would be awesome even for a private retail web site, and would likely imply over a million enrollments in October.

However, there is a very good chance that in fact this is very bad news.  Since this is based on survey data, it means that 21% THINK they enrolled.  But what very well may have happened is that they eventually were successful in creating a user account, and believe that having an exchange user account means they are enrolled for insurance, which is clearly not true.

We shall see.

Here is his new excuse for his "you can keep your health insurance" promise being broken.  It is -- wait for it, you will never guess -- insurance companies' fault.

"One of the things health reform was designed to do was to help not only the uninsured but also the under-insured," Obama said. "And there are a number of Americans, fewer than 5 percent of Americans, who've got cut-rate plans that don't offer real financial protection in the event of a serious illness or an accident.

"Remember, before the Affordable Care Act, these bad apple insurers had free rein every single year to limit the care that you received or used minor pre-existing conditions to jack up your premiums or bill you into bankruptcy."

This is absurd.   Kaiser Permanente cut zillions of policies.  Are they a bad apple?  My policy was cut by Blue Cross / Blue Shield of Arizona.  Are they some fly-by-night cut-rate insurer?

Frequently, in selling Obamacare, President Obama and Administration officials said that if you like your health insurance you can keep it, period.

Suddenly, as of yesterday they are arguing that there were actually all sorts of implicit asterisks to this promise.  The exact meme is still evolving retroactively, but the favored excuse is to say that of course this promise only applied to "real" insurance, "real" being defined as having the features the President thinks the policy should have  (this despite the fact that the promise very clearly defines insurance suitability based on the customer's, not the President's, preferences -- he said if you like your insurance, not if I like your insurance).

But what strikes me is the word "period."  This word adds no extra detail to the promise.  The only point to including it is to emphasize that this is the entirety of the promise, without any additional disclaimers or elaborations necessary.   By saying "period", Obama was saying that there were no asterisks, no hidden small print.

Via the Daily Caller:

The White House is pressuring insurance companies not to speak publicly about Obama administration policies that could eliminate the existing health insurance plans of millions of Americans.

The administration made “clarifications” to the 2010 Affordable Care Act after it was passed that have already wiped out hundreds of thousands of existing health plans.

“Basically, if you speak out, if you’re quoted, you’re going to get a call from the White House, pressure to be quiet,” said CNN investigative reporter Drew Griffin on Anderson Cooper 360 Wednesday night. Insurance companies executives, Griffin said, ask heads of consulting firms not to criticize the Obamacare rollout debacle publicly.

“They feel defenseless before the White House P.R. team,” Griffin said. “The sources said they fear White House retribution.”

Prior to the Obamacare rollout, insurance companies issued warnings to the White House about the possibility of mass cancellations, which the administration ignored.

As has become usual of late, Jay Carney channels Ron Ziegler with this absurd answer.  Apparently, the fact that insurance companies are still engaged in routine conversations with their customers proves they have not been silenced from publicly criticizing Obamacare.

White House press secretary Jay Carney, however, waved off the allegations.

“That accusation is preposterous and inaccurate,” Carney said. “Plus, it ignores the fact that every day, insurance companies are out talking about the law, in large part because they are trying to reach new customers who will now have new, affordable insurance options available from providers through the new marketplaces.”

Obviously, the whole Obamacare implementation is in disarray.  Some of this I expected -- the policy cancellations -- and some of it I did not -- the horrendous systems implementation.  But I actually thought that most of this would be swept under the rug by a willing media.

What I really expected was for the true shock to come next fall.  And I think it is still coming.  I believe that despite rate increases, insurers are likely being overly optimistic about how much adverse selection and cost control issues they are going to have.  As a result, I expected, and still expect, huge premium increases in the fall of 2014.

Why?  The main benefit of Obamacare is for people who cannot afford health insurance but want it, and for people who are very sick and have lost their insurance.   Obamacare is a terrible plan as implemented because it futzes with virtually everything in the health care system when a more limited plan could have achieved the same humanitarian coverage goals.

