Reprehensible Republicans Ruin Medicare

Do you remember reading this from the Associated Press in mid-April? 

Suddenly, bipartisanship has broken out on Capitol Hill.

We were supposed to feel so proud of our Congress! They worked together, reached across the aisle, and enacted a permanent repeal of Medicare’s reviled SGR Fix (or Doc Fix)! 

Well, the Drive-By Media didn’t tell the rest of the story. What happened is this:

212 House Republicans and 46 Senate Republicans
joined the Democrats in radically changing the way
Medicare providers are paid
— and controlled —
by the federal government.

That’s right. The same GOP leaders vowing to repeal Obamacare just grafted it Big Time onto Medicare.

We expect this from the progressive members of Congress. But weren’t we supposed to expect a Republican Congress to lessen the size and scope of government? Didn’t last November’s election results reflect “a mandate to pass sensible legislation?”

And they wonder why we don’t take them seriously.

So who’s gonna pay for this knucklehead move? Eventually, you. 

Thanks to Congress, it’ll soon be very difficult to find a health care professional who’ll accept your Medicare card, since MACRA (Medicare Access and CHIP Reauthorization Act) applies Obamacare’s experiments to the whole program.

It wasn’t as if Medicare was untouched before MACRA, despite what HuffPo’s Jeffrey Young thinks. Thanks to Obamacare, pay-for-performance schemes like Accountable Care Organizations (ACOs) began in Medicare in 2012, and they’ve produced less than impressive results thus far. That didn’t stop our 2015 Republican “leaders” from expanding them.

What are ACOs? Think of the Health Maintenance Organizations (HMOs) of the 1990s, an idea that proved so wildly unpopular that patients revolted in near-universal protests about limited provider networks and rationed care. 

Still, the Obamacare Congress thought it was wise to apply HMO 2.0 to Medicare patients, but with an additional feature: patient satisfaction scores. That means ACO providers are financially rewarded for limiting care and procedures, but also have to make the patient feel happy about it!

(Never mind that payment for satisfaction is associated with higher health care expenses and a greater likelihood of hospitalization and death. The Obamacare Congress knows best.)

MACRA essentially forces all Medicare providers into Obamacare’s experimental ACOs. This spells the end to private independent healthcare practices, as providers must align themselves with a huge health system to survive.

Well, to be fair, doctors do have a choice. They can continue in traditional fee-for-service care, but anti-Obamacare warrior and ophthalmologist Kris Held explains the dangers of this route:

Government bureaucrats and committees will call the shots for Medicare patients. The law actually creates Alternative Payment Models (APMs) and a Merit-based Incentive Payment System (MIPS) which require physicians to follow a government rubric on which we will be graded in grade school fashion. Physicians, now defined as “eligible providers,” will get grades from 0-100 as determined by the Secretary of Health and Human Services. The grade for doing what the Secretary prescribes is called the Composite Performance Score. The score is publicly posted on the Physician Compare Internet Website of CMS, and the Secretary of HHS assigns each physician a payment adjustment factor based on this score. The payment adjustment factor will be positive, 0, or negative. Based on how well a doctor “performs” for the Secretary, the pay could be adjusted 9% up or 9% down, meaning the Secretary’s most compliant doctors will be paid 18% more than those who don’t perfectly make her wishes our commands. What will doctors put up with, and what will we do or not do for patients in order to be paid 18% more than those government deems “less quality” doctors and to avoid public humiliation on the government website? This is indeed chronic and continued abuse taken to a higher, institutionalized level.

That’s right. In either scenario, doctors will be scrutinized by federal bureaucrats aiming to reduce Medicare expenses by dictating care according to one-size-fits-all treatment protocols.

Since the passage of MACRA, many doctors are considering resignation from Medicare. “Opt out providers” will still treat you, but you’re gonna have to pay privately, outside Medicare’s supervision and reimbursement mechanisms.

This has one obvious disadvantage for the typical Medicare patient, since, depending upon the arrangement negotiated, costs may be higher to see these opt-out doctors. 

