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Patient Protection and Affordable Care Act - Wikipedia
The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) or Obamacare, is a United States federal statute enacted by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act amendment, it represents the most significant regulatory overhaul of the U.S. healthcare system since the passage of Medicare and Medicaid in 1965. Under the act, hospitals and primary physicians would transform their practices financially, technologically, and clinically to drive better health outcomes, lower costs, and improve their methods of distribution and accessibility.
The Affordable Care Act was intended to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage and reduce the costs of healthcare. It introduced mechanisms including mandates, subsidies and insurance exchanges.[1][2] The law requires insurers to accept all applicants, cover a specific list of conditions and charge the same rates regardless of pre-existing conditions or sex.[3] In 2011, the Congressional Budget Office projected that the ACA would lower future deficits[4] and Medicare spending.[5]
The law and its implementation faced challenges in Congress and federal courts, and from some state governments, conservative advocacy groups, labor unions, and small business organizations. The United States Supreme Court upheld the constitutionality of the ACA's individual mandate as an exercise of Congress's taxing power,[6] that states cannot be forced to participate in the ACA's Medicaid expansion,[7][8][9] and that the law's subsidies to help individuals pay for health insurance are available in all states, not just in those that have set up state exchanges.
In March 2015, the Centers for Disease Control and Prevention reported that the average number of uninsured during the period from January to September 2014 was 11.4 million fewer than the average in 2010.[10] In April 2016, Gallup reported that the percentage of adults who were uninsured dropped from 18% in the third quarter of 2013 to 11% in the first quarter of 2016.[11]
As implementation began, first opponents and then most others adopted the term "Obamacare" to refer to the ACA.[12]ACA[13][14] includes provisions to take effect between 2010 and 2020, although most took effect on January 1, 2014. The number and complexity of changes was unprecedented in the US health care system. Not all provisions took full effect. Some were made discretionary, some were deferred and others were discarded before implementation.
Individual insurance
Guaranteed issue prohibits insurers from denying coverage to individuals due to pre-existing conditions. States were required to ensure the availability of insurance for individual children who did not have coverage via their families.
States were required to expand Medicaid eligibility to include individuals and families with incomes up to 133% of the federal poverty level, including adults without disabilities or dependent children.[15] The law provides a 5% "income disregard", making the effective income eligibility limit for Medicaid 138% of the poverty level.[16]
The State Children's Health Insurance Program (CHIP) enrollment process was simplified.[15]
Dependents were permitted to remain on their parents' insurance plan until their 26th birthday, including dependents that no longer live with their parents, are not a dependent on a parent's tax return, are no longer a student, or are married.[17][18]
Among the groups who remained uninsured were:
- Illegal immigrants, estimated at around 8 million—or roughly a third of the 23 million projection—are ineligible for insurance subsidies and Medicaid.[19][20] They remain eligible for emergency services.
- Eligible citizens not enrolled in Medicaid.[21]
- Citizens who pay the annual penalty instead of purchasing insurance, mostly younger and single.[21]
- Citizens whose insurance coverage would cost more than 8% of household income and are exempt from the penalty.[21]
- Citizens who live in states that opt out of the Medicaid expansion and who qualify for neither existing Medicaid coverage nor subsidized coverage through the states' new insurance exchanges.
Subsidies
Households with incomes between 100% and 400% of the federal poverty level were eligible to receive federal subsidies for policies purchased via an exchange.[23][24] Subsidies are provided as an advanceable, refundable tax credit[25][26] Small businesses are eligible for subsidies.[27] Under the law, workers whose employers offer "affordable coverage" will not be eligible for subsidies via the exchanges. To be eligible the cost of employer-based health insurance must exceed 9.5% of the worker's household income.
Subsidies (2014) for Family of 4[28][29][30][31][32]
133% 3% of income $31,900 $992 $10,345 $5,040
150% 4% of income $33,075 $1,323 $9,918 $5,040
200% 6.3% of income $44,100 $2,778 $8,366 $4,000
250% 8.05% of income $55,125 $4,438 $6,597 $1,930
300% 9.5% of income $66,150 $6,284 $4,628 $1,480
350% 9.5% of income $77,175 $7,332 $3,512 $1,480
400% 9.5% of income $88,200 $8,379 $2,395 $1,480
a.^ Note: In 2014, the FPL was $11,800 for a single person and $24,000 for family of four.[33][34] See Subsidy Calculator for specific dollar amount.[35] b.^ DHHS and CBO estimate the average annual premium cost in 2014 would have been $11,328 for a family of 4 without the reform.[30]
Premiums were the same for everyone of a given age, regardless of preexisting conditions. Premiums were allowed to vary by enrollee age, but those for the oldest enrollees (age 45-64 average expenses $5,542) could only be three times as large as those for adults (18-24 $1,836).[36][original research?]
Mandates
Individual
The individual mandate[37] is the requirement to buy insurance or pay a penalty for everyone not covered by an employer sponsored health plan, Medicaid, Medicare or other public insurance programs (such as Tricare). Also exempt were those facing a financial hardship or who were members in a recognized religious sect exempted by the Internal Revenue Service.[38]The mandate and the limits on open enrollment[39][40] were designed to avoid the insurance death spiral in which healthy people delay insuring themselves until they get sick. In such a situation, insurers would have to raise their premiums to cover the relatively sicker and thus more expensive policies,[37][41][42] which could create a vicious cycle in which more and more people drop their coverage.[43]
The mandate was to allow a stable equilibrium relying on relatively high premiums for the insured and little coverage (and thus more illness and medical bankruptcy) for the uninsured.[41][44][45] Studies by the CBO, Gruber and Rand Health concluded that a mandate was required.[46][47][48] The mandate increased the size and diversity of the insured population, including more young and healthy participants to broaden the risk pool, spreading costs.[49] Experience in New Jersey and Massachusetts offered divergent outcomes.[44][47][50]
Business
Businesses that employ 50 or more people but do not offer health insurance to their full-time employees pay a tax penalty if the government has subsidized a full-time employee's healthcare through tax deductions or other means. This is commonly known as the employer mandate.[51][52] This provision was included to encourage employers to continue providing insurance once the exchanges began operating.[53] Approximately 44% of the population was covered directly or indirectly through an employer.[54][55]Insurance standards
Essential health benefits
The Institute of Medicine defined the law's "essential health benefits" as "ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care"[56][57][58][59][60][61][62] and others[63] rated Level A or B by the U.S. Preventive Services Task Force.[64] In determining what would qualify as an essential benefit, the law required that standard benefits should offer at least that of a "typical employer plan".[61] States may require additional services.[65]
Contraceptives
One provision in the law mandates that health insurance cover "additional preventive care and screenings" for women.[66] The guidelines mandate "[a]ll Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity".[67] This mandate applies to all employers and educational institutions except for religious organizations.[68][69] These regulations were included on the recommendations of the Institute of Medicine.[70][71]
Risk management
ACA provided three ways to control risk for insurers in the individual and business markets: temporary reinsurance (insurance for insurers against unexpectedly high claims), temporary risk corridors and permanent risk adjustment. Risk adjustment was a permanent program. The other two closed after 2016. These limit insurer losses.[citation needed]
Risk adjustment attempts to spread risk among insurers to prevent purchasers with good knowledge of their medical needs from using insurance to cover their costs (adverse selection). Plans with low actuarial risk compensate plans with high actuarial risk.
Other provisions
- Annual and lifetime coverage caps on essential benefits were banned.[72][73]
- Prohibits insurers from dropping policyholders when they get sick.[74]
- All health policies sold in the United States must cap an individual's (or family's) medical expenses out of pocket annually (excluding premiums).[75]
A partial community rating requires insurers to offer the same premium to all applicants of the same age and location without regard to gender or most pre-existing conditions (excluding tobacco use).[76][77][78] Premiums for older applicants can be no more than three times those for the youngest.[79]
Preventive care, vaccinations and medical screenings cannot be subject to co-payments, co-insurance or deductibles.[80][81][82] Specific examples of covered services include: mammograms and colonoscopies, wellness visits, gestational diabetes screening, HPV testing, STI counseling, HIV screening and counseling, contraceptive methods, breastfeeding support/supplies and domestic violence screening and counseling.[83]The law established four tiers of coverage: bronze, silver, gold and platinum. All categories offer the essential health benefits. The categories vary in their division of premiums and out-of-pocket costs: bronze plans have the lowest monthly premiums and highest out-of-pocket costs, while platinum plans are the reverse.[61][84] The percentages of health care costs that plans are expected to cover through premiums (as opposed to out-of-pocket costs) are, on average: 60% (bronze), 70% (silver), 80% (gold), and 90% (platinum).[85]
Insurers are required to implement an appeals process for coverage determination and claims on all new plans.[74]
Insurers must spend at least 80–85% of premium dollars on health costs; rebates must be issued to policyholders if this is violated.[86][87]
Exchanges
Established the creation of health insurance exchanges in all fifty states. The exchanges are regulated, largely online marketplaces, administered by either federal or state government, where individuals and small business can purchase private insurance plans.[88][89][90]
Setting up an exchange gives a state partial discretion on standards and prices of insurance.[91][92] For example, states approve plans for sale, and influence (through limits on and negotiations with private insurers) the prices on offer. They can impose higher or state-specific coverage requirements—including whether plans offered in the state can cover abortion.[93] States without an exchange do not have that discretion. The responsibility for operating their exchanges moves to the federal government.[91]
State waivers
From 2017 onwards, states can apply for a "waiver for state innovation" that allows them to conduct experiments that meet certain criteria.[94] To obtain a waiver, a state must pass legislation setting up an alternative health system that provides insurance at least as comprehensive and as affordable as ACA, covers at least as many residents and does not increase the federal deficit.[95] Such states can exempt states from some of ACA's central requirements, including the individual and employer mandates and the provision of an insurance exchange.[96] The state would receive compensation equal to the aggregate amount of any federal subsidies and tax credits for which its residents and employers would have been eligible under ACA plan, if they cannot be paid out due to the structure of the state plan.[94]
In May 2011, Vermont enacted Green Mountain Care, a state-based single-payer system for which they intended to pursue a waiver to implement.[97][98][99] In December 2014, Vermont decided not to continue due to high expected costs.[100]
Accountable Care Organizations
The Act allowed the creation of Accountable Care Organizations (ACOs), which are groups of doctors, hospitals and other providers that commit to give coordinated, high quality care to Medicare patients. ACOs were allowed to continue using a fee for service billing approach. They receive bonus payments from the government for minimizing costs while achieving quality benchmarks that emphasize prevention and mitigating chronic disease. If they fail to do so, they are subject to penalties.[101]
Unlike Health Maintenance Organizations, ACO patients are not required to obtain all care from the ACO. Also, unlike HMOs, ACOs must achieve quality of care goals.[101]
OthersThe Medicare payment system switched from fee-for-service to bundled payments.[102][103] A single payment was to be paid to a hospital and a physician group for a defined episode of care (such as a hip replacement) rather than individual payments to individual service providers. In addition, the Medicare Part D coverage gap (commonly called the "donut hole") was to shrink incrementally, closing completely by January 1, 2020.[104]
The Hospital Readmissions Reduction Program (HRPP) was established as an addition to the Social Security Act, in an effort to reduce hospital readmissions. This program penalizes hospitals with higher than expected readmission rates by decreasing their Medicare reimbursement rate.
Medicare Part D participants received a 50% discount on brand name drugs purchased after exhausting their initial coverage and before reaching the catastrophic-coverage threshold.[105]
Health care cost/quality initiatives including incentives to reduce hospital infections, to adopt electronic medical records and adopt bundled payments to coordinate care and prioritize quality over quantity.[106]
The Community Living Assistance Services and Supports Act (or CLASS Act) established a voluntary and public long-term care insurance option for employees,[107][108][109]
Consumer Operated and Oriented Plans (CO-OP), member-governed non-profit insurers, could start providing health care coverage, based on a 5-year federal loan.[110]
Family budgetsMaximum Out-of-Pocket Premium as Percentage of Family Income and federal poverty level, under Patient Protection and Affordable Care Act, starting in 2014 (Source: CRS).[200]
Health insurance premiums for employer-provided family coverage 1999-2014. The 3.0% increase for 2013-2014 was tied for lowest over the 16-year period.
In 2010 the CBO forecast that by 2016 that premiums per person would increase by 10% to 13% but that over half of these individuals would receive subsidies that would decrease the premium paid to "well below" premiums charged under current law.[201][202] Subsidies were projected to be worth an average of $5,548 per receiving household.[203]
CBO forecast that small group (13% of the market) premiums would be impacted 1% to -3%, and -8% to -11% for those receiving subsidies; for large groups (70%), premiums would be impacted 0% to -3%, with those under high premium plans subject to excise taxes paying 9% to 12% less. Factors included increased benefits, particularly for the individual market, more healthy policyholders due to the mandate, administrative efficiencies related to the health exchanges and high-premium insurance plans reducing some benefits in response to the tax.[202]
A 2016 informal survey of Blue Cross/Blue Shield insurers estimated that 40% of individual enrollees (including 15% of those who purchase plans on exchanges) do not receive subsidies and are therefore subject to the full impact of annual premium increases.[204][205] A 2016 survey found that since 2011, deductibles had grown at 10 times the rate of inflation and nearly six times as fast as wages. Half of employer-insured workers had individual deductibles of at least $1,000 compared to 10 percent in 2006. Premiums and deductibles grew by 63%, while incomes grew by 11% over the period.[206]
Healthcare cost inflation
US Health Care Cost Growth[209]
Year Rate of increase (%)
2007 11.9
2008 9.9
2009 9.2
2010 9.0
2011 9.0
2012 8.5
2013 7.5
2014 6.5
2015 6.8
2016 6.5 (estimated)
2017 6.5 (estimated)
The Centers for Medicare & Medicaid Services (CMS) reported that U.S. spending on drugs increased by 12.2% in 2013. A 2015 study found that retail prices for 115 widely used specialty drugs increased 10.6% from 2012 to 2013.[citation needed]
Several studies found that the financial crisis and accompanying recession could not account for the entirety of the slowdown and that structural changes likely share at least partial credit.[210][211][212][213]
A 2013 study estimated that changes to the health system had been responsible for about a quarter of the recent reduction in inflation.[214] Paul Krawzak claimed that even if cost controls succeed in reducing the amount spent on healthcare, such efforts on their own may be insufficient to outweigh the long-term burden placed by demographic changes, particularly the growth of the population on Medicare.[215]
In a 2016 review of ACA, Obama[who?] reported that from 2010 through 2014 mean annual growth in real per-enrollee Medicare spending was negative, down from a mean of 4.7% per year from 2000 through 2005 and 2.4% per year from 2006 to 2010; similarly, mean real per-enrollee growth in private insurance spending was 1.1% per year over the period, compared with a mean of 6.5% from 2000 through 2005 and 3.4% from 2005 to 2010.[216]
Employer mandate and part-time work
For more details on health insurance mandates, see Health insurance mandate.
The employer mandate applies to employers with more than 50 employees that do not offer health insurance to their full-time workers.[245]
Critics claimed that the mandate created a perverse incentive for business to keep their full-time headcount below 50 and to hire part-time workers instead.[246][247] Between March 2010 and 2014 the number of part-time jobs declined by 230,000, while the number of full-time jobs increased by 2 million.[248][249] In the public sector full-time jobs turned into part-time jobs much more than in the private sector.[248][250] A 2016 study found only limited evidence that ACA had increased part-time employment.[251]
Several businesses and the state of Virginia added a 29-hour-a-week cap for their part-time employees,[252][unreliable source?][253][unreliable source?] to reflect the 30-hour-or-more definition for full-time worker.[245] As of yet, however, only a small percent of companies have shifted their workforce towards more part-time hours (4% in a survey from the Federal Reserve Bank of Minneapolis).[247] Trends in working hours[254] and the effects of the Great Recession correlate with part-time working hour patterns.[255][256] The impact of this provision may have been offset by other factors, including that health insurance helps attract and retain employees, increases productivity and reduces absenteeism; and the lower training and administration costs of a smaller full-time workforce over a larger part-time work force.[247][254][257] Relatively few firms employ over 50 employees[247] and more than 90% of them offered insurance.[258] Workers without employer insurance could purchase insurance on the exchanges.[259]
Most policy analysts (on both right and left) were critical of the employer mandate provision.[246][258] They argued that the perverse incentives regarding part-time hours, even if they did not change existing plans, were real and harmful;[260][261] that the raised marginal cost of the 50th worker for businesses could limit companies' growth;[262] that the costs of reporting and administration were not worth the costs of maintaining employer plans;[260][261] and noted that the employer mandate was not essential to maintain adequate risk pools.[263][264] The effects of the provision generated vocal opposition from business interests and some unions not granted exemptions.[261][265]
A 2013/4 survey by the National Association for Business Economics found that about 75 percent of those surveyed said ACA hadn’t influenced their planning or expectations for 2014, and 85 percent said the law wouldn’t prompt a change in their hiring practices. Some 21 percent of 64 businesses surveyed said that the act would have a harmful effect and 5 percent said it would be beneficial.[266]
Hospitals
From the start of 2010 to November 2014, 43 hospitals in rural areas closed, according to the North Carolina Rural Health Research Program. Critics claimed that the new law caused these hospitals to close. Many of these rural hospitals were built using funds from the 1946 Hill–Burton Act, to increase access to medical care in rural areas. Some of these hospitals reopened as other medical facilities, but only a small number operated emergency rooms (ER) or urgent care centers.[267]
Between January 2010 and 2015, a quarter of emergency room doctors said they had seen a major surge in patients, while nearly half had seen a smaller increase. Seven in ten ER doctors claimed that they lacked the resources to deal with large increases in the number of patients. The biggest factor in the increased number of ER patients was insufficient primary care providers to handle the larger number of insured patients.[268]
Insurers claimed that because they have access to and collect patient data that allow evaluations of interventions, they are essential to ACO success. Large insurers formed their own ACOs. Many hospitals merged and purchased physician practices. The increased market share gave them more leverage in negotiations with insurers over costs and reduced patient care options.[101]"Death panels"
Main article: Death panel
On August 7, 2009, Sarah Palin pioneered the term "death panels" to describe groups that would decide whether sick patients were "worthy" of medical care.[292] The allegation was named PolitiFact's "Lie of the Year",[292][293] one of FactCheck.org's "whoppers"[294][295] and the most outrageous term by the American Dialect Society.[296] AARP described such rumors as "rife with gross—and even cruel—distortions".[297] In 2010, the Pew Research Center reported that 85% of Americans were familiar with the claim, and 30% believed it was true, backed by three contemporaneous polls.[298] A poll in August 2012 found that 39% of Americans believed the claim.[299]
"Death panel" referred to two claims about early drafts. One was that under the law, seniors could be denied care due to their age[300] and the other that the government would advise seniors to end their lives instead of receiving care. The ostensible basis of these claims was the provision for an Independent Payment Advisory Board (IPAB).[301] IPAB was given the authority to recommend cost-saving changes to Medicare by facilitating the adoption of cost-effective treatments and cost-recovering measures when the statutory levels set for Medicare were exceeded within any given 3-year period. In fact, the Board was prohibited from recommending changes that would reduce payments to certain providers before 2020, and was prohibited from recommending changes in premiums, benefits, eligibility and taxes, or other changes that would result in rationing.[302][303]
The other related issue concerned advance-care planning consultation: a section of the House reform proposal would have reimbursed physicians for providing patient-requested consultations for Medicare recipients on end-of-life health planning (which is covered by many private plans), enabling patients to specify, on request, the kind of care they wished to receive.[304] The provision was not included in ACA.[305]Health care quality
In 2014 97 ACOs qualified for bonus payments of more than $422 million. In 2015 6 million Medicare beneficiaries were in an ACO. More than 744 organizations became ACOs. Some 23.5 million people received service from an ACO.[101]
Hospital systems in many areas purchased many physician practices as part of becoming an ACO.[101]
Large health insurers, including Humana, UnitedHealth and Aetna, formed ACOs for the private market.[101]
Repeal efforts
ACA was the subject of unsuccessful repeal efforts by Republicans in the 111th, 112th, and 113th Congresses: Representatives Steve King (R-IA) and Michele Bachmann (R-MN) introduced bills in the House to repeal ACA the day after it was signed, as did Senator Jim DeMint (R-SC) in the Senate.[349] In 2011, after Republicans gained control of the House of Representatives, one of the first votes held was on a bill titled "Repealing the Job-Killing Health Care Law Act" (H.R. 2), which the House passed 245–189.[350] All Republicans and 3 Democrats voted for repeal.[351] House Democrats proposed an amendment that repeal not take effect until a majority of the Senators and Representatives had opted out of the Federal Employees Health Benefits Program; Republicans voted down the measure.[352] In the Senate, the bill was offered as an amendment to an unrelated bill, but was voted down.[353] President Obama had stated that he would have vetoed the bill even if it had passed both chambers of Congress.[354]
Following the 2012 Supreme Court ruling upholding ACA as constitutional, Republicans held another vote to repeal the law on July 11;[355] the House of Representatives voted with all 244 Republicans and 5 Democrats in favor of repeal, which marked the 33rd, partial or whole, repeal attempt.[356][357] On February 3, 2015, the House of Representatives added its 67th repeal vote to the record (239 to 186). This attempt also failed[358]
2013 federal government shutdown
Strong partisan disagreement in Congress prevented adjustments to the Act's provisions.[359] However, at least one change, a proposed repeal of a tax on medical devices, has received bipartisan support.[360] Some Congressional Republicans argued against improvements to the law on the grounds they would weaken the arguments for repeal.[261][361]
Republicans attempted to defund its implementation,[345][362] and in October 2013, House Republicans refused to fund the federal government unless accompanied with a delay in ACA implementation, after the President unilaterally deferred the employer mandate by one year, which critics claimed he had no power to do. The House passed three versions of a bill funding the government while submitting various versions that would repeal or delay ACA, with the last version delaying enforcement of the individual mandate. The Democrat Senate leadership stated the Senate would only pass a "clean" funding bill without any restrictions on ACA. The government shutdown began on October 1.[363][364][365] Senate Republicans threatened to block appointments to relevant agencies, such as the Independent Payment Advisory Board[366] and Centers for Medicare and Medicaid Services.[367][368]
Economic consequences
As of 2014 company policies were still the norm, since tax laws continued to make benefits cheaper than cash until 2018. Many employees have been losing their "paternalistic" corporate policies and must find their own insurance. Under ACA employers who stopped their company sponsored insurance plan eliminated one of their largest non-wage benefits and shifted more costs to employees. These include insurance premiums rising to 28% in 2013, compared with 26% in 2003, according to the Kaiser Family Foundation, and more workers paying deductibles of $1,000, reaching 38% in 2013, more than twice that of 2008. According to one study, as of 2014, only 25% of firms saw themselves offering insurance in 10 years.[369]
In 2015 the Center for Economic and Policy Research found no evidence that companies were reducing worker hours to avoid ACA requirements[370] for employees working over 30 hours per week.[371]
Cohn, citing CBO's projections, claimed that ACA's primary employment effect was to alleviate job lock: "People who are only working because they desperately need employer-sponsored health insurance will no longer do so."[372] He concluded that the "reform's only significant employment impact was a reduction in the labor force, primarily because people holding onto jobs just to keep insurance could finally retire", because they have health insurance outside of their jobs.[373]
Impact of repeal on federal budget projections
In May 2011, CBO analyzed proposals to repeal the law and estimated that repealing the entire law (both its taxing and spending provisions) would increase the net 2011–2021 federal deficit by $210 billion.[374][375] Revised CBO accounting, following the July 11, 2012, House repeal vote (H.R. 6079), and taking into account the impact of the Supreme Court ruling, was consistent with its previous estimate: that repeal would increase federal budget deficits by $109 billion over the 2013–2022 period.[376]
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Apr 14, 2017 | economistsview.typepad.com
yuan -> sanjait... , April 14, 2017 at 03:42 PMi support a public option at the provider level in the context of single payer.Sanjait -> yuan... , April 14, 2017 at 04:39 PM
Huh?yuan -> Sanjait... , April 14, 2017 at 05:08 PMIs that your way of saying you want an NHS style system? Or for government to open a network of public providers that compete with private ones? I don't really understand the comment.
i definitely support a fully nationalized system; however, i think a public provider network is necessary to make single payer work well. imo, this "option" is necessary to control (and hopefully lower) the high cost of private and nonprofit providers* and their intermediaries.yuan -> yuan... , April 14, 2017 at 05:13 PM*often oligopolistic or even monopolistic.
http://kff.org/medicare/fact-sheet/medicare-spending-and-financing-fact-sheet/DeDude -> yuan... , April 14, 2017 at 06:52 PMThe main reason that the insurance industry and their little sock puppet, Lieberman fought so hard to block the public option was that they knew they would not be successfully able to compete against it.
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The Washington Post
single payer, 7:42 PM EDT
Here is what you support with ACA................or AHAC......or anything like it.
Cigna CEO David Cordani: $17.3 million
Aetna CEO Mark Bertolini: $17.3 million
UnitedHealth CEO Stephen Hemsley: $14.5 million
Anthem CEO Joseph Swedish: $13.6 million
Humana CEO Bruce Broussard: $10.3 millionphimom , 7:46 PM EDT
The Drug company CEO's are even worse with salaries in the $30M to $46M range. If you took the health insurance industry middle man out of the equation and capped drug company CEO salaries that would probably cover everyone who needed a subsidy. Better yet, require drug companies to be non profit.
single payer, 8:04 PM EDT
Don't be too quick with the "non-profit" term.............generally it tends to simply mean "creative spending".............
Non-profit hospitals are some of the worst price gougers. ........
Farang Chiang Mai, 7:39 PM EDT
The GOP and this administration are overwhelmingly self-avowed Christians yet they try to deny the poor to benefit the rich. This is not Christian but evil pure and simple.
I would love to see this lying, cheating, selfish, crazy devil (yeah, I know I sound a bit OTT but the description is fact based) of a president and his enablers challenged on their Christian values. They are an American taliban, just going about their subversion in a less overtly violent way.
angie12106, 7:44 PM EDT
Republican Jesus detests the poor and favors the rich -- doncha know?
Republicans have USED Christians to win elections for decades -
then when elected - cast votes for the Devil.Farley X Wilbur, 7:38 PM EDT
Why is it that the rich of this country feel entitled to not pay taxes? It seems to be the one entitlement to which they are completely committed. Since the majority of Americans make less than $75,000 per year, as a couple, it is only right that the majority of taxes fall on those above that income. I don't think we need tax cuts. We need hefty tax increases on those who earn enough to afford those taxes.
bobbynorwich222, 7:37 PM EDT
Paul Ryan's District, the 1st Wisconsin, only has a median household income of $53,000, only 25% college graduates, is evenly split Republican/Democratic and has a relatively large Hispanic population of 8%. Now that he's showing his true stripes by proposing laws which enrich the wealthy at the expense of the average guy, why can't someone run against him and get this hateful man out of office?
TylerToo, 7:37 PM EDT
The Ryan Trump plan was a canard primarily designed to remove the small surtax on wealthy investor income and the very tiny .09% increase in the medicare payroll tax on wealthy wage earners. This $600 billion dollar tax cut for the top 1% would have blown a huge hole in the budget deficit projections without any way to pay for all of the necessary benefits retained in the Republican bill and it would have violated Trump's own campaign promise to protect medicare and medicaid from any current and future cuts in funding & benefits.
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Mar 27, 2017 | www.nakedcapitalism.com
Bklyn , , March 26, 2017 at 10:26 amScottW , , March 26, 2017 at 11:49 am... Obamacare is now unaffordable for people with incomes above the subsidy limits. Two friends, independent workers, are paying $900 a month. A couple, $1,700. All are over 50. But they also know the GOP would likely raise their rates even further or leave them with useless coverage.
If anything, the GOP healthcare effort might have offered people a little more clarity about how the current system works. Public options, single payer or something along those lines would be a real blessing.
RUKidding , , March 26, 2017 at 3:43 pmI pay over $1500/mo. for my me and my wife. When I tell my friends about the 20% increase, they don't say much. Both are on company provided health insurance. Therein lies the problem. As with every social ill, if you don't directly experience the pain, it is hard to get worked up about it. I think the majority of Americans reaction to Medicare for All is, "How will that affect my current plan?" Once the disinformation machine rears its ugly head, support dwindles. Sad.
ohioprole , , March 26, 2017 at 5:27 pmEven company provided health care is going up, up, up. I am a govt employee, and not all of my premiums are covered by my govt employer. Plus my deductibles and other costs have risen. IOW, complete crappification of my "health care." It's not as dire as what people experience when they're on their own, but it's not great, either.
I'm not sure what is happening the private sector where companies still offer health insurance to their employees. I can't imagine it's any better. The type of health insurance I have now is what's considered to be among the best on offer. It still sucks.
ambrit , , March 26, 2017 at 11:24 amWell, let me tell you.
I live in the Akron, Ohio area and currently work in a distribution center for a nationally known manufacturer of consumer goods. The plan I turned down cost $82/mo for the privilege of paying the first $2400 if I need something outside of preventative care. After that the insurance company kicks in a percentage (I don't recall the split) until my out-of-pocket maxes out at something over $5000. I don't have it. I'm making $14/hr and this is better than similar work in the area. I'm sure this is better than the exchange plans, but for me it is still unaffordable.
Ulysses , , March 26, 2017 at 9:21 pmIt could be Ulysses if it is framed as being of benefit for everyone. "Universal" schemes aren't always perceived as being "all inclusive." The word "communitarian" comes to mind when this subject arises. See: https://en.wikipedia.org/wiki/Communitarianism Such a framing is anathema to neoliberalism. I'm constantly reminded that the meanings of words change in the public interpretation of them over time. Today's 'Liberal' is not the Eighteenth Centuries 'liberal.' The Classical Greek 'Demos' is not today's 'demos.' It's time for some more dialectic action.
susan the other , , March 26, 2017 at 1:44 pm"It's time for some more dialectic action."
Yes! If not us, who? If not now, when?
Small business owners should be the strongest proponents of single-payer, since it would level the playing field for them. Why should mega-corporations be the only ones able to afford giving their employees decent healthcare?
The main reason Social Security has lasted as long as it has is that everyone who pays into it is entitled to benefits, rich and poor alike.
The bean counters in the budget office are fine-tuning health care to a fare-thee-well. It's a lot like the Fed fine-tuning interest rates to protect the value of the dollar. The Fed has messed around with the stats in order to achieve what used to be the 6% solution – 6% unemployment kept wage-price inflation down – but this must now be closer to 15% to achieve support of the dollar. Likewise a big shell game is going on in health care. Obamacare only dared to remedy those who are virtually deprived of health care, which is a national disgrace no matter how you tweak it, but Obamacare has proved too expensive for all concerned and is imploding because the health care "industry", just like the finance industry, needs to screw the bottom 15% in order to make their sacred profits. If all of us gradually get as screwed as the poorest 15% among us, then we'll see a scramble by the politicians. It looks like this will happen, but not today. Donald Trump does not have the leverage.
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Apr 02, 2017 | economistsview.typepad.com
anne , April 01, 2017 at 09:09 AMhttp://cepr.net/publications/op-eds-columns/medicaid-saved-obamacare-and-single-payer-universal-health-insurance-may-be-back-on-the-agenda-sooner-than-you-thinkMarch 31, 2017
Medicaid Saved Obamacare, and Single-Payer Universal Health Insurance May Be Back on the Agenda Sooner Than You Think
By Mark WeisbrotA lot of the reporting on Trump's epic failure on the attempted repeal of Obamacare has focused on the Freedom Caucus, a group of libertarian-minded representatives for whom the administration's bill did not go far enough in obliterating the gains from the Obama administration's expansion of health care coverage.
But the defeat of Trump's American Health Care Act (AHCA) may have had more to do with the pressure - including grassroots organizing - and risks faced by many Republican representatives who feared taking away insurance that most voters want. And one cannot assume that all members of the Freedom Caucus acted out of ideological concerns; they too have constituents that need health care.
Much of this is explained, with examples and some history, in an excellent article * from The New York Times. And there are broader implications for the way forward.
About 11 million of the approximately 20 million people who gained health insurance under Obamacare did so under its provision for expansion of Medicaid, the joint Federal/state program that provides health insurance for low-income Americans. The expansion included people with income up to 138 percent of the poverty line.
The Times summed up how far-reaching Medicaid had become, now enrolling 21 percent of the population - more than Medicare (the program of public health insurance for Americans over 64):
Medicaid now provides medical care to four out of 10 American children. It covers the costs of nearly half of all births in the United States. It pays for the care of two-thirds of people in nursing homes. And it provides for 10 million children and adults with physical or mental disabilities [ ] almost two-thirds of Americans in a poll by the Kaiser Family Foundation said they were either covered by Medicaid or had a family member or friend who was.
Medicaid is not a universal entitlement, but it is an entitlement that now affects tens of millions of people who are not poor. This provides it with some considerable political protection. The only major entitlement that was taken away from us was Aid to Families with Dependent Children (AFDC), which was undone by the Clinton administration in 1996. It was vulnerable because it served only poor people; sadly, since its repeal, there has been a large increase in the number of people living in extreme poverty.
The Republicans thought they could similarly decimate a program that was designed for low-income people, but this one now has too big of a base. The Congressional Budget Office estimated that the Republican bill would have reduced the number of people receiving Medicaid by 14 million over 10 years. And a lot more people would be affected than these numbers indicate: millions go in and out of enrollment, and millions of people have family members in nursing homes or who are disabled, that they could not afford to take care of without Medicaid.
In the area of health insurance, as in retirement income, universal social insurance is clearly the way to go. Social Security has become the "third rail" of American politics - nobody can touch it - because it works and because most Americans believe in the basic values that it represents: that people have a right to a secure retirement, and it is reasonable to tax current income in order to provide for the future retirement security of everyone. Attempts to partially privatize it in the 1990s and in 2005 were defeated.
Obamacare was a step toward universal health care, most importantly with the expansion of Medicaid. Obama could not get universal, single payer health care but the system that was created suffers from a number of weaknesses, including adverse selection in the private insurance exchanges that it created (i.e. not enough healthy people in the insurance pool). Trump has announced that he would await its impending "implosion" and "explosion," and has plenty of administrative power to sabotage the current system. Other Republicans have declared they will find a way to repeal it....
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Mar 30, 2017 | economistsview.typepad.com
pgl , March 29, 2017 at 07:10 AMThe close of the NYTimes discussion on Republicans and health care offers an interesting twist:reason -> pgl... , March 29, 2017 at 07:22 AM'The private markets are less safe. They have already had more problems than the Medicaid expansion. Price could try to fix those problems, and I hope he does. Or he could set out to aggravate the problems, which he has taken initial steps to do. Above all, he could make changes that discourage healthy people from signing up, causing prices to rise and insurers to flee. Now, think about the political message this would send to Democrats: It's not worth expanding health coverage in a conservative-friendly way, because Republican leaders won't support it anyway. Politics aside, private markets in many areas of the economy have substantive advantages over a government program. They create competition, which leads to innovation and lower prices. But private markets in medical care tend to be more complicated and less successful.'
So Democrats should just pass the popcorn as the Republicans blow up the current system and then push hard for Medicare for All? Maybe.
Earlier this discussion talked briefly about going after "professional guilds". We need more of that discussion.
How about pushing to expand access to medical school places and reduction of student debt.pgl -> reason ... , March 29, 2017 at 07:51 AMNow that is what I call supply side policy.
Somehow the left side of politics needs to learn to talk in terms of the great risk shift and how it acts to concentrate income and power.
"How about pushing to expand access to medical school places and reduction of student debt."Excellent idea. I think this dates back to something Milton Friedman wrote in 1962.
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Mar 28, 2017 | economistsview.typepad.com
Tom aka Rusty, March 27, 2017 at 10:28 AMSomebody did well with the Obama health plan:Faulkner was appointed to the committee that wrote the EMR standards, and not surprisingly EPIC was the template for the standards.
Much cost and misery inflicted on providers.
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Mar 26, 2017 | economistsview.typepad.com
New Deal democrat -> Lee A. Arnold ...One issue going forward is whether the Dems should offer their own plan. I think they should.
As a few others have pointed out, Trump is not wedded to the GOP establishment. If he thinks he can "WIN bigly!" by allying with Dems, he will do so. I happen to think that he is mainly against "Obamacare" because Obama humiliated him at the White House Correspondents' Dinner once upon a time, and he is nothing if not vengeful. He wants to obliterate Obama's legacy.
So Dems need to make a big stink any time Trump administrativley undercuts Obamacare provisions to try to make it fail. But also they should give him the chance to do something he can call Trumpcare that actually works.
Obamacare does have some major problems (the individual mandate is hated, and the penalty isn't big enough. More young people need to buy in. Some of the Exchanges and health care provider networks are too narrow.
In addition to the "public option" and age 55+ Medicare buy-in, one thing that might work is abollishing the mandate and penalty and replaciing them with automatic enrollment. Call it "You're employed, you're covered!"
Just like SS, Medicare, unemployment and disability deductions to paychecks, establish a Health Care automatic deductible. If your employer offers healthcare, the deductible is reduced by the amount of the premium, all the way to zero if applicable.
If your employer doesn't offer healthcare, if you are under age 40, you are automatically enrolled in the least expensive Bronze plan in your state. If you are 40 or older, you are automatically enrolled in the least expensive Silver plan in your state.The deductible would also include a small contribution towards Medicaid. Then, if you are unemployed, you are automatically enrolled in Medicaid, but can continue with the silver or bronze plan as above if you choose.
Dems could turmpet such a plan to "Reform and Improve" Obamacare, and campaign on pushing for it if they get a Congressional majority. Call it Trumpcare and President Caligula might sign on.
Reply Saturday, March 25, 2017 at 07:35 AM Lee A. Arnold , March 25, 2017 at 04:48 AM"Medicare for all" may be the best battle cry. 65-70% of the U.S. people want a single-payer. Bernie Sanders has effectively destroyed the old Democratic Party and sits in a commanding position as spokesman, he gets 6 TV cameras with an hour's notice and he is probably the most popular politician in the U.S. The Democrats don't have to push it for now, they can wait for news to develop. This is all on the Republicans. Let the managerial disaster of Trump and the utter immorality of the "Freedom Caucus" sink in a little more, this story has "legs" as they say in show biz.mulp -> Lee A. Arnold ... , March 25, 2017 at 04:48 AMName the Senators, representatives, and governors Bernie Bros have delivered?jonny bakho , March 25, 2017 at 04:54 AMWhere are the Bernie Bros Newts, Cruz, Marcos, ...?
I'm in my 70th year. Conservatives attacked liberals in the 60s, my youth, as promising free lunches to gain power. But what they really hated was liberals convinced voters to tax all voters to pay for the things most voters wanted everyone to have, BASED ON SOUND ECONOMICS TO MAXIMIZE EFFICIENCY AND WELFARE.
Friedman led the effort to distort theory to eliminate the broad meaning of general welfare in economics. He did it by eliminating the hard connection between labor cost and gdp. He argued that labor costs and consumption can be cut to increase profits, and that contrary to theory, higher profits is more efficient.
Laffer applied operations theory to taxes, as if government was taxing to maximize profits.
Thus supply side theory of profit maximization. The result delivered was the imperative to cut taxes. To cut labor costs. Thus they argued that every economic measure improves if taxes and wages are cut.
Reaganomics would deliver more stuff at lower cost, higher profut, and that makes everyone better off, especially those in poverty. Friedman saw consumption as a bad thing. He wanted higher gdp, less consumption. In other words, he rewrote Adam Smith attack on mercantile economics into a justification of returning to mercantile economic policy.
So, who do Bernie Bros offer as the Milton Friedman and Laffer to create an intellectual foundation to refute Adam Smith, FDR, Keynes, Galbraith, are return to hunter gatherer economics? Who is the economist who can convince us that Marxist economic theory will work, as long as it's not captured by right wing capitalists like Fidel Castro, Chavez, Stalin, Lenin, the founders of Israel, ....
Bernie certainly must be influenced by the same economic theory that created Israel. It grew from the same Marxist roots in Germany that powered Stalin and Lenin. Bernie is a pre-WWII Zionist as best I can tell.
Why wouldn't Bernie deliver Israel governance to the US? How would he prevent the greedy from joining the Movement?
And Israel has the social welfare state system Bernie wants. Hundreds of thousands of men do not work so they can study supported by welfare. Universal health care. Women are very equal in status.
I grew up heating the Zionist Dream, theory, much like Bernie did, but from conservative Indiana. Seemed very idealist virtue becoming reality in the 50s and 60s. I have often used Israel as the example of a good universal health care system, of education, of welfare. Never heard Bernie say, "I want the US to be like Israel." Why not? Why Sweden?
Frank is wrong. What the GOP establishment dislikes most about Obamacare is the taxes on the wealthy. Medicare for all would have to be paid for by taxes on the wealthy or substantial payroll tax increases on the working class.RC AKA Darryl, Ron -> jonny bakho... , March 25, 2017 at 05:14 AM
This does not meet GOP or Trump objectives for tax cuts on the wealthy.
