Two Midnight Rule: What Do You Expect?

What happens when government takes over health care?  You get dozens of bureaucratic horrors like the "two midnight" rule for Medicare.  What is the two midnight rule?  It is rule CMS 1599-F.

This new, Obamacare-forced rule specified that a hospital stay can only be paid for by Medicare insurance if that stay “(1) expects the beneficiary to require a stay that crosses at least two midnights and (2) admits the beneficiary to the hospital based upon that expectation.”

In the American Spectator, Jeffrey Lord does a fine job of playing the Democratic Party helpless victims game, telling the story of one Frank Alfisi, who died because he needed to be admitted to hospital to get a kidney dialysis.  A dialysis doesn't need a two day stay, so Medicare wouldn't cover it and the hospital wouldn't perform the dialysis.  Alfisi was too sick for a regular dialysis.



So President Obama killed Frank Alfisi.



On the contrary, this is what you get when you put the government in charge of things.



This is what you get when you pretend that the government can act like a compassionate daughter, like Frank's daughter Amy.



This is what happens when you believe politicians that say that they care about people.



This is what happens when people buy health insurance and assume that it takes care of everything.



The fact is that all institutions, from government to insurance companies to hospitals, run on rules.  The rules are arbitrary.  The rules say that we will do stuff for you if you the facts say one thing, and we won't do it if they say another.



Of course our modern world is drenched in institutions like this, starting with the rule of abstract principles.  Everything is subject to the tyranny of rules and principles.



In fact, of course, life is a lot messier than the rules and the abstract principles pretend.  You see it in the assumptions of Newtonian mechanics, that it is dealing with point particles and frictionless motion.



And you see it in the assumptions of 1,000 page bills to reform the whole health care system.



There are two things that can overcome the rules.



One of them is money.  If you have the money, you can tell the hospital: screw the rules; I'll pay for the admission and the dialysis.  Unfortunately for Frank Alfisi he had already spent all his money caring for his deceased wife in her terminal illness.



The other thing is love.  You can say: I don't mind what it costs, we are going to stump up the cash for dear old Dad.



But in our degenerate age we prefer to re-enact the helpless victim as poster boy melodrama.  We ask, with TV cameras rolling, how "they" could be so heartless as to deny care to Frank or to deny coverage to Betty.  Everyone knows their role, from tough reporter to tearful relative, and plays it to perfection.



Some of the better modern thinkers have recognized the problems with the modern age of reason.  They recognize that instrumental reason is mechanical, that institutions based on modern reason act "strategically," that you can't make an omelette without breaking eggs.  That something else is needed, something other than systems and bureaucracies.



The modern era has been going for about 200-500 years, depending on your taste.  It's long past time for anyone to be shocked by the heartlessness of modernity.  We should all recognize that modern governments and insurance companies and hospitals are purely "strategic" institutions.



If you don't want to fall between the cracks you need a Plan B.  Otherwise the "two midnight" rule or its close bureaucratic relative is going to get you.

What Will Happen to the Loser in Obamacare's War

I was talking to a dentist this morning about his win-win strategy at work.  He has a scheduler that gets a bonus every time she fills the daily schedule for the hygienists.  Win-win.  Win for the dentist, keepings his expensive hygienists busy earning revenue; win for the scheduler, who gets to share in the profits of the firm's extra revenue.


Now let's talk about government.  In the last few months I've moved from Government is Force to the idea that government needs a war.  That's why we have wars on communism, wars on poverty, wars on drugs.  It's obvious.  If government is force then government needs a job where force is called for.  Force is, we'll agree, an extreme remedy for any ill, so any government initiative must represent itself as a remedy for a monstrous evil in its inevitable call for force.  In other words, a war.



But the thing about a war is that usually it ends up with a winner and a loser.  In the great wars between nations the losing side really gets hammered.  I am thinking about France in 1815 after the Second Hundred Years War.  The fact is that France has never amounted to anything since 1815.  Or Germany after 1945.  The fact is that Germans invented pretty well everything in the period from 1800 to 1930.  But after Hitler stripped the brain out of Germany and tossed it over the Atlantic, and after Germany lost WWII, well, Germany just doesn't cut it any more.  Russia after losing the Cold War?  Not so hot.



And here's another thing.  Germany and Japan and Russia, the three big losers in the last century, all have very low birth rates, way below replacement.  In other words they are heading for oblivion.  Is that always what happens to nations defeated in war?