Anyway, one reason Obamacare is so comprehensive is that it is based on a goal of cost control for the whole system.  Unfortunately, most all of its cost control goals are faulty.  From Megan McArdle, in an amazing article covering a huge range of Obamacare issues:

But I think it’s also clearly true that the majority of the public did not understand this. In 2008, the Barack Obama campaign told them that their premiums would go down under the new health-care law. And the law’s supporters believed it.

Q. Obama says his plan will save $2,500 annually for my family. How?

A. Through a combination of developing efficiencies in the system, expanding coverage to all Americans, and picking up the cost of some high-cost cases. Specifically:

-- Health IT investment, which will reduce unnecessary and wasteful spending in the health care system. Examples include extra hospital stays because of preventable medical errors and duplicative diagnostic tests;

-- Improving prevention and management of chronic conditions;

-- Increasing insurance industry competition and reining in the abusive practices of monopoly insurance and drug companies;

-- Providing reinsurance for catastrophic cases, which will reduce insurance premiums; and

-- Ensuring every American has health coverage, which will reduce spending on the “uncompensated” care of uninsured people who end up in emergency rooms and whose care is picked up by institutions and then passed through higher charges to insured individuals.

The part about reinsurance was always nonsense; unless it’s subsidized, reinsurance doesn’t save money for the system, though it may reduce the risk that an individual company will go broke. But the rest of it all sounded entirely plausible; I heard many smart wonks make most of these arguments in 2008 and 2009. However, it’s fair to say that by the time the law passed, the debate had pretty well established that few to none of them were true. “We all knew” that preventive care doesn’t save money, electronic medical records don’t save money, reducing uncompensated care saves very little money, and “reining in the abusive practices” of insurance companies was likely to raise premiums, not lower them, because those “abuses” mostly consist of refusing to cover very sick people.

The result?  Many of these things that supposedly reduced costs actually increase them.  So if you think the shock is high now, wait until next fall.  We will see:

• Rates going up
• Less choice, as insurers pull out of many local markets
• Narrowing of doctors networks, and reduced choice in doctors
• Companies dropping health care and dumping workers (and retirees if they can get away with it) into the exchanges and Medicare.

So I guess the Left has hit on its favored meme in response to the millions of insurance cancellations.  From Obama to Valerie Jarrett to any number of bloggers, the explanation is that the cancelled policies were "sub-standard".  We may have thought we liked them, but it turns out we were wrong.  Deluded in fact.

These folks -- despite not knowing my income, my net worth, my health situation, my age, my family size, my number and age of kids, my risk adversity, my degree of hypochondria, my preventative care habits, my diet, my lifestyle, my personal preferences and priorities, or any details about my insurance policy that I spend many hours analyzing and cross-comparing -- have decided they know better than I what health insurance I should want.

My plan was not substandard.  I graduated magna cum laude in engineering from Princeton and was first in my class at Harvard Business School.  I spent hours shopping for my coverage and was fully satisfied with my resulting policy.  Many of the aspects of my policy that cause Obama to call it "sub-standard" -- lack of mental health care, lack of pediatric dental care, lack of maternity care, lack of free contraception, a higher than average deductible -- were my preferences.  I got what I wanted.

More expensive, more highly featured products are not necessarily "better".  A Mercedes is not necessarily the best car choice for a middle class buyer just because it has more features than his Taurus.  Would Obama tell that person his Taurus is "sub-standard" and force him to pay for a Mercedes? If not, why the hell is doing the exact same thing but with health insurance OK?

From his speech today, via Bryan Preston

When Obama came to that section of his speech when the line usually falls, he went with a new spin. If you’ve lost your healthcare thanks to his law, he wants you to know that you were just “under-insured.” Because he says so.

“One of the things health reform was designed to do was to help not only the uninsured but also the under-insured,” he said.

