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Contents Bulletin Scripting in shell and Perl Network troubleshooting History Humor

Obamacare vs. Trumpcare and staggering incompetence of Trump administration

Fake election time promise of Trumpcare as a better replacement for Obamacare
proved to be as ephemeral as his promise not to engage the USA in foreign wars

Incompetence of Trump administration during discussion of the replacement was staggering

News Trump's bustard neoliberalism and his betrayal of his voters Recommended Links The Audacity of Greed Medicare, Social Security and Debt Posturing Amorality and criminality of neoliberal elite Populism
Balance Billing Hospital overcharges Medicare Haggling with doctors and health insurers Neoliberal rationality First, do no harm  Groupthink
Cargo Cult Science Scientific Fraud Pseudoscience and Scientific Press Dumbing down america Quotes Humor Etc

Trumpo administration brought half-based reform of Obamacare and was defeated. Partially die to lack of preparation, partially due to serious defects in the content of the legislation,  which cut costs for Federal government and, at the same time, makes provided healthcare much less acceptable then highly defective Obamacare system for important constituencies (Keep It Simple In The Age Of Trump by Adam Ozimek ):

During the administration's struggle to replace Obamacare, President Trump remarked “nobody knew healthcare could be so complicated”. Indeed, the complexity of the issue to Trump has been reported by Politico as one of the key problems.

In his negotiations with the Freedom Caucus, Trump “didn't have sufficient command of the policy details to negotiate what would or would not be realistic for Ryan to shepherd through the House.”

As a result, many republicans are claiming the bill failed because Trump ”lacked familiarity with the legislation itself, and thought it was Ryan’s job to sell the specifics”.

And Obamacare like all neoliberal legislation is exceedingly complicated. Which created additional opportunities for profit for private insurance companies and miling of public by financial intermediaries, who mostly extract rents, while providing little or no positive contribution to provision of healthcare itself. Which consume around 20 cents or each dollar spend in US health services. Talk about the level of inefficiency.  And actually encourage some practices that are tantamount to racket -- Balance Billing. With CEO getting multimillion bonuses at the expense of patients.  

Add to this the fact that Obama was a very sleazy individual, the real master and "bait and switch", who was unwilling to fight for interest of his voters and actually served to Wall Street no less dutifully then Bush II,  and you get the idea -- Obamacare was a compromise in favor of insurance companies and at the expense of patients. 

As a compromise tilted toward insurers interests, Obamacare contains several complex interrelations, which make dismantling of the selected part of it, which you do not like, very complex. You can't just eliminate "insurance mandate" (the most objectionable from the point of view of Trump and Trump supporters part of Obamacare) which mandates that you should iether buy insurance or be penalized (unless you are a member of specific, known to IRS cult -- implicit advertisement for cults ;-).  Because this way you instantly change the composition of insured pool to the worse,  and thus increase premiums for those who remain in the pool.

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:

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

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]

Others

The 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 budgets

Maximum 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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Old News ;-)

[Sep 17, 2017] Obamacare is a symptom of a bigger American health care cost problem. If How much larger portion of the US economy can healthcare take before the entire system collapses? Its currently 17% heading for 20%, while competitor nations spend half that. Obamacare, was a hail mary to continue the party for the health insurance and overall industry at tax payer expense, and it was so poorly conceived that as you note, it is falling apart.

Sep 17, 2017 | vascript:void 0

There are two real question facing the US as to what sort of president will Trump be.

1. Thus far he looks to me to be a man who will run a tight ship deciding major issues himself and will make deals with whomever has the power to enable him to reach his goals.

IMO that means that the Republicans in Congress will either go along with Trump's legislative proposals or see Trump go across the aisle to seek votes.

A good example would be whatever it is that Trump decides that he wants to do about the obvious failure that is the ACA, presently sinking under the weight of far higher costs than expected and smaller enrollments. Democrats understand that the law must be modified to survive and to preserve the increase in health care coverage that it has brought. The hardline Republicans in both Houses of Congress want to destroy Obamacare and they have no realistic alternative other than the usual blather about private health accounts. Trump will not want to alienate his working class followers. Why would Trump not make a deal with the Democrats to get what he wants and needs?

ISL said... Dear Colonel,

Obamacare is a symptom of a bigger American health care cost problem. If How much larger portion of the US economy can healthcare take before the entire system collapses? Its currently 17% heading for 20%, while competitor nations spend half that. Obamacare, was a hail mary to continue the party for the health insurance and overall industry at tax payer expense, and it was so poorly conceived that as you note, it is falling apart.

I am hopeful that Pres Trump, who is not beholden to the insurance industry, unlike Obama, will take the side of the US (non-health care) business community and pull our costs to be more in line with those of the rest of the world.

I predict twitter storms against recalcitrant Repubs and Dems that mobilize via social media Trump's constituency to =scare the bejeezus of them for the mid terms. Reply 10 November 2016 at 11:08 AM Pete Deer said... "Why would Trump not make a deal with the Democrats to get what he wants and needs?"

He doesn't care about health insurance for anyone other than himself or his family. He is on record as supporting repeal and replace. And he is an incompetent person who is not a very good negotiator. In fact, he won't do any negotiating at all, leaving that to his staff as that would imply doing the hard work of governing, which is something he is really not all that interested in doing. I say that after having watched him over the past 30 years as he has bankrupted several business, stiffed his contractors and investors and cheated on his various wives. Why should he be any different now?

Pete Reply 10 November 2016 at 11:13 AM Anna said... Medicare for all would solve the crushing ACA problem at once - and this would endear Trump to the working class, progressives, small-business owners... to the absolute majority of the US citizenry. A process of reorganization from the current mess of viciously-profiteering middlemen (insurance companies) toward the Medicare for all could be achieved in one year. The reorganization must be approached as a nationwide emergency that demands a swift, drastic solution. There can be no restoration of the middle class and its purchasing power without first solving the scandalous healthcare crisis. The current system of penalties for not buying a health insurance is in fact a clear case of taxation without representation. Moving to a Single-payer system is perhaps the most urgent task for the US government Reply 10 November 2016 at 12:40 PM shaun said in reply to Anna... we don't do solutions this is the USA./ Reply 10 November 2016 at 02:13 PM Edward Amame said in reply to Anna... Anna

Do you remember why there was no banking reform in the aftermath of the 2008 crash? A very frustrated Sen. Dick Durbin admitted on the radio, "And the banks, hard to believe in a time when we're facing a banking crisis that many of the banks created, are still the most powerful lobby on Capitol Hill. And they frankly own the place."

Likewise with health insurance reform. HRC ran into an insurance industry/health care industry firestorm when she tried to reform the system in the early 1990s.

That's how we got Obamacare. Democrats had the full support of most of the base because the other side and the the insurance industry/healthcare industry were not willing to even entertain the idea of Medicare for all. We thought Obamacare was something that could get passed in a bi-partisan way because it was a "market-based" solution birthed in the Heritage Foundation that the insurance industry/healthcare industry got sort-of behind.

http://www.forbes.com/sites/theapothecary/2011/10/20/how-a-conservative-think-tank-invented-the-individual-mandate/#7380f885621b

Obamacare got passed without the public option because the insurance industry, the GOP, and some Blue Dog Dems demanded it be gone and yet the final version of Obamacare did not get a single GOP vote.

Based on what do you think Trump and the GOP House/Senate would even consider a major new entitlement like Medicare for all? Reply 10 November 2016 at 02:49 PM Anna said in reply to Edward Amame... If the only sensible solution to the healthcare crisis - the Single payer system - were not implemented, then Trump's other important projects will be destined for failure. Reply 10 November 2016 at 05:51 PM FourthAndLong said in reply to Anna... That it is. But medical care has always been for the priveleged historically. Emergency care and first aid excepted. Believing politicians actually care about the public is sort of like thinking parents will be around forever to look out for you, or worse. Egotist desire for a legacy is the best bet. Reply 10 November 2016 at 08:52 PM r whitman said... The individuals speaking out against the ACA do not have insurance under that program. They are medically secure under Medicare, Tricare, Corporate care, etc. The 6 people I know personally that have ACA insurance are happy with it within limits compared to their choices if any before the program.

The excuse that the finances are out of whack is a nonstarter. Every government program that subsidizes an area loses money--Medicare, Medicaid, the Military commissary system, the Farm program, AFDC, food stamps. All these were supposed o be self sustaining but as usual politicians lied about them. The ACA deficit is just more of the same. I am sure that it will evolve into a better system in time. In the meantime 20 million US citizens have some health insurance, same as the rest of us. Reply 10 November 2016 at 02:16 PM ISL said in reply to r whitman... r whitman,

Oh come on, do you really think that poorly of Americans that we are incapable of doing as poorly as the vast majority of European countries (if not sabotaged by crony capitalism), which have better health outcomes that the US? If we could do as well as Belgium (forget Denmark) costs would be half and people would live years longer.

Its not rocket science. Its that Obama was the single largest receiver of donations of any senator by a factor of TWO from the health insurance industry. Deplorable USA sent a message - the pay to play corruption of the establishment sucks. Expect the same message again in two years if their voice is ignored.
Reply 10 November 2016 at 04:29 PM r whitman said in reply to ISL... You miss my point. These people have health insurance. They did not have it before. They are reasonably happy with it. Do not confuse it with the cost. The USA always has the highest cost of government programs, health care or otherwise. Reply 10 November 2016 at 05:20 PM Anna said in reply to r whitman... "The individuals speaking out against the ACA do not have insurance under that program. They are medically secure under Medicare, Tricare, Corporate care, etc."
Could you conceive an idea that the majority of people that are against the ACA are very unhappy with paying the racket money to insurance companions while, at the same time, having no real coverage because of the exorbitant deductibles? The ACA is going to be more expensive next year - up at least 25% and to the whooping 144% - with zero (0) improvement in the coverage. But the most insulting aspect of the program is the penalty for not buying an insurance from the national racketeers; in some states the federal penalty has an additional state penalty. Instead of imposing an honest tax and providing the citizenry with universal health care (at least on the basic level), the racketeering class managed to tax the populace without representation. This is an act of murder of small businesses in the US. Reply 10 November 2016 at 06:09 PM r whitman said in reply to Anna... Are you an ACA participant?? There you go with the cost again. Forget the crooked government costs. The ACA people have health care which they did not have before. Several small businesses that I know have sent their employees to the ACA for health insurance and subsidize their premiums instead of screwing with insurance companies.

You need to divorce actual health care from the cost of health care. Health care is beneficial and in some cases curative. The cost is a racket like most government subsidy programs Reply 11 November 2016 at 10:45 AM

[Jul 25, 2017] Congress is obviously determined to replace Obamacare this year, without a viable alternative, and I think lobbying from hedge funds may be one of their motivations

Notable quotes:
"... Congress is obviously determined to replace Obamacare this year, without a viable alternative, and I think lobbying from hedge funds may be one of their motivations. ..."
"... All this comes back to the mystifying need in congress to enact a new healthcare bill this year that basically just removes a few key components of Obamacare. One of those key components is the Net Investment Income Surtax, which is a 3.8% tax on investment income that is used to increase Medicaid's coverage of people with low incomes. Is it possible that the urgency to pass a new healthcare bill this year is primarily related to its removal of a tax which helps calculate the $25-$100 billion that hedge funds will owe the government next year? If so, my guess is this will also have some influence on any tax cuts included in next years budget. ..."
"... "When asked if they would feel safe using a self-driving car, just 34% said they would while 67% said they would not." Huh? ..."
"... in the form of an amendment to the Republican bill ..."
"... even Republicans ..."
"... unless you give them your personal information. ..."
"... a high-risk investment in undeveloped and unproven ..."
Jul 25, 2017 | www.nakedcapitalism.com

JimTan , , July 25, 2017 at 3:16 pm

"And a majority doubt that President Trump .has a clear plan to replace Obamacare if Congress manages to repeal it."