The TV and radio talk uses Obamacare bashing to sell ads. They can easily change the subject to some other click bait.
Medicare for all? NaGonnaHappNFrank was not suggesting that the GOP establishment would support Medicare for all. Frank was suggesting that Trump would essentially change parties to become a Democrat. As dubious as that notion is, more importantly it is premature. If Democrats win back both chambers of Congress, then it would at least be mechanically possible if still extraordinarily dubious. Mostly though Frank was just reaching for something worth saying. Now is a tuff time for commentary on the political economy.Lee A. Arnold -> jonny bakho... , March 25, 2017 at 06:10 AMJonny Bakho: "Medicare for all would have to be paid for by taxes"RC AKA Darryl, Ron -> Lee A. Arnold ... , March 25, 2017 at 07:30 AMTheoretically you don't have to raises taxes if you get private insurers out of the game. They are a big expense, and give no value-added.
Doesn't mean that is politically possible, with Trump and a GOP Congress. But Trump and a Democratic Congress? I couldn't predict. Keep in mind that this man is almost an ideological vacuum, no managerial skills, has no constant concerns for anything except keeping himself in the spotlights, to be loved. And he just learned that the Freedom Caucus is implacably nuts.
"They are a big expense, and give no value-added."RC AKA Darryl, Ron -> Lee A. Arnold ... , March 25, 2017 at 11:29 AM[Someone has to do claims processing. The resistance against growing the federal payroll is an unnecessary hurdle for Medicare for all (MFA) to jump. Better administer it more like Medicaid. Let insurance companies handle the operations for a fee. Federal claim payments are handled on a pass thru. Then let the operational administration default to the MFA supplemental plan carrier if the insured has one, else the lowest cost carrier in the insured's state. For MFA clients then there could be a single claims process for providers even for patients with both MFA and MFA supplemental policies. That lowers the hurdle for MFA to leap over the insurance company lobby as well.]
Most of health insurance claims processing has been automated for a long time. Still it takes a lot of worker-hours to reconcile the errors.Lee A. Arnold -> mulp... , March 25, 2017 at 11:27 AMImagine how many worker hours it will take to reconcile liabilities for the first multi-car multi-fatality pile up of robot cars on the LA freeway. It will not matter that in total there have been less collisions and less fatalities when the big one hits. Computers are incapable of intuitive judgement which leads to blunders of potentially a colossal scale occurring that could have easily been foreseen by a human. To err is human but it takes a computer to really screw things up beyond all recognition. It is just a matter of time and time is always on Murphy's (that which can go wrong will go wrong) side. I know that myths about computers that never make mistakes and never need to be programmed again abound and I am sure that they will still be with us 20,000 years from now, when we are not even in any memory banks. I spent my entire career about to be replaced by software, but I was finally laid off because of administrative concerns with regards to legacy managed employees in context of the re-compete of the NG/VITA outsourcing contract (which is far less catchy). Computers have the potential to speed transit and reduce fatalities, but that potential will not be permanently realized as long as people are intent upon removing all human control and intervention. Computers can be capable copilots under almost all circumstances, but their owners cannot weather the fallout from their inability to conceive a response on their own when confronted with conditions that they were not programmed for. Such dramatic consequences will eventually raise a great furor, horror, deep sorrow, and extensive liability concerns. Even if you could sue a computer it is unlikely that they could demonstrate the means to pay. Incarceration of a computer for criminal negligence seems a bit ludicrous as well. The owner of the offending property better have their insurance premiums all paid up, but what then? Who will insure the next owner? Advocates of computer driven cars are planning on no fault insurance being mandated in each and every state. Good luck with that.
My wife works for Anthem although not in claims processing. She used to work in membership which is also automated. Software developers for health insurance mostly use Agile methods. One facet of that is that they only expect automation to handle roughly 90% (ideally more) of the workload because they have learned that there will never be a no defects computer system and they are saving expensive labor time in development by allowing lower paid workers to pick up a lot of the more complicated cases manually. That reduces time spent in the iterative process of testing and correcting defects. I am sure that you remember the problems with the ACA's automated insurance membership market. Stuff happens all the time in IT.
It is not that I had to work in IT for 47 years to understand the limitations. Merely my childhood education on the mathematical system of logic that underlies their circuitry and programming would have been sufficient, but a bit of empirical confirmation never hurts. Understanding reality is unfortunately a pre-requisite, but once that is accomplished then there are great opportunities to achieve improved results. Computers are not the problem, but can often be an essential part of the solution rather than a faceless soulless panacea. Does not compute can happen anywhere, but worse though when it happens at 75 MPH.
Every serious study that looks at current costs in the multipayer healthcare insurance concludes that moving to single-payer will save 15-20% of total spending. Here is yet another one:RC AKA Darryl, Ron -> Lee A. Arnold ... , March 25, 2017 at 11:40 AM
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/There is nothing about that paper that would not hold true or even truer of a two tiered system of Medicare for all with administrative processing collocated with the supplemental insurer whenever there is one. Just do a work flow model and note how many steps are cut out at each the provider and insurer if primary and secondary coverage administrative processing for membership, claims, and policy holder services are collocated.RGC -> jonny bakho... , March 25, 2017 at 11:40 AMGovernment Funds 60% of U.S. Healthcare Costs - Far Higher than Previously BelievedRGC -> Chris G ... , March 25, 2017 at 08:04 AM"We Pay for National Health Insurance but Don't Get It"
"Universal coverage is affordable - without a big tax increase," continued Dr. Himmelstein. "Because taxes already fund 60% of health care costs, a shift about the size of the recent tax cut ($130 billion a year) from private funding to public funding would allow us to cover all the uninsured and improve benefits for everyone else. Insurers/HMOs and drug companies buy-off our politicians with huge campaign contributions and hordes of lobbyists."
Beyond the Affordable Care Act: A Physicians' Proposal for Single-Payer Health Care ReformRGC -> RC AKA Darryl, Ron... , March 25, 2017 at 08:04 AMDuring a transition period, all public funds currently spent on health care – including Medicare, Medicaid, and state and local health care programs – would be redirected to the unified NHP budget. Such public spending – together with tax subsidies for employer-paid insurance and government expenditures for public workers' health benefits – already accounts for 60% of total U.S. health expenditures.28 Additional funds would be raised through taxes, though importantly these would be fully offset by a decrease in out-of-pocket spending and premiums.
Is Donald Trump still 'for single-payer' health care?
"Perry said Trump is "for single-payer health care."
Fifteen years ago, Trump was decidedly for a universal healthcare system that resembled Canada's system, in which the government pays for care for all citizens.Recently, he's said he admires Scotland's single-payer system and disses the Affordable Care Act as incompetently implemented.
However, a Trump spokesman denied that the candidate supported "socialized medicine" and suggested Trump prefers a "free-market" solution. Other than that, though, the Trump campaign has been silent about what his specific health care policies are; perhaps Trump will be pressed on this point during the Aug. 6 debate.
Given the current evidence, Perry's attack is partially accurate, but leaves out details. We rate the statement Half True.
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Mar 26, 2017 | economistsview.typepad.com
Fred C. Dobbs , March 25, 2017 at 07:35 AMIn a Call to The Times, Trump Blames Democrats for theFred C. Dobbs -> Fred C. Dobbs... , March 25, 2017 at 08:02 AM
Failure of the Health Bill https://nyti.ms/2nNPHD9
NYT - MAGGIE HABERMAN - MARCH 24, 2017WASHINGTON - Just moments after the Republican plan to repeal and replace the Affordable Care Act was declared dead, President Trump sought to paint the defeat of his first legislative effort as an early-term blip.
The House speaker, Paul D. Ryan, was preparing to tell the public that the health care bill was being withdrawn - a byproduct, Mr. Trump said, of Democratic partisanship. The president predicted that Democrats would return to him to make a deal in roughly a year.
"Look, we got no Democratic votes. We got none, zero," Mr. Trump said in a telephone interview he initiated with The New York Times.
"The good news is they now own health care. They now own Obamacare."
Mr. Trump insisted that the Affordable Care Act would collapse in the next year, which would then force Democrats to come to the bargaining table for a new bill.
"The best thing that can happen is that we let the Democrats, that we let Obamacare continue, they'll have increases from 50 to 100 percent," he said. "And when it explodes, they'll come to me to make a deal. And I'm open to that."
Although enrollment in the Affordable Care Act declined slightly in the past year, there is no sign that it is collapsing. Its expansion of Medicaid continues to grow.
In a later phone interview with The Times, the Senate minority leader, Chuck Schumer, ridiculed Mr. Trump's remarks about Democrats being at fault.
"Whenever the president gets in trouble, he points fingers of blame," Mr. Schumer said. "It's about time he stopped doing that and started to lead. The Republicans were totally committed to repeal from the get-go, never talked to us once. But now that they realize that repeal can't work, if they back off repeal, of course we'll work with them to make it even better."
Mr. Trump said that "when they come to make a deal," he would be open and receptive. He singled out the Tuesday Group moderates for praise, calling them "terrific," an implicit jab at the House Freedom Caucus, which his aides had expressed frustration with during negotiations. ...
On health-care, as on so much else,
President Trump passes the buck, reports
https://www.theatlantic.com/politics/archive/2017/03/the-buck-doesnt-stop-here-anymore/520839/
The Atlantic - David A. Graham - March 24, 2017Speaking in the Oval Office Friday afternoon, President Trump surveyed the wreckage of the Obamacare repeal effort and issued a crisp, definitive verdict: I didn't do it.
The president said he didn't blame Speaker Paul Ryan, though he had plenty of implied criticism for the speaker. "I like Speaker Ryan. He worked very hard," Trump said, but he added: "I'm not going to speak badly about anybody within the Republican Party. Certainly there's a big history. I really think Paul worked hard." He added ruefully that the GOP could have taken up tax-reform first, instead of Obamacare-the reverse of Ryan's desired sequence. "Now we're going to go for tax reform, which I've always liked," he said.
As for the House Freedom Caucus, the bloc of conservatives from which many of the apparent "no" votes on the Republican plan were to come, Trump said, "I'm not betrayed. They're friends of mine. I'm disappointed because we could've had it. So I'm disappointed. I'm a little surprised, I could tell you."
The greatest blame for the bill's failure fell on Democrats, Trump said.
"This really would've worked out better if we could've had Democrat support. Remember we had no Democrat support," Trump said. Later, he added, "But when you get no votes from the other side, meaning the Democrats, it's really a difficult situation."
He said Democrats should come up with their own bill. "I think the losers are Nancy Pelosi and Chuck Schumer, because they own Obamacare," he said, referring to the House and Senate Democratic leaders. "They 100 percent own it."
Trump was very clear about who was not to blame: himself. "I worked as a team player," the president of the United States said, demoting himself to bit-player status. He wanted to do tax reform first, after all, and it was still early. "I've been in office, what, 64 days? I've never said repeal and replace Obamacare within 64 days. I have a long time. I want to have a great health-care bill and plan and we will."
Strictly speaking, it is true that Trump didn't promise to repeal Obamacare on day 64 of his administration. What he told voters, over and over during the campaign, was that he'd do it immediately. On some occasions he or top allies even promised to do it on day 1. Now he and his allies are planning to drop the bill for the foreseeable future.
It is surely not wrong that there is lots of blame to go around. Congressional Republicans had years to devise a plan, and couldn't come up with one that would win a majority in the House, despite a 44-seat advantage. The House bill was an unpopular one, disliked by conservatives and moderates in that chamber; almost certainly dead on arrival in the Senate; and deeply unpopular with voters. Even before the vote was canceled, unnamed White House officials were telling reporters that the plan was to pin the blame on Ryan. ...
The Republicans fold and
withdraw their health-care bill https://www.theatlantic.com/politics/archive/2017/03/trump-republicans-failure-obamacare/520788/
The Atlantic - Russell Berman - March 24, 2017... Defeat on the floor dealt Trump a major blow early in his presidency, but its implications were far more serious for the Republican Party as a whole. Handed unified control of the federal government for only the third time since World War II, the modern GOP was unable to overcome its internecine fights to enact a key part of its policy agenda. The president now wants to move on to a comprehensive overhaul of the tax code, but insiders on Capitol Hill have long believed that project will be an even heavier lift than health care.
As the prospect of a loss became more real on Friday, the frustrations of GOP lawmakers loyal to the leadership began to boil over. "I've been in this job eight years, and I'm wracking my brain to think of one thing our party has done that's been something positive, that's been something other than stopping something else from happening," Representative Tom Rooney of Florida said in an interview. "We need to start having victories as a party. And if we can't, then it's hard to justify why we should be back here."
Nothing has exemplified the party's governing challenge quite like health care. For years, Republican leaders resisted pressure from Democrats and rank-and-file lawmakers to coalesce around a detailed legislative alternative to Obamacare. That failure didn't prevent them from attaining power, but it forced them to start nearly from scratch after Trump's surprising victory in November. At Ryan's urging, the party had compiled a plan as part of the speaker's "A Better Way" campaign agenda. Translating that into legislation, however, proved a much stiffer challenge; committee leaders needed to navigate a razor's edge to satisfy conservatives demanding a full repeal of Obamacare and satisfy moderates who preferred to keep in place its more popular consumer protections and Medicaid expansion. They were further limited by the procedural rules of the Senate, which circumscribed how far Republicans could go while still avoiding a Democratic filibuster. ...
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Mar 25, 2017 | economistsview.typepad.com
anne : March 25, 2017 at 07:54 AM , 2017 at 07:54 AMhttp://cepr.net/blogs/beat-the-press/new-health-care-plan-open-source-drugs-immigrant-doctors-and-a-public-optionanne -> anne... , March 25, 2017 at 07:56 AMMarch 25, 2017
New Health Care Plan: Open Source Drugs, Immigrant Doctors, and a Public Option
Now that the Republican health care plan has been sent to the dust bin of history, it's worth thinking about how Obamacare can be improved. While the Affordable Care Act was a huge step forward in extending insurance coverage, many of the complaints against the program are justified. The co-pays and deductibles can mean the plans are of little use to middle income people with relatively low bills.
This is a great time to put forward ideas for reducing these costs and making other changes in the health care system. Obviously this congress and president are not interested in reforms that help low and middle income families, but the rest of us can start pushing these ideas now, with the expectation that the politicians will eventually come around.
There are two obvious directions to go to get costs down for low and middle income families. One is to increase taxes on the wealthy. The other is to reduce the cost of health care. The latter is likely the more promising option, especially since we have such a vast amount of waste in our system. The three obvious routes are lower prices for prescription drugs and medical equipment, reducing the pay of doctors, and savings on administrative costs from having Medicare offer an insurance plan in the exchanges.
Taking these in turn, the largest single source of savings would be reducing what we pay for prescription drugs. We will spend over $440 billion this year for drugs that would likely sell for less than $80 billion in a free market without patent monopolies and other forms of protection. If we paid as much as people in other wealthy countries for our drugs, we would save close to $200 billion a year. We spend another $50 billion a year on medical equipment which would likely cost around $15 billion in a free market.
If the government negotiated prices for drugs and medical equipment its savings could easily exceed $100 billion a year (see "Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer" * ). It could use some of these savings to finance open-source research for new drugs and medical equipment.
We already fund a huge amount of research, so this is not some radical departure from current practice. The government spends more than $32 billion on research conducted by the National Institutes of Health. It also picks up 50 percent of the industry's research costs on orphan drugs through the Orphan Drug Tax Credit. Orphan drugs are a rapidly growing share of all drug approvals, as the industry increasingly takes advantage of this tax credit.
The big change would not be that the government was funding research, but rather the research results and patents would be in the public domain, rather than be used by Pfizer and other drug companies to get patent monopolies. As a result, the next great breakthrough drug will sell as a generic for a few hundred dollars rather than hundreds of thousands of dollars. And MRI scans would cost little more than X-rays.
The second big potential source of savings would come from reducing the protectionist barriers which largely exclude foreign-trained physicians. Under current law, a foreign doctor is prohibited from practicing in the United States unless they complete a U.S. residency program. This keeps hundreds of thousands of well-qualified from physicians from practicing in the United States. As a result, our doctors earn on average more than $250,000 a year, roughly twice the average pay in other wealthy countries. (There are similar protectionist restrictions which inflate the pay of dentists.)
If we removed this barrier and allowed qualified foreign doctors to practice in the United States, we would likely get their pay down to levels comparable to that of doctors in countries like Canada and Germany. This could save us close to $100 billion a year on our health care bill, at least half of which would be savings to the government.
There is a concern that we would attract more doctors from developing countries. We could easily offset this brain drain by paying these countries enough so that they can train two or three doctors for every one that comes to the United States, thereby ensuring they gain from this arrangement as well. It is worth noting that these countries receive zero compensation now for the doctors they pay to train, but who then practice in the United States.
The third big source of saving would be having Medicare offer an insurance plan in the exchanges. This would ensure both that everyone had at least one good option regardless of where they lived and also that the private insurers in the system would face real competition. In 2010, the Congressional Budget Office projected that a public option would save the government $23 billion a year by 2020 and $29 billion by 2023.
The total savings to the government from these three changes easily exceed $150 billion a year, in addition to large savings that individuals outside the exchanges would see in their health care expenses. This is far more than enough to make the deductibles zero for each of the roughly 10 million people now in the exchanges. That would make Obamacare considerably more attractive.
Of course if the plans in the exchanges became more generous more people would opt to take advantage of them and we would see people leaving employer-provided plans. That is a problem that we can deal with at the time it happens. (We would need to have a portion of workers' current payments for employer provided plans go to the government to cover the cost of additional enrollees in the exchanges.) But the way forward in improving Obamacare is to use the market to make our health care system more efficient and reduce the ridiculous rents that now go to the wealthy as a result of waste in the system.
* http://deanbaker.net/images/stories/documents/Rigged.pdf
-- Dean Baker
http://deanbaker.net/images/stories/documents/Rigged.pdfgeoff -> anne... , March 25, 2017 at 08:43 AMOctober, 2016
Rigged: How Globalization and the Rules of the Modern Economy Were Structured to Make the Rich Richer
By Dean BakerThe Old Technology and Inequality Scam: The Story of Patents and Copyrights
One of the amazing lines often repeated by people in policy debates is that, as a result of technology, we are seeing income redistributed from people who work for a living to the people who own the technology. While the redistribution part of the story may be mostly true, the problem is that the technology does not determine who "owns" the technology. The people who write the laws determine who owns the technology.
Specifically, patents and copyrights give their holders monopolies on technology or creative work for their duration. If we are concerned that money is going from ordinary workers to people who hold patents and copyrights, then one policy we may want to consider is shortening and weakening these monopolies. But policy has gone sharply in the opposite direction over the last four decades, as a wide variety of measures have been put into law that make these protections longer and stronger. Thus, the redistribution from people who work to people who own the technology should not be surprising - that was the purpose of the policy.
If stronger rules on patents and copyrights produced economic dividends in the form of more innovation and more creative output, then this upward redistribution might be justified. But the evidence doesn't indicate there has been any noticeable growth dividend associated with this upward redistribution. In fact, stronger patent protection seems to be associated with slower growth.
Before directly considering the case, it is worth thinking for a minute about what the world might look like if we had alternative mechanisms to patents and copyrights, so that the items now subject to these monopolies could be sold in a free market just like paper cups and shovels.
The biggest impact would be in prescription drugs. The breakthrough drugs for cancer, hepatitis C, and other diseases, which now sell for tens or hundreds of thousands of dollars annually, would instead sell for a few hundred dollars. No one would have to struggle to get their insurer to pay for drugs or scrape together the money from friends and family. Almost every drug would be well within an affordable price range for a middle-class family, and covering the cost for poorer families could be easily managed by governments and aid agencies.
The same would be the case with various medical tests and treatments. Doctors would not have to struggle with a decision about whether to prescribe an expensive scan, which might be the best way to detect a cancerous growth or other health issue, or to rely on cheaper but less reliable technology. In the absence of patent protection even the most cutting edge scans would be reasonably priced.
Health care is not the only area that would be transformed by a free market in technology and creative work. Imagine that all the textbooks needed by college students could be downloaded at no cost over the web and printed out for the price of the paper. Suppose that a vast amount of new books, recorded music, and movies was freely available on the web.
People or companies who create and innovate deserve to be compensated, but there is little reason to believe that the current system of patent and copyright monopolies is the best way to support their work. It's not surprising that the people who benefit from the current system are reluctant to have the efficiency of patents and copyrights become a topic for public debate, but those who are serious about inequality have no choice. These forms of property claims have been important drivers of inequality in the last four decades.
The explicit assumption behind the steps over the last four decades to increase the strength and duration of patent and copyright protection is that the higher prices resulting from increased protection will be more than offset by an increased incentive for innovation and creative work. Patent and copyright protection should be understood as being like very large tariffs. These protections can often the raise the price of protected items by several multiples of the free market price, making them comparable to tariffs of several hundred or even several thousand percent. The resulting economic distortions are comparable to what they would be if we imposed tariffs of this magnitude.
The justification for granting these monopoly protections is that the increased innovation and creative work that is produced as a result of these incentives exceeds the economic costs from patent and copyright monopolies. However, there is remarkably little evidence to support this assumption. While the cost of patent and copyright protection in higher prices is apparent, even if not well-measured, there is little evidence of a substantial payoff in the form of a more rapid pace of innovation or more and better creative work....
Medicare for all is a great idea but still well out of political reach for a while. On the other hand, cheaper drugs is a goal even trumpers could support with the right sales pitch.Peter K. -> geoff ... , March 25, 2017 at 08:59 AMthe pushers are unusually profitable:
and they make for a pretty scummy pond in the swamp:
https://www.opensecrets.org/lobby/indusclient.php?id=h04
hey, it could happen here:
https://www.law360.com/articles/903111/canada-prevails-in-383m-eli-lilly-case
Trump met with the heads of the drug companies and decided the solutions was more deregulation.DeDude -> anne... , March 25, 2017 at 10:23 AMI generally love most of what Dean Baker does. But his weaknesses are on display in this piece. Just enough insights to sound convincing, but not enough to be the real McCoy. Yes we pay our medical doctors a lot more than France. However, ours first come out of undergraduate training having paid over $200K for that, then add another $300K for medical school. So that is a cool $500K in debt that their French counterparts don't have to deal with. Next (and before they can se any patients are internships (3 years) where they are not paid enough to begin paying down the student debt, followed by another 2-5 years of specialty training again with a compensation that cover living but not paying down the debt. Finally after becoming specialists (and those who don't are not paid $250K per year), they can begin paying down that student debt which in the meantime has grown substantially (with its private market interest rates).anne : , March 25, 2017 at 08:10 AMIf you were to put all those foreigners with their free education in direct competition with the domestic crop there would be no US born doctors. But that would be the least of the problems. American medical schools are for the most part outstanding and even the least of those graduating are quite good. That cannot be said for many of the other places in the world where we get most of our foreign trained doctors. There is a very good reason we demand that foreigners go through a US residency program before they can practice medicine. Regardless of what their (real or fake) papers say about their education, they have to perform up to US standards to pass the US residency programs and be licensed – and that is a good thing.
https://www.nytimes.com/2017/03/24/upshot/health-insurance-medicare-obamacare-american-health-care-act.html?ref=businessanne -> anne... , March 25, 2017 at 08:15 AMMarch 24, 2017
What Comes Next for Obamacare? The Case for Medicare for All
By ROBERT H. FRANKRepublicans are in a bind. They've been promising to repeal Obamacare for seven years, and having won control of the White House and Congress, they had to try to deliver. But while their bitter denunciations of the Affordable Care Act may have depressed its approval numbers, they didn't make replacing it any easier.
On the contrary, the repeal-and-replace bill designed by House Speaker Paul D. Ryan drew withering criticism from the left and the right. Liberals condemned its use of reductions in health coverage for the poor to pay for large tax cuts for the wealthy, while conservatives bemoaned its retention of many subsidies adopted under Obamacare.
In the end, the repeal effort's biggest hurdle may have been loss aversion, one of the most robust findings in behavioral science. As numerous studies have shown, the pain of losing something you already have is much greater than the pleasure of having gained it in the first place. And the nonpartisan Congressional Budget Office estimated that Mr. Ryan's American Health Care Act (A.H.C.A.) would have caused more than 14 million people to lose coverage in the first year alone, with total losses rising to 24 million over the next decade. Many Republicans in Congress were nervous about the political firestorm already provoked by the mere prospect of such losses.
Loss aversion actually threatened the repeal effort on two fronts: voters' fear of losing their coverage, and lawmakers' fear of losing their seats. Like the first fear, the second appeared well grounded. Republican voters wouldn't have been the only ones losing coverage, of course, but early studies suggested that losses would have been concentrated among people who voted for President Trump. The Congressional Budget Office estimated, for example, that the A.H.C.A. would have caused premiums to rise more than sevenfold in 2026 for 64-year-olds making $26,500.
Now that Republicans have withdrawn Mr. Ryan's bill from consideration, attention shifts to what comes next. In an earlier column, I suggested that Mr. Trump has the political leverage, which President Obama did not, to jettison the traditional Republican approach in favor of a form of the single-payer health care that most other countries use. According to Physicians for a National Health Program, an advocacy group, "Single-payer national health insurance, also known as 'Medicare for all,' is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands." Christopher Ruddy, a friend and adviser of the president, recently urged him to consider this option.
Many Republicans who want to diminish government's role in health care view the single-payer approach with disdain. But Mr. Trump often seems to take pleasure in being unpredictable, and since he will offend people no matter which way he turns, he may want to consider why liberals and conservatives in many other countries have embraced the single-payer approach.
Part of the appeal of Medicare for all is that single-payer systems reduce financial incentives that generate waste and abuse. Mr. Ryan insisted that by relegating health care to private insurers, competition would lead to lower prices and higher quality. Economic theory tells us that this is a reasonable expectation when certain conditions are met. A crucial one is that buyers must be able to compare the quality of offerings of different sellers. In practice, however, people have little knowledge of the treatment options for the various maladies they might suffer, and policy language describing insurance coverage is notoriously complex and technical. Consumers simply cannot make informed quality comparisons in this industry.
In contrast, they can easily compare the prices charged by competing insurance companies. This asymmetry induces companies to compete by highlighting the lower prices they're able to offer if they cut costs by degrading the quality of their offerings. For example, it's common for insurance companies to deny payment for procedures that their policies seem to cover. If policy holders complain loudly enough, they may eventually get reimbursed, but the money companies save by not paying others confers a decisive competitive advantage over rivals that don't employ this tactic. Such haggling is uncommon under single-payer systems like Medicare (though it is sometimes employed by private insurers that supplement Medicare).
Consider, too, the mutually offsetting expenditures on competitive advertising and other promotional efforts of private insurers, which can exceed 15 percent of total revenue. Single-payer plans like Medicare spend nothing on competitive advertising (although here, also, we see such expenditures by supplemental insurers).
According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of total operating expenditures, less than one-sixth of the rate estimated for the private insurance industry. This difference does not mean that private insurers are evil. It's a simple consequence of a difference in the relevant economic incentives.
American health care outlays per capita in 2015 were more than twice the average of those in the 35 advanced countries that make up the Organization for Economic Cooperation and Development. Yet despite that spending difference, the system in the United States delivers significantly less favorable outcomes on measures like longevity and the incidence of chronic illness....
http://www.oecd.org/health/health-systems/oecd-health-statistics-2014-frequently-requested-data.htmNovember, 2016
Organisation for Economic Co-operation and Development Health Data
Total health care spending per person, 2015 *
United States ( 9451)
OCED average ( 3814)France ( 4407)
Total health care spending as a share of GDP, 2015
United States ( 16.9)
OCED average ( 9.0)France ( 11.0)
Pharmaceutical expenditure per person, 2014 *
United States ( 1112)
OECD average ( 538)France ( 656)
Practising physicians per 1,000 population, 2014
United States ( 2.6)
OECD average ( 3.3)France ( 3.3)
Practising nurses per 1,000 population, 2014
United States ( 11.2)
OECD average ( 8.9)France ( 9.6)
Physician consultations per person, 2014
United States ( 4.0)
OECD average ( 6.8)France ( 6.3)
Medical graduates per 100,000 population, 2014
United States ( 7.3)
OECD average ( 11.4)France ( 10.0)
* Data are expressed in US dollars adjusted for purchasing power parities (PPPs), which provide a means of comparing spending between countries on a common base. PPPs are the rates of currency conversion that equalise the cost of a given "basket" of goods and services in different countries.
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Fred C. Dobbs : , March 25, 2017 at 07:35 AMIn a Call to The Times, Trump Blames Democrats for theFred C. Dobbs -> Fred C. Dobbs... , March 25, 2017 at 08:02 AM
Failure of the Health Bill https://nyti.ms/2nNPHD9
NYT - MAGGIE HABERMAN - MARCH 24, 2017WASHINGTON - Just moments after the Republican plan to repeal and replace the Affordable Care Act was declared dead, President Trump sought to paint the defeat of his first legislative effort as an early-term blip.
The House speaker, Paul D. Ryan, was preparing to tell the public that the health care bill was being withdrawn - a byproduct, Mr. Trump said, of Democratic partisanship. The president predicted that Democrats would return to him to make a deal in roughly a year.
"Look, we got no Democratic votes. We got none, zero," Mr. Trump said in a telephone interview he initiated with The New York Times.
"The good news is they now own health care. They now own Obamacare."
Mr. Trump insisted that the Affordable Care Act would collapse in the next year, which would then force Democrats to come to the bargaining table for a new bill.
"The best thing that can happen is that we let the Democrats, that we let Obamacare continue, they'll have increases from 50 to 100 percent," he said. "And when it explodes, they'll come to me to make a deal. And I'm open to that."
Although enrollment in the Affordable Care Act declined slightly in the past year, there is no sign that it is collapsing. Its expansion of Medicaid continues to grow.
In a later phone interview with The Times, the Senate minority leader, Chuck Schumer, ridiculed Mr. Trump's remarks about Democrats being at fault.
"Whenever the president gets in trouble, he points fingers of blame," Mr. Schumer said. "It's about time he stopped doing that and started to lead. The Republicans were totally committed to repeal from the get-go, never talked to us once. But now that they realize that repeal can't work, if they back off repeal, of course we'll work with them to make it even better."
Mr. Trump said that "when they come to make a deal," he would be open and receptive. He singled out the Tuesday Group moderates for praise, calling them "terrific," an implicit jab at the House Freedom Caucus, which his aides had expressed frustration with during negotiations. ...
On health-care, as on so much else,
President Trump passes the buck, reports
https://www.theatlantic.com/politics/archive/2017/03/the-buck-doesnt-stop-here-anymore/520839/
The Atlantic - David A. Graham - March 24, 2017Speaking in the Oval Office Friday afternoon, President Trump surveyed the wreckage of the Obamacare repeal effort and issued a crisp, definitive verdict: I didn't do it.
The president said he didn't blame Speaker Paul Ryan, though he had plenty of implied criticism for the speaker. "I like Speaker Ryan. He worked very hard," Trump said, but he added: "I'm not going to speak badly about anybody within the Republican Party. Certainly there's a big history. I really think Paul worked hard." He added ruefully that the GOP could have taken up tax-reform first, instead of Obamacare-the reverse of Ryan's desired sequence. "Now we're going to go for tax reform, which I've always liked," he said.
As for the House Freedom Caucus, the bloc of conservatives from which many of the apparent "no" votes on the Republican plan were to come, Trump said, "I'm not betrayed. They're friends of mine. I'm disappointed because we could've had it. So I'm disappointed. I'm a little surprised, I could tell you."
The greatest blame for the bill's failure fell on Democrats, Trump said.
"This really would've worked out better if we could've had Democrat support. Remember we had no Democrat support," Trump said. Later, he added, "But when you get no votes from the other side, meaning the Democrats, it's really a difficult situation."
He said Democrats should come up with their own bill. "I think the losers are Nancy Pelosi and Chuck Schumer, because they own Obamacare," he said, referring to the House and Senate Democratic leaders. "They 100 percent own it."
Trump was very clear about who was not to blame: himself. "I worked as a team player," the president of the United States said, demoting himself to bit-player status. He wanted to do tax reform first, after all, and it was still early. "I've been in office, what, 64 days? I've never said repeal and replace Obamacare within 64 days. I have a long time. I want to have a great health-care bill and plan and we will."
Strictly speaking, it is true that Trump didn't promise to repeal Obamacare on day 64 of his administration. What he told voters, over and over during the campaign, was that he'd do it immediately. On some occasions he or top allies even promised to do it on day 1. Now he and his allies are planning to drop the bill for the foreseeable future.
It is surely not wrong that there is lots of blame to go around. Congressional Republicans had years to devise a plan, and couldn't come up with one that would win a majority in the House, despite a 44-seat advantage. The House bill was an unpopular one, disliked by conservatives and moderates in that chamber; almost certainly dead on arrival in the Senate; and deeply unpopular with voters. Even before the vote was canceled, unnamed White House officials were telling reporters that the plan was to pin the blame on Ryan. ...
The Republicans fold and
withdraw their health-care bill https://www.theatlantic.com/politics/archive/2017/03/trump-republicans-failure-obamacare/520788/
The Atlantic - Russell Berman - March 24, 2017... Defeat on the floor dealt Trump a major blow early in his presidency, but its implications were far more serious for the Republican Party as a whole. Handed unified control of the federal government for only the third time since World War II, the modern GOP was unable to overcome its internecine fights to enact a key part of its policy agenda. The president now wants to move on to a comprehensive overhaul of the tax code, but insiders on Capitol Hill have long believed that project will be an even heavier lift than health care.
As the prospect of a loss became more real on Friday, the frustrations of GOP lawmakers loyal to the leadership began to boil over. "I've been in this job eight years, and I'm wracking my brain to think of one thing our party has done that's been something positive, that's been something other than stopping something else from happening," Representative Tom Rooney of Florida said in an interview. "We need to start having victories as a party. And if we can't, then it's hard to justify why we should be back here."
Nothing has exemplified the party's governing challenge quite like health care. For years, Republican leaders resisted pressure from Democrats and rank-and-file lawmakers to coalesce around a detailed legislative alternative to Obamacare. That failure didn't prevent them from attaining power, but it forced them to start nearly from scratch after Trump's surprising victory in November. At Ryan's urging, the party had compiled a plan as part of the speaker's "A Better Way" campaign agenda. Translating that into legislation, however, proved a much stiffer challenge; committee leaders needed to navigate a razor's edge to satisfy conservatives demanding a full repeal of Obamacare and satisfy moderates who preferred to keep in place its more popular consumer protections and Medicaid expansion. They were further limited by the procedural rules of the Senate, which circumscribed how far Republicans could go while still avoiding a Democratic filibuster. ...
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New Deal democrat -> Lee A. Arnold ...One issue going forward is whether the Dems should offer their own plan. I think they should.
As a few others have pointed out, Trump is not wedded to the GOP establishment. If he thinks he can "WIN bigly!" by allying with Dems, he will do so. I happen to think that he is mainly against "Obamacare" because Obama humiliated him at the White House Correspondents' Dinner once upon a time, and he is nothing if not vengeful. He wants to obliterate Obama's legacy.
So Dems need to make a big stink any time Trump administrativley undercuts Obamacare provisions to try to make it fail. But also they should give him the chance to do something he can call Trumpcare that actually works.
Obamacare does have some major problems (the individual mandate is hated, and the penalty isn't big enough. More young people need to buy in. Some of the Exchanges and health care provider networks are too narrow.
In addition to the "public option" and age 55+ Medicare buy-in, one thing that might work is abollishing the mandate and penalty and replaciing them with automatic enrollment. Call it "You're employed, you're covered!"
Just like SS, Medicare, unemployment and disability deductions to paychecks, establish a Health Care automatic deductible. If your employer offers healthcare, the deductible is reduced by the amount of the premium, all the way to zero if applicable.
If your employer doesn't offer healthcare, if you are under age 40, you are automatically enrolled in the least expensive Bronze plan in your state. If you are 40 or older, you are automatically enrolled in the least expensive Silver plan in your state.The deductible would also include a small contribution towards Medicaid. Then, if you are unemployed, you are automatically enrolled in Medicaid, but can continue with the silver or bronze plan as above if you choose.
Dems could turmpet such a plan to "Reform and Improve" Obamacare, and campaign on pushing for it if they get a Congressional majority. Call it Trumpcare and President Caligula might sign on.
Reply Saturday, March 25, 2017 at 07:35 AM Lee A. Arnold : , March 25, 2017 at 04:48 AM"Medicare for all" may be the best battle cry. 65-70% of the U.S. people want a single-payer. Bernie Sanders has effectively destroyed the old Democratic Party and sits in a commanding position as spokesman, he gets 6 TV cameras with an hour's notice and he is probably the most popular politician in the U.S. The Democrats don't have to push it for now, they can wait for news to develop. This is all on the Republicans. Let the managerial disaster of Trump and the utter immorality of the "Freedom Caucus" sink in a little more, this story has "legs" as they say in show biz.mulp -> Lee A. Arnold ... , -1Name the Senators, representatives, and governors Bernie Bros have delivered?Where are the Bernie Bros Newts, Cruz, Marcos, ...?
I'm in my 70th year. Conservatives attacked liberals in the 60s, my youth, as promising free lunches to gain power. But what they really hated was liberals convinced voters to tax all voters to pay for the things most voters wanted everyone to have, BASED ON SOUND ECONOMICS TO MAXIMIZE EFFICIENCY AND WELFARE.
Friedman led the effort to distort theory to eliminate the broad meaning of general welfare in economics. He did it by eliminating the hard connection between labor cost and gdp. He argued that labor costs and consumption can be cut to increase profits, and that contrary to theory, higher profits is more efficient.
Laffer applied operations theory to taxes, as if government was taxing to maximize profits.
Thus supply side theory of profit maximization. The result delivered was the imperative to cut taxes. To cut labor costs. Thus they argued that every economic measure improves if taxes and wages are cut.
Reaganomics would deliver more stuff at lower cost, higher profut, and that makes everyone better off, especially those in poverty. Friedman saw consumption as a bad thing. He wanted higher gdp, less consumption. In other words, he rewrote Adam Smith attack on mercantile economics into a justification of returning to mercantile economic policy.
So, who do Bernie Bros offer as the Milton Friedman and Laffer to create an intellectual foundation to refute Adam Smith, FDR, Keynes, Galbraith, are return to hunter gatherer economics? Who is the economist who can convince us that Marxist economic theory will work, as long as it's not captured by right wing capitalists like Fidel Castro, Chavez, Stalin, Lenin, the founders of Israel, ....
Bernie certainly must be influenced by the same economic theory that created Israel. It grew from the same Marxist roots in Germany that powered Stalin and Lenin. Bernie is a pre-WWII Zionist as best I can tell.
Why wouldn't Bernie deliver Israel governance to the US? How would he prevent the greedy from joining the Movement?
And Israel has the social welfare state system Bernie wants. Hundreds of thousands of men do not work so they can study supported by welfare. Universal health care. Women are very equal in status.
I grew up heating the Zionist Dream, theory, much like Bernie did, but from conservative Indiana. Seemed very idealist virtue becoming reality in the 50s and 60s. I have often used Israel as the example of a good universal health care system, of education, of welfare. Never heard Bernie say, "I want the US to be like Israel." Why not? Why Sweden?
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Mar 25, 2017 | economistsview.typepad.com
Peter K. : March 25, 2017 at 10:24 AM
http://www.newyorker.com/news/john-cassidy/the-health-care-debacle-was-a-failure-of-conservatismmulp -> Peter K.... , March 25, 2017 at 10:44 AMTHE HEALTH-CARE DEBACLE WAS A FAILURE OF CONSERVATISM
By John Cassidy March 24, 2017
Let the recriminations begin! Actually, the health-care-failure finger-pointing got under way well before Friday, when Donald Trump and Paul Ryan cancelled a House vote on the American Health Care Act. A day earlier, aides to the President let it be known that he had come to regret going along with Ryan's idea of making health care his first legislative priority.
In the coming days and weeks, there will be more of this blame shifting, and, in truth, there is plenty of blame to go around. Ryan failed to unify the House Republican caucus. Trump's staff allowed him to endorse a bill that made a mockery of his campaign pledge to provide health insurance for everybody. And Trump himself blundered into a political fiasco, apparently believing he could win over recalcitrant Republican members of Congress simply by popping over to Capitol Hill.
But this is just politics. The larger lesson here is that conservatism failed and social democracy won.
After seven years of fulminating against the Affordable Care Act and promising to replace it with a more free-market-oriented alternative, the House Republicans-who are in the vanguard of the modern conservative movement-failed to come up with a workable and politically viable proposal. Obamacare survived, and that shouldn't be so surprising. When it comes to health-care policy, there is no workable or politically viable conservative alternative.