But it also means Creepy Uncle Sam won’t be in the exam room, and you’ll have care that is tailored to the individual, not forced onto you by Washington DC bean counters.

And it’s likely to be far more affordable than you may think, since health care professionals who opt out of arrangements with government and private insurance have reduced overhead costs. These doctors can charge less than their hand-cuffed peers, who can’t reduce fees for cash patients without violating government and insurance contracts.

As the Association of American Physicians and Surgeons pointed out when MACRA was passed, “opted-out physicians are able to charge a mutually agreeable fee (sometimes lower than the Medicare copayment), drastically reduce administrative overhead, give their patients the time that they need, keep records confidential, and prescribe according to their best judgment rather than a government-approved protocol.”

It’s reasonable to expect that, due to the “rising misery index” and increasing retirement rates among physicians, there will be far fewer of them in coming years. Among those that remain, a growing number will opt out of The System.

And you’ll know who to blame. This time, Republicans are the ones who apparently didn’t bother to read the bill.

Medicare providers wishing to learn how to opt out can visit here.

Americans wishing to do business with liberty-minded physicians can find them here.

Obamacare Scorecard: Takers Taking, Makers Breaking

When market research company J.D. Power released its 2015 Health Insurance Marketplace Exchange Shopper and Re-Enrollment (HIX) Study last Thursday, progressive health care reporters rushed to their laptops to declare Obama’s remarkable achievement:

Wowie!
Obamacare customers
are more satisfied
than people with job-based plans!

Vox’s Sarah Kliff offered her ‘splainer of the study, which was based on data collected from December 9, 2014, through February 24, 2015. 

People who had coverage through Obamacare had an average satisfaction score of 696 in 2014, thinking back to their last year of coverage. During that same year, people in mostly employer-based plans had a satisfaction rating of 679 — 17 points lower.

So did Sarah Ferris at The Hill:

People who bought coverage through ObamaCare are generally more satisfied than those with other types of insurance, according to a new national survey. ObamaCare customers rated their satisfaction over the last year as 696 out of 1,000, compared to the 679-point rating by customers with employer-based plans, according to a large survey by the consumer research firm J.D. Power.

And let’s not forget young Jonathan Cohn, who wrote a Huffington Post piece titled Obamacare News That Should Make Conservatives Happy, But Won’t:

J.D. Power uses a numerical index, from zero (low) to 1,000 (high), to measure consumer satisfaction. The figure for Affordable Care Act consumers was 696. To put that in perspective, the figure for people with employer-sponsored insurance — the source of coverage for most working-age Americans — was 670 [sic].

Here’s a question for Kliff, Ferris, and Cohn:

Are you really surprised that getting free stuff is popular?

…especially since J.D. Power found that “cost is the most influential attribute driving satisfaction among Marketplace plan members?”

Reporters of all stripes ought to know why Obamacare customers are happier than those in employer plans.

  • Obamacare enrollees enjoy the taxpayer’s helping hand with their premiums: in 2014, 90 percent received premium subsidies, and 69 percent paid $100 or less per month. 
  • Those in job-based plans are being increasingly hammered by rising out-of-pocket costs, as employers reduce benefits to avoid Obamacare’s Cadillac Tax. 

The New York Times provides one example of the excise tax’s impact on workers.

Starting this year, they have a combined deductible of $2,300, compared with just $500 before. And while she was eligible for a $1,400 hospital contribution to a savings account linked to the plan, the couple is now responsible for $6,600 a year in medical expenses, in contrast to a $3,000 limit on medical bills and $2,000 limit on pharmacy costs last year. She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.

Remember: Obamacare enrollees don’t have to pay the Cadillac Tax; only those with company plans suffer that burden.

The real story in the J.D. Power release, though, is not found in comparisons of people with different types of coverage: it’s found when one examines the insurance satisfaction index over time.

