Three Blind Mice

Three-parts gubernatorial candidate; one-part people's vote on the Massachusetts Sales Tax Rollback.   Apparently, that's the recipe for a bun cake of retarded political douchebaggery, according to this article from Boston.com.   This story (curiously?) came and went with little fanfare or discussion in this little blue state, considering the November mid-term races are heating up.

How is it that all three candidates have absolutely zero response for the prospect of a $2.4B revenue gap?  Maybe list out some sensible budget cuts?   Instead they simply bang away on the scare-tactic of "limiting local aid" which has been a proven winner to sway the pussified liberals here in the past. 

[T]he major candidates for governor, all of whom say they oppose the initiative to reduce the sales tax rate from 6.25 to 3 percent, a move that would cost the state up to $2.4 billion in annual revenue beginning Jan. 1.

What if voters approve it anyway? Well, the candidates say they'll cross that bridge when they come to it.

"If that's the decision they make, we're all going to have to deal with it in state government one way or another," said Republican candidate Charles Baker, who supports rolling the rate back to 5 percent. "Of course everything would be on the table."

Baker's lack of a plan is shared by independent candidate Tim Cahill and incumbent Democrat Deval Patrick.

Cahill, who also supports rolling the sales tax back to 5 percent, said he will "enforce the will of the voters and will wait to see what they decide," but hasn't outlined what he would cut to make up for the sudden loss of revenue.

Patrick, who supports returning the sales tax rate to 5 percent after the state fully recovers from the recession, also has yet to detail how he would cope with the cut but warned through his campaign that a cut to 3 percent "would have a devastating impact on the essential services that everyone in the Commonwealth relies upon."

This should be eye-opening to any voters who believe the ridiculous notion that either party is serious about fiscal sanity.  They both want to spend.  One is no better than the other.   Time for residents in this state to wake up and choose someone who will lay it on the line and start talking about cuts. 

Good Dem, Bad Dem

So Politico posted a piece on Sunday, claiming that President Obama's 2010 priority is getting Deval Patrick re-elected as governor of Massachusetts.    To which I say, are you out of your God Damned Mind?!

Deval Patrick is political fucking napalm - and not in the ass-to-mouth-loving, Jessica Simpson way.   This is a guy who fucked over the unions that got him elected, raised the state sales tax, built his entire campaign on legalizing casinos (which failed miserably), and just cost a major provider of jobs in the state $100M when employment is already on shaky ground as it is.

This guy embodies  reason that Scott Brown got elected to the Senate in January; people are sick of tax-and-spend-achusetts and Deval represents the very foundation of that angst.   As I've said before in this space, while Obama's voting record as a Senator may have been to the left, his governing as president has been very much centered.   This is what makes him a desirable political figure in today's age of hyper-partisanship and hate-fueled rhetoric.    Aligning himself with a guy who's liberalism would make Gore Vidal blush can't possibly be a political home run.   He shouldn't have to disown the guy, but he should at least watch from a safe distance.

Deval Patrick - you're doing it wrong, ctd.

Dammit all, Deval.

Using crappy public opinion of health insurers to your political advantage is a deceptive practice, to be sure, and to boot he clearly doesn't understand how premiums are established.  In fact he probably thinks like these commenters on Boston.com do:

Thanos73 wrote:

ToniCa wrote:
"Deval just doesn't get it. Health care cost increases come from hospitals and doctors. The insurance companies have to increase their rates based on what the hospitals and doctors charge them"

Wow, you really need to put the pipe down. The Insurance companies dictate rates to Doctors and Hospitals, they don't negotiate.

Thanos73 here may want to ask the hundreds of people who work in Provider Contract negotiators and Actuaries at insurance companies what they think about his comment.  Does he really think payers pull premium increases out of thin air? 

Then there's this...

JasonSeacrest wrote:

I have yet to hear from the Insurance carriers WHY they needed these huge increases (yet again.). There's no inflation..so why are only YOUR costs increasing?

Is it to feed the stockholders that 10%+ return on their investment? Nobody else is getting raises, why should you?

EXPLAIN!

SURE, JASON!   In Massachusetts fully-insured plans are Not for Profit, so it's not as if shareholders are making a ton of money every year because (drum roll, please) there are no shareholders!  Why isn't Jason calling his PCP and asking why he's getting that 10% raise every year?   The misconceptions in this debate are staggering. 

