[ArtK78]

kenberg, on 2013-December-10, 16:26, said:

...the Republicans can nominate a kangaroo in 2016 (they could and might do worse) and win the election.

I thought they did that already (Bush Jr.).

[PassedOut]

kenberg, on 2013-December-10, 18:23, said:

First, I am claiming something simpler. I am looking at the government's income and expenses for the ACA. Consider, from http://www.nytimes.c...odayspaper&_r=0.

Thanks for the link, but I did not see a breakdown of the government's income and expenses. No doubt there are additional expenses for folks with medical problems who suffered with no treatment, as there is additional income.

kenberg, on 2013-December-10, 18:23, said:

Just for starters, where is the money coming from to pay for the medical care of the 567,000 new Medicaid patients? Can this be answered on the basis of enrollments as they stand now, or must it assume large future enrollments by young and healthy adults who so far have shown no interest in enrolling?

You might have other information, but I expect that a good number of your 567,000 did go to the emergency room in the past instead of suffering in silence, and we all paid for that.

Considering that the US pays twice as much per capita for medical care as other countries -- and with poorer results -- I find it hard to believe that the money now in the pot is grossly insufficient because of the good fortune of some folks who will gain relief from their suffering. The very poor management of this by the Obama administration is a real issue. The amount of money in the pot should not be.

[awm]

There is a tax hike associated with the ACA -- they added an extra 0.9% medicare tax to income over 250k, and also applied the entire medicare tax (including this part) to capital gains income. There are also some other minor tax increases (like on tanning salons). In addition, there are significant cuts to medicare providers (esp. hospitals) and to overpayments where medicare advantage was paid more than regular medicare to cover the same services. These things (more than) pay for the subsidies and medicare expansion.

The reduction in medicare expenditures is supposed to be based on better cost controls and reduction in the reimbursement for care provided to the uninsured (who should be fewer in number).

[kenberg]

awm, on 2013-December-10, 21:18, said:

There is a tax hike associated with the ACA -- they added an extra 0.9% medicare tax to income over 250k, and also applied the entire medicare tax (including this part) to capital gains income. There are also some other minor tax increases (like on tanning salons). In addition, there are significant cuts to medicare providers (esp. hospitals) and to overpayments where medicare advantage was paid more than regular medicare to cover the same services. These things (more than) pay for the subsidies and medicare expansion.

The reduction in medicare expenditures is supposed to be based on better cost controls and reduction in the reimbursement for care provided to the uninsured (who should be fewer in number).

Thanks for this. I had heard bits and pieces. If this indeed covers the costs I will be delighted. I was somewhat stunned to see that (so far) more than two-thirds of expanded coverage is for Medicare rather than policies. Medicare, by its nature, is heavily subsidized. This seems expensive to me.

I will wait and see how this goes, what else would I do, but I remain skeptical (I trust you, but the government not so much). I have read that the enrollments by the young and healthy are nowhere near what the model is based on, and that these monies are needed if the books are to balance as they envisioned. We shall see.

Basically I guess my view is that there cannot be any more screw ups here. Football coaches lose there jobs for far less.

[Mbodell]

The other bit "bending the cost curve" of insurance premium costs is the Medical Loss Ratio. Basically 85% of premiums collected for large groups (80% for small groups and individuals) must go to actual medical costs. So overhead and profit is limited a little, or else the insurance companies have to give rebates, so there is less incentive to increase premiums just because interest rates are down.

The health insurance costs for my company this year are actually lower for individuals than they were last year (at least what the company pays the insurance company - my employer jacked up the employee contribution so my out of pocket is up, but that is going to my employer, not the insurance company and not the medical industry).

[Zelandakh]

kenberg, on 2013-December-10, 11:03, said:

At it's most basic, I think the policy was based on duplicity and wishful thinking

I think the policy was based primarily upon what they could get through The Hill. If the Obama administration had written the ACA alone I am sure it would have been radically different. This seems to be a recurring theme in American politics - the opposition re-writes a bill to try and make it fail and when it does the people blame the administration. If such opposition tactics were punished by voters at the ballot box then they would stop, yet in America the tactics, which are mostly harmful to the country, are apparently encouraged.

kenberg, on 2013-December-10, 18:23, said:

Obama claimed that the ACA books would balance, or at least mostly balance.