In 2009, the year before Obamacare was passed, that number was 712 out of 1000. In 2010, it plummeted to 701. And now, for those with employer-provided insurance, that number is 679 — and 696 for those in the individual market.

In their reports, the research firm (strangely) never mentions the sampling errors and confidence intervals that would allow for meaningful year-by-year comparisons. However, they do say they consider a ten-point change to be significant.

So overall, Americans are vastly less satisfied with their health insurance since Obamacare started monkeying around with it. That’s the story.

But our progressive health care journos didn’t write about that tidbit, did they? 

Instead, they put a happy face on the numbers, gleefully announcing that those getting freebies are happy with their free provisions, and those subsidizing those freebies are much less so. 

Duh. They must think their readers were educated at the Jonathan Gruber School of Stupid.

[Sigh] It’s all fun and games until we “run out of other people’s money.”

Meet Jeffrey Young, HuffPo’s Medicare Donut Hole

On April 17, Huffington Post’s Jeffrey Young admitted he doesn’t know squat about Obamacare. 

Referring to a Bloomberg article on Obamacare polling, he asked his Twitter followers to enlighten him as to one woman’s claims.

And then he revealed that he has no idea whatsoever as to Obamacare’s impact on Medicare.

“Eventually” deducing that she’s “almost certainly on Medicare,” not Obamacare, he writes off her report as nonsense.

Why, it’s as if Medicare and Obamacare are two distinct and unrelated programs! 

His reasoning? On the one hand, some poor schlubs lost their plans and had to sign up for lousy coverage in the exchanges. On the other, there’s Medicare, the insurance plan for the elderly and disabled. And never the twain shall meet, right?

WRONG, Mr. Young.  And Ms. Stone isn’t a befuddled octogenarian who doesn’t know the difference. 

Ms. Stone was treated at physicians’ offices through Russell Medical Center, which has partnered with the University of Alabama at Birmingham Health System (UAB) since August, 2012. At the time, RMC agreed to a plan of “working together to solve problems in health care delivery.”  In September, 2013, UAB embraced Obamacare’s ambition to reduce health care costs.

Ms. Stone has never had heart problems, but during a routine blood draw, her triglycerides tested at 600, almost 10 times her usual result. Her internist put her on multiple medications and referred her to one of RMC’s cardiologists. 

She then became a cardiac patient. 

With three master’s degrees and two specialty degrees, including one in psychometry, Ms. Stone was no fool. “I knew the lab was wrong.” But she couldn’t convince her doctors to retest her.

“They told me I couldn’t get another test for three months and that I’d need to take all of these medicines in the meantime. They said Obamacare was the reason.”

And they explained how Obamacare is influencing patient care: “The doctors are very dissatisfied, and many of them are not able to give their patients the attention that they feel that they need because they can’t have too many appointments, too many tests.”

The unaware and uninterested Jeffrey Young, HuffPo’s Obamacare expert, admits he’s “puzzled” by this. And this revelation is surprising since he’s written about the donut hole repair, Medicare costs, and the increasing out-of-pocket costs Americans are enduring. He even weighed in on King v. Burwell. One could fairly assume he’s researched the law in its entirety. 

Did he stop reading Obamacare when it came to its reforms of Medicare? Did he get sleepy?

As a national health care reporter, Mr. Young ought to know that no other group is as affected by Obamacare as are seniors on Medicare. The law created a variety of pay-for-performance experiments in Medicare, including the following:

Section 3001: Hospital Value-Based Purchasing Program
Section 3002: Improvements to Medicare’s Physician Quality and Reporting System (PQRS)

Section 3003: Expansion of Medicare’s Physician Feedback Program 
Section 3007: Application of Medicare’s Value-Based Physician Payment Modifier (VBPM) to Physicians Payments 
Section 3022: Medicare’s Shared Savings Program for Accountable Care Organizations
Section 3023: Bundled Payment Pilot 

The goals of these experiments are to reduce costs (in large part by limiting tests and procedures) and to improve the quality of care by “rewarding value” rather than the number of services delivered. 