Of course, that isn't how conservative lawmakers, pundits, and policy wonks will spin this. They will argue that Trump and Ryan betrayed free-market principles: if only they had proposed the outright repeal of Obamacare, and put forward a bill that genuinely liberated the health-care industry from federal intervention, everything would have worked out well. That will be the story-and it is a fairy tale.
The fact is that the health-care industry, which makes up about a sixth of the American economy, isn't like the market for apples or iPhones. For a number of reasons (which economists understand pretty well), it is riven with problems. Serious illnesses can be enormously costly to treat; people don't know when they will get ill; the buyers of health insurance know more about their health than the sellers; and insurers have a strong incentive to avoid providing their product to the sick people who need it the most.
Since the days of Otto von Bismarck, most developed countries have dealt with these problems by setting up a system in which the state provides medical insurance directly, or else mandates and subsidizes the purchase of private insurance, setting strict rules for what sorts of policies can be sold. Obamacare amounts to a hybrid model. It supplements employer-provided insurance, the traditional American way of obtaining health care, with a heavily regulated (and subsidized) individual insurance market and an expanded Medicaid system.
It is far from perfect. But, in combining mandates with subsidies, regulation, and access to a state-administered system for the poverty-stricken and low-paid, it is intellectually coherent. (Many of the problems it has encountered arose because the mandate to purchase insurance hasn't been effectively enforced, and not enough young and healthy individuals have signed up.) Since it leaves in place the basic structure of private insurance and private provision, Obamacare is also conservative. As is well known, parts of it resemble a proposal that the Heritage Foundation put forward in 1992.
Today's conservatives act as if they can simply wish away some of the problems that Obamacare was created to deal with. The original version of the American Health Care Act left in place many of the A.C.A.'s regulations but cut back the subsidies and gutted its Medicaid expansion. Had it been enacted, it would have led to higher premiums, at least in the short term, and a huge drop in coverage-twenty-four million people over ten years, according to the Congressional Budget Office. As these implications of the G.O.P. proposal became known to the public, the plan's approval rating fell and fell. In the end, according to a Quinnipiac poll, only nineteen per cent of Americans supported it.
The Freedom Caucus, a group of right-wing conservatives in the House, wanted a bill that stripped away more regulations, which they claimed would enable insurers to offer cheaper and more flexible plans. On the eve of the vote, Ryan agreed to change a clause defining the "essential health benefits" that insurers are required to provide if they sell policies on the Obamacare exchanges-benefits including maternity and mental-health services. But this change would have created two insurmountable problems.
Once insurers were able to craft individual policies without adhering to any list of required benefits, buyers would self-select. Young, healthy people would choose cheap, crappy policies, and older, sicker people would choose more comprehensive policies. Insurers, knowing this, would raise the prices of the good policies. "Worthless policies would get really cheap, but comprehensive policies would get astronomically expensive," Mother Jones's Kevin Drum pointed out. "Virtually no one would be able to afford them."
The other problem was political. Americans need maternity coverage, mental-health benefits, prescription drugs, pediatric services, lab tests, and the other things included on the list of essential health benefits. When moderate Republicans in places like New York, New Jersey, and Pennsylvania heard that these services might be eliminated under the amended legislation, they abandoned it in significant numbers. It was their desertion that ultimately killed the bill.
O.K., you might say: The American Health Care Act was a disaster, but what about all the other Republican health-care proposals that are out there? Maybe one of them provides a workable alternative to Obamacare. Let's briefly look at a few of them.
When he was in Congress, Tom Price, the Secretary of Health and Human Services, who supported the A.H.C.A., put forward a bill of his own. But it was basically a less generous version of the bill that just died: in gutting Medicaid and strictly limiting federal funding for high-risk pools to insure sick people, it would surely lead to a big rise in the number of uninsured. Something similar applies to a bill put forward by Senator Orrin Hatch, who chairs the Senate Finance Committee.
There are a few other plans kicking around conservative think tanks, some of which, like Obamacare, tie the level of subsidies to income. But all of these plans have other serious problems. In eschewing purchasing mandates, they run into the issue of younger people being unlikely to sign up for coverage. In giving insurers more freedom to offer different plans and different pricing structures, they encourage self-selection and undermine the risk-pooling that is at the heart of successful insurance schemes. And in cutting federal support for Medicaid, they dismantle the element of Obamacare that has been the most successful at insuring more people at a reasonable cost.
Another Republican plan that may now attract some attention is the proposal put forward by Senators Bill Cassidy, of Louisiana, and Susan Collins, of Maine. But, far from dismantling Obamacare, the Cassidy-Collins plan would allow big, populous states like New York and California to keep the current system in place, including the Medicaid expansion and the surtaxes on high earners. Red states that don't like Obamacare would be able to take federal money and design their own systems to provide basic, catastrophic coverage plans to everybody.
Because it retains so much of Obamacare, this proposal seems unlikely to receive majority support inside the G.O.P. In the coming weeks, Republicans in the Senate and the House will be trying anew to come up with an alternative that they can unite around, portray as a big break from the A.C.A., and sell to the American public. The lesson of the past few weeks is that they are likely to fail. As a novice to the subject noted recently, health care is complicated. Too complicated for ad-hoc policymaking and simplistic conservative nostrums.
The evil Obama created Obamacare that was so conservative that conservatives can't find an alternative that benefits the majority of conservatives.Peter K. : , March 25, 2017 at 10:32 AMA few conservatives have prided themselves on commuting suicide by not treating their cancer in principled opposition to Obamacare, but most simply bitch about the high premiums which requires they get huge Obamacare tax credits while still paying a lot out of pocket because they bought the high deductible policy that makes the patient have skin in the game.
They want patients to pay out off a savings account to have skin in the game without needing to actually "save" to fill the HSA and have low premiums for insurance you buy with cancer treatment only when you have cancer. After all, if you buy insurance without cancer coverage, you qualify to buy insurance with cancer treatment because you have continuously bought insurance for five years.
... ... ...
https://www.nytimes.com/2017/03/24/upshot/health-insurance-medicare-obamacare-american-health-care-act.html?partner=rss&emc=rss&_r=1"...
Now that Republicans have withdrawn Mr. Ryan's bill from consideration, attention shifts to what comes next. In an earlier column, I suggested that Mr. Trump has the political leverage, which President Obama did not, to jettison the traditional Republican approach in favor of a form of the single-payer health care that most other countries use. According to Physicians for a National Health Program, an advocacy group, "Single-payer national health insurance, also known as 'Medicare for all,' is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands." Christopher Ruddy, a friend and adviser of the president, recently urged him to consider this option.
Many Republicans who want to diminish government's role in health care view the single-payer approach with disdain. But Mr. Trump often seems to take pleasure in being unpredictable, and since he will offend people no matter which way he turns, he may want to consider why liberals and conservatives in many other countries have embraced the single-payer approach.
..."
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Mar 25, 2017 | economistsview.typepad.com
llisa2u2, March 25, 2017 at 08:30 AMPresident Donald Trump said on Friday that he was disappointed that a conservative faction in the House of Representatives blocked his healthcare legislation and said "we learned a lot about loyalty" from the effort. OMG. Who's playing political games? Who is NOT focused on not draining anything, except draining the pockets of the "relatively poor" majority for the profits of a "relatively wealthy" majority?Peter K. , March 25, 2017 at 08:36 AMThe issue isn't about "loyalty". The issue is about establishing reasonable and affordable healthcare for at least the majority of American citizens that have gross earnings under $250,000 annually.
Neoliberal DeLong is good on the Insane Clown Posse of the Republican Party.Peter K. -> Peter K.... , March 25, 2017 at 08:37 AMShould-Read: It was always just dingbat kabuki all the way down:
Joe Barton: Representative, R-TX: "[Asked by] reporters... why, after Republicans had held dozens of nearly-unanimous votes to repeal ObamaCare...
"... under President Obama, they were getting cold feet now that they control the levers of power. "Sometimes you're playing Fantasy Football and sometimes you're in the real world", [Rep. Joe Barton R-TX] admitted. "We knew the president, if we could get a repeat bill to his desk, it would almost certainly be vetoed. This time we knew if it got to the president's desk it would be signed.""
t has, as far as the Republican congressional caucus is concerned, always been dingbat kabuki--at least, ever since Gingrich's revolt against George H.W. Bush at the start of the 1990s, if not ever since the passage of the Reagan "none of us really understands what's going on with all these numbers" tax cut in 1981.
David Brooks: "Any large vision...
...was beyond the drafters of this legislation.... They were more concerned with what this internal faction.... In 24 hours of ugly machinations, the Trump administration was willing to rip out big elements of the bill and insert big new ones, without regard to substance or ramification. House members were rushed to commit to legislation even while major pieces of it were still in flux... when the Congressional Budget Office had no time to score it, when the effect on health outcomes of actual Americans was an absolute mystery....
This House Republican plan would increase suffering, morbidity and death among the middle class and poor in order to provide tax cuts to the rich. It would cut Medicaid benefits by $880 billion between now and 2026. It would boost the after-tax income for those making more than $1 million a year by 14 percent.... This bill takes the most vicious progressive stereotypes about conservatives and validates them.... This bill has just a 17 percent approval rating....
If we're going to have the rough edges of a populist revolt, you'd think that at least somebody would be interested in listening to the people. But with this bill the Republican leadership sets an all-time new land speed record for forgetting where you came from.... The Republicans can't run policy-making from the White House because they have a marketing guy in charge of the factory. But they can't run policy from Capitol Hill because it's visionless and internally divided.... The politics driving the substance, not the other way around. The new elite is worse than the old elite-and certainly more vapid.
The irony is that the failure of the neoliberal centrism of Brooks and DeLong to deliver shared prosperity is churning up a populist revolt against the establishment.
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Mar 23, 2017 | economistsview.typepad.com
Peter K. : Reply Thursday, March 23, 2017 at 05:54 AM , March 23, 2017 at 05:54 AMReminds me of PGL, EMichael, "Anachronism" etc.JohnH -> Peter K.... , March 23, 2017 at 07:35 AMhttps://lbo-news.com/2017/03/22/never-demand/
Never Demand
by Doug Henwood
March 22, 2017Matt Bruenig already wrote* about this (now deleted) tweet from Paul Waldman, which was a response to one from Bernie Sanders
Paul Waldman: Like saying "Never lose sight of the fact that our goal is to remodel the kitchen" when there are arsonists pouring gasoline on your porch."
Bernie Sanders: "Never lose sight of the fact that our ultimate goal is not just playing defense. Our goal is a Medicare-for-all, single payer system."
and before typing any more, I must confess to feeling guilty about writing a second blog post (god knows there are probably more) about a tweet. But, onwards.
As Bruenig writes, "The difference between Obamacare and AHCA is 24 million uninsured people while the difference between single-payer and Obamacare is 28 million uninsured people." Obamacare, with all its omissions and cost-shifting, isn't innocent of monstrousness.
There's a point about political strategy here worth drawing out here. Waldman, who self-identifies as "Washington Post blogger. Columnist for The Week. Senior Writer at the American Prospect.," was on the Cabalist, a secret listserv for liberal pundits which I strangely spent two or three years on. (I assume he still is, though I can't know now that I'm off the thing.) I was invited on, I suppose, for ideological diversity, but left as what most members probably saw as an annoying provocateur.
Waldman's tweet reflects a consensus on the list that one must never make demands or express ambitious political goals in the way Sanders' tweet does. All we can do it defend what we have, because the right holds all the cards. I never could convince them that this was a doomed strategy-that, principle aside, if you don't make big demands you can't win even small victories, or that without radicals pushing things in threatening ways their wimpy appeals to compromise will have no audience. To your modal Cabalister, to push for single-payer would be to "relitigate" (a favorite word of theirs, reflecting I suspect their preference for litigation over actual politics) Obamacare, and so expose it to repeal. That was their line a couple of years ago, when no one could have imagined President Trump. Now that it is under the threat of repeal, it's more urgent than ever to assume a defensive crouch.
You can see this sort of thinking behind the Democrats' responses to Trump. They're still stuck in the Hillary mode of treating him as an anomaly, something different from a "normal" Republican. They obsess about his alleged Russia ties, but offer nothing as a serious alternative to the Trump (or Ryan) agenda.
Obamacare has never been so popular now that it may go away. Millions of people have gotten something good out of it, as flawed as it is. Imagine how popular a program that offered everyone full coverage would be.
Democrats play defense so much that occasionally they score on goals..handing victories to opponents because they could no effective offense of their own.RC AKA Darryl, Ron said in reply to JohnH... , March 23, 2017 at 08:19 AMImagine where Democrats could be if they deigned to talk to workers, actively pushed for higher minimum wages, and crafted a coherent economic message that spoke to "people who work hard and play by the rules."
Not going to happen: the corrupt, sclerotic Democratic leadership has grown comfy playing Washington General to Republicans' Harlem Globetrotter. They even refuse to sack a leadership who has lost most everything between the coasts.
Fortunately for them, we live in a duopoly, so there is always a place for the losing team.
Yep.im1dc -> JohnH... , March 23, 2017 at 08:57 AMDittos, and S. Sanders proved it last year. Why it is taking the current DEM leadership so long to put the lesson learned into action is beyond me and it angers me too.RC AKA Darryl, Ron said in reply to Peter K.... , March 23, 2017 at 08:18 AMExcellent article.T : , March 23, 2017 at 06:12 AMWhen the history is written, the Clinton Administration (and the Brad DeLongs in it) will be remembered for 4 things:painer -> T... , March 23, 2017 at 06:24 AM1) a massive increase in inequality carrying on the tradition began by Reagan;
2) incarcerating a large and increasing share of the black male population causing unfathomable damage to the black community;
3) passing a welfare reform package that was both cruel and unproductive to the least fortunate in our society;
4) negotiating and cheer-leading a Chinese trade deal that led to the loss of at least three million manufacturing jobs, primarily in the Midwest, and the destruction of community after community. And laying the seeds for those Democratic states to turn Republican.
Meanwhile Brad continues to let his "neoliberal freak flag fly."
Liberal consciencesPeter K. -> T... , March 23, 2017 at 06:26 AMAttend to this indictment
So true. Also on macro policy he bent the knee to Greenspan/The Fed/the bond market, dumping his fiscal expansion campaign promise in exchange for deficit reduction.Democrats have become all about deficit reduction and "the era of big government is over."
It is interesting to listen to David Beckworth's interview with Jason Furman who expresses the conventional thinking of Democrats.
Fiscal expansion is now good and desired within the context of the Zero Lower Bound and how unconventional monetary policy supposedly doesn't work.
But still they are okay with the Fed being paranoid about inflation, another legacy of the Clinton era.
Clinton did deliver a brief moment of a high-powered economy at the end of the 90s as Greenspan held off on raising rates.
But he also gave us the dot.com bubble with a push for deregulation, exemplified by repealing Glass-Steagall on behalf of the financial sector, the same people who would give us an epic financial crisis.
And Clinton was never big on union/organizing rights or anti-trust. He signed the Defense of Marriage Act etc etc etc.
But hey he was better than Republicans!
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Mar 22, 2017 | economistsview.typepad.com
Anachronism : March 22, 2017 at 10:55 AMhttps://www.bloomberg.com/view/articles/2017-03-22/republicans-want-to-repeal-medicaid-toolibezkova -> Anachronism ... , March 22, 2017 at 05:09 PMRepublicans Want to Repeal Medicaid, Too
Obamacare, President Donald Trump is fond of saying, is a "complete and total disaster" and must be replaced. Yet one of the most significant features of his party's proposed replacement has little to do with Obamacare.
The American Health Care Act would drastically reshape Medicaid -- ending the federal government's long-running, open-ended commitment to help states pay for care for the poor. Instead, in 2020, Washington would make limited per capita contributions that would shrink as a share of costs with every passing year.
True, expanded eligibility for Medicaid is an important part of Obamacare. And the AHCA would reverse this expansion. But its much bigger change is to the Medicaid program as it existed long before Obamacare. Medicaid is a popular and relatively efficient insurance program that has provided health care and peace of mind for millions of Americans for more than half a century. Why start taking it apart now?
Part of the rationale is that the changes to Medicaid would save $880 billion over 10 years, allowing Congress to make further tax cuts later this year. (Trump telegraphed the strategy in a speech to supporters Monday.) At the same time, many Republicans have long disliked the program's open-ended promise of federal money.
Whatever the reason, it's a step in the wrong direction. Those who lose Medicaid coverage would still need care, and their fellow Americans would still have to pick up the tab.
As things stand now with Medicaid, states pay doctors for providing care to enrollees, and the federal government reimburses the states up to 75 percent of that cost. When a state spends more than usual -- in the event of a hurricane or an opioid epidemic, for example -- the federal share keeps up.
Under the AHCA, each state would instead be given a capped allowance, and that amount would rise each year with medical inflation. It would not account for any unforeseen expenses. Over time, as the rise in per-patient costs outstripped the rise in general medical inflation -- as the Congressional Budget Office assumes they will -- the federal share of funding would decline. Hundreds of billions in costs would be shifted from the federal government to the states. In response, states would need to either raise their own spending on Medicaid -- or more likely, offer fewer services to fewer people.
It is this last possibility that is most disturbing. Medicaid has been required to cover some groups of people -- mothers and children living in poverty, for example -- but not all. One of the consequences of the AHCA would be to discontinue coverage to many who just recently gained coverage under the expansion funded by Obamacare. If a state took the option, now included in the AHCA, to accept a Medicaid block grant rather than a per-capita allotment, it could set its own eligibility standards.
Sending large groups of people back to the private insurance market in a post-Obamacare world, with its increasingly unaffordable premiums and increasingly expensive out-of-pocket costs, would be not only inefficient but also unjust.
"Medicaid is a popular and relatively efficient insurance program that has provided health care and peace of mind for millions of Americans for more than half a century. Why start taking it apart now?"Because that is the genes of neoliberalism. A wolf can't stop hunting. This is a predatory ideology. And that creates the seeds of it own demise, despite being pretty resilient after 2008 crash.
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Mar 22, 2017 | jessescrossroadscafe.blogspot.com
"The problem of the last three decades is not the 'vicissitudes of the marketplace,' but rather deliberate actions by the government to redistribute income from the rest of us to the one percent. This pattern of government action shows up in all areas of government policy."Dean Baker
"When the modern corporation acquires power over markets, power in the community, power over the state and power over belief, it is a political instrument, different in degree but not in kind from the state itself. To hold otherwise - to deny the political character of the modern corporation - is not merely to avoid the reality.
It is to disguise the reality. The victims of that disguise are those we instruct in error."
John Kenneth Galbraith
And unfortunately the working class victims of that disguise are going to be receiving the consequences of their folly, and then some.
Secure in their monopolies and key positions with regard to reform and the law, the corporations are further acquiring access to the protections of the rights of individuals as well, it appears, at least according to Citizens United .
Maybe our leaders and their self-proclaimed technocrats will finally do the right thing. I personally doubt it, except that if they do it will probably be by accident.
More likely, the right thing will eventually come about the old-fashioned way- under the duress of a crisis, and the growing protests of the much neglected and long suffering.
History will look back at us with the same wonder that we look back on the mad excesses of certain nations founded in devotion to extreme, almost other-worldly, ideologies of the last century.
... ... ...
Apparently the slashing of health benefits for the unfortunate is not severe enough in the proposed Trump/Ryan plan. Our GOP house neo-liberals are enthusiastic to unleash the wonders of the cure-all deregulated market on the American public, again. Like a dog returns to its vomit.
Better if they start breaking up corporate health monopolies and embrace real reform at the sources of the soaring costs. The US pays far, far too much for drugs and healthcare, and deregulating the markets is not the solution. We do have the example of the rest of the developed world for what to do about this. It is called 'single payer.'
But players keep on playing. And politicians and their enablers in the professions will not see what their big money donors do not wish them to see. And that is one of their few bipartisan efforts.
Might one suggest that our political animals stop trying to do all the reforming and cost controls bottom up, while applying the stimulus top down? That approach they have been flogging to no avail for about thirty years is a recipe for a dying middle class.
Here is a short video from the Bernie Sanders WV town hall that shows The Face of American Desperation. By the way, the governor of West Virginia is a Democrat. He wasn't there.
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Mar 21, 2017 | economistsview.typepad.com
Peter K. -> pgl... March 20, 2017 at 06:37 AM , 2017 at 06:37 AM"It means less in income taxes on the rich and more in sales taxes for the rest of us."pgl -> Peter K.... , March 20, 2017 at 09:45 AMNah glibertarians are against the sales tax because they see how it has increased in Europe and led to bigger government. That's why they're opposing Paul Ryan's tax reform which includes progressive wage subsidies.
You must not get Paul Ryan. He wants a smaller government paid for exclusively by sales taxes. His agenda is to eliminate all taxes on capital income. FYI - Europe still has rather high profits taxes. Ryan's latest would end that for the US.ken melvin -> anne... , -1Congress critters from red states are demanding that people must have a job bin order to qualify for medicaid. In red states, most jobs don't pay enough to afford health care.Peter K. -> anne... , March 20, 2017 at 09:01 AMExplained to an environmental class the other day how it was that before EPA people knowingly (and unknowingly) took hazardous jobs in order to make a living -- a trade off. This is where these guys are headed.
http://cepr.net/blogs/beat-the-press/paul-krugman-and-the-republican-corporate-income-tax-proposalPeter K. -> anne... , March 20, 2017 at 09:01 AMPaul Krugman and the Republican Corporate Income Tax Proposal
by Dean Baker
Published: 28 January 2017
The current corporate income tax is a massive cesspool. There are so many routes for avoidance that it is almost becoming voluntary. This matters not only because we don't get the revenue we should from the tax, but also because it has created a massive tax avoidance industry.
The tax avoidance industry is a big deal. This is an industry that contributes nothing to the economy. It involves people designing clever tricks to allow corporations to avoid paying their share of taxes.
The tax avoidance industry is also an important source of inequality since it is possible to get very rich designing clever ways to avoid taxes. My colleague Eileen Appelbaum (along with Rose Batt) show how the private equity industry is largely a tax avoidance industry in their recent book Private Equity at Work. Many of the very richest people in the country got their wealth as private equity fund partners.
In his movie, Capitalism: A Love Story, Michael Moore highlighted "dead peasant" insurance policies. This is when a major company like Walmart buys life insurance policies on tens of thousands of front line workers, like checkout clerks. Usually the insuree doesn't even know of the existence of the policy, but if they die, the company collects.
Moore emphasized the morbid nature of this game, but missed the real story. The point of these policies is to smooth profits, partly to manipulate share prices, but also for tax purposes. The real highlight of this story is that there is someone who likely got very rich by developing dead peasant insurance policies, rather than contributing anything productive to the economy.
I mention this as background to the corporate income tax discussion since to my view a major goal of corporate tax reform is to eliminate the enormous opportunities for gaming that currently exist. These opportunities are making some people very rich and are a complete waste from an economic standpoint.
For this reason, I am sympathetic to the plan the Republicans are debating. In its conception it would be enormous simplification relative to the current system. Of course, that is the conception, we will have to see the plan as it is drafted in legislation to reach any final judgement.In this vein, I have been unhappy to see some of the attacks leveled by people for whom I have considerable respect, notably Paul Krugman. In a post yesterday, Krugman makes the case that the basic tax proposal would be a subsidy for domestic production and therefore inconsistent with free trade principles.
While I don't disagree with the logic, I question its importance. He contrasts the border adjustment with the Republican tax proposal with the border adjustment with a traditional value-added tax (VAT), pointing out that the latter doesn't give a domestic production subsidy in the same way. There are two important points left out of Krugman's discussion.
The first is the issue of size. VATs in our trading partners typically raise well over ten percent of GDP in revenue and sometimes more than 20 percent. By contrast, the corporate income tax has raised less than 1.7 percent of GDP in recent years. The Republicans are undoubtedly looking to reduce this amount further in their tax reform (hopefully they will not succeed), but the imposition of a tax equal to 15 percent of GDP matters much more for trade than a tax equal to 1.7 percent of GDP. (Suppose the dollar falls or rises by 1.7 percent in a week, as it often does. This has the same impact.)
The second issue is the point of reference. We don't currently have a VAT in the United States. We have various taxes that are assessed in the production process, including the income tax workers pay on their wages, that get passed on in the price of the product. If we snapped our fingers and replaced the income tax with a value added tax, we would then refund this tax on exported products. That would look like an export subsidy, relative to our current system. Similarly, we would slap the VAT on all items that are imported. That would look like an import tariff, relative to our current system.
Conventionally, economists urge us not to worry about this issue, since changes in currency values will even things out. This is probably true, at least over the long-run, if not immediately in a transition process. This is a situation where we should accept the economists' conventional wisdom on the net effect on trade, remembering that the amount at stake as an export subsidy or import tariff is just not that large in any case.
The Republican tax proposal, when it is actually put on the table, should be evaluated based on the extent to which it eliminates the waste associated with the tax avoidance industry and also for the amount of revenue it raises. Arguing for its rejection based on it being an unfair subsidy for domestic production is just silly.
There are plenty of very real reasons not to like the things Republicans are putting forward in the Trump administration. We don't have to invent fake ones.
http://cepr.net/blogs/beat-the-press/washington-post-pushed-fear-on-corporate-tax-reformWashington Post Pushed Fear on Corporate Tax Reform
by Dean Baker
Published: 29 January 2017The headline warned readers that the Republican's proposal for reforming the corporate income tax is coming for your toys, literally:
"Trump-era tax reform could come for your toys."
Okay, we get it. The Washington Post doesn't like the tax reform and is not content to keep its views to the opinion pages. (This article ran at the top of the Sunday business section.)The basic story is almost Trumpian in its unreality. The tax reform includes a border adjustment tax on imports. This is similar (not identical) to what countries with value-added taxes do, which is almost every other wealthy country. The conventional wisdom among economists is that currencies adjust so that the net effect on the price of imports, including toys, is minimal.
While this piece notes this argument, it implies that consumers and retailers have great cause for concern over the tax. In this respect, it is worth pointing out that currencies fluctuate by large amounts all the time, in ways that are likely to have far more impact on the price of imported toys than this tax. The figure below shows the inflation-adjusted value of the dollar measured against the currencies of our major trading partners.
fredgraph10
Note that the dollar fell by more than 25 percent against the currencies of our major trading partners in the years between its peak in 2002 and its trough in 2008. This would have sent the price of imported toys up by far more than the new tax possibly could, even though it never prompted an article in the Post warning readers that a falling dollar was coming for their toys.
As a practical matter, a currency adjustment will take time and may not be complete, but in the technical language of economists, so what? If the price of imported toys rises by 3–4 percent as a result of the tax, what would be the big deal. This change is swamped by movements in currency values that never even get mentioned. (I discuss the tax reform proposal, which could get rid of the tax avoidance industry, at more length here.)
It is also worth pointing out that incredible hypocrisy and/or ignorance underlying these discussions. If the United States is to get back to something closer to balanced trade, as opposed to having a trade deficit of more than $500 billion (around 2.7 percent of GDP), it is likely to require a lower valued dollar and higher import prices.
We can count on news outlets like the Post pointing out that the higher import prices mean that lower income people will have to pay more for imported goods at Walmart. This is true, but they are also more likely to be able to get relatively good paying jobs in manufacturing. Also, the availability of these jobs is likely to put upward pressure on the wages of less-educated workers more generally. The net effect for these people is almost certain to be positive.
If this is hard to understand, suppose we remove the protectionist barriers that allow our doctors to earn twice as much as doctors in other wealthy countries. This would likely cause the pay of our doctors to be more in line with pay in Europe and Canada (@ $150,000 a year, as opposed to an average of more than $250,000 a year now). The doctors would all benefit because they and their families would now pay less for their health care, or at least this is how it would be covered using the Washington Post standard.
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Mar 21, 2017 | economistsview.typepad.com
anne : March 20, 2017 at 05:50 AM , 2017 at 05:50 AMhttp://cepr.net/blogs/beat-the-press/why-no-one-is-taking-robert-samuelson-s-medicaid-deal-seriouslypgl -> anne... , March 20, 2017 at 06:04 AMMarch 20, 2017
Why No One Is Taking Robert Samuelson's Medicaid Deal Seriously
Robert Samuelson put forward what would ordinarily be a very reasonable proposal on Medicaid and Medicare in his column * today. He suggested that the federal government take over the portion of Medicaid that deals with low-income elderly and fold it into the Medicare program, while leaving states with full responsibility for dealing with the part of Medicaid that deals with low-income families below retirement age.
While he is right that this sort of consolidation could likely reduce costs and prevent seniors from falling between the cracks in the two systems, there is a basic problem with turning Medicaid over to the states. There are a number of states controlled by Republicans where there is little or no interest in providing health care for low income families.
This means that if Medicaid were turned completely over to the states, millions of low income families would lose access to health care. For this reason, people who want to see low income families get health care, which is the purpose of Medicaid, want to see the program remain partly under the federal government's control.
-- Dean Baker
"There are a number of states controlled by Republicans where there is little or no interest in providing health care for low income families. This means that if Medicaid were turned completely over to the states, millions of low income families would lose access to health care."Anachronism said in reply to pgl... , March 20, 2017 at 06:56 AMDean Baker is right to go after this idea from Robert (no relationship to Paul) Samuelson but two additional comments.
(1) This is really the Paul Ryan agenda.
(2) For states like mine that will take care of these low income families, this Ryan agenda does not mean less in taxes. It means less in income taxes on the rich and more in sales taxes for the rest of us. The ultimate Paul Ryan agenda.
There are 2 theories about how to argue with a republican. Neither one works.RC AKA Darryl, Ron said in reply to Anachronism ... , March 20, 2017 at 07:16 AMWhat they care about is "lessez faire", which means low income families should die off from lack of healthcare. If they deserved healthcare, they should have been able to afford it themselves.
If God had wanted poor people to have healthcare then he would have made them be born rich :<)pgl -> Anachronism ... , March 20, 2017 at 09:43 AMI might ask what those two theories are but I suspect you are right about neither one of them working.
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Mar 20, 2017 | onclick="TPConnect.blogside.reply('6a00d83451b33869e201b7c8e235d6970b'); return false;" href="javascript:void 0">
Monday, March 20, 2017 at 01:54 AM ken melvin said in reply to mulp... Let them eat ideology. Reply Monday, March 20, 2017 at 04:25 AM RC AKA Darryl, Ron said in reply to mulp... "...TANSTAAFL"https://en.wikipedia.org/wiki/There_ain%27t_no_such_thing_as_a_free_lunch
"There ain't no such thing as a free lunch" (alternatively, "There is no such thing as a free lunch" or other variants) is a popular adage communicating the idea that it is impossible to get something for nothing. The acronyms TANSTAAFL, TINSTAAFL, and TNSTAAFL, are also used. Uses of the phrase dating back to the 1930s and 1940s have been found, but the phrase's first appearance is unknown.[1] The "free lunch" in the saying refers to the nineteenth-century practice in American bars of offering a "free lunch" in order to entice drinking customers.
The phrase and the acronym are central to Robert Heinlein's 1966 science-fiction novel The Moon Is a Harsh Mistress, which helped popularize it.[2][3] The free-market economist Milton Friedman also popularized the phrase[1] by using it as the title of a 1975 book,[4] and it is used in economics literature to describe opportunity cost.[5] Campbell McConnell writes that the idea is "at the core of economics".
[I was a bigger fan of Robert Heinlein's than I was of Milton Friedman and even then it was "Stranger in a Strange Land" and "The Unpleasant Profession of Jonathan Hoag" rather than later works that appealed to me.]
Reply Monday, March 20, 2017 at 04:59 AM ken melvin said in reply to mulp... She ate his lunch
http://crooksandliars.com/2017/03/joy-reid-destroys-lawmakers-medicaid-fear Reply Monday, March 20, 2017 at 05:08 AM pgl said in reply to ken melvin... "Appearing on Reid's Sunday morning program, Carter immediately got off to a rocky start after the MSNBC host asked how Georgia would be "better off" with nearly 500,000 people losing their Obamacare coverage."Buddy Carter wasn't prepared. Joy Reid was. Thanks for the link. Reply Monday, March 20, 2017 at 05:44 AM Helicopter Appraisal Rules said in reply to mulp... kinds of medical treatments everyone expects insurance to pay for, like injuries from accidents, gunshots, child birth, premature birth neonatal care,
"Insurance is a private matter unless subsidized. What inflation payers and taxpayers should never be forced to subsidize are childbirth and neonatal care. We shouldn't pay for what we have too much of already. Hell!
With global famine looming later this year and workers losing jobs to robotics, the last thing we need is more birth. Did Jean-Paul Sartre once quip, "Here is my definition of hell :
other people
"
?No! He never learned to speak English. Or
did
he
?
Reply Monday, March 20, 2017 at 08:24 AM
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Mar 20, 2017 | economistsview.typepad.com
Fred C. Dobbs : March 19, 2017 at 06:07 AM , 2017 at 06:07 AM'If you really want to free Americans and unburden
American employers, why not try, or at least seriously consider, some form of government-managed health care,
like almost every other capitalist democracy? There
are many ways of giving people choice and excellent
care under government management. Universal publicly
managed health coverage would even free America's corporations and businesses to streamline their
operations, releasing them from bureaucratic
obligations that ... look weirdly socialist.
Would this mean they would have to pay
more in taxes? Possibly.'(Not 'Possibly'. Inevitably. So be it.)
The Fake Freedom of American
Health Care https://nyti.ms/2nDNgAm
NYT - ANU PARTANEN - MARCH 18, 2017Last week the nonpartisan Congressional Budget Office estimated that the new Republican health plan would increase the number of uninsured Americans by 24 million people within a decade, mostly because changes in regulations, subsidies and Medicaid coverage would make insurance too expensive for them.
Republican leaders seem unfazed by this, perhaps because, in their minds, deciding not to have health care because it's too expensive is an exercise of individual free will. As Representative Jason Chaffetz, Republican of Utah, put it: "Americans have choices. And they've got to make a choice. And so maybe, rather than getting that new iPhone that they just love, and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care."
There is an appealing logic to such thinking. The idea is that buying health care is like buying anything else. The United States is home to some of the world's best medical schools, doctors, research institutes and hospitals, and if you have the money for the coverage and procedures you want, you absolutely can get top-notch care. This approach might result in extreme inequalities and it might be expensive, but it definitely buys you the best medical treatment anywhere. Such is the cost of freedom. As House Speaker Paul Ryan put it in a tweet: "Freedom is the ability to buy what you want to fit what you need." Vice President Mike Pence picked up that baton: "Obamacare will be replaced with something that actually works - bringing freedom and individual responsibility back to American health care."
In practice, though, this Republican notion is an awfully peculiar kind of freedom. It requires most Americans to spend not just money, but also time and energy agonizing over the bewildering logistics of coverage and treatment - confusing plans, exorbitant premiums and deductibles, exclusive networks, mysterious tests, outrageous drug prices. And more often than not, individual choices are severely restricted by decisions made by employers, insurers, doctors, pharmaceutical companies and other private players. Those interest groups, not the consumer, decide which plans are available, what those plans cover, which doctors patients can see and how much it will cost.
And I haven't even mentioned the millions of Americans who don't earn enough to pay for insurance or a lifesaving treatment. If you can't afford it, not buying it is hardly a choice.
Eight years ago I moved to the United States from Finland, which like all the Nordic nations is a wealthy capitalist economy, despite the stereotypes you may have heard. And like all those countries, Finland has invested in a universal, taxpayer-funded and publicly managed health care system. Finns constantly debate the shortcomings of their system and are working to improve it, but in Finland I never worried about where my medical care came from or whether I could afford it. I paid my income taxes - which, again despite the stereotypes, were about the same as what I pay in federal, state and local income taxes in New York City - and if I needed to see a doctor, I had several options.
For minor medical matters, I could visit a private physician who was provided as a perk by my employer. Or I could call the public clinic closest to my home. If I saw the private doctor, my employer picked up the tab, with the help of public subsidies. If I went to the public clinic, it might cost me a small co-payment, usually around $20. Had I been pregnant, most care would have been free.
If I had wanted to, I also could have easily paid to see a private doctor on my own, again with the help of public subsidies. All of this works without anyone ever having to sign up for or buy health insurance unless he wants additional coverage. I never had to worry whether I was covered. All Finns are covered for all essential medical care automatically, regardless of employment or income.
Republicans are fond of criticizing this sort of European-style health care. President Trump has called Canada's national health care system "catastrophic." On CNN recently, Senator Ted Cruz gave multiple examples of how patients in countries with universal, government-managed health care get less care than Americans.
In Europe, he said, elderly people facing life-threatening diseases are often placed in palliative care and essentially told it's their time to go. According to the Republican orthodoxy, government always takes away not only people's freedom to choose their doctor, but also their doctor's ability to choose the correct care for patients. People are at the mercy of bureaucrats. Waiting times are long. Quality of care is dismal.
But are Republicans right about this? Practically every wealthy capitalist democracy in the world has decided that some form of government-managed universal health care is the most sensible and effective option. According to the latest report of the O.E.C.D. - an organization of mostly wealthy nations - the United States as a whole does not actually outshine other countries in the quality of care.
In fact, the United States has shorter life expectancy, higher infant mortality and fewer doctors per capita than most other developed countries. When it comes to outcomes in some illnesses, including cancer, the United States does have some of the best survival rates in the world - but that's barely ahead of, or even slightly behind, the equivalent survival rates in other developed countries. In breast cancer survival, for example, the United States comes in second, after Sweden. Third-best is Norway, then Finland. All three countries have universal, government-run health care systems.
For colorectal cancer, the five-year survival rate after diagnosis in the United States brings it to a not very impressive ninth place in the O.E.C.D. statistics. Ahead of the United States are South Korea, Israel, Australia, Sweden and Finland, all with some form of government-managed universal health care. And when it comes to cervical cancer, American women are at a significant disadvantage: The United States comes in only 22nd. Meanwhile, life expectancy at age 65 is higher in 24 other developed nations, including Canada, Britain and most European nations.
Americans might still assume that long waits for care are inevitable in a health care system run by the government. But that's not necessarily the case either. A report in 2014 by the Commonwealth Fund, a private foundation specializing in health care research, ranked the United States third in the world in access to specialists. That's a great achievement. But the Netherlands and Switzerland did better. When it comes to nonemergency and elective surgery, patients in several countries, including the Netherlands, Germany and Switzerland, all of which have universal, government-guided health care systems, have faster access than the United States.
It's not just American patients who endure endless bureaucratic hassles. American doctors were also significantly more likely to report as major problems the amount of time they spent on dealing with administrative burdens related to insurance and claims, as well as on getting patients medications or treatment because of restrictions imposed by insurance companies, compared with doctors in most of the other 10 countries studied - including Sweden and Britain.
Overall, Americans spend far more of their hard-earned money on health care than citizens of any other country, by a very wide margin. This means that it is in fact Americans who are getting a raw deal. Americans pay much more than people in other countries but do not get significantly better results.
The trouble with a free-market approach is that health care is an immensely complicated and expensive industry, in which the individual rarely has much actual market power. It is not like buying a consumer product, where choosing not to buy will not endanger one's life. It's also not like buying some other service tailored to individual demands, because for the most part we can't predict our future health care needs.
The point of universal coverage is to pool risk, for the maximum benefit of the individual when he or she needs care. And the point of having the government manage this complicated service is not to take freedom away from the individual. The point is the opposite: to give people more freedom. Arranging health care is an overwhelming task, and having a specialized entity do the negotiating, regulating and perhaps even much of the providing is just vastly more efficient than forcing everyone to go it alone.
What passes for an American health care system today certainly has not made me feel freer. Having to arrange so many aspects of care myself, while also having to navigate the ever-changing maze of plans, prices and the scarcity of appointments available with good doctors in my network, has thrown me, along with huge numbers of Americans, into a state of constant stress. And I haven't even been seriously sick or injured yet.
As a United States citizen now, I wish Americans could experience the freedom of knowing that the health care system will always be there for us regardless of our employment status. I wish we were free to assume that our doctors get paid a salary to look after our best interests, not to profit by generating billable tests and procedures. I want the freedom to know that the system will automatically take me and my family in, without my having to battle for care in my moment of weakness and need. That is real freedom.
So is the freedom of knowing that none of it will bankrupt us. That is the freedom I had back in Finland.
Here is my appeal to Republicans: If you really want to free Americans and unburden American employers, why not try, or at least seriously consider, some form of government-managed health care, like almost every other capitalist democracy? There are many ways of giving people choice and excellent care under government management. Universal publicly managed health coverage would even free America's corporations and businesses to streamline their operations, releasing them from bureaucratic obligations that to me, coming from Finland, I have to say look weirdly socialist. Would this mean they would have to pay more in taxes? Possibly.
Many countries require employers and employees to contribute to the health care system through payroll taxes, more than the United States does. But again, Americans are paying far more for health care than anyone else, and America's businesses are stuck managing this mess. It's true that in countries with universal health care the cost of hiring a new employee can be significant, especially for a small employer. Yet these countries still have plenty of thriving businesses, with lower administrative burdens. It can be done.