“If you had one of these substandard plans before the Affordable Care Act became law, and our really liked that plan, you are able to keep it. That’s what I said when I was running for office.”

“But ever since the law was passed, if insurers decided to cancel or downgrade these substandard plans, what we said, under the law, is you have got to replace them with quality, comprehensive coverage,” he said, “because, that, too, was a central premise of the Affordable Care Act from the very beginning.”

Update:  ugh

Update #2:  Yesterday I said the time seemed right for the Left to pick a meme to explain the insurance cancellations and then give the media its marching orders.  David Firestone of the NYT has gotten the memo

The so-called cancellation letters waved around at yesterday’s hearing were simply notices that policies would have to be upgraded or changed. Some of those old policies were so full of holes that they didn’t include hospitalization, or maternity care, or coverage of other serious conditions.

Republicans were apparently furious that government would dare intrude on an insurance company’s freedom to offer a terrible product to desperate people.

“Some people like to drive a Ford, not a Ferrari,” said Marsha Blackburn of Tennessee. “And some people like to drink out of a red Solo cup, not a crystal stem. You’re taking away their choice.”

Luckily, a comprehensive and affordable insurance policy is no longer a Ferrari; it is now a basic right. In the face of absurd comments and analogies like this one, Ms. Sebelius never lost her cool in three-and-a-half hours of testimony, perhaps because she knows that once the computer problems and the bellowing die down, the country will be far better off.

So you see the talking points as the media gets their orders.  1.  All policies that were cancelled were sub-standard.  2.  People will be better off with more expensive policies, even if they are too dumb to konw it.

My policy was perfectly fine.  I was not tricked.  I am willing to bet I am at least as smart as David Firestone.  I am positive I am smarter than Barrack Obama.  And yet my policy was cancelled.

And folks, the opponents of my plan are trying to scare you. But if you like your health insurance the way it is, and if I like your health insurance the way it is, then you can keep it.

Seriously, this is how Jay Carney explains it

White House press secretary Jay Carney on Tuesday said President Obama's claim that all Americans could keep their health insurance plans under the new health law deserved a “fuller explanation,” acknowledging millions of consumers would not keep their current coverage.

After the passage of Obamacare, the president has repeatedly insisted that if any individual likes their health care plan, they could “keep it.”

Carney on Tuesday added a crucial caveat to that promise, saying Americans could keep their insurance if the plan is “still available.”

This is absolutely absurd.  The whole meaning of the "If you like your health insurance..." promise was that the government would not ban your current policy, that the program was simply about adding options for the uninsured, not reducing options for the insured.  Now Carney was saying, as if we all should have known, that what Obama meant was that you can keep your policy as long as we don't ban it.

I think it is now clear why the Administration could not delay the exchanges, even when Republicans essentially cast them a lifeline during the budget debate by trying to delay the mandate by a year:  I think the Administration knew that a massive wave of insurance policy cancellations were already in the mail, and that the recipients of these letters would be facing huge price increases for their policies.

It is telling that the one thing you are NOT hearing from Administration officials in response to the policy cancellations is surprise.  If they were surprised, they would be yelling stuff like, "what the hell are those insurance companies doing?"  They knew this was coming, and you get the sense they were grimly bracing for it to be made public, hoping that perhaps their friends in the media would not make a big deal about it.

The minimum requirements on health plans that is driving these cancellations cannot at this point be cancelled.  Or, put more precisely, they could be cancelled but the act would be meaningless, because insurance companies have no way to suddenly go back to the old policies and pricing.  It takes too much planning to work out their product line and they can't just switch back on a dime.

So the huge wave of cancellations and price increases in the individual market was unstoppable.  That being said, the Administration has to be able to offer an alternative, and the only one they have is the hope one might get his or her new policy subsidized by other taxpayers.  But that is only possible through the exchanges.  So that had to be allowed to go forward and made to work, somehow.

There is no fix to this mess.  This is an avalanche that was loosed three years ago and cannot be stopped.

