Tuesday, April 1, 2014

ACA Sign Ups: 7.1 Million ?

I can't wait until a fact checker site goes through this.

CNN ACA Hits 7.1 Million Sigh-Ups
Fox News WH Runs Victory Lap
Politifact 20Feb14

It seems there are tons of opportunities for spin in these numbers.

How many:
  • Total
  • Because ACA cost them their insurance.
  • Medicaid adds
  • Other
  • Real ACA add
  • How many are paying their premiums?
  • How many are us tax payers paying for?
Personally, adding insured at the cost of tax payers isn't much of a step forward.

Thoughts?

80 comments:

Anonymous said...

The problem for Republicans now is that their position is that they want to take away health insurance from 7 million Americans, and that number is rising. They want to send out 7 million cancellation letters, the very same thing they railed against Democrats for doing. In terms of political strategy, they haven't begun to understand how to do that, which is why they were and continue to be, so focused on the early software glitches.

Seven million. It's a number Republicans like to toss around, but they can't even tell you whether the problem is that it is too high or too low. That's because they haven't provided an alternative, which means that they have nothing to compare it too, and numbers without context are meaningless in terms of helping us to understand the issues in a public policy debate.

--Hiram

Anonymous said...

Something incredible has happened in our politics, something I would never have believed possible. Republicans have become intimidated by fact checkers. We have seen vivid illustrations of this in how so many Republican health care anecdotes have failed to survive even the gentlest, back of the envelope, kind of scrutiny. We are now beginning to see the results of that. Fewer and fewer Republican commercials are featuring real people, and the issues they talk about are becoming less specific. When challenged, they pretend to believe that the challenge is on the people in the commercials, not the people who made them. This is a favorite tactic of Megyn Kelley. The most recent batch of commercials I have seen, are barely linked to Obamacare at all. They are just designed to create a vague, non specific sense of unease, expressing fear about an uncertain future. There is no great answer to that particular point except to point out that the future always has been uncertain, and that something that's likely to continue. That life is full of uncertainty is not something that Obamacare changed.

--Hiram

John said...

I am not sure this is as much of a problem as you claim.

If the GOP can show that 7 million are getting almost free health insurance coverage because the other 300 million of us are paying for it in our premiums and taxes... They will likely have a compelling argument to kill ACA...

Sean said...

The fact of the matter is that much of the country got government health care before the ACA, so I doubt very much there would be some giant revolt over it.

Besides, all the polling shows that people don't want full repeal -- they want changes to make it better.

Anonymous said...


If the GOP can show that 7 million are getting almost free health insurance coverage because the other 300 million of us are paying for it in our premiums and taxes..

the hard part of showing that is that it that isn't true.

The question I expect to asking a lot of Republicans is why do you want to take the health insurance of Americans?

==Hiram

Anonymous said...

"Besides, all the polling shows that people don't want full repeal -- they want changes to make it better."

What specific changes? And the problem with any specific changes that are proposed are subject to the same analysis as the original law.

What is the Republican position today? That's difficult to say. While they have voted to repeal Obamacare 50 times, they haven't enacted even one comprehensive alternative despite being in total command in the house. I could make some suggestions concerning a Republican proposal, but from a lot of experience, I know I will be immediately attacked for creating straw men. But what the heck.

As I understand it, the main policy objection of Republicans at the moment is cost. Obamacare simply doesn't reduce the cost of health care in America the way we wanted it too. By and large, the Republicans accept what's popular about Obamacare, coverage of pre-existing conditions and what not. While they may not exactly support universal health care, they are generally in favor of health care provided universally, a distinction that seems to make sense to the Republican mind but which baffles the rest of us.

So it does come down to cost. How do your reduce it without compromising quality or getting a deal done prior to our sun turning into one of Neil DeGrasse Tyson's black holes? The fact is, the political problem of reducing costs in a consensus based political system hasn't changed. What has changed is the disappearance of the consensus, which is unlikely to return in our lifetime. So we are stuck with the system we have, with just the chance of a minor tweak here and there when an unlikely although not impossible political consensus appears.

I would add here that a big problem Republicans have here is that Obamacare adopts so many Republican ideas that it's difficult for Republicans to construct an alternative program that doesn't bear a strong resemblance to Obamacare.

--Hiram

John said...

I think it will pretty easy to prove.

We know that all the medicaid folks are getting a handout from tax payers.
We know that all the tax subsidies are handouts from tax payers.

John said...

So that's why the make up of the 7 million is a big deal.

And if a fair number had insurance previously that they liked, and ACA led to the cancellation of those policies... I would assume those people may be conflicted.

Sean said...

Well, if you're opposed to health care funded by taxpayer handout, do you favor ending the tax break for those receiving health care through their employer?

Anonymous said...

And if a fair number had insurance previously that they liked, and ACA led to the cancellation of those policies... I would assume those people may be conflicted.

If Republicans are against cancellation of insurance policies, they will have to find a way to distinguish that from their desire to cancel insurance policies under Obamacare.

--Hiram

Sean said...

Hiram makes a good point. The GOP's opposition to any sort of change that has resulted from the ACA is going to make it that much harder for them to come up with a workable health care proposal.

If no one can lose their current policy, no one can see their premium or deductible change, no one can see changes in their network of physicians, etc., then there's literally no policy solution that will work.

Many of the plans available on the exchanges fit the health care model that Republicans favored in the last decade -- HSAs with high deductibles. Today, the GOP decries such plans.

