Archive for the ‘ObamaCare’ Category

Trump threatens to make Congress live by the laws they pass ….

July 31, 2017

Starting with Congressional ObamaCare carve-outs.

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It’s no secret that I get annoyed every time Congress passes legislation that provides that it doesn’t apply to them.

See Should lawmakers (and regulators) have to eat their own cooking?

So, I was delighted when President Trump tweeted over the weekend:

“If a new HealthCare Bill is not approved quickly … BAILOUTS for Members of Congress will end very soon!”

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Here’s the back story …

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To fix healthcare, the GOP has to nuke the legislative filibuster …

July 27, 2017

The past couple of weeks of Repeal & Replace has been annoying along several dimensions.

Foremost, all of the chatter has been about health insurance, not healthcare … just fiddling with who is going to get stuck paying … moving nickels around.

Woefully little talk about how to improve healthcare delivery.

That’s not surprising since the Senate’s fillibuster rules require 60 votes to pass any legislative action.

Keep in mind that Obama had 60 Senate votes in 2009 and 2010 … thanks to the DOJ sidelining Ted Stevens and Al Franken pulling a narrow upset in a disputed election.

Today, there are 48 Dems who reliably vote in lemming-like lockstep against anything the GOP proposes.

Even if centrist Dems were to band together with moderate GOPs,  the middle-of-the-roaders wouldn’t have enough votes to get a sensible proposal enacted.  It would be squashed by either the ultra-conservatives or the ultra-liberals.

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So, the GOP-controlled Senate has its hands tied … it has to work through the “reconciliation” process which, by definition, just moves nickels around.

I think its time for McConnell to go nuclear…

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Wonder why it’s so hard to untangle ObamaCare?

July 24, 2017

Here’s a (scary) chart that puts the program in context.

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Seriously, here’s a graphic of the ObamaCare organization structure and processes …

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Here’s a link to enlarged version and another to a summary that decodes the chart and lists some of the bill’s key provisions.

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Take a quick glance at the flowchart and ask yourself: ”Think this will work?”

The bill’s laundry list special interest provisions caught my eye…

(more…)

If you’re one of the 155 million people on employee-based health insurance plans …

July 18, 2017

Here’s the main reason why YOUR health insurance premiums have gone up.

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All the repeal & replace attention seems to be on the 20 million people who are getting insurance via Extended Medicaid or ObamaCare Exchanges.

Virtually no light is being shined on the vast majority of folks who are covered by employer plans.

Case-in-point: the soaring premiums being paid by employees … hardly the $2,500 reduction that was promised.

Here’s one of the reasons that premiums have gone up not down …

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Most people – probably bordering on all – would agree that people with pre-existing conditions should be able to get health insurance.

I accept that as a non-debatable point.

But, I got curious about the economics of so-called “guaranteed coverage”… i.e. how much does it cost, and who pays for it?

Specifically, for folks covered by employer plans, how much of their increase in health insurance premiums over the past couple of years is attributable to guaranteed coverage?

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Let’s take a whack at the numbers …

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Killer chart: OC’s middle class crunch …

June 30, 2017

Yesterday’s post recapped articles from the NYT and WSJ that made a common, largely unrecognized point:

The expansion of “free” and near-free healthcare to approximately 15 million currently uninsureds (out of about 45 million uninsured citizens) is – to a large extent – being funded by the working middle class.

Case in point: the net insurance premiums paid after subsidies on the Obama Exchanges.

Using the Kaiser Foundation subsidy calculator , I picked off the net premiums for single, non-smoking 25 year olds across a range of incomes … and calculated the net premium as a percentage of income.

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Here are the fundamental takeaways …

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Flashback: Even the NYT admitted that ObamaCare had losers, too …

June 29, 2017

And, those folks reside in the middle class !

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Since healthcare (err, make that “health insurance”) is front and center again, I thought I’d dust this one off:

Way back in 2013, the NY Times published an argument defining article titled; Don’t Dare Call the Health Law ‘Redistribution’

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I assumed that it would be a typical NYT pro-Obama pitch about how ObamaCare wasn’t a redistribution of wealth … that it was simply a well-intended effort to improve the wasn’t a redistribution of wealth … that it was simply a well-intended effort to improve the health care system by providing universal insurance coverage.

To the contrary.

The article put in black & white the “truth” that, at it’s core, ObamaCare is a wealth distribution scheme with both winners and losers.

OMG, they said it.

Not “like it, keep it with lower premiums” but “winners & losers”

Here are the killer quotes ….

(more…)

Has ObamaCare provided more healthcare?

June 28, 2017

Not really: it just covered more people with health insurance?

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In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.

Makes sense, doesn’t it?

Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?

 

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Source: AAMC

My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.

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Did ObamaCare exacerbate a shortage of doctors?

May 1, 2017

Answer: Of course it did … it’s simple arithmetic.