In wealthy capitalist democracies all around the world the government itself also has an essential kind of freedom. It's a freedom that enables the government to do work on behalf of the citizens who elect it, including negotiating the prices of health care with providers and pharmaceutical companies - a policy that has led to lower drug prices in those countries.
Americans today are paying vastly more in money, worry and hassle for the same, and sometimes worse, care than people in other wealthy capitalist democracies. Some Americans have coverage that serves them well, but judging by the current mood, the number of Americans who think the system needs to change is growing. No health care system is perfect. But in a nation that purports to champion freedom, the outdated disaster that is the United States health care system is taking that freedom away.
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Mar 16, 2017 | economistsview.typepad.com
RGC -> anne... March 14, 2017 at 04:11 AM , 2017 at 04:11 AMWestern politicians and mainstream economists have the same game plan:anne -> RGC... , March 14, 2017 at 05:10 AM
Given choice 1 and choice 2....Republicans choose 1a Democrats choose 1b
Neoliberals choose 1a Neo classicals choose 1b
1a is "hard" laissez-faire
1b is "soft" laissez-faire
2 is democratic socialism
Clever, and worth developing as a complete argument.ilsm -> anne... , March 14, 2017 at 05:19 AMArrow said it decades ago, the market does not work for health care. The Brits have known it since WW II or before.anne -> ilsm... , March 14, 2017 at 07:04 AMhttps://en.wikipedia.org/wiki/National_Health_ServiceThe National Health Service (NHS) is the name of the public health services of England, Scotland and Wales, and is commonly used to refer to those of Northern Ireland. They were established together as one of the major social reforms following the Second World War on the founding principles of being comprehensive, universal and free at the point of delivery. Today, each provides a comprehensive range of health services, the vast majority of which are free for people ordinarily resident in the United Kingdom.
Taken together, the four National Health Services in 2015-16 employed around 1.6 million people with a combined budget of £136.7 billion. UK residents are not charged for most medical treatment, with exceptions such as a fixed charge for prescriptions; dental treatment is administered differently, with standard charges for most procedures. For non-residents, the NHS is free at the time of use, for general practitioner (GP) and emergency treatment not including admission to hospital.
The NHS began on the 'Appointed Day' of 5 July 1948.
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Mar 16, 2017 | economistsview.typepad.com
anne : March 14, 2017 at 03:26 AM , 2017 at 03:26 AMhttp://econospeak.blogspot.com/2017/03/health-care-and-market-based-solutions.htmpgl -> pgl... , March 14, 2017 at 04:24 AMMarch 13, 2017
Health Care and Market Based "Solutions"
The opening of a critique of TrumpDoesn'tCare by John Osborne has this canard:
"The excerpts are interesting, not because there were stunning disclosures or revolutionary ideas, but to the contrary they reveal what many have been saying for some time: there is no plan that will enable the Republican Congress to effectively replace Obamacare by relying solely on conservative, market-based solutions...at least not without risking great disruption to an already skittish insurance market."
The canard is that conservatives have some "market based solution". This begs solution to what? I wonder if these conservatives have read the 1983 paper by John Moskop ?:
"This paper considers whether Rawls' theory of justice as fairness may be used to justify a human right to health care. Though Rawls himself does not discuss health care, other writers have applied Rawls' theory to the provision of health care. Ronald Green argues that contractors in the original position would establish a basic right to health care."
While Moskop does not entirely agree with Ronald Green, many of us see the health care debate as one of basic fairness – not just efficiency....
-- ProGrowthLiberal
Check out the subtitle:JF -> pgl... , March 14, 2017 at 06:21 AM'A total of 54 million individuals would be uninsured in 2026 under the GOP plan, according to the White House analysis.'
So the TrumpCare proposal will double the number of uninsured. In relative terms, about 8% of the population would be without insurance. Under TrumpCare - make that 16%. We need an improvement of ObamaCare. This is the opposite.
Pgl, ok to talk about an insurance solution but can you also mention healthcare itself?pgl -> JF... , March 14, 2017 at 07:01 AMPeople care about their health when confronted with it, few care about insurance organizations. The discussion, as I think you'd agree, needs to be more about health and public-health (a societal level view, considering many years). It is not a good debate to just talk about insurance and insurance contracts/plans.
In my latest at Econospeak I did talk about ending the doctor cartel as well as the pharma cartel. You are right - the real reason we pay too much for health care are the economic rents reaped by the providers.JF -> pgl... , March 14, 2017 at 07:32 AMAlignments of incentives a la Arrow. Healthcare delivery system is not a place where ideal free markets can arise, as most know, it just is not possible from the nature of the service itself.pgl -> JF... , -1Now few markets ever attain the ideal, of course. This is one of the reasons why the republicans talk mostly about insurance, here market verbiage has more traction. But these are 'financial' insurance products, they are not healthcare. As we know, you only insure your finances if you have something financial at risk. Most young people and families, and many others are not looking to insure their finances, they do need healthcare, however.
Society's need is to have a rational healthcare delivery system. Subsidization of a financial insurance industry is no where close to being equivalent.
Know you know this. Would want journalists and analysts to know this and write accordingly.
"Society's need is to have a rational healthcare delivery system. Subsidization of a financial insurance industry is no where close to being equivalent."Anachronism : , March 14, 2017 at 05:03 AMAgreed. So much time on how to pay for it but almost no time on how health care is delivered. Both are important topics.
With apologies to Anne, the article simply won't copy paste. You'll have to read it.anne -> Anachronism ... , March 14, 2017 at 05:17 AMThe title is: No easy answers: why left wing economics is not the answer to right wing populism
http://www.vox.com/world/2017/3/13/14698812/bernie-trump-corbyn-left-wing-populism
http://www.vox.com/world/2017/3/13/14698812/bernie-trump-corbyn-left-wing-populismanne -> Dan Kervick... , March 14, 2017 at 07:56 AMMarch 13, 2017
No easy answers: why left-wing economics is not the answer to right-wing populism
By Zack BeauchampOn November 20, less than two weeks after Donald Trump's upset win, Bernie Sanders strode onto a stage at Boston's Berklee Performance Center to give the sold-out audience his thoughts on what had gone so disastrously wrong for the Democratic Party.
Sanders had a simple answer. Democrats, he said, needed to field candidates who would unapologetically promise that they would be willing "to stand up with the working class of this country and ... take on big-money interests."
Democrats, in other words, would only be able to defeat Trump and others like him if they adopted an anti-corporate, unabashedly left-wing policy agenda. The answer to Trump's right-wing populism, Sanders argued, was for the left to develop a populism of its own.
That's a belief widely shared among progressives around the world. A legion of commentators and politicians, most prominently in the United States but also in Europe, have argued that center-left parties must shift further to the left in order to fight off right-wing populists such as Trump and France's Marine Le Pen. Supporters of these leaders, they argue, are motivated by a sense of economic insecurity in an increasingly unequal world; promise them a stronger welfare state, one better equipped to address their fundamental needs, and they will flock to the left.
"[It's] a kind of liberal myth," Pippa Norris, a Harvard political scientist who studies populism in the United States and Europe, says of the Sanders analysis. "[Liberals] want to have a reason why people are supporting populist parties when their values are so clearly against progressive values in terms of misogyny, sexism, racism."
The problem is that a lot of data suggests that countries with more robust welfare states tend to have stronger far-right movements. Providing white voters with higher levels of economic security does not tamp down their anxieties about race and immigration - or, more precisely, it doesn't do it powerfully enough. For some, it frees them to worry less about what it's in their wallet and more about who may be moving into their neighborhoods or competing with them for jobs.
Take Britain's Labour Party, which swung to the populist left by electing Jeremy Corbyn, a socialist who has proposed renationalizing Britain's rail system, as its leader in 2015. The results have been disastrous: the Brexit vote in favor of leaving the European Union, plummeting poll numbers for both Corbyn and his party, and a British political scene that is shifting notably to the right on issues of immigration and multiculturalism....
https://www.weforum.org/agenda/2017/01/full-text-of-xi-jinping-keynote-at-the-world-economic-forumEMichael -> anne... , March 14, 2017 at 08:18 AMJanuary 17, 2017
Speech to Davos
Wrtten by Xi Jinping
President of the People's Republic of ChinaI'm delighted to come to beautiful Davos. Though just a small town in the Alps, Davos is an important window for taking the pulse of the global economy. People from around the world come here to exchange ideas and insights, which broaden their vision. This makes the WEF annual meeting a cost-effective brainstorming event, which I would call "Schwab economics".
"It was the best of times, it was the worst of times." These are the words used by the English writer Charles Dickens to describe the world after the Industrial Revolution. Today, we also live in a world of contradictions. On the one hand, with growing material wealth and advances in science and technology, human civilization has developed as never before. On the other hand, frequent regional conflicts, global challenges like terrorism and refugees, as well as poverty, unemployment and widening income gap have all added to the uncertainties of the world.
Many people feel bewildered and wonder: What has gone wrong with the world? ...
Amazing he had the balls to say this:pgl -> Dan Kervick... , March 14, 2017 at 08:11 AM"Countries, big or small, strong or weak, rich or poor, are all equal members of the international community. As such, they are entitled to participate in decision-making, enjoy rights and fulfill obligations on an equal basis."
Seriously?
Well said. It should be about governance - not who wins a popularity contest.Dan Kervick -> anne... , March 14, 2017 at 06:55 AMI agree with Beauchamp that what we are seeing in the US and Europe is a broader wave against liberalism itself, not just a vote for some particular economic policy or other. But for writers like Beauchamp, it always seems to be just a coincidence that this great antiliberal wave coincides with the aftermath of the worst economic catastrophe since the Great Depression. Doesn't he wonder what causes upticks in xenophobia and racism, resistance to immigration, and similar behaviors? These things rise when people are unhappy about many other things in their lives. And that happens when a country is not thriving economically.JF -> Dan Kervick... , March 14, 2017 at 07:42 AMI suspect one source of western malaise is exasperation with liberalism - whether of the rightish, laissez faire capitalist variety or of leftish neoliberal capitalism + welfare state variety – is that contemporary liberalism takes an overly passive view toward future, deferring all of the major social outcomes to the inventions and innovations or capitalist entrepreneurs, and neglecting any strategic planning role for government.
In my lifetime, China as transformed itself from a land of impoverished peasants into a world economic powerhouse, doing it with a combination of capitalist and socialist mechanisms. Meanwhile, we in the US just drift along in the end-of-history shallows, waiting to see what new toy clever business-people will invent for us. We're destroying the planet and its biosphere, & yet the usual neoliberal response is "Maybe Gates or Musk will think of something."
"Tacking to the left" economically must be understood as more than expansion of the welfare state. It includes expansion of the government role in planning and setting the agenda or direction in the productive sphere, and also regulating firms and the distribution system at the root level, to assure a more equitable distribution of income. People must be guaranteed the possibility of stable and secure lifetime employment, and reliable retirement incomes, and protected from the economic devastation of personal healthcare emergencies. Meanwhile, we need to use government to formulate and execute long term economic plans.
People are bored and dismayed by the lack of purpose, leadership, direction and transformative ambition from our dysfunctional and complacent governments. They respond to "Make America Great Again" message because at least they detect some sense of energy and purpose behind that message. So yes, I sort of agree with Beauchamp to this extent: people are turning against liberalism itself, which seems decrepit, vacuously individualistic and adrift. So, the question is how to save what is good in liberalism, while moving on and forward from what is shallow & decadent in it. Do you want fascism? Or a reinvigorated, purposeful & powerful left with an ambitious plan for engineering a viable future?
Enjoy the writing and thought. Thanks.JF -> JF... , March 14, 2017 at 07:47 AMThe lessons to be taken from China, as you note above, is that they have reached the conclusion that things like pricing mechanisms and markets and even the enforceability of loan contracts, if desired, all work well to effect a societally useful economic system. This is what needs to be higlighted when trying to reach westerm thinkers, in my opinion.
The central and authoritarian control aspects are not good points to highlight - in China, in Russia, or in the US. These aspects offend me and many.
But we do need thoughtful and intentional economic policies uniformly established via the public's law, if we can keep the Republican-form aspects that legitimize US governance; and we are losing this 'we the people' aspect to a radical faction who would implement their notion of central plans of benefit to their new aristocracy.Dan Kervick -> JF... , March 14, 2017 at 01:03 PMChina didn't get decades of gigantic growth rates just by handing its economy over to markets and private contracts. They have had a national investment plan and long-term strategy spearheaded by a heavily-involved and assertive central government.RC AKA Darryl, Ron -> Dan Kervick... , March 14, 2017 at 07:47 AMYes I know many Americans are offended by the very idea of central planning, and have powerful, kneejerk reactions to all suggestions of that kind. Well, they can keep being offended and we keep drifting along with our old-fashioned ideas of radically decentralized liberal capitalism. We can keep letting our wonderful capitalist freedom cook the planet and decimate the biopshere, and segregate our anxious, increasingly angry population into winners and losers at each others's throats.
Well said.
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Mar 16, 2017 | economistsview.typepad.com
pgl : March 14, 2017 at 01:49 AM , 2017 at 01:49 AMHere is a link to the CBO report:jonny bakho -> pgl... , March 14, 2017 at 06:11 AMTom Price says it is not believable. I guess he does not want to admit that 24 million people will lose their insurance but I bet his colleagues will hype this:
"CBO and JCT estimate that enacting the legislation would reduce federal deficits by $337 billion over the 2017-2026 period."
That's only $34 billion per year and read on:
"The largest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act's (ACA's) subsidies for nongroup health insurance. The largest costs would come from repealing many of the changes the ACA made to the Internal Revenue Code-including an increase in the Hospital Insurance payroll tax rate for high-income taxpayers, a surtax on those taxpayers' net investment income, and annual fees imposed on health insurers-and from the establishment of a new tax credit for health insurance."
Hey it is easy to reduce the deficit if one abdicates responsibility for taking care of the truly needy. But hey – more tax cuts for the rich!
The reaction from Pence home state of Indiana:JF -> jonny bakho... , March 14, 2017 at 07:20 AM"It's reality hitting home," Republican Senate leader Dave Long, of Fort Wayne, said earlier this month. "The issue of the working poor is real. It's not going to be easy."
More than 400,000 poor people in Indiana have health insurance after former Gov. Mike Pence, now the vice president, championed an expansion of Medicaid, which relies on the federal government for at least 90 percent of its funding.
Pence, who is being counted on by Trump to help sell the House plan, is now poised to help unwind one of his legacy achievements as governor if the bill is signed into law.
A Pence spokesman declined to comment.
Holcomb said he understands that there is a pressing need to rein in federal spending, but he said HIP 2.0, the program Pence implemented in Indiana, is working.
"I have not seen a more successful program," Holcomb said. "I don't want to overreact but I do think that HIP 2.0 is part of that answer in how our nation can address the issue of health care."
HIP = Healthy Indiana Plan = Medicaid expansions in IN under waiver
Holcomb is new governorPublic financing, sure its successful. Happy for people there.JF -> JF... , March 14, 2017 at 09:19 AMI assume that the reason why the proposed bill delays the Medicaid changes is so that the States that refused to sign up before get a chance to sign up for a few years.
This means that politicians who purposely sacrificed their population's health to make some ideological bow in order to undermine the successes of the ACA would get new public financing support, allowing them to claim this new success. Unctuous. Ugly.
I wonder how CBO scored this, did they recognize that new States would sign on to the Medicaid increased Fed Financing Supports for a few years, increasing the benchmark numbers for the block grants that then replace Medicaid in those States.
Again, I would be more than sanguine to see these States poorer populations better served, that would be success, at least for a few years. But the politics are radical, bald and unseemly.
And annual fiscal changes would be less then too, and wonder what CBO considered would happen.
CBO gave no details but nited that State reactions to the bills provisions are uncertain.If we presume all those nonparticipating states actually sign on to the ACA until the medicaid elements are changed in 2020, at which time they would do something to protect their budgets, the national budget savings would shrink. These are areas worth congressional hearing questions of CBO.
Apparently the bill proposes to grant special subsidies to the state who had not joined before. This rewards those zealots for screwing their own people, it is sad, but It is better to expand than screw them some more. Such bald, raw political engineering here.
Again, deserves congressional questions of CBO to explain their assumptions and to highlight this reward for what it is.
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Mar 14, 2017 | economistsview.typepad.com
Fred C. Dobbs : March 13, 2017 at 07:23 AM
Lousy Customer Service? A Better Way in Health Care
https://nyti.ms/2mBJxmw via @UpshotNYT
NYT - Austin Frakt - MARCH 13, 2017You've all experienced it: There's a problem with your health care bill, or you have difficulty getting coverage for the care you need. Your doctor or hospital tells you to talk to your insurer. Your insurer tells you to talk to your doctor or hospital. You're stuck in an endless runaround.
A small patient advocacy industry has sprung up to help, but that help can cost several hundred dollars an hour. Is there a way to get the customer service we deserve?
Turns out, some kinds of health insurance plans provide better customer service than others. Among those that do are plans offered directly by hospitals or health systems, according to results from a recent study by me; Garret Johnson, now a medical student at Harvard; and Zoë Lyon, a research assistant at the Harvard T.H. Chan School of Public Health.
Our conclusions are based on analysis of Medicare Advantage plans - private insurance alternatives to traditional Medicare. Medicare Advantage plans are offered by major insurers like UnitedHealthcare, Humana, Aetna, BlueCross BlueShield affiliates and others. But nearly one-quarter of the plans are issued by hospitals or health systems. These provider-offered plans are more likely found in dense, urban areas in the Northeast and the West.
The government collects data on health care quality from surveys and medical claims, then aggregates them into ratings of plans. These are publicly reported in units of stars: Five stars represents the highest quality, and one the lowest. Our study, published this month in the health policy journal Health Affairs, found that provider-offered plans have higher quality ratings.
(Provider-Offered Medicare Advantage Plans:
Recent Growth And Care Quality
http://content.healthaffairs.org/content/36/3/539.abstract )Plans offered by insurers have average ratings of just over 3.5 stars for both nondrug and drug service. An average provider-offered plan has quality ratings that are about one-third of a star higher for both, after adjusting for factors that could confound the comparison, like socioeconomic status and the types and number of doctors where plans are offered.
Our study dug deeper to examine the kinds of quality enhancements available in provider-offered plans. Some aspects of quality are clinically focused. For instance, measures of preventive screening - like that for colorectal cancer - or management of chronic conditions assess the quality of care delivered by doctors and hospitals in a plan's networks. Provider-offered plans perform somewhat better than insurer-offered plans in such areas.
Other aspects of quality pertain to customer service. In measures of complaints, responsiveness to customers and the enrollees' overall experiences, provider-offered plans really shine. In each area of customer service we examined, provider-offered plans are rated one-half star higher than insurer-offered ones. (This is a big difference. For comparison, over half of plans are within one star of each other in overall quality.)
These results make some sense. When a customer has an issue - like a problem with a hospital bill - the easiest thing for a health plan to do is pass it off to the hospital. Likewise, the hospital's easiest course of action is to blame the health plan. The patient, stuck in the middle, is not likely to rate his plan (or hospital) highly for customer service in this case.
However, when the plan and hospital are one and the same, neither can pass the buck to the other. Problems may be resolved faster; they may be less likely to develop in the first place. This could lead to the higher customer satisfaction reflected in the quality ratings.
If the higher ratings are enough to interest you in trying a provider-offered plan, how would you find one? Unfortunately, there's no readily accessible source to inform consumers (or researchers) about this feature of plans. Sometimes the plan's name gives away the relationship. The UPMC Health Plan practically has the health system that offers it right in the name - UPMC stands for University of Pittsburgh Medical Center. In other cases, consumers can identify the relationship on plans' or health systems' websites. For example, the Vital Traditions plan website identifies as its parent company the largest nonprofit hospital system in Texas, Baylor Scott & White.
But in many cases, it's not so easy to figure out. In fact, this is why there has been so little analysis of provider versus insurer plans. For our study, we had to scroll through hundreds of websites, news articles and documents to build a research data set on provider-offered plans from 2011 to 2015. Because of the work involved, there are very few studies on the subject. Another, published in Health Service Research by me, Roger Feldman of the University of Minnesota and Steven Pizer of Northeastern University, found a similar quality relationship when examining 2009 data.
That earlier study also found that provider-offered Medicare Advantage plans charge higher premiums. But a recent study of marketplace plans found that provider-offered ones are not necessarily the most expensive. For some, a higher premium may outweigh the benefits of greater quality, but for others it may not.
From our study, we can't be certain that provider sponsorship of plans causes higher quality. It could be that higher-quality providers are the ones that choose to offer plans. Nevertheless, such tight integration between plans and providers is at least a signal of higher quality, even if it doesn't cause it.
Recent trends suggest more health systems are offering plans in other health care markets for the working-age population, not just in Medicare Advantage. Not all markets may be hospitable to provider-offered plans, however. Some systems that did offer plans are pulling back. According to The Wall Street Journal, Catholic Health Initiatives, which runs over 100 hospitals across 18 states, is divesting itself of some of its health insurance plans. After struggles with profitability, Tenet Healthcare and several other health systems have said they will do the same. ...
Big hospital operator retreats from health-insurance foray
http://www.wsj.com/articles/big-hospital-operator-retreats-from-health-insurance-foray-1481814003
via @WSJ - December 15
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Mar 14, 2017 | economistsview.typepad.com
Peter K. : March 13, 2017 at 05:46 AMPeter K. -> Peter K.... , March 13, 2017 at 05:51 AMFred Dobbs corrected me by saying Romenycare started in Massachusetts, not a Republican think tank. Not according to David Warsh in today's links.
"How did a Republican program introduced on the eve of the George H.W. Bush administration wind up in the crosshairs of the Republican Congress under House Speaker Paul Ryan (R-Wis.) twenty-five years later? Here, at the beginning of the attempt to repeal Obamacare, let's take a quick trip down memory lane.
It was in 1989 that economist Stuart Butler proposed an individual mandate in a Heritage Foundation monograph, A National Health System for America, practically on the eve of Bush's inauguration:
The requirement to obtain basic insurance would have to be enforced. The easiest way to monitor compliance might be for households to furnish proof of insurance when they file their tax returns. If a family were to cancel its insurance, the insurer would be required to notify the government. If the family did not enroll in another plan before the first insurance coverage lapsed and did not provide evidence of financial problems, a fine might be imposed.
That autumn, in Assuring Affordable Health Care for All Americans, a conference talk, Butler explained why the provision of health care is unlike almost all other markets:
If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance. If we find that he has spent his money on other things rather than insurance, we may be angry but we will not deny him services – even if that means more prudent citizens may wind up paying the tab.
In 1991 Mark Pauly, of the University of Pennsylvania, elaborated on the concept, in a widely-read article in the journal Health Affairs. The individual mandate became the basis for a Congressional Republican proposal introduced in 1993 as an alternative to Hillary Clinton's anticipated proposal of a single-payer national health service. The scheme was subsequently endorsed (subscription required) by Newt Gingrich.
..."
http://www.economicprincipals.com/issues/2017.03.12/1980.html
Up above in comments, PGL is getting all strident about Paul Ryan watering down what is essentially a Republican water-downed alternative to Hillarycare.
"He is gloating that we have more "choices" as he takes away any possible means for actually paying for our health care. This in a nutshell is the entire GOP approach. We are free to die."
The comedians are having a fun time pointing out how Trump won't put his name on the replacement plan even though he loves putting his name on things.
Was Hillarycare a single-payer?im1dc -> EMichael... , March 13, 2017 at 08:44 AMhttps://en.wikipedia.org/wiki/Clinton_health_care_plan_of_1993
"To achieve this, the Clinton health plan required each US citizen and permanent resident alien to become enrolled in a qualified health plan on his or her own or through programs mandated to be offered by businesses with more than 5,000 full-time employees. Subsidies were to be provided to those too poor to afford coverage, including complete subsidies for those below a set income level. Users would choose plans offered by regional health alliances to be established by each state. These alliances would purchase insurance coverage for the state's residents and could set fees for doctors who charge per procedure.[5][6] The act provided funding to be sent to the states for the administration of the plan, beginning at $14 billion in 1993 and reaching $38 billion in 2003."
Short Sweet Bernie Sanders Takedown of the Ryan Repeal and Replace Health Care Planim1dc : , March 13, 2017 at 09:30 AM"Bernie Sanders Demolishes Paul Ryan's Obamacare Replacement In An Incredible 82 Seconds"
By Jason Easley...Mar 12th, 2017
"Sen. Bernie Sanders needed just 82 seconds to completely demolish Speaker of the House Paul Ryan's Obamacare replacement on Face The Nation.
The full interview with Sen. Sanders on CBS's Face The Nation:
Face The Nation video
Sen. Sanders was asked if the Ryan Obamacare replacement can get 51 votes in the Senate, and he answered, "I hope not. It is an absolute disaster. It is a disgrace, and by the way, this really has nothing to do with healthcare. What this has everything to do with is a massive shift of wealth from working people and middle-income people to the richest people in this country. It is a 275 billion dollar tax break for the top two percent. Millionaires will get about $50,000 a year in tax breaks, while at the same time 5-10 million people are going to lose their health insurance, premiums are going to soar. The AARP says that if you are 64 years of age and you're making about 25,000 a year, you're going pay up to $7,000 more for you're health insurance. They're going to defund Planned Parenthood. Deny over 2 million the right to choose they healthcare that they need. They're going to decimate Medicaid, which is why the American Medical Association, the AMA, and the American Hospital Association oppose it, in addition to the AARP. This is a disgrace, and by the way, they are so cowardly that they want to go forward before the CBO gives an estimate of what it will cost, and how many people will lose their insurance."...
Anyone mention Single Payer? No? Why not..."Republican lawmakers think the biggest problem with health insurance is that too many people have it"
"Ryancare doesn't fix health care, but here are some ideas that would"
By Rex Nutting, Columnist...Mar 13, 2017...7:53 a.m. ET
"Congressional Republicans are moving forward with a bill to repeal and replace the Affordable Care Act, but the proposed bill doesn't do very much to improve on the flaws in Obamacare. The Republican plan doesn't solve any of our health-care problems, because it wasn't designed to.
Instead, it tries (and fails) to solve a political problem.
What are the main complaints about Obamacare? That, even with subsidies, health care is too costly, with rising premiums and high out-of-pocket costs. That, in some areas, there aren't enough choices for health insurance, and there aren't enough choices about doctors or other medical-care providers. That there's a mandate to purchase insurance, even if you're healthy.
Paul Ryan's replacement bill doesn't address any of those concerns. Instead, it would drive costs up for almost everyone except the very healthy and the very rich, and would hit those in their 50s and 60s particularly hard. It would phase out expanded Medicaid coverage, so millions of working-class Americans would lose their insurance completely. It doesn't guarantee that you'll have more choices, and it maintains a mandate to buy insurance.
Unfortunately, the bill's penalty for not buying continuous insurance coverage would create such perverse incentives that it would likely result in even fewer healthy people buying health insurance, which would in turn lead to higher premiums for sick people as the insurance pool becomes smaller and sicker, culminating in the very "death spiral" that supposedly killed Obamacare.
So what is the Republican bill all about? It's an attempt to square the circle politically. Republicans have an intractable problem: People really like having health insurance and the care that goes with it, but Republican lawmakers think the biggest problem with health insurance is that too many people have it.
As Mike Konczal writes: "Conservatives talk compassion, but they really believe that the problem with health care is too much coverage, too little risk for individuals and too much taxation."
Or as my colleague Caroline Baum writes: "Republicans are getting a crash course on what they already knew, or should have known: once an entitlement, always an entitlement." In other words, Republicans should go back to the principle that no one should get anything they can't afford. There's no free lunch, and no free health care.
As you can see, there is no way to square this. People want affordable health care, and Republicans don't want to give it to them. So of course the bill is a mess, pleasing no one except those who foolishly think that the people wouldn't notice that the Republicans had replaced Obamacare with something much worse.
The problems of health care
So how should we improve our health-care system? The first step is to identify what's wrong with it. Several things:
...Everyone should be insured, with the costs fairly divided among all of us. Make it so.
...We could control some costs by shifting the way we reimburse doctors and hospitals.
...We should make sure that health-care providers don't benefit financially from the treatments they prescribe.
...Introducing more competition would drive down prices.
...let's take away the patents for drugs and medical equipment and establish alternative means of encouraging research, innovation and invention
...Finally, we need more transparency about prices, as well as about the risks and benefits of the treatments recommended for us. Prices ought to be posted on the wall of every waiting room and admittance office."...
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Noni Mausa : March 13, 2017 at 04:13 PM What the wealthy right wing has decided in the past 40 years is that they don't need citizens. At least, not as many citizens as are actually citizens. What they are comfortable with is a large population of free range people, like the longhorn cattle of the old west, who care for themselves as best they can, and are convenient to be used when the "ranchers" want them.Of course, this is their approach to foreign workers, also, but for the purpose of maintaining a domestic society within which the domestic rich can comfortably live, only native born Americans really suit.
With the development of high productivity production, farming, and hands-off war technology the need for a large number of citizens is reduced. The wealthy can sit in their towers and arrange the world as suits them, and use the rest of the world as a "farm team" to supply skills and labour as needed.
Proof of this is the fact that they talk about the economy's need for certain skills, training, services and so on, but never about the inherent value of citizens independent of their utility to someone else.
No wonder the unemployed increasingly kill themselves, or others. The whole economy tells them, indirectly but unmistakably, that their human value does not exist. ken melvin : , March 13, 2017 at 04:48 PM
Can someone get me from $300 billion tax cut for the rich to getting the markets work for health care?ken melvin : , March 13, 2017 at 04:54 PMIt isn't about 'markets', never is. It is about extraction of as much profit as possible using whatever means necessary. This is what the CEOs of insurance companies get payed to do. Insurance policies they don't pay out, the ones Ryan is referring to, are as good as any for scoring.libezkova : , March 13, 2017 at 07:09 PM"It isn't about 'markets', never is. It is about extraction of as much profit as possible using whatever means necessary. This is what the CEOs of insurance companies get payed to do."ilsm : , March 13, 2017 at 01:41 PMWhat surprises me most in this discussion is how Obamacare suddenly changed from a dismal and expensive failure enriching private insurers to a "good deal".
Lesseevilism in action ;-)
When the PPACA band-aid is pulled off the US health care mess the gusher will be blamed on "the Russians running the White House".jeff fisher said in reply to ilsm... , March 13, 2017 at 01:58 PMCuba does better than the US despite being economically sanctioned for 55 years. Distribution of artificially scarce health care resources is utterly broken. This failed market is financed by a mix of 'for profit' insurance and medicare (which sublets a big part to 'for profit' insurance).
Coverage!!! PPACA added taxpayers' money to finance a bigger failed market. It did nothing to address the market fail!
Single payer would not address the market failure. Single payer would put the government financing most of the failed market.
Democrats have put band-aids on severe bleeds since Truman made the cold war more important than Americans.
At least we know what Trump stands for!
Cuba is the shining example of how doing the first 20% of healthcare well for everyone gets you 80% of the benefit cheap.jonny bakho : , March 13, 2017 at 12:09 PMThe US is the shining example of how refusing to do the first 20% of healthcare well for everyone only gets you 80% of the benefit no matter how much you spend.
Mark's very nice argument does nothing to address The Official Trump Counter Argument:[Shorter version: Obamacare is doomed, going to blow up. Any replacement is therefore better than Obamacare; Facts seldom win arguments against beliefs]
"During a listening session on healthcare at the White House on Monday, President Donald Trump said Republicans "are putting themselves in a very bad position by repealing Obamacare."
Trump said that his administration is "committed to repealing and replacing" Obamacare and that the House Obamacare replacement will lead to more choice at a lower cost. He further stated, "[T]he press is making Obamacare look so good all, of a sudden. I'm watching the news. It looks so good. They're showing these reports about this one gets so much, and this one gets so much. First of all, it covers very few people, and it's imploding. And '17 will be the worst year. And I said it once; I'll say it again: because Obama's gone."
He continued, "And the Republicans, frankly, are putting themselves in a very bad position - I tell this to Tom Price all the time - by repealing Obamacare. Because people aren't gonna see the truly devastating effects of Obamacare. They're not gonna see the devastation. In '17 and '18 and '19, it'll be gone by then. It'll - whether we do it or not, it'll be imploded off the map."
He added, "So, the press is making it look so wonderful, so that if we end it, everyone's going to say, 'Oh, remember how great Obamacare used to be? Remember how wonderful it used to be? It was so great.' It's a little bit like President Obama. When he left, people liked him. When he was here, people didn't like him so much. That's the way life goes. That's human nature."
Trump further stated that while letting Obamacare collapse on its own was the best thing to do politically, it wasn't the right thing to do for the country.
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Lee A. Arnold -> jonny bakho... March 10, 2017 at 03:59 AM Obama and the Dems can avert the blame by saying,"Get private insurers out of the game, they are taking 20% of everyone's money, for no value-added. Create a public option that will knock the price down, and will lead us to a single payer, like 'Medicare for All'. Healthcare can't work as a totally free market, it has to work like Medicare. Don't blame the Democrats, blame the Republicans for obstructing smart economics. ACA tried to bring everybody into the system, to reveal our true costs as a nation."
This shouldn't be hard, people!! jonny bakho -> Lee A. Arnold ... , March 10, 2017 at 04:37 AM
People do NOT like dealing with insurance period. A program that is automatic enroll / file to opt out would require less effort and be more appealing. Programs that force people to do things (Read health care legalese) will create a lot more grumbling than programs that auto enroll. It should be as simple as signing up for Medicare. The GOP could buy good will by keeping most of ObamaCare and changing the process. However, the primary GOP goal is to eliminate the taxes on the wealthy that pay for Obamacare subsidies. It is not to do something for their uninsured votersLee A. Arnold -> jonny bakho... , March 10, 2017 at 04:51 AMTotally agree in regards to healthcare, (and we should get rid of the Medicare donut-hole too). Note that part of Obamacare's taxation covers the shortfall in Medicare, so that repealing Obamacare puts Medicare back into jeopardy. Probably one reason that the GOP is trying to avoid a CBO score for as long as possible. Medicare goes on the chopping-block next, make no mistake about it.Lee A. Arnold -> Lee A. Arnold ... , March 10, 2017 at 05:07 AMIf you have watched a senior try to deal with the Medicare donut-hole, you realize the enormous and cruel burden it places upon some of them. A county-level bureaucrat advised me that this travesty was included to make some people get sick and die faster, so that they don't burden the Medicare system. Old people can get the idea that they have no right to live, because the money ain't there; they don't want to be a burden.Benedict Arnold -> Lee A. Arnold ... , -1pgl -> Lee A. Arnold ... , March 10, 2017 at 05:43 AM
county-level bureaucrat advised me that this travesty was included to make some people get sick and die faster, so that they
"
~~Lee A. Arnold said~This is even worse!
"
Senator Michael Enzi and Michigan Representative Fred Upton advocated the extension from October into November especially to allow children to go trick-or-treating in more daylight.[13]Under Section 110 of the Act, the U.S. Department of Energy was required to study the impact of the 2007 DST extension no later than nine months after the change took effect. The report, released in October 2008, reported a nationwide electricity savings of 0.03% for the year of 2007.[14]
An October 2008 study conducted by the University of California at Santa Barbara for the National Bureau of Economic Research found that the 2006 DST adoption in Indiana increased energy consumption in Indiana by an average of 1%. Although energy consumption for lighting dropped as a result of the DST adoption, consumption for heating and cooling increased by 2 to 4%.
"From this can you easily visualize what a bunch of clowns and jokers we have in Congress? Look!
Railroads, ships, and planes need a consistent system of time that is the same in all parts of the World, the kind of time that does not confuse the human mind. Sure!
computers can be properly reprogrammed to compensate for the stupidity of Congress, but humans using the computers and programming the computers have been confused enough already. We need to revert back to Greenwich Mean Time that has been slightly tweaked by atomic clock but essentially the same in all countries simultaneously. Look!
There is nothing wrong with having lunch at 7:00 in Washington; nothing wrong with having midnight at 19:00 in DC. Hell!
That's even better! At least you know where you are on the planet just from knowing when folks have sun-transit. Sure!
Folks can move trick-or-treat to a different schedule or move school-bus to a different time whenever they like. Sure! Folks can change from one month to the next when to open the glof-course, but don't try to change the entire system of conventional time just to suit your golfing foursome!
Fore
!"they are taking 20% of everyone's money, for no value-added. Create a public option that will knock the price down". Exactly.Lee A. Arnold -> pgl... , March 10, 2017 at 05:55 AMTheir gross margin have risen above 20%. We are talking about operating expenses near 15% of premium revenue which is about twice what this should be. Profits margins are near 6% of premium revenue which translates into ROAs near 25%. And reasonable analysis would suggest that the cost of capital is less than 8% so profit margins closer to 2% would be generous.
Of course - we know why. An oligopoly structure means no real competition. But that is what Paul Ryan wants as he is bought and paid for by the health insurance oligopolists. Remember that when they talk about "free market principles". All talk - no reality.
I thought that ACA restricted the insurers to a "medical loss ratio" (MLR) no lower than 80%, i.e. no more than 20% for themselves.Anachronism -> Lee A. Arnold ... , March 10, 2017 at 06:00 AMIt does. Don't know about anyone else in this blog, but I'm self employed and buy my own insurance, so I am directly affected by ACA.pgl -> Anachronism ... , March 10, 2017 at 06:36 AMEvery August, I get a check from Blue Cross for the excess charged (that "no more than 20% for themselves). This year is was just a hair under $2K.
This gives me a thought about the usual Republican babble as to how price controls create shortages (their free market spin of late). Let's suppose my back of the envelope guess of what a competitive gross margin should be is right - that it would be 10% but for the oligopoly structure. With the oligopoly and no ceiling - let's say they are getting a 25% gross margin off of us not on ACA. Then the ACA ceiling is actually a movement towards competition both lowering prices and increasing quantity provided. Standard economics for a market infested with monopoly power.Anachronism -> pgl... , March 10, 2017 at 06:57 AMThis says there are two ways to move the market more efficient - either enforce competition (public option) or impose a lower ceiling. So ACA did not go far enough with this 20% ceiling. It should be cut in half.
Maybe non-serious republicans think the health insurance market is a free-market situation, but I don't see how. It is rife with imperfect knowledge about the marketplace and failures in pricing.pgl -> Lee A. Arnold ... , March 10, 2017 at 06:20 AMWithout knowing if your back-of-the-envelope is correct, I'd guess the difference between the 10% margin and the actual 20% is a political quid pro quo (I give you the extra 10% and you support the legislation).
What I can say is that I know Medicare operates with a 3 1/2% overhead margin, so moving to a public option should definitely reduce premiums.
You may be right but ACA covers only a subset of the population. I'm thinking about the overall financials for these companies. Maybe this is why they don't like ACA. They prefer setting this absurdly high gross margin even higher. It could be and should be less than 10%.EMichael -> pgl... , March 10, 2017 at 06:52 AMThe ACA mandates a MLR of 85% for employer provided insurance.anne -> Lee A. Arnold ... , March 10, 2017 at 07:32 AM"Get private insurers out of the game, they are taking 20% of everyone's money, for no value-added...."Lee A. Arnold -> anne... , March 10, 2017 at 08:31 AMWhere is this quote taken from? I assume the 20% figure refers to the Medical Loss ratio, * but I do not understand how low that ratio could be under any insurance system.
The Affordable Care Act requires health insurance issuers to submit data on the proportion of premium revenues spent on clinical services and quality improvement, also known as the Medical Loss Ratio (MLR). It also requires them to issue rebates to enrollees if this percentage does not meet minimum standards. The Affordable Care Act requires insurance companies to spend at least 80% or 85% of premium dollars on medical care, with the rate review provisions imposing tighter limits on health insurance rate increases.
Anne: "I do not understand how low that ratio could be under any insurance system"anne -> Lee A. Arnold ... , March 10, 2017 at 08:39 AMI think that Social Security and Medicare only spend around 2%.
"I do not understand how low that Medical Loss ratio could be under any insurance system"EMichael -> Lee A. Arnold ... , March 10, 2017 at 08:48 AMI think that Social Security and Medicare only spend around 2%.
[ This is what I was after and is especially important. What we need then is to document the administrative cost of Medicare and Social Security. ]
A little higher than that, but obviously lower. At the same time, SS does not count except that it makes Medicare Admin costs lower.Lee A. Arnold -> EMichael... , March 10, 2017 at 09:40 AMAlso, admin costs will be lower when you are talking about the simple fact that once people are on Medicare there are no changes(or not many) that has to be dealt with. In the private marketplace there are constant changes(births, policy changes, etc), and these make for higher admin costs.
Not to say these costs are not too high, but there will be higher admin costs for those under 65.
EMichael: "there will be higher admin costs for those under 65."EMichael -> Lee A. Arnold ... , March 10, 2017 at 09:46 AMPut everybody into one big public risk pool, & the incidence of disease, the treatment costs, and the actuarial tables ought to be pretty steady and predictable.
