Saturday, January 31, 2015

Federal Bureaucracies Have Now Authorized More Than 30 Exemptions to Obamacare's Individual Mandate, New York Times

This is getting comical. I regularly have to laugh to cope with the frustration. In early December we reported: 
Obama administration officials and other supporters of the Affordable Care Act say they worry that the tax-filing season will generate new anger as uninsured consumers learn that they must pay tax penalties and as many people struggle with complex forms needed to justify tax credits they received in 2014 to pay for health insurance. 
The White House has already granted some [There were 25 just a month ago.] exemptions and is considering more to avoid a political firestorm. ... 
Federal officials have authorized more than 30 types of exemptions from the penalty for not having insurance. One is available to low-income people who live in states that did not expand Medicaid. Another is available to people who would have to pay premiums amounting to more than 8 percent of their household income. The government will also allow a variety of hardship exemptions and in most cases [but far more importantly, not in all cases] will require taxpayers to send in documents as evidence of hardship. ...
Note that the reason the White House has added more exemptions to the individual mandate is not to make the law work better.  It's not to ensure more folks are covered or that the cost of care is reduced: the original stated goals of PPACA. No, it is purely political.

The vast majority of elected officials do not have the intestinal fortitude to fine their constituency.  Hence administrative agencies are used to make a bad law worse lest it offend potential voters.  PPACA is a butchered shadow of the 2,500 pages that were passed without reading in 2010. It is now a 30,000 to 40,000 page maze of bureaucracy and political favoritism.


Thursday, January 29, 2015

Senate Democrats, Every Democrat in the U.S. House and the White House Just Agreed: Obamacare Hurts Hiring. On Armstrong & Getty

In a bipartisan showing of unity, every single member of the U.S. House of Representatives, all 26 members of a U.S. Senate Committee and the White House agree that Obamacare hurts hiring. Not one single member or Administration official was willing to come out and
state that no such dis-incentive exists.

Despite heaping evidence to the contrary, it appears as though not all lessons from economics 101 have eluded the Washington Illuminati. Impressively, these two branches of our government have agreed that veterans should not be subjected to the economic suppression of PPACA.

Why not agree to keep PPACA from harming all Americans, now? The labor force participation rate is the number of employed Americans divided by the total number of Americans over the age of 16 who are looking for work.  At 62.7% it is the lowest it has been since the stagnation of the 1970s. Its time to repeal the employer mandate. 
And if you are not willing to exempt all of us, what about people on Medicaid or food stamps?  Shouldn't we do absolutely all we can to create incentive for employers to hire people off of our means tested benefit programs?  How about a person with a disability? Couldn't they also use the extra incentive? And our youth? Youth unemployment is at an all time high. 
This is the beginning of the end for Obamacare's employer mandate.  Now that every single politician has agreed it harms hiring, the mandate will be dismantled in the near future.    
In a rare show of bipartisanship over President Barack Obama's health care law, a Senate committee voted unanimously Wednesday to exclude veterans from the 50-worker threshold that triggers required coverage for employees under that statute.  
The Senate Finance Committee vote was 26-0, a departure from the usual party-line fights over Obama's showcase 2010 law. ... 
Obama's law is gradually phasing in a requirement that companies with at least 50 workers offer health coverage to their employees. The Senate bill would let employers exclude from that count veterans who receive health care from the Department of Veterans Affairs or the military. ... 
The House approved the legislation earlier this month 412-0 with White House support. 
On Friday, January 30, I was on the Armstrong and Getty Radio Program to discuss this story and some more of the latest on Obamacare:

Tuesday, January 27, 2015

On the Michael Berry and Craig Roberts Radio Shows Today for the Latest on Obamacare

In the 5 PM CST hour of the Michael Berry Show:

And, in the 6 PM hour

Later on in the evening I was on Lifeline with Craig Roberts.  My discussion begins at the 47 minute point:

And continues into his second hour, concluding at 20:30: 