Congress is obviously determined to replace Obamacare this year, without a viable alternative, and I think lobbying from hedge funds may be one of their motivations.

Hedge funds are compensated for their investment services using the standard 2 an 20 model, which means a management fee of 2% of all assets under management, and a performance fee of 20% of profits over a predetermined benchmark. Annual performance fees depend on how well the fund invests; low or no performance means no performance fee. This performance fee is classified by hedge funds as Carried Interest , which is a tax loophole that allows them to pay a low tax rate on these profits.

Annual management fees are independent of performance, and are always large numbers calculated as 2% of their multi-billion dollar assets under management. This management fee is commonly used to fund an offshore 'reinsurance company', because another tax loophole allows profits invested in these offshore insurance companies to be deferred indefinitely.

Apparently the 2008 bank bailout ( Emergency Economic Stabilization Act of 2008 ) closed this loophole and gave hedge funds until April 2018 to pay taxes on all these management fees they have been deferring in these offshore companies. On July 20th, the Wall Street Journal and CNBC estimated hedge fund managers collectively owe between $25-$100 billion in taxes on this money.

According to the article some hedge-fund managers face personal tax bills of over $100 million including Steven Cohen ( formerly SAC Capital ), David Einhorn ( Greenlight Capital ), and Daniel Loeb ( Third Point LLC ).

The article also says these deferred fees lower a hedge funds compensation costs, which suggests that many high level employees have past bonuses tied up in these offshore entities which are about to be taxed. To avoid some of these impending taxes, there is apparently an exodus of hedge funds moving to Florida which has no state income tax.

All this comes back to the mystifying need in congress to enact a new healthcare bill this year that basically just removes a few key components of Obamacare. One of those key components is the Net Investment Income Surtax, which is a 3.8% tax on investment income that is used to increase Medicaid's coverage of people with low incomes. Is it possible that the urgency to pass a new healthcare bill this year is primarily related to its removal of a tax which helps calculate the $25-$100 billion that hedge funds will owe the government next year? If so, my guess is this will also have some influence on any tax cuts included in next years budget.

IowanX , , July 25, 2017 at 7:08 pm

Hmmm. Tim Kaine was gushing on NPR yesterday about if the D's and R's worked together, what are the "fixes" and he's got a bill for "re-insurance"–but I don't know the details. Favorable tax treatment (I would guess) is almost certainly part of the bill.

Tim , , July 25, 2017 at 3:16 pm

"When asked if they would feel safe using a self-driving car, just 34% said they would while 67% said they would not." Huh?

Lambert, I think what is going on is driving used to be fun when there weren't very many cars on the road, now driving is so congested and commutes are so long that it is not only not fun, it is extremely stressful, so people are willing to take a hear no evil see no evil approach to driving just so they don't have the stress of doing the driving themselves.

The move to self driving cars is about safety at a society and government level, but at the individual level it is just about de-stressing and saving your concentration for other tasks.

I live 5 miles from work in a fully built out part of San Diego with good road infrastructure, so driving is still fun for me and I drive a stick shift, but I can see the guy stuck in LA traffic for 2-3 hours every day wanting to disconnect from that driving experience as soon as possible even if it may be less safe.

ChrisPacific , , July 25, 2017 at 7:30 pm

What's going on is that the poll is completely useless. I would like my next car to be autonomous. If it can fly, run without fuel, and transform into a magic fairy that cooks dinner and does the dishes, I'd like that too. Am I willing to entrust my safety to the current models on offer from the likes of Google and Uber (or their near term evolutions) knowing what I know about them and about their respective attitudes to regulatory and safety compliance? That's a totally different question.

What was the methodology for the survey? Who funded it? Where is the raw data? Providing disclosure on these points is standard surveying best practice. None of them are answered. The embedded links go to reportlinker.com which is a for-profit organization that produces business analytics. Who was their client in this case? I couldn't find that answer either.

I would file this one under advertising if I'm being kind, or propaganda otherwise.

River , , July 25, 2017 at 7:54 pm

If the car was like Ahmed from Count Zero , then sure I'd take one.

https://books.google.ca/books?id=dFX1xN7q-AgC&pg=PA113&lpg=PA113&dq=count+zero+ahmed&source=bl&ots=UwuJ_cxJpN&sig=Djqvols6Uu39bkQjnm2fOaocExY&hl=en&sa=X&ved=0ahUKEwim1NK20KXVAhWBzIMKHQGyDe8Q6AEIOTAC#v=onepage&q=count%20zero%20ahmed&f=false

page 112-113.

Mo's Bike Shop , , July 25, 2017 at 8:46 pm

Will our self driving cars be powered by the hydrogen economy?

Is SDC all unicorn feed, or is there some real tech being spun? I find everything bewildering about SDC evaporates when, like a fortune cookie, you add "on a battlefield" to the end.

Lambert Strether Post author , , July 25, 2017 at 3:21 pm

And :

Vice President Mike Pence cast the tie-breaking vote, clearing the procedural motion and allowing the Senate to begin debating an ObamaCare repeal.

On to the skinny bill, and then to the conference? But wait! Under reconciliation, there's the vote-o-rama to come:e

Those rules, defined by law, include allowing only 20 hours for debate but it also includes a process called "vote-a-rama," in which amendments may be proposed and must be voted on before the final passage of the bill. That's where Levin's idea comes in: He proposed introducing tens of thousands of amendments that would need to be voted on before the Senate's bill could be passed. In theory, Levin figured, Democrats could introduce enough amendments to shut down the Senate for a year.

It would be hilarious if Sanders introduced his single payer bill in the form of an amendment to the Republican bill . I don't know if that's possible under the rules, but why putz around with 1000s of little amendments?

mary , , July 25, 2017 at 3:26 pm

It would even more hilarious if the Senate Dems then all voted for it.

IowanX , , July 25, 2017 at 7:12 pm

+++++++100! Perfect. I think such an amendment would entirely be "in order". Lambert, you are a genius, and also a funny, funny man.

Cujo359 , , July 25, 2017 at 8:14 pm

I don't know what the rules allow, either, but you'd think that re-writing the House Medicare for All bill (HR 676) to be an amendment wouldn't take long. Neither the OC Repeal bill nor M4All is all that complex..

MikeW_CA , , July 25, 2017 at 3:31 pm

"Why Republicans should keep doing nothing" is a brilliant recommendation as far as I'm concerned, but at some point, don't even Republicans have to do something to deliver the goods their clients are paying for? What's the point of holding out for 2018 when you already have what should be the power to do whatever you want?

jo6pac , , July 25, 2017 at 3:39 pm

http://start.att.net/news/read/article/the_associated_press-the_latest_trump_keeps_up_twitter_pressure_on_heal-ap

Done and now part 2

Jim Haygood , , July 25, 2017 at 4:06 pm

Record closes today for the S&P 500 (at 2,477) and Nasdaq Composite.

This puts the "round number strange attractor" into effect: 2,500 or bust.

Dead Dog , , July 25, 2017 at 4:12 pm

Thank you, Lambert. Haven't posted a comment for a few days. Timing thing

Lots of news and links, but it feels less suspenseful at the mo – ie after the last 18 months or so – elections (US, UK, France), Brexit, Trump, Sanders, Corbyn, North Korean, the Russians, Yemen, Qatar and on, and on

Probably a good thing, I get more things done.

My home town of Cairns ticks along, same as. Well, as long as those pesky tourists keep coming (damn you Barrier Reef).

And, at least in my pub, the locals pay no attention whatsoever to anything happening south of Gordonvale (about 20k away). No, we are sophisticated. No politics, geo, neo, or whatever, or you have no friends. So, we sit there and take the piss out of everyone and we focus on footy, golf, the price of beer, cars, bikes, boats, fishing, camping and gossip.

I mean, why be curious like me? Nothing they can do to change things. And, as my partner says, I just don't want to know about that stuff (eg climate change, politics).

!!

One of the hidden news stories here in Oz is that a growing number of politicians (two Greens Senators, incl the QLD leader) have had to resign because of dual citizenship. ie you must be an Australian, and only an Australian (in our Constitution). (For example, I never renounced my UK citizenship (Anfield Boy) and would need to if I were to nominate to enter an election (not gonna happen).

The latest is our Resources Minister, Matt Canavan – who has resigned from the Parliament, after being told by his mother he was Italian, as well as Australian. See https://www.macrobusiness.com.au/2017/07/dual-citizenship-claims-canavan/

You can't make this up, eh? Hope they make him pay back the salary he has received during the years since he was elected.

To use the local venacular, Gold, pure Gold

6 am, still dark, cold, like about 17 degrees

Have a great day everyone

The Rev Kev , , July 25, 2017 at 7:11 pm

This story is hilarious. The ruling conservatives tore the Greens a new one last week over how they showed "extraordinary negligence" and "incredible sloppiness" over not checking that if their people had dual citizenship. Now it has come back to bite them hard and I heard that there may be about two dozen others from both major parties in the same boat.
Most people here say if you don't want to give up your other citizenship to serve another country in government, then don't bother putting your name in.The local 'intelligentsia'(?) are making noises that this is wrong and we should abolish that clause in our constitution. This clause does stop a country from flying in a bunch of carpetbaggers, err, technocrats and making them citizens on the spot to serve in government (I'm looking at you Ukraine).
Apparently countries like the US have no real problem with dual citizens serving in government ( http://thehill.com/blogs/congress-blog/homeland-security/240572-when-dual-citizenship-becomes-conflict-of-interest ) but at the end of the day, you have to wonder who they are actually serving at time. Could you imagine how it would look if, on CNN, if the members of the Senate and House of Reps were asked to put their hands up in the air if they were also citizens of another country? Not a good look I would imagine.

Dead Dog , , July 25, 2017 at 7:19 pm

Thank you, Kev, as you say, hilarious.

Now that the LNP have been caught being as sloppy as the greens, they've tried to argue that Canavan knew nothing, it was a staffer's fault, so he should be fine.

If you are right and this is start of a few more, then the make up of the Senate and the power therein could change in a bielection. Australians unlikely to vote in a party's replacement candidate – just the way we see things.

I didn't know the law officer ha ha

And, pay the family blog money back. Have to sell a few IPs?

Too sad

The Rev Kev , , July 25, 2017 at 8:12 pm

Sounds like he tried the Sergeant Schultz defense ( https://www.youtube.com/watch?v=UmzsWxPLIOo )
Come to think of it, didn't Shane Warne blame his mother too when accused of performance-enhancing drug taking?

Synoia , , July 25, 2017 at 10:06 pm

So, we sit there and take the piss out of everyone and we focus on footy, golf, the price of beer, cars, bikes, boats, fishing, camping and gossip.

All male group? No discussion of women? Or by women?

clarky90 , , July 25, 2017 at 4:40 pm

"The Democrats' 'Better Deal' is a box-office dud"

The cute, sad eyed puppy (The Democrats), that we brought home has grown up to be a thuggish Pit Bull Terrier. If it would only stop mauling the local children! So embarrassing. We must stare intensely at this dog with love- using positive affirmations. Then our Pit Bull will magically turn into a Labrador? (I don't think so.)

IMO, the democrats are hopeless. It is better to start a new party, or join the Republicans and influence that party? (Can I say this?)

The Dems are no longer the party of FDR. The Dems were pro slavery in the 1800s. Lincoln's Party was the Republicans.