I think the claim is that the ACA would be fiscally balanced against projections of healthcare spending cost increases over the next X years. It was never claimed (to my limited knowledge as a European) that the ACA would balance against current spending.

[ArtK78]

Zelandakh, on 2013-December-11, 06:55, said:

I think the policy was based primarily upon what they could get through The Hill. If the Obama administration had written the ACA alone I am sure it would have been radically different. This seems to be a recurring theme in American politics - the opposition re-writes a bill to try and make it fail and when it does the people blame the administration. If such opposition tactics were punished by voters at the ballot box then they would stop, yet in America the tactics, which are mostly harmful to the country, are apparently encouraged.

This is the most important point made in this entire thread. The health care bill that was passed is what could be passed, not what should have been passed. And the opposition has imposed obstacles to the bill, inside and out, and now sits back and criticizes what the bill does and doesn't do (both factually and otherwise).

Think back to the attempt by the Clinton administration to get a health care bill through Congress. It could not be accomplished. The Obama Administration should be congratulated, not excoriated, for getting the ACA through Congress. And, although it is far from the bill that Obama wanted, at least it is in place.

As I have said in prior posts, in looking back on the ACA, history will place it alongside Social Security and Medicare as milestones in social policy.

[kenberg]

This argument that a better bill could not have been passed if not for the opposition's efforts only takes us so far. I would not, for example, accept that it justifies deception. And I don't much care for the argument that if the bill is a crappy one it is the fault of someone else. Obama is repsonsible for the law that he brought into being and for the statements that he made about it. If I ends up a success, he gets, and will surely claim, the credit. If not, well that falls on him also.

PS It is true, if I remember correctly, that the law was passed on a party-line vote. This is unfortunate, but once he accepted this fate it should have given him some flexibility in what went into it.

[PassedOut]

ArtK78, on 2013-December-11, 07:16, said:

This is the most important point made in this entire thread. The health care bill that was passed is what could be passed, not what should have been passed. And the opposition has imposed obstacles to the bill, inside and out, and now sits back and criticizes what the bill does and doesn't do (both factually and otherwise).

Think back to the attempt by the Clinton administration to get a health care bill through Congress. It could not be accomplished. The Obama Administration should be congratulated, not excoriated, for getting the ACA through Congress. And, although it is far from the bill that Obama wanted, at least it is in place.

As I have said in prior posts, in looking back on the ACA, history will place it alongside Social Security and Medicare as milestones in social policy.

The situation prior to the ACA was a total train wreck and had to be changed. The runaway costs were damaging our businesses and forcing us to spend way too much time on insurance issues instead of business-related matters. The ACA is surely not ideal by any means (it would have been a lot better simply to remove the Medicare age limit), but the ACA barely passed as it was. It has a lot of moving parts.

The additional taxes were a bone of contention then and now. But the Medicare Part D prescription had been unfunded and the ACA corrected that. Furthermore, the "donut hole" is being closed gradually, and will be gone by 2020. You can find arguments that closing the donut hole is a terrible idea, but I think it fair to say that most folks don't see it that way.

And, as Ken has pointed out, there are folks who simply went untreated, so the only costs formerly rung up by those people were the costs associated with spreading untreated diseases and the indirect losses in productivity. Ken expressed concern over 567,000 new Medicaid recipients. But suppose that there are a million of the working poor who had gone without care altogether, not even going to the emergency room for treatment. And suppose that under the ACA, they now receive an average of $5000 of medical care per year -- a pretty high figure for those who are not elderly. Those additional medical expenditures would still account for less than 2% of the annual healthcare costs of the US. Considering that we in the US pay around twice as much per capita as do countries that offer better medical care, we can absorb that 2%.