Shocking CBO Report: Obamacare Costs Taxpayers $50,000 for Each U.S. Enrollee

  • Obamacare program costs $50,000 in taxpayer money for every American who gets health insurance 
  • The stunning figure comes from Congressional Budget Office (CBO) report that revised cost estimates for the next 10 years 
  • Government will spend $1.993 Trillion over a decade and take in $643 Billion in new taxes, penalties and fees related to Obamacare 
  • The $1.35 trillion net cost will result in 'between 24 million and 27 million' fewer Americans being uninsured – a $50,000 price tag per person at best 
  • By CBO estimates, about 42 million non-elderly residents of the United States were uninsured in 2014. In 2025 that number is expected to be 31 million for a net reduction of only 11 million. 
  • The law will still leave 'between 29 million and 31 million' nonelderly Americans without medical insurance 
  • Numbers assume Obamacare insurance exchange enrollment will double between now and 2025

Sources: David Martosko, The Daily Mail, January 26, 2015, and the updated CBO Report here


Saturday, January 24, 2015

As Many as 10 Million Americans Losing Hours to Obamacare's Employer Mandate

...  Sen. Alexander started the hearing by citing a Hoover Institution study, which found that the 30-hour standard puts 2.6 million working-age Americans at risk of losing jobs and work hours. Alexander claimed many of these employees work in the hospitality, retail, and restaurant industries, and are disproportionately women. Dr. Doug Holtz-Eakin, President of the American Action Forum, testified that this number of workers at risk of having their hours reduced on account of the 30-hour definition was as high as 9.8 million. 
Andrew F. Puzder, CEO of CKE Restaurants, explained: 
The ACA's math is simple: Three employees working 40 hours a week will produce 120 hours. Five employees working 24 hours per week will also produce 120 hours. Under the ACA, employers must offer the three full-time employees health insurance or pay a penalty. They have no such obligations to the five part-time employees, making part-time employment less costly. In this way, the ACA unintentionally encourages our general managers to reduce their employees' hours to under 30 a week. 
Dr. Holtz-Eakin described this disincentive to hire more full-time employees as "essentially a tax on the growth of small businesses." He noted also that "30 [hours a week] is simply at odds with the data on labor markets in the U.S."  According to Holtz-Eakin, 72% of workers work over 40 hours per week, and 50.2% work exactly 40 hours per week.... 

Tuesday, January 20, 2015

Future of Disability Management: Researchers Use Fitbits to Monitor & Predict Back Surgery Recovery Time

This is from Greg Goth at Health Data Management (H/T to Ryan Kennedy):
Researchers from the University of California-San Francisco, New York University, and Northwestern Medicine are monitoring physical activity using Fitbit trackers in an ongoing study to better predict recovery over time for patients who undergo spine surgery. 
During the four weeks before a surgery and for six months afterward, the Fitbits will capture personal data on a patient’s steps and activity levels. 
“An activity monitor allows us to have an objective, numerically exact and continuous measure of activity. This can show exactly how much function a patient has regained and, critically, when and if it occurs during the recovery period,” said Zachary Smith, M.D., assistant professor of neurological surgery at Northwestern and a principal investigator of the study. “This may allow us to predict when a patient will be back to 50 percent activity, 100 percent activity or even 200 percent activity in the future.” ...
“We’ve already seen how surgery changes activity in our first patients,” he said. “It appears that almost all patients go through a four- to six-week period where their activity is decreased. Just over a month out from many of the surgeries, they get back to their pre-operative level. Then they slowly continue to climb to new levels of activity that they could never have reached before.” ...