Now back to the US and our notorious divided nation.  And Obamacare.



Let us leave aside the notion that one of the arguments for limited government might be that we want to avoid winners and losers here at home.  Because we are all in this together.  We lost that argument, at least until the next revolution.



Let us think instead about the risk in a big domestic war like Obamacare that the folks that started the war might lose it.



It's a commonplace that nations start wars without seriously thinking about the consequences.  Certainly this has been true about Obamacare.  The Democrats went for Obamacare because it has been part of their 39 Articles since whenever: national health care.



We won, they said in 2009.  So we are going to do Obamacare.  We aren't going to do health reform that gets some Republicans in for a fig-leaf "bipartisan" bill.  So the Democrats went for decisive victory.



Imagine what would have happened if Obamacare had been a stunning success.  It would have demolished the Republican Party.  But it wasn't, and we know why.



Obamacare violated Irving Kristol's Rule.  If you want to help the poor, you must deal in the middle class.  Only Obamacare didn't.  It couldn't, because the middle class already has health insurance.



So, as Rush Limbaugh pointed out, the smart middle class voted Obamacare down in 2010.  The non-smart middle class is going to be voting against it in 2014.



Here's what I wonder.  What is going to happen to the Democrats after their glorious Eastern campaign for Obamacare hits its Stalingrad in the fall of 2014?



The reason that politicians are notorious and annoying trimmers and compromisers and log-rollers is that they instinctively know that a decisive battle is too risky.  Yeah, they could win, but what if they lose?



The consequence of Democrats losing in 2014 as the American people turn decisively against Obamacare is incalculable.  Because there has been nothing like it in our collective experience. A great government program in which one of the US political parties has invested all its marbles gets decisively defeated.  And the political party in question gets stuck owning the devastating defeat and failure.



Democrats have no clue what is about to happen to them.

Reaching Out to Minorities

Everyone says that Republicans should reach out to minorities, especially Hispanics and blacks.

But, Thomas Sowell writes,

Too many Republicans seem to think that the way to "reach out" is to offer blacks and other minorities what the Democrats are offering them. Some have even suggested that the channels to use are organizations like the NAACP and black "leaders" like Jesse Jackson -- that is, people tied irrevocably to the Democrats.

Fuggedaboudit, he says. "Voters who want what the Democrats offer can get it from the Democrats."

Actually, I think that there are two things to consider here.  The Democrats have two ways they appeal to their voters, as any political party does.  First, they appeal to greed; second, they appeal to fear.  Greed is the free stuff, of course, the programs, the appeal to resentment with the inequality agenda.

Obviously the greed agenda is a hard row for Republicans to hoe, as Sowell recognizes, because the Republican greed agenda is tax cuts and deregulation and spending cuts.  You'd have to be talking to a middle-class minority to get them to sign on to the Republican greed agenda.

But in my view it is the fear agenda that yields a 90 percent black vote for Democrats.  You cannot get a 90 percent vote on anything without scaring the heck out of people.  It is the notion that whites are getting together just around the corner planning the tactics to bring back Jim Crow that keeps the African Americans at home voting for Democrats.  And Democrats work on that every day.

And that's not all.  Democrats use the immigration issue to strike fear into Hispanics; they want Hispanics to fear that Republicans are ready to deport every last one of them back where they came from.

And there's a fear factor with Jews.  Scratch a Jewish-American and you will find someone frightened by anti-semitism.  And who does she fear?  The Christian fundamentalists that vote Republican.  Earth to Jews: it's the left that's turning anti-semitic, because the left experiences the Palestinians as victims of colonialism, and the Islamic masses in the First World cities as victims of racism.

If you ask me, Republicans need to get to work countering the Democratic fear game.  I'm not a messaging expert, so I don't know how you do it.  I suspect that you have to fight fear with fear.  If blacks are afraid of a return to Jim Crow, then maybe the only way to neutralize it is with a counter-fear.  Maybe that abortion is a cunning trick to commit genocide on blacks and browns?

Could Republicans accuse Democrats of hating blacks because they give them lousy schools as Sowell suggests?  You'd think, but in Washington, DC blacks voted out the mayor that hired Michelle Rhee to turn around the DC school system.  Why?  Because more important that education to DC voters are the jobs that they get in the school system.