The problem? Federal government bureaucrats, not health care professionals, are the ones defining quality treatment. And when health care providers don’t attest to their compliance with government-approved standards, they’re penalized.

This is what ophthalmologist and Obamacare rebel Kris Held means when she refers to the law’s perverse incentives that shift focus away from what’s best for the patient to what’s best in the eyes of The System’s cost-cutters.

As physician editor of The Hospitalist Danielle Scheurer cautioned last year, “there is a legitimate concern that physicians will be overwhelmingly motivated to play to the test, so that their efforts to perform exceedingly well at a few metrics will crowd out and hinder their performance on unmeasured metrics. This tendency can result in lower-value care in the sum total, even if the metrics show stellar performance.” 

And lower-value care is just what Dell Stone received, thanks to bureaucratic interference with her treatment. When her triglyceride levels tested alarmingly high, her physician clicked the boxes in his electronic health record and prescribed heart medications, including a potentially dangerous statin drug. And due to the drive to keep testing expenses low, a second lipid panel had to wait.

Thankfully, when Ms. Stone returned to her cardiologist two weeks ago, her three-month wait paid off and she was granted a retest. This time her triglyceride reading was 67.

So, yes, Mr. Young, Obamacare did cause harm to this senior — and is in the process of harming countless others. 

When The System begins experimenting with your grandmother’s care, Mr. Young, will you bother to research Obamacare a bit more?

Citizen Journalist v. Citizen Cohn: Obamacare Is All About Redistribution

This morning Huffington Post’s Jonathan Cohn let the cat out of the bag, admitting that Obamacare was a redistribution scheme.

Touché, Mr. Weinstein.

Do you remember anyone — journalist or politician — divulging that information before the law was passed? How about when Obama was running for reelection? Of course not. The policy would have been as unpopular as the Cadillac Tax is now becoming.

It’s unclear when Jonathan Cohn learned Obamacare was a redistribution tool, but he admits he was pretty cozy with the Obamacare architects during the law’s creation, especially with Jonathan Gruber.

And remember when Jonathan Gruber told his guests that Obamacare was written in a “tortured way” so as to deceive voters, especially as regards its redistributive mechanisms? 

In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in — you made explicit that healthy people pay in and sick people get money? — it would not have passed. Lack of transparency is a huge political advantage.

Where was the American press on this nugget? Oh, that’s right. They weren’t interested in doing any investigative journalism on the law. That discovery was left to a financial advisor in Philly, an ordinary American who tried for well over a year to get the incurious press’ attention.

But Obamacare doesn’t only redistribute wealth. It also redistributes health.

In his January, 2015, Forbes piece titled “Is Obamacare Squeezing The Middle Class?” John Goodman explains:

Poor, long-uninsured patients are getting Medicaid through Obamacare and finally going to the doctor’s office for care. But middle-class patients are increasingly staying away…Gallup polling shows what has been happening over time: Even though more people are insured today than in quite some time, more people are putting off medical treatment because of cost than has been the case in the past eight years.”

Even The Los Angeles Times had to agree:

[T]he law hasn’t provided much relief to American workers either, according to a new study of employer-provided health benefits. Workers continue to be squeezed by rising insurance costs, eroding benefits and stagnant wages, the report from the nonprofit Commonwealth Fund found…”Workers are paying more but getting less protective benefits,” the report’s authors noted. 

Last December, The New York Timessurvey showed the impact of health care expenses on Americans, concluding that:

Affording medical care is more of a hardship.
Out-of-pocket expenses have gone up.

It’s an axiom of economics (and common sense): when you increase the costs of a commodity, in this case health care, you reduce demand for it. And so middle-class Americans, hammered by rising expenses, are avoiding care, even if that doesn’t bode well for their long-term physical and emotional health.

This will be a story that plays out over coming years.

But the concepts of health and wealth redistribution should have been put before the American public, by lawmakers and journalists like Jonathan Cohn, before the law was passed — and then cemented by Obama’s reelection.