The Road to a Welfare Benefited Society | The United States' Growing Reliance on Welfare Benefits in the Last 30 to 50 Years

This is from Nicholas Eberstadt at National Affairs, Winter 2015:
... Over the half-century between 1963 and 2013, entitlement transfers were the fastest growing source of personal income in America — expanding at twice the rate for real per capita personal income from all other sources, in fact. Relentless, exponential growth of entitlement payments recast the American family budget over the course of just two generations. In 1963, these transfers accounted for less than one out of every 15 dollars of overall personal income; by 2013, they accounted for more than one dollar out of every six. 
The explosive growth of entitlement outlays, of course, was accompanied by a corresponding surge in the number of Americans who would routinely apply for, and accept, such government benefits. Despite episodic attempts to limit the growth of the welfare state or occasional assurances from Washington that "the era of big government is over," the pool of entitlement beneficiaries has apparently grown almost ceaselessly. The qualifier "apparently" is necessary because, curiously enough, the government did not actually begin systematically tracking the demographics of America's "program participation" until a generation ago. Such data as are available, however, depict a sea change over the past 30 years. 
By 2012, the most recent year for such figures at this writing, Census Bureau estimates indicated that more than 150 million Americans, or a little more than 49% of the population, lived in households that received at least one entitlement benefit. Since under-reporting of government transfers is characteristic for survey respondents, and since administrative records suggest the Census Bureau's own adjustments and corrections do not completely compensate for the under-reporting problem, this likely means that America has already passed the symbolic threshold where a majority of the population is asking for, and accepting, welfare-state transfers.  
Between 1983 and 2012, by Census Bureau estimates, the percentage of Americans "participating" in entitlement programs jumped by nearly 20 percentage points. One might at first assume that the upsurge was largely due to the graying of the population and the consequent increase in the number of beneficiaries of Social Security and Medicare, entitlement programs designed to help the elderly. But that is not the case. Over the period in question, the share of Americans receiving Social Security payments increased by less than three percentage points — and by less than four points for those availing themselves of Medicare. Less than one-fifth of that 20-percentage-point jump can be attributed to increased reliance on these two "old age" programs.

Overwhelmingly, the growth in claimants of entitlement benefits has stemmed from an extraordinary rise in "means-tested" entitlements. (These entitlements are often called "anti-poverty programs," since the criterion for eligibility is an income below some designated multiple of the officially calculated poverty threshold.) By late 2012, more than 109 million Americans lived in households that obtained one or more such benefits — over twice as many as received Social Security or Medicare. The population of what we might call "means-tested America" was more than two-and-a-half times as large in 2012 as it had been in 1983. Over those intervening years, there was population growth to be sure, but not enough to explain the huge increase in the share of the population receiving anti-poverty benefits. The total U.S. population grew by almost 83 million, while the number of people accepting means-tested benefits rose by 67 million — an astonishing trajectory, implying a growth of the means-tested population of 80 persons for each 100-person increase in national population over that interval. 
In the mid-1990s, during the Clinton era, Congress famously passed legislation to rein in one notorious entitlement program: Aid for Families with Dependent Children. Established under a different name as part of the 1935 Social Security Act, AFDC was a Social Security program portal originally intended to support the orphaned children of deceased workers; it was subsequently diverted to supporting children from broken homes and eventually the children of unwed mothers. By the 1980s, the great majority of children born to never-married mothers were AFDC recipients, and almost half of AFDC recipients were the children of never-married mothers. The program's design seemed to create incentives against marriage and against work, and it was ultimately determined by bipartisan political consensus that such an arrangement must not continue. So with the welfare reforms of the 1990s, AFDC was changed to TANF — Temporary Aid to Needy Families — and eligibility for benefits was indeed restricted. By 2012, the fraction of Americans in homes obtaining AFDC/TANF aid was less than half of what it had been in 1983. ...
The entire report is absolutely worth reading, here.

Sunday, January 18, 2015

Just 3 States and D.C .Have Seen Median Incomes Increase Since 2008 | Less People Working in Every State (But not D.C.)