"Anitya, anitya, anitya" (Impermanence). Everything changes. IMO, the Democrats are "a dead horse". Horse whispering will not work. Whipping will not work. Stand back and let time turn the carcass back into soil.

diptherio , , July 25, 2017 at 4:42 pm

Venezuela Constituent Assembly YES! Interference NO!

The U.S. State Department, the oligarchy and the Venezuelan right, together with the regional and European right have not let up in their attempt to destroy the enormous achievements accomplished by the Bolivarian Revolution of Venezuela and the Government of Nicolas Maduro.

The main objective that drives them, constantly and permanently, is to put into practice various methods of war in order to take control of the vast natural resources of the country, especially oil. Since Chavez, all those resources have been put in the hands and stewardship of the Venezuelan people.

It is the first time in two hundred years of history that this has happened, thanks to the emancipatory and anti-imperialist efforts of Commander Hugo Chávez – a direction continued by the Government of Maduro. The oil income is now at the disposal of huge projects aimed at benefiting those who were always forgotten and humiliated; the people, workers, farmers, blacks and native people.

Also for the first time in the history of Venezuela, illiteracy has been eradicated; more than 1,500,000 affordable homes have been built, education, culture and sports now reaches every corner and mountain top of the country and is no longer just a privilege to be enjoyed by the rich. Women have recaptured their dignity and today they occupy important positions at all levels of the life of the country, including the armed forces. Social missions have been multiplied to give a roof, work and land to those who never had anything .

Imperialism just could not stand what was happening.
So they plotted and invented a humanitarian crisis, by urging the Venezuelan right and the oligarchy to hide and destroy food and medicine while the imperialists themselves prevented shipments of these vital items. They gave cover to the cowardly terrorist imperialist right who have systematically refused to engage in dialogue while failing to organize even one "peaceful demonstration" that even remotely matched the size that the legitimate government of Maduro has been able to bring together.
Instead they have resorted to the most inhumane extreme tactics by funding, providing and sponsoring mercenaries that kill in the most horrendous ways any young man who looks like they could be a supporter of Chavez. Many times the color of their skin is enough to be set on fire.

http://theinternationalcommittee.org/venezuela-constituent-assembly-yes-interference-no/

curlydan , , July 25, 2017 at 4:42 pm

Maybe I'm the old hag. Anytime I read a summary of a Twitter fight (e.g. Joan Walsh), I get nauseous.

PKMKII , , July 25, 2017 at 4:56 pm

And tweetstorms. If you have that much to say, take it to a blog or Facebook.

clarky90 , , July 25, 2017 at 4:58 pm

Did South Park invent the alt-right?
http://www.avclub.com/article/south-park-raised-generation-trolls-258253

"South Park turns 20 years old this summer .The show celebrated this existential crisis-inducing fact last year with a tongue-in-cheek ad, depicting South Park as a sort of benevolent guarantor keeping reliable watch over a girl from infancy until her first trip to college. It was a typically self-effacing joke, but it's true: Our world is now filled with people for whom South Park has always been there, a cultural influence that, in some cases, is completely foundational to their point of view. The ad doesn't end with the girl logging onto Twitter to complain that social justice warriors are ruining the world, but otherwise, spot on."

polecat , , July 25, 2017 at 5:19 pm

You could say the same for, say, SNL no?
.. comedy of a different face, but still

MyLessThanPrimeBeef , , July 25, 2017 at 5:48 pm

Should I not have quit watching TV?

The quoted passage sounds quite foreign to me.

Richard , , July 25, 2017 at 9:07 pm

I used to frequent AV Club religiously, until they lost most of their best, veteran writers in what seemed like a purge a few years ago. Whenever I peeked in in '16, it seemed like Team Blue Central, shoehorning every feature into a critique of Trump, stupid conservatives, ignorant deplorables, etc.
That said, Sean O'Neill (a holdover from that earlier period) is an awesome writer, who has always had a penchant for holding elites (mostly cultural elites) up to well deserved ridicule in his news updates. And this is a fine piece. I wouldn't go as far as the title suggests, and neither does O'Neill actually; he backs down a bit in his conclusion.
I have real respect for South Park. Its writers have always understood an essential component of satire that liberal darlings (on the same network!) like the Daily Show and the Colbert Report tended to miss: you have to be merciless, and you can't make nice afterwards. You need to keep your distance.
It's possible the South Park and NC are a match made in heaven even! Co-creator Matt Stone's comment, " I hate conservatives, but I really (family blogging) hate liberals!"

Daryl , , July 25, 2017 at 9:40 pm

I don't think South Park is foundational to anyone's world view.

ewmayer , , July 25, 2017 at 5:49 pm

"At its core, the Times's internal transformation focuses on upending the paper's copy desk blah blah blah" [Vanity Fair] -- VF writer expends much digital ink fretting over the Verwandlung of the NYT, somehow omits the "and it's *still* an elite establishment propaganda rag which for the good of humankind would best be taken out into the alley and shot" bit.

Pat , , July 25, 2017 at 6:09 pm

OMG, the comedy just writes itself. McCain gets up after the vote to proceed and announces he won't vote for the bill itself because it is a shell of a bill. And then begs his fellow senators to work together. While it isn't quite Hillary Clinton giving an impassioned speech noting all the reasons NOT to vote for AUMF before voting for it, it is still pretty high up on the 'have it both ways' thing. And the bargaining begins.

McConnell better have lots left in that slush fund.

https://www.washingtonpost.com/news/the-fix/wp/2017/07/25/were-getting-nothing-done-john-mccains-no-holds-barred-lecture-to-the-senate-annotated/?utm_term=.30aa247203f5

Mad Pear , , July 25, 2017 at 6:25 pm

A better bad deal is still a bad deal. America doesn't need a better bad deal. America needs a good deal.

Steely Glint , , July 25, 2017 at 7:02 pm

2018, what is needed is a full throated roar of money is not speech, except in the "Market" and politics do NOT belong in the market sphere. That is why Bernie's message resonated, and why his list is so important! The 90 percent will be heard. And until the " little" people who are waiting for this to happen get a response, important matters like health insurance, demise of monopolies in agriculture "Red State" fly over country matter a great deal. Want to know why consumer spending on new cars are falling? Look no farther than the gig economy, where today's paycheck may be gone tomorrow, due to H1B visas, or what ever trade agreements have locked us into. Sorry, mic drop.

Oregoncharles , , July 25, 2017 at 7:18 pm

" an out-of-work auto mechanic whose nerve-damaged shoulder makes it impossible to lift his 11-month-old baby. " Or work.

Good luck to him. When my shoulder was damaged (admittedly, by doing something dumb), medical care was considerably worse than useless. Nerve damage? I know of nothing that will help that.

3.14e-9 , , July 25, 2017 at 7:18 pm

OT question for NC readers familiar with auto lending:

I recently got an auto loan from my credit union (awesome deal on a hybrid SUV on eBay, but that's another story). At the signing last month, I had to provide proof of insurance meeting minimum requirements, standard for auto loans: comprehensive and collision, max $1,000 deductible, with credit union listed as lienholder. I had it all set up beforehand, the loan officer approved it, so far, so good.

Then, in yesterday's mail, I received a letter saying that the credit union had received "evidence of insurance," but was "unable to fully accept this policy," because it didn't include comprehensive or collision coverage. I'm like, WTF? My policy actually exceeds the requirements, with $500 deductible C&C, plus an added premium for the balance to be paid to the lender in case something happens to the car before the loan is paid off.

I emailed the loan officer, and here's where it gets interesting. She apologized for the inconvenience and said it likely was because the credit union recently partnered with a third party for their insurance paperwork. She called it Allied Insurance, but a quick search showed that it's actually Allied Solutions LLC, which is a subsidiary of Securian. I'm not exactly sure what they do or why the credit union partnered with them, but alarm bells are going off in my head, starting with what they're doing with my private information.

After a few exchanges with the loan officer, I'm told that the proof-of-insurance form I signed authorized the credit union to provide its "Insurance Service Center" with the necessary information to verify coverage. Why they would need verification when they had the policy right in front of them is beyond me. More to the point, though, it doesn't say "third-party" insurance center. The average borrower/CU member could be excused for thinking this was an internal department.

I looked back over the letter I received last night. Nowhere does it identify the sender as Allied Solutions – not even on the outside of the envelope – and in fact it has my credit union's logo in the upper left-hand corner. It is signed simply, "Insurance Service Center." Further, it said I could have my insurance company forward a copy of my policy or, "for [my] convenience," I could verify the information online by accessing "my account" on myinsuranceinfo.com, or my insurance company could do it. Deafening alarm bell.

The letter not only was threatening ("You don't have the proper insurance on your car!"), but it essentially was accusing me of changing my insurance policy after the fact, since the loan officer had already approved it. Meanwhile, the loan officer is telling me I gave the credit union permission to share my insurance information with this company, even though they aren't named on the insurance paperwork or even identified as a generic "third party," and didn't identify themselves as such on their correspondence. Does this just "border on" fraud, or is it outright fraud?

The loan officer also sent me a copy of the CU's privacy policy saying they can legally share personal information for "everyday business purposes." Is the average bank/CU customer supposed to somehow just assume this means their auto insurance policy can be shared with third parties? And that they don't have to be notified about how that third party will use their private information?

In fact, the "terms of service" page on myinsuranceinfo.com says that any information you give them in feedback, comments, and the like, becomes theirs to use as they please. They collect personal information about visitors to the site only for statistical purposes, blahblah, unless you give them your personal information. Here's the exact language:

Allied Solutions will not obtain personally-identifying information about you when you visit our site, unless you choose to provide such information to us, nor will such information be sold or otherwise transferred to unaffiliated third parties without the approval of the user at the time of collection.

Well, now, how do you sign into "your account" and verify your insurance without providing them your personal information? I don't know, because I didn't even consider signing in.

I did a little more research and found a few credit union sites that link to myinsuranceinfo as a "service" to their members. From what I can tell, Allied offers the same service to banks.

In addition to the above questions, can any NC readers in financial services explain what's really going on here? Or maybe this is normal, and I should hop back on the turnip truck? Of course, that's not all Allied does. It looks to me like maybe they buy and sell auto loans, but I concede that I never understood that whole process, so I could be mistaken. What I do know – well, from what I've read in comments on NC – is that there's some weird activity going on lately with auto loans. Does the situation I describe fit into that in any way?

THANKS!!!

Jean , , July 25, 2017 at 9:17 pm

I wish I could help. Commiseration count? It's almost like a sci-fi plot – the mind-fuck of it.

Altandmain , , July 25, 2017 at 8:04 pm

Chlorinated chicken? Yes, we really can have too much trade
https://www.theguardian.com/commentisfree/2017/jul/25/chlorinated-chicken-trade-britain-us-food-standards-globalisation

Quite alarming if you think about US food standards.

Democrats Don't Know the First Thing About "Chasing" Rural Voters
http://progressivearmy.com/2017/07/25/democrats-dont-know-first-thing-chasing-rural-voters/

More policing, less spent on social programs
https://blavity.com/center-popular-democracy-policing-budget-study

alex morfesis , , July 25, 2017 at 8:30 pm

This day which will live in infamy lost behind the Trumpcare kabuki of john mccain & the declaration of war against russia, iran & 1dumbsun (419-3 ww3 here we come ) as the queen bee has previously pointed out litigation futures of darkoynz bit and ether and lite et al

sec comes out with report suggesting ico nonsense is actionable

https://www.sec.gov/litigation/investreport/34-81207.pdf

although "no action" for some reason on this german firm they go beyond just the indiviual
coynz themselves and insist the "exchanges" must also register as a National Securities Exchange

wow know a handful of securities attorneys who could probably clean up and fix the ico messes

but how many firms have actually worked on the being registered as an exchange side of things heck how many tall building law firms can even suggest they can do it

https://www.sec.gov/news/press-release/2017-131

and in all the risk factors suspect not even one ICO had the sec favored language of:

a high-risk investment in undeveloped and unproven

although this could get somewhat interesting if the sec allows a flood of these ico national security exchanges, it will possibly open up the scenario of local stock exchanges or "angel" exchanges much like in the days prior to the "big bang"

but the queen bee was spot on

most of these ico things will probably need to do roll ups and merge just to sustain the costs involved even if they go ahead and have a nice healthy carl icahn "end of the world" 2 inch thick litigation proof set of potential risk disclosures it will be interesting

sorry about the bold here .tried to cut and paste and redo and could not figure out how to make it go away..