Look, I get it: we all saw Erin Brokovich and know there are evil health insurance companies out there that deny services for the really sick and reject coverage for those with pre-existing conditions all while whistling their way to the bank.  Those companies needed to be dealt with and ObamaCare did that for the other 49 states.  But in Massachusetts, land of Non-Profit health, universal care and bans on preX denials?  Why the hell are you stomping all over us?  We're not the bad guys!!

As I've noted before on this blog, this concept of limiting the premiums without addressing what drives 90% of those costs addresses the symptom and not the disease.  Provider contracts are negotiated on a bi-annual basis and those contracts that are already set for this coming year can't be changed because they're, you know, legally binding and all that.  Also premiums are based upon utilization as well and there's been a spike, which the proposed rates were an answer to.  So basically two unmovable forces are crashing head-on into the now-easily-moved-because-Deval-said-so force.

It's a bandaid and one of two things will happen as a result.  1) Payers with already shaky bottom-lines will be in trouble and you could see some smaller plans go out of business, or 2) Rates will go up in subsequent - *ahem* non-election - years to offset the loss caused by this year's rejection.

Another crappy thing about the potential byproducts are their indirect impact on the national health care debate.   For Republican's dying for talking points to bash ObamaCare, this overreach by Deval Patrick and Massachusetts democrats comes at just the right time.  "Look at Massachusetts!   They passed universal health care and within three years were setting costs in the private market!"

My prediction:  when Fallon or one of the other smaller insurers goes out of business, the first headline you'll see on Fox News:  "ObamaCare claims first victim!"  Even though anyone with half a noodle in their head  knows the two are not related. But it doesn't have to have a basis in reality if it sounds scary! 

If this is Deval's Hail Mary for re-election, he may have just tossed it right through the hands of Barrack Obama.

Deval Patrick - you're doing it wrong (again!)

Raise your hand if you want Health Care costs to go down (or stop going up)

Wow, that's just about everyone.  No surprises there.   Now raise your hand if you think capping insurer premium hikes without capping provider contract hikes is a financially viable way to control premiums.

Confused?   Well don't feel bad because the Governor of Massachusetts doesn't understand this either.  See, if 90% of premiums cover medical expenses and those expenses can rise by 10-12%  but the premiums can't rise higher than 4.8%, then there's a bit of a discrepancy on the bottom line. 

Simple-minded people like using lemonade stands for analogies and I like simple terms so let's try this one.   Little Cindy runs her lemonade stand and can only purchase lemons from Massachusetts lemon growers.   One of those growers is a massive conglomerate that has banded together most of the biggest lemon farms in the state for bargaining power.   They pretty much dictate what the costs should and will be for all farmers in the state.  Every year this massive group jacks up the cost of lemons by 10-12%.

Now, Deval Patrick doesn't like that every time he stops at Cindy's stand the cost for a glass goes up.  So he makes a law that says Cindy can't raise her lemonade cost but in the meantime the lemon growers can still demand the big increase because no law prevents that.   Eventually, where does Cindy's margin go?  How can she pay workers' salaries to squeeze the lemons and run the stand?   She can't and now little Cindy is on little kiddie unemployment.  

Look, from a free market perspective, telling the doctors they can't make money is no better than telling insurers they can't but by imposing this on the insurer side is treating the symptom but ignoring the cause.  The biggest mistake the general public makes is to constantly lay the blame solely at the feet of the insurers without ever asking why the docs' costs have to go so high every year. 

What can you do to help?  Well, unless you're a physician or a contract negotiator at one of the payers, you can't have a direct impact.   But indirectly you can be prudent about the care you utilize and push back on your doc when they order excessive tests or visits for ridiculous things.  

One of my bigger pet peeves was when my doc prescribed my a pump blocker for heartburn.  He told me when he wrote it that I would have to take this medication for the rest of my life.   But then when the script ran out, the office manager told me I had to come in for a refill?!  Huh?   We already know what I have to take and why and no magical new information can be garnered from the visit.  Why on earth would I be asked to come in for this needless formality?    Because it's in the doctor's best interest to schedule as many appointments as possible.  Straight Cash Homey.  Obviously I argued this point and established a standing order with my primary for the meds.   It's that easy.   

So be smart.  Ask questions.  Demand that your health care costs are being used in efficient ways.  You have the right and you certainly have reason to do so, if you want premiums to go down.