As Armstrong and Getty like to say, the government is the most dominant, profitable and monopolistic "industry" in the United States.  These two maps really help to drive that point home.  As the country's employment situation continues to languish, the federal government and those who lobby it regularly, flourish. Check out these maps from Pew Charitable Trusts’ Stateline blog and here:

Interactive version:

Saturday, January 17, 2015

New Public Employee Debt Bomb Worse than Pensions: Nearly $1 Trillion in Unfunded Retiree Healthcare

U.S. Debt Clock as of 1/17/15 at 1:30 PM PST.
This is from Robert Pozen at Brookings:
Public-pension funds have garnered attention in recent years for being underfunded, but a more precarious situation has received much less notice: health-care obligations for public retirees. 
Unlike pension plans, governments are not required to contribute to separate trusts to support health-care promises. As a result, only 11 states have funded more than 10% of retiree health-care liabilities, according to a November 2013 report from the credit-rating agency Standard & Poor’s. For example, New Jersey has almost no assets backing one of the largest retiree health-care liabilities of any state—$63.8 billion. 
Only eight out of the 30 largest U.S. cities have funded more than 5% of their retiree health-care obligations, according to a study released last March by the Pew Charitable Trust. New York City tops the list with $22,857 of unfunded liabilities per household. 
What exactly are retiree health-care obligations? State and local governments typically pay most of the insurance premiums for employees who retire before they are eligible for Medicare at age 65. That can be a long commitment, as many workers retire as early as 50. Many governments also pay a percentage of Medicare premiums once retired workers turn 65.

Total U.S. unfunded health-care liabilities exceeded $530 billion in 2009, the Government Accountability Office estimated, but the current number may be closer to $1 trillion, according to a 2014 comprehensive study released by the National Bureau of Economic Research. ...
Emphasis added. 

More than Half of Large Employers Unprepared to Comply with PPACA While Employees are to be Rewarded & Protected for Whistleblowing

This could get very ugly for employers.  Disgruntled employees can issue protected whistleblower claims against employers, even in error, and receive federal protection.  In reality, however, those claims never need to be in error. Obamacare and its resulting regulatory framework are so complex I can assure you that every employer has a violation someplace.  This survey found that the most capable employers with the most resources admit that they are not confident with their compliance. 

This is from a recent ADP survey:
While the majority of large employers (70%) handle ACA compliance internally, the study revealed that these employers do not feel fully prepared to manage several critical compliance requirements, including Exchange notices (62%), ACA penalties (60%) and annual health care reporting (IRS Forms 1094/1095-C) (49%). ...
And this is from Mary Pivec & Igor Babichenko of Williams Mullen
An employer need not commit an actual violation of the ACA to be subject to a whistleblower claim.  The ACA’s whistleblower provision provides protection for employees who merely voice a concern about a possible violation.  Specifically, the ACA’s whistleblower provision prohibits retaliation against any employee who provides information relating to any act that he or she reasonably believes to be a violation of the ACA.  Under this “reasonable belief” standard, the employee need only show that he or she believed that the employer’s conduct violated the ACA and not that the employer actually violated the law. Thus, an employer who is in full compliance with the substantive provisions of the ACA still may run afoul of the whistleblower provision....
The ACA’s whistleblower provision provides an incentive for employees to report employer violations—both willful and inadvertent—of the ACA. Accordingly, employers must be vigilant in familiarizing themselves with the ACA’s whistleblower rules so as not to fall into a whistleblower trap. Understanding the regulations and maintaining vigorous compliance programs are the keys to avoiding and defeating whistleblower claims. As with any law that provides whistleblower protection, employers must be careful to ensure that, if and when a possible ACA violation is reported, no adverse actions are taken against the whistleblowing employee without a legitimate, non-retaliatory, and non-discriminatory reason for the decision.
What kind of whistleblowing protections are available to employees? PPACA 
authorizes the Secretary of Labor to conduct investigations into retaliation complaints and issue determinations, and the Rule delegates that duty to OSHA. Retaliating employers can be required to, among other things, reinstate terminated employees, provide back pay with interest, and pay compensatory damages, attorneys’ fees, and expert witness fees. 