It’s likely, however, that they thought we were too stupid to understand how amazingly awesome Obamacare would be for us. Progressive elitists always think they know what’s best for the unwashed masses, and if they have to lie to get their policies through, they will. To Obama and his ilk, the ends always justify the means.

How Obama Learned To Stop Worrying And Love The Obamacare Bomb

Last fall Duke University research scholar Chris Conover wrote a powerful piece titled “Obamacare’s Three-Legged Stool of Deception,” in which he explained the covert way Obamacare crafters aimed to eliminate job-based health insurance through the Cadillac Tax.

  • The first leg is that the Cadillac tax is paid by insurance companies, when in reality it is paid by employees. 
  • The second leg is that the Cadillac tax is aimed at “lavish” high cost plans, when in reality it is designed to eventually hit virtually every employer health plan (even those with lower-than-average costs). 
  • The third leg is that the Cadillac tax is functionally equivalent to a reform long championed by conservatives: a cap on the tax exclusion for employer-sponsored health insurance. 

Dr. Conover hit a home run in detailing the duplicitousness of the law’s architects, and his piece is probably the best exposé of the Cadillac Tax you’ll find.

But who designed the Cadillac Tax, and how did Obama come to love it?

In his first presidential campaign, Obama repeatedly maintained that he was dead-set against taxation of health insurance benefits. He even chastened his opponent, Senator McCain, for proposing that Americans receive tax credits instead of tax-free insurance benefits.

“This is your plan, John: for the first time in history,
you will be taxing people’s health care benefits.”

Ezekiel Emanuel, special advisor for health policy during the law’s creation, gives us important insights into how, in the summer of 2009, Obama decided campaign promises weren’t as important as was more money in the federal coffers.

Zeke describes a “hot Friday July afternoon” in the White House when he says the “core health team” was working on Obamacare. After about an hour, he recalls, the president walked in, “in his shirt sleeves with his cuffs rolled up. He was there to give us a sort of uplift.” After pleasantries were exchanged,

“I raised with the President one of the issues that had been burning up the staff — the issue of something called the Tax Exclusion.”

In both videos linked above, Zeke describes the issues he and others had with tax-free employee benefits: 

“The big argument we were having was, people on what was called the economic part of the health team…we wanted to do something about the tax exclusion because it’s inflationary, it’s regressive, it’s a lot of money.”

One obstacle? Obama wasn’t clear on his stance: 

“We got into some weeds, and he would say, ‘What did we say about that? What was my position on that? ‘Cos the people should know I stand by my position.’” 

And since David Axelrod, his senior advisor, pointed out that he’d spent $100 million running ads against McCain’s position, the Campaigner-in-Chief stalled, worried that he’d be contradicting his promises.

“David Axelrod, as part of this debate internally, created a montage of all the ads that President Obama had run against John McCain attacking McCain’s proposal — which was basically to get rid of the tax exclusion and give people a tax credit instead to buy health insurance.”

Eventually the economic team won Obama’s heart by showing him how much power and money ($250 billion per year) the Cadillac Tax would grant him.

“I said, you know, Mr. President, as President, you can control a lot related to the public provision of health care insurance — Medicare, Medicaid, CHIP, veterans health benefits — but you don’t have a lot of power over the private side. And that, after all, is the bigger side. It’s most of the money, covers half the American population.” 

That “hot Friday” was July 17, 2009, when the Washington, D.C., temperature soared to 90.9º.

“(O)ver the course of the next few days, this was Friday, then Monday and Tuesday we had meetings around this, the idea began to hold that we should do something about it, we shouldn’t roll it back, but we should modify it.”

The following Monday and Tuesday were July 20 and July 21, 2009. White House visitor logs show an “Economics Team” indeed met the morning of the 20th. (White House visitor logs also indicate that the beloved Jonathan Gruber was in attendance!)

So why did THIS happen, on Thursday, July 23, 2009, in Shaker Heights, Ohio?