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In yesterday’s post, I concluded that ObamaCare increased the demand for healthcare by providing health insurance to 20 million previously uninsured Americans … but that ObamaCare didn’t increased the aggregate amount of healthcare that Americans are getting.

Since the supply of healthcare is constrained by too few doctors, the amount of healthcare is just being redistributed

It’s a zero sum game …  previously uninsured people are getting more healthcare … previously insured people are getting less healthcare … and total healthcare delivered is staying about the same.

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I got a few questions about the incremental doctor shortage created by ObamaCare, so I pulled together a quick & dirty  estimate.

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Has ObamaCare provided more healthcare?

April 27, 2017

Or, has it just covered more people with health insurance?

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In my consulting / problem-solving class, I emphasize asking the right question before starting to gather data, doing analyses, drawing conclusions and making recommendations.

Makes sense, doesn’t it?

Then, would someone please explain to me why the politcos (on both sides) obsess over health insurance coverage (how many people are covered) and largely ignore the quantity & quality healthcare that Americans are getting?

 

image

Source: AAMC

My conclusion: More Americans now have health insurance, but healthcare hasn’t increased … it has just been re-distributed.

(more…)

Are emergency rooms required to treat all patients?

April 12, 2017

More specifically, the question that a friend and I were discussing recently was:

“Are emergency rooms required to treat all patients? … whether or not they have insurance?”

I said “yes” but decided to fact-check my answer.

image “.

 

Here’s what I found…

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Remember how ObamaCare was going to divert patients from ERs to doctors’ offices?

April 11, 2017

Turns out that the number of people flocking to ERs is increasing, not decreasing.

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According to the Louisville Courier-Journal:

One of ObamaCare’s goals was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they’ve seen more visits since ObamaCare was enacted.

That’s a problem since an average ER visit costs $580 more than a trip to the doctor’s office.

image

 

Why’s this happening?

(more…)

How much did ObamaCare increase premiums?

March 27, 2017

ObamaCare survived … so did the higher (and increasing) premiums we all pay.

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Previously, we posted: Here’s the main reason why YOUR health insurance premiums have gone up.

We just ballparked the premium impact of “guaranteed issue” to folks with pre-existing conditions (about 27% increase in premiums attributable to guaranteed issue)

Below is a more complete analysis compiled The Daily Signal

Headline: “Obamacare Regulations Drove Up Premium Costs By Up to 68%.”

The biggest chunk is, in fact, attributable to guaranteed issue … which the DS pegged between 15% and 30%.

Our prior observation: almost everybody agrees that people with pre-existing conditions should be able to get coverage … but virtually no one realized that they were paying (much) higher premiums to provide that “social good” …  especially since they were told that their premiums would go down by $2,500.

See Remember how healthcare costs were going to drop by $2,500 for every family?

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A couple of other notable conclusions …

1) The EHBs – the controversial “Essential Health Benefits” mandated into all policies – increased premiums by about 8%.

2) “Community Rating” – which equalized premiums for men & women and contained old folks’ premiums – really increased premiums for the under 35 crowd by 19% to 30.

No wonder the young healthies were reluctant to sign up.

 

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Follow on Twitter @KenHoma            >> Latest Posts

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“The under-26 provision is one of Obamacare’s biggest flaws”

March 23, 2017

Senator: “We didn’t think ahead” … and consider ramifications.

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From the get-go, I’ve questioned the “wildly popular” ObamaCare provision allowing “adult children” to say on their parents’ health insurance policies until they’re 26.

My objection was two-fold.

First, it removes a significant source of motivation for adult-children to get a job.

In the old days, parents encouraged their college kids to get a degree that might just qualify them for a paying job.

Unfocused, impractical exploration wasn’t a viable option for most families.

And, in the old days, parents used to nudge their kids to land jobs with benefits (not the same as “friends with benefits”) that included “hospitalization” … the old school name for health insurance.

I guess those days are gone …

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Second, as we’ve posted before, due to the weird insurance pricing schemes that let all except a family’s 1st child ride free on their parents plans, an adult-child rides completely free unless he-she is the family’s only covered child.

That means that all other plan members who pay premiums end up paying higher premiums to cover the cost of the free-riding adult-children

I don’t like these kinds of hidden cross-subsidies.

On this point, an insurance buddy of mine advised me to settle down since these adult-children are generally healthy and don’t consume much medical care.

True, but that raises an even biggest issue …

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If you’re one of the 155 million people on employee-based health insurance plans …

March 21, 2017

Here’s the main reason why YOUR health insurance premiums have gone up.

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All the repeal & replace attention seems to be on the 20 million people who are getting insurance via Extended Medicaid or ObamaCare Exchanges.

Virtually no light is being shined on the vast majority of folks who are covered by employer plans.

Case-in-point: the soaring premiums being paid by employees … hardly the $2,500 reduction that was promised.

Here’s one of the reasons that premiums have gone up not down …

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Most people – probably bordering on all – would agree that people with pre-existing conditions should be able to get health insurance.