Choosing the route of political expediency today will hurt the GOP and the country in the long run.

John said...

Sean,
I must say you lost me with that hard left... I'll take a guess and you can correct me afterward...

Medicaid and ACA subsidies come from Public/Taxpayer funds directly. Taxpayers fund dollar
for premium/benefit dollar.

Company provided insurance is just a different form of compensation, and is paid via Private funds. Neither the companies nor the employee receive any public subsidies directly to offset the insurance premium.

Now I do agree there is some benefit in that the costs come off the companies profits just like every other company expense. (ie salaries, supplies, shipping, etc)

I could support letting everyone pay for their own insurance, and allowing them to take it as an income deduction. (ie not a credit/ subsidy)

Personally I wish companies were out of healthcare all together... Then they could pay us more cash and we could by our own policies. Just like auto insurance...

John said...

Hiram,
I think most people will be able to distinguish the difference between discontinuing private purchased insurance policies and medicaid/public paid insurance policies.

Especially if they can explain how it can reduce the deficit or reduce their taxes...

John said...

By the way, I don't mind ACA. I just disagree with the wealth transfer aspects of it.

Sean said...

If you have health insurance through your employer, it's not considered income to the employee. That's a $250 billion tax expenditure annually. (And, some employers do receive tax credits to provide insurance to their employees as well.) So let's not pretend there's no subsidization going on here. It's not going directly to paying premiums, but it matters little if the money goes into the left pocket or the right pocket in the end.

Sean said...

Here's the GOP's problem personified by one Gov. Bobby Jindal:

http://thinkprogress.org/health/2014/04/02/3422233/gop-presidential-hopeful-offers-health-plan-that-would-kick-millions-off-their-insurance-plans/

Anonymous said...

"I think most people will be able to distinguish the difference between discontinuing private purchased insurance policies and medicaid/public paid insurance policies."

Possibly, but what matters is that Republicans will be trying to take their insurance away.

--Hiram

Anonymous said...

The fact that employers get a deduction for health insurance, but it doesn't count as income for employees is always high on the list of tax issues, many reformers feel is in need of reform. It can be looked at as a subsidy. But I also point that in many ways, we make it more difficult to hire employees. Does it really make sense to take away one of thing that makes it easier and cheaper for companies to hire workers?

I did see that Jindal issued a health care proposal today, which among other things, proposes closing that tax advantage. From our perspective, a lot of what he proposes are things Obamacare is already doing. He just makes it a little more complicated to disguise what's it's happening. Among other things, Jindal is seeking to extend some of the worst and most problematic features of Obamacare. He proposes a premium support system for Medicare I believe. Unlike Medicare now, Obamacare is itself a premium support system., and whatever the merits of that system in terms of substance, it's complicating in practice, which will mean glitches in implementation. In general, Jindal proposes an extremely complicated, state based system and that is inevitably a mess.

It's a simplicity issue, and as I have often noted in the tax context, simplicity never wins because simplicity doesn't have a constituency and isn't, therefore a priority. Like creators of Obamacare, Jindal is much more focused on what he sees as high policy than he is on making the interaction between the consumer and provider as easy as possible.

--Hiram

John said...

Think Prog: Kick People Off

Anonymous said...

As for that link, this is a problem Republican advocacy. While criticizing Obamacare, Republicans haven't taken a position of their own. An advantage of this is that their criticisms don't have to be consistent with any proposal of their own. They are free, for example, to criticize Obamacare for resulting in contract terminations, without having to deal with the fact that contract terminations would also follow from typical Republican proposals.

One virtue of the Jindal proposal from a political perspective is that it is immensely complicated. It addresses the need Republicans have for an alternative to Obamacare while making it politically difficult to respond to it. Once we start looking at this sort of thing point by point, eyes really start to glaze over.

--Hiram

Anonymous said...

When the president delayed implementation of the employer health insurance mandate, lots of folks complained that it was unfair to lift the employer mandate while leaving the individual mandate in place. There was an inconsistency of a kind there, but in practical terms, the two situations were very different. Under the status quo, while employers are not required to provide health insurance, there is a strong, and usually compelling incentive to provide such insurance. That's because the current policy is a subsidy to employers and employees. An employer today who decides to terminate health insurance would either have to pass the cost savings on to the employer, or deal with the reality that he has cut his employees wages substantially, something that's very difficult to do, and which would put them at a real competitive disadvantage to other employers, who provide their employees with cheaper group insurance, and who also benefit from the de facto tax subsidy. What this means in practice is that even when employers are not mandated to provide health insurance, the mandate isn't really necessary because they are under such pressure to provide such service anyway.

--Hiram

John said...

Hiram
"who also benefit from the de facto tax subsidy" Tell me more...

From my perspective. The employer could pay more, drop insurance and deduct the extra pay cost... What is this de facto subsidy?

I think businesses give it to us because we want it. And we want it for the group savings and tax free compensation.

Sean,
Which businesses get a "credit" for offering health insurance? When did it start? (ie ACA or before)

Anonymous said...

:"From my perspective. The employer could pay more, drop insurance and deduct the extra pay cost... What is this de facto subsidy?

To make the employee whole, he has to pay more in increased compensation.