Via Bloomberg

The health-care law eliminates “substandard policies that don’t provide minimum services,” said Jay Carney, a White House spokesman, in response to the cancellations. The “80-plus percent” of Americans with employer plans or covered by government programs are unaffected.

I chose my policy very carefully, and don't think it is "sub-standard" because it does not include pediatric dental care for two people in their fifties.  This is the worst consumer dis-empowerment that I can remember in my lifetime.

And I totally agree with this

Now an effective levy of several thousand dollars on the small fraction of middle class Americans who buy on the individual market is not history’s great injustice. But neither does it seem like the soundest or most politically stable public policy arrangement. And to dig back into the position where I do strong disagree with Cohn’s perspective, what makes this setup potentially more perverse is that it raises rates most sharply on precisely those Americans who up until now were doing roughly what we should want more health insurance purchasers to do: Economizing, comparison shopping, avoiding paying for coverage they don’t need, and buying a level of insurance that covers them in the event of a true disaster while giving them a reason not to overspend on everyday health expenses.

If we want health inflation to stay low and health care costs to be less of an anchor on advancement, we should want more Americans making $50,000 or $60,000 or $70,000 to spend less upfront on health insurance, rather than using regulatory pressure to induce them to spend more. And seen in that light, the potential problem with Obamacare’s regulation-driven “rate shock” isn’t that it doesn’t let everyone keep their pre-existing plans. It’s that it cancels plans, and raises rates, for people who were doing their part to keep all of our costs low.

With my high deductibles, I am actually out shopping every day on health care prices and I can tell you from my experience that if everyone did so, we would see a reversal of health care inflation.  More here

I try to read a couple of team-politics blogs from both the red and blue side, to stay in touch with what they are saying and stay out of an echo chamber.  Also, of course, libertarians make common cause with both parties on various issues.  But the mindless team politics angle can really be a bore.

One of the reasons I like to read Kevin Drum on the left is that his initial reactions to things often seems pretty honest.  When his side really screws up, like the IRS scandal or failing Obamacare exchanges, his initial reaction will generally be to honestly critique a bad situation.  And then about 3-5 days into the scandal or crisis or discussion of an issue, he will catch on to and adopt the party line on an issue and then become incredibly tedious (for example, on the IRS scandal, he was honestly critical for a while and then adopted the silly "leftish groups were equally targeted meme" and has stuck to it by rote since).  But at least there are those few days of honesty, which separates him from a lot of the left and right team politics blogs.

So the timing is just about right for the Left to pick a meme to explain away the millions of people who are getting their policies cancelled despite being told that they could keep their health insurance.  Mainstream outlets like CBS and NBC are pushing the story, not just right-wing and libertarian blogs, so the Ezra Klein's of the world must be working diligently to pick a meme and then enforce it.  It will be interesting to see what they choose.

Update:  Well, here is an early entrant from Valerie Jarrett:

FACT: Nothing in #Obamacare forces people out of their health plans. No change is required unless insurance companies change existing plans.

This is hilarious.  Technically true, since my cancellation came from Blue Cross and not the government, but obviously the Blue Cross decision to cancel me was forced by the terms of the law.  This is obviously absurd, but is it too absurd for the media?  I don't know, and of course it gets extra lefty bonus points for blaming government-caused problems on private businesses.  Next up, Exxon to blame for gasoline taxes!

From CBS

Obamacare forces them to drop many of their plans that don't meet the law's 10 minimum standards, including maternity care, emergency visits, mental health treatment and even pediatric dental care.

For those of you who are on corporate health plans and do not participate in the individual market, here is something that those of us who do so participate learn early:  Unless you are really, really, really adverse to the smallest unpredictability in expenses, don't buy dental coverage.

The reason is that for the vast, vast majority of people, dental costs are entirely predictable.  Let's say for the average person they are X per year.  For most people, the costs don't vary very far from X.   While certain dental procedures can be expensive (and remember, dental plans do not cover orthodonture), they are seldom if ever catastrophically expensive.  Few people have been bankrupted by an insurable dental problem.  This is particularly true in kids with pediatric dental care.