Friday, January 16, 2015

U.S. Healthcare Solution, Back to the Future? Concierge Medicine and Third-Party-Free Practices

This is from the NCPA, summarizing Gerard J. Gianoli, "Saying Goodbye to Third-Party Medical Payments," Wall Street Journal, January 15, 2015:
At concierge practices, patients pay a flat monthly or annual fee, gaining access to a doctor, and many practices don't accept insurance. Similarly, third-party-free practices take on patients but refuse to accept insurance -- patients pay cash for visits and services, free from the complexity and confusion of insurance companies, copays and deductibles. Patients know their costs upfront, and Gianoli says both patients and doctors can save money this way:
  • Without insurance billing, doctors save 40 percent on average in administrative expenses.
  • With reduced administrative fees, patients are charged less for visits and services.
  • Gianoli's own third-party-free practice charges three to four times less than the industry average for the same services. 
With these models, patients are left with more money in their pockets and more control over their own health care decisions. 

Thursday, January 15, 2015

Penalties for Noncompliance Are The Only Way Wellness Programs Save Money

This is from Sharon Begley writing at Reuters:
... [T]here is almost no evidence that workplace wellness programs significantly reduce those costs. That's why the financial penalties are so important to companies, critics and researchers say. They boost corporate profits by levying fines that outweigh any savings from wellness programs. 
"There seems little question that you can make wellness programs save money with high enough penalties that essentially shift more healthcare costs to workers," said health policy expert Larry Levitt of the Kaiser Family Foundation.... 
At Honeywell International, for instance, employees who decline company-specified medical screenings pay $500 more a year in premiums and lose out on a company contribution of $250 to $1,500 a year (depending on salary and spousal coverage) to defray out-of-pocket costs. 
Kevin Covert, deputy general counsel for human resources, acknowledged it was too soon to tell if Honeywell's wellness and incentive programs reduce medical spending. But it is clear that the company is benefiting financially from the penalties. Slightly more than 10 percent of the company's U.S. employees, or roughly 5,000, did not participate, resulting in savings of hundreds of thousands of dollars. 
Last year, Honeywell was sued over its wellness program by the Equal Employment Opportunity Commission. The EEOC argued that requiring workers to answer personal questions in the health questionnaire - including if they ever feel depressed and whether they've been diagnosed with a long list of illnesses - can violate federal law if they involve disabilities, as these examples do....

Wednesday, January 14, 2015

5 Questions to Ask Your Doctor Before Taking Prescription Drugs to Maximize Your Savings

This is from Dr. Eric Bricker at Compass:
  1. Is this generic? ...
  2. If a pill is a combination of two medications, ask your healthcare provider if you can take the two medications separately as two separate pills that are generic....
  3. Ask if there is a way to treat your condition without taking a medication....
  4. If you are taking a chronic medication, [ask if you can] use mail order. 
  5. [For infusion therapy drugs, can] the doctor infuse them in his or her office ... [rather] than at the hospital or hospital outpatient facility [which often costs more]? ...

New California Law Strengthens Children's Right to Access Birth Control, Abortion Services, and Mental Healthcare Without Notifying Parents

This is from Kenny Goldberg at KPBS:
Health plans typically communicate with the main policyholder about medical care accessed by family members. 
That can be awkward for people who seek birth control or mental health care but a new law  [SB 138] aims to prevent that situation. 
The Confidential Health Information Act allows individuals to keep their medical information private by submitting a special request to their health plan. That request can be made by phone or in writing. ...
[T]he prime beneficiaries of the new law are the hundreds of thousands of young adults in California who are covered by their parent's insurance plans....
Under California law, teenagers have the right to access birth control, abortion services, and mental healthcare without notifying their parents.

Not Everybody Wants a Taxpayer Handout - Pride Is Slowing Obamacare Enrollments Among Some in Year Two

This is from Kimberly Leonard writing at U.S. World and News Report:
Grace Brewer says she never thought she would be without health insurance at this stage of her life. "I'm a casualty of Obamacare," says Brewer, 60, a self-employed chiropractor in the Kansas City, Kansas, area.