I accept that as a non-debatable point.

But, I got curious about the economics of so-called “guaranteed coverage”… i.e. how much does it cost, and who pays for it?

Specifically, for folks covered by employer plans, how much of their increase in health insurance premiums over the past couple of years is attributable to guaranteed coverage?

image

Let’s take a whack at the numbers …

(more…)

Wonder why it’s so hard to untangle ObamaCare?

March 17, 2017

Here’s a (scary) chart that puts the program in context.

=======

Seriously, here’s a graphic of the ObamaCare organization structure and processes …

image

Here’s a link to enlarged version and another to a summary that decodes the chart and lists some of the bill’s key provisions.

=====

Take a quick glance at the flowchart and ask yourself: ”Think this will work?”

The bill’s laundry list special interest provisions caught my eye…

(more…)

About the “Extended Medicaid” bruhaha …

March 16, 2017

It’s center stage in the current debate.

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So, I dug in a bit to understand the issue.

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Here are my takeaways ….

(more…)

Another hidden cost of ObamaCare …

March 15, 2017

For most doctors, Medicaid patients are a losing proposition.

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It’s hard to find anybody opposed to healthcare for the poor.

In the past, most doctors took on Medicaid patients –- which were relatively few in number — as a public service.

Some took Medicaid patients to fill empty appointment slots and, thus, increase capacity utilization (think, airlines filling empty seats).

But, an increasing number of doctors are demotivated to serve Medicaid patients.

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What’s the problem?

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A hidden cost of ObamaCare: Docs getting stiffed.

March 14, 2017

ObamaCare’s high deductible plans pushing up bad debts.

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Chatting with a doctor-friend recently.

His is a very specialized 1-doctor practice (supported by a handful of well-trained techs).

Patients who are referred to him usually have a very serious condition needing sophisticated diagnostics.

My friend casually mentioned to me that – in the past couple of years — he has had to write-off more than $2 million in bad debts.

Way more than in prior years.

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Here’s what’s going on …

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Remember how ObamaCare was going to divert patients from ERs to doctors’ offices?

March 10, 2017

Turns out that the number of people flocking to ERs is increasing, not decreasing.

=======

According to the Louisville Courier-Journal:

One of ObamaCare’s goals was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they’ve seen more visits since ObamaCare was enacted.

That’s a problem since an average ER visit costs $580 more than a trip to the doctor’s office.

image

 

Why’s this happening?

(more…)

Don’t faint: I agree with ObamaCare on this one …

March 9, 2017

For the record, I think that ObamaCare is an expensive, amateurish travesty that should be repealed and rebuilt from the ground up by professionals.  Keep the high risk pools for pre-exiting conditions, keep the subsidies for the poor … but lose the  micro-narrow provider networks and the junk mandated into policies (e.g. my favorite: universally free birth control for law schoolers).

And, I think that Dr. Dr. Ezekiel Emanuel – Rahm’s brother and one of the ObamaCare architects – is a complete butt.

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That said, I was on Zeke’s side when he sparred with O’Reilly  …

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Obamacare For me, it’s personal…

March 8, 2017

Higher costs, higher taxes, longer waits, primary doc absentia, still working

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My primary care doctor is on the faculty at Georgetown’s med school … and on the staff at Georgetown Hospital

Shortly after ObamaCare was passed, I asked him what he thought the implications would be.

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His reply surprised me …

“Not much change … it will just shift around who’s going to be paying the bills…. now, the hospital would treat anybody and just write off unpaid bills … going forward, I guess, those bills will be paid by the government and insurance companies.”

When pressed, about service levels, he opined:

“I’m working full days now, seeing as many patients as I can … so, it’ll be harder for current patients to get appointments unless we hire more doctors or stop accepting new patients … and, I don’t see us doing either of those two things.”

At the time, I thought his assessment was a bit dismissive.

Looking back, he had had deftly cut to chase.

In the final analysis healthcare – and, hence – ObamaCare impacts are strictly personal.

Here’s my saga. It’s one that many of my friends can relate to.

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Remember when an ObamaCare architect called you stupid?

March 7, 2017

Let’s flashback to a November 2014 post ….

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Even if you believe that “the end justifies the means”, this has gotta make your skin crawl.

Some background: Prof. Jonathan Gruber is an MIT economist who helped on RomneyCare in Massachusetts and was one of the primary architects of ObamaCare.

He was caught on video  speaking quite frankly about the crafting of ObamaCare.

His basic message:

“The bill was written in a tortured way … to be sure that the CBO didn’t score the mandate as a tax …  otherwise the bill would die … so, it was written to do that.

With regards to the subsides … if people figured out that healthy pay in to give sick people money, it wouldn’t have passed … lack of transparency is a huge political advantage.

Basically, call it the stupidity of the American voter or what … that was critical to getting the bill to pass … yeah, it would be better to be transparent, but I’d rather have this law than not.”