Of course they would. I said the same thing.Lee A. Arnold -> EMichael... , March 10, 2017 at 10:25 AMJust saying they will not be as low as Medicare, and that the insurance companies do not increase costs by 20%.
I am not sure I understand you. In a universal public healthcare system, why would administrative costs be different than for Medicare?anne -> Lee A. Arnold ... , March 10, 2017 at 08:49 AMhttp://www.pnhp.org/sites/default/files/Medicare_admin_costs_JHPPL.pdfanne -> anne... , March 10, 2017 at 09:03 AMFebruary 15, 2013
How to Think Clearly about Medicare Administrative Costs: Data Sources and Measurement
By Kip SullivanAbstract
The Centers for Medicare and Medicaid Services (CMS) annually publishes two measures of Medicare's administrative expenditures. One of these appears in the reports of the Medicare Boards of Trustees and the other in the National Health Expenditure Accounts (NHEA). The latest trustees' report indicates Medicare's administrative expenditures are 1 percent of total Medicare spending, while the latest NHEA indicates the figure is 6 percent. The debate about Medicare's administrative expenditures, which emerged several years ago, reflects widespread confusion about these data. Critics of Medicare argue that the official reports on Medicare's overhead ignore or hide numerous types of administrative spending, such as the cost of collecting taxes and Part B premiums. Defenders of Medicare claim the official statistics are accurate. But participants on both sides of this debate fail to cite the official documents and do not analyze CMS's methodology. This article examines controversy over the methodology CMS uses to calculate the trustees' and NHEA's measures and the sources of confusion and ignorance about them. It concludes with a discussion of how the two measures should be used.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.htmlanne -> anne... , March 10, 2017 at 09:09 AMDecember 6, 2016
Historical
The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States. Dating back to 1960, the NHEA measures annual U.S. expenditures for health care goods and services, public health activities, government administration, the net cost of health insurance, and investment related to health care. The data are presented by type of service, sources of funding, and type of sponsor.
http://www.pnhp.org/sites/default/files/Medicare_admin_costs_JHPPL.pdfLee A. Arnold -> anne... , March 10, 2017 at 09:45 AMFebruary 15, 2013
Medicare Administrative Expenses as Percent of Total Expenditures
( Medicare Trustees) ( National Health Expenditure Accounts)
2000 ( 2.0) ( 3.8)
2001 ( 1.6) ( 3.5) Bush
2002 ( 1.8) ( 3.3)
2003 ( 1.7) ( 3.1)
2004 ( 1.9) ( 3.6)2005 ( 1.8) ( 4.0)
2006 ( 1.5) ( 5.3)
2007 ( 1.5) ( 5.6)
2008 ( 1.4) ( 5.3)
2009 ( 1.3) ( 5.7) Obama2010 ( 1.3) ( 5.9)
2011 ( 1.4)-- Kip Sullivan
Considering the jump in administrative expenses in the National Health Expenditure Accounts after 2004, we ought to investigate whether this was caused by the passage of privatized Medicare Part D in 2003.pgl -> anne... , March 10, 2017 at 09:34 AMEven at 6%, this is far lower than what the private insurers pay.pgl -> anne... , March 10, 2017 at 09:32 AMAetna's 10K reports its health care costs relative to its health care premiums. That is the main part of its gross profit margin and indeed it is as high as he says. And I still stand by my contention that this margin could be cut in half.anne -> pgl... , March 10, 2017 at 09:49 AMSupposing I understand the research, administration costs for Medicare ranged between 1.3% and 5.9% of total Medicare spending between 2000 and 2010. Medical Loss ratios for insurers under the Affordable Care Act have been set between 80% and 85%. Here then we would seem to have boundaries within which to argue.New Deal democrat -> jonny bakho... , March 10, 2017 at 04:49 AMYes, agreed. Just to flesh out your point a little ...reason -> New Deal democrat... , March 10, 2017 at 05:12 AMThe GOP really wants to repeal Obamacare in full and "replace" it with "save money for when you get sick." Oh, and tax cuts for the rich as always.
But they can't do that outright now that 20 million people have coverage under Obamacare, and it is really helping them.
So in "phase 1" of their plan, they kick away the funding, for which they only need 50 votes (+the VP) in the Senate.
"Phase 2" deals with the coverage. It is really crappy. They can accomplish this by nuking the filibuster, *OR* they can tell Dems that if they don't go along, they will get blamed for the death spiral of the existing law (now that funding is gone). Since the GOP plan is also designed to go into a death spiral, the Dems probably will hold the line.
But either way, there is a death spiral. The GOP wurlitzer will be easier to crank up with blaming the Dems when they don't go along. And since it will block grant Medicaid and cause the Medicare trust fund to be exhausted in 2024, it tees up the next round of gutting the civil state.
This is the Republican plan - but it is a disaster for Trump. The problem is of course that he is too stupid to realize it.reason -> jonny bakho... , March 10, 2017 at 05:09 AMplacate (not place) - for those who are having trouble reading jonny bakho here.
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jonny bakho : March 10, 2017 at 04:30 AM , 2017 at 04:30 AMKevin Drum understands:Lee A. Arnold : , March 10, 2017 at 04:46 AM
Republicans knew exactly what problem they were trying to solve. Their preference has always been to repeal Obamacare and do nothing in its place, but they don't have the votes to overcome a Democratic filibuster, so they can't do that. They also realize that the optics of baldly ripping away health coverage from 20 million people would be mildly troublesome.So their goal was simple: do what they could to destroy Obamacare and take away as much health coverage as they could, without making it look like they weren't offering a replacement. The result is a plan that offers the trappings of health care-subsidies, pre-existing conditions, etc.-but which is all but useless to the people who actually need it. It's too stingy for poor people, and mostly unnecessary for middle-class folks who already get health insurance from their employers. It will cost very little because virtually nobody will use it.
The part they apparently didn't realize is that keeping the pre-existing conditions clause-which is both popular and impossible to repeal-while tearing down the rest of Obamacare is likely to destroy the individual insurance market. At least, I assume they didn't realize that, since this would be bad news even by Republican standards. Maybe they're just counting on their repeal bill failing in the Senate, so nothing bad will happen and they can get back to complaining about Obamacare.
It's odd that the GOP didn't understand this, because they have had enough time to figure it out. All roads politically lead to a single-payer (perhaps accompanied by a secondary market for add-on coverage for the rhinestone-encrusted lifestyle) however long and bumpy the road will be. So either they are 1. intellectually incompetent (always a good bet) or 2. they are short-term punters who understand the limited attention-span of the U.S. voter, or 3. they believe that free-market capitalism is a religious emotion that salves all wounds if only it can be impressed far enough into the psyche.pgl -> Lee A. Arnold ... , March 10, 2017 at 05:45 AM"they have had enough time to figure it out".kthomas -> pgl... , March 10, 2017 at 08:23 AMThe latest GOP spin is that they have been talking about their plan for over 7 years. Really? Is that why they kept their plan a secret until a few days ago?
There was never any plan. Ryan is a charlatan.pgl -> kthomas... , March 10, 2017 at 09:34 AMYep.George H. Blackford : , March 10, 2017 at 05:38 AMDemocrats ran away from Obamacare in 2010, 2012, and 2014. Then Hillary wasted her time ridiculing Trump without offering a solution to the rising cost of healthcare except more of the same.pgl -> George H. Blackford ... , March 10, 2017 at 05:48 AMThe obvious solution for rising healthcare costs is either a public option or extending Medicare to younger and younger people, but Democrats, other than Sanders, refuse to offer or defend these solutions.
Democrats make no more sense in this regard than the Republicans do. Why should anyone listen to Democrats in this situation when the Democrats have nothing to offer but more of the same?
Back in 1993 Mrs. Clinton was supposed to come up with some awesome health care reform. Maybe her team did but they never really got the message out clearly. In the meantime the Republicans savaged the air waves and nothing got done. ACA may have been Romney's plan but at least Obama got it past. And of course even Mitt Romney has spent the last 7 years attacking this former Republican plan. The new plan is really awful but the current Republicans are pushing it through as if it were written by God.George H. Blackford -> pgl... , March 10, 2017 at 05:51 AMQEDAnachronism said in reply to pgl... , March 10, 2017 at 06:03 AMThey're pushing it thru because they want it passed before the CBO can score it. They're afraid of the results.pgl -> Anachronism ... , March 10, 2017 at 06:22 AMThe Brookings Institute scored it and estimated 7 million reduced from direct purchasing of healthcare, another 7 million off of Medicaid roles, and costs roughly $800 billion over 10 years.
I was hoping some independent and credible group would score this awful thing. I bet Paul Ryan decries Brookings as "librul".Anachronism said in reply to pgl... , March 10, 2017 at 06:59 AMAnyone who disagrees with them is not credible.pgl -> Anachronism ... , March 10, 2017 at 09:35 AMWe have a consensus. As kthomas wrote:Ed Brown -> pgl... , March 10, 2017 at 07:54 AM"Ryan is a charlatan."
Thinking back to Mrs. Clinton's activities in 1993 on this issue: imagine if Melania Trump was currently working to architect something significant, such as trade policy. It would be odd, no? She was not elected.EMichael -> Ed Brown... , March 10, 2017 at 08:06 AMThe Clinton's have consistently exhibited a certain level of arrogance and entitlement which has not been helpful to the political left over the years.
Oh well, spilled milk I guess.
Liberals are the worst team mates in the world.Pinkybum -> Ed Brown... , March 10, 2017 at 08:39 AMYeah, having HRC work on healthcare was surely an example of "arrogance and entitlement".
geez
https://learnodo-newtonic.com/eleanor-roosevelt-accomplishments
"imagine if Melania Trump was currently working to architect something significant, such as trade policy. It would be odd, no? She was not elected."EMichael -> Pinkybum... , March 10, 2017 at 09:09 AMHahahaha! Plenty of people who are not elected work on policy.
Nelson was the only Dem Senator that held his vote to end debate in order to get something. He was "paid off" and dropped his filibuster.sanjait -> Pinkybum... , March 10, 2017 at 10:08 AMLieberman, along with every Rep senator, stopped the public option.
Best part of the whole sorry process was the work of Pelosi, who took away Nelson's kickback through reconciliation. Something she could not do to Lieberman.
"Hahahaha! Plenty of people who are not elected work on policy."yuan -> Ed Brown... , March 10, 2017 at 09:19 AMYes. It was such a strange criticism.
The worst thing about Hillary Clinton is that somehow she is a magnet for this kind of faux serious critic.
It's especially odd considering that we are talking about an effort to expand healthcare access, and doubly especially odd considering the instrumental role HC played in getting SCHIP passed after "Hillarycare" crashed.
hopefully more like the dustbin of history...pgl -> Ed Brown... , March 10, 2017 at 09:36 AMMelania Trump may not be the sharpest pencil in the box but I bet she could do a better job than Peter Navarro.jonny bakho said in reply to George H. Blackford ... , March 10, 2017 at 06:41 AM"Hillary wasted her time ridiculing Trump without offering a solution to the rising cost of healthcare except more of the same."George H. Blackford -> jonny bakho... , March 10, 2017 at 08:15 AMThis strikes me as revisionist history. The AntiObamacare voters were not persuadable. They believed and still believe Trump's lies about creating a better program.
Obamacare has been bending health care costs.
The solution to Health care costs requires reform of the medical care delivery system. There is zero public support for that
There is zero public support for that because Democrats, except for Sanders, refuse to make it an issue in a campaign and explain it to the American people. It was Democrats who rejected Sanders and nominated more of the same Hillary.yuan -> George H. Blackford ... , March 10, 2017 at 09:24 AM"There is zero public support for that because Democrats, except for Sanders"EMichael -> George H. Blackford ... , March 10, 2017 at 06:57 AMthis is not accurate, imo. a more accurate statement would be that triangulation of the democratic party (clinton and obama) into conservative territory has created a repubicanesque punish-the-poors voting block.
I'll ignore the straw man you place firmly in your first sentence and just ask how you can say,Peter K. -> EMichael... , March 10, 2017 at 07:01 AM"Democrats make no more sense in this regard than the Republicans do."
What it means is that you think the ACA is as good as this GOP plan.
Seriously?
I am also more than a little tired of supposed liberals repeating constantly the "dems did not want the public option" meme. Beyond tiring, and self defeating.
Liberals make the worst team mates in the world.
They didn't want it. Obama didn't fight for it. Lieberman blocked it.sanjait -> Peter K.... , March 10, 2017 at 10:09 AMYou can always count on EMichael to defend the Democrats no matter what the accusation.
Why is that?
Whose payroll is he on?
Peter unwittingly illustrates EMichael's point...George H. Blackford -> EMichael... , March 10, 2017 at 08:32 AMEMichael, What it means is exactly what I said:EMichael -> George H. Blackford ... , March 10, 2017 at 08:42 AMThe obvious solution for rising healthcare costs is either a public option or extending Medicare to younger and younger people, but Democrats, other than Sanders, refuse to offer or defend these solutions.
Democrats make no more sense in this regard than the Republicans do. Why should anyone listen to Democrats in this situation when the Democrats have nothing to offer but more of the same?
The obvious answer to that rhetorical question is that there is no reason anyone should listen to Democrats given their refusal to offer a solution to the problem of the rising cost of healthcare, and the result of this is Trump.
I think it is a bit much to blame voters for the failures of the Democrats to come up with sensible programs.
Good is not the enemy of perfect.George H. Blackford -> EMichael... , March 10, 2017 at 09:06 AMIn the US, there are only two choices.
The Dems tried to get a public option (which would certainly result in single payer)into law. Not one single GOP senator was even in favor of allowing the public option to get to the floor. Only one Rep House member voted for the public option.
And someone you think they are the same.
Wonder why Sanders did not try to run for the Rep nomination?
You've got it exactly right, and the Democrats refused to make it a campaign issue to bring it to the electorate and fight for it.EMichael -> George H. Blackford ... , March 10, 2017 at 09:13 AMNeither Republicans nor Democrats make any sense on this issue since neither are willing to fight for anything that makes sense.
To my mind, what that means is that trying to defend either one against the other is nonsense.
I don't know, maybe it is me.George H. Blackford -> EMichael... , March 10, 2017 at 09:24 AMSeems to me that defending a program that has saved more than 100,000 American lives makes sense.
Seem to me that defending a program that has given more than 20 million Americans health insurance makes sense.
Not perfect. But then again there are only two choices.
The moral of the story is that both the Democrats and the Republicans have proved to be so incompetent that we ended up with Trump!EMichael -> George H. Blackford ... , March 10, 2017 at 09:37 AMIt seems to me that it is a serious mistake to ignore this fact and to try to blame the mess we are in on someone else.
The fault, dear Brutus, is not in our stars But in ourselves, that we are underlings.
Please.George H. Blackford -> EMichael... , March 10, 2017 at 10:07 AMDon't move that goal post on me.
I do not ignore the fact that Democrats have not been successful in their admin efforts on many levels.
Some of that is incompetence. Some of that is Rep opposition. Both can be cured.
But neither can be cured by thinking they are all the same.
Bernie Sanders knows that. Why can't everyone figure that out?
Facts Liberal elites refuse to face:pgl -> George H. Blackford ... , March 10, 2017 at 09:40 AMa) In the 70s, a Dem congress began deregulating the financial system with the help of a Dem president.
b) In the 80s, a Dem congress continued deregulation and cut taxes on the rich, increased taxes on the not so rich, cut SS benefits and essential government programs, and abandoned the unions.
c) In the 90s, a Dem president reappointed Greenspan to the Fed, further deregulated and cut essential programs, and signed draconian crime, welfare, and student loan bills into law.
d) In 07, the Dems took back the congress and did nothing to hold accountable those who had led us into a war under false pretenses, turned us into a nation of torturers, and politicized the Justice Department as the concentration of income rose until the economy blew up in the fall of 08.
e) In 09 the Dems took complete control of the federal government and ignored students and homeowners as they bailed out the banks, passed a Heritage Foundation healthcare plan championed by the insurance and drug companies as incomes and wages plummeted.
The working and middle classes were decimated throughout this process, and, somehow, it's the voters' fault we ended up with a throw the bums out Trump instead of a more of the same Hillary? I don't think so!
Liberal elites are in a state of denial. It's time to wake up and face reality:
http://www.rweconomics.com/htm/Ch_1.htm
http://www.rweconomics.com/Deficit.htm
http://www.rweconomics.com/Sanders1.htm
Harris Wofford was a nobody in 1992 until he decided to take on the health care issue. And he shocked the world by beating one of the stars in the GOP machine. We should have had a real health care bill in 1993 but we failed. Obama sort of succeeded by dusting off the Republican plan. We need the next Harris Wofford.Pinkybum -> George H. Blackford ... , March 10, 2017 at 08:43 AM"The obvious solution for rising healthcare costs is either a public option or extending Medicare to younger and younger people, but Democrats, other than Sanders, refuse to offer or defend these solutions."EMichael -> Pinkybum... , March 10, 2017 at 09:14 AMMedicare for all was not offered because politically it was a non-starter. The public option was offered and once the Republicans (and Democrats who might as well be Republicans) realized what it meant (out-competing insurance companies) they opposed it.
oops, put this in the wrong place.yuan -> Pinkybum... , March 10, 2017 at 09:32 AM
Nelson was the only Dem Senator that held his vote to end debate in order to get something. He was "paid off" and dropped his filibuster.
Lieberman, along with every Rep senator, stopped the public option.
Best part of the whole sorry process was the work of Pelosi, who took away Nelson's kickback through reconciliation. Something she could not do to Lieberman.
"and Democrats who might as well be Republicans"George H. Blackford -> yuan... , March 10, 2017 at 09:41 AMpeople who try to equate these class traitors to all democrats are carrying their water.
[[House Speaker Nancy Pelosi (D-CA) pledged at the time that the House bill would include a public option.15 Indeed, a public option offered through a private insurance exchange was included in all three versions of the bill passed by House committees in the summer of 2009 (House Ways and Means and House Education and Labor on 17 July 2009; House Energy and Commerce on 31 July 2009), as well as in the bill passed by the full House of Representatives on 7 November 2009 (the Affordable Health Care for America Act, HR 3962). A public option was also included in the bill passed by the Senate Health, Education, Labor, and Pensions Committee on 15 July 2009 (the Affordable Health Choices Act, S 1679).Senate Democrats were engaged in a highly contentious debate throughout the fall of 2009, and the political life of the public option changed almost daily. The debate reached a critical impasse in November 2009, when Sen. Joseph Lieberman (I-CT), who usually caucuses with the Democrats, threatened to filibuster the Senate bill if it included a public option.
Sen. Charles Schumer (D-NY) and Sen. Jay Rockefeller (D-WV) made last-minute attempts to introduce amendments to include a public option as the bill was about to be voted on by the Senate Finance Committee. Those failed, and there was no public option in either the bill that emerged from that committee or the bill that passed the full Senate on 24 December 2009]]
My question is, why was this allowed to die there?yuan -> George H. Blackford ... , March 10, 2017 at 09:47 AMWhy wasn't it raised as a campaign issue in the 2010, 2012, and 2014 elections, explained to the public, and fought for by the Democrats?
i think obama's conservatism played a huge role.EMichael -> George H. Blackford ... , March 10, 2017 at 09:53 AMIt wasn't allowed to die there. It did die there.George H. Blackford -> EMichael... , March 10, 2017 at 10:11 AMFairly easy to see that the election of a black man brought the GOP together in a way that nothing else could.
Dems took a beating in the mid terms, not because of the lack of a public option, but because of a black man in the white house. They could not run on further health care reform, cause that was not possible.
One thing.
Congress controls legislation. And to spit into the wind is stupid.
It died because the Democrats ran away from it in the 2010 election.pgl -> Pinkybum... , March 10, 2017 at 09:43 AMThe Republicans have no ideas but they are very good at shutting down the best ideas for policy. Of course when people think of health care like they think about buying groceries getting past the GOP BS re market solutions needs louder and crispy messaging.Jerry Brown : , March 10, 2017 at 06:46 AMPart of me hopes the Republicans enact their dumb plan. It is not a good plan, not even as good as Obamacare which isn't all that great itself. But at least they will be on record for voting for it. Almost as soon as it goes into effect, it will be very obvious (even to many Republicans) that it needs to be fixed. At that point I am sure Democrats would be willing to help fix it. And if they don't fix it, their plan will crash, and then maybe we can enact real Health Care for Americans rather than subsidized premiums for insurance companies.Anachronism said in reply to Jerry Brown... , March 10, 2017 at 07:02 AMThis plan is bad, and enacting it will be harmful to many Americans in the short term- but enacting it at least will affirm that even Republicans accept a role for government in the provision of health care.
You're correct that most people don't understand the abstract. They have to see it implemented in order to be able to say "Gee, this is horrible".Jerry Brown said in reply to Anachronism ... , March 10, 2017 at 07:17 AMBut when that happens, you now are inflicting a lot of pain on a lot of people who don't deserve it.
I like Will Rogers quote: "Some people can figure things out for themselves. Others learn by reading. The rest of the world needs to pee on the electric fence".
Yes, it will inflict a lot of unnecessary pain on people, including me. And that is very unfortunate and should be considered criminal or at least sociopathic. And it should not be necessary. But I think that is what we will get out of this Congress and this President.pgl -> Jerry Brown... , March 10, 2017 at 09:44 AMAnd then we may be able to fix it or even better scrap it for a Medicare for all type plan.
It is a bad plan but given that we have been at this since Nixon, maybe the pain of this awful idea will finally wake people up. BTW - as bad a President as Nixon was, at least he wanted health care reform.Fred C. Dobbs : , March 10, 2017 at 06:51 AM(So there.)Fred C. Dobbs said in reply to Fred C. Dobbs... , March 10, 2017 at 06:55 AMHow a Republican Obamacare replacement plan could
leave rural areas farther behind, from @fivefifths: https://www.theatlantic.com/politics/archive/2017/02/the-gop-plan-to-create-health-coverage-deserts/517839/
The Atlantic - Vann R. Newkirk II - Feb 28, 2017The devil's always in the details, but if the details of a new 100-page leaked draft of a House Republican plan to repeal Obamacare are too dense to parse, here's a brief snapshot: Millions of people in rural areas where it's already hardest to find doctors might no longer be able to afford health insurance in a few years.
The basics of that plan, which was unveiled by House Speaker Paul Ryan two weeks ago, and the rough shape of which has the support of new health secretary Tom Price and the Trump administration, are known. The plan removes the individual and employer mandates to purchase and provide insurance, respectively, and it would also repeal most of the taxes that fund Obamacare. It would roll back funding for the Affordable Care Act's Medicaid expansion and dramatically restructure the Medicaid program's funding. Further, the plan would replace the Affordable Care Act's cost-sharing subsidies and premium tax credits with an age-rated tax credit, all while keeping Obamacare's popular pre-existing conditions ban.
With the leaked draft legislation released by Politico last week, there are more details as to exactly how House Republicans and the Trump administration plan to repeal Obamacare and usher in a replacement. The draft specifies that Obamacare's Medicaid expansion for low-income able-bodied adults won't be completely eliminated, but the eligibility and funding will be rolled back after 2020. The draft also contains a provision changing federal funding for Medicaid in 2020 onward from an open-ended obligation to a system where the per-person spending every year is capped based on spending levels in 2019 and increased annually to correspond with medical inflation.
Although the draft plan repeals the tax-based individual mandate, it re-establishes a kind of mandate through its incentive to maintain continuous health-insurance coverage. For people not covered by employers or public insurance who have to purchase insurance on individual, small group, or exchange markets, this proposal would allow insurers to charge up to 30 percent more in premiums to people who go without coverage at any point for more than two months, and also for young adults who don't enroll in coverage as soon as they age out of their parents' plans, a surcharge that would not be remitted as taxes to sustain the system, but would be paid as profits to insurers. The effects of this potential measure on individuals' pockets are potentially limited by a reduction of federal oversight over what can be considered health-insurance coverage, which would allow people to avoid penalties by purchasing barebones coverage.
After reforming Medicaid, repealing the taxes and mandates of Obamacare and establishing continuous-coverage requirements, the last major reform of this preliminary scheme is to replace the cost-sharing reductions and premium tax credit subsidies of Obamacare's exchanges with a refundable tax credit. Unlike the Obamacare tax credit, which is adjusted by income, age, and the average price of insurance in a person's market, this new credit would only take age into account, starting with $2,000 per year up to age 30 and capping at $4,000 for people over 60. So while older people with more health needs receive more than "young invincibles," lower-income people who tend to have more pressing health needs would have even less ability to take care of those needs given their existing ability to pay.
The result of all these provisions would almost certainly be a system that benefits people who already have wealth and health and penalizes others, but there would also be very strong geographic effects. For one, pegging Medicaid spending to a base year would reduce states' ability to ramp up health-care spending because of disasters or emerging health problems, and these problems already exert the most pressures on states and areas with infrastructure that is ill-equipped to combat them. Rural residents already rely much more heavily on public insurance than do city-dwellers, so any reductions of funding and funding flexibility will have a larger effect on the health issues they face. ...
The tax-credit structure in the Republican draft plan might be even more damaging than the Medicaid changes to those underserved and rural areas. The existing Obamacare tax credits are not only adjusted by family income, but also by the actual cost of health-care plans in a given market. That geographic adjustment is one of the most important parts of the basic logic of Obamacare, since health-care costs vary quite a bit from place to place.
In the most extreme example, Alaskans in the Obamacare exchanges currently receive tax credits at rates double the average for the rest of the country, a number that reflects the scarcity of coverage in Alaska and the demands of covering a frontier population. The Republican proposal might knock all 16,000 of these Alaskans out of insurance markets. ...
A tax-credit plan that doesn't account for the actual cost of a person's health insurance might reasonably be expected to create areas where coverage is simply unaffordable, and not just in Alaska. Research indicates that health-insurance premiums are higher for rural counties and states, particularly towards the interior and western frontier of the country-prime Trump country. Those costs increase even as rural residents have less access to basic health care and worse overall health status than their metropolitan peers.sanjait -> Fred C. Dobbs... , March 10, 2017 at 10:14 AMThat disparity between costs and access for rural residents creates a conundrum for Republicans. By reducing state Medicaid financial flexibility, reducing oversight over minimum insurance requirements, instilling continuous coverage requirements, and removing regional costs offsets, their Obamacare replacement would in essence put health insurance even further out of reach for sicker, rural patients who need it more and then penalize them for being left out. These patients already suffer the effects of "health-care deserts" as rural hospital systems collapse and access to basic specialty services like maternal care wane. In addition to those health care and service deserts in rural areas, Republicans would be contributing to brand-new "coverage deserts."
The result might be a national health-insurance system that does relatively well for so-called "coastal elites" with decent access to physicians and robust state public-health infrastructure, but rather badly for the denizens of Middle America that Trump and the GOP place at the center of their rhetoric. As more and more Republican congressmen in those places face hostile town halls about Obamacare and a real fear of losing coverage from constituents, this new policy outline doesn't seem likely to alleviate those fears.
Didn't read past the heading ... but yes, rural residents would be screwed by the GOP's bill.Fred C. Dobbs : , March 10, 2017 at 07:35 AMRural residents are more likely to be receiving subsidies under the expanded Medicaid and exchanges.
Perhaps worse,*rural hospitals* are always hanging on by a thread, and when more of their patients are uninsured that tips the balance toward insolvency for them. The American Health Carnage Act would result in significantly reduced access to healthcare for rural residents, because geography.
BLUEXITFred C. Dobbs said in reply to Fred C. Dobbs... , March 10, 2017 at 07:39 AMA Modest Proposal For Separating Blue States From Red
The New Republic - KEVIN BAKER - March 9, 2017
https://newrepublic.com/article/140948/bluexit-blue-states-exit-trump-red-america
Dear Red-State Trump Voter,
Let's face it, guys: We're done.
For more than 80 years now, we-the residents of what some people like to call Blue America, but which I prefer to think of as the United States of We Pay Our Own Damn Way-have shelled out far more in federal tax monies than we took in. We have funded massive infrastructure projects in your rural counties, subsidized your schools and your power plants and your nursing homes, sent you entire industries, and simultaneously absorbed the most destitute, unskilled, and oppressed portions of your populations, white and black alike.
All of which, it turns out, only left you more bitter, white, and alt-right than ever.
Some folks here in self-supporting America like to believe that there must be a way to bring you back to your senses and to restore rational government, if not liberal ideals, sometime in the foreseeable future. Everyone seems to have an answer for how to do this. Every day another earnest little homily finds its way to me over my internet transom: "Think locally, act globally," or "Make art and fight the power," or the old Joe Hill standby-"Don't mourn. Organize."
To which I say: Don't organize. Pack.
Not literally, of course. Not even the good people of Canada should have to stomach a mass migration of moping American liberals mumbling, "Live locally make art." What I mean is that it's time for blue states and cities to effectively abandon the American national enterprise, as it is currently constituted. Call it the New Federalism. Or Virtual Secession. Or Conscious Uncoupling-though that's already been used. Or maybe Bluexit.
Truth is, you red states just haven't been pulling your weight. Not for, well, forever. Red states are nearly twice as dependent on the federal government as blue states. Of the twelve states that received the least federal aid in return for each tax dollar they contribute to the U.S. Treasury, ten of them voted for Hillary Clinton-and the other two were Michigan and Wisconsin, your newest recruits. By the same count, 20 of the 26 states most dependent on federal aid went to Trump.
Take Mississippi (please!), famous for being 49th or 50th in just about everything that matters. When it comes to sucking at the federal teat, the Magnolia State is the undisputed champ. More than 40 percent of Mississippi's state revenue comes from federal funding; one-third of its GDP comes from federal spending; for every dollar it pays out in federal taxes, it takes in $4.70 in federal aid; one in five residents are on food stamps-all national highs. You people-your phrase, not mine-liked to bash Obama for turning America into what you derisively referred to as "Food Stamp Nation." In reality, it's more like Food Stamp Red America-something your Trump-loving congressmen will discover if and when they fulfill their vow to gut the program.
Trump's characterization of "American carnage" in our urban centers aside, cities now generate the vast majority of America's wealth-the cities, that is, where blue folks live. It's true that Hillary Clinton carried just 487 counties in 2016. It's also true that those 487 counties generate almost two-thirds of the nation's economic activity. ...
Except for California (a bigyuan -> Fred C. Dobbs... , March 10, 2017 at 09:34 AM
exception), Red states are
where most of our food
comes from, yes?Hmmm.
i guess you have never visited oregon and washington.Fred C. Dobbs said in reply to yuan... , March 10, 2017 at 09:59 AMActually, I have, if briefly.New Deal democrat said in reply to Fred C. Dobbs... , March 10, 2017 at 08:13 AM
The home of Harry & David.They may have to keep us alive.
The Constitution does allow Interstate Compacts, and it is high time the blue states banded together to offer social insurance via that route.llisa2u2 : , March 10, 2017 at 09:25 AMIt would also be fun to talk up an "Interstate Balanced Budget Amendment" enacting Baker's proposition, just for the shits and giggles of watching the red states squirm.
"But the answer, of course, is that they were all lying, all along - and they still are. On this, at least, Republican unity remains impressively intact."llisa2u2 : , March 10, 2017 at 09:32 AMWhat a shame that there really is no integrity in this "replace" process.
MSM, CSPAN discussions and townhall meetings need to address and compare specific medical scenario examples as to "What will be the real costs to the American Citizen".. What options will the American Citizen have to consider for coverage and at what price? Discussions have been so superficial, and just rehashing trite to simplistic process, and primarily Ryan's Powerpoint presentation. Probably the only real take-away from his presentation is the fact that he spoke with his shirt-sleeves rolled up!
How about comparisons as to costs for coverage for what medical services that citizens pay in England, Canada, Germany, France, Switzerland, Norway, Denmark, Sweden, Spain?
How much does a specific drug cost in those countries versus in the US? There is absolutely no addressing the reality of annual costs to the American Citizen and what he/she is paying for. Presently my superficial takeaway is I presume that the majority of citizens will be paying annually $6,000 just for the right to say they have paid for the right to have access to any kind of medical insurance, then there will be various options for any kind of real coverage for specific procedures and services....The Dems and Repubs and everybody else needs to cut the BS!
Quit talking about nothing! Put some real cut and dry facts out to LaLaLand....Every member of Congress, retiree of Congress, President, and past president, every Federal and State employee needs to be under exactly the same coverage options, with no exceptions to entitled separate "exclusive" coverage as governmental employees, as all other American citizens.Sanjait : , March 10, 2017 at 09:36 AMThe GOP plan makes perfect sense when you realize it was designed with talking points in mind, rather than impact.DrDick -> Sanjait... , March 10, 2017 at 10:50 AMThey replaced the mandate with "responsibility", replaced coverage standards with "choice", put in block grants because "states rights" and "flexibility," and delayed the onset of spending cuts because "stability."
It was a strategy, just not an effective one. few people right now are buying their talking points, so it just looks like a "WTF?" situation.
Governance by talking point.DeDude : , March 10, 2017 at 09:38 AMHow about allowing everybody to buy into Medicare, Medicaid, VA or congresses own health insurance plan - with subsidies to those who cannot afford it. Those programs are the most cost-effective in all of US. If the private sector want to provide something more cost effective it would be welcome to do so in a direct competition. What could be more market based and efficient than that?RC AKA Darryl, Ron said in reply to DeDude... , March 10, 2017 at 10:22 AMThe VA healthcare plan is about the same as the Republican plan. If you can afford to live in or travel to Bethesda MD then you may live. Otherwise, costs are controlled by a mortality expectation that is shorter than wait time.im1dc : , March 10, 2017 at 09:43 AMPK: "the modern G.O.P. always wants to comfort the comfortable and afflict the afflicted; so the bill ends up throwing away the taxes on the rich that help pay for subsidies, and redirects the subsidies themselves away from those who need them to those who don't."yuan -> im1dc... , March 10, 2017 at 09:49 AMAbsolutely loved reading this expose of the GOP in D.C.
it's an accurate description, imo. funny how the so called "liberal media" can't find the courage to use similarly honest language.im1dc : , March 10, 2017 at 10:11 AMSomething I have noticed in my neighborhood in Deep Red Tennessee is that Trump Supporters really want Obamacare repealed and not replaced BUT almost to a person these are people who have either Federal or State funded Health Insurance or Medicare.Fred C. Dobbs said in reply to im1dc... , March 10, 2017 at 11:01 AMIOW, they got theirs and expect everyone else to get theirs from the Tooth Fairy like they think they got theirs.
Indeed. Folks who feel thatFred C. Dobbs : , March 10, 2017 at 10:57 AM
have worked hard in their
lives believe they are entitled,
and those who haven't - for
whatever reasons - are not.Which takes little account of
those who have been severely
disadvantaged over many years.It has been noted that many of those
who voted for Mr Trump are opposed
to providing medical benefits for
those they regard as 'freeloaders'.Also, those in the Red states seem
to be opposed to basing benefit amounts
in favor of those Blue staters who have
extra-expensive medical care.Clearly, the Ryan-Trump plan deals with both issues.
And will further jeopardize healthcare in
a lot of GOP-supporting areas, ironically.(I'd bet something is going to be
done to fix that anomaly.)
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Mar 10, 2017 | economistsview.typepad.com
im1dc : March 10, 2017 at 09:43 AMPK: "the modern G.O.P. always wants to comfort the comfortable and afflict the afflicted; so the bill ends up throwing away the taxes on the rich that help pay for subsidies, and redirects the subsidies themselves away from those who need them to those who don't."yuan -> im1dc... , March 10, 2017 at 09:49 AMAbsolutely loved reading this expose of the GOP in D.C.
it's an accurate description, imo. funny how the so called "liberal media" can't find the courage to use similarly honest language.im1dc : ,Something I have noticed in my neighborhood in Deep Red Tennessee is that Trump Supporters really want Obamacare repealed and not replaced BUT almost to a person these are people who have either Federal or State funded Health Insurance or Medicare. IOW, they got theirs and expect everyone else to get theirs from the Tooth Fairy like they think they got theirs.libezkova -> im1dc... , March 10, 2017 at 01:52 PMEnvy as a sister of competition story ;-)Fred C. Dobbs -> im1dc... , March 10, 2017 at 11:01 AMIndeed. Folks who feel thatDrDick : , March 10, 2017 at 11:34 AM
have worked hard in their
lives believe they are entitled,
and those who haven't - for
whatever reasons - are not.Which takes little account of
those who have been severely
disadvantaged over many years.As someone said the other day on the intertubes, this is an upper class tax cut funded by eliminating healthcare for the poor.
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Mar 10, 2017 | economistsview.typepad.com
libezkova -> ilsm... March 10, 2017 at 05:01 PMI like the guys who first created meth epidemic in the US and now shed crocodile tears about deficiencies of Obamacare replacement.RC AKA Darryl, Ron : March 10, 2017 at 03:08 PM , 2017 at 03:08 PM
Why did Republicans propose a "sick joke of a health plan"?libezkova -> RC AKA Darryl, Ron... March 10, 2017 at 05:23 PM , 2017 at 05:23 PM[I am guessing that is a rhetorical question. Just saying that the Republican Party is a sick joke of a political party is both too easy and too obvious.]
The problem is not that "the Republican Party is a sick joke of a political party". That's given. Just look at McCain and friends.RC AKA Darryl, Ron -> libezkova... March 10, 2017 at 05:32 PM , 2017 at 05:32 PMThe problem is that the Democratic Party became the same sick joke. Even slightly sicker in some respects as they more rely on betrayal of voters and bait and switch tactics pursuing the same neoliberal policies.
Republicans were neoliberal party, the party of big business for a long time. They gave us Reagan and Bush II. But Democrats became the party of Wall Street relatively recently during Clinton presidency.
Get people decent jobs and healthcare plan issues might be more solvable. Institute higher minimal wage as a start. Tax neoliberal "masters of the universe" (and especially the strata of Wall Street speculators and Buffet wannabees ) at Eisenhower rates and put those money into national health insurance fund for everybody, providing for "catastrophic insurance" for a start.
Destroy at least a part of sick, criminal links between medical insurance and for profit hospitals using RICO statute. They are really a new type of mafia. All those useless stent surgeries are not that different from shooting people on the street.
But redistribution policies are a taboo under neoliberalism, so DemoRats will just complain about Trumpcare and than support Republicans in enacting it. The same story as before. Vichy DemoRats will always remain Vichy DemoRats.
If you have no money for both apartment and food like many Wal-Mart workers (living on foodstamps) I doubt that you can pay for health insurance either. So for really poor folks Obamacare was a sick joke. It really was. Obama sold himself to medical-industrial complex which is no less vicious and greedy the military industrial complex.
So all this neoliberals cries about deficiencies of Trumpcare plan are just crocodile tears.
That was a bit harsh but there is more than a grain of truth in it. It is late now and I don't have the time now to go into a more measured accounting of how we got from the New Deal to here, but my falling out with the Democratic Party goes back to at least 1968, with concerns even earlier when I was still a school kid.Power corrupts is one of the immutable laws of economics. Democracy is not a good spectator sport.
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Mar 10, 2017 | economistsview.typepad.com
Fred C. Dobbs : March 10, 2017 at 06:51 AM , 2017 at 06:51 AM(So there.)Fred C. Dobbs -> Fred C. Dobbs... , March 10, 2017 at 06:55 AMHow a Republican Obamacare replacement plan could leave rural areas farther behind, from @fivefifths: https://www.theatlantic.com/politics/archive/2017/02/the-gop-plan-to-create-health-coverage-deserts/517839/
The Atlantic - Vann R. Newkirk II - Feb 28, 2017The devil's always in the details, but if the details of a new 100-page leaked draft of a House Republican plan to repeal Obamacare are too dense to parse, here's a brief snapshot: Millions of people in rural areas where it's already hardest to find doctors might no longer be able to afford health insurance in a few years.
The basics of that plan, which was unveiled by House Speaker Paul Ryan two weeks ago, and the rough shape of which has the support of new health secretary Tom Price and the Trump administration, are known. The plan removes the individual and employer mandates to purchase and provide insurance, respectively, and it would also repeal most of the taxes that fund Obamacare. It would roll back funding for the Affordable Care Act's Medicaid expansion and dramatically restructure the Medicaid program's funding. Further, the plan would replace the Affordable Care Act's cost-sharing subsidies and premium tax credits with an age-rated tax credit, all while keeping Obamacare's popular pre-existing conditions ban.
With the leaked draft legislation released by Politico last week, there are more details as to exactly how House Republicans and the Trump administration plan to repeal Obamacare and usher in a replacement. The draft specifies that Obamacare's Medicaid expansion for low-income able-bodied adults won't be completely eliminated, but the eligibility and funding will be rolled back after 2020. The draft also contains a provision changing federal funding for Medicaid in 2020 onward from an open-ended obligation to a system where the per-person spending every year is capped based on spending levels in 2019 and increased annually to correspond with medical inflation.