[Jul 25, 2017] Dont underestimate how personally piqued McCain is over President Obama, taking McCains turn, when it comes time for a vote. McCain is a nasty man

Notable quotes:
"... One of my neighbors has this to say about McCain: "I worked for American Continental. So I know what kind of a crook he is!" Said neighbor is also of the "McCain was a traitor while in North Vietnamese custody!" school. ..."
"... As to your neighbor's opinion of McCain as a collaborator, this post from Ron Unz of the Unz Review is rather eye-opening . ..."
"... McCain comes back from getting health care to help make sure others don't get health care. That's nice. ..."
"... One would have though McCain's incessant pounding on the war drums would have been enough to turn people off. I can't understand how he is so eager to send people off to repeat what happened to him. ..."
"... It probably doesn't matter whether Arizonans notice or not. McCain isn't up for reelection until 2022, so even if he survives longer than the average person with his type of cancer, in 2022 he'll still probably be dead or too weak to campaign for another term. ..."
Jul 25, 2017 | www.nakedcapitalism.com

NotTimothyGeithner , July 25, 2017 at 2:31 pm

Don't underestimate how personally piqued McCain is over President Obama, taking McCain's turn, when it comes time for a vote. McCain is a nasty man. Now that Herr Trump beat Hillary, even McCain might have done it.

Pat , July 25, 2017 at 5:11 pm

Which only proves that McCain truly is an idiot, or doesn't expect to live for another two or so years. Having a signature 'achievement' fail outright to be far more embarrassing than repealing it and having your version of healthcare, whatever it is, fail as badly or worse than ACA would, Especially since delusional folk will still think we would be in the best shape ever if only the big bad Republicans hadn't repealed Barack Obama's health reform plan. There is no such glittery unicorn if ACA continues and dies of its own weight.

(I should note that for those us not under the media induced delusion of McCain as mavericky upstanding moral leader McCain being a vindicative idiot is very old news.)

Arizona Slim , July 25, 2017 at 6:19 pm

One of my neighbors has this to say about McCain: "I worked for American Continental. So I know what kind of a crook he is!" Said neighbor is also of the "McCain was a traitor while in North Vietnamese custody!" school.

JerseyJeffersonian , July 25, 2017 at 6:51 pm

As to your neighbor's opinion of McCain as a collaborator, this post from Ron Unz of the Unz Review is rather eye-opening .

Worthy of a read, particularly for the links to researchers' posts on the matter.

JohnnyGL , July 25, 2017 at 3:09 pm

McCain comes back from getting health care to help make sure others don't get health care. That's nice.

Tim , July 25, 2017 at 3:21 pm

I noticed that irony too, I don't see how anybody in the public would NOT notice that irony, since it is a well known fact that congress gets their own health care guaranteed.

Roger Smith , July 25, 2017 at 3:40 pm

Maybe if they have brain cancer they wouldn't notice . oh.

One would have though McCain's incessant pounding on the war drums would have been enough to turn people off. I can't understand how he is so eager to send people off to repeat what happened to him.

Vatch , July 25, 2017 at 5:33 pm

It probably doesn't matter whether Arizonans notice or not. McCain isn't up for reelection until 2022, so even if he survives longer than the average person with his type of cancer, in 2022 he'll still probably be dead or too weak to campaign for another term.

Arizona Slim , July 25, 2017 at 6:22 pm

And he keeps getting weak opponents on the D side of the ballot. In 2016, it was Ann Kirkpatrick. To this day, I can't figure out why she was so compelling to the Arizona Democratic Party establishment. Oh, in 2010, you're gonna love this: Rodney Glassman. Guy didn't even complete a single term on the Tucson City Council, but he thinks he can go up against one of the best-known names in American politics. Epic fail.

[Jun 28, 2017] Follow the Money: Non-Profit Hospital CEOs Quietly Collect Their Millions While US Health Care Reform Battle Rages by Roy M. Poses MD

Jun 28, 2017 | hcrenewal.blogspot.com
June 22, 2017 In Washington, DC the health care policy wars continue, with a few Republican senators working behind closed doors on a bill to "repeal and replace" Obamacare, aka the Affordable Care Act, and Democrats decrying their secrecy. Just as during the era in which Obamacare was enacted, there is constant discusison of how US health care costs continually rise, driving up insurance premiums, and how access to health insurance is continually in peril.

However, while the current Republican process to write new legislation seems strikingly opaque, in neither era has there been a frank discussion of why US health care costs are so amazingly high, and disproportionate to our mediocre health care outcomes. In particular, there has hardly been any discussion of just who benefits from the rising costs, and how their growing wealth may impede any real cost-cutting measures.

An obvious example is the gravity defying pay given to top health care managers, particularly the top managers of non-profit hospital systems.

Such systems provide much of the hospital care to Americans, and most have declared their missions to be providing the best possible care to all patients, or words to that effect. Many explicitly include care of the poor, unfortunate and vulnerable as a major part of their missions. As non-profit organizations, their devotion of mission provides some rationale to their freedom from responsibility for federal taxes.

As we last discussed in detail in May, 2016 , we have suggested that the ability of top managers to command ever increasing pay uncorrelated with their organizations' contributions to patients' or the public's health, and often despite major organizational shortcomings indicates fundamental structural problems with US health, and provides perverse incentives for these managers to defend the current system, no matter how bad its dysfunction.

In particular, we have written a series of posts about the lack of logical justification for huge executive compensation by non-profit hospitals and hospital systems. When journalists inquire why the pay of a particular leader is so high, the leader, his or her public relations spokespeople, or hospital trustees can be relied on to cite the same now hackneyed talking points.

As I wrote in 2015, and in May, 2016 ,

It seems nearly every attempt made to defend the outsize compensation given hospital and health system executives involves the same arguments, thus suggesting they are talking points, possibly crafted as a public relations ploy. We first listed the talking points here, and then provided additional examples of their use. here , here here, here , here, and here , here and here .

They are:

Yet as we discussed recently , these talking points are easily debunked. Additionally, rarely do those who mouth the talking points in support of a particular leader provide any evidence to support their applicability to that leader.

Boston, Massachusetts area, August, 2016 ( Per the Boston Business Journal )

West New York State, August, 2016 ( Per the Buffalo News

New Jersey, September, 2016 NJ Advance Media)

Top 10 hospital CEOs received total compensation from $1.94 million to $4.7 million

New Orleans, Lousisiana, September, 2016 (Per the Times-Picayune)

Gastonia, North Carolina, February, 2017 (Per the Gaston Gazette )

York County, Pennsylvania, April, 2017 (Per the York Daily Record)

Tri-Cities region, Tennessee and Virginia, June, 2017 (Per WJHL )

Connecticut, June, 2017 ( Per the Connecticut Post)

Summary and Conclusions

The current inflamed discussion of "Obamacare" and Republican attempts to "repeal and replace" it focuses on the costs of care and how they affect individual patients. Examples include concerns about health insurance premiums that are or could be unaffordable for the typical person; insurance that fails to cover many costs, and thus may leave patients at risk of bankruptcy due to severe illness; poor people unable to or who might become unable to obtain any insurance, and perhaps any health care. Yet there is little discussion of what really drives high and ever increasing health care costs (while quality of health care remains mediocre).

That may be because those who are benefiting the most from the status quo want to prevent discussion of their role. There are many such people, but top management of non-profit hospitals provide a ready example. Their institutions' mission is to provide care to sick patients. Many such hospitals specifically pledge to provide care to the poor, vulnerable, and disadvantaged. Non-profit hospitals have no owners or stockholders to whom they owe revenue.

Yet these days the top executives of non-profit hospitals receive enough money to become rich.

See the examples above.

The justification for such compensation is pretty thin. Consider the talking points above. Apparently hospitals are extremely concerned about paying top management enough to recruit and retain them. Yet there is much less evident concern about paying a lot of money to recruit and retain the health care professionals who actually take care of patients to fulfil the hospitals' mission. Hospital CEOs are frequently proclaimed to be brilliant, visionaries, or at least incredibly hard workers with very complex jobs. I wonder if those who make such proclamations have any idea what it takes to be a good physician or a good nurse. Yet such health care professionals' hard work, long training, devotion to duty, and ability to deal with trying situations and make hard decisions rarely inspire hospitals to shower them with money.

Furthermore, hospital CEO compensation is almost never justified in terms of their ability to uphold and advance the fundamental hospital mission, taking care of sick people. The articles above do not contain any justifications of generous CEO compensation based on hospitals' clinical performance or health care outcomes. At best, hospital executive pay seems to be justified by the hospitals' financial, not clinical performance.

As we discussed here , there is a strong argument that huge executive compensation is more a function of executives' political influence within the organization than their brilliance or the likelihood they are likely to be fickle and jump ship for even bigger pay. This influence is partially generated by their control over their institutions' marketers, public relations flacks, and lawyers. It is partially generated by their control over the make up of the boards of trustees who are supposed to exert governance, especially when these boards are subject to conflicts of interest and are stacked with hired managers of other organizations.

Furthermore, such pay may provide perverse incentives to grow hospital systems to achieve market domination, raise charges, and increase administrative bloat. As an op-ed

Outrageous pay gives top executives an incentive to behave outrageously. To hit the pay jackpot, they'll do most anything. They'll outsource and downsize and make all sorts of reckless decisions that pump up the short-term corporate bottom line at the expense of long-term prosperity and stability.

So I get to recycle my conclusions from many previous posts....

We will not make any progress reducing current health care dysfunction if we cannot have an honest conversation about what causes it and who profits from it. In a democracy, we depend on journalists and the news media to provide the information needed to inform such a discussion. When the news media becomes an outlet for propaganda in support of the status quo, the anechoic effect is magnified, honest discussion is inhibited, and out democracy is further damaged.

True health care reform requires publicizing who benefits most from the current dysfunction, and how and why. But it is painfully obvious that the people who have gotten so rich from the current status quo will use every tool at their disposal, paying for them with the money they have extracted from patients and taxpayers, to defend their position. It will take grit, persistence, and courage to persevere in the cause of better health for patients and the public.

And for our musical interlude, the beginning of "For the Love of Money," sung by the O'Jays, used in the official intro of season 2 of guess what show?

https://www.youtube.com/embed/rgr6EuG6zBw

[Jun 28, 2017] Trump betrayed all three his electin time promises about changes to Oabamacare: everybody got to be covered, no cuts to Medicaid, and Every bit as good on pre-existing conditions as Obamacare

Jun 28, 2017 | economistsview.typepad.com

im1dc June 25, 2017 at 09:27 AM

Here is a 5 day old article on Trump deregulating Big Pharma that directly impacts the skyrocketing costs of American Health Care to go with the above posts re the Republican Party's AHCA cutting of coverage and transfer of wealth to the wealthiest in America

Trump is the #1 problem with American Health Care today, he works for the interests of the corporations not the people's

https://www.nytimes.com/2017/06/20/health/draft-order-on-drug-prices-proposes-easing-regulations.html

"Draft Order on Drug Prices Proposes Easing Regulations"

By SHEILA KAPLAN and KATIE THOMAS...JUNE 20, 2017

"In the early days of his administration, President Trump did not hesitate to bash the drug industry. But a draft of an executive order on drug prices appears to give the pharmaceutical industry much of what it has asked for - and no guarantee that costs to consumers will drop.