Watch the video … it’s even more chilling to hear Prof. Gruber say the words: Obfuscate and bank on American stupidity.

How do these guys sleep at night?

 

 

P.S. Another Gruber video got some wide play..

He’s on tape saying that the specific language in the bill that only provided subsidies for folks going through state exchanges was intentional to motivate states to build exchanges,

ObamaCare supporters started claiming that  it was just a typo that didn’t represent intent.

The Supreme Court agreed with them … with life & death consequence for ObamaCare.

As Forrest Gump would say:” Stupid is as stupid does.”

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Remember how healthcare costs were going to drop by $2,500 for every family?

March 7, 2017

In 2016, employees paid $11,000 out-of-pocket … up $2,500 since 2012.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

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Gains, losses, the endowment effect … and ObamaCare

March 3, 2017

Here’s why repeal & replace is so challenging …

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Behavioral theorists have long observed that most people are risk adverse and, due in part to an “endowment effect”, they “value” losses greater than gains.

Endowment Effect: People tend to ascribe a higher value to things that they already own than to comparable things that they don’t own. For example, a car-seller might think his sleek machine is “worth” $10,000 even though credible appraisers say it’s worth $7,500. Sometimes the difference is due to information asymmetry (e.g. the owner knows more about the car’s fine points), but usually it’s just a cognitive bias – the Endowment Effect.

The chart below illustrates the gains & losses concept.

  • Note that the “value line” is steeper on the losses side of the chart than on the gains side.
  • L & G are equivalently sized changes from a current position.
  • The gain (G) generates an increase in value equal to X.
  • The loss (L) generates a decrease in value that is generally found to be 2 to 3 times an equivalently sized gain

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For example, would you take any of these coin flip gambles?

  1. Heads: win $100; Tails: lose $100
  2. Heads: win $150; Tails: lose $100
  3. Heads: win $200; Tails: lose $100
  4. Heads: win $300; Tails: lose $100

Most people pass on #1 and #2, but would hop on #3 and #4.

OK, now let’s show how all of this relates to ObamaCare.

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Amazon, ObamaCare … and the “power of free”

February 28, 2017

Since “repeal & replace” is in play, it’s time to update a prior ObamaCare posts …

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Everybody knows that Amazon’s free shipping program has been a resounding success.

The free shipping program’s success was highly predictable based an an apparently inadvertent “matched market test” that Amazon did.

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Early-on, Amazon launched  free shipping on $25 orders in the U.S. and sales skyrocketed.

In the UK, Amazon launched “nominal shipping” (think, 99 cents) for orders totaling the equivalent of $25.

Sales increased … but only by a fraction of the U.S. sales gain.

Proof-positive of the “power of free” … and evidence an equally important dynamic: there’s a big difference between “free” and “almost free” … when you slip a price on something – even a small one, people recoil.

Now, what’s the link to ObamaCare?

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There are 3 Americas (not 2) … thanks to Obamacare.

January 11, 2017

ObamaCare is front & center on the legislative agenda again, so …

Last week, we reported that — according to Gallup — ObamaCare is under water by 7 points (51% to 44%) … and that 29% think their families have been hurt by ObamaCare versus 18% who think that their families have been helped).

obamacare-jan-2017

In other words, the disapproval is grounded in the program’s fundamentals.

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Cutting to the chase, an article in the WSJ quoted David Cutler, a Harvard health-care economist:

Obamacare may be “a story of three Americas.”

One group, the rich, can afford health care easily.

The poor can access public assistance.

But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue.”

No kidding, Dr. Cutler …

HomaFiles was all over this one back in June:

Remember how healthcare costs were going to drop by $2,500 for every family?

We concluded that in 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

“Employees” … you know the working class … the middle class.

Here’s the essence of our original post …. worth re-reading …. glad others are catching up to it.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

clip_image002

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

(more…)

“Most Americans support ObamaCare” … say, what?

January 5, 2017

18% say the law has helped their families; 29% say it has hurt them

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ObamaCare is front-and-center again as the GOP controlled Congress starts the process of repealing and replacing.

A repeated Dem talking point yesterday was how the majority of Americans support ObamaCare.

Sorry, Charlie, but the data doesn’t seem to support the claim.

Gallup has been tracking public sentiment towards ObamaCare for the past couple of years.

Bottom line:

More people have disapproved of ObamaCare since its inception … for most of the past 4 years, a majority has disapproved … most recently, the there has been a 7 point gap – 51% disapproving to 44% approving.

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Why the majority disapproval ?

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What if Trump governs like Obama?

January 4, 2017

President Obama seems determined to leave office ungracefully … spending his lame duck time igniting a steam of transitional stink bombs to welcome the President-elect.

Or, as pundits like to say (when somebody other than Obama is doing it): “taking unprecedented unilateral action”.

Those who are gleefully cheering him on, should keep in mind that what goes around, comes around.

Some day, Trump may be in a lame duck period with a Dem president-elect ready to launch.