I do look at the CBO projections for the ACA each year and have seen no cause for alarm. It would not surprise me to learn that these figures have worsened some with the latest tizzy, but I haven't been able to locate the specific figures that seem to be raising new alarms. If anyone has a link to some dramatically new projections, I'd be interested in taking a look.

Quote

Taking the coverage provisions and other provisions together, CBO and JCT have estimated that the ACA will reduce deficits over the next 10 years and in the subsequent decade.

So, more folks get the care they need, and the deficits go down as a result of the ACA. It's not perfect, for sure, but it's a whole lot better than what we had.

[Winstonm]

Concerning how the ACA came about. The progressive caucus was told by Nancy Pelosi that a strong public option would be included in the ACA to replace the push for single payer. (it was not added).

From Matt Taibi:

Quote

Once single-payer was off the table, the Democrats lost their best bargaining chip. Rather than being in a position to use the fear of radical legislation to extract concessions from the right — a position Obama seemingly gave away at the outset, by punting on single-payer — Republicans and conservative Blue Dog Democrats suddenly realized that they had the upper hand. Pelosi and Senate Majority Leader Harry Reid would now give away just about anything to avoid having to walk away without a real health care bill.

[PassedOut]

Winstonm, on 2013-December-11, 10:05, said:

Concerning how the ACA came about. The progressive caucus was told by Nancy Pelosi that a strong public option would be included in the ACA to replace the push for single payer. (it was not added).

From Matt Taibi:

Quote

Once single-payer was off the table, the Democrats lost their best bargaining chip. Rather than being in a position to use the fear of radical legislation to extract concessions from the right — a position Obama seemingly gave away at the outset, by punting on single-payer — Republicans and conservative Blue Dog Democrats suddenly realized that they had the upper hand. Pelosi and Senate Majority Leader Harry Reid would now give away just about anything to avoid having to walk away without a real health care bill.

Early on, Obama invested heavily in bipartisanship. Grassley and others were working with democrats on the bill, and Obama expected some republican support for this vital legislation. He was wrong.

I remember an exchange between Obama and Lamar Alexander where Alexander said that he couldn't support the ACA because it didn't include tort reform, a position opposed by the trial lawyers (who had supported Obama). Obama told Alexander that he'd include tort reform despite the trial lawyers' opposition if Alexander would vote for the ACA. Alexander said no.

[Winstonm]

I agree with Ken that regardless of the outcome when it comes to the ACA Obama owns the results.

[PassedOut]

Winstonm, on 2013-December-11, 10:50, said:

I agree with Ken that regardless of the outcome when it comes to the ACA Obama owns the results.

Yes, I think we all agree on that.

[PassedOut]

Seems like John Boehner is getting sick and tired of the whacko-birds (to use John McCain's term) who shut down the government over the ACA a couple of months ago:
Boehner lashes out at conservative groups on budget deal

Quote

"They're using our members and they're using the American people for their own goals," an animated Boehner told reporters at the Capitol. "This is ridiculous."

Ryan and Murray, the top budget officials in their respective chambers, announced an agreement that would set baseline spending levels for the 2014 and 2015 fiscal years. The agreement calls for spending levels slightly above the cap established by the automatic spending cuts known as the "sequester" through a combination of reforms, cuts and new, non-tax revenue.

Conservative groups had been girding themselves against the deal before its details were finalized, mostly because the spending levels exceed sequester levels. The Club for Growth, Americans for Prosperity and Heritage Action -- each of them well-financed conservative advocacy groups that hold some sway over Republican primary voters -- have begun lobbying furiously against the modest government funding agreement.

Here in the Michigan 1st District, we're reminding out tea-party guy, Benishek, that shutting down the government is still a bad idea.

[kenberg]

This country seems to be good at eventually backing of from bizarre extremes. Probably because we have had so much practice at it. Maybe for the next extreme movement we can move through the process more quickly. Or even just skip it. As a kid we had this expression for something that seemed foolish: Let's not and say we did.