The draft, which The New York Times obtained on Tuesday, is light on specifics but clear on philosophy: Easing regulatory hurdles for the drug industry is the best way to get prices down.

The proposals identify some issues that have stoked public outrage - such as the high out-of-pocket costs for medicines - but it largely leaves the drug industry unscathed. In fact, the four-page document contains several proposals that have long been championed by the industry, including strengthening drugmakers' monopoly power overseas and scaling back a federal program that requires pharmaceutical companies to give discounts to hospitals and clinics that serve low-income patients.

Mr. Trump has often excoriated the drug industry for high prices, seizing on an issue that stirs the anger of Republicans and Democrats alike. He has accused the industry of "getting away with murder," and said that he wanted to allow the federal government to negotiate directly with drug companies over the price of drugs covered by Medicare.

But the proposed order does little to specifically call out the drug industry and instead focuses on rolling back regulations, a favorite target of the administration..."

im1dc -> im1dc... , June 25, 2017 at 09:37 AM
Additional evidence of Trump lying about his and the Republican AHCA repeal of Obamacare

https://www.usatoday.com/story/news/politics/2017/06/24/promises-trump-made-health-care-repeal-plans/426089001/

"3 promises Trump made about health care that repeal plans haven't kept"

Eliza Collins , USA TODAY ...June 24, 2017

"...Here are three promises Trump made that will not come true under the current bills moving through Congress:

  1. 'Everybody's got to be covered.'...
  2. 'No cuts' to Medicaid"...
  3. 'Every bit as good on pre-existing conditions as Obamacare.'...
im1dc -> pgl... , June 25, 2017 at 11:53 AM
Cuts, cuts, and more cuts to reimbursement that's the Trump Republican AHCA in a nutshell.

All it will accomplish is to transfer $Billions to 'Trump's People', his fellow $Billionaires and MegaMillionaires.

It will not deliver on any Promise Trump made on Health Care and when he and the Republicans say it does they are lying, pure and simple.

More care does not come from far less money spent especially as the need increases due to population and need.

im1dc -> im1dc... , June 25, 2017 at 09:45 AM
I don't know the reason for persistence at attempts to understand the Economics of Trump's and the Republican various remake of the American Economy from an academic Economics perspective by this blog.

It is not possible to do any such rational analysis, b/c as Paul Krugman has pointed out recently and pointedly, there is no rhythm or reason to what they are doing except to obtain the sole single outcome of a major transfer of wealth to the wealthiest Americans in the form of a huge tax cut for most of America's Billionaires and Mega-Millionaires by eliminating as much as possible of the American Safety Net and other protections from the 99%.

[Jun 28, 2017] We can spend endless amounts of money on the NSA, wars overseas, political campaigns and bailing out banks, tha we canaffort single payer helathcare system

Jun 28, 2017 | economistsview.typepad.com

Christopher H. , June 28, 2017 at 08:10 AM

We can spend endless amounts of money on the NSA, wars overseas, political campaigns and bailing out banks, but PGL and the weak tea centrists demand "how are we going to pay for it???" now that single-payer is becoming a real possibility. Every other advanced nation does it better with massive savings for their taxpayers.

http://www.latimes.com/opinion/op-ed/la-oe-pollin-single-payer-healthcare-healthy-california-20170621-story.html

Op-Ed Single-payer healthcare for California is, in fact, very doable

by Robert Pollin

June 21, 2017

The California Senate recently voted to pass a bill that would establish a single-payer healthcare system for the entire state. The proposal, called the Healthy California Act, will now be taken up by the state Assembly. [not]

The plan enjoys widespread support - a recent poll commissioned by the California Nurses Assn. found that 70% of all Californians are in favor of a single-payer plan - and with good reason. Under Healthy California, all residents would be entitled to decent healthcare without having to pay premiums, deductibles or copays.

But as critics of the bill have pointed out, a crucial question remains: Is Healthy California economically viable? According to research I conducted with three colleagues at the University of Massachusetts, Amherst, the answer is yes.

Enacting Healthy California would entail an overhaul of the state's existing healthcare system, which now constitutes about 14% of California's GDP. In particular, it would mean replacing the state's private health insurance industry with government-managed insurance. Our study - which was also commissioned by the California Nurses Assn. - concludes not only that the proposal is financially sound, but that it will produce greater equity in the healthcare sector for families and businesses of all sizes.

California will spend about $370 billion on healthcare in 2017. Assuming the state's existing system stayed intact, the cost of extending coverage to all California residents, including the nearly 15 million people who are currently uninsured or underinsured, would increase healthcare spending by about 10%, to roughly $400 billion.

That's not the full story, though. Enacting a single-payer system would yield considerable savings overall by lowering administrative costs, controlling the prices of pharmaceuticals and fees for physicians and hospitals, reducing unnecessary treatments and expanding preventive care. We found that Healthy California could ultimately result in savings of about 18%, bringing healthcare spending to about $331 billion, or 8% less than the current $370 billion.

How would California cover this $331-billion bill? For the most part, much the same way it covers healthcare spending right now. Roughly 70% of the state's current spending is paid for through public programs, including Medicare and MediCal. This funding - totaling about $225 billion - would continue, as is required by law. It would simply flow through Healthy California rather than existing programs.

The state would still need to raise about $106 billion a year to cover the cost of replacing private insurance. This could be done with two new taxes.

First, California could impose a gross receipts tax of 2.3% on businesses, but with an exemption for the first $2 million of revenue. Through such an exemption, about 80% of all businesses in California - small firms - would pay nothing in gross receipts tax, and medium-sized businesses would pay an effective tax rate of less than 1%.

Second, the state could institute a sales tax increase of 2.3%. The tax would not apply to housing, utilities, food purchased for the home or a range of services, and it could be offset for low-income families with a 2% income tax credit.

Relative to their current healthcare costs, most Californian families will end up spending less, even with these new taxes, and some will even enjoy large gains. Net healthcare spending for middle-income families would fall by between 2.6% and 9.1% of income. Most businesses would also see a drop in spending. Small firms that have been providing health insurance for their workers will see costs fall by 22% as a share of payroll. For medium-sized firms, costs will fall by an average of between 6.8% and 13.4% as a share of payroll. Even most large firms will see costs fall, by an average of between 0.6% and 5% of payroll.

At the moment, about 2.7 million of California's residents, or about 8% of the population, have no health insurance. Another 12 million residents, or about 33% of the population, are underinsured. A large proportion of the remaining 60% of the population who are adequately insured still face high costs, as well as anxiety over President Trump's proposal to repeal and replace Obamacare.

Healthy California is capable of generating substantial savings for families at most income levels and businesses of most sizes. These savings are in addition to the benefits that the residents of California will gain through universal access to healthcare.

[Jun 28, 2017] how many people know, understand or even care what an "individual mandate" is

Jun 28, 2017 | economistsview.typepad.com

JohnH , June 28, 2017 at 08:17 AM

The message matters...something that eludes comprehension by Democrats... Question is are they really this stupid, or are they paid to be this stupid?

"How did [the healthcare debate] get to this point? A point where Harvard researchers are warning of 217,000 additional deaths over the next decade from a loss of health coverage? Part of the blame has to lie with the Democrats, who failed to heed Luntz's advice to the Republicans...

First, in defending Obamacare, they lacked "words that work." For instance, how many people know, understand or even care what an "individual mandate" is? How about insurance "exchanges"? Or the "public option"? These technical terms and phrases have obscured more than they have clarified. They have also played into the hands of the Republicans, who have worked hard to ensure that the public view health care only through a partisan lens.

Remember: around one in three Americans is unaware of the fact that there is no difference between Obamacare and the Affordable Care Act (ACA) - they are one and the same. Many of these people tell pollsters that they like the ACA but dislike Obamacare. (Isn't it odd how so many Americans' view of a health care system changes when you put the foreign-sounding name of a black man in front of it?)

Second, Democrats have turned down opportunity after opportunity to offer a comprehensive health care alternative that guarantees coverage to all Americans (unlike Obamacare, which leaves around 27 million Americans uninsured.) During the Democratic primaries, Hillary Clinton said a single-payer "health care for all" system would "never, ever come to pass." Inspiring, huh?

As for those on the left like Bernie Sanders and - belatedly - Elizabeth Warren, who are keen to offer a progressive alternative to both Trumpcare and Obamacare in the form of guaranteed, government-funded health care for all, they may have a clear and inspiring policy alternative but whether they have a clear and inspiring message for it remains to be seen. For example, according to a February 2016 poll by the Kaiser Family Foundation, "nearly two thirds (64%) of Americans say they have a positive reaction to the term 'Medicare-for-all,' and most (57%) say the same about 'guaranteed universal health coverage.' Fewer have a positive reaction to 'single payer health insurance system' (44%) or 'socialized medicine' (38%)."

The words don't work and, as a result, ignorance abounds.
"About half (53%) of Democrats say they have a very positive reaction to 'Medicare-for-all' compared with 21 percent who say the same for 'single payer health insurance system,'" according to the Kaiser poll. But to be clear: "Medicare-for-all" and "single payer" refer to the same exact thing.
So then "Medicare-for-all" must be the way to go, right? Rather than the bureaucratic-sounding and yawn-inducing "single payer"? Perhaps. Invoking Medicare to make the case for a system in which the government covers the cost of all health care claims, however, may not be the silver bullet that some on the left seem to think it is. Not everyone associates Medicare with the government. Remember the anti-Obamacare town halls in the summer of 2009, where attendees carried placards that read "Keep government out of my Medicare"? An August 2009 poll found that 39% of Americans said they wanted government to "stay out of Medicare" - which is, of course, impossible.

Why don't progressives go with the simpler option of calling their single-payer proposal "universal health care"? Or "health care for all"? In San Francisco, a single payer system called "Healthy San Francisco" was launched a decade ago and has had very high approval ratings. How about Sanders, Warren et al push for a federal version called "Healthy America"?"
https://theintercept.com/2017/06/28/memo-to-democrats-you-need-a-clear-message-for-universal-healthcare/

[Jun 25, 2017] Obama basically decided against marketing his healthcare plan.

www.unz.com

JohnH -> kurt... , June 23, 2017 at 07:05 PM

Jun 25, 2017 | economistsview.typepad.com
Obama basically decided against marketing his healthcare plan. In February, 2009 the Obama campaign contacted campaign workers and asked them to convene neighborhood groups to make suggestions for the plan. My wife and eye convened such a group. We believed it was to be part of a national grass roots push to overwhelm the naysayers.

We sent in the neighborhood's suggestions. We were told they would get back to us. They never did. Grassroots organizing was eliminated. There was no grassroots push. Obama hardly marketed his plan, letting Republicans define it for him.

That was when I began to smell a rat...

JohnH -> sanjait... , June 23, 2017 at 07:48 PM
"It's the Message, Stupid"
http://inthesetimes.com/article/5030/its_the_message_stupid

Back in 2009, Greenberg, Carville and Bauman developed a strategy for selling healthcare reform to the public...most of which Democrats just ignored. http://www.democracycorps.com/wp-content/files/dcorps-healthcare-062509.pdf

Much of it still applies today, but Democrats are clueless...they fear their big donors would revolt if they actually stated what the American people want and need.