Let's say the employer pays the worker a hundred dollars in health benefits. I am just making the numbers up, obviously. The employer gets the deduction for the hundred bucks, and the employee has a hundred bucks worth of health insurance, an no taxable income. If you make health insurance taxable to the employee, he has to receive, and to make him whole, the employer has to increase wages to compensate for the additional tax consequences to the worker. The numbers aren't quite exact, but say if the employee is in a 30 percent tax bracket, the employer has to pay the worker 130 dollars to make the worker whole. Even that assumes the worker can get the same insurance individually at the same cost, that he got through employer's group plan.

Basically, the current system allows the employer to give the employee a 130 bucks of compensation for a hundred bucks. If I went up to you today and said, I will give you a hundred and thirty bucks in exchange for a hundred bucks, would you take the deal? Would you really need a law requiring you to take the deal? If a law requiring you take the deal were delayed in it's implementation, would that stop you from still taking the deal today? Even if you were reluctant to take the deal, would it make a difference that your competitors were taking the deal, perhaps using the cost savings to hire away your best employees?

--Hiram

Anonymous said...

I think businesses give it to us because we want it.

Historically, in America, business provides health insurance because it was a way around WW II wage restrictions which were at the time considered necessary to fight inflation. That rationale is no longer in place, but as time both employers and employees acquired a vested interest in the status quo. It's possibly the irrationality of that policy, the fact that it's base, that it was created for historical reasons which no longer exist, that upsets tax policy theoreticians. One big problem is that our current policy here, best suits the industrial model in existence at the time it was created, a model which has changed a lot over time, in ways to which health care policy has not adequately adapted.

In economic and business terms, I think the best way to look at health insurance as compensation in another form. Employers compensate you in that way, for competitive reasons, and because it's a good deal for them. Because your health insurance is part of your compensation for working, it belongs to you, not your employer.

--Hiram



jerrye92002 said...

Oh, come now. This notion that "Obamacare is here to stay" is just Dems whistling past the graveyard. Obama has already unilaterally and illegally "killed it." (Although since it was never fully implemented, I suppose you could say he aborted it.) And compared to the promises made for it, it's some sort of zombie horror, eating the brains of those who still support it.

All Republicans have to do is to create the sensible alternative (which IMHO is to simply repeal it and go back to the status quo ante, but could be easily improved), which will cost less (for both taxpayers and patients), provide better care (more choice of doctors and treatments) and then announce that anybody with a private Obamacare plan can keep it, and mean it. Those currently receiving subsidies under Obamacare that make the cost less than what their new private plans would cost, would be "grandfathered in" to those for as long as they qualified, or become part of what Republicans have long wanted to do, of transitioning to a "premium support" model for Medicaid (and eventually Medicare). I'm going to take a wild guess here and say there will be but a handful of these folks because a) only 17 states have exchanges, and by ACA as written, ONLY state exchanges can dole out subsidies, and b) at last count, the software for paying out the subsidies hadn't been created yet.

Folks keep talking about the "good things" in the Obamacare mandates, the coverage of 25-year-olds on parents' policies and the coverage for pre-existing conditions, but what is overlooked is that these are very expensive MANDATES that we all have to pay for, when we should be asking those who want such things to pay for them.

Anonymous said...

This notion that "Obamacare is here to stay" is just Dems whistling past the graveyard.

I rule nothing out but nothing has changed the political dynamic at work here. We do have a consensus based political system, and that means to change the status quo, you need a consensus. Obamacare is now the status quo. Repealing it would require Democratic support, and maintaining Republican unity. I just don't think the Republicans have the stomach for cancelling the insurance of 7 million Americans, a number that will only rise, especially when they know they will be incapable of providing an alternative.

The premium support thing is effectively Obamacare. Republicans who support it will have the difficult task of why they want to expand a system they also want to repeal. The reason they are having is this problem is that not having adopted an alternative position, they are free to criticize Obamacare both from the left and the right. When they are attacking Obamacare for it's complexity, it's glitchiness, they are attacking it from the left. Folks like me would have much preferred a less complex single payer system like Medicare. By making an issue of Obamacare's complexity, Republicans are implicitly making the case for single payer, the opposite of the system, their overall doctrine favors. They can do that as long as they don't explicitly adopt an alternative. But when they do, as Jindal wants them to do, they risk giving up the line of attack that so far, has proven most politically effective for them. Whatever it's other merits, the system Jindal is proposing is immensely complex, and it is a law of computers and nature, that the more complex a system, the more that can go wrong. The rollout of Obamacare has just reminded us of that truth that really all of us understand on some level or another.

Will we really want to relive the history of Obamacare for Jindalcare, which despite it's complexity in terms of substantive policy, really isn't that much different?

--Hiram

jerrye92002 said...

Here's another way to look at the number. Obamacare's raison d'etre was to cover the 47 million uninsured, right? Secondarily, to bring down costs (big time fail on that one, but that's not being spoken of). If only 7 million signed up by the deadline, it is a miserable failure by any objective measure, and that is BEFORE we start picking that 7 million number to pieces. One of the ways I would do that is to note that something like 12 million of the original 47 million uninsured were those eligible for Medicaid but who hadn't enrolled. So, on that basis alone, any new Medicaid enrollees should not be counted, and there are still at least 5 million people STILL uninsured, in that group alone!

Subtract from the 7 million the 6 million who lost the insurance they liked and wanted to keep, and the estimated 50 million that will lose their insurance that they like and want to keep once Obama quits postponing it for political purposes, and you have a huge negative achievement.

jerrye92002 said...