When he starts complicating life for the president-to-come, today’s cheer squad will have no legitimacy to whine.

Obama’s recent power plays reminded me of a  “must read” opinion piece in the Washington Post archives.

The article was penned by left-leaning GWU law professor Jonathan Turley

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Turley has long been warning that Dems may think it is clever and appropriate when Obama circumvents the Congress and courts to implement his partisan policies, but that they should be forewarned that what goes around, come around.

Specifically, he says:

Democrats have supported President Obama’s claims of unchecked authority in a variety of areas.

Obama has been particularly aggressive in his unilateral actions.

From health care to immigration to the environment, he has set out to order changes long refused by Congress.

Thrilled by those changes, supporters have ignored the obvious danger that they could be planting a deeply unfortunate precedent if the next president proves to be a Cruz or Trump rather than a Clinton.

While the policies may not carry over to the next president, the powers will.

The Obama model will be attractive to successors who, although they may have a different agenda, have the same appetite for unilateral decisions.

Here are some specifics that he cites:

(more…)

Score one for the Little Sisters of the Poor …

November 12, 2016

Remember when the Obama DOJ decided to go after the Little Sisters of the Poor?

We posted about the law suit in January 2014:  Let’s have a little fun with the nuns …

Looking back, it may have been a defining moment for some folks.

Sicking the IRS on the Tea Party was one thing …

Going after the Little Sisters, though, was a visible, and mobilizing metaphor.

Let’s flashback ….

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When I heard the news report, I thought it was a joke.

The full force of the DOJ is being thrown at, believe it or not …

THE LITTLE SISTERS OF THE POOR.

Not just nuns, “little” nuns.

Not just little nuns, little nuns who dedicate their lives to God and spend every waking hour praying or caring for the poor.

Not just little nuns who care for the poor, little poor-caring nuns who are, on average, probably about a hundred years old.

These are the nuns who are literally icons for the helpless.

So much so that weak sports teams – like those on Georgetown’s early season basketball schedule — have forever been referred to as representing The Little Sisters of the Poor.

Those Little Sisters of the Poor.

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Source

What’s the government’s beef?

(more…)

Flashback: What if Trump gets elected and acts like Obama?

November 10, 2016

What goes around, comes around.

Here’s what we posted March 8, 2016:

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There was a “must read” opinion piece in the Washington Post .

The article was penned by left-leaning GWU law professor Jonathan Turley

clip_image001

Turley has long been warning that Dems may think it is clever and appropriate when Obama circumvents the Congress and courts to implement his partisan policies, but that they should be forewarned that what goes around, come around.

Specifically, he says:

Democrats have supported President Obama’s claims of unchecked authority in a variety of areas.

Obama has been particularly aggressive in his unilateral actions.

From health care to immigration to the environment, he has set out to order changes long refused by Congress.

Thrilled by those changes, supporters have ignored the obvious danger that they could be planting a deeply unfortunate precedent if the next president proves to be a Cruz rather than a Clinton.

While the policies may not carry over to the next president, the powers will.

The Obama model will be attractive to successors who, although they may have a different agenda, have the same appetite for unilateral decisions.

Here are some specifics that he cites:

(more…)

ObamaCare has bent the cost curve …

October 20, 2016

Unfortunately, it has bent it up, not down.

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Hillary’s lucky that the MSM is burying ObamaCare coverage, so she can continue to tout it as a resounding success.

Remember how ObamaCare was going to save each family $2,500?

Well, turns out to be just the opposite.

According to Federal Reserve data, once the full program kicked in, real personal healthcare expenditures — the “net total” of insurance premiums, deductibles and other out-of pocket spending, adjusted for inflation — has turned up, not down.

obamacare-bending-the-cost-curve-up

Her are some details …

(more…)

Who is Dr. John Gruber?

October 11, 2016

Trump referenced him in the debate as an ObamaCare architect.

Why the shout out?

Let’s flashback to a November 2014 post ….

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Even if you believe that “the end justifies the means”, this has gotta make your skin crawl.

Some background: Prof. Jonathan Gruber is an MIT economist who helped on RomneyCare in Massachusetts and was one of the primary architects of ObamaCare.

He was caught on video  speaking quite frankly about the crafting of ObamaCare.

His basic message:

“The bill was written in a tortured way … to be sure that the CBO didn’t score the mandate as a tax …  otherwise the bill would die … so, it was written to do that.

With regards to the subsides … if people figured out that healthy pay in to give sick people money, it wouldn’t have passed … lack of transparency is a huge political advantage.

Basically, call it the stupidity of the American voter or what … that was critical to getting the bill to pass … yeah, it would be better to be transparent, but I’d rather have this law than not.”

Watch the video … it’s even more chilling to hear Prof. Gruber say the words: Obfuscate and bank on American stupidity.

How do these guys sleep at night?

 

 

P.S. Another Gruber video will get wide play in the next couple of months.