JohnH -> mulp ... , June 23, 2017 at 08:06 PM
"actually works" is in the eye of the beholder.

Numbers of economists defended Bernie's proposals...but establishment ones linked with the Democratic Party did not.
http://observer.com/2016/02/liberal-economists-defend-bernie-sanders-against-a-chorus-of-critics/

Bill Black and Jaimie Galbraith were among the most prominent...but you never heard about their push-back because the liberal media blocked it out.

pgl , June 23, 2017 at 12:04 PM
Steve Beshear who was the Democratic Kentucky Governor who did a great job of implementing Obamacare for his state was asked about the stances of his state's two Senators. He really laid in McConnell which was no surprise. His comment re Rand Paul? Senator Paul wants to take our nation back to the 18th century.
jonny bakho -> Lee A. Arnold ... , June 23, 2017 at 05:12 PM
Please... Susan Collins is just as bad as the rest of them. Her carefully crafted public image is all show.

GOP moderates always cave because they are not moderates, they just play to the tastes of their purple states

The GOP will throw a few crumbs, make a big show about the "moderates" improving the bill and then they will be free to vote for it.
Trump, ever the con artist will sell it as Trump steak

JohnH -> kurt... , June 23, 2017 at 04:05 PM
Oh, BS. That the party is corrupt was made evident to anyone who watched Bubba sign away Glass-Steagall, just in time for Hillary to announce her run for Senator from New York/Wall Street. Of course, Bubba insists that there was no quid quo pro. Those who believe him would be good customers for buying the Brooklyn Bridge...

Since then, it's only gotten worse.

[Jun 24, 2017] The Secret Republican Plan to Unravel Medicaid by Robert Reich

Jun 24, 2017 | economistsview.typepad.com

Christopher H, June 23, 2017 at 01:23 PM

http://robertreich.org/post/162168911075

The Secret Republican Plan to Unravel Medicaid

by Robert Reich

FRIDAY, JUNE 23, 2017

Bad enough that the Republican Senate bill would repeal much of the Affordable Care Act.

Even worse, it unravels the Medicaid Act of 1965 – which, even before Obamacare, provided health insurance to millions of poor households and elderly.

It's done with a sleight-of-hand intended to elude not only the public but also the Congressional Budget Office.

Here's how the Senate Republican bill does it. The bill sets a per-person cap on Medicaid spending in each state. That cap looks innocent enough because it rises every year with inflation.

But there's a catch. Starting 8 years from now, in 2025, the Senate bill switches its measure of inflation – from how rapidly medical costs are rising, to how rapidly overall costs in the economy are rising.

Yet medical costs are rising faster than overall costs. They'll almost surely continue to do so – as America's elderly population grows, and as new medical devices, technologies, and drugs prolong life.

Which means that after 2025, Medicaid will cover less and less of the costs of health care for the poor and elderly.

Over time, that gap becomes huge. The nonpartisan Urban Institute estimates that just between 2025 and 2035, about $467 billion less will be spent on Medicaid than would be spent than if Medicaid funding were to keep up with the expected rise in medical costs.

So millions of Americans will lose the Medicaid coverage they would have received under the 1965 Medicaid act. Over the long term, Medicaid will unravel.

Will anyone in future years know Medicaid's unraveling began with this Senate Republican bill ostensibly designed to repeal and replace the Affordable Care Act? Probably not. The unraveling will occur gradually.

Will future voters hold Republicans responsible? Again, unlikely. The effects of the unraveling won't become noticeable until most current Republican senators are long past reelection.

Does anyone now know this time bomb is buried in this bill?

It doesn't seem so. McConnell won't even hold hearings on it.

Next week the Congressional Budget Office will publish its analysis of the bill. CBO reports on major bills like this are widely disseminated in the media. The CBO's belated conclusion that the House's bill to repeal and replace the Affordable Care Act would cause 23 million Americans to lose their health care prompted even Donald Trump to call it "mean, mean, mean."

But because the CBO's estimates of the consequences of bills are typically limited to 10 years (in this case, 2018 to 2028), the CBO's analysis of the Senate Republican bill will dramatically underestimate how many people will be knocked off Medicaid over the long term.

Which is exactly what Mitch McConnell has planned. This way, the public won't be tipped off to the Medicaid unraveling hidden inside the bill.

For years, Republicans have been looking for ways to undermine America's three core social insurance programs – Medicaid, Medicare, and Social Security. The three constitute the major legacies of the Democrats, of Franklin D. Roosevelt and Lyndon Johnson. All continue to be immensely popular.

Now, McConnell and his Senate Republican colleagues think they've found a way to unravel Medicaid without anyone noticing.

Don't be fooled. Spread the word.

[Jun 19, 2017] Republicans are embarrassing Democrats by showing them how legislation gets passed with a bare majority, when Democrats failed with a filibuster proof majority

Jun 19, 2017 | economistsview.typepad.com

JohnH, June 19, 2017 at 06:48 AM

Republicans are embarrassing Democrats by showing them how legislation gets passed with a bare majority...when Democrats could barely get anything done with a filibuster proof majority!

Moral of the story? Democrats under Obama didn't really want to get much done. Rather, they preferred to do nothing and blame Republicans instead. Worse, now that Republicans want to destroy what precious little Democrats managed to accomplish, Democrats are just standing around, frozen like deer in the headlights, clueless as to how to use their 48 votes.

How pathetic can Democrats get?

libezkova, June 19, 2017 at 06:40 PM
"Republicans are embarrassing Democrats by showing them how legislation gets passed with a bare majority...when Democrats could barely get anything done with a filibuster proof majority!"

Not only that.

Neoliberal stooges like Krugman now shed crocodile tears after pushing Sanders under the bus.

They essentially gave us Trump and now have an audacity to complain. What a miserable hypocritical twerp this Nobel laureate is!

Where is the DemoRats "Resistance" now? Are they fighting against the war in Syria on behave of Israel and Gulf states? Protesting sanctions against Cuba? Complaining about the record arms sale with Saudi Arabia (with its possible 9/11 links ?)

No, they are all on MSNBC or CNN dragging out a stupid investigation all the while pushing Russia to war. And congratulating themselves with the latest Russian sanctions designed to block supplies of Russian gas to Western Europe...

I want to repeat this again: Neoliberal Democrats created Trump and brought him to the victory in the recent Presidential elections.

[May 22, 2017] Medical insurance coverage is measure of social security for nearly everyone amd as such is close to Four Freedoms that were articulated by FDR

Notable quotes:
"... Being able to access care is an important freedom as well ..."
"... Trump as candidate promised no cuts to Medicaid. But then he had to get the Paul Ryan seal of approval so it is a massive cut that will leave 10 million people uninsured: ..."
"... Republicans have been using free lunch economic theory to make increasingly bigger promises leading to Trump promising universal health care with no taxes or mandates that will give everyone many more choices on getting far more health care with it costing much less. Trump won by being more extreme and explicit in the free lunch promises the Republican started making with Reagan. ..."
"... It's just standard Reaganomics... the same propaganda (trickle-down & rising tides) & standard tax cuts for the rich based on supply side b.s. ..."
May 22, 2017 | economistsview.typepad.com

Sanjait, May 22, 2017 at 11:36 AM

This is an important concept that has been fought for but hasn't been well articulated by Dems since Four Freedoms.

ACA is an example. It provides insurance coverage for many and a measure of security for nearly everyone. It reduces the risk of living as an American, nominally limiting the "freedom" to benuninsurednor buy crappy insurance in exchange for giving everyone enhanced ability to access preventative and major medical care, even if low income or stricken with a pre-ex medical condition.

Being able to access care is an important freedom as well .

Dems really face planted politically trying to sell this notion, but now that it is under threat of being taken away, Americans suddenly realized they like it and think it is right that people should have this access.

pgl - , May 22, 2017 at 11:50 AM
Exactly. I wonder if the folks have this captured in their little freedom indices.
ilsm - , May 22, 2017 at 03:32 PM
my freedom index has nothing to do with hospital insurance, or NCA. DNC (as good as Cato's) freedom index very far right of Thoreau!
DrDick , May 22, 2017 at 03:32 PM
For conservatives, freedom means the freedom of the rich and corporations from taxes and restrictions on their actions and nothing else.
pgl , May 22, 2017 at 11:53 AM
Trump as candidate promised no cuts to Medicaid. But then he had to get the Paul Ryan seal of approval so it is a massive cut that will leave 10 million people uninsured:

https://www.washingtonpost.com/business/economy/trump-to-propose-big-cuts-to-safety-net-in-new-budget-this-week/2017/05/21/62c01f44-3e34-11e7-adba-394ee67a7582_story.html?utm_term=.01d130c2f913

More tax cuts for the rich! That is their entire agenda.

mulp - , May 22, 2017 at 12:44 PM
Progressives see conservatives as winning by hijacking the Republican Party and being more and more radical, making Congress totally incapable of doing anything and increasingly popular, and getting Trump elected with a minority of the vote to an environment where he can accomplish even less that very moderate Obama and a Democratic majority, and they want Democrats to become more like Republicans:

able to win power, but unable to deliver on anything.

Republicans have been using free lunch economic theory to make increasingly bigger promises leading to Trump promising universal health care with no taxes or mandates that will give everyone many more choices on getting far more health care with it costing much less. Trump won by being more extreme and explicit in the free lunch promises the Republican started making with Reagan.

Progressives want a Bernie elected making big free lunch promises.

It's not about delivering, but about winning.

TANSTAAFL

Longtooth , May 22, 2017 at 03:38 PM
It's just standard Reaganomics... the same propaganda (trickle-down & rising tides) & standard tax cuts for the rich based on supply side b.s.

[May 08, 2017] Can we rescue the individuals with no exchange choices by allowing them to buy into MediCare

Notable quotes:
"... We have more good cop/bad cop. We are supposed to forget that the DNC democrats gave us deregulation, killed Glass-Steagall, refused to prosecute banksters, gave us a hokey republican health insurance plan, tried to give us TPP, continued more ME wars, screw with Russia, etc. ..."
May 08, 2017 | economistsview.typepad.com
paine , May 08, 2017 at 05:47 AM
Pk instead of keening away over
her lead role in the latest

FED borg folly

Trumpcare is a nasty

paine -> EMichael... , May 08, 2017 at 06:47 AM
A simple side swipe at trumpcare
to wield against yellen and the fed borg

Now is the moment to

RC AKA Darryl, Ron -> paine... , May 08, 2017 at 06:47 AM
The Fed Borg has not done anything unexpected whether we are basing that on Krugman's expectations or the expectations that you and I shared of her way back when she lead the Fed to liftoff. Now, we might have had different hopes and maybe even Krugman as well had different hopes, but none of us ever expected anything different than what the Fed actually did from then to now. We all know that we have a bankers' Fed and not a people's Fed.

OTOH, Krugman had very different expectations about the 2016 POTUS election than what actually happened in November. Krugman is just dealing with his disappointment in the best way that he can. It at least creates the illusion that he is making a difference and perception is at least 90% of reality for intellectual elites.

RGC , May 08, 2017 at 06:06 AM
"This is an act of deliberate betrayal":

PK knows whereof he speaks.

We have more good cop/bad cop. We are supposed to forget that the DNC democrats gave us deregulation, killed Glass-Steagall, refused to prosecute banksters, gave us a hokey republican health insurance plan, tried to give us TPP, continued more ME wars, screw with Russia, etc.

The bad cop tells us he is going to have some guys beat us up and then he has some guys beat us up. The good cop tells us he is going to take care of us and then he has some guys beat us up.

How long do people fall for that game?