“First of all, in terms of taxing benefits, I said I oppose the taxing of health care benefits that people are already receiving, so that’s not a proposal that I’m supportive of…But what I said and I’ve taken off the table would be the idea that you just described, which would be that you would actually provide — you would eliminate the tax deduction that employers get for providing you with health insurance, because, frankly, a lot of employers then would stop providing health care, and we’d probably see more people lose their health insurance than currently have it.”

Dear President Obama, wasn’t that exactly the goal? That we lose our plans and have to join your lousy exchanges?

It’s very odd that Obama repeatedly characterizes his views using terms like “what I’ve said is,” rather than “what I believe is.” 

But it’s more than disappointing to learn that Obama lied to his Shaker Heights audience — and America — mere days after he fell in love with the bomb that will blow up job-based insurance.

H/T Citizen researcher Kathy in Alabama

April Fools’ Bracket: Who Wins? The Cannon or The Gruber?

Financial services company Sun Life is again hosting its Wake Up Summit. Its last webinar explored the effect of Obamacare on the nation, and Jonathan Gruber, MIT economist and Obamacare architect, was a speaker in the keynote address and a contributor to one panel discussion (registration required to view). 

The conference could have been described as boringly collegial.

This year’s webinar occurs on April Fools’ Day and may prove more provocative. Wake Up Summit 2015 will again feature Jonathan Gruber, but this time alongside Michael Cannon, the Cato Institute’s director of health policy studies and, with legal scholar Jonathan Adler, one of the masterminds of the so-called Obamacare “subsidies cases.” The informed reader will recall King v. Burwell as the case most recently heard at the Supreme Court.

If you’re free at 2:00 p.m. on Wednesday, you can register to watch it live here. Click the RSVP button on the right side of the page.

You can also make the event more lively. Sun Life is inviting questions before the event. 

You may have a variety of questions of your own for Mr. Gruber. But you could also pose questions like these, for either participant:

1. Everyone’s heard that “if you like your plan, you can keep your plan.” Would you please explain how the ACA affects those who receive health insurance from their employers?”
2. When Senator Obama ran for office he promised not to eliminate the tax exclusion for job-based insurance. But doesn’t the Cadillac Tax achieve the same goal over an extended time frame?

3. Don’t you think the Cadillac Tax is mislabeled since it appears to eventually impact most if not all job-based plans?
4. Why does the Cadillac Tax cap grow at CPI or CPI +1? Won’t that assure that most if not all plans become Cadillac Tax plans?
5. What do you think of S&P Capitals’ recent prediction that by 2020 90% of those with job-based coverage will be shifted to the ACA exchanges?
6. Do you agree with Medicare chief actuary Richard Foster’s prediction that “essentially all Americans” will over time get their private coverage through ACA exchanges?
7. Exactly how does the ACA cause “wage growth” for workers?
8. The CBO scores the ACA as improving the deficit more in the out years than in the first ten years. Why is that?
9. Do you think the ACA is more like Romneycare or Hillarycare?
10. If states do not establish their own exchanges, what role do states really have with regard to the ACA?
11. Is a “single payer“ health system more likely if the ACA fails or if the ACA succeeds?

Of course, you’re also free to ask not-so-serious questions of either Mr. Gruber or Mr. Cannon, questions like these:

1. Why aren’t you, Mr. Gruber, still hiding under a rock?
2. Are you, Mr. Gruber, capable of feeling shame?

3. Mr. Gruber, would you like to clarify your “falling off a building” prediction for workers losing job-based insurance?
4. Mr. Gruber, why were your Obamacare models so wrong?
5. Have you, Mr. Gruber, apologized to your family for publicly humiliating them?
6. Has MIT placed any sanctions on you, Mr. Gruber, given your damaging effects on its reputation?
7. Mr. Gruber, when will you turn over your “research assistants’” records?
8. Mr. Cannon, how did you become so flipping awesome?

Feel free to offer your questions in the comments section below. But it’s far more important that you send them to Sun Life.

