Things must be getting grim on the Obamacare front if the Obama administration feels it must send "Zeke the Bleak" Emanuel out to defend it.
Though he was on relatively good behavior compared to previous interviews he has given, Emanuel, rather than visibly losing his cool, kept on using Stuart Varney's first name in his responses during a Fox Business interview this week to the point where it nearly came off as an attempt at parent-child condescension.
The sad fact is that Obamacare has become a ever more expensive (to the taxpayers), fraud-vulnerable, and fraud-riddled mess.
Emanuel, considered one of the key players in the development of the Affordable Care Act, is a champion of medical rationing. In the interview, he refused to characterize "risk corridors" and "reinsurance," schemes by which the government covers participating insurers' losses without question, as subsidies, which they absolutely are — unless you want to call them flat-out giveaways or wealth redistribution, terms which are really more accurate.
As will be seen, Varney wasn't in a mood to let Emanuel's pathetic attempts at defense slide. They weren't as dense as the line of argument Mike Barnicle tried on MSNBC on Friday (i.e., insurance companies should "retool their approach to it in order to make [money]"), but they weren't constructive, or anything that hasn't been tried (HT The Blaze):
Transcript of most of the interview (bolds and numbered tags are mine):
STUART VARNEY: ... How are you going to keep people like the United Healthcare Company, how are you going to keep them in the system? Because you've got to have them. Are you going to consider giving them government money, subsidizing them?
EZEKIEL EMANUEL: So first of all, you're absolutely right, we after have insurers, they have to offer Products for the exchanges to be viable. Second, we need to put united in context. United was very tepid about joining the exchanges early on, did very little, has never been a very active player. Even at its absolute peak, the largest insurer in the country, as you mentioned, had 6% of the exchange market. It's never been a big player, and it is not completely exiting the exchanges. We still don't know how many States it's going to leave. They've said five so far. B But it's been an 34 states, so they may well stay in most of the states. But I think your point —
VARNEY: You're sounding a little defensive here.
EMANUEL: No I disagree with you.
Look last year last year you guys highlighted 39 insurers are leaving marketplaces. It turns out, 40 were joining, but you didn't advertise that. The fact is that net last year, for 2016, we actually had an increase in the insurers. And again, you're focusing on United, but you're not focusing on others. I do agree with you on one important point, which is the exchanges have had more people who are at higher risk of more healthcare services than we anticipated. That's because there was a lot of latent, unmet medical need among poor people. [1]
VARNEY: You need the United healthcare as of this world in. What do you do?
EMANUEL: I think there are three important things that need to be done.
The first is, you have to attract more healthy people to get into the exchanges, and that involves making sure that the website keeps improving, and gets substantially better.
Second of all, you have to continue to educate the public. Still, many people, they read these high increases. They don't realize that net-net for 2016, after most of them got their subsidies, actually premiums went down for them, not up. [2] And so I still think there's a big educational push that we need to make.
And the third thing is, I do think, and I've always advocated this, because of the uncertainties of the market, it still hasn't settled down. We still need reinsurance and risk corridors. And I think those are important things.
Do you label them subsidies? I don't label them subsidies. I think they're good business practices in an uncertain market, where we're still not sure who's going to participate. That's not a subsidy. [3]
VARNEY: You are not as chesty as you were the last time you were on the show.
EMANUEL: Oh I'm very chesty.
... VARNEY: mid-level silver Obamacare plan, the premium increases 11% this year, more next year probably -
EMANUEL: Now now now wait. Stuart, you always - You are not telling the truth.
VARNEY: - deductibles of thousands of dollars a year.
EMANUEL: Stuart, now you're trying to throw out red meat to me by not telling the truth.
VARNEY: it's not going well and you know it. Come on. Where's in admission then maybe you should've done this or that?
EMANUEL: Stuart, the fact of the matter is that for 2016 which is the only time we have premiums data, If You know, 12, the premium level went down in 12 states. The average after the subsidy premium was actually down 9%, not up across the country. [2] So you're idea that this is falling apart is simply wrong.