RGC -> RGC... , May 08, 2017 at 06:24 AM
Pelosi Refuses to Back Single Payer, Despite GOP Deathmongering Suddenly Taking Center Stage

"No, I don't," Rep. Nancy Pelosi (D-Calif.) promptly said, when asked by a reporter if she thinks single payer should be in Democrats' 2018 party platform.

"I was carrying single payer signs probably around before you born, so I understand that aspiration," the House Minority Leader told Vice's Evan McMorris-Santoro. She then claimed that "the comfort level with a broader base of the American people is not there yet," with single payer.

"So I say to people: if you want it, do it in your states. States are laboratories," the Dem leader added. "States are a good place to start," she also said.

Pelosi's assertions about single payer's popularity, however, are called into question by public polling.

http://rinf.com/alt-news/newswire/pelosi-refuses-to-back-single-payer-despite-gop-deathmongering-suddenly-taking-center-stage/

RGC -> RGC... , May 08, 2017 at 06:35 AM
Nancy Pelosi Feels the Bern, Faces Pro-Sanders Primary Challenger

House Minority Leader is 'really out of touch'

http://observer.com/2017/04/nancy-pelosi-pro-sanders-primary-challenger-stephen-jaffe/

DeDude -> pgl... , May 08, 2017 at 09:14 AM
Yes and you can cherry pick pools (that have deliberate or unintended flaws) such that you can get one answer or the other. So you have to get consistency of pooling on an issue before you even consider trusting them. The good news is that Pelosi does not write the Democratic platform, the delegates do. If a majority of democratic party actives believe we are ready to include a national health care plan in the platform, then it will become the dems policy and I will support them. If they refuse to get it in there then we are not ready and I will support that position.
paine -> RGC... , May 08, 2017 at 06:49 AM
Rescue the exchanges
with a pub op

That is all dems should push

DeDude -> paine... , May 08, 2017 at 09:19 AM
Or we could rescue the individuals with no exchange choices at all - by allowing them to buy into MediCare. That way we would not need to "build" a public option (that could be attacked). We could also claim to have given the private sector the opportunity - and only let the government step in when private sector solutions fail. Most importantly the GOP would suddenly start doing everything they could to help the exchanges rather than trying to sabotage them.
paine -> DeDude... , May 08, 2017 at 12:45 PM
Excellent
libezkova -> DeDude... , May 08, 2017 at 07:10 PM
The costs are not going away in your solution.

I understand that we spend much more on bombing brown people, but still uncontrolled expansion of Medicare is somewhat problematic solution.

Simple question to you -- treatment of opiates epidemics victims -- who should pay for their treatment and multiple conditions they already have? Normally private insurers avoid those people as a plague.

Alaska model ( compensating private insurers for most complex and expensive cases -- outliers in costs) also can work. On state level more in known about those people and some measures can be legislated to cut the costs of most egregious cases connected with neoliberalism as a very cruel social system.

For example, homeless people are periodically taken to the hospital and then released to the streets to get in to hospital again and again until they die; some have dangerous for public infections (such a tuberculosis).

RGC -> RGC... , May 08, 2017 at 06:51 AM
Three More Join HR 676 Single Payer Bill in House

Three more members of the House of Representatives have signed on as co-sponsors of HR 676, the single payer bill in the House.

Carolyn Maloney (New York), Adriano Espaillat (New York) and Nanette Barragan (California) - signed onto HR 676 yesterday, bringing the total number of co-sponsors to 72.

https://www.singlepayeraction.org/2017/03/23/three-more-join-hr-676-single-payer-bill-in-house/

JohnH -> pgl... , May 08, 2017 at 08:57 AM
Who's talking about giving up? The Washington Generals always made it a good show against the Harlem Globetrotters...and lost by design...kind of like corrupt, sclerotic Democrats...

[May 08, 2017] How Alaska fixed Obamacare

Notable quotes:
"... That's when Wing-Heier and other Alaska officials had an idea. The state already had a tax on insurance plans (not just health but also life and property insurance). Usually the money goes to a general Alaska budget fund, but the state decided to divert $55 million of the tax revenue into a reinsurance program. ..."
"... The new reinsurance program convinced Premera to only raise rates 7 percent in 2017. Alaska suddenly went from having one of the highest rate increases in the nation to one of the lowest. ..."
"... This didn't just save customers money. The federal government subsidizes premium costs for 86 percent of Alaska's Obamacare enrollees. With cheaper premiums, the federal government didn't have to spend as much money. The cost of these subsidies fell by $56 million when Alaska created the reinsurance fund. ..."
"... If the waiver does go through - and Wing-Heier says she is "confident" the Trump administration will approve it - Alaska expects that Obamacare rates might actually do something unheard of in 2018: They might decrease. The state estimates that an additional 1,650 people will join the marketplace due to the lower premiums. ..."
Apr 17, 2017 | economistsview.typepad.com
im1dc , April 16, 2017 at 09:39 AM
"How Alaska fixed Obamacare"

A potential model that could save and expand Obamacare that the Trump Administration apparently agrees with

http://www.msn.com/en-us/news/us/how-alaska-fixed-obamacare/ar-BBzNr7p

"How Alaska fixed Obamacare"

by Sarah Kliff...Vox.com...4-16-2017...4 hrs ago

"Last year, Alaska's Obamacare marketplaces seemed on the verge of implosion. Premiums for individual health insurance plans were set to rise 42 percent. State officials worried that they were on the verge of a "death spiral," where only the sickest people buy coverage and cause rates to skyrocket year after year.

So the state tried something new and different - and it worked. Lori Wing-Heier, Alaska's insurance commissioner, put together a plan that had the state pay back insurers for especially high medical claims submitted to Obamacare plans. This lowered premiums for everyone. In the end, the premium increase was a mere 7 percent.

"We knew we were facing a death spiral," says Wing-Heier. "We knew even though it was a federal law, we had to do something."

Now other states are interested in trying Alaska's idea, especially because Wing-Heier is working with the Trump administration to have the federal government, not the state, cover those costs.

There are rampant concerns about the future of Obamacare right now. We don't know whether its marketplaces will remain stable in 2018 or, as the president has predicted, explode as premiums rise and insurers drop out. But Alaska's experiment is a reminder that the future of Obamacare isn't entirely up to Republicans in Washington. The work happening 3,000 miles away in Alaska shows that states have the ability to fix Obamacare too - and that the Trump administration might even support those policies.

How Alaska prevented an Obamacare horror story - and is trying to make the federal government pay for it

Premiums in the individual market went up a lot last year. The national average was a 25 percent hike. Alaska was bracing for an even higher 42 percent increase from its one remaining Obamacare insurer, Premera Blue Cross.

That's when Wing-Heier and other Alaska officials had an idea. The state already had a tax on insurance plans (not just health but also life and property insurance). Usually the money goes to a general Alaska budget fund, but the state decided to divert $55 million of the tax revenue into a reinsurance program.

This would give Obamacare insurers - at this point, just Premera - extra money if they had some especially large medical claims. Reinsurance essentially backstops insurers' losses; it guarantees they won't be on the hook for the bills of a handful of exceptionally sick patients.

The new reinsurance program convinced Premera to only raise rates 7 percent in 2017. Alaska suddenly went from having one of the highest rate increases in the nation to one of the lowest.

This didn't just save customers money. The federal government subsidizes premium costs for 86 percent of Alaska's Obamacare enrollees. With cheaper premiums, the federal government didn't have to spend as much money. The cost of these subsidies fell by $56 million when Alaska created the reinsurance fund.

This got Wing-Heier thinking: Why shouldn't we get that money back?

"Why shouldn't the money come back to us to fund the reinsurance program?" she recalls thinking. "It was that simple."

Alaska applied for a waiver in late December, asking the federal government to refund its spending. The state got conditional approval in mid-January from former Health and Human Services Secretary Sylvia Mathews Burwell. Current HHS Secretary Tom Price has spoken favorably of the Alaska approach too.

In a letter last month to governors, he described their idea as an example for other states to follow. It was, he said, an "opportunity for states to lower premiums for consumers, improve market stability, and increase consumer choice."

Alaska officials say the Trump administration has so far been easy to work with, helping them make sure the application looks right and moves quickly toward review.

If the waiver does go through - and Wing-Heier says she is "confident" the Trump administration will approve it - Alaska expects that Obamacare rates might actually do something unheard of in 2018: They might decrease. The state estimates that an additional 1,650 people will join the marketplace due to the lower premiums.

Other states want to get that same kind of funding too

Alaska's marketplace is far from perfect. The state only has one insurance plan selling coverage on its Obamacare marketplace, and doesn't project any more to join in 2018. Premiums are high in Alaska; the state is large and rural, which means it can be expensive to get patients to a hospital or a specialty doctor. A midlevel plan on the Obamacare marketplace there cost, on average, $904 in 2017.

But even with those problems, Wing-Heier says, it's still a whole lot better than where the state would have been without this policy change.

"Do I think it's a perfect solution? No, but it works for us," she says. "It's working in the right direction. It did what it was intended. It brought stability to our market, and the waiver is going to bring funding to us."

Alaska's approach has inspired other states. Minnesota is looking into building a reinsurance fund. At the insurance conference I went to last weekend, regulators from New York were asking lots of questions about Alaska's approach.

It's easy to see why this is appealing to other states, given the combination of additional federal money and lower Obamacare premiums. Most interesting, though, is that Alaska's approach is something the Trump and Obama administrations apparently agree on. There aren't many examples of that right now - so the ones that exist are certainly worth watching."

EMichael -> im1dc... , April 16, 2017 at 10:09 AM
Strange for Kliff not to mention in her piece the effects of the GOP destruction of the risk corridor program on premiums, amount of insurance companies participating, and co-ops.

Alaska's actions are why the risk corridor program was in the ACA.

"The risk corridors were intended to help some insurance companies if they ended up with too many new sick people on their rolls and too little cash from premiums to cover their medical bills in the first three years under the health law. But because of Mr. Rubio's efforts, the administration says it will pay only 13 percent of what insurance companies were expecting to receive this year. The payments were supposed to help insurers cope with the risks they assumed when they decided to participate in the law's new insurance marketplaces.

Mr. Rubio's talking point is bumper-sticker ready. The payments, he says, are "a taxpayer-funded bailout for insurance companies." But without them, insurers say, many consumers will face higher premiums and may have to scramble for other coverage. Already, some insurers have shut down over the unexpected shortfall.

"Risk corridors have become a political football," said Dawn H. Bonder, the president and chief executive of Health Republic of Oregon, an insurance co-op that announced in October it would close its doors after learning that it would receive only $995,000 of the $7.9 million it had expected from the government. "We were stable, had a growing membership and could have been successful if we had received those payments. We relied on the payments in pricing our plans, but the government reneged on its promise. I am disgusted."

Blue Cross and Blue Shield executives have warned the administration and Congress that eliminating the federal payments could have a devastating impact on insurance markets.

Twelve of the 23 nonprofit insurance cooperatives created under the law have failed, disrupting coverage for more than 700,000 people, and co-op executives like Ms. Bonder have angrily cited the sharp reduction in federal payments as a factor in their demise."

https://www.nytimes.com/2015/12/10/us/politics/marco-rubio-obamacare-affordable-care-act.html?_r=0

trump is continuing the attack.

im1dc -> EMichael... , April 16, 2017 at 11:18 AM
Not so strange imo b/c Rubio's undermining of the Obamacare subsidies happened years ago and the Alaska Obamacare subsidies are today and forward looking not back looking.
EMichael -> im1dc... , April 16, 2017 at 11:42 AM
To a point, but what happened this year in Alaska would not have happened if the risk corridors were not unfunded.