She wanted to keep the catastrophic health insurance plan she once had, which she says fit her needs. But under the Affordable Care Act, the government's health care reform law, the plan was discontinued because it did not comply with the law's requirements, and her bills doubled to more than $400 a month. "I wanted a minimal plan and I’m not allowed to have it," she says. "That seems like an encroachment on my freedom." 
The Affordable Care Act requires everyone to buy insurance or pay a penalty. Government subsidies can reduce costs for low- and middle-income Americans and without them, many say they could not afford insurance. Americans qualify for subsidies if they are under the age of 65 and have an annual income of up to $46,680 as an individual, or up to $95,400 for a family of four.

Though Brewer could pay less for a plan if she were to accept a subsidy from the federal government, she refuses. "I want to pay my own way," she says. "I will not take a handout." 
Her sentiment is unusual, but brokers say they do hear from clients who are eligible for subsidies – which are based on household income and not assets – but want no part of them. Health officials have been boasting that 6.6 million people have enrolled in health coverage through state or federal marketplaces created under the Affordable Care Act, but in sharp contrast stands a small group of Americans who say they want nothing to do with the plans, even if they would save money. Their reasons vary: Some are protesting Obamacare, while others simply feel it's unethical to accept taxpayer dollars to pay for health insurance. ...

For Brewer, buying a plan on her own would mean she would not have enough to pay for housing, she says, so she chose not to be insured this year and will have to pay a penalty in her 2016 tax filing that is likely to be 2 percent of her income. She has no dependents, is healthy, does not use prescriptions and says she has been careful about her health choices, not overusing medical care.

"I am frustrated. I am angry. And I say 'no' to the exchanges," she says. "Somebody has to stand up and this is the only way I can do it. I will not be signing up under duress. I’m taking care of myself." 
Dave Klemencic, 55, also has chosen to go without health insurance. He could receive a tax subsidy, but says on principle he will not, adding that he does not believe it's in the best interest of the country.

Klemencic, the sole proprietor of Ellenboro Floors in Ritchie County, West Virginia, says he sees the federal subsidy program as welfare, which he does not believe in. He also does not think the government has the constitutional authority to offer the subsidies. 
“I take care of myself fine,” he says. “I’m not going to increase the debt or take money from a taxpayer.” 
Klemencic's total spending on health care last year amounted to $200 for dental checkups, he says, and he plans to continue paying for doctor visits out of pocket. He may have to pay a penalty for that choice, but first he is waiting on a Supreme Court case challenging the government's provision of subsidies in states that did not create their own insurance exchanges. The outcome of the case could exempt him and millions of others from the penalty. ...
Complicating the ethical question is that some people who qualify for subsidies based on their income could afford to pay their own way. “There is no question that we are enrolling people through these programs who would otherwise be considered middle-class or even affluent,” says Ed Haislmaier, a senior research fellow for health policy studies at the right-leaning Heritage Foundation think tank. “We are seeing people with enrollment in these programs that have significant assets, but for whatever reason – usually a temporary reason – fall below the income line.” ...
The fact that the subsidies are causing controversy among the very people they're intended to help is “evidence that the government doesn’t do charity very well,” says Michael Cannon, director of health policy studies at the libertarian Cato Institute think tank.

“Prior to Obamacare, the federal government was subsidizing all sorts of people who did not need health insurance subsidies,” he adds, referring to services like the Children's Health Insurance Program, Medicaid and Medicare, the government's health program for seniors. “With Obamacare, we are subsidizing even more people who don’t need assistance.” ... 
Steve Morgan, a self-employed insurance agent from Faribault, Minnesota, says he and his family pay more for private health insurance because he had a negative experience with the exchange website. 
"I had a strong feeling of distrust and absolutely no faith in this government program," Morgan, 61, tells U.S. News in an email. His family pays $14,000 a year in premiums and $2,600 in deductibles. If he were to take the subsidies, he could save a couple hundred dollars a month. "Yes, maybe I am lucky to afford these premiums, but we have cut donations to worthy causes and certainly do not go out very often."