Probably the only thing that helps Republicans in the long term is to promote a culture of Americanism. The Democrats work to hyphenate their voters, to get them to think of themselves as African- Hispanic- female- gay- Americans.  They talk inclusion but they practice division.  When voters lose the hyphen they lose their attachment to Democrats.

But probably in 2014 and 2016 it won't matter because voters will be so mad about Obamacare.

Liberals Swatting at Gnats

I was dining with some liberal friends the other night and they were all tut-tutting about "Switchgate," GM's recall scandal.  GM knew for years that it had defective switches in up to 1.7 million vehicles, but refused to recall them.  About 12 people have died in accidents because of this defect.



There are two aspects of the scandal: the defect itself, and the bureaucratic coverup.



Yeah.  It's terrible.  But how many people have died as a result of Obamacare, already?  I mean, here's a story of a guy who claims his cancer medication has gone up from "$100 a pop" to "$600 a pop."  Suppose there are a mere 10,000 folks out there like him?  How many, do you think, have already decided they can't afford it?



Yeah.  Liberals are quick to rage at the horrible corporate greed in GM trying to save a few bucks on defective ignition switches.  Or the monstrosity of the Keystone XL pipeline that will put the crimp on Warren Buffett's railroad profits, or the hell of fracking.  Boy can they strain out a gnat.



But then they swallow camels by the dozen.  What about the millions of lives ruined by welfare?  What about the millions of retired Americans devastated by the government's crazy zero interest rate policy?  What about the millions of lower-income children denied a decent education by half a century of liberal special interest pandering to teachers' unions and liberal education fads?



I will tell you what this is all about.  It is about tribalism.  Let us start with John Derbyshire at Takimag:

The ordinary modes of human thinking are magical, religious, social, and personal.…Scientific objectivity is a freakish, unnatural, and unpopular mode of thought, restricted to small cliques whom the generality of citizens regard with dislike and mistrust.

 No quite, John.  Don't forget "tribal."  And the difficulty humans have with scientific ways of thinking also applies to economics and markets.



Collectivism is tribal and political.  We hesitate to criticize our own tribe.  That is why it is so hard to criticize "our teachers" in the public school system; that is why it is so hard to reform a government program.  All these things are part of our collective identity in our tribe of America.  To criticize them is to criticize America, or as the Obamis say "who we are."



But individualism, the market, the corporation, science: these are brand new concepts in the cultural experience of humans.  People are not at all sure about them and do not hesitate to criticize them for the least mistake.  We give government the benefit of the doubt while ragging on corporations for the least little thing.



We ought, instead, to give individuals and markets and corporations the benefit of the doubt and come down on politicians, bureaucrats, and political action groups like a ton of bricks.  Why?  Well let's start with the fact that politicians and bureaucrats come armed with the power of force.  Corporations and markets only act indirectly through the power of money.  You can say: I refuse to buy at Walmart.  You cannot say: I refuse to pay my taxes.



Maybe after another year of Obamacare there will be a lot of people, even a few liberals, ready to start tut-tutting about the universal scandal of government programs that kill people, and the government officials that cover up their mistakes.

Rush: In 2014 Midterms Obamacare is Reality

Rush Limbaugh is America's greatest unsung political analyst.  Again and again he "nails it," as he likes to say.



Yesterday, St. Paddy's Day, Rush nailed the difference between the 2010 midterms and the 2014 midterms.



Back in 2010 the people that rebelled against Obamacare and voted in a Republican House were Tea Partiers, smart people that knew that Obamacare could never live up to its billing of keeping your doctor, enrolling the uninsured, and lowering insurance premiums.  Because economics.  Because Hayek.



In other words, these were people that knew, from theory, that a great big complicated government redistribution program like Obamacare would never work.



Now, in 2014, the people that are going to turn the US Senate are ordinary Americans that believed the president when he promised to let them keep their doctor, lower their premiums, etc.  But now these trusting Americans are experiencing the reality of Obamacare.  They are losing their doctors, losing their insurance, paying higher premiums and deductibles.



In 2014 a whole new bunch of people are going to vote against Obamacare.  Because reality.