Although the draft plan repeals the tax-based individual mandate, it re-establishes a kind of mandate through its incentive to maintain continuous health-insurance coverage. For people not covered by employers or public insurance who have to purchase insurance on individual, small group, or exchange markets, this proposal would allow insurers to charge up to 30 percent more in premiums to people who go without coverage at any point for more than two months, and also for young adults who don't enroll in coverage as soon as they age out of their parents' plans, a surcharge that would not be remitted as taxes to sustain the system, but would be paid as profits to insurers. The effects of this potential measure on individuals' pockets are potentially limited by a reduction of federal oversight over what can be considered health-insurance coverage, which would allow people to avoid penalties by purchasing barebones coverage.
After reforming Medicaid, repealing the taxes and mandates of Obamacare and establishing continuous-coverage requirements, the last major reform of this preliminary scheme is to replace the cost-sharing reductions and premium tax credit subsidies of Obamacare's exchanges with a refundable tax credit. Unlike the Obamacare tax credit, which is adjusted by income, age, and the average price of insurance in a person's market, this new credit would only take age into account, starting with $2,000 per year up to age 30 and capping at $4,000 for people over 60. So while older people with more health needs receive more than "young invincibles," lower-income people who tend to have more pressing health needs would have even less ability to take care of those needs given their existing ability to pay.
The result of all these provisions would almost certainly be a system that benefits people who already have wealth and health and penalizes others, but there would also be very strong geographic effects. For one, pegging Medicaid spending to a base year would reduce states' ability to ramp up health-care spending because of disasters or emerging health problems, and these problems already exert the most pressures on states and areas with infrastructure that is ill-equipped to combat them. Rural residents already rely much more heavily on public insurance than do city-dwellers, so any reductions of funding and funding flexibility will have a larger effect on the health issues they face. ...
The tax-credit structure in the Republican draft plan might be even more damaging than the Medicaid changes to those underserved and rural areas. The existing Obamacare tax credits are not only adjusted by family income, but also by the actual cost of health-care plans in a given market. That geographic adjustment is one of the most important parts of the basic logic of Obamacare, since health-care costs vary quite a bit from place to place.
In the most extreme example, Alaskans in the Obamacare exchanges currently receive tax credits at rates double the average for the rest of the country, a number that reflects the scarcity of coverage in Alaska and the demands of covering a frontier population. The Republican proposal might knock all 16,000 of these Alaskans out of insurance markets. ...
A tax-credit plan that doesn't account for the actual cost of a person's health insurance might reasonably be expected to create areas where coverage is simply unaffordable, and not just in Alaska. Research indicates that health-insurance premiums are higher for rural counties and states, particularly towards the interior and western frontier of the country-prime Trump country. Those costs increase even as rural residents have less access to basic health care and worse overall health status than their metropolitan peers.That disparity between costs and access for rural residents creates a conundrum for Republicans. By reducing state Medicaid financial flexibility, reducing oversight over minimum insurance requirements, instilling continuous coverage requirements, and removing regional costs offsets, their Obamacare replacement would in essence put health insurance even further out of reach for sicker, rural patients who need it more and then penalize them for being left out. These patients already suffer the effects of "health-care deserts" as rural hospital systems collapse and access to basic specialty services like maternal care wane. In addition to those health care and service deserts in rural areas, Republicans would be contributing to brand-new "coverage deserts."
The result might be a national health-insurance system that does relatively well for so-called "coastal elites" with decent access to physicians and robust state public-health infrastructure, but rather badly for the denizens of Middle America that Trump and the GOP place at the center of their rhetoric. As more and more Republican congressmen in those places face hostile town halls about Obamacare and a real fear of losing coverage from constituents, this new policy outline doesn't seem likely to alleviate those fears.
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Mar 10, 2017 | economistsview.typepad.com
sanjait : March 10, 2017 at 09:36 AM , 2017 at 09:36 AM
The GOP plan makes perfect sense when you realize it was designed with talking points in mind, rather than impact.llisa2u2 : March 10, 2017 at 09:25 AM , 2017 at 09:25 AMThey replaced the mandate with "responsibility", replaced coverage standards with "choice", put in block grants because "states rights" and "flexibility," and delayed the onset of spending cuts because "stability."
It was a strategy, just not an effective one. few people right now are buying their talking points, so it just looks like a "WTF?" situation.
"But the answer, of course, is that they were all lying, all along - and they still are. On this, at least, Republican unity remains impressively intact."llisa2u2 : March 10, 2017 at 09:32 AM , 2017 at 09:32 AMWhat a shame that there really is no integrity in this "replace" process.
MSM, CSPAN discussions and townhall meetings need to address and compare specific medical scenario examples as to "What will be the real costs to the American Citizen".. What options will the American Citizen have to consider for coverage and at what price?
Discussions have been so superficial, and just rehashing trite to simplistic process, and primarily Ryan's Powerpoint presentation. Probably the only real take-away from his presentation is the fact that he spoke with his shirt-sleeves rolled up!
How about comparisons as to costs for coverage for what medical services that citizens pay in England, Canada, Germany, France, Switzerland, Norway, Denmark, Sweden, Spain?
How much does a specific drug cost in those countries versus in the US? There is absolutely no addressing the reality of annual costs to the American Citizen and what he/she is paying for. Presently my superficial takeaway is I presume that the majority of citizens will be paying annually $6,000 just for the right to say they have paid for the right to have access to any kind of medical insurance, then there will be various options for any kind of real coverage for specific procedures and services....
The Dems and Repubs and everybody else needs to cut the BS! Quit talking about nothing! Put some real cut and dry facts out to LaLaLand....
Every member of Congress, retiree of Congress, President, and past president, every Federal and State employee needs to be under exactly the same coverage options, with no exceptions to entitled separate "exclusive" coverage as governmental employees, as all other American citizens.
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Mar 10, 2017 | economistsview.typepad.com
Fred C. Dobbs : March 09, 2017 at 01:49 PM , 2017 at 01:49 PMRyan defends health care bill amid fierce protestanne : , March 09, 2017 at 01:54 PM
http://www.bostonglobe.com/news/politics/2017/03/08/house-committees-convene-over-controversial-health-care-law/6LfoZ7S1GBh5cEO4EhV7KJ/story.html?event=event25
via @BostonGlobe - March 8WASHINGTON (AP) - Speaker Paul Ryan staunchly defended the House Republican health care plan Wednesday as the only alternative to the current Obama-era law, as he confronted forceful opposition from conservatives, medical professionals and others.
''This is the choice we face. Are we going to stay with Obamacare ... or are we going to do what we said we would do,'' Ryan said at a Capitol Hill news conference after a private GOP meeting in which he tried to rally support.
Shortly after Ryan's comments, two committees - Ways and Means and Energy and Commerce - kicked off what are expected to be marathon sessions to finalize the legislation that would scrap major parts of Barack Obama's health overhaul while also fundamentally restructuring Medicaid for low-income people.
Democrats resorted to delaying tactics. At Energy and Commerce, the clerk was forced to start reading the legislation word for word after Rep. Ben Lujan, D-N.M., objected to routinely dispensing with such a reading. At Ways and Means, Republicans voted down a motion by Rep. Lloyd Doggett, D-Texas, to delay deliberations so lawmakers could have more time to study the bill.
Ryan cast the task for the GOP as fulfilling seven years of promises to ''repeal and replace'' with a ''conservative wish list'' scaling back the role of government in health care, cutting money for Planned Parenthood and overhauling mandatory programs.
''Most importantly, we get Washington out of the business of being a nanny state,'' he said.
President Donald Trump and Vice President Mike Pence back the House plan, and Ryan is confidently predicting it will win passage. Behind closed doors on Wednesday, Ryan pointedly told fellow lawmakers that the president is all-in and suggested they should fall in line. ...
Joe Kennedy III attacks GOP health plan for its 'malice'
http://www.bostonglobe.com/metro/2017/03/08/kennedy-rips-gop-health-plan/IWpUdBxaIrjA50ooQ1z43J/story.html?event=event25
via @BostonGlobe - Joshua Miller - March 8, 2017US Representative Joe Kennedy III ripped into the House GOP's plan to repeal the Affordable Care Act Wednesday in a surprisingly pointed jibe at Speaker Paul Ryan.
Ryan said Tuesday that Republicans are "doing an act of mercy" by repealing the law known as Obamacare and replacing it with something else.
Kennedy, shall we say, does not share that assessment.
"I was struck last night by a comment that I heard made by Speaker Ryan, where he called this repeal bill 'an act of mercy.' With all due respect to our speaker, he and I must have read different Scripture," Kennedy said as the House Energy and Commerce Committee dove into the details of the GOP effort.
"The one I read calls on us to feed the hungry, to clothe the naked, to shelter the homeless, and to comfort the sick.
"It reminds us that we are judged not by how we treat the powerful, but by how we care for the least among us," said the Brookline Democrat and scion of the most famous Massachusetts political dynasty.
"There is no mercy in a system that makes health care a luxury. There is no mercy in a country that turns their back on those most in need of protection: the elderly, the poor, the sick, and the suffering. There is no mercy in a cold shoulder to the mentally ill," he said, appearing to read from notes.
"This is not an act of mercy. It is an act of malice," he said. ...
Senator Warren says GOP health care plan is 'fundamentally cruel'
http://www.bostonglobe.com/metro/2017/03/09/senator-warren-says-gop-health-care-plan-fundamentally-cruel/UOwTdHl3KFloausjuGQK0H/story.html?event=event25
via @BostonGlobe - March 9BOSTON (AP) - Sen. Elizabeth Warren says the health care bill rolled out by Republicans is ''fundamentally cruel'' and will end up benefiting the wealthy at the expense of middle and working class families.
The Massachusetts Democrat said Wednesday that Republicans seem more interested in bragging about getting rid of ''Obamacare'' than helping people stay healthy.
Warren says the GOP plan will ''work great for those at the top and just kick dirt in the faces of everybody else.'' ...
http://www.oecd.org/health/health-systems/oecd-health-statistics-2014-frequently-requested-data.htmanne -> anne... , March 09, 2017 at 02:04 PMNovember, 2016
Organisation for Economic Co-operation and Development Health Data
Total health care spending per person, 2014 *
United States ( 9451)
OCED average ( 3814)Australia ( 4420)
Austria ( 5016)
Belgium ( 4611)
Canada ( 4608)
Chile ( 1728)
Czech Republic ( 2464)
Denmark ( 4943)
Finland ( 3984)
France ( 4407)
Germany ( 5267)
Greece ( 2245)
Hungary ( 1845)
Iceland ( 4012)
Ireland ( 5131)
Israel ( 2533)
Italy ( 3272)
Japan ( 4150)
Korea ( 2488)
Luxembourg ( 7765)
Mexico ( 1052)
Netherlands ( 5343)
New Zealand ( 3590)
Norway ( 6567)
Poland ( 1677)
Portugal ( 2631)
Slovak Republic ( 2064)
Spain ( 3153)
Sweden ( 5228)
Switzerland ( 6935)
Turkey ( 1064)
United Kingdom ( 4003)* Data are expressed in US dollars adjusted for purchasing power parities (PPPs), which provide a means of comparing spending between countries on a common base. PPPs are the rates of currency conversion that equalise the cost of a given "basket" of goods and services in different countries.
Correcting date for data:http://www.oecd.org/health/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm
November, 2016
Organisation for Economic Co-operation and Development Health Data
Total health care spending per person, 2015 *
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Mar 09, 2017 | economistsview.typepad.com
im1dc : March 09, 2017 at 02:25 PM , 2017 at 02:25 PMThe case for Single Payer just go strongerhttp://www.huffingtonpost.com/entry/insurance-companies-medicare-for-all_us_58c1b1fae4b054a0ea690dc8
"Insurance Companies Just Accidentally Made The Case For Medicare For All"
'It's all about the overhead and profit'
By Daniel Marans...03/09/2017...03:51 pm ET...Updated 23 minutes ago
"America's Health Insurance Plans, the trade group for commercial health insurance companies, published an infographic this month breaking down how the industry spends every dollar it receives in premiums.
The group apparently crafted the visual aid to defend rising premiums its member companies are charging customers.
But the chart also inadvertently helps explain why commercial health insurance is a bad deal.
The graphic shows that about 80 percent of every premium dollar goes toward medical expenses ― prescription drugs, doctor visits, hospitalization and other services. Approximately 18 percent goes to administrative costs, and some 3 percent is profit. (The total is more than 100 percent because of rounding. America's Health Insurance Plans explains how it gathered the figures for its infographic here... https://ahip.org/health-care-dollar/
Graphic 'Premium Dollar Breakdown'
By contrast, Medicare, the largest U.S. public insurer, paid just 1.5 percent of its budget to administer traditional insurance plans for seniors and workers with severe disabilities in 2015, according to official data. The rest of Medicare's budget went to paying doctors, hospitals, drug companies and other health care providers.
When you account for administrative costs of Medicare's private plans, which cover some one-third of Medicare beneficiaries, Medicare's overhead approaches 6.4 percent of its budget.
The comparison shows that expanding Medicare to cover the entire population ― or adopting a single-payer health insurance system ― would significantly reduce health care costs by eliminating a whole lot of expenses that aren't related to medical care. That's in part because Medicare does not have to advertise its services, make a profit for investors, or reward its executives with multi-million-dollar compensation packages, as private insurers do.
If the Republican health care replacement law takes effect, it could encourage companies to jack up executive pay even higher. The legislation would raise limits on how much executive compensation a company can deduct from taxes.
Some critics claim the Medicare figures are misleading, because the government insurance program benefits from Social Security Administration and Internal Revenue Service help in collecting the taxes it needs to fund its operations.
In fact, Medicare reimburses the other federal agencies for their services, according to Paul Van de Water, a senior fellow at the liberal Center on Budget & Policy Priorities.
"The notion that there are all these federal costs that are not accounted for is absolutely positively false," Van de Water said.
There are risks and tradeoffs of a single-payer system, like the possibility that insurance coverage will provide fewer benefits than the private insurance market, according to Austin Frakt, a health economist for the Department of Veterans Affairs with academic posts at Boston University and Harvard.
And there are other systems for bringing down costs, like all-payer rate setting, which allows multiple insurers to negotiate provider prices as a single unit, Frakt added.
But "if you look just at cost control, you almost can't do better than single payer," Frakt said.
Thanks, America's Health Insurance Plans!"
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Mar 09, 2017 | economistsview.typepad.com
anne : March 09, 2017 at 02:18 PM , 2017 at 02:18 PMhttp://www.pnhp.org/news/2017/march/pnhp-on-gops-re-branded-and-far-meaner-version-of-acaanne -> anne... , March 09, 2017 at 02:25 PMMarch 8, 2017
Physicians for a National Health Program on GOP's re-branded and far meaner version of ACA
The 'American Health Care Act' perpetuates the basic structure of the Affordable Care Act, including the subsidization of the private health insurance industry, while cutting benefits to the poor and middle class, and giving hundreds of billions in tax breaks to the rich
Proposed as a replacement of the Affordable Care Act (ACA), the AHCA would maintain its basic structure. The bill would:
• Continue to channel billions of taxpayer dollars through wasteful private insurers;
• Sharply reduce the ACA's subsidies (or "tax credits") available to lower-income persons, particularly older adults, to purchase coverage;
• End the ACA's cost-sharing subsidies for copayments and deductibles, increasing the cost of care for those with chronic medical conditions;
• Replace the ACA's "individual mandate" penalty on the uninsured with a 30 percent surcharge on insurance premiums for those who experienced a lapse in insurance coverage;
• Slash federal funding for the Medicaid expansion beginning in 2020, and move towards a "per capita" cap on Medicaid spending that would squeeze state Medicaid budgets and push millions of enrollees out of the program;
• Increase the tax-favored status of Health Savings Accounts, which mostly benefit people in high income brackets;
• Reduce taxes on pharmaceutical, medical device and health insurance companies;
• Offer tax reductions totaling $274.6 billion over 10 years to the wealthiest 2 percent of Americans.
These and other provisions would take the nation in the wrong direction. Even with the ACA in place, 29 million remained uninsured in 2015; the ACHA would only push that number higher. And today, even many Americans with coverage face bankrupting medical bills for copayments, deductibles and uncovered services. By lowering the standards of private insurance plans and ending cost sharing subsidies, the ACHA would only intensify the problem of "underinsurance."
The ACHA would replace the ACA with a worse, more regressive version of the original bill. This is not what Americans want or need. PNHP instead urges Congress to replace the ACA with a single-payer national health care program. Unlike the ACA or the ACHA, single-payer, Medicare for All reform could effectively control costs while creating a right to high-quality healthcare for everyone in America.
Clarifying:libezkova -> anne... , March 09, 2017 at 05:37 PMhttp://www.pnhp.org/news/2017/march/pnhp-on-gops-re-branded-and-far-meaner-version-of-aca
March 8, 2017
The 'American Health Care Act' perpetuates the basic structure of the Affordable Care Act, including the subsidization of the private health insurance industry, while cutting benefits to the poor and middle class, and giving hundreds of billions in tax breaks to the rich
By Physicians for a National Health Program"• Sharply reduce the ACA's subsidies (or "tax credits") available to lower-income persons, particularly older adults, to purchase coverage;"That's a shame. Over 50 and unemployed is hard enough for most Americans to be hit with additional health insurance charges.
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Mar 07, 2017 | economistsview.typepad.com
anne : March 07, 2017 at 11:10 AM , 2017 at 11:10 AMhttp://cepr.net/blogs/beat-the-press/republicans-look-to-top-50-million-uninsuredMarch 7, 2017
Republicans Look to Top 50 Million Uninsured
In the years before the Affordable Care Act (ACA) the uninsured population peaked at just over 50 million people. It fell sharply when the main provisions of the ACA took effect, falling to less than 28 million in recent quarters. However, in its effort to make America great again, the Republicans expect to raise the number of uninsured back above 50 million. Serious analysis of their plan shows that they have a good shot at meeting this goal.
While the Republicans are in principle keeping some of the provisions of the ACA that were responsible for lowering the number of uninsured, this effect will be temporary. In most cases the situation for most people not covered by their employers will be the same or worse than before the ACA took effect.
For example, the plan leaves in place the expansion of Medicaid through 2020. This should be long enough so that most currently serving Republican governors will not have to deal with the effect of the elimination of this provision. After 2020 people benefiting from the expansion will be allowed to remain on Medicaid, but new people will not be added. Since people tend to shift on and off Medicaid (something rarely understood by reporters who cover the ACA), after two or three years the vast majority of the people who benefited from the expansion will no longer be getting Medicaid. By 2025 the impact of the expansion on the number of the uninsured will be trivial.
The plan also allows insurers to charge people with pre-existing conditions higher rates, if they allow their insurance to lapse. While the provision allowing people to avoid being penalized for pre-existing conditions, if they maintain continuous coverage, may appear to provide protection, in reality this is not likely to be the case. Before the ACA workers were allowed to keep employer based coverage for a substantial period of time after they left their employer under COBRA. * The take up rate under this law was always low, primarily because most workers could not afford to keep their coverage once they left their jobs. This is likely to be the case when the Republican plan takes effect as well.
The Republican plan does provide modest subsidies to people for buying insurance, but the impact of these subsidies will be swamped by the rise in health care costs. The subsidies would be $2000 a year for those under 30 and $4,000 a year for those over age 60. According to the Center for Medicare and Medicaid Services the average cost of health care per person was $9,100 in 2013. Per person costs are projected to rise to $15,800 by 2025.
The Republicans will be further helped in their plans to raise the uninsured population back above 50 million with their proposals for segmenting the market by encouraging healthy people to buy low cost catastrophic health care plans. The Republicans propose to raise caps on health savings accounts, which will give healthy people a strong incentive to buy plans with very high deductibles. As a result, plans that have lower deductibles will have a less healthy population and therefore be very expensive. This should make it more difficult for people with health conditions to afford insurance.
On net, it seems likely the Republican proposal will succeed in raising the number of uninsured above the pre-ACA level. Since this seems the likely outcome, it is reasonable to assume that it is the intention of the Republican designers of the bill.
* https://en.wikipedia.org/wiki/Consolidated_Omnibus_Budget_Reconciliation_Act_of_1985
-- Dean Baker
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Mar 07, 2017 | economistsview.typepad.com
mrrunangun : March 07, 2017 at 06:26 PM , 2017 at 06:26 PMThe Republican plan appears to be a poorly considered rush job, not unlike the original ACA. It solves none of the problems created by the ACA and creates new problems of its own. Perhaps there are enough sensible people left in the Congress to do away with this nonsense, but I doubt that there are enough people there with a sufficient sense of public purpose to work together to improve on the precarious existing system resulting from the ACA.libezkova -> mrrunangun... , March 07, 2017 at 07:58 PMA very good insight ! Thank you !Sporkfed : , March 07, 2017 at 04:36 PMIncreasing the demand for healthcare by providing insurance through a third party willsanjait : , March 07, 2017 at 12:48 PM
not contain healthcare costs, nor in the long run, provide quality, affordable, healthcare for the majority of the intended recipients. The monopolies that exist in American medicine must be
eliminated to reduce costs, all other "tweaks" are just bandaids. Single payer may be the best
solution to an intractable problem.Dems need to stand firm and be clear on their messaging, and they will win this debate and stop the GOP from passing a bill.Fred C. Dobbs : , March 07, 2017 at 12:12 PMThe GOP bill slashes Medicaid and the support that working families get for exchange insurance, all to finance big tax cuts for the rich. Those are the main things it accomplishes, and Americans are rapidly becoming aware of this reality.
The polarization in the US isLee A. Arnold -> sanjait... , March 07, 2017 at 01:26 PM
such that while Dems & progressives
have accepted that 'universal
healthcare' is a basic right,
GOPsters & conservatives take
the other side. Except when they
too have become enlightened,
partially & somewhat, it seems.House Republicans Unveil Plan to Replace Health Law https://nyti.ms/2myipXZ
... On Monday, four Republican senators - Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska - signed a letter saying a House draft that they had reviewed did not adequately protect people in states like theirs that have expanded Medicaid under the Affordable Care Act.
Three conservative Republicans in the Senate - Mike Lee of Utah, Rand Paul of Kentucky and Ted Cruz of Texas - had already expressed reservations about the House's approach. ...
See also:
4 GOP senators demand to keep Obamacare
Medicaid expansion http://politi.co/2lVflBPFour Republican senators from states that expanded Medicaid under Obamacare say they can't support a draft House repeal bill because it won't protect people enrolled in the health entitlement - a move that could doom the legislation's prospects.
"We are concerned that any poorly implemented or poorly timed change in the current funding structure in Medicaid could result in a reduction in access to life-saving health care services," Sens. Rob Portman of Ohio, Shelley Moore Capito of West Virginia, Cory Gardner of Colorado and Lisa Murkowski of Alaska wrote in a letter to Majority Leader Mitch McConnell. "The February 10th draft proposal from the House does not meet the test of stability for individuals currently enrolled in the program and we will not support a plan that does not include stability for Medicaid expansion populations or flexibility for states." ...
Sanjait: "Going 'single payer' in response is like throwing a Hail Mary pass"Wrong analogy really, because a single-payer isn't legislatively possible at this moment. Kevin Drum has this right, as almost always. Beyond that, the GOP will never go for a single-payer; this is NOT the point. The point is that 65-70% of the people want a single-payer. It is time to start making that into an electoral reality, and the way to do that is to start beating that drum now. The free market will never work for universal healthcare. God knows whether the Democrats have enough political brains to follow Bernie on this, however.
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Feb 19, 2017 | economistsview.typepad.com
Peter K. -> Chris G ... , February 18, 2017 at 07:35 AMvia J.W. Mason (lots of F-bombs!):ilsm -> Peter K.... , February 18, 2017 at 12:47 PMhttp://democracyjournal.org/arguments/keep-it-simple-and-take-credit/
Keep It Simple and Take Credit
BY JACK MESERVE
FROM FEBRUARY 3, 2017, 5:42 PMAs Democrats stare down eight years of policies being wiped out within months, it's worth looking at why those policies did virtually nothing for their electoral success at any level. And, in the interest of supporting a united front between liberals and socialists, let me start this off with a rather long quote from Matt Christman of Chapo Trap House, on why Obamacare failed to gain more popularity:
There are parts to it that are unambiguously good - like, Medicaid expansion is good, and why? Because there's no f!@#ing strings attached. You don't have to go to a goddamned website and become a f@!#ing hacker to try to figure out how to pick the right plan, they just tell you "you're covered now." And that's it! That's all it ever should have been and that is why - [Jonathan Chait] is bemoaning why it's a political failure? Because modern neoliberal, left-neoliberal policy is all about making this shit invisible to people so that they don't know what they're getting out of it.
And as Rick Perlstein has talked about a lot, that's one of the reasons that Democrats end up f!@#$ing themselves over. The reason they held Congress for 40 years after enacting Social Security is because Social Security was right in your f!@ing face. They could say to you, "you didn't used to have money when you were old, now you do. Thank Democrats." And they f!@#ing did. Now it's, "you didn't used to be able to log on to a website and negotiate between 15 different providers to pick a platinum or gold or zinc plan and apply a f!@#$ing formula for a subsidy that's gonna change depending on your income so you might end up having to retroactively owe money or have a higher premium." Holy shit, thank you so much.
This point has been made before on Obamacare, but the tendency behind it, the tendency to muddle and mask benefits, has become endemic to center-left politics. Either Democrats complicate their initiatives enough to be inscrutable to anyone who doesn't love reading hours of explainers on public policy, or else they don't take credit for the few simple policies they do enact. Let's run through a few examples.
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missed the point the big winner is FIRE. ACA should have been everyone in medicare, and have medicare run Part B not FIRE. Obamcare is welfare for FIRE, who sabotage it with huge deductibles and raging rises in premium..
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Feb 01, 2017 | economistsview.typepad.com
EMichael : January 31, 2017 at 05:34 AMMeanwhile, have you noticed this from Drum?Peter K. -> EMichael... , January 31, 2017 at 05:44 AM"I've written before about the possibility that repealing bits and parts of Obamacare-which is all Republicans can do-will destroy the individual insurance market. Not just the Obamacare exchanges, but the entire market. Insurers would still be required to insure everyone who applies for coverage, but there would be no subsidies and no mandate. The result would be a flood of super-expensive patients like me, and virtually no healthy people to balance out the pool. If that happens, insurers will simply exit the individual market rather than take huge losses
Here's the only reaction I could find from the insurance industry:
"At a time when the individual market faces challenges, we need as many people as possible to participate - so that costs go down for everyone," said Kristine Grow, spokeswoman for America's Health Insurance Plans.
This wasn't even a reaction to Obamacare repeal, either. It was a reaction to the Trump administration's childish attempt at sabotaging signups for 2017. Basically, the insurance industry has been curiously quiet about the whole thing.
Why? They know the stakes better than anyone. Recent premium hikes hold out the promise that after years of losses, their Obamacare business will finally turn profitable this year or next. But a ham-handed repeal effort does just the opposite. The individual market would become massively unprofitable, and insurers would have to decide whether to ride it out for a year or two, or simply abandon the individual market altogether. These are really lousy alternatives."
I think I know the reason for the insurance company's silence. They want to go back to the old way. Sure, if the ACA stays in place as it is, they are OK and will profit once they find the proper premium levels. But with what the Reps have already done to the ACA they doubt the program can move forward, especially now.
But even if the Reps just let it stand(which they won't), the insurance companies have figure out that they would be far better off with the old private markets of high deductibles, pre existing condition bans, recissions and cancelling of policies once the holder gets sick.
Combine that with losing medical loss ratios on both private and employer provided insurance and it would be a bonanza for health insurance companies.
So they stay silent(in public anyway) cause no matter what happens they make out, and this way it seems like they are just following orders and working to "help" the public.
Don't people argue that if we go back to the old way, that the entire system will collapse and we'll get single payer eventually after many painful years?DeDude -> EMichael... , January 31, 2017 at 06:38 AMTrump and that clown Stephen Moore keep talking about competition across state lines but I don't see that happening.
ObamaCare required a lot of things, including that they didn't use more than 20% of the premiums on profits. They couldn't just be a scam collecting premiums and kicking people off their plans if/when they got sick. In the old model it was a lot easier to make fat profits out of the asymmetrical knowledge between them and the marks.EMichael -> DeDude... , January 31, 2017 at 06:54 AMIf the insurance companies thought that medical loss ratios would make it into the bill, they would never have allowed Lieberman to break the filibuster.DeDude -> EMichael... , January 31, 2017 at 07:22 AMMeanwhile, over at Angry Bear, Run has a great post.
http://angrybearblog.com/2017/01/38918.html
I am not sure whether the House is the only one that can change their rules to avoid a CBO analysis. Trying to find out.
Yes banning the CBO from scoring repeal and revealing that it is a big budget buster - was a classic GOP trick (keep the people uninformed before you screw them). I agree that it is a little surprising that democrats have not yet gotten the big guns our and pointed out how MediCare will go bankrupt when ACA is repealed. There must be some tactical calculation there. They probably want that perfect storm of scared seniors to call their Senators at a specific time when it will be most likely to tip over the wagon.DeDude -> DeDude... , January 31, 2017 at 07:26 AMThe GOP repeal of ACA will bankrupt MediCare and Paul Ryan doesn't want you to know about it !!!!!!!!!!!!!!!pgl -> DeDude... , January 31, 2017 at 08:30 AMWrite your Senators and write your representative demanding that they reveal all the details of their nefarious plans.
"more than 20% of the premiums on profits"pgl -> EMichael... , January 31, 2017 at 08:29 AMGross or operating? Operating profit margins are only 8% (4 times greater than a competitive return). Gross margins include the bloated operating expenses. Think X-inefficiency.
"Combine that with losing medical loss ratios on both private and employer provided insurance and it would be a bonanza for health insurance companies."EMichael -> pgl... , January 31, 2017 at 08:45 AMOne minus the medical loss ratio is the gross profit margin for these oligopolists. This margin should be less than 10% for reasons I have noted before. But wait - they now exceed 20%. What one gets when one allows unfettered monopoly power.
No, they do not exceed 20%. That is the max in the private market, 15% in the employer market.DeDude -> EMichael... , January 31, 2017 at 09:13 AMI should have been a little more precise. "The 80/20 rule requires insurance companies to rebate any excess premium charged if they spend less than 80% of premiums on medical care and efforts to improve the quality of care"https://www.cms.gov/CCIIO/Resources/Files/Downloads/mlr-report-02-15-2013.pdf
So it includes everything including administration.
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Jan 21, 2017 | www.jacobinmag.com
Over his two terms, Barack Obama signed a number of major health-care bills into law, most significantly the Affordable Care Act of 2010 (ACA), though also more recently the 21st Century Cures Act of 2016. Though the GOP's coming assault on health care is likely to be heartless - and though resistance to it must be resolute - we would be better served by a sober assessment of Obama's health-care legacy than by triumphalist acclaim of such laws.The ACA, passed without any Republican votes, has had a significant impact on health-care access: mainly through the expansion of Medicaid together with the subsidization of private health insurance, it achieved a partial reduction in the number of the uninsured, from 48.6 million in 2010 to 28.4 million in early 2016 (still an enormous number!), according to National Health Interview Survey estimates . Other provisions of the law, like those eliminating co-payments for some preventive care or banning preexisting condition discrimination, benefited many more.
Yet those who trumpet such gains while scratching their heads at the law's relative unpopularity are missing the crux of the problem: despite President Obama's reforms, the health-care system continues to fail much of the nation.
One example: in Canada, physicians and hospitals are free when you use them. In the United States, co-payments and deductibles for such care (which average $7,474 for a family marketplace silver plan) often rations medical care by economic status. Studies have shown that those with inadequate insurance avoid going to the ER even when they need it, delay care when in the throes of a heart attack , and face financial strain and sometimes bankruptcy when sickness strikes. Such injustices preceded the ACA, but because the law failed to fix them, it is blamed - fairly or unfairly - for their persistence.
More recently, Obama signed the 21st Century Cures Act into law, which among other things incrementally reduced the rigor of the Food and Drug Administration's drug approval process. These provisions were tantamount to a generous handout to the pharmaceutical industry, which had lobbied heavily for the bill. Not surprisingly, it also did precisely nothing about sky-high drug costs .
This is a decidedly mixed legacy. The gains of the ACA are evident: indeed, for some of those who gained coverage, it was lifesaving. Its shortcomings, however, are equally evident: some twenty-eight million uninsured, persistently high cost-sharing, inequalities in access, uncontrolled drug prices, and so forth.
Of course, Republican designs, whether repeal and/or modification, will only make things worse. When that happens, we should dub the resultant fiasco GOP-Care, and blast it for all its injustices. However, it should also be clear that "Let's go back to 2016" will not be a winning campaign slogan for Democrats in coming elections: people want - and deserve - real change.
To defeat GOP-Care, we will need a more powerful weapon than Obamacare. For this reason, the time to push for universal single-payer health care is right now
-Adam Gaffney
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Jan 18, 2017 | economistsview.typepad.com
Fred C. Dobbs : January 15, 2017 at 08:37 AM , 2017 at 08:37 AMThe Biggest Changes Obamacare Made, and Those ThatFred C. Dobbs -> Fred C. Dobbs... , January 15, 2017 at 08:42 AM
May Disappear https://nyti.ms/2itydsr via @UpshotNYT
NYT - Margot Sanger-Katz - January 13, 2017It looks like the beginning of the end for Obamacare as we know it.
After years of vowing to repeal the Affordable Care Act, as it is formally known, Republican lawmakers in both chambers of Congress have now passed a bill that will make it easier to gut the law.
Because they are using a special budget process, Republicans won't be able to repeal all provisions of the health law. But it seems like a good time to look at the major changes Obamacare brought to health care, which of those changes may now disappear, and what might replace them.
An important note: We still don't know the details of a repeal bill, and passage is not guaranteed. But Republicans passed a similar package in 2015, vetoed by President Obama, that provides a rough template. Republicans have also said they hope to make further changes through additional legislation. We'll provide updates when new legislative language arrives, expected in several weeks.
1) Obamacare insured millions through new insurance markets.
The health law reduced the number of uninsured Americans by an estimated 20 million people from 2010 to 2016. One of the primary ways it did so was by creating online markets where people who didn't get insurance through work or the government could shop for a health plan from a private insurer. The law offered subsidies for Americans with lower incomes to help pay their premiums and deductibles.
What would happen? The Republican bill is expected to eliminate the subsidies. This would make insurance unaffordable for millions of Americans and sharply reduce the number who buy their own health coverage.
With many fewer people buying coverage, the insurance markets are likely to become increasingly unstable. Many insurers will stop offering policies, and the remaining customers are likely to be sicker than current Obamacare buyers, a reality that will drive up the cost of insurance for everyone who buys it, and force more people out of the markets. The Urban Institute estimates that the change would cause a total of 22.5 million people to lose their health insurance.
What might replace it? Separate legislation may include some new form of subsidy to help people afford insurance. Plans from House Speaker Paul Ryan and the budget committee chairman Tom Price, President-elect Donald J. Trump's pick to lead the Department of Health and Human Services, would both offer a flat tax credit to help buy insurance that varies by age. A proposal from the House Republican Study Committee would give all Americans a standard tax deduction to buy insurance.
2) Obamacare insured millions more by expanding Medicaid.
The health law provided federal funds for states to offer Medicaid coverage to anyone earning less than about $16,000 for a single person or $33,000 for a family of four. Not every state chose to expand, but most did.
What would happen? The Republican plan is expected to eliminate federal funding for the expansion. An estimated 12.9 million people would lose Medicaid coverage, according to the Urban Institute's projections.
What might replace it? Republican leaders have discussed reforming the remaining Medicaid program to give states more autonomy and to reduce future federal investment.
3) Obamacare established consumer protections for health insurance.
One of the law's signature features prevents insurance companies from denying coverage or charging a higher price to someone with a pre-existing health problem. The law included a host of other protections for all health plans: a ban on setting a lifetime limit on how much an insurer has to pay to cover someone; a requirement that insurers offer a minimum package of benefits; a guarantee that preventive health services be covered without a co-payment; a cap on insurance company profits; and limits on how much more insurers can charge older people than younger people. The law also required insurance plans to allow adult children to stay on their parents' policies until age 26.
What would happen? These rules can't be changed using the special budget process, so they would stay in place for now. But eliminating some of the other provisions, like the subsidies, and leaving the insurance rules could create turmoil in the insurance markets, since sick customers would have a much stronger incentive to stay covered when premiums rise. .
What might replace it? Mr. Trump has said that he'd like to keep the law's policies on pre-existing conditions and family coverage for young adults, but Senate Republicans recently voted against nonbinding resolutions to preserve those measures, suggesting they may be less committed. Some of the other provisions would probably be on the table if there were new legislation. Republicans in Congress would probably eliminate rules that require a minimum package of benefits for all insurance plans and allow states to determine what insurers would have to include. Mr. Trump has said he'd like to encourage the sale of insurance across state lines, a policy likely to make coverage more skimpy but less expensive for many customers. Republicans would also like to expand tax incentives for people to save money for health expenses.
Many of the Republican proposals would also establish so-called high-risk pools, which would provide subsidized insurance options for people with chronic health problems who wouldn't be able to buy insurance without rules forcing insurers to sell them coverage.
4) Obamacare required individuals to have health insurance and companies to offer it to their workers.
To ensure that enough healthy people entered insurance markets, the law included mandates to encourage broader coverage. Large employers that failed to offer affordable coverage, or individuals who failed to obtain insurance, could be charged a tax penalty.
What would happen? The bill is expected to eliminate the mandates. Some experts think that eliminating the individual mandate, in particular, could destabilize insurance markets by reducing incentives for healthy people to buy coverage. The mandate had less of an impact on the employers, which had already been offering coverage.
What might replace it? Some Republican plans would allow insurers to charge much higher rates to customers who allow their coverage to lapse than to those who renew their policies every year. Such a system might provide a different financial incentive for healthy people to stay insured.
5) Obamacare raised taxes related to high incomes, prescription drugs, medical devices and health insurance.
To help pay for the law's coverage expansion, it raised taxes on several players in the health industry and on high-income earners.
What would happen? The G.O.P. package may roll back those tax increases, though there is some disagreement among Republican lawmakers about the deficit impact of such changes.
What might replace it? Republicans have not discussed raising new taxes to replace those in the Affordable Care Act. But some of their plans would limit the tax benefits offered to people who get their health insurance through work. That change would increase tax revenues, but would increase the cost of health insurance for many people who get it through work.
6) Obamacare made major reforms to Medicare payments.
The law cut the annual pay raises Medicare gives hospitals and reduced the fees Medicare pays private insurance companies. It created new incentives for hospitals and doctors to improve quality. It also set up a special office to run experiments in how Medicare pays doctors and hospitals for health care services. Those experiments are now widespread and have begun changing the way medicine is practiced in some places.
What would happen? The new legislation is expected to leave these changes alone, even though many have come under criticism by Republicans in Congress over the years, including from Mr. Price, an orthopedic surgeon. Many of the experiments could be reshaped or eliminated through regulation or through a future budget process.
What might replace it? Republicans in Congress have long talked about even more ambitious changes to Medicare, intended to move more beneficiaries into private insurance coverage. Mr. Trump has said that he does not want to make major changes to Medicare, so it is unclear if such a proposal would move forward.
7) Obamacare made many smaller changes that will probably last.
Obamacare had a range of policies meant to improve health and health care, including requirements that drug companies report payments made to physicians, a provision written by the Iowa senator Chuck Grassley, a Republican; a requirement that chain restaurants publish calorie counts on their menus; and a rule that large employers must provide a space for women to express breast milk.
What would happen? When Republicans talk about repealing Obamacare, they tend to focus on the parts of the law that expanded insurance coverage and regulated health insurance products, not these ancillary parts. That means that portions of the Affordable Care Act that people don't associate with the word "Obamacare" are likely to endure.
Perhaps the most horrendous lossim1dc -> Fred C. Dobbs... , January 15, 2017 at 11:32 AM
(to Big Healthcare) will be if ~20M
people lose coverage, even if it is
high-deductible 'catastrophic' coverage,
hospitals will lose billions in insurance
reimbursements for 'free care', which had
*much* to do with why/how Massachusetts
got the ball rolling in the first place.
Every time I read an article about the Republicans 'Repeal of Obamacare' I remind myself that Trump has not said he would sign Repeal only.DeDude -> im1dc... , January 15, 2017 at 12:49 PMRather, he repeatedly has said and recently reiterated that he wants Repeal to coincide with Replace, hours, days, not weeks, months, or years.
That sets up an Executive Branch vs Legislative Branch conflict.
One of the party's pledges will have to give to the others, either Trump or the Speaker Ryan House Republican majority and or the Majority Leader McConnell's Republican majority Senate.
Today I'm guessing Trump gets his wish.
But that leads me to ask what are the Republicans going to substitute for PACA/Obamacare that is 'cheaper and provides more and better health care' that Donald Trump promised, repeatedly.