He’s on tape saying that the specific language in the bill that only provided subsidies for folks going through state exchanges was intentional to motivate states to build exchanges,

Now, ObamaCare supporters are claiming it was just a typo that didn’t represent intent.

Well, the Supreme Court has signed on to settle the matter … with life & death consequence for ObamaCare.

This is gonna get interesting …

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#HomaFiles

Follow on Twitter @KenHoma            >> Latest Posts

There are 3 Americas (not 2) … thanks to Obamacare.

September 1, 2016

Article in yesterdays WSJ quoted David Cutler, a Harvard health-care economist:

Obamacare may be “a story of three Americas.”

One group, the rich, can afford health care easily.

The poor can access public assistance.

But for lower middle- to middle-income Americans, “the income struggles and the health-care struggles together are a really potent issue.”

No kidding, Dr. Cutler …

HomaFiles was all over this one back in June:

Remember how healthcare costs were going to drop by $2,500 for every family?

We concluded that in 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

“Employees” … you know the working class … the middle class.

Here’s our original post …. worth re-reading …. glad others are catching up to it.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

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Remember how healthcare costs were going to drop by $2,500 for every family?

June 1, 2016

In 2016, employees will pay $11,000 out-of-pocket … up $2,500 since 2012.

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Milliman – a well-regarded actuarial consulting” firm – has published an annual recap of healthcare spending since 2001.

The Milliman Medical Index tracks the total costs of providing health care to an average family of four covered by an employer-sponsored “preferred provider plan” … that’s about 155 million employees and their dependents.

The total includes the health insurance premiums paid by both the employer and the employee, as well as the actual expenditures for health care paid by the insurance plan and out of pocket by the insured family.

The big news: In 2016, the average healthcare costs for a family of 4 surpassed $25,000 for the first time … the $25,826 is triple the cost to provide health care for the same family in 2001 … and up about $5,000 since 2012.

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The bad(est) news is the increased proportion of the healthcare costs being shouldered by individual employees …

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What if Trump gets elected and acts like Obama?

March 8, 2016

Now that it looks like Trump will be the GOP candidate. it’s time to reprise a “must read” opinion piece that appeared in the Washington Post a couple of months ago.

The article was penned by left-leaning GWU law professor Jonathan Turley

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Turley has long been warning that Dems may think it is clever and appropriate when Obama circumvents the Congress and courts to implement his partisan policies, that they should be forewarned that what goes around, come around.

Specifically, he says:

Democrats have supported President Obama’s claims of unchecked authority in a variety of areas.

Obama has been particularly aggressive in his unilateral actions.

From health care to immigration to the environment, he has set out to order changes long refused by Congress.

Thrilled by those changes, supporters have ignored the obvious danger that they could be planting a deeply unfortunate precedent if the next president proves to be a Cruz rather than a Clinton.

While the policies may not carry over to the next president, the powers will.

The Obama model will be attractive to successors who, although they may have a different agenda, have the same appetite for unilateral decisions.

Here are some specifics that he cites:

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What if Trump gets elected and acts like Obama?

December 16, 2015

There was a “must read” opinion piece in the Washington Post last weekend.

The article was penned by left-leaning GWU law professor Jonathan Turley

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Turley has long been warning that Dems may think it is clever and appropriate when Obama circumvents the Congress and courts to implement his partisan policies, that they should be forewarned that what goes around, come around.

Specifically, he says:

Democrats have supported President Obama’s claims of unchecked authority in a variety of areas.

Obama has been particularly aggressive in his unilateral actions.

From health care to immigration to the environment, he has set out to order changes long refused by Congress.

Thrilled by those changes, supporters have ignored the obvious danger that they could be planting a deeply unfortunate precedent if the next president proves to be a Cruz rather than a Clinton.

While the policies may not carry over to the next president, the powers will.

The Obama model will be attractive to successors who, although they may have a different agenda, have the same appetite for unilateral decisions.

Here are some specifics that he cites:

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Amazon and the “power of free” …

November 13, 2015

Yesterday in class, I mentioned some work by Chris Anderson of Wired on the “Power of Free”

Free: How Today’s Smartest Businesses Profit by Giving Something for Nothing

Here’s a real life example of the power of free.

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Everybody knows that Amazon’s free shipping program has been a resounding success.

So much so. that the company has announced that it will be moving the minimum qualifying order up from $25 to $35 … inducing shoppers to fill  their carts fuller or switch to the highly profitable Amazon Prime program.

The free shipping program’s success was highly predictable based an an apparently inadvertent “matched market test” that Amazon did.

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Here’s the skinny on the Amazon’s inadvertent market test …

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Would your boss fire you if your project underperformed plan by 50% ?

October 20, 2015

Answer: Apparently not if your boss is President Obama …  and your project was ObamaCare.

In a conference call with reporters last week, HHS Secretary Sylvia Burwell said “We believe 10 million is a strong and realistic goal” for 2016 enrollment in ObamaCare Exchanges.  That represents an increase not significantly different from zero.