Of course, as Mr. Cannon points out, Mr. Gruber may not show up at all. 

John Kerry Is No More Trustworthy Than The Disgraced Jonathan Gruber

In summer of 2009, as Obamacare crafters were assembling their plan to destroy the U.S. health care industry, they faced several problems, and most of them involved financing.

Over twenty years ago, Mrs. Clinton’s health reform plan died when the Congressional Budget Office (CBO) determined it would cost too much. 

Learning from her failure, White House officials knew they had to create a plan the CBO could score as budget-neutral. But where, oh, where, would they find the money to not only subsidize insurance purchases but also fund an “unknowable” number of new agencies, boards, commissions, and task forces? 

It was at that point in late-July that Obama’s economic team advocated that the plan eliminate the tax exemption for job-based insurance. What was later dubbed the Cadillac Tax would result in an estimated federal tax grab of $250 billion per year. 

But, as Jonathan Gruber told a Boston audience, any plan that ended the tax exclusion would have been a political hot potato. “Economists have called for 40 years to get rid of the regressive, inefficient and expensive tax subsidy provided for employer provider health insurance…It turns out politically it’s really hard to get rid of.”

That’s where then-Senator John Kerry became Gruber’s “Massachusetts hero” by introducing a scheme to trick Americans. “No, no,” Gruber quotes Kerry, “we’re not going to tax your health insurance. We’re going to tax those evil insurance companies!” 

 When we all know it’s a tax on people who hold those insurance plans.

An ordinary person responsible for such duplicity might have experienced regret, even shame. But not Kerry, who, like Gruber, aimed to exploit Americans’ “lack of basic economic understanding.”

Less than six months later, Kerry doubled down on his deceit, penning a January 2010 Huffington Post piece explaining his support for the Cadillac Tax.

It will help control future health care costs without — I repeat without — directly taxing employees.

Notice the word “directly?” By this he means the tax on insurance companies will be borne by the worker, but certainly not clearly or directly. It was intended that Americans blame insurance companies and employers for jacking up premiums, deductibles, and copayments. (In fact, Harvard faculty members are already blaming the university for out-of-pocket cost increases.) Later, they hope, we will curse our bosses for eliminating job-based insurance altogether.

The excise tax included in the Senate-passed health care bill will affect only a small portion of the very highest cost health plans.

Not according to the American Health Policy Institute, who projects the tax will “hit 17 percent of all American businesses, and 38 percent of large employers” in 2018. And as Gruber explained, the method establishing the yearly tax threshold means that eventually all plans will be subject to the Cadillac Tax. 

For the small sub-set of plans that are affected, the likely impact will be to increase workers’ wages. MIT economist Jon Gruber recently found that the excise tax included in the Senate bill would lead employers to raise wages by $223 billion between 2010 and 2019. In 2019, wages for those affected by the provision will be higher by about $660 per household. I repeat — raise wages.

Did anyone think to ask Kerry how a tax on insurance companies naturally produces higher pay for America’s workers? That’s a curious connection, isn’t it?

Well, you see, Secretary Kerry conveniently omitted the “Employers-Kill-Your-Health-Plan” factor in his analysis. What he failed to mention is his apparent belief that, as employers shrink insurance benefits or dump employees in Obamacare exchanges, they’ll compensate them with higher wages. 

(By the way, this is an assumption based on Gruber modeling, the same model predicting that our health insurance premiums would fall under Obamacare.) 

Finally,

After spending years and years hearing from workers tired of seeing their unions forced to spend all of their energy at the bargaining table just to hold on to health care instead of negotiating for better wages, we now have a way to help increase wages and improve health care simultaneously.

If Kerry believed union workers would gleefully skip off to the Obamacare exchanges, he was wildly uninformed.

Let’s not forget: this is the same John Kerry currently negotiating a nuclear agreement with Iran. 

More than likely, Iran’s mullahs will fare better than Americans have with Obamacare. 

But they may have to sign the deal to find out what’s in the deal.