Those who claim Republicans have no alternative, or at best only an unproven/untested one, don't recognize how bad Obamacare really is, that the status quo ante was BETTER, and regardless of its faults, was "working." Obamacare really hasn't been "tried" yet, because of the 15 or so delays and dodges done for political reasons. And what has actually been done so far proves it a failure, in sum, and most certainly with respect to the promises made for it. The only reason it WON'T be repealed is because Democrats won't admit to the reality and choose to substitute their own.

John said...

Hiram,
Since you seem to believe that the businesses are getting the benefit of the "employee not being taxed" on healthcare benefits. I think it is important to review the different paradigms again... Except that #2 would read

2. Society is subsidizing the company workers with tax free healthcare benefits because ???

"Hi Tim,
Please keep in mind that Paul believes in paradigm 1, as shows in his answer. I disagree with him and believe that 2 & 3 are more likely. I personally think benefits for the low income folks are better for them than a higher minimum wage. I mean those benefits are paid for almost exclusively through income and business taxes. Whereas all of us will pay higher costs as the min wage is increased, even those Paul intends to help.

3 possible paradigms as to who is being subsidized by a low minimum wage, that is offset by tax payer funded programs for those with low incomes.

1. Society is subsidizing the businesses by paying their expenses. (ie neutral to regressive tax?)

2. Society is subsidizing the poor who are unwilling to work hard to improve their income earning potential. (ie progressive tax)

3. Society is subsidizing all of us by keeping our "Service/Product Industries" less expensive. And they are doing this at the expense of the tax payers. (ie progressive tax)"

Sean said...

The ranks of the uninsured have been decreased by over 9.5 million, if you take into account all of the changes (including the negative ones).

http://www.latimes.com/nation/la-na-obamacare-uninsured-national-20140331,0,5472960.story#axzz2xkp62wB4

Now, certainly, there's still a long ways to go, but that's the largest number of folks taken out of the ranks of the uninsured in decades.

Anonymous said...

"Society is subsidizing the company workers with tax free healthcare benefits because ???

There are several different ways to answer that question. The historical reason is that not counting health insurance was a way of getting around WW II wage controls. Over time, that temporary decision became structural, as employees came to accept that health insurance was part of their compensation, and employers found it beneficial in several different ways to pay their workers in health insurance. To a large extent, we the system continues because no one has a compelling reason to change, and lots of compelling reasons to let it remain the same.

In a consensus based political system, change is always difficult.

"1. Society is subsidizing the businesses by paying their expenses. (ie neutral to regressive tax?)"

But then, business is subsidizing society by paying for it's health care costs. Remember it's society that needs health care. When's the last time a corporation needed a vaccination? In many, many different ways, we ask business to subsidize society. Is it so terrible if the show appears on the other foot every once in a while?

"2. Society is subsidizing the poor who are unwilling to work hard to improve their income earning potential. (ie progressive tax)."

We are unwilling to let people die at the emergency room door. I won't apologize for that. I will leave it to others to provide the death panels who will tell us who the deserving and undeserving poor are, who gets to live and who gets to die.

"3. Society is subsidizing all of us by keeping our "Service/Product Industries" less expensive. And they are doing this at the expense of the tax payers. (ie progressive tax)"

Since we are all society, we are subsidizing ourselves. Moving money from one pocket to another is not an economically significant transaction.

The funny thing here is that what is being made here is an argument against placing the burden of American health care on business. It's not that I disagree with that, the problem is that my agreement with that argument is most emphatic. Our system is fundamentally silly. But what' the alternative? If the burden of health care isn't placed on business, where does it go? Where do you thin Jindal places it?

All lot of this goes back to Woody Allen's basic joke. Two ladies in a restaurant, one lady says to the other, "The food is terrible here", and the other lady responds, "Yes, and such small portions."

--Hiram

Anonymous said...

"Those who claim Republicans have no alternative, or at best only an unproven/untested one, don't recognize how bad Obamacare really is, that the status quo ante was BETTER, and regardless of its faults, was "working.""

Oh my heavens. If that's the case, why are Republicans adopting the benefits of Obamacare, things like requiring insurers to cover pre-existing conditions? Why is Governor Jindal proposing not only the subsidized premium feature, that Democrats, in our heart of hearts, deplore but is proposing to extend it to Medicare?

I have never seen any significant Republican proposal that when you got down to it wasn't a watered down, or sometimes hyped up version of what Democrats, against the wishes of many of us, enacted.

Hiram

Anonymous said...

Part of what conservatives like Jindal are trying to do is maintain freedom of choice in the marketplace. But he is a business consultant, and a politician, not an economist, and what he fails to understand is how often Adam Smith's invisible hand contains a gun pointed at one's head.

Take my example of an offer of 130 dollars in exchange for a hundred bucks no strings attached. A businessman has the freedom to refuse that offer, doesn't he? But is that freedom real? Or is it illusory? What does that businessman tell his boss, his board of directors, his shareholders, that he turned down free money? How long does that businessman stay gainfully employed? How long can the business that employs him, compete with other businesses who don't turn down free money? Is the businessman really free, in any meaningful way, to turn down my offer?

--Hiram

John said...

LA Times Number of Uninsured

John said...

"uninsured have been decreased by over 9.5 million"

At who's expense? If 5 million of them went on Medicaid, would that really be a good thing in anyway...

Laurie said...

"If 5 million of them went on Medicaid, would that really be a good thing in anyway"

that is a very callous statement

Sean said...

At who's expense?

You're already paying for their healthcare today. Why not give them the opportunity to take care of conditions before they require expensive ER care or before it becomes a chronic condition?