If it is exciting to watch a train wreck then it is exciting to watch this budding and self-inflicted catastrophe develop in Republican controlled D.C., although I would rather not.
"what are the Republicans going to substitute for PACA/Obamacare that is 'cheaper and provides more and better health care' that Donald Trump promised"DeDude -> Fred C. Dobbs... , January 15, 2017 at 01:02 PMYes my guess is that TrumpCare will not be bigger and better. More likely it will be small - like his hands
She missed the biggest and most important part. ACA reduced the size of the doughnut hole in Medicare part D. Indeed ObamaCare was going to make the doughnut hole go completely away by 2020. So if we go back to the old Bush part D there will suddenly be a $4000 gap of no coverage for prescription drugs for our seniors. What are the GOPsters going to do about that?Fred C. Dobbs -> DeDude... , January 15, 2017 at 01:19 PMGet rich(er), I'd guess.
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Jan 13, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AMThere are 3 ways we could reduce what we pay for health care:Observer -> pgl... , January 13, 2017 at 07:12 AM(1) Ending the oligopoly power of the health insurance companies;
(2) Ending the doctor cartel;
(3) Reducing the monopoly power of Big Pharma.
Alas, the Republicans have no intention in doing any of this. So when they tell people they want to lower their costs, they are talking to rich people. The cost to the rest of us will go up if they have their way.
From what I read, and recall from data Anne has posted a number of times, pharma costs are about 10% of total health care costs, and run about 2X EU average, or Canada, if we adopt that as a reference baseline. If we cut it in half, that would reduce our costs about 5%.anne -> Observer... , January 13, 2017 at 07:37 AMDoctors fees (physicians and clinical services in this reference) are about 20%. I think you have mentioned before we pay about 2X typical EU wages. So if we cut that in half, it reduces our costs about 10%.
Taken together, that's ~ 15% reduction. Not nothing, but in a few years of cost growth we are back to current cost levels.
Do you see that differently?
I don't have offhand figures for what insurance overhead runs. I think reducing that is probably the best argument for single payer, although comparisons to medicare overhead seem suspect (I'd expect much lower overhead percentages when much of your costs you are processing are $40K end of life hospital events vs. routine GP visits.) So one might zero out the profit, and reduce costs by having one IT/billing system. What's the scale of the opportunity here - another 15%?
https://www.nytimes.com/2017/01/12/us/politics/health-care-congress-vote-a-rama.htmlJanuary 12, 2017
Senate Takes Major Step Toward Repealing Health Care Law
By THOMAS KAPLAN and ROBERT PEARIn its lengthy series of votes, the Senate rejected amendments proposed by Democrats that were intended to allow imports of prescription drugs from Canada, protect rural hospitals and ensure continued access to coverage for people with pre-existing conditions, among other causes....
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Jan 11, 2017 | www.nakedcapitalism.com
By Lambert Strether of Corrente .Let me begin by summariing (from thi s excellent post by Jane Timm of NBC ) what we might politely call Trump's intellectual journey on health care policy:
As GOP lawmakers begin the process of repealing President Obama's landmark legislation, it's worth taking a look at the eight times Trump has changed his position on Obamacare since announcing his bid for president more than a year and a half ago:
1. Repeal Obamacare. Look to Canada for inspiration.
2. Repeal Obamacare. Cover everybody.
3. Repeal Obamacare, but 'I like the mandate'
4. Repeal Obamacare. Replace it with something.
5. Repeal Obamacare. Not everyone will be covered.
6. I do want to keep parts of it, we might just amend it.
7. Begin to repeal on day one.
8. 'Be careful' - don't take the blame!Do Trump's views even matter? Some answer no, arguing that Trump will just delegate everything to Mike Pence, Tom Price, and the rest of the Republican nomenklatura . We'll see, but I don't think The Donald sliced through not one but two party establishments like a hot knife through butter with the goal of handing off power to the Mikes and Toms of this world. So Trump's views matter. We just don't know what they are! Interestingly, Zeke Emmanuel met with Trump on health care policy. His reaction : "I found him engaged, curious, and he asked a lot of thoughtful questions and had a lot of opinions, as you might expect." So, whatever the reasons for Trump's shifting positions, I don't see them as random. Or focus-grouped, either. So there's that).zd
That said, Trump does seem to want TrumpCare to cover pre-existing condtions (or at least be seen to). Politically, that's sensible, since pre-existing conditions skew old , and Trump's base is older . Covering pre-existing conditions is also the right thing to do, as Trump himself seems to recognize :
Code Name D , January 9, 2017 at 6:21 pmTrump has consistently supported requiring insurers to cover those with pre-existing conditions, a regulation called guaranteed issue. "I would absolutely get rid of Obamacare," Trump said in a February 25 during the Republican primary, but "I want to keep [the provision regarding] pre-existing conditions. It's the modern age, and I think we have to have it."
Frank Stain , January 9, 2017 at 2:00 pmI don't agree. The "free rider" problem distorts the issue of afordabity. Young people do not buy coverage because they can not aford it – regardless of weather they want it or not. Issurance is so expensive its pricing people out of the markets.
So called "continus coverage" is a typical market solution. "Can't aford it? Well we will keep raising rates until you can. If you can aford it, we will keep rasing rates until you can't."
There still are no price controles.
ProNewerDeal , January 9, 2017 at 2:30 pmAre people that hate the mandate because it's government coercion really going to like the Continuous Coverage imperative? The mandate is a soft penalty that taxes individuals who fail to be good citizens by getting their health insurance. The imperative of Continuous Coverage says: 'Do not go without health insurance, because if you get sick, you won't be able to afford any'.
This replaces the soft nudge of the mandate with the the very firm stick of inevitable financial ruin and uncurable sickness if you make a mistake and get sick when you didn't expect to. Why is this preferable to a mandate? Because you can still gamble?
A subsidiary point: are junk catastrophic plans going to count for purposes of Continuous Coverage once they ditch community rating? Those plans aren't going to provide anything like the $$ in the system that allow for coverage of pre-ex conditions.Frank Stain , January 9, 2017 at 2:49 pm"The mandate is a soft penalty that taxes individuals who fail to be good citizens by getting their health insurance"
The mandate is an ATROCIOUS penalty that penalizes people who cannot afford to purchase a crapified health insurance premium, or those that can "afford the premium" but don't have $6K in emergency savings with which to pay the annual deductible – e.g. can NOT afford to actually use the "insurance". Reminder: US personal adult median income is ~$30K, & net wealth is ~$37K, so this would cover a large portion if not a majority of USians that you are poor-shaming by saying "fail to be good citizens".
Roger Smith , January 9, 2017 at 2:56 pmI was sort-of quoting the elite liberal line, not trying to poor-shame. But surely it makes sense to call a financial penalty 'soft' in comparison to the much harder penalty of financial ruin + incurable sickness if you mess up by gambling you won't get sick, and then you do.
J , January 9, 2017 at 3:19 pmAtrocious indeed. It is a way to divert attention from the real problem and blame the perceived personality faults of random people you do not know. With all the talk of Trump being some variation of fascist, I cannot figure out how people reconcile this mandate (or forced auto insurance mandates).
I have noticed that a lot of the Obama administration's "legacy" or general work was made by fudging numbers and not actually solving any of the problems at hand. Charging people for not buying a service they already could not afford as a way to punish them into making your numbers look good seems to fit the bill.
steven , January 9, 2017 at 6:10 pmThe insurance is for 'catastrophic' coverage only. There are many, many scenarios where you could have an MI, stroke, major trauma, cancer, etc. and end up with surgical, hospital, nursing home and rehab costs running into the $1M+ range. The insurance prevents you from complete financial wipeout; it doesn't exist to make your PCP appointments or Lipitor "free" every month.
Second point, we can argue all we want about who's going to pay for healthcare in this country – the individual, the employer, the government, or some combination thereof. Healthcare will be unaffordable to a large degree based on how fat and sick the US population is. It doesn't matter who's paying when the average healthcare consumer is now 50+ years old with a BMI of 30+, has diabetes, hypertension, sleep apnea, asthma, and continues to smoke, eat fast food, not exercise and has no intention to change.
Last point, we do not ration care at the end of life like other countries with single payor systems do. Most of a person's total lifetime cost of care comes in the last 6 months of life. An enormous amount of savings could be achieved by stopping futile care at the end of life. In my experience, hardly any Americans die at home, everyone dies in an ICU on a ventilator, with multiple IV drips running, often on dialysis too. This is insane. We as a society have to find somewhere to draw the line where certain things shouldn't be done – like dialyIng 90 year olds
KK , January 9, 2017 at 2:07 pmI don't think anyone is addressing frank's point which is:
In what way is creating a penalty, which tells people who cannot maintain consistent coverage that they can be permanently locked out of the market, better than the individual mandate? The brunt of both approaches is borne by the same people and both approaches inflict pain to coerce behavior. The mandate is a penalty that can be removed at any time by buying a subsidized guaranteed issue policy and the ACA had mechanisms in place to make it feasible to get into coverage. Under repeal, If you have a coverage gap you then face much higher premiums or refusal of needed coverage with no mechanism(such as substantial enough subsidies) to ever be able to afford to get back into the market. Saying that this is better because the government isn't forcing you to buy insurance, when no one goes without insurance if they can afford it in the first place, seems rather silly. Pushing these people into high risk pools has been tried numerous times in this country and has never worked out as the costs are always enormous and there is never the public will to subsidize the pools to the extent needed to keep them afloat.
We know perfectly well that the republicans have no intention of providing the level of subsidy that is necessary to get everyone covered because they don't believe that doing without health insurance/health care is a problem that government should be trying to fix.
As for lambert's statement about trump not shaking things up in order to hand power to others:
Trump doesn't care about policy and has no views on how his power should be used other than to aggrandize his own name. He is a dreaming narcissist whose views change 10 times in a day depending on what he thinks is expedient. He is the perfect malleable president for congressional republicans, an amoral blank slate driven only by his vision of himself as benign dictator. There is no way to counter the clear and organized agenda of the republican establishment, that now completely controls congress, unless you have some coherent policy view of your own. Donald Trump is going to rubber stamp the republican party's agenda and then claim that everyone's problems are solved and most of his supporters will be stupid enough to believe all their problems have disappeared because their all powerful proto-fascist daddy figure waved his big d!#k around and said it is so.
Tom , January 9, 2017 at 2:14 pmHow clever is the American system, no work, no medicine
Waldenpond , January 9, 2017 at 2:40 pmExcellent, excellent snapshot of where we stand during this moment of calm before the storm (or rather, this moment between the current storm (ACA disintegration) and the next, bigger storm (ACA replacement).
grayslady , January 9, 2017 at 3:40 pmThis was for voteforno6
Here's what I found:
[There is no Constitutional provision explicitly giving the president the power to issue executive orders. Article II, Section 1 ("The executive power shall be vested in a President of the United States of America.") and Article II, Section 3 ("he shall take Care that the Laws be faithfully executed) have been cited as a grant of this power. Even so, presidential executive orders have the legal force of law if made pursuant to an Act of Congress. The authority for such orders can be either inherent or implied. The power is inherent when the executive order is derived from the powers conferred upon the President as commander-in-chief or, in international situations, as head of state; the power is implied when the order represents a reasonable interpretation of the powers expressly granted to the President under the Constitution.]
and
[Only two Presidential executive orders have been overturned by the courts. The first involved a 1952 presidential order issued by President Truman, Executive Order 1034, placing the nation's steel mills under federal control in order to prevent labor strikes from affecting steel production and thus hurting the national economy.[1] The U.S. Supreme Court determined that the Truman Order was unconstitutional because it overstepped the boundary between executive and legislative powers, holding that President's power to issue the order must stem either from an act of Congress or from the Constitution.[2].
The second executive order overturned by a court was issued by President Clinton. Executive Order 12954 prevented the federal government from entering into contracts with organizations that hire replacements for striking employees.[3] The court determined that the Order was regulatory in nature and preempted by the National Labor Relations Act, which guarantees employers the right to hire permanent replacements.[4]]
My understanding is the executive orders are legitimate if congress has not acted. With all the talk of mcr for all, basic income, ubi, unions, outsourcing, taxing the parasite class and guillotines, that movement needed to win or it will be crushed and I imagine the Ds and Rs will quickly rectify this in the next 2 to 4 years so if the wealthy were unfortunate enough to get someone like Sanders who might do something like this, it will be off the table.
ProNewerDeal , January 9, 2017 at 2:42 pmExecutive orders mostly work for issues that don't require congressional funding approval. Based on your excellent brief summary, Trump could probably lower the age of Medicare by Executive Order, but then he would have to find a way to pay for it. My memory may be faulty, but I believe that only Congress can impose taxes, not the President, so Trump would still need to propose a method of paying for Medicare-for-all that Congress would approve. Even if he found a way to pay for healthcare that didn't require congressional funding approval, if the funding source was considered to be too outrageous, Congress could impeach him.
Clive , January 9, 2017 at 3:07 pm0bamaBots & H1llaryB0ts spent years trashing Social Democrats/Sanders voters as "unrealistic" "far-left" "fair-dusty" "un-pragmatic".
Perhaps it was psychological projection, because IMHO 0bama & H1llary were un-pragmatic.
Imagine if 0bama earnestly tried to implement MedicareForAll in 2010? 0bama could've stayed sold-out to the other monopolistic industries that own US pols. Even the most strident left 0bama critics like say Glen Ford would have to say, "look, 0bama is a war criminal, has dictator-murdered US citizens without due process, tried to raise the social security age for GenX & younger, pursued the TPP; but 0bama deserves 1 prop for implementing MedicareForAll & saving 45K USians/yr per Harvard Public Health".
But no, 0bama & H1llary insist on staying sold-out to all major BigBiz groups. Fighting even 1 of them ala FD Roosevelt "I welcome their hatred" to investment bank$tas, is excessively pragmatic for these DLC neoliberal Reagan-clone scumbags.
oho , January 9, 2017 at 3:19 pmFrom an insurance industry point of view, certainly in the U.K. market which I doubt is significantly differently to the U.S., insurers hate complex underwriting. They either want scheme-compliant customers or, if those customers turn up and are found to be wide of scheme, they'd simply rather not have them as customers.
If an insurer is forced to take whatever business rolls up at its door, one way of avoiding having to specialist underwriting is to simply use pricing to deter anyone with a functioning brain cell from ever actually buying a policy. In other words, the fact that you genuinely need underwriting is used to whack the premium or the co-pay up. Okay, technically you are not denying coverage but in practice that's exactly what you are doing because most people will (certainly under the ACA) just pay the fine.
What the politicians - who know diddly squat about insurance product design - hadn't counted on though is, as noted though (correctly) above, you still get a death spiral because a lot of just-above-impoverished and slightly to moderately-severe unwell people will still enter the pool because they realize that even expensive (in-effect catastrophe) insurance is still better than pay-as-you-go. What you're going to deter is a mass market of impoverished or just-above-impoverished but slightly unwell (some sort of pre-existing condition which probably won't result in huge claims - a significant proportion of the potential pool will be this class of customer) potential customers who, in bulk, would contribute the vast proportion of your float (the reserves to pay out claims), because they think, usually correctly, they won't make a mega huge claim and are paying money for nothing.
If any changes in U.S. healthcare policy is considered which involves, to some extent, insurance (assuming Single Payer is off he table, which, however lamentable, sounds like reality) then policy makers really must consult with insurance marketing experts. Failure to understand consumer behavior in this industry will result in policy failures - yet again. None of this is new or not throughly understood - travel insurance has a vast trove of market and customer data to determine who chooses to take out medical expenses cover, who doesn't and why they don't (i.e. chose to spin the roulette wheel and risk not having coverage).
All of which makes me think - remind me again what is so wrong with Single Payer?
Carla , January 9, 2017 at 8:53 pm' remind me again what is so wrong with Single Payer?'
Of all the black swans out there--I'd bet that the most likely black swan is Trump expanding Medicare to under-65's in some form.
Seriously. Nixon to China >>> Takes a jingoistic, nationalistic, hotelier w/massive health insurance bills to like the idea of dumping those costs onto the government.
Trump is already on record liking drug re-importation from Canada and sticking it to Big Pharma.
(but again, it's the most likely of unlikely events) and I'm not holding my breath
Thor's Hammer , January 9, 2017 at 11:09 pm' remind me again what is so wrong with Single Payer?'
It treats everybody the same, something the 1% absolutely cannot abide.
A decade ago, I was traveling in Italy with a friend. When we were staying in the beautiful walled city of Lucca, he developed an infection in his index finger. We asked at our B&B where he might get treatment and were directed to the ER of a hospital about 2 blocks away. We joined a couple of other people in the waiting room and after about 5 minutes, someone came and took my friend to an examining room. Nobody in the ER spoke English and we had no Italian. About 10 minutes later, my friend emerged with a neatly bandaged finger and a prescription for antibiotic ointment written in Italian. He explained to me that they had lanced the finger, drained the pus, applied a disinfectant, and bandaged him up. When he took his credit card out to pay, they smilingly waved it away. You see in Italy, if you are hurting, you receive care and treatment because you are a human being.
American one-percenters just can't stand that. Apparently it somehow robs them of their specialness.
grayslady , January 9, 2017 at 3:46 pmDuring my first week of employment in Vancouver Canada the financial secretary of the company called me into the office. "Have you received your Care Card yet?
"I'm a f--ing Yank– Don't I have to become a landed immigrant to apply?
"You are in a civilized country now– we don't allow anybody to go without health care."
I filled out a single page form and was immediately covered for all medical expenses including my pre-existing cancer. Administrative cost for universal coverage– a fraction of the bureaucratic overhead doctors face in the US in order to comply with the ACA & Medicare regulations.
During my stay in Canada I never stood in a line waiting to see a doctor or was placed in a room awaiting a fly-by visit by a doctor seeking to maximize his "production" as is often the case in the USA.
sj , January 9, 2017 at 8:47 pmThe favorite method of U.S. insurers to avoid paying for true insurance is to eliminate potential service providers. For example, under your Obamacare policy, all forms of contraception are supposed to be covered; but if no gynecologist in your network performs IUD insertions, then, essentially, you are denied coverage. Happens here a lot with surgical specialties, wherein no doctor in a particular network is qualified to perform certain surgeries even though Obamacare allows for coverage.
John k , January 9, 2017 at 3:25 pmYou know, I'm getting rather tired of the argument that Medicare payments are so abysmal. Doctors will leave, boo-hoo, yadda yadda.
Under the system we have now, those potential losses just get shifted to the uninsured. I just had a medical procedure and reviewed the billing from the hospital.
Cost of the procedure: $6600. Write off for insurer: $5564 Payment by me (since I had not met the deductible) $1036. My insurance company paid nothing.
Now, I'm lucky. I have insurance, and I had been stashing money into an FSA account and so I actually had the $1K. But in what world is it okay to penalize those unable to afford insurance by charging them six times as much as they write off for an insurance company. I
The whole healthcare-for-profit business is obscene. It's the "for profit" part that is subsuming the time of doctors and their staffs. Not the "patient care" part.
The so-called doctor exodus is a red herring. If someone becomes a doctor so that they roll in the money, I don't want to be their patient. Let them leave. Maybe we can actually get back to a healer model.
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Lot's of interesting articles to be found with this search:https://www.google.com/#q=how+much+time+to+doctors+spend+working+with+insurance+companies
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I'm not even going into the fact that so often doctors start out so deep in debt they might feel the need to gouge their patients. That a different, if related, issue.reslez , January 9, 2017 at 3:41 pmTrump's base is 50+. So what if he drops Medicare to 50+? Even somebody 45 would be happier thinking he would be covered in five years. And 50-65 is more in need than 35-50.
Midwest would be happy, and lots of reps from Midwest just trump proposing this would give it a life of its own and make dems look like pikers.Course, this would someday be expanded, dooming health insurance does trump owe them anything? Didn't that industry donate to her?
Meanwhile, other corps should be happy to get their sickest workers covered always puzzled other industries haven't lobbied for Medicare expansion.And with talk of changing Obamacare, why isn't Bernie jumping up and down for Medicare expansion?? Do all dems have undying fealty to insurance?
MyLessThanPrimeBeef , January 9, 2017 at 4:06 pm> why isn't Bernie jumping up and down for Medicare expansion?
Clearly Bernie hasn't learned the art of the deal. But I think everyone figured that out after the primary.
As many problems as there are with Medicare I honestly believe expansion is the only way for Trump to square this circle. In addition it's the best solution for the country in the short-term. Think of how many billions of dollars will be saved on administrative overhead alone.
I don't see how Trump or the Republicans can get around Obamacare repeal, it was a core campaign promise. He can drag Congress along with promises of privatizing it in the future. That's a battle I'm willing to fight. Maybe they'll try to privatize it at the same time, though. I think they'd have to preserve a "public option" either way, simply because there are tons of seniors the health insurers won't touch with a 50 foot pole.
Carla , January 9, 2017 at 9:04 pmContrasting with Medicare for all, Medicare from 50+ on is the lesser of 2 evils (the other being keeping the status quo).
In the spirit of 'not letting good be the enemy of perfect,' i am interested and would like to know more if more people are advocating this.
Why should people die because they can't afford healthcare? Why should people go into debt to get treated? This is more important than no college education without free tuition.
james wordsworth , January 9, 2017 at 7:46 pmI agree. In the spirit of 'not letting the good be the enemy of perfect,' we should only let people 49 and under die because they can't afford healthcare.
Who needs people 49 and under, anyway?
ProNewerDeal , January 9, 2017 at 8:16 pmThe crazy thing is that Medicare for all has a solid business argument in its favor (although not for the AMA or big pharma, or big insurance). All companies pay similar amounts for coverage per employee (no more time spent wasted with analyzing plans), so a level playing field, while not as good as a field tilted in your favor, is better than one tilted against you. Great for small companies trying to get new employees, Individuals can start their own businesses without having to worry about losing health benefits (or the high costs of small plans). Everything about medicare for all screams economic efficiency (you know, having doctors doctor, not spending 50% of their time arguing with insurance companies).
Of course this all flies in the face of the american mantra of self reliance and that is where a great economic argument gets destroyed by the reality of a messed up culture in a modern world. Self reliance is great, but in an urban modern world, cooperation works better.
Dr Duh , January 10, 2017 at 1:23 am+1 IIRC 1 of the US auto mfgers explicitly claimed that the factories in Canada were more cost efficient for them, solely due to the health care costs.
It is as if US business leaders are adherents to neoliberal religion, that for-profit businesses will ALWAYS in ALL product/services provide a better product/svc per $ cost than a government or nonprofit private org can.
The same scenario exists with info tech, ppl wil bitch about Microsoft as OS vendor or office suite software vendor, when they could pay for corporate-level support from Ubuntu Linux or LibreOffice. They bitch about getting jacked by Oracle or SAP ERP, when say 10 MNCs could found a nonprofit dedicated to creating industrial/MNC-level ERP software that could be installed on-site or cloud-computing hosted. Etc.
meeps , January 10, 2017 at 2:14 amMy idea, which helps ameliorate but doesn't solve the problem of the uninsured is to incentivize physicians to provide charity care. As it stands, you take significant risk for minimal to no reward.
The uninsured don't pay and Medicaid pays pennies on the dollar compared to private insurance. To make matters worse these are typically the sickest and the unhealthiest patients, i.e., they put off coming in so their disease is often at a crisis point and have bad nutrition, obesity, tobacco addiction and weak social support systems. They are bad outcomes waiting to happen. To cap it off, they are the most likely to sue you, they have stronger economic incentives to do it and have less social trust in physicians.
I know plenty of people (mostly anesthesiologists) who routinely complain about being paid despite being compelled to do all this work and take all this risk (including non-trivial risk to their own health from needle sticks and the like). I think that a big part of the resentment is that they are compelled to provide charity care as a condition of maintaining their privileges at the hospital.
Instead, let physicians write off charity care at their standard rates, i.e., I normally get $903 to come in at midnight and take out someone's ruptured appendix then take care of them in hospital for a week and provide follow up care for 90 days, but if the person is uninsured, I can deduct the $903 from my adjusted gross income as if it were a charitable donation. Further, physicians could be protected from civil liability for charity care. Though they would still be subject to criminal liability for criminal misbehavior and professional sanctions for substandard care, a bad outcome would not lead to a lawsuit.
I think the most important thing is that this would remove the compulsion to work for free. Most physicians and certainly anyone who has started in the past 10 years didn't do it for money. There's far more money and less stress in finance or tech. Most physicians like taking care of people. It's certainly the best part of my day, but being forced to do something sticks in the craw.
While this would certainly push up physician income.dejavuagain , January 10, 2017 at 8:48 amThanks for the extra detail regarding the 'continuous coverage' conditions.
The 18 month contract term reeks of post-ACA era grandfathered plans (my spouse's employer has a 12 month no coverage contract term) which is the very feature that prices us out of it. People who were priced-out under Obamacare are in for another brain-freeze should the incoming administration order up another self-licking ice cream cone.
I'm concerned that Pence will declare that having two X chromosomes is a pre-existing condition, but that's a subject for another post.
Trump seems to have some opportunity to cultivate an image as the 'most beautiful deal-maker ever' if he can deliver an improved Medicare For All plan. Of course, there's a risk that Republicans will crapify it first and then claim they delivered. But that strikes me as equally risky for Trump and the Republicans. Obama should never have staked his name and the reputation of the Democrats on Romneycare. They lost all credibility and the party is going extinct. I have a low opinion of Trump's branding but I suspect he thinks it's just great! It'd be inept beyond measure to sully it with something even worse than Obamacare. I'll refrain from placing odds just now
In the old pre-existing conditions day, the other game played by the insurance companies was to challenge insureds for failing to disclose pre-existing conditions to the insurance company. Even if the insured was not aware of the existence of the pre-existing condition, the insurance company would deny coverage. So, in every big claim, the insurance company would simply deny coverage. Good luck.
And, I was the victim once of an insurance company "losing" my check, and cancelling my health insurance. Scary walking around without health insurance for a few months.
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Jan 11, 2017 | www.nakedcapitalism.com
At least some Republicans seem mindful of the concept, "If you break it, you own it."Even though Obamacare polls as having more opponents than supporters (see here and here ), many of the people who have benefitted from the program are strong supporters. In addition, those who have gotten coverage via Medicaid expansion may not realize that the ACA is the reason. And even with a majority of the public typically polling as not liking Obamacare, only 20% are willing to ditch it with no replacement .
So it should not come as surprise to find that the Republicans, finding themselves in the unexpected position of being able to end Obamacare, are in a squabble over what to do about the, um, opportunity. Obamacare repeal was not a Trump priority and as Lambert has pointed out, Trump has even made statements that sound remarkably un-Republican, like copy the Canadians.
But it appears that regardless of what Trump is willing to do regarding Obamacare, he seems cognizant of the risk of creating disarray and being blamed for it a concern he oddly does not have on other issues. It's likely that this caution is purely cynical: that he understands how complicated implementing a replacement or even a stopgap would be, and he does not want Congress spending time on the Republican party bete noire of Obamacare to the detriment of pushing through Trump's priority items, particularly early in his term when he has the best chance to take ground quickly.
And the Republicans are divided enough to potentially forestall quick action. Politico and Bloomberg put different spins on the same story. Politico goes with the party line: GOP leaders vow to plow ahead with Obamacare repeal . The wee problem is that GOP leadership isn't what it is cracked up to be. Remember how Boehner was repeatedly unable to bring the unruly Tea Party faction to heel? And one of the first acts of the incoming House, to gut its own ethics office , turned into a PR disaster and was quickly scuttled. dbk , January 10, 2017 at 6:42 am
Normal , January 10, 2017 at 7:53 amas Lambert has pointed out, Trump has even made statements that sound remarkably un-Republican, like copy the Canadians.
I get the impression T is clued in about how popular a "Canadian-style" health care plan could potentially be.
That there are this many R senators in doubt/on the fence about this particular repeal might lend hope to the possibility that there might be divisions re: other issues, including key nominees. Let's hope the D's have their staffs working full-time on who might be willing/inclined to break ranks for particularly problematic nominations.
My personal concerns here are those for AG (someone who has emerged straight out of 1963) and the Dept of Education, but the list is long and opinions may differ about priorities.
Kemal Erdogan , January 10, 2017 at 8:53 amThey need the lobbyists to write the replacement law ASAP. Then they can proceed with reckless abandon.
Code Name D , January 10, 2017 at 11:33 amBut, the trouble is the obamacare is more or less what lobbyists wanted.
So, no I see a real trouble here. However militant the republicans seem they would not shoot themselves in the foot. My take is that they will claim that they replaced the law with something better while not touching anything meaningful at the core of it for the simple reason that for such a system to work, it must be more or less the same as what obamacare is. Think how M. Romney's plan looks very similar to Obama's.
The fact is the other workable alternatives are far too much to the left for their liking. So once such a low is introduced that even marginally helps the mid-lower classes, they tend to stick, unless the country falls into open dictatorship that is.
Art Eclectic , January 10, 2017 at 12:07 pmDing ding ding!!! That's the billion-dollar observation here. Obamacare is Free-market economics at its best. For it to fail would generate an intellectual crisis among neo-liberals and libertarians alike. To repeal the ACA is to admit that free markets don't work.
For the industry, their bottom line is literally – the bottom line. That ACA is failing is already apparent. So, something must be done to stabilize the ACA before it collapses completely, and give single payer advocates even more political clout than they already have. Wait too long, and single payer might -gasp- be placed on the table.
But I am seeing some odd behavior from the Democrats. They seem to be actively pushing the healthcare battle onto the floor. Keep in mind they are convinced the ACA both works and is extremely popular. If they can get Republicans to repeal the ACA, then they win the mid-term elections and retake congress.
Trump may act the buffoon. But his election proves he is smarter than most people suspect. You underestimate Trump at your own peril. Sending out mixed messages is probably Trumps version of his poker face, while at the same time he is able to read his opponents projections as they react to various seemingly random messages. The further the ACA descends on its death-spiral, the more clout he will acquire to compel changes according to his vision.
Sound of the Suburbs , January 10, 2017 at 7:59 amActually, I don't think the Dems think the ACA works an is extremely popular, I think they see the opportunity to nuke the thing and get single payer on the table. With Trump on records as admiring the Canadian system, that provides an opening (real or not) that would simply not be possible with any other political figure in the oval office. Not even HRC could have pushed through single payer against Republican opposition, Obama did the best he could with Romneycare. The only shot at single payer comes in the form of forcing Trump's hand, so they might as well take their shot.
DJG , January 10, 2017 at 8:43 amIn a globalised world you just have to look around to see how expensive the US healthcare system is.
Check international league tables and copy someone else's cheaper and better system.
It's that easy.
Eclair , January 10, 2017 at 8:58 amPresident Susan Collins, as Atrios used to refer to her. And here she is again, a wise elder on health care. Sheesh. The flashbacks of her wondrous bipartisanship and moderation are starting to overwhelm me already.
And President John McCain, who has squandered whatever moral authority he may ever have gained from his stay in the Hanoi Hilton, telling us how to deal with Boris and Natasha.
And Ron Johnson, the most clueless man in Wisconsin except for Scott Walker.
They don't have two synapses to rub together among the three of them. Not one of them has a sense of political economy. They mainly react, and not well. They will end up making Trump look like a statesman. And, ironically, they would have taken the same positions with Hillary Clinton.
So Obama and Trump are not transitional or tranformational. We are marking time as the roofing tiles drop off the buildings from neglect.
marym , January 10, 2017 at 9:11 amColorado, one of the states that fully embraced the ACA, extending Medicare to hundreds of poor and disabled residents (the state's uninsured rate dropped from 15.8% in 2011 to 6.7 percent in 2015), is bracing for impact, according to the Denver Post.
Of course, the state's voters overwhelmingly rejected a proposed health care cooperative that would have provided residents with universal health coverage a la Canada in last November's election.
Thankfully, we can all saunter over to our neighborhood pot store and stock up. Who needs doctors anyway.
Code Name D , January 10, 2017 at 11:07 amAHIP demands for Obamacare replacement – The first link to TPM shows a screen shot. Haven't found an actual link to an AHIP publication. The second link to NYT has a discussion of some of the items.
http://www.nytimes.com/2016/12/06/business/health-insurers-obamacare-republicans.html
marym , January 10, 2017 at 11:29 amHahahah! They only THINK they are working on it. The TPM is your typical corporate boardroom speak. "Seek solutions for this, that, and the other thing. Send the right messages. Reassure the confidence fairy. Don't rock the boat." In other words, they delegate solutions to minions to figure out while they pose for the camera.
PKMKII , January 10, 2017 at 9:30 amAgreed on your general assessment of TPM, but not sure I understand your comment. The screenshot is presented as a copy of the actual demands from AHIP, the insurance industry. It does use some pseudo-caring-about-"consumers" language, and I'm no expert, but generally these demands seem to say – keep the money coming; don't send us too many poor/sick people; don't make any rules; or at least none that we don't write.
RUKidding , January 10, 2017 at 10:36 amThe dogs chasing the car finally got it, and now they don't know what to do with it.
It's to laugh, otherwise we'll all cry and/or pound our heads against brick walls.
It's my understanding that CA has used ACA in a useful way that is benefitting citizens who otherwise would be really up the creek with no paddle. So be it.
ACA is what friggin' BigPharma, BigHospital, BigInsurance, et al, wanted. IOW a Republican's wet dream of a "health care" insurance system. But because the Blackity Black black black Kenyan Muslim got the credit for it, rather than RMoney well then it's simply terrible. If RMoney had enacted the exact same thing, the R Team would be extolling it's virtues 24/7/365.
The impact on me, personally, is smallish. I get that it's been a worthless POS for many, but there are the 20 to 30 million who truly benefitted from it. I know some people personally in that category, and I read comments in blogs from others.
Of course, the most draconian of TeaPartiers simply want to repeal ACA and that's the end of it. You're on your own is their Ayn Randian rally cry. Frankly what's always bugged the sh*t out of me is that the R Team wasted the last 8 years endlessly (was it 60 times?) attempting to vote out ACA, but they spent not one iota of a second in devising a replacement. They have zip, zilch, nada, bupkiss to offer. What a worthless group of grifters.
I doubt that Trump gives a stuff what happens to his voters, other than that he probably has a notion that he'll need their fealty and votes in 4 years. Therefore, Trump may try to get something that has some minimum usefulness enacted.
I can't wait. /s
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Jan 06, 2017 | economistsview.typepad.com
Chris Lowery said... January 05, 2017 at 06:42 AM And an interesting take on Trump voters' views on healthcare
http://www.nytimes.com/2017/01/05/opinion/the-health-care-plan-trump-voters-really-want.html?ref=opinionThe Health Care Plan Trump Voters Really Want
By DREW ALTMAN•JAN. 5, 2017
This week Republicans in Congress began their effort to repeal and potentially replace the Affordable Care Act. But after listening to working-class supporters of Donald J. Trump - people who are enrolled in the very health care marketplaces created by the law - one comes away feeling that the Washington debate is sadly disconnected from the concerns of working people.Those voters have been disappointed by Obamacare, but they could be even more disappointed by Republican alternatives to replace it. They have no strong ideological views about repealing and replacing the Affordable Care Act, or future directions for health policy. What they want are pragmatic solutions to their insurance problems. The very last thing they want is higher out-of-pocket costs.
The Kaiser Foundation organized six focus groups in the Rust Belt areas - three with Trump voters who are enrolled in the Affordable Care Act marketplaces, and three with Trump voters receiving Medicaid. The sessions, with eight to 10 men and women each, were held in late December in Columbus, Ohio, Grand Rapids, Mich., and New Cumberland, Pa. Though the participants did not agree on everything, they expressed remarkably similar opinions on many health care questions. They were not, by and large, angry about their health care; they were simply afraid they will be unable to afford coverage for themselves and their families. They trusted Mr. Trump to do the right thing but were quick to say that they didn't really know what he would do, and were worried about what would come next.
They spoke anxiously about rising premiums, deductibles, copays and drug costs. They were especially upset by surprise bills for services they believed were covered. They said their coverage was hopelessly complex. Those with marketplace insurance - for which they were eligible for subsidies - saw Medicaid as a much better deal than their insurance and were resentful that people with incomes lower than theirs could get it. They expressed animosity for drug and insurance companies, and sounded as much like Bernie Sanders supporters as Trump voters. One man in Pennsylvania with Type 1 diabetes reported making frequent trips to Eastern Europe to purchase insulin at one-tenth the cost he paid here.
Surveys show that most enrollees in the Affordable Care Act marketplaces are happy with their plans. The Trump voters in our focus groups were representative of people who had not fared as well. Several described their frustration with being forced to change plans annually to keep premiums down, losing their doctors in the process. But asked about policies found in several Republican plans to replace the Affordable Care Act - including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage - several of these Trump voters recoiled, calling such proposals "not insurance at all." One of those plans has been proposed by Representative Tom Price, Mr. Trump's nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept.
When told Mr. Trump might embrace a plan that included these elements, and particularly very high deductibles, they expressed disbelief. They were also worried about what they called "chaos" if there was a gap between repealing and replacing Obamacare. But most did not think that, as one participant put it, "a smart businessman like Trump would let that happen." Some were uninsured before the Affordable Care Act and said they did not want to be uninsured again. Generally, the Trump voters on Medicaid were much more satisfied with their coverage.
There was one thing many said they liked about the pre-Affordable Care Act insurance market: their ability to buy lower-cost plans that fit their needs, even if it meant that less healthy people had to pay more. They were unmoved by the principle of risk-sharing, and trusted that Mr. Trump would find a way to protect people with pre-existing medical conditions without a mandate, which most viewed as "un-American."
If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs. It would also address consumer issues many had complained about loudly, including eliminating surprise medical bills for out-of-network care, assuring the adequacy of provider networks and making their insurance much more understandable.
Several states are addressing the problem of surprise medical bills. But other steps urged by these Trump voters will be harder to achieve, including controlling drug costs. Republican health reform plans would probably increase deductibles, not lower them. And providing the more generous subsidies for premiums and deductibles that these voters want would require higher taxes, something the Republican Congress seems disinclined to accept.
In general, the focus among congressional Republicans has been on repealing the Affordable Care Act. There has been little discussion of the priorities favored by the Trump voters who spoke to us. But once a Republican replacement plan becomes real, these working-class voters, frustrated with their current coverage, will want to know one thing: how that plan fixes their health insurance problems. And they will not be happy if they are asked to pay even more for their health care.
Drew Altman is president and chief executive of the Henry J. Kaiser Family Foundation.
Reply Thursday, January 05, 2017 at 06:42 AM pgl said in reply to Chris Lowery ... Excellent story. Yesterday Pence and Paul Ryan lied to us. They are basically assuming Trump supporters are really stupid. This says these supporters are smarter than the GOP frauds assume:But asked about policies found in several Republican plans to replace the Affordable Care Act - including a tax credit to help defray the cost of premiums, a tax-preferred savings account and a large deductible typical of catastrophic coverage - several of these Trump voters recoiled, calling such proposals "not insurance at all." One of those plans has been proposed by Representative Tom Price, Mr. Trump's nominee to be secretary of Health and Human Services. These voters said they did not understand health savings accounts and displayed skepticism about the concept. Reply Thursday, January 05, 2017 at 06:53 AM JohnH said in reply to pgl... The partisan hack opines...oblivious to the fact that people might have good reason to be angry at skyrocketing prices for what used to be known as catastrophic coverage.
Sad that there seems to be no one but Bernie and his supporters to stand for real health care reform. Instead the debate gets left to partisan hacks, who have nobody's interest in mind except the party's. Reply Thursday, January 05, 2017 at 07:42 AM Peter K. said in reply to JohnH... Obamacare is basically Romneycare, a Republican plan set up to be an alternative to universal care.
Know-nothing Republicans hate it because Obama signed it into law.
Reply Thursday, January 05, 2017 at 07:45 AM pgl said in reply to Chris Lowery ... "If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs."As in reigning in the monopoly power of Big Pharma. We should also reign the doctor cartel. And of course end the oligopoly power of the health insurance sector. Of course Paul Ryan is in the pockets of the latter - so it ain't gonna happen under his "leadership". Reply Thursday, January 05, 2017 at 06:55 AM EMichael said in reply to Chris Lowery ... Now is not the time to ignore what was actually the "real" problem.
" Republicans Hate Obamacare Because _______
I'm not one to defend the worst parts of Obamacare and those who find themselves on the receiving end of the mandate with no subsidies have some genuine complaints, but generally the bit that goes in the blank there is "it was the blah president's signature legislative achievement."And yes those whose incomes are too high for subsidies do have a complaint.
But for the most part, the single most important "problem" with the ACA is that healthcare in the US is incredibly expensive.
One day people will stop attacking the ACA because of something the ACA had absolutely nothing to do with.
I am thinking that will be when it is gone, and people will then be shocked to see that healthcare in the US is very expensive. Reply Thursday, January 05, 2017 at 07:31 AM JF said in reply to EMichael... Yes, it is expense. This results from pricing that is free from any real market balances or alignments. The incentives are all misaligned.