The value of knowledge and science and theory and reason and all that stuff is simple.  Does it work?  If you act as if a piece of knowledge is true does it make a difference?  Let us return to my piece on Hillary Clinton and Pragmatism, William James style.   Writes James:

The pragmatic method... is to try to interpret each notion by tracing its respective practical consequences.  What difference would it practically make to any one if this notion rather than that notion were true?  If no practical difference whatever can be traced, then the alternatives mean practically the same thing, and all dispute is idle.

Back in 2010 President Obama and his acolytes said that Obamacare would mean that the nation would provide health insurance for the uninsured and lower insurance premiums.  Conservatives and Tea Partiers said that Obamacare would increase premiums.



"What practical difference would it make to anyone" if Obama rather than the Tea Partiers were right?



I will tell you what difference, at this point, it will make.  The difference is going to be which party wins the US Senate in 2014.



And the point can be enlarged some more.  Barack Obama and his policies represent a theory of the world and society, a world view if you like.  We were told by the high priests of the Cathedral that Obama and his ideas, from the economy to green energy to health care, were going to usher in Hope and Change and fundamentally transform America.



But now we know that Barack Obama's ideas don't work.  Not in the economy, not in global warming, not in foreign policy.  And any fool can see it.



If you are a conservative then you were saying back in 2009 that his ideas would never work.  I certainly did.  Back in 2009 I wrote that the Obamis needed to redo their agenda which was written back in 2007 before the Crash of 2008.  Forget health reform, I said.  Forget more Keynesian stimulus and more spending.



Why did I write this?  Not because I'm brilliant, but Because Hayek.  Because I believe in classical and Austrian economics.  I believe that classical and Austrian economics are helpful guides to understanding the economy.



Today it's conventional wisdom that the 2009 Keynesian stimulus was a waste and that Obamacare is a disaster.  And green energy is a crony capitalist embarrassment.  Because reality.  And today the American people get it.



The sad thing is that the American people are good people, and they don't deserve Obama.  But the American people haven't learned their economics, and many that have have learned the wrong, Keynesian, lessons from it.



When a businessman makes a wrong decision he pays with decreased profits and maybe even devastating losses and bankruptcy.



When voters make a wrong decision they must pay too.  And really, wrong political decisions are more fateful and cause more hardship than wrong business decisions.



Fortunately the thing about America is, according to Winston Churchill, that America always makes the right decision... after exhausting all other possibilities.



We hope.

Conservatives' Dream World

We are hearing a lot about the liberal bubble and political reality.  Liberals all thought that Obamacare would be sweetness and light as they rammed it through Congress and talked to each other about how wonderful it all was.



But the American people hate Obamacare, because most people are getting socked with big increases in health care costs.  Who could have seen that coming.  Well I did, for one.  The fact is that the average American already has health insurance.  So obviously a government program to extend health insurance people to the uninsured was going to cost the average American.



Forget the principle, or the glorious vision of affordable health care for all.  What real people want is free stuff if they can get it.  But if they can't have free stuff, they sure resent having to pay for somebody else's free stuff.



Same thing with green energy.  Liberals like Tom Steyer and his wife Kat live in a San Francisco liberal bubble and everyone they know agrees that we must do something about greenhouse gases and save the planet before fossil fuels cause catastrophic warming.  But the average person just thinks about the cost of filling up the truck and the cost of natural gas for heating.  In the 2008 election the greenies almost got wiped out by "Drill Baby Drill" until the collapse of Lehman Brothers brought on the Crash of 2008 and the election of Barack Obama.



Liberals may live in a bubble, but conservatives have our blind spots too.  One is that a constitutional convention would change things.  Look I love Mark Levin and The Liberty Amendments, but there's two little things getting in the way.  Here they are, from Table 3.2 in the Budget of the United States Government.

Federal Entitlements
Sub- func.	Program	FY2015 $ billion
571	Medicare	519.0
651	Social Security	867.3

Just sayin', but the American people will give up on Medicare and Social Security when we take it out of their cold dead hands, and it is fantasy to imagine otherwise.  That's why whenever the Democrats get into trouble they accuse Republicans of plotting to cut Social Security and Medicare. (Yeah, and the Democrats are the ones planning huge cuts to Medicare, as in Death Panels, to pay for Obamacare.)  Most people cannot imagine funding their retirement with their own savings and insurance.  They imagine that the way over-committed entitlement programs represent security for them.



Government is force.  But collectivism is force too.  And most people like it that way; it makes them feel secure.