Ed Anderson, an account manager at the Hawkins Insurance Group in Edina, Missouri, says he has clients who say they don’t want anything to do with Obamacare. “They think it’s inappropriate for the government to be involved in the first place,” he says. ...

Tuesday, January 13, 2015

Employers: Beware of Actions that Could Result in ACA Whistleblower Liability

This is from Mary Pivec at Ford Harrison, LLP:
... [The] ACA prohibits an employer from discharging or in any manner discriminating against any employee with respect to compensation or other terms, conditions or privileges of employment because the employee (or an individual acting at the request of the employee has) 
  1. Received a credit or a subsidy for purchasing health benefits;
  2. Provided, caused to be provided, or is about to provide or cause to be provided to the employer, the federal government, or the attorney general of a state, information relating to any violation of, or any act or omission the employee reasonably believes to be a violation of Title I of the ACA;
  3. Testified or is about to testify in a proceeding concerning such violation; Assisted or participated, or is about to assist or participate, in such a proceeding; or
  4. Objected to, or refused to participate in, any activity, policy, practice, or assigned task that the employee (or other such person) reasonably believed to be in violation of any provision of ACA or any order, rule, regulation, standard or ban under Title I of the ACA.
DOL published procedures for handling ACA whistleblower complaints on February 13, 2013. Under the regulations, an aggrieved employee (or representative) must file an administrative complaint with the Occupational Safety and Health Administration, Whistleblower Directorate, within 180 days following an adverse employment action taken in whole or in part based upon the employer's knowledge of the employee's participation in ACA-protected activity. ...

Monday, January 12, 2015

A Calorie is Not a Calorie | There are huge differences in the way different types of calories impact our bodies

This is from Mark's Daily Apple:
... Whole foods take more energy to process and digest than processed foods. In one example, subjects either ate a “whole food” sandwich (multigrain bread with cheddar cheese) or a “processed food” sandwich (white bread with cheese product). Both meals were isocaloric (same number of calories) and featured roughly identical macronutrient (protein, fat, carb) ratios. Those eating the multigrain sandwiches expended 137 calories postprandially (after their meal). The white bread group expended only 73 calories, a 50% reduction in the thermic effect of food.  Protein takes more energy to process and digest than other macronutrients. Compared to a low-fat, high-carb diet, a high-protein diet increased postprandial energy expenditure by 100% in healthy young women. And in both obese and lean adults, eating a high-protein meal was far more energetically costly (by almost 3-fold) than eating a high-fat meal. ...
[100 calories of sugar will make you fatter than 100 calories of fat.]  Study: ... For two weeks, participants either supplemented their diets with isocaloric amounts of candy (mostly sugar) or roasted peanuts (mostly fat and protein). This was added to their regular diet. After two weeks, researchers found that body weight, waist circumference, LDL, and ApoB (a rough measure of LDL particle number) were highest in the candy group, indicating increased fat mass and worsening metabolic health. In the peanut group, basal metabolic rate shot up and neither body weight nor waist size saw any significant increases. ...
[Calories counts are rarely accurate.]  Most foods at the grocery store have labels. Even restaurants are beginning to emblazon menus with calorie counts for each item. As humans, we implicitly trust the printed word. It looks so official and authoritative, and it spells out with great specificity exactly how many calories we’re about to eat.
Except studies show that’s not the case. Whether it’s the nutritional information provided by restaurants, the calorie counts on supposedly “low-calorie” foods, or the nutritional labels on packaged foods, calorie counts are rarely accurate. Food manufacturers can even underreport calories by 20% and pass inspection by the FDA