So for most people, dental insurance is just pre-paid care.  All it does is add cost.  There is no free lunch.  The insurance company knows your costs are likely to be X.  So they are going to charge you X + a markup.  Actually, it is worse than this.  Because I pay cash, I get a lower price from the dentist.  So in fact with dental insurance you are paying X + dentist insurance markup + insurance company markup.  All this does is add costs.  I have happily paid my kids' dental costs out of pocket their entire life and have saved a fortune over what 18 years of pediatric dental care would have cost.

But now, courtesy of Obamacare, we are forced by law to buy this unnecessarily expensive product.

We are going to cancel the health care policies of millions of middle class Americans, then raise their rates, and then give half of them taxpayer subsidies so it seems like they got a rate cut.

Industry experts like Larry Levitt, of the Kaiser Family Foundation, say the insurance companies have no choice. "What we're seeing now is reality coming into play," he said.

Obamacare forces them to drop many of their plans that don't meet the law's 10 minimum standards, including maternity care, emergency visits, mental health treatment and even pediatric dental care.

That means consumers have to sign on to new plans even if they don't want or need the more generous coverage. Industry experts say about half the people getting the letters will pay more -- and half will pay less, thanks to taxpayer subsidies. Levitt said, "The winners outnumber the losers here, but because of all the website problems, it's hard to find out who the winners are because they don't even know it themselves."

Millions of middle class people who were independent and paid for their own health insurance will soon be wards of the state.

Here is my health insurance cancellation letter, cancelling the insurance I was very happy with.  Click on any of the below to enlarge

Here was roughly what I was paying for a family of four (this is from the renewal 18 months ago but it is about the same now).  We had a couple of minor pre-existing conditions so this was rated up from the lowest possible price of $525.85, or about a 6.6% increase.

Here are the features of this plan.  It has a high deductible, but once the deductible is met, it covers 100% in network, and the network is very good.   The deductible amounts may be high to some.  I asked myself, "what level of unexpected medical cost could I handle in a year." and set the limits there.  It is NOT pre-paid medical care, which I do not believe in.

To the question of "was Obama lying or was he ignorant", I cannot get inside his head but I can say that many people, including me, who were not involved in the process saw this coming even in 2009 in his draft legislation.  It is hard to believe that if random folks like myself understand this, that the person actually sponsoring the legislation did not.

Many folks are arguing it has to have been an out-and-out lie.

None of this should come as a shock to the Obama administration. The law states that policies in effect as of March 23, 2010 will be “grandfathered,” meaning consumers can keep those policies even though they don’t meet requirements of the new health care law. But the Department of Health and Human Services then wrote regulations that narrowed that provision, by saying that if any part of a policy was significantly changed since that date -- the deductible, co-pay, or benefits, for example -- the policy would not be grandfathered. 

Buried in Obamacare regulations from July 2010 is an estimate that because of normal turnover in the individual insurance market, “40 to 67 percent” of customers will not be able to keep their policy. And because many policies will have been changed since the key date, “the percentage of individual market policies losing grandfather status in a given year exceeds the 40 to 67 percent range.” 

That means the administration knew that more than 40 to 67 percent of those in the individual market would not be able to keep their plans, even if they liked them.

Enter the lies:

Yet President Obama, who had promised in 2009, “if you like your health plan, you will be able to keep your health plan,” was still saying in 2012, “If [you] already have health insurance, you will keep your health insurance.”

“This says that when they made the promise, they knew half the people in this market outright couldn’t keep what they had and then they wrote the rules so that others couldn’t make it either,” said  Robert Laszewski, of Health Policy and Strategy Associates, a consultant who works for health industry firms. Laszewski estimates that 80 percent of those in the individual market will not be able to keep their current policies and will have to buy insurance that meets requirements of the new law, which generally requires a richer package of benefits than most policies today.