[Vampyr]

ArtK78, on 2013-December-11, 07:16, said:

Think back to the attempt by the Clinton administration to get a health care bill through Congress. It could not be accomplished.

I heard that the Republican Whip (I believe it was Bob Dole) instructed Republican senators to, under no circumstances, support this initiative or vote for a bill. The reason was that health care reform would be extremely popular among the American people, and would strengthen the Democratic party and create a lasting legacy for them and for Bill Clinton.

[kenberg]

Vampyr, on 2013-December-11, 12:36, said:

I heard that the Republican Whip (I believe it was Bob Dole) instructed Republican senators to, under no circumstances, support this initiative or vote for a bill. The reason was that health care reform would be extremely popular among the American people, and would strengthen the Democratic party and create a lasting legacy for them and for Bill Clinton.

Dole was, I think, the Majority Leader (or Minority Leader, depending) not the Whip. More importantly, this doesn't sound like Dole to me. Maybe I am naive but while I think of him as a very tough campaigner I don't think of him as petty in this way.

[kenberg]

PassedOut, on 2013-December-11, 09:16, said:

And, as Ken has pointed out, there are folks who simply went untreated, so the only costs formerly rung up by those people were the costs associated with spreading untreated diseases and the indirect losses in productivity. Ken expressed concern over 567,000 new Medicaid recipients. But suppose that there are a million of the working poor who had gone without care altogether, not even going to the emergency room for treatment. And suppose that under the ACA, they now receive an average of $5000 of medical care per year -- a pretty high figure for those who are not elderly. Those additional medical expenditures would still account for less than 2% of the annual healthcare costs of the US. Considering that we in the US pay around twice as much per capita as do countries that offer better medical care, we can absorb that 2%.

I hope that I have been clear enough that no one thinks that I am opposed to providing medical care for people in tough circumstances. I am not.

[PassedOut]

kenberg, on 2013-December-11, 14:54, said:

I hope that I have been clear enough that no one thinks that I am opposed to providing medical care for people in tough circumstances. I am not.

I think you've made that very clear to everyone. The issue is paying for medical care without exploding the deficit, and I don't see that as a danger unless something changes dramatically.

[Cthulhu D]

kenberg, on 2013-December-04, 15:03, said:

Whew. Broken arms, detached retinas. Sounds like a dangerous place.


I have no idea what happens if a foreign visitor needs unplanned for medical assistance in the U.S. but I am willing to bet that it is not good.

As an Australian we have negotiated 'shared coverage' with a bunch of nations - so if a New Zealander gets treated here they quality for government assistance and visa versa. The US does not partake in these arrangements obviously, so you have to buy private travel insurance or get stuck with a huge bill - but private travel insurance for a trip to the US is almost twice the price of any other country because the US is a higher insurance risk due to the insanely high prices of care.

This is one of the reasons I hate travelling to the US.

hrothgar, on 2013-December-08, 18:22, said:

1. Rand Paul just got busted for repeated instances of plagiarism. One would think that you might have learned something from this. If you're quoting other people, use quotation marks and provide a link. This hold doubly true when you are quoting a piece of ***** rag like the Daily Caller...

http://dailycaller.c...h-care-in-2011/

2. Its ridiculous to characterize the Frasier Institute as non partisan.
They are hard right libertarians.

3. Nothing that you write actually contradicts Winston's point. While 46,159 is a specific number, without context its impossible to know whether this is a significant fraction of the total number of Canadians who sought health care. In a similar vein, why should we care about the difference in wait times since 1993? Why was this number chosen? How does this compare to what happened in the US?

FWIW, the actual paper includes the following quote whic directly supports what WInston reported

It's also worth noting that the Canadians quite sensibly use the US for profit system to provide surge capacity (though this is not why all Canadians leave Canada for medical care, it is why some Canadians do so) - the Government send you to a hospital across the boarder and pick up the tab like they would if you were treated in Canada. This is quite prudent for them as it means they don't have to build capacity to deal with demand spikes.