Staggering Increase in Use of Social Security Disability Since the Welfare was Reformed in the 1990s

This is from Mike Shedlock at Mish's Global Economic Trend Analysis
  1. Every month 14 million Americans receive a disability check.
  2. In 1961 the leading cause of disability was heart disease and strokes, totaling 25.7% of cases. Back pain was 8.3% of cases.
  3. In 2011 the leading cause of disability was a hard to disprove back pain, totaling 33.8% of cases. The second leading cause was an equally difficult to disprove "mental illness" at 19.2%. Strokes and heart disease fell to 10.6%.
  4. In West Virginia, a whopping 9% of the population collects disability checks. In Arkansas, 8.2% are on disability, and in Alabama and Kentucky, 8.1% collect disability. In Alaska, Hawaii, and Utah, the figure is 2.9%.
  5. In Hale County Alabama 1 in 4 receive disability checks.
  6. Nearly every case in Hale County Alabama has Dr. Perry Timberlake in common.
  7. Those on Supplemental Security Income, a program for children and adults who are both poor and disabled is nearly seven times larger than 30 years ago.
  8. Once people go onto disability, they almost never go back to work. Fewer than 1 percent of those who were on the federal program for disabled workers at the beginning of 2011 have returned to the workforce.  

Monday, January 5, 2015

2015 Post Holiday Update | Assorted Links on PPACA, California Law & Employment Law

This is an excellent summary of the monumental challenges for employers using temporary staffing agencies under Obamacare rules. (SHRM).

The growth rate of healthcare spending has slowed, quite simply, because people now spend a greater portion of their own money with the prevalence of higher deductibles and copays under consumer driven and Obamacare plans. (

Quote: "Giving money and power to government is like giving whiskey and car keys to teenage boys." P.J. O'Rourke.  

Oh how times have changed: 

College Professors Who Helped Craft and Praised Cost Shifting onto Employees in Obamacare Now Squeal When Implemented on Their Plan

I know this is an incredibly sad story - try not to cry as you read it.  

Karma, irony, disillusioned intelligentsia, schadenfreude ... this story has it all. It might be my all time favorite New York Times column. 

For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar. 
Members of the Faculty of Arts and Sciences, the heart of the 378-year-old university, voted overwhelmingly in November to oppose changes that would require them and thousands of other Harvard employees to pay more for health care. The university says the increases are in part a result of the Obama administration’s Affordable Care Act, which many Harvard professors championed. 
The faculty vote came too late to stop the cost increases from taking effect this month, and the anger on campus remains focused on questions that are agitating many workplaces: How should the burden of health costs be shared by employers and employees? If employees have to bear more of the cost, will they skimp on medically necessary care, curtail the use of less valuable services, or both? 
“Harvard is a microcosm of what’s happening in health care in the country,” said David M. Cutler, a health economist at the university who was an adviser to President Obama’s 2008 campaign. But only up to a point: Professors at Harvard have until now generally avoided the higher expenses that other employers have been passing on to employees. That makes the outrage among the faculty remarkable, Mr. Cutler said, because “Harvard was and remains a very generous employer.”
In Harvard’s health care enrollment guide for 2015, the university said it “must respond to the national trend of rising health care costs, including some driven byhealth care reform,” otherwise known as the Affordable Care Act. The guide said that Harvard faced “added costs” because of provisions in the health care law that extend coverage for children up to age 26, offer free preventive services like mammograms and colonoscopies and, starting in 2018, add a tax on high-cost insurance, known as the Cadillac tax.
Richard F. Thomas, a Harvard professor of classics and one of the world’s leading authorities on Virgil, called the changes “deplorable, deeply regressive, a sign of the corporatization of the university.” 
Mary D. Lewis, a professor who specializes in the history of modern France and has led opposition to the benefit changes, said they were tantamount to a pay cut. “Moreover,” she said, “this pay cut will be timed to come at precisely the moment when you are sick, stressed or facing the challenges of being a new parent.” ...
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