Or, why don't you just be honest and say that if you're not willing to pay for them, we should just let them die?

John said...

Laurie and Sean,
I understand that you are not concerned about the downsides of socialism and the entitlement / free loading mentality that I believe comes with it. Or the incredible problems that I believe are the natural consequences of encouraging free loading.

It seems that you are very comfortable carte blanche taking money from some citizens that you believe have "too much" and giving it to other citizens who you believe have "too little".

As I explained to Laurie before... I have 3 daughters who are all very different. If one of them works hard and saves, and another does not work and spends. The first daughter will have a lot in her piggy bank, and the other will have little.

Now, what you seem to believe is proper and healthy is that on a regular basis I should take money from the saver/worker and give it to the couch potato/spender.

Meaning I would be taxing / punishing the daughter who is exhibiting the bahaviors that I want to promote. And I would be rewarding the other daughter for her sloth and waste.

I am sorry but I think that would be a very unwise thing to do in my household, my state or my country.

John said...

Now charity is a different thing altogether. If my "wealthy" daughter chooses to help her "poor" sister, both can gain something from that transaction.

And if the poor sister refuses to change her ways, should the "wealthy" sister be forced to subsidize them?

John said...

I have an acquaintance who's child got into drugs. He spent thousands and thousands of dollars and many years trying to help her. However she was unwilling or unable to change.

He finally had to leave her to the natural consequences of her choices.

From what you are saying here, I assume you believe we tax payers should take over where he left off. We should pay for her housing, food, medical, etc forever. Is that correct?

Laurie said...

Many hard working people are on both food stamps and medicaid. Why is that so hard for you to understand? Your family analogies have little to do with reality.

Minimum Wage Value Falling But Fairness Is Debated

Sean said...

I'll thank you to allow me to make my arguments for myself.

If anything, the Affordable Care Act encourages personal responsibility by requiring -- except for the most destitute -- a contribution towards society's guarantee to all of us that we won't be allowed to bleed out on the corner. Heck, Mitt Romney understood this, which is why he implemented practically the same darn thing in his state when he was governor.

John said...

Laurie,
The analogy has everything to do with human nature. Ignore it at our nation's peril. Punishing desired behaviors and rewarding undesireable behaviors is that path to hell that is paved with good intentions.

Sean,
As you just pointed out earlier, no one bled out on any corner before ACA. The system and charities absorbed those costs when they had to. The difference was that people weren't waiting for the check or insurance card from the government that they felt entitled to.

Both,
You avoided the question... What do we do with the lost like my friend's daughter?

John said...

How far to the Left is far enough?
G2A Continuum

Currently we are approximately dead center at ~38% of the country's GDP being "distributed" by local, state and the federal governments... Personally I think that is great plenty...

Now how do we get them to spend it more wisely... Whatever that means...

Sean said...

Under the old system, people didn't have insurance, went to the ER and left everyone else with the bill. Now, they pay part of their insurance premium or a penalty to help finance that care that they receive. How is that worse?

I don't accept the premise of your other question because you continue to treat my position as a broad stereotype divorced from reality. I do not and never have suggested that we can "take" everything from the wealthy/virtuous and give it to the poor/lazy, but that is how you describe any position that is to the left of yours.

Laurie said...

I believe addicts are deserving of food and medical care, though I really don't understand the point of your question. Do you think most of the formerly uninsured are addicts?I am pretty sure most are low wage workers.

John said...

Sean,
I do not believe you want to take "everything", I do believe you want to take more than I do.

Just as I don't think that "every" government aid recipient is lazy or addicted. I just think that there are more out there than you do.

Remember what I said above... "By the way, I don't mind ACA. I just disagree with the wealth transfer aspects of it."

John said...

Laurie,
Until I see the data I have no idea how many of the 7 million were uninsured, low wage, etc.

This is just an extension of our long standing discussion. How much government spending is enough?

The Liberals keep pulling to Left while saying its the Conservatives that are trying to change things...

jerrye92002 said...

"The premium support thing is effectively Obamacare." -- Hiram

I see no equivalence whatsoever. Premium support would offer everyone a fixed stipend to buy their own insurance, with the coverage they liked, on the competitive market. Obamacare offers NO choice on a NON-competitive market, prices are much higher and the subsidies are... who knows? They're certainly not fairly distributed.

jerrye92002 said...

"The ranks of the uninsured have been decreased by over 9.5 million,..."-- Sean

Even if your number is true-- and it's a number I haven't seen anywhere else-- it is still woefully short based on the deadline having passed and, far worse, it continues the liberal fantasy that having health INSURANCE means that you have health CARE. Since emergency rooms were required by law to treat all comers, insured or not, essentially NOBODY was denied health CARE. Other studies have shown that emergency room visits have not declined under Obamacare, and doctors and hospitals are now refusing Obamacare patients because their insurance is "inadequate" under Obamacare and people are refusing to buy it because it costs too much. I'm really struggling to see the "success" here.

Sean said...

The GOP Medicare premium support plan would require folks to buy a package of benefits equivalent to (or better than) current Medicare benefits.

Certainly, it's less complicated because it's a common subsidy for everyone. Of course, that means we're subsidizing the wealthy, too. I guess that explains why Republicans like it so much.

Sean said...

John, I would argue there's more wealth transfer going on in the pre-ACA system. It's just happening in a different way. The ACA attempts to hold everyone responsible to contribute to the system in some way -- something that didn't happen before hand.