Next step for me, I get to experience the exchange.  I recognized a bunch of business losses last year, so my income was less than zero (I have a s-corp which passes earnings through to my individual tax statement).  It will be interesting to see if I get offered a subsidy.  Heck, they may offer to enroll me in Medicare.

1.  The first Obama Administration response to people (like myself) who have had their health insurance cancelled because of Obamacare and who are facing much higher future premiums is that many of can expect a subsidy.  Do you realize how awful this is?  Basically they are acknowledging that millions of people who paid for their own health care in the past will now be getting taxpayer money.  Essentially, a huge and unnecessary increase in government dependency.

2.  The other equally awful Obama Administration answer is that our new health coverage will be more expensive because it will be "better".  First, there is no evidence of this -- early returns are that people are paying more for less.  Second, though, this is horribly arrogant.  A $200,000 Maserati sedan is likely "better" than my car I am driving, but given its price I would consider myself worse off if forced to buy a Maserati.  In the same sense, forcing me to by expensive insurance options I don't want is not "better", even if I am making choices Obama's advisers would not make for themselves.  I spent a lot of time shopping for health insurance and running numbers on various cases and picking the best plan for me, and am insulted that Obama does not respect my decision.

By the way, I will remind you of what I said way back in 2007 about government health care proposals

Americans are unbelievably charitable people, to the extent that they will put up with a lot of taxation and even losses of freedoms through government coercion to help people out.

However, in nearly every other case of government-coerced charity, the main effect is "just" an increase in taxes.  Lyndon Johnson wants to embark on a futile attempt to try to provide public housing to the poor?  Our taxes go up, a lot of really bad housing is built, but at least my housing did not get any worse.  Ditto food programs -- the poor might get some moldy cheese from a warehouse, but my food did not get worse.  Ditto welfare.  Ditto social security, unemployment insurance,and work programs.

But health care is different.... what is different about many of the health care proposals on the table is that everyone, not just the poor will get this same crappy level of treatment.  It would be like a public housing program where everyone's house is torn down and every single person must move into public housing.  That is universal state-run health care.  Ten percent of America gets pulled up, 90% of America gets pulled down, possibly way down.

This may be an elaborate hoax (the ads are that goofy) but these appear to be actual ads from the Colorado health insurance exchange.  The potential for Photoshop fund is incredible.  I took a quick shot at a couple.  Here is the original.

Update:  more here

On September 26 of this year, President Obama said this of the new Obamacare exchanges:

“If you’ve ever tried to buy insurance on your own,” he said, “I promise you this is a lot easier.”

Well, let's see.  Here are some notes on my previous health insurance buying decision

• I was able to price shop policies online without creating an account, without giving up my social security number.  The websites to do so worked and operated quickly

• A broker who had decades of experience in health care (rather than being a former Obama campaign worker with a few hours of training) walked me through the options and how they worked.

• Once we chose a policy, the application process online was quick and easy

Here is one thing that was likely worse

• I had to provide medical history information, which probably is not required under Obamacare because of community rating (though I am not sure)

And here is one thing that was better for me but I guess must be worse for the Left since they complain about it so much

• There was a lot more choice.  If the process was "harder" in any way before, it was because there were far more choices.  It was harder in the same way that it is generally harder to shop in the US than, say, in the old Soviet Union.  Obamacare circumscribes policies such that a large package of benefits are mandated, not optional (I have to pay for mental health coverage and probably aromatherapy) and the size of one's deductible is capped.

It is also this latter difference that will make my next policy substantially more expensive.  In standardizing options, the Congress standardized on the most expensive options (broadest possible benefits, smallest possible deductible).

By the way, this is not proven yet but there is probably one other way my Obamacare policy will be worse than my last one:  the doctor network in my policy will very likely be a LOT smaller.  We could almost be sure this would happen precisely because Obama promised it wouldn't  (his promises on health care are pretty good "tells" that the opposite will happen).