Moving forward, once the insurance companies had a realistic basis for the respective markets, they would stabilize. That was the plan at the very beginning.

Everyone knew that new markets would be incredibly risky for insurance companies. But that given a couple of years, they would figure out the price levels. They also knew that the first year or two would be really rough, as people who had gone without insurance put off healthcare for decades.

According to the CBO (who has been pretty accurate throughout) premiums are stabilizing. If Rubio and the GOP's attack had not happened, Alaska would not have to have done this.

Course, no one can figure out what other attacks will happen, but if they stopped with the risk corridors Alaska will have no need to do such in the future.

I will not bet that the GOP will not make it even worse, so they can just say the ACA collapsed upon itself.

im1dc -> EMichael... , April 16, 2017 at 06:06 PM
Agreed but the point is that the Obamacare Risk Corridors did not work as hoped but this Alaska workaround appears to be working in its place.

I am sure you and I don't care how we get there as long as we get there, saving Obamacare for 30,000,000 Americans.

I don't trust Trump or the Conservative Tea Baggers in Congress either. If they can they will pull defeat from the jaws of victory and call themselves saviors.

They are not nice or caring or smart, just ideologues without a clue to what they are doing.

cm -> im1dc... , April 16, 2017 at 07:05 PM
TLDR: The fedgov pays a significant part of this reinsurance scheme. (According to the article funds that come out of "saved" premium subsidies? - not clear.)

But one can argue this is how it is supposed to work. It doesn't really matter at what "level" the subsidizing happens.

im1dc -> cm... , April 17, 2017 at 04:42 AM
Agreed.

[May 08, 2017] Under the most recent version of the GOP repeal bill, states would be allowed to opt out of requiring insurers to cover everyone at the same price and to offer all 10 essential health benefits in all policies

May 04, 2017 | www.nakedcapitalism.com
MyLessThanPrimeBeef , May 4, 2017 at 4:27 pm

From the CNN article in the Links:

Prior to the health reform law, consumers who have or who previously had medical issues - even if it were years earlier and completely resolved - could be denied coverage or charged much more in premiums. Obamacare remedies that by requiring insurers to cover everyone and charge them the same amount, regardless of their health history. Also, it mandates all policies cover 10 essential health benefits, including prescription drugs, hospitalization and doctors' visits , so the sick could be assured their treatments are covered.

"The rules under Obamacare were comprehensive," said Karen Pollitz, senior fellow at the non-partisan Kaiser Family Foundation.

This expansive coverage, however, comes with a high price tag. It bumps up the cost of premiums for everyone. That's why the conservative Freedom Caucus set its sights on getting rid of these popular provisions.

Related: Key GOP lawmakers flip on health care after Trump meeting
Under the most recent version of the GOP repeal bill, states would be allowed to opt out of requiring insurers to cover everyone at the same price and to offer all 10 essential health benefits in all policies. This would likely lead insurers to jack up rates for those with pre-existing conditions who didn't maintain continuous coverage and to offer skimpy plans that don't pay for the treatments the sick need.

---

1. Is it still a plan if it doesn't offer 'doctors visits?'

That is scary. And I have to ask, is it me not reading it correctly, or is it on the writer?

2. It bumps up the cost of premiums for everyone those popular provisions.

Probably the situation is more complex. Intuitively, more costly for everyone is not often associated with being popular.

3. jack up rates for those with pre-existing conditions who didn't maintain continuous coverage.

Those with pre-existing conditions are today covered for those who are not paying a penalty. They are in 'continuous' coverage, are they not? And the risk is jacked up rates – that is, a money issue.

The difference between Medicare for All, and Free Medicare for All is also a money issue.

Ian , May 4, 2017 at 4:30 pm

This is a gift to the corporate democrats as it provides cover for and shifts blame to the GOP in regards to a system that was well on its way to painfully dying. The people that keep focus on single payer will be blamed even more as well for worsening the situation. A lot more revisionism is coming our way as the terrible reality that was Obama will be made out to look like Trump is the root cause of what is going on. As stated earlier, if Trump wanted to destroy the Dems all he'd have to do is let ACA be run by the Dems and let that run it's natural course, now the GOP own it. As shown by the first commenter. Political Kabuki.

[May 08, 2017] There are three general types of universal health care systems: socialized medicine, single-payer, all payer

Apr 21, 2017 | economistsview.typepad.com
RGC , April 20, 2017 at 05:00 AM
Different Universal Health Care Systems
17 Apr 2017

Jon Walker

There are three general types of universal health care systems. Each system, which other industrialized democracies rely upon, has its quirks.

Socialized medicine
Examples: United Kingdom, Norway, and Denmark
Closest American analogy: Veterans Health Administration


Single-payer
Example: Canada
Closest American analogy: Medicare


All-payer
Examples: Belgium, Japan, Germany, Switzerland
Closest American analogy: Federal Employer Health Benefits, ACA exchanges
.....................
https://shadowproof.com/2017/04/17/road-single-payer-understanding-different-universal-health-care-systems/

Fred C. Dobbs -> RGC... , April 20, 2017 at 05:25 AM
FWIW,

Should there be 'bare counties' (no insurance
plans offered) under ObamaCare in the coming
year it *might* be possible that a Medicaid
Buy-in plan would be offered.

NYT: Katherine Hempstead, who studies health insurance markets at the Robert Wood Johnson Foundation, was more confident than former Obama administration officials that a motivated executive branch could devise new policies to help people in bare counties, such as letting them buy a Medicaid plan, or including them in the state employee benefit pool. "I do think there will be solutions," she said. ...

Bare Market: What Happens if Places Have No
Obamacare Insurers? https://nyti.ms/2pxTTEY
via @UpshotNYT - Margot Sanger-Katz - APRIL 18

RGC -> Fred C. Dobbs... , April 20, 2017 at 05:40 AM
How about a Medicare plan, instead of Medicaid?
Fred C. Dobbs -> RGC... , April 20, 2017 at 06:05 AM
Personally, I'm guessing that
the latter is more likely, but
not much more so, than the former.
paine -> RGC... , April 20, 2017 at 06:17 AM
Yes the public option
at least in counties under provided
By corporate insurers

[May 07, 2017] The Unspeakable

Notable quotes:
"... The Donald did not care what bill was passed, as long as he ended up with something that would allow him to say he kept his promise and could claim as an accomplishment. He is all appearance over substance. ..."
May 07, 2017 | jessescrossroadscafe.blogspot.com
"A culture that does not grasp the vital interplay between morality and power, which mistakes management techniques for wisdom, and fails to understand that the measure of a civilization is its compassion, not its speed or ability to consume, condemns itself to death."

Chris Hedges


"In this way people are thrown aside as if they were trash."

Francis I


"Those who are at present so eager to be reconciled with the world at any price must take care not to be reconciled with it under this particular aspect: as the nest of The Unspeakable. This is what too few are willing to see."

Thomas Merton, The Unspeakable

The French elections will be this weekend, with market pricing in a win by the Europhile businessman Macron over the nationalist right with Le Pen.

The SP and Nasdaq closed at all time highs today. Gold and silver continued to move sideways. The dollar also moved lower. Must have been a 'risk on' day for the one percent and their financiers.

The Health-scare Bill (sic) passed by the House is widely being disregarded by the more astute observers as a cynical exercise in political flimflammery. It is so outrageously bad that the Senate is unlikely to pass it at anything like its current form. It is yet another of their symbolic repeals of a healthcare system formulated by the conservative Heritage Foundation and embraced by the Wall Street wing of the Democrats under Obama and Clinton. The Donald did not care what bill was passed, as long as he ended up with something that would allow him to say he kept his promise and could claim as an accomplishment. He is all appearance over substance.

No matter if this legislation would devastate members of the woeful working class who carried him into office. He and the Congressmen cared so little for the consequences of this law to the public that they did not even wait for the impact analysis that is customary for major legislation.

The House GOP took advantage of Donald's egomania by passing a bill which would deny affordable healthcare insurance to millions of Americans, the weak, the poor, and the elderly, in order to finance a $600 billion tax cut over the next ten years for the richest of the one percent. And afterwards they all celebrated with a beer party in the Rose Garden.

It would have been better for them if they had never been born.

[Mar 22, 2017] The Men Who Stole the World

Notable quotes:
"... 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. ..."
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.

...

[Mar 21, 2017] Why No One Is Taking Robert Samuelson's Medicaid Deal Seriously

Mar 21, 2017 | economistsview.typepad.com
anne : March 20, 2017 at 05:50 AM , 2017 at 05:50 AM
http://cepr.net/blogs/beat-the-press/why-no-one-is-taking-robert-samuelson-s-medicaid-deal-seriously

March 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.

* https://www.washingtonpost.com/opinions/medicaid-is-out-of-control-heres-how-to-fix-it/2017/03/19/05167e9e-0b2e-11e7-a15f-a58d4a988474_story.html

-- Dean Baker

pgl -> anne... , March 20, 2017 at 06:04 AM
"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."

Dean 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.

Anachronism said in reply to pgl... , March 20, 2017 at 06:56 AM
There are 2 theories about how to argue with a republican. Neither one works.

What 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.

RC AKA Darryl, Ron said in reply to Anachronism ... , March 20, 2017 at 07:16 AM
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 AM
I might ask what those two theories are but I suspect you are right about neither one of them working.

[Mar 14, 2017] No wonder the unemployed increasingly kill themselves, or others. The whole economy tells them, indirectly but unmistakably, that their human value does not exist.

Mar 14, 2017 | economistsview.typepad.com
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 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. 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."

What 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 ;-)

ilsm : , March 13, 2017 at 01:41 PM
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".

Cuba 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!

jeff fisher said in reply to ilsm... , March 13, 2017 at 01:58 PM
Cuba is the shining example of how doing the first 20% of healthcare well for everyone gets you 80% of the benefit cheap.

The 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.

jonny bakho : , March 13, 2017 at 12:09 PM
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.

http://www.breitbart.com/video/2017/03/13/trump-republicans-putting-bad-position-repealing-obamacare/

[Feb 19, 2017] As Democrats stare down eight years of policies being wiped out within months, but those policies did virtually nothing for their electoral success at any level.

Notable quotes:
"... 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. ..."
"... 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.. ..."
Feb 19, 2017 | economistsview.typepad.com
Peter K. -> Chris G ... , February 18, 2017 at 07:35 AM
via J.W. Mason (lots of F-bombs!):

http://democracyjournal.org/arguments/keep-it-simple-and-take-credit/

Keep It Simple and Take Credit

BY JACK MESERVE
FROM FEBRUARY 3, 2017, 5:42 PM

As 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.

...

ilsm -> Peter K.... , February 18, 2017 at 12:47 PM
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..

[Jan 13, 2017] Reducing the cost of healthcare

Jan 13, 2017 | economistsview.typepad.com
pgl -> Fred C. Dobbs... , January 13, 2017 at 06:14 AM
There are 3 ways we could reduce what we pay for health care:

(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.

Observer -> pgl... , January 13, 2017 at 07:12 AM
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%.

Doctors 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.cdc.gov/nchs/fastats/health-expenditures.htm

anne -> Observer... , January 13, 2017 at 07:37 AM
https://www.nytimes.com/2017/01/12/us/politics/health-care-congress-vote-a-rama.html

January 12, 2017

Senate Takes Major Step Toward Repealing Health Care Law
By THOMAS KAPLAN and ROBERT PEAR

In 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....

[Jan 2, 2016] Notice the subtle change from employers having a commitment to provide coverage for employees to a commitment to "sponsor" coverage.

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

I'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.

Greg T, January 2, 2016 at 4:43 pm

This 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.

Dave, January 2, 2016 at 9:33 pm

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.