Anonymous said...

"Premium support would offer everyone a fixed stipend to buy their own insurance, with the coverage they liked, on the competitive market. Obamacare offers NO choice on a NON-competitive market, prices are much higher and the subsidies are... who knows?"

Have you been on the MnSure website? It offers a myriad of choices from many providers. It's a little bit boggling actually. As for fixed premium support, Obamacare premiums are income based not fixed, something Republicans like a lot more than Democrats.

Generally speaking, cost controls are something we gave up to get the deal done. Given our choice, we would have been much tougher on health care costs than Obamacare allows. But the moment we start cracking down on costs, the Republicans responsive is immediate and reflexive. Socialized medicine! Interfering with the free market! Etc., the litany goes on. You note the Republican choice here, fixing premium support, doesn't in any way limit costs. If it did, Obamacare which is also a form of premiunm support would have more impact on costs that it does.

--Hiram

Anonymous said...

The suspicion by the way, of Republican fixed premium support is that the cost savings will be achieved when the fixed premium fails to keep pace with the increasing cost of medical care. The theory there, I suppose, is that market forces require tht prices will not rise faster than the ability to pay. But markets don't work that way. What markets say is that if you can't afford a Mercedes, you don't get a Mercedes.

Maybe I should also mention once again, that the existence of markets in no way guarantees that prices get cheaper. If it did, the stock market would always go down.

--Hiram

John said...

"Obamacare premiums are income based not fixed, something Republicans like a lot more than Democrats."

Please explain your rationale. Democrats historically love benefits/credits that phase out as incomes increase... (ie only go to the poor) I mean they even do this with Social Security and Medicare which should be immune from these games.

Meaning the "wealthy" likely paid the maximum premiums and therefore should get the maximum benefit. But instead there are limits and tax issues to punish those who paid the most.

And worse yet the Liberal groups want to remove the "premium cap" without giving those who pay more additional benefits.

Sean said...

"Meaning the "wealthy" likely paid the maximum premiums and therefore should get the maximum benefit."

If you think Social Security and Medicare are investment programs, this would be true. That's not what they are, though.

Anonymous said...

Social security comes to mind. It's generally our view that that benefits can extend to the wealthy because that gives them a stake in outcomes. But in any event that point is not very significant in that context. Both Obamacare an Jindalcare provide for premium supports to individuals to purchase in the marketplace. It's very much a republican approach. Under Jindalcare, as with Obamacare, those premium supports would be paid for by wealthier taxpayers, would constitute a wealth redistribution between rich and poor, young and old. That great principle of economics, that turnips are not a source of blood is not to be violated.

--Hiram

John said...

I don't think SS or Medicare are investment programs, I think they are supposed to be insurance programs. And if one pays the full premium, one should get the full benefit.

If the wealthy pay more and get less, then social security and medicare are no different than welfare and medicaid.

As for subsidies, I assume Jindahl's plan would give a fixed dollar subsidy up to some income level. That would be the typical GOP method.

Whereas Medicaid/ACA will pay the full premium for the poor and nothing for the middle class or wealthy. That would be the typical DFL method.

Anonymous said...

Ss serves three function. It's an investment program an insurance program and a welfare program. A lot of problems in running the program and understanding it comes from whipsawing through these various functions.

ACA will have lots of benefits for all, particularly the coverage of pre existing conditions. And again, I would point out that Jindalcare a republican program has the same features you find problematic with Obamacare. It too, is a wealth transferring welfare program.

--Hiram

Laurie said...

about "our long standing discussion. re How much government spending is enough?"

I think at the most basic level our disagreement about "wealth transfer" is my belief that our form of capitalism has major flaws in how earnings and wealth are distributed, whereas you see no problem in CEO's earning 273 times the pay of their median-paid employee.

Sean said...

"Whereas Medicaid/ACA will pay the full premium for the poor and nothing for the middle class or wealthy. That would be the typical DFL method."

Subsidies under the ACA are available to families of four with incomes up to about $90,000 (about $20,000 higher than the median household income). That's most assuredly not "nothing for the middle class".

Do you really understand how the ACA works, John? Saying things like the above lead me to believe that you don't.

Laurie said...

I know this thread is about health care, but I have been finding reading about food stamps interesting, especially the brief story about how little Walmart would have to raise prices to pay their employees enough to get off food stamps.

SECRET LIFE OF FOOD STAMPS

jerrye92002 said...

You can use food stamps or you can use Obama care as the example; either works. The whole problem with either of these programs is that it takes the responsibility off of the individual and dumps it on the collective taxpayers. And wastes about half of it in the process. It creates a set of perverse incentives on both sides of the exchange (or all three sides, technically – the payer, the recipient and the provider.

I've mentioned before that I was once eligible for food stamps if I had done three things: sell my existing house and buy a bigger one that I couldn't afford, sell my car and by a newer one that I couldn't afford, and take a lavish vacation to spend down my savings account. That is not the kind of irresponsibility you or I would want to encourage, but government programs do it as standard operating procedure. Obama care subsidies, for example, go to anyone who claims to need them. And the penalties don't apply if you say you can't afford it, or couldn't get onto the website. Does anyone see the potential for fraud here?

The big advantage to premium support is that it puts the responsibility for health insurance back on the beneficiary, while offering a fair level of support for those not making ends meet. And since this support would be "progressive," the incentive to earn more would always be there. And the fact that this insurance would be purchased in the competitive free market means that costs would go down and supply of care law will go up, the opposite of the current incentives.