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Let’s put that number in context … and show how performance against plan is even worse than it initially appears.

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Obama: Against mumbo jumbo … say, what?

October 6, 2015

During last Friday’s press conference, President Obama criticized opponents to his policies as having “half-baked ideas” and speaking “mumbo jumbo” …  and, he said that Congress should tighten gun control laws because “the polling says the majority of Americans understand we should be changing these laws “ and “Congress should act on behalf of the majority”  Source

Yesterday, we commented on the majority rule part of the teaching moment …. pointing out that “acting on behalf of the majority” didn’t seem to be important for ObamaCare or the Iran Deal.

Perhaps the President has had a change of heart re: the will of the majority.

Or he, himself, may be spewing some mumbo jumbo.

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Today, let’s dig a little deeper on the basic premise behind his call for action on stricter gun laws:  a majority of Americans favor such a move.

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Obama: For majority rule, against mumbo jumbo …

October 5, 2015

Say, what?

During last Friday’s press conference, President Obama criticized opponents to his policies as having “half-baked ideas” and speaking “mumbo jumbo” …  and, he said that Congress should tighten gun control laws because “the polling says the majority of Americans understand we should be changing these laws “ and “Congress should act on behalf of the majority”  Source

Today, we’ll just deal with the last part: acting on behalf of the majority.

First, I was pleased to hear the President come out in favor of majority rule.

A couple of notable examples suggest that it’s a change of heart.

Let’s start with his Iran Deal.

What does the polling say?

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According to a Quinnipiac University poll ….

American voters oppose  57% to 28%,  the nuclear pact negotiated with Iran …. 58% say the nuclear pact will make the world less safe.”

Hmmm.

Looks like a majority to me.  A sizable majority.

But, full steam ahead…

Or, how about my predictable, favorite example ….

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Papal Visit: Little Sisters call in Big Papa…

September 25, 2015

Everybody must have their favorite moments from the Pope’s visit.

Here are my top 2 in reverse order:

#2  Obama was late getting to Andrew’s Air Force Base, so the Pope’s plane was put in a holding pattern over North Carolina to blow some time and arrive concurrently with the President.  Source

Pope's flight path

I got a kick out of this one since the men — who were totally in sympatico re: climate change change — didn’t flinch at the notion of burning a couple of hundred gallons of jet fuel.

The symbolism was awesome..

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What could possibly beat that ?

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ACA: More Americans insured, but vast majority are less insured …

September 3, 2015

I’ve  been wrestling with a conundrum ..…

Mainstream media continues to tout the success of ObamaCare … always focusing on the number of previously uninsured folks who now have insurance.

Most recent CBO numbers say that about 19 million previously uninsureds now have insurance – mostly from Medicaid and subsidized ACA Exchange policies.

Now, about 80% of the non-elderly population is covered … but, about 36 million are still uninsured.

Said differently, over half of the previously uninsureds are still uninsured.

Huh?image

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Let’s look at the cost …

ObamaCare added about $100 billion in annual government spending .

So, the cost per newly insured person is roughly $5,000 per newly insured person per year.

That sounds about right since an average individual health insurance policy is about $5,000 per year.

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OK, so what’s the rub?

Some simple arithmetic suggests that the aggregate monetary amount of insurance provided to the full population of non-elderly citizens has actually declined.

Here’s my logic …

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Stiffing Docs: High deductible plans pushing up bad debts … thanks, ACA

September 2, 2015

Chatting with a doctor-friend recently.

His is a very specialized 1-doctor practice (supported by a handful of well-trained techs).

Patients who are referred to him usually have a very serious condition needing sophisticated diagnostics.

My friend casually mentioned to me that – in the past couple of years — he has had to write-off more than $2 million in bad debts.

Way more than in prior years.

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Here’s what’s going on …

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Remember how your healthcare costs were going to go down by $2,500 per family?

August 18, 2015

Recently, a friend casually mentioned to me that his family finances were being strained by healthcare costs.

Why?

His family’s annual deductible had gone up from $2,500 to $12,500.

What?

Think about that for a moment … a 10-grand bump in out-of-pocket healthcare costs before the insurance even kicked in (with co-pays, of course).

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The discussion piqued my curiosity, and I did some digging to put my friend’s predicament in perspective … what I found was surprising (and certainly under-reported in the main stream media)

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Amazon and the “power of free” …

July 1, 2015

Everybody knows that Amazon’s free shipping program has been a resounding success.

So much so. that the company has announced that it will be moving the minimum qualifying order up from $25 to $35 … inducing shoppers to fill  their carts fuller or switch to the highly profitable Amazon Prime program.

The free shipping program’s success was highly predictable based an an apparently inadvertent “matched market test” that Amazon did.

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Here’s the skinny on the Amazon’s inadvertent market test …

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The irony of King vs. Burwell

March 5, 2015

Yesterday, the Supreme Court heard oral arguments in the latest  — and perhaps, the most significant challenge to ObamaCare.