Need to stop using the word, 'cost' so much. It is all about a non-market space where pricing is unfettered.
Normally, the public brings in uniform rules of Commerce to apply here, or the public does the services directly. Alas. Reply Thursday, January 05, 2017 at 09:07 AM Peter K. said in reply to Chris Lowery ... "If these Trump voters could write a health plan, it would, many said, focus on keeping their out-of-pocket costs low, control drug prices and improve access to cheaper drugs."
Why don't the Democrats do this?
Progressive neoliberalism.... Reply Thursday, January 05, 2017 at 08:44 AM pgl said... "Michigan's expansion of Medicaid health insurance coverage has boosted the state's economy and budget, and will continue to do so for at least the next five years, according to a new University of Michigan study."
When Mike Pence and Paul Ryan appeared together to declare Obama's medical reforms a complete failure, it is odd that they never mentioned Michigan - which seems to be a success story. Reply Thursday, January 05, 2017 at 06:50 AM
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Nov 01, 2016 | economistsview.typepad.com
JohnH : November 01, 2016 at 03:42 PM
The private market has rejected the government sponsored private/public partnership. The government should return the favor and reject the private market, which has shown that it can't deliver, either by itself or in partnership.Time to bring back the public option...or just nationalize the health insurance cartel.
Reply Tuesday, November 01, 2016 at 03:42 PM
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www.nakedcapitalism.com
Pat October 26, 2016 at 3:56 pm
Joseph Hill October 26, 2016 at 4:49 pmCaught part of the View this morning including their section on the admission from the Administration that premiums are going to increase in double digits some high for the next year. After some defense of it and info about one of the problems of it (including a somewhat dissonant outburst from Clinton's biggest fan Joy Behar about why should health care be for profit) Goldberg went on a rant. After her starting the defense part of it, it was interesting to hear her go on about paying more and more for less and less and never seeing any kind of rebate because she hadn't used the insurance she paid for for over a decade. She has almost realized she has been had.
jrs October 26, 2016 at 4:59 pmIn my inbox today courtesy of CareFirst Blue Cross Blue Shield:
"Your premium: The monthly premium you paid in 2016 was $315.62. Beginning January 1, 2017,
your monthly premium will change to $520.59 for the coverage plan you have been automatically
renewed into.
Please understand that premium rates are approved by State regulators pursuant to strict federal and
state rules. We deeply regret increases, but these rates realistically reflect the actual costs of providing
care to you and all other individuals who have bought coverage under the ACA. "
65% annual premium increase (and an deductible increase as well). Absolute F**king disaster.Joseph Hill October 26, 2016 at 5:11 pmThey are telling you a way to change it though. The premium rates are approved by State regulators, means the states should push back.
Skip Intro October 27, 2016 at 8:30 amRight. I'll call my lobbyist.
That's what I call an October Surprise!
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Oct 28, 2016 | www.nakedcapitalism.com
Waldenpond October 27, 2016 at 2:39 pm
Jim Haygood October 27, 2016 at 2:45 pmIt's not just premiums. Health care penalty to double. http://newyork.cbslocal.com/2016/10/26/obamacare-premiums-penalties/
Societies that keep ramping up law and punishment are a sign of what?
MyLessThanPrimeBeef October 27, 2016 at 3:35 pmThank you, 0bama!
Thank you, John Roberts!Pat October 27, 2016 at 2:59 pmI can see the headlines now – the higher the health care penalty and premiums, the bigger Hillary's landslide victory.
Funnily enough, I'm pretty damn sure that the eventual response to this is going to be "pound sand". There is lots of information out there about how to derail that penalty.
The real fix is, of course, single payer and a highly regulated health care market. That said, I'm pretty damn sure that if I were to read the fix article I could pick it apart without much problem, and not just because it has taken the obvious solution off the table. And everyone of my 'solutions' would be ignored because they would come from the point of view that the first goal will be to provide HEALTH CARE and the profits of insurance companies, pharma and private medical are the least important part of the equation.
temporal October 27, 2016 at 3:04 pmAccording to the IRS, shared responsibility payments will jump to $695 per adult and $347.50 per child, with the family maximum not to exceed $2,085 or 2.5 percent income above the filing threshold. That's up from $325 per adult and $162.50 per child, with a maximum of $975 per family for the 2015 tax year.
…
According to the IRS, the national average premium for a bronze level healthcare plan on the Obamacare marketplace was $2,484 a year, or $207 per month for individuals, and $12,240 a year, or $1,020 per month for a family of five or more.
…The article compares last years ACA bronze cost to this year's penalty. Not quite valid.
The NY ACA website shows current catastrophic coverage to be $5500 a year with a $6500 per person deductible, so two grand looks like a bargain unless you have some sort of serious medical condition. And two grand is probably only a few months worth of groceries so what's not to like?OIFVet October 27, 2016 at 3:12 pmPat October 27, 2016 at 3:19 pmIt is still cheaper to pay the penalty than to pay large premiums for a plan that covers practically nothing and has a small provider network. From the NYT article, the 0bama administration argues that having worthless insurance is not paying for nothing, because even people with monster deductibles have "protections against catastrophic costs." Did I miss the part where the 0bama administration instituted out of network maximum on out of pocket costs? There are no out of pocket maximums on out of network costs, and given the small and ever shrinking networks, the administration's contention that crappy policies provide people with "protection" is an utter BS. Yet 0bama has the temerity to insist that we ought to be thanking him for this travesty. It is worth noting that many of my acquaintances who were strongly in favor of 0 care have now began to admit that it does not work. But they don't blame 0bama for it, they blame the republicans. Which is part of their justification for voting for Hillary, because apparently she will "fix 0 care". It is driving me nuts, this willful blindness and unwillingness to question democrat orthodoxy.
OIFVet October 27, 2016 at 3:41 pmMy personal opinion is that until ALL emergency room coverage is covered regardless of network including hospitalization until transfer (at insurance company cost) is medically feasible, these plans are largely useless. Although there could be a good business in emergency medical jewelry that tells paramedics/EMTs the hospital(s) where they can take you and those you most avoid no matter what the circumstances. Especially since those would need to change yearly, if not more often.
Tom October 27, 2016 at 4:22 pmEmergency rooms are half of it. The other problem is that given the small networks, it is quite possible that these networks do not include specialists in particular specialised care that might be needed. Then there is the very high probability that one is operated by an in-network surgeon in an in-network hospital, but the anesthesiologist is out-of-network, as is the post-op nurse. It is not going to be easy for anyone to sort these things out even in case of non-emergency care. This is where the outrage about the increasing high deductibles and huge premium hikes is doing a disservice to the people, beciause I hardly ever see any article that mentions the fact that these increases are accompanied by large shrinkage of provider networks, and then goes on to mention the unlimited out of network costs and links it to the shrinking networks. It is an effing travesty, the whole lot of it.
I am very much incensed on the issue of access to medical care and how 0 care did not improve it one bit for most people. I could easily just lean back and not give a sh!t because I got mine through the VA, so to hell with everyone else. But I can't, my father died for lack of access to care in this "great, exceptional" country of ours. It is a hurt that will never go away, particularly as the democrat party continues to defend this monstrosity and 0bama callously pats himself on the back. Every time he intones "Thanks 0bama" I feel it as a direct affront on our collective dignity and our basic human right to receive healthcare. An effing narcissist and a sociopath is what he is
craazyboy October 27, 2016 at 4:24 pmF*ck Yeah!
JohnnyGL October 27, 2016 at 4:49 pmHillary mentioned there were a couple or two thingies with it that needed fixing. Thanks in advance, Hillary!
With prices compounding at 20-40% annually, Hillary better move fast.
craazyboy October 27, 2016 at 6:29 pmHere comes the magic sparkle pony "public option" dressed up to hide the fact that it'll actually be a massive bailout!
The fines/penalties associated with the "individual mandate" are like the duct tape that holds the whole ACA marketplaces together. The duct tape is looking a bit worn.
Jim Haygood October 27, 2016 at 3:58 pmThen the provider network gets narrowed down to a few local barbershops.
A friend told me his doctor told him he was "re-focusing" his practice on "corporate accounts", which is apparently what it sounds like, and my buddy had to look for a new doc.
Tom October 27, 2016 at 4:26 pm" There could be a good business in emergency medical jewelry … especially since those would need to change yearly, if not more often. "
Your emergency bracelet or necklace needs to be connected to the IoT (Internet of Things).
Then your EMT can just press a button to find out where you're "covered" today.
Thank you, 0bama!
tgs October 27, 2016 at 3:30 pmHa! The patient's medical jewelry would sync with the EMT vehicle's nav system:
Nav Voice: "The nearest hospital in your cardiac arrest patient's network is … 20 miles away. Based on your patient's vital signs, the prognosis is not good. Would you like to recalculate your route? The nearest mortuary is … 2 miles away."
Tom October 27, 2016 at 4:30 pmLost my full time job and insurance in August of 2015 (along with over a hundred colleagues). I determined that I would pay a penalty of around $300 if I didn't get Obamacare. On the other hand, I would have paid over $800 for a bottom level policy that I would never use for the four final months of 2015.
So, I will be paying the penalty in 2016 unless I manage to find a job that gives me coverage. I have a little over a year until I quality for medicare.
Katharine October 27, 2016 at 2:46 pmNow that's having some skin in the game!
P.S. I emphathize with your plight. I went without insurance for 2 years after my business tanked in 2009 and it is no fun to have to make that decision and live with it.
JohnnyGL October 27, 2016 at 4:53 pmHere's a howler from the Guardian:
African revolt threatens international criminal court's legitimacy
https://www.theguardian.com/law/2016/oct/27/african-revolt-international-criminal-court-gambiaThe US refusal to participate didn't threaten its legitimacy, of course, because it was always supposed to be for other people, but when they start refusing to be judged–well, really! What's the world coming to? Its senses?
dk October 27, 2016 at 3:26 pmtgs and Tom,
Don't think you're missing out on much. Over here, my employer has been dishing out ACA-style, high-deductible plans with hefty co-insurance since WAY back before it was cool.
Even if you have coverage, the Insurers don't actually pay for stuff. My family as a whole has about $10K in bills backlogged and all four of us are perfectly healthy.
I can only imagine what actual, sick people have wracked up.
different clue October 27, 2016 at 3:27 pm… some think that whether they send hundreds of dollars to the I.R.S. or thousands to an insurance company, they are essentially paying something for nothing.
The opportunity to select my own treatments and providers, and negotiate payment? That's not nothing. But having to pay extra for it is quite an insult.
polecat October 27, 2016 at 4:08 pmWell, when the penalty costs as much or more than the ObamaCare crapsurance itself, then the boycotters can give in and buy the shitsurance. Perhaps the boycotters will have exterminated Obamacare with death spirals by then anyway.
dk October 27, 2016 at 4:43 pmperhaps the public should just quit filing their taxes …. en mass !
THAT might send a message !!
Sammy Maudlin October 27, 2016 at 4:05 pmDoesn't work so good for people paying in through their wages, and filing to get a refund.
polecat October 27, 2016 at 5:03 pmFrom Jonathan "Stupidity of the American Voter" Gruber's appearance on CNN :
Look, once again, there's no sense of oh it just has to be fixed. The law is working as designed; however, it could work better, and I think probably the most important thing experts would agree on is that we need a larger mandate penalty. We have individuals who are essentially free riding on the system . They're essentially waiting until they get sick and then getting health insurance. The whole idea of this plan which was pioneered in Massachusetts was that the individual mandate penalty would bring those people into the system and have them participate. The penalty right now is probably too low and that's something ideally we would fix.
In other words, he believes the problem with the ACA lies with "deadbeats" who refuse to purchase a substandard product despite a government-imposed penalty. His solution? Make the government-imposed penalty higher. What comes next? Hmm, let's set the wayback machine to November 27, 2013 and see if anyone has any ideas…
Lambert Strether
November 27, 2013 at 1:41 amThen again, perhaps I wasn't cynical enough. If you don't assume ObamaCare is about health care, a lot falls into place.
Sammy Maudlin
November 27, 2013 at 10:55 amIt's obviously not about "health care." Where's dollar one towards nutrition education? Subsidies for organic farming? Tax breaks towards gym membership and/or the purchase of exercise equipment? Why are health savings accounts being gutted?
Nope, it's about creating a captive market for the health insurance companies consisting of every American citizen. You don't buy health insurance, there will be tax consequences courtesy of your federal government. Currently, those consequences are minimal. However, how long will it be before ACA "deadbeats" (who aren't paying their "shared responsibility" and costing the rest of us!) are in the crosshairs of the government and a media campaign is launched to repeal the ban on criminal liability for non-compliance?
If I were more cynical, it might look like a protection racket to me.
I'm still not that cynical because they are not asking for criminal penalties yet. But I'm getting there.
Jim Haygood October 27, 2016 at 5:27 pmThis is exactly the kind of clueless rhetoric that has caused uprisings in the past ….
I was speechless having read that transcript …… I mean …I read that as … "lets BLEED THEM EVEN MORE !!!"
jawbone October 27, 2016 at 7:39 pmWe had to destroy the consumers in order to save them.
EmilianoZ October 27, 2016 at 4:43 pmAll of which comments above indicate that the Dems have firmly joined the "Hurry Up and Die" as set forth by the Repubs.
ObamaCare, while it has been good for some portion of those insured by it, is essentially a Profit Protection Plan for The Bigs.
timbers October 27, 2016 at 2:42 pmIs being on Medicaid better than being on 0bamacare?
MyLessThanPrimeBeef October 27, 2016 at 3:47 pmHealth Care
From I think the same NYT article:
The I.R.S. says that 8.1 million returns included penalty payments for people who went without insurance in 2014, the first year in which most people were required to have coverage. A preliminary report on the latest tax-filing season, tabulating data through April, said that 5.6 million returns included penalties averaging $442 a return for people uninsured in 2015.
How can any sane person ignore that as a failure warning as are Obama and Clinton?
The same folks who see Iraq, Afghanistan, Libya, Yemen, Somalia, Syria, and Ukraine as not failures also think Obamacare a success. Higher penalties, more subsidies to rich gigantic insurance corporation is what Hillary will fight for. Oh…and more Iraqs, Libyas, Syrias, and Ukraines, too.
ProNewerDeal October 27, 2016 at 4:06 pmAre penalty payments considered taxes?
If so, they are destroying money with this law.
fw http://www.vox.com/policy-and-politics/2016/10/25/13396118/obamacare-mandate
Marie Antoinette-level out of touch Matthew Yglesias, claims the ACA could be solved by making the Individual Mandate needs to be "much bigger" & "generous special exemptions" should be removed.
Matthew Yglesias, making an attempt at being the Douchiest Bag.
Adult median income is ~29K. 75% of workers live "paycheck to paycheck", their pay barely meets purchase of essentials like housing rent & food. Student loan debt topped $1 Trillion & is the biggest consumer debt, yet many student loan debtors are Type 1 &/or Type 2 Underemployed, adding another extra cost.
People are already getting insulted by paying the Individual Mandate, or the Tax on Time waiting on hold for IRS Customer No-Service to possibly get a form indicating a "generous exemption". But to Yglesias, if the Mandate was "much bigger", that would compel them to purchase ACA.
Yglesias doesn't mention what "much bigger" Mandate Penalty means. Is it double? Is it half of what a Bronze plan premimums is, & what would that be, ~5X the current Mandate Penalty?
Yglesias makes no mention that many ACA policy holders cannot afford to actually use the insurance, due to the high ~$6K deductibles.
Yyglesias makes no mention of having the Nostradamus Jan 2018 & predict calendar 2017 income, despite many jobs becoming increasingly unstable, gig economy'd or otherwise crapified & unpredictable.
Yglesias makes no mention of the heinous Medicad Estate recovery.
Yglesias does at least suggest that his "bigger Penalty" should be accompanied by a "public option" health insurance.
BTW I recall Yglesias fellow dbag, 0bot Lawrence O'Donnell condescendingly smugly claim on msDNC that the "Indivdual Mandate Penalty" is optional. AFAIK, O'Donnell has never apologized or corrected his incorrect claim.
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Oct 27, 2016 | economistsview.typepad.com
pgl : , October 26, 2016 at 08:05 AMBrad and Michael DeLong make a strong case for more vigorous anti-trust enforcement re the health insurance sector:im1dc -> pgl... , -1Of course a public option would also lead to more vigorous competition. This needs to be on the top of President Clinton's agenda come January 2017. Trump on the other hand thinks we should just get rid of Obamacare and offer "more choices" whatever that means. Of course Trump has no idea what any of this means.
The Obama Administration Justice Dept has been asleep until this past year on Medical competition/consolidation.Justice has begun this past 9 months to oppose Hospital Mergers b/c it has been shown to drive up Health Care Costs, i.e., when Hospital Systems consolidate and control markets medical prices go up.
Justice is opposing the merger of the only two Hospital Systems in my MSA, regardless the merger is still on.
If it goes through there will be one provider which will control health care costs in a 50+ mile radius in East TN and Western Virginia, although they pledge not to, of course.
Competition works, consolidation does not, even in Healthcare. Consolidation makes some people very wealthy and powerful at the expense of everyone else.
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Oct 25, 2016 | economistsview.typepad.com
anne : October 25, 2016 at 05:32 AM
http://cepr.net/blogs/beat-the-press/nyt-reports-on-sharp-slowing-of-insurance-costs-under-obamacare
October 25, 2016
New York Times Reports on Sharp Slowing of Insurance Costs Under Obamacare
Just kidding. Actually, insurance costs have slowed sharply in the years since the Affordable Care Act was passed, but it is unlikely many readers of the NYT would know this. Instead, it has focused on the large increase (not levels) in premium costs for the relatively small segment of the population insured on the exchanges. In keeping with this pattern, it gives us a front page piece * telling readers about the 25 percent average increase in premiums facing people on the exchange this year. There are two points to keep in mind on this issue.
First, the focus on premiums is exclusively on the relatively small segment of the population getting insurance through the exchanges and specifically through the exchanges managed through the federal government. According to the latest numbers, 12.7 million people are now getting insurance through the exchanges ** (roughly 4.0 percent of the total population). This article refers to the premiums being paid by the 9.6 million people insured through the federally managed exchange (3.0 percent of the total population). Many states, such as California, have well run exchanges that have been more successful in keeping cost increases down.
There are two reasons that costs on the exchanges have been rising rapidly. The first is that insurers probably priced their policies too low initially. Even with the increases this year premium prices are still lower than had been expected in 2010 when the law was passed. In fact, there has been a sharp slowing in the pace of health care cost growth in the last six years. While not all of this was due to the ACA, it was undoubtedly a factor in this slowdown. In the years from 1999 to 2010, health care costs per insured person rose at an average annual rate of 5.7 percent. In the years from 2010 to 2015 costs per insured person rose at an average rate of just 2.3 percent.
[Graph]
The other reason that premiums on the exchanges have risen rapidly is that more people are stiill getting insurance through employers than had been expected. The people who get insurance through employers tend to be healthier on average than the population as a whole. The Obama administration expected that more employers would stop providing insurance, sending their workers to get insurance on the exchanges. Since they have continued to provide insurance, the mix of people getting insurance through the exchanges is less healthy than had been expected.
Note that this has nothing to do with the "young invincible" story that had been widely touted in the years leading up to the ACA. The problem is not that healthy young people are not signing up. The problem is simply that healthy people of all ages are getting their insurance elsewhere. The overall percentage of the population getting insured is higher than projected, not lower as the young invincible silliness would imply.
** https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-04.html
-- Dean Baker
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Oct 25, 2016 | economistsview.typepad.com
Fred C. Dobbs -> anne... October 25, 2016 at 09:19 AM
(Just because Robert Pear does a pieceEMichael -> Fred C. Dobbs... , October 25, 2016 at 10:26 AM
about the problem doesn't mean it's
not a real one.Would you believe NPR?)
Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too
https://n.pr/2eokAZGOctober 24 - All Things Considered - Alison Kodjak
The cost of health insurance under the Affordable Care Act is expected to rise an average of 22 percent in 2017, according to information released by the Obama administration Monday afternoon.
Still, federal subsidies will also rise, meaning that few people are likely to have to pay the full cost after the rate increases to get insurance coverage.
"We think they will ultimately be surprised by the affordability of the premiums, because the tax credits track with the increases in premiums," said Kevin Griffis, assistant secretary for public affairs at the Department of Health and Human Services.
The 22 percent rise reflects the average for all insurance marketplaces, both federal and state-based exchanges for which data are available. For insurance purchased through the federal HealthCare.gov exchange the rise will average 25 percent.
During a media briefing Monday, Griffis said the 2017 rates are roughly at the level the Congressional Budget Office forecast when the law was proposed. "The initial marketplace rates came in below costs," he said. "Many companies set prices that turned out to be too low." ...
(Assuming Clinton is in the White House,
and enough Dems are in Congress next year,
this had better be dealt with pronto.)No, there is a problem, but Pear has no idea what it actually is and spends no time in putting it in perspective.DeDude -> anne... , October 25, 2016 at 05:55 AMThese increases were certainly expected, as were the decreases expected in the areas that had them. This is a totally unknown insurance pool. There is no experience with these people at all. To make it worse, the first people to sign up were the people who had been denied insurance because of pre existing conditions who really need medical care and could not afford it.
It'll calm down, but people like Pear are not interested in facts at all, and certainly not interested in perspective.
Why don't people like Pear state, "even with these premium increases insurance through the exchanges will be be less expensive than insurance through employers"? Nah, not the right message.
Or how about, "while the percentage increases are high, more than 3/4 of the insured will not have those kind of increases?" Nah, that doesn't sound that bad.
Or how about finding out what the average premium payments are under the exchanges and putting the increases into perspective? Something like, "Most new enrollments were for low premium policies. Phoenix is going to have some of the highest increases, in some cases going up as high as 111%. Last year a 30 year old single with no subsidy paid, at that low premium level, $60 a month in premiums, or $720 a year. Now that will be $120 a month or $1440 a year. Meanwhile that same person, if he had employer provided insurance would have paid an average premium of(between him and his employer) $6435 a year". Nah, that doesn't say what he wants to say.
Course, deductibles are different in all of those cases. Max out of pocket is fixed under the ACA at $7150 per person. So that 30 year old in Phoenix is going to pay a minimum of $1440 a year for his healthcare. If he gets seriously injured or sick he will pay at most, $8590.
Lot of money, no question. But the guy with employer provided insurance is going to pay a minimum of $6435 a year. His deductible will be around $1478 a year and then add in the out of pocket max that varies drastically, with 14% having less than $2000 as the OOP max and 18% having an OOP max of more than $6000.
http://kff.org/report-section/ehbs-2016-summary-of-findings/
You tell me which is cheaper, which you would rather have, especially if you were a healthy 30 year old.
One more thing. The exchange numbers are for 2017, the employer numbers are for 2016.
Charlatans like Pear are no better than the front page of the National Enquirer. He should not be paid attention to for any reason. And he has been doing it for decades.
Just put a public option on each of these exchanges.anne -> DeDude... , October 25, 2016 at 06:26 AMJust put a public option on each of these exchanges.EMichael -> anne... , October 25, 2016 at 06:50 AM[ Important, though I would argue not a permanent solution:
February 25, 2016
Clinton's 'Public Option' is a Diversion: We Need Single Payer, Medicare for All
By Don McCanne, M.D. ]It is not a diversion, it is part of the process.Adamski -> EMichael... , October 25, 2016 at 07:15 AMA public option would lead to single payer.
If Congressional Dems chicken out of single payer due to the power of the insurance and drug lobbies, then the same lobbies will oppose a public option as they did when the ACA was being debated. Either policy needs the determination to defeat those lobbies, so the same Dems might as well pass single payer. That's why a public option is both a diversion and unlikely to pass.EMichael -> Adamski... , October 25, 2016 at 07:23 AMWhen the ACA was going through, a public option didn't need 60 votes in the Senate, because they were doing it by reconciliation so it only needed 51. So they whipped against a public option!
As bad and uninformed as your entire post is, this takes the cake:JohnH -> Adamski... , October 25, 2016 at 07:37 AM
"When the ACA was going through, a public option didn't need 60 votes in the Senate, because they were doing it by reconciliation so it only needed 51. So they whipped against a public option!"That comment has no basis in reality. You really should not talk with such certainty(even using an exclamation mark)on a subject that you surely have no knowledge.
Agreed...EMichael always tries to find a way to let corrupt Democrats off the hook. Democrats have become past masters at explaining away their ineptitude in 2009. Fact is, they really didn't have any intention of accomplishing much for the American people, and their big majority put them in an embarrassing situation that exposed their 'liberal' agenda as being little more than hot air.pgl -> JohnH... , October 25, 2016 at 07:57 AMMore troubling yet...if Democrats couldn't pass a public option with 60 votes in their Senate caucus, how will Hillary be able to pass any positive health care reforms with a bare majority in the Senate...if she even gets that? Overall Democrats will be happy, because they will have a plausible explanation for doing nothing...
Getting the facts right is letting corruption off the hook? I would say you've lost your mind but me thinks you never found it in the first place.Dan Kervick said in reply to Adamski... , October 25, 2016 at 07:57 AMBoth would be very difficult to pass. But single payer would be much more difficult, by many orders of political magnitude, since it involved putting the entire private health insurance industry out of business; moving many, but not all, of the workers in that industry into the new public health insurance bureaucracy; and creating new jobs for the people dislocated by the transition.JohnH -> Dan Kervick... , October 25, 2016 at 09:17 AMSince Clinton has not run as a single payer advocate, and thus will have no popular mandate to pass it, it is difficult to imagine her being able to mobilize the huge political effort that would be needed for such a gargantuan political task, even if she wanted to do this.
At this point, the best that can be hoped for is a public option that is then grown and expanded over time, by steps, into a single payer system.
The best way to provide single payer would be to nationalize the health insurance industry, which would not be that hard, since it is rapidly consolidating into an oligopoly consisting of a few big firms. And it wouldn't cost that much either.pgl -> JohnH... , October 25, 2016 at 09:37 AMBut, as your say, that's politically impossible...and we're not supposed to entertain that possibility, even though economists love to entertain themselves with pie in the sky stuff like helicopter money.
"The best way to provide single payer would be to nationalize the health insurance industry".Dan Kervick said in reply to pgl... , October 25, 2016 at 09:46 AMThis is like saying the best way to drink coffee is to drink coffee. I guess you do not know what single payer means.
It's clear JohnH means that the industry is first nationalized as is, and then methodically consolidated over some period of time to transform it into a lean and proper single payer system..Tom aka Rusty said in reply to pgl... , October 25, 2016 at 09:49 AMActually, there is a difference.Dan Kervick said in reply to Tom aka Rusty... , October 25, 2016 at 10:21 AMThere could be single payer insurance without nationalizing health care services.
Sure, I guess there could be a privately run health insurance monopoly. But who is advocating for that?Dan Kervick said in reply to Dan Kervick... , October 25, 2016 at 10:24 AMJohnH didn't say anything about nationalizing health care services. He said we could nationalize the health *insurance* industry.pgl -> Dan Kervick... , October 25, 2016 at 10:39 AMAgain - exactly my point. Someone today actually ate his Wheaties and can read with precision.Dan Kervick said in reply to pgl... , October 25, 2016 at 10:57 AMSorry, I have no idea what your point was.pgl -> Dan Kervick... , October 25, 2016 at 10:38 AMNo one. Exactly my point. Leave it to Rusty to advocate a private monopoly for health insurance.Tom aka Rusty said in reply to pgl... , October 25, 2016 at 11:11 AMHuh?Julio -> Dan Kervick... , October 25, 2016 at 09:31 AMYou apparently do not understand the difference between a government single payer insurance and a government monopoly provider.
Oh, nonsense. Just give Republicans their wishes. Ability to sell across state lines. Deregulation. Non-enforcement of antitrust.Peter K. -> Julio ... , -1
We'll have a single payer in no time.Yggies suggests a combo harsher penalities for the Bernie Bros and Gals with a public option.http://www.vox.com/policy-and-politics/2016/10/25/13396118/obamacare-mandate
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Oct 25, 2016 | n.pr
October 24 - All Things Considered - Alison Kodjak
The cost of health insurance under the Affordable Care Act is expected to rise an average of 22 percent in 2017, according to information released by the Obama administration Monday afternoon.
Still, federal subsidies will also rise, meaning that few people are likely to have to pay the full cost after the rate increases to get insurance coverage.
"We think they will ultimately be surprised by the affordability of the premiums, because the tax credits track with the increases in premiums," said Kevin Griffis, assistant secretary for public affairs at the Department of Health and Human Services.
The 22 percent rise reflects the average for all insurance marketplaces, both federal and state-based exchanges for which data are available. For insurance purchased through the federal HealthCare.gov exchange the rise will average 25 percent.
During a media briefing Monday, Griffis said the 2017 rates are roughly at the level the Congressional Budget Office forecast when the law was proposed. "The initial marketplace rates came in below costs," he said. "Many companies set prices that turned out to be too low." ...
(Assuming Clinton is in the White House,
and enough Dems are in Congress next year,
this had better be dealt with pronto.) Reply Tuesday, October 25, 2016 at 09:19 AM EMichael said in reply to Fred C. Dobbs... No, there is a problem, but Pear has no idea what it actually is and spends no time in putting it in perspective.These increases were certainly expected, as were the decreases expected in the areas that had them. This is a totally unknown insurance pool. There is no experience with these people at all. To make it worse, the first people to sign up were the people who had been denied insurance because of pre existing conditions who really need medical care and could not afford it.
It'll calm down, but people like Pear are not interested in facts at all, and certainly not interested in perspective.
Why don't people like Pear state, "even with these premium increases insurance through the exchanges will be be less expensive than insurance through employers"? Nah, not the right message.
Or how about, "while the percentage increases are high, more than 3/4 of the insured will not have those kind of increases?" Nah, that doesn't sound that bad.
Or how about finding out what the average premium payments are under the exchanges and putting the increases into perspective? Something like, "Most new enrollments were for low premium policies. Phoenix is going to have some of the highest increases, in some cases going up as high as 111%. Last year a 30 year old single with no subsidy paid, at that low premium level, $60 a month in premiums, or $720 a year. Now that will be $120 a month or $1440 a year. Meanwhile that same person, if he had employer provided insurance would have paid an average premium of(between him and his employer) $6435 a year". Nah, that doesn't say what he wants to say.
Course, deductibles are different in all of those cases. Max out of pocket is fixed under the ACA at $7150 per person. So that 30 year old in Phoenix is going to pay a minimum of $1440 a year for his healthcare. If he gets seriously injured or sick he will pay at most, $8590.
Lot of money, no question. But the guy with employer provided insurance is going to pay a minimum of $6435 a year. His deductible will be around $1478 a year and then add in the out of pocket max that varies drastically, with 14% having less than $2000 as the OOP max and 18% having an OOP max of more than $6000.
http://kff.org/report-section/ehbs-2016-summary-of-findings/
You tell me which is cheaper, which you would rather have, especially if you were a healthy 30 year old.
One more thing. The exchange numbers are for 2017, the employer numbers are for 2016.
Charlatans like Pear are no better than the front page of the National Enquirer. He should not be paid attention to for any reason. And he has been doing it for decades. Reply Tuesday, October 25, 2016 at 10:26 AM DeDude said in reply to anne... Just put a public option on each of these exchanges. Reply Tuesday, October 25, 2016 at 05:55 AM anne said in reply to DeDude... Just put a public option on each of these exchanges.
[ Important, though I would argue not a permanent solution:
February 25, 2016
Clinton's 'Public Option' is a Diversion: We Need Single Payer, Medicare for All
By Don McCanne, M.D. ] Reply Tuesday, October 25, 2016 at 06:26 AM EMichael said in reply to anne... It is not a diversion, it is part of the process.A public option would lead to single payer. Reply Tuesday, October 25, 2016 at 06:50 AM Adamski said in reply to EMichael... If Congressional Dems chicken out of single payer due to the power of the insurance and drug lobbies, then the same lobbies will oppose a public option as they did when the ACA was being debated. Either policy needs the determination to defeat those lobbies, so the same Dems might as well pass single payer. That's why a public option is both a diversion and unlikely to pass.
When the ACA was going through, a public option didn't need 60 votes in the Senate, because they were doing it by reconciliation so it only needed 51. So they whipped against a public option! Reply Tuesday, October 25, 2016 at 07:15 AM EMichael said in reply to Adamski... As bad and uninformed as your entire post is, this takes the cake:
"When the ACA was going through, a public option didn't need 60 votes in the Senate, because they were doing it by reconciliation so it only needed 51. So they whipped against a public option!"That comment has no basis in reality. You really should not talk with such certainty(even using an exclamation mark)on a subject that you surely have no knowledge. Reply Tuesday, October 25, 2016 at 07:23 AM JohnH said in reply to Adamski... Agreed...EMichael always tries to find a way to let corrupt Democrats off the hook. Democrats have become past masters at explaining away their ineptitude in 2009. Fact is, they really didn't have any intention of accomplishing much for the American people, and their big majority put them in an embarrassing situation that exposed their 'liberal' agenda as being little more than hot air.
More troubling yet...if Democrats couldn't pass a public option with 60 votes in their Senate caucus, how will Hillary be able to pass any positive health care reforms with a bare majority in the Senate...if she even gets that? Overall Democrats will be happy, because they will have a plausible explanation for doing nothing... Reply Tuesday, October 25, 2016 at 07:37 AM pgl said in reply to JohnH... Getting the facts right is letting corruption off the hook? I would say you've lost your mind but me thinks you never found it in the first place. Reply Tuesday, October 25, 2016 at 07:57 AM Dan Kervick said in reply to Adamski... Both would be very difficult to pass. But single payer would be much more difficult, by many orders of political magnitude, since it involved putting the entire private health insurance industry out of business; moving many, but not all, of the workers in that industry into the new public health insurance bureaucracy; and creating new jobs for the people dislocated by the transition.
Since Clinton has not run as a single payer advocate, and thus will have no popular mandate to pass it, it is difficult to imagine her being able to mobilize the huge political effort that would be needed for such a gargantuan political task, even if she wanted to do this.
At this point, the best that can be hoped for is a public option that is then grown and expanded over time, by steps, into a single payer system. Reply Tuesday, October 25, 2016 at 07:57 AM JohnH said in reply to Dan Kervick... The best way to provide single payer would be to nationalize the health insurance industry, which would not be that hard, since it is rapidly consolidating into an oligopoly consisting of a few big firms. And it wouldn't cost that much either.
But, as your say, that's politically impossible...and we're not supposed to entertain that possibility, even though economists love to entertain themselves with pie in the sky stuff like helicopter money. Reply Tuesday, October 25, 2016 at 09:17 AM pgl said in reply to JohnH... "The best way to provide single payer would be to nationalize the health insurance industry".
This is like saying the best way to drink coffee is to drink coffee. I guess you do not know what single payer means. Reply Tuesday, October 25, 2016 at 09:37 AM Dan Kervick said in reply to pgl... It's clear JohnH means that the industry is first nationalized as is, and then methodically consolidated over some period of time to transform it into a lean and proper single payer system.. Reply Tuesday, October 25, 2016 at 09:46 AM Tom aka Rusty said in reply to pgl... Actually, there is a difference.
There could be single payer insurance without nationalizing health care services. Reply Tuesday, October 25, 2016 at 09:49 AM Dan Kervick said in reply to Tom aka Rusty... Sure, I guess there could be a privately run health insurance monopoly. But who is advocating for that? Reply Tuesday, October 25, 2016 at 10:21 AM Dan Kervick said in reply to Dan Kervick... JohnH didn't say anything about nationalizing health care services. He said we could nationalize the health *insurance* industry. Reply Tuesday, October 25, 2016 at 10:24 AM pgl said in reply to Dan Kervick... Again - exactly my point. Someone today actually ate his Wheaties and can read with precision. Reply Tuesday, October 25, 2016 at 10:39 AM Dan Kervick said in reply to pgl... Sorry, I have no idea what your point was. Reply Tuesday, October 25, 2016 at 10:57 AM pgl said in reply to Dan Kervick... No one. Exactly my point. Leave it to Rusty to advocate a private monopoly for health insurance. Reply Tuesday, October 25, 2016 at 10:38 AM Tom aka Rusty said in reply to pgl... Huh?
You apparently do not understand the difference between a government single payer insurance and a government monopoly provider. Reply Tuesday, October 25, 2016 at 11:11 AM Julio said in reply to Dan Kervick... Oh, nonsense. Just give Republicans their wishes. Ability to sell across state lines. Deregulation. Non-enforcement of antitrust.
We'll have a single payer in no time. Reply Tuesday, October 25, 2016 at 09:31 AM Peter K. said in reply to Julio ... Yggies suggests a combo harsher penalities for the Bernie Bros and Gals with a public option.http://www.vox.com/policy-and-politics/2016/10/25/13396118/obamacare-mandate
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MaroonBulldog, January 2, 2016 at 5:34 pm
In 2014, the company I retired from also stopped providing retiree medical coverage to Medicare-eligible retirees like me, and replaced it with a health reimbursement account (HRA) to reimburse premiums for Medicare Advantage plan coverage or Medicare Supplement insurance and Medicare Part D insurance, which we retirees must pay in the first instance, and we too only get the reimbursement if we purchase the coverage through an exchange administered by the same benefits consulting vendor that also manages the claims under the HRA account.
I don't think this move had anything to do with Obamacare. My Obamacare obligations to purchase coverage are satisfied by my payment of premiums for Medicare Parts B and D. As far as I know, Obamacare doesn't force me to face a penalty for failing to purchase Medicare Supplement Insurance.
I think the move was prompted by the following financial considerations: the move enables the employer to shift contractual retiree medical obligations from a defined benefit obligation to a defined contribution obligation. This shifts the risk of rising premiums from the employer to the retirees. It also enables the employer to work its way out of the obligations over time, since it has no obligation to raise its defined contribution amount to keep up with inflation in health care premium costs. Finally, it divorces retirees from any medical benefits that active employees and younger retrirees get, over and above what Medicare provides. Medicare Supplement Insurance only covers deductibles and copayments under Medicare Part B.
My sister-in-law also retired from the same company, from a union-represented position. Her union went along with the employer, and agreed to stick bargaining unit retirees with the same deal management and the non-represented got.
This is not your expose. Maybe it's a start.
Mark, January 2, 2016 at 10:47 am
Greg T, January 2, 2016 at 4:43 pmI've lately become aware of an unfortunate consequence of Obamacare that perhaps Yves or Lambert could devote a post to: the rise of private exchanges.
My wife is a retiree with health benefits from the Ohio Public Employees Retirement System. Starting this year, OPERS eliminated its group Medicare Advantage plan for retirees, replacing it with – you guessed it – an exchange. Specifically, Towers Watson's OneExchange. OPERS retirees now choose a plan each year. They then pay the premiums directly to the insurer, with subsidization (in the form of a reimbursment) from a Health Benefit Account funded each month by OPERS.
After we started getting mailings from OPERS about the switchover last fall, I did a little online searching. It seems "exchangification" is a new trend in private health insurance – for employees as well as retirees. Here's how Towers Watson touts OneExchange:
"Private health insurance exchanges enable U.S. employers to rein in rising health benefit costs and mitigate the associated risks, while keeping their commitment to sponsoring coverage for employees. Towers Watson's OneExchange, today's most sophisticated private health insurance exchange, combines advanced exchange technology with Towers Watson's long history of innovation in health care benefit plan design and implementation."
(www.towerswatson.com/en-US/Services/our-solutions/OneExchange)
Notice the subtle change from employers having a commitment to provide coverage for employees to a commitment to "sponsor" coverage.
Obamacare – the gift that keeps on giving.
Dave, January 2, 2016 at 9:33 pmThis passage is pretty typical for a Democratic partisan. One would expect a similar essay from the likes of Sean Wilentz, but mr. rosenfeld's is laced with a bit more criticism and is less overtly apologetic.
The ACA is hardly an unqualified success story. It does some good things; Medicaid expansion in most states, it has reduced the number of uninsured. However it's success at controlling costs is ambiguous. Moreover, most participants now realize that they have bought a catastrophic care plan, that they have to pay very high deductibles before insurance even takes effect. This is simply a subsidy to the health insurance industry, it's not a system designed to protect the health and welfare of citizens. ACA is better than what existed before, but not by much.
The author's characterization of Russia's " land grab in Ukraine" is completely misleading and conveniently ignores the role of the US in engineering a coup of the duly elected Yanukovich government. It likewise ignores US support for a neo-Nazi government there that threatens Russia's interests in Russia's sphere of influence.
Maybe one should ask if Middle Eastern countries agree with the Obama Administration' s emphasis on diplomacy.30 to 40% boosts in health "insurance" premiums for Middle Class Americans and small businesses mean that there's no or little money for consumer spending, starting households etc.
Wait until year over year December sales numbers are released. The Obamacare expense recession has already begun.
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