Sean said...

"Obama care subsidies, for example, go to anyone who claims to need them. And the penalties don't apply if you say you can't afford it, or couldn't get onto the website. Does anyone see the potential for fraud here?"

That's just flat-out not how it works.

John said...

Sean,
I truly don't know much about ACA and hope not to, however I can see there is little subsidy for the middle class folks as compared to the poverty folks.

And if assuming most middle class folks work for a company that pays part of the premium, then I am pretty sure the only benefit is that the value is not taxed.

Daily KOS Subsidy Chart

Hiram,
Since Jindalcare is from the GOP, I am certain that is also compassionate to those in need. However I am guessing there are some differences.

John said...

Laurie,
I promise to post your links to some new headings yet this weekend.

I heard some of the SNAP discussions on NPR. It was fascinating.

Also, what is your source for this statement. I can't wait to look into the details and determine if this an oddity or typical...
"CEO's earning 273 times the pay of their median-paid employee"

Laurie said...

if you google the phrase you have in quotes this link pops up:

The CEO-to-Worker Compensation Ratio in 2012 of 273 Was Far Above That of the Late 1990s and 14 Times the Ratio of 20.1 in 1965

looks like a reliable source to me.

Why is it that you have so little concern about the wealth transfer from middle class people to the 1%?

John said...

No one is forced to give their money to the 1%...

The 1% will be thrown in jail if they don't pay their taxes...

Thanks. I'll read it later.

John said...

FYI.. The source's mission statement...

"The Economic Policy Institute’s mission is to inform and empower individuals to seek solutions that ensure broadly shared prosperity and opportunity."

It should be interesting.

Anonymous said...

I am sure there are tweaks in Jindalcare that differentiate it from the Affordable Care Act. But the problem Republicans have to deal with now is that they crafted their attack on Obamacare after the point where they no longer felt the need to present an alternative plan, and therefore, did not feel compelled to make sure that their criticisms would be consistent with any plan they would one day propose themselves. And this problem is exacerbated by the fact that Obamacare is so close to Republican thinking on the subject that it is incredibly difficult to propose a Republican plan that doesn't also possess the features that they object to in Obamacare. Obamacare is complex and messy, relying on the coordination of a lot of moving parts, which act independently of it, and independently of each other. Fifty states, fifty websites, fifty plans per states. What could possibly go wrong? Jindalcare does that too. Wealth redistribution? Like Obamacare, Jindal care is a premium support system. A transference of young to old, that can't be avoided because young people are healthier than old people, something neither Obamacare nor Jindalcare changes.

I am beginning to see the first signs that Democrats are beginning to run hard, and Republicans are beginning to run scared on these issues. I believe the commentariat, cocdooned in their own gold plated employer provided health care plans, fully aware that it's their wealth that Obamacare is redistributing now, and which Jindalcare would redistribute in the future, still immersed in discussions of the software problems that plagued the rollout of Obamacare, and would no doubt be an issue for the immensely complicated Jindalcare system, have not yet come to grips with how Obamacare has already changed America in ways that are irreversible.

--Hiram

Anonymous said...

Let's also look at Jindalcare, or at least a straw man version of what Republican health care would like from the perspective of John's tripartite analysis. First, let's throw out time. Obamacare was under severe time constraints because the Democratic veto proof majority was tenuous both because the term was limited, and because it depended on two members whose own health was tenuous. Instead of two years, the window for enactment was more like a few months. Republicans will basically have no time at all making the current exercise irrelevant so let's throw that out.

Under the Republican plan, I assume the quality will not change, will even improve in some ways. If you have an off brand doctor, one who isn't part of the lengthy list of accepted health care insurer providers everyone else seems to be a part of, in all likelihood you will get to keep him.

The stumbling block is cost. That increased quality will come with an increased cost, something that someone will have to pay. The reason why your off brand doctor isn't a part of a health plan could very well be that he wants to charge more than any health care plan will allow. Somebody has to pick up the difference. If it's the patient, no doubt their will be whining about how Jindalcare is punishing his choice of doctors and increasing his health care costs by leaving a portion of his bill unpaid. Boo. Hoo. A Republican plan, especially after the criticism leveled at Obamcacre, would be less likely to exclude junk insurance. This would make insurance cheaper however, but let's recall under John's analysis, lower cost means lower quality, when time is off the table. Cheaper insurance, basically means caps on spending, but sadly enough, doesn't mean caps on what money is spent on. Those additional costs will go back to the rest of us, in one form or another. Bear in mind too, that they will be higher than they otherwise would have been, because they come up abruptly, in a narrow time frame, which means they negatively affect quality, or more likely cost. Emergency care, in whatever form it takes, is more expensive, and that added expense, one way or another will be passed on to the rest of us.

So what are the merits of Jindalcare? In a word, freedom. But as we have seen freedom can be real but it also can be illusory. My freedom to buy a Chevy instead of a Ford, or to put off the purchase of a care is pretty real, but how real is the freedom we have in making our health care choices? If a child has a life threatening medical gcondition, in what sense do we as individuals or as a participants moral society have with regard to his care? Do we let children die when the power to save them is easily, if expensively within our reach? And if a choice is compelled, how can it ever be free?

--Hiram

--Hiram

jerrye92002 said...