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In a nutshell, the essence of the case is whether the ObamaCare law provides for insurance subsidies to folks buying health insurance through the Federal Insurance Exchange.

The argument centers on very specific – and very literal wording in the law.

To “motivate” individual states to set up their own insurance exchanges, the law law says that subsidies would only be provided to people who buy their health insurance thru state exchanges.  No provision was made for subsidies thru the Federal exchange.

ObamaCare supporters are arguing that the wording was a “drafting error” and that the legislative intent was to provide subsidies regardless of whether the insurance was bought thru a state or Federal exchange.  That’s somewhere between revisionist history and boldface lie.

Failing that argument, the fallback line of reasoning is that bad things will happen ObamaCare if it’s implemented the way it’s written.

That may be true, but this is a legal issue not a social issue.

Conservatives argue that the intent was clear (to bully states into creating exchanges) and that the law needs to be interpreted as written, not based on what might have been intended.

Of course, Chief Justice Roberts violated the latter point when he let the law fly when the individual mandate was challenged — coining the penalty to be a tax.

I expect the Justices to find for the plaintiffs and against ObamaCare.

Here’s where the irony creeps in …

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Bitter pill: Harvard faculty thought ObamaCare didn’t apply to them … oops.

January 7, 2015

According to the NY Times , the Harvard faculty is throwing a collective hizzy fit.

What’s their beef?

In a touch of irony, the same folks who cheer-led the passage of ObamaCare now feel aggrieved because they’re being forced to shoulder some of the costs.

To quote my grandson Ryne, “Oh me oh my.”

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Here’s the scoop … with some priceless snippets from the Times’ article

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Sen. Schumer awakens to gains, losses, the endowment effect

December 1, 2014

Last week, Sen. Chuck Schumer caused a stir in Democrat ranks’ by observing that President Barack Obama’s insistence on revamping the healthcare system was, in Schumer’s words, “misguided” and was a major cause of the GOP’s mid-term election romp & stomp.

Schumer is still all for massive healthcare changes.

His observation is strictly political.

His reasoning:

“Democrats were targeting the uninsured, a population that  makes up only about 5 percent of registered voters. Only about one-third of the uninsured are registered or eligible to vote.”  Source

Schumer’s on the right track, but misses a bigger point: When people are forced to give up something they have, they overvalue the loss and try hard to recoup it.

Think, the higher premiums and changed doctors that millions of folks have had had to endure.

Behavioral theorists have long observed that most people are risk adverse and, due in part to an “endowment effect”, they “value” losses greater than gains.

Endowment Effect: People tend to ascribe a higher value to things that they already own than to comparable things that they don’t own. For example, a car-seller might think his sleek machine is “worth” $10,000 even though credible appraisers say it’s worth $7,500. Sometimes the difference is due to information asymmetry (e.g. the owner knows more about the car’s fine points), but usually it’s just a cognitive bias – the Endowment Effect.

The chart below illustrates the gains & losses concept.

  • Note that the “value line” is steeper on the losses side of the chart than on the gains side.
  • L & G are equivalently sized changes from a current position.
  • The gain (G) generates an increase in value equal to X.
  • The loss (L) generates a decrease in value that is generally found to be 2 to 3 times an equivalently sized gain

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For example, would you take any of these coin flip gambles?

  1. Heads: win $100; Tails: lose $100
  2. Heads: win $150; Tails: lose $100
  3. Heads: win $200; Tails: lose $100
  4. Heads: win $300; Tails: lose $100

Most people pass on #1 and #2, but would hop on #3 and #4.

OK, now let’s show how all of this relates to ObamaCare.

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Weird poll results … explained by the “power of free”.

November 20, 2014

 

This was a wild week for ObamaCare.

First, there’s the steady stream “You’re stupid, America” videos from Prof. Jon Gruber.

Then, the 2nd Annual Open Enrollment period started for the Federal Health Insurance Exchange.

No big news there.

But, the combo of Gruber and the Open Enrollment, got the pollsters springing into action … with the politicos spinning like tops.

A couple of Gallup polls made news … with seemingly contradictory results.

The first was headlined:

 

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The second poll reported that moe than 70% of the folks who got their insurance through the Federal Exchange rated it as “good” or “excellent” …

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Seems contradictory, right?

Is it 37% or 70%?

Let’s drill down a bit to reconcile the numbers …

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Amazon and the “power of free” …

November 19, 2014

Everybody knows that Amazon’s free shipping program has been a resounding success.

So much so. that the company has announced that it will be moving the minimum qualifying order up from $25 to $35 … inducing shoppers to fill  their carts fuller or switch to the highly profitable Amazon Prime program.

The free shipping program’s success was highly predictable based an an apparently inadvertent “matched market test” that Amazon did.

image

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Here’s the skinny on the Amazon’s inadvertent market test …

(more…)