What people like is this.  Government and collectivism remove responsibility from their lives, and reduces their lives to their "rights".  And people with "rights" are quite happy to have the government apply force to other people so they can get theirs.



I was listening to Michael Medved on the radio extolling the charitable virtues of the Koch Brothers.  And their giving really is spectacular.  Yeah, but, said a caller.  They could be using that money to pay a little more to their employees; same with the heirs to the Walton fortune over at Walmart.  You can see what's going down.  The caller would like to force the Koch Brothers and the Waltons to spend their money on people like them rather than on hospitals and schools.



We conservatives need to realize that individualism, the idea that each of us is individually responsible for contributing to society, is a brand new concept and utterly terrifying to most people.  Their default society is the village and its "big man."  In village society the big man looks after you and he keeps any would-be Koch Brothers in line, and loots them to hand out free stuff to the people. Yeah, baby!



The great truth of our modern era, the truth blazing in the sky that nobody can see, is that from the moment we stopped the village big man from sucking up all the oxygen in the room and gave the Koch Brothers their economic freedom, the Koch Brothers and their kind all over the world started creating wealth like humans had never known or even imagined before.



And how do people respond to economic miracle?  They say: "they'd better not touch my Medicare."



People won't give up on big government and its free stuff until big government collapses in financial ruin.  And maybe not even then.

President Obama is Leading Dems into the Wilderness

My big idea about President Obama is that he threw away a big opportunity to make the Democrats into the middle-term majority party for years to come.



He could have taken Judis and Teixeira's Emerging Democratic Majority of minorities, women, young people and the educated into long-term dominance.  But that would have required a stimulus that combined Keynesianism with a dab of supply-side, an Obamacare that recognized that the uninsured were uninsured by choice, and a soft pedal on the green energy organ.



Instead President Obama has force marched the Democratic Party to the left.  Now here's Josh Kraushaar in National Journal arguing that it's "Time for Truth in Labeling: Obama Is Not Centrist."  Obama's leftward lurch is opening up a divide between liberals and moderates in the party.



Liberals. writes Krauschaar, don't care about the deficit; liberals are the only people in the country that want high prices for energy, etc.  In other words,

on all five major issues that divide the Democratic Party's liberals and moderates—the budget deficit, income inequality, the environment, social issues, and America's role in the world—Obama is on the leftward side.

And he seems to be trying to go leftward at warp speed as though there will never be another chance to implement leftist policies in our lifetime.



To me this only makes strategic sense -- from the liberal, Democratic Party point of view -- if the Dems will never have to answer to the voters for their leftward lurch.  Otherwise it risks a brutal reverse at the polls, what demoralized liberals in the Seventies called a "backlash."



You see, I think that the reason you don't sicc the IRS on the opposition is that it's bad for your side.  You really don't want to rile up the opposition unless the opposition is never again going to get the chance to vote your side out of office.



I think that the reason you don't put ideological extremists on the National Labor Relations Board to push the union side is that you convince the opposition that the NLRB has to go.



I think the reason that you don't nominate Mumia's defense lawyer to oversee the Justice Department's Civil Rights Division is that it convinces the opposition that a major rewrite of civil rights law is needed.



And so on.  The point is that government is force, and if you are the government you want to distract attention away from this truth, because the truth about government reminds people that the only way to oppose force is with force.



It has become a banality to say that President Obama is nothing more than a jumped-up community organizer applying Alinsky's Rules for Radicals on a national stage. (Curiously he does not apply Rules on the international stage against the Putins of the world.)  But Obama certainly seems to think that the way to succeed as president is to push his partisan agenda to the utmost and get in the face of the opposition.



Against the president's way of governing is the consensus idea, that to make lasting change you need to form a bipartisan consensus, you need to co-opt the opposition.



My feeling is that the consensus approach is not the strategy of the softie, but hard-headed Macchiavelli.  If you are the ruler you want to keep the opposition divided and uncertain.  You want it to vacillate between cooperating with you and opposing you.



The ruler really does not benefit when he drives everyone except his strong supporters into the opposition.  Not in the long term, and probably not in the short term.



I wonder what the Democrats are afraid of.  Here they are, dominating the academy, education, the media, entertainment, and supported by their cadres of activists.  What's the need for the strong-arming? What's the hurry?



Maybe they know something that I don't know.  Or maybe they are just politicians that live by division and attack, and don't know any other way to live.