VARNEY: Simply wrong. Okay.
EMANUEL: Yes. I agree with you, we do need to attract insurers, we need to keep them in, we need to attract more healthy people to participate and get health insurance, and we need to provide reinsurance and risk corridors.
VARNEY (talking while Emanuel repeats his talking points): “You have no idea how many people come to us and say, ‘These deductibles, they’re killing me. It’s not insurance, it’s just, I’m paying through the nose. [4]
EMANUEL: Correct.
VARNEY: You have no idea how many people come to me and complain, "80 percent of the people in these exchanges are getting a subsidy — I’m paying for them." It goes on, and on, and on. [5] You can’t tell me that Obamacare’s a wild success, can you?
EMANUEL: Stuart, let me give you a suggestion. When you get your insurance through Fox, all your coworkers are paying a subsidy for you too, and that is the way insurance works. [5] Insurance works by everyone pooling their resources, and whoever needs it, needs it. We do it for Medicare. [6] Again most people who paid into Medicare have not paid in the amount they're actually going to take out. We do it in lots of other ways. Health insurance is the way that we spread the risk of across everyone. That's its purpose. That's what we want. So when people need healthcare, they don't have a financial barrier, and Obamacare is working to that goal.
... EMANUEL: I have been advocating to control healthcare costs precisely to keep premiums down. That is the key. [7]
Notes:
[1] — That doesn't pass the stench test, for a few reasons. First, Medicaid has been there for truly poor individuals and families all along. Second, Obamacare's enrollment process forces people into Medicaid based on their income and regardless of their assets, so a lot of what looks like unmet need is really "shifted utilization. Third, the administration, and GOP presidential candidate John Kasich, to his eternal shame, have been claiming that "Medicaid is not part of Obamacare," despite the fact that one of the obvious goals of the Obamacare enrollment process has been to herd as many people into Medicaid as it possibly can.
[2] (tagged twice) — If premiums went up as Varney stated and if the net premium after subsidies went down as Emanuel claimed, then the taxpayers have been placed on the hook for funding the subsidies to a far greater degree than in previous years. This is not progress.
[3] — Insurance companies have tried to price Obamacare policies competitively and affordably (with Uncle Sam watching over their shoulders constantly), and have been unable to do it. If "risk corridors," a euphemism for "covering the industy's losses," existed, there would be no incentive for insurers to abandon a losing cause when they clearly should. The industry would never "settle down." Emanuel just doesn't like that fact that when Obamacare settles down, it will be because so many insurers jump ship that the program becomes obviously and unacceptably unsustainble forever.
[4] — Varney is exactly right. Obamacare has attempted to force down medical spending by raising deductibles to the point where people are putting off medical procedures more than they were before the law took effect, reaching an all-time high of 33 percent in 2014. Even with people holding back on getting treatment, costs are still skyrocketing.
[5] (tagged twice) — Real insurance spreads risk. Obamacare redistributes wealth, charging differentially higher costs well beyond any risk-based justification for, among other things, people whose incomes are higher, people who use tobacco, and those who are married.
[6] — Medicare isn't "insurance" in any way, shape, or form. In Medicare, today's workers pay for healthcare for the elderly. There is no meaningful "trust fund, making it a pure intergenerational Ponzi scheme.
[7] — "Zeke the Bleak" wants to control costs by rationing care. Obamacare's Independent Payment Advisory Board is ready to step in when the time is right to start making it happen.
In sum, Obamacare, in vastly expanding the Medicaid rolls and making millions of Americans depend on subsidies to obtain and retain insurance, is functioning as a step towards what Nevada Democratic Senator Harry Reid, in a rare moment of candor, admitted in 2013: a single-payer system where the government has control over how, when and whether you'll get the medical you need.
Cross-posted at BizzyBlog.com.