"Why is it that you have so little concern about the wealth transfer from middle class people to the 1%?" -- Laurie

Laurie, how do you see unequal salaries as being a "wealth transfer"? Who PAYS these CEO salaries? Certainly not the "median employee," or ANY employee. And if you are worrying about the "gap," then how about the gap between an NFL football star and the high school football coach? Personally, I wouldn't want a CEO job, or you would have to pay me an incredible amount to take it. What's wrong with that? Would you prefer that government step in and mandate that a CEO be paid TWICE what he/she now earns? Then why would you want government mandating they get less? How does it help the median worker if the CEO earns less?

Anonymous said...

Here is how the arithmetic of wealth redistribution works out in terms of government. As is often the case, Republicans are right, they just aren't aware of the extent to which they are right.

Let's say the top one percent pays forty percent of the taxes. That' a wealth transfer since the top one percent don't get forty percent of the value of what their taxpayers. The soldier putting his life on the line for our freedoms benefits each of us on a per capita basis. So in benefiting from his service equally, the greater amount the rich person pays the poor person for that service is a wealth redistribution. It's an inescapable consequence of the arithmetic of the situation.

Is there an alternative? Sure there is and Jason Lewis identified once, a moment of euphoria. Let's not have a progressive system of taxation where the rich pay more. Let's tax people in the same way people receive benefits, on a per capita basis, which means with certain adjustments, each individual pays the same. It's fairer, and we are all big fans of fairness, right?

Well, Houston, we have a problem with that. The reason why rich people pay taxes is that they are the ones who have the money to pay them. We are up again, against that inexorable and unfair law of life, that blood is not to be had from turnips. It falls on rich people to pay unequally for things that benefit them equally because there is no one else that can do it. A jobless single mother on welfare simply doesn't have the wherewithal to buy a tank, and so the rich person is stuck with the bill.

The laws of arithmetic while inexorable, can be evaded. One way to do that is the "opt out. In terms of personal security, one can move to an armed enclave, and cut the police budget for everyone else. In terms of health care, the healthy can construct plans for themselves that exclude the unhealthy. In terms of education, the rich can create schools for themselves, and restrain spending on schools to which the rest of us send of our kids. In terms of military service, well in that case it's perfectly ok for poor folk to keep rich folk safe in their mansions. I mean, isn't it fairer when wealth redistribution works the other way on occasion?

--Hiram

John said...

I copied the last 2 comment over to the CEO Pay Post

Anonymous said...

Who PAYS these CEO salaries? Certainly not the "median employee," or ANY employee.'

Think of a corporation as a pie. When top managers get a bigger portion, someone else must get a smaller portion. Oddly enough, it's the folks whose job it is to divide up the pie, are the ones who not only get the biggest piece but pieces which get bigger every year.

"And if you are worrying about the "gap," then how about the gap between an NFL football star and the high school football coach?.

I don't worry about gaps myself. Gaps are two issues artificially combines into one. For example, the one issue is the gap between NFL and high school coaches too large, is two really two issues, how much should NFL coaches be paid and how much should high school coaches be paid, neither of which has much to do with the other. It's not a pie question, when a pay increase for the NFL choice must be paid for by a cut in the college coach's salary.

--Hiram

Sean said...

"I truly don't know much about ACA and hope not to, however I can see there is little subsidy for the middle class folks as compared to the poverty folks."

Well, it sure doesn't stop you from opining about it.

I would think that the idea that the subsidy is on a sliding scale would be preferable to you. After all, shouldn't the government only subsidize those who need the subsidy?

John said...

The question is...

How much is enough? What should we do for people who live in the USA?

Should we ensure every man and woman who lives on American soil gets at least $20,000 in income whether they choose to work or not? Whether they choose to become educated or not?

I mean that would be the perfect sliding fee scale.. Someone makes zero, we give them $20,000 of free stuff... They make $10K we give them $10K of free stuff...

Seems like a nice nirvana, especially for those who can happily live on $20K, or play the system.

By giving them $5+k of insurance, we are 25% of the way there... Then there is SNAP... And housing subsidies... And heating subsidies... Etc...

What do people deserve just for standing on American soil?

Is it right that others pay the bills for their being here?

Does the $20,000 minimum motivate, help or demotivate?

John said...

I had a very interesting conversation with one of my peers from Germany the other day. He said that if someone on unemployment or welfare does not find a job within a prescribed amount of time, government finds them something to do. It made me think back to China.... G2A Making Jobs in America

Any reason we shouldn't have people on welfare, extended unemployment, etc cash recipients out working to beautify America?

Anonymous said...

How much is enough?

It's somewhere between too much and too little. In life we draw lines all the time. Football fields are full of them. For me, the fact that line drawing can at times be difficult just isn't a convincing argument for abandoning the enterprise altogether.

"He said that if someone on unemployment or welfare does not find a job within a prescribed amount of time, government finds them something to do."

Sounds like socialism to me. Or the movie "Dave".

jerrye92002 said...

There have been studies around of the "welfare cliff," claiming that with all of the various welfare programs, a single mother of two would need $30/hour, full time, to "break even" going to work. Anything less, and she would be losing money by working. That's wrong.

I really liked Nixon's "negative income tax" idea. First off, everybody filed a return (you don't, you don't get paid.) Second,you register with a welfare agency that tries to advise you, find you a job or training, whatever, but doesn't control how much you get. Third, the tax is "progressive" all the way DOWN, so that if you need $5k more to get up to poverty level, you get $3k. If you need $20k, you get $17k. You're always "ahead" by working more or making more. And you pay all your own bills.