"It seems to me that supporters are determined to see the positives of ACA, and the opponents are determined to see the negatives of ACA.For more, see the Minnpost site. Thoughts?
I like to think of it as Medicaid_Lite, many of the people who did not qualify for medicaid and yet could not afford Typical Insurance are now able to afford insurance because the rest of us who pay taxes, buy medical devices and have traditional company supported plans are subsidizing their premiums. Plus we are paying more to cover kids until they are 26 and to ensure that people with pre-existing conditions can get reasonable coverage.
It is an extra expense for most of us, but I am not sure it is "terrible". It helps some people to have coverage, but I am not sure it is "great".
The worst thing about the bill was the billions of dollars spent to just set up these unnecessary exchanges. Maybe a tax credit that varied based on income level would have been more cost effective." G2A
"I love that comment, it gets to the crux of the situation and explains why the two views are so divergent. Krugman and crew focus on the millions helped. And the Conservatives focus on the many millions paying to help the millions. And both ignore the other's group of citizens.
"ACA has helped millions but adversely affected more."" G2A
Friday, May 1, 2015
Another ACA Disagreement
MinnPost Krugman on ACA
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73 comments:
When conservatives can come up with a better idea -- one that covers more people at a lower cost, let me know. Until then, I'm satisfied with the step forward the ACA represents.
John,
You seem to have missed the main point of Krugman's column, that all of the ways conservatives predicted that Obamacare would fail turned out to be wrong.
You seemed to have missed my point, Krugman is only measuring and evaluating based on factors that he values and appreciates. And he is ignoring the huge costs that were incurred.
I whole heartedly agree that some anti-ACA idiots said some stupid things, just as pro-ACA idiots often said some stupid things. Proving that those on both sides are idiots does not prove that ACA is good or bad, though Krugman would likely disagree based on this article.
you are still missing the point. Most of the predictions that conservatives made regarding problems with the ACA act were wrong. They can hate it both before and after it was implemented, but facts are facts and they were wrong in the predictions about costs and effects.
His column is not about picking facts to support the opinion that is is a bad (or good) program. It is about did the law work as it was intended. and predicted by those who created it. Which part of Obamacare is not working as it was intended? You seem to be confusing his column with an opinion piece. The huge costs that were incurred were part of the bill and not relevant to the point of his column which is the conservatives were wrong when the predicted a variety of problems that would prevent the law from working.
about - pro-ACA idiots often said some stupid things.
Do you have an example of something in the law that is not workiing, other than problems with using the exchages, which I believe have been mostly resolved. You have nothing that Proves that those on both sides are idiots.
First of all: the law was passed by Democrats only for the most part. Even if it was working exactly as planned the results may still not be acceptable to many.
This individual seems relatively pragmatic and he anxious about rates.
Forbes Rates
"All this is to say that the story is more complicated than either side would like you to believe. It is a good thing that premiums on Obamacare’s exchanges aren’t rising rapidly for 2015. But premiums did go up a lot in 2014. And they may go up again, as the “three R” program phases out.
The bottom line is that if you shop for coverage on your own, and you don’t qualify for Obamacare’s subsidies, you’re probably paying a lot more for insurance today than you did before. And that’s why Obamacare remains unpopular with the public."
Here is an interesting site. Were these really all intended consequences?
ACA Fail Stories
Forbes What 60 Minutes Didn't Say
Gallup Survey
"The worst thing about the bill was the billions of dollars spent to just set up these unnecessary exchanges. Maybe a tax credit that varied based on income level would have been more cost effective."" G2A
People wanted insurance exchanges because the decision had been made to retain a role for private insurance companies, and they wanted to provide a market place in which they would compete. What was the Republican alternative? Single payer, which would have largely eliminated insurance companies? No marketplace which would have made the system less transparent, and less competitive?
The problem with conservative opposition to Obamacare is that it isn't grounded in any ideological perspective at all. This allows them to criticize Obamacare for having features, they firmly support, and for not doing well enough things they work very hard to prevent them from doing at all.
--Hiram
There were plenty of ways to buy insurance before ACA, the exchanges are an expensive duplication of the free market.
Please remember that many of my family and friends are self employed farmers and they all had health insurance and were happy with it before ACA.
There were plenty of ways to buy insurance before ACA, the exchanges are an expensive duplication of the free market.
Sure there were. People create market places, not because trading is impossible without them but because it make trading more efficient. That's why all through history, people have created them. Certainly, the marketplaces created by Obamacare could be improved, but it's conservatives, not folks like me, who are against improving them.
--Hiram
One of the many problems with our health care discourse, is that conservatives oppose the measures they support. Conservatives, who passionately believe in markets, criticize Obamacare for creating them. Conservatives, who passionately support the idea health insurance should be available for sale across state lines, even more passionately oppose the creation of the national marketplace that would make that possible. Conservatives who want markets to be more efficient, instead of one, favor the creation of 50 different new markets created from scratch, each one of which duplicates the job each of the others are doing?
As Yoda might say, "Is it coming they are or going?"
--Hiram
The complaint is that the insurance exchanges are too expensive. No one doubts that they are more expensive than they have to be or that logic would require. Creating 50 exchanges from scratch, has got to be more expensive than one national exchange. But conservatives who want us to be able to buy insurance nationally oppose measures that would facilitate that. Oh well.
But I do believe it is the case that insurance companies pay part although not all the costs of the exchanges, needlessly made more expensive by conservative opposition. One obvious solution to that is to make insurance companies absorb more if not all the costs of creating the exchanges, so beneficial to their bottom lines. So do conservatives who complain so vociferously about the high cost of the exchanges support such a common sense measure? If you believe they do, I have for sale a very nice bridge in Brooklyn that you might be interested in purchasing.
--Hiram
Here is a summary of the ways Kruger expalins conservatives were wrong about Obamacare:
1. Americans, declared a May 2013 report from a House committee, were about to face a devastating “rate shock,” with premiums almost doubling on average.
2. the right’s favored experts were warning about a “death spiral” in which only the sickest citizens would sign up, causing premiums to soar even higher and many people to drop out of the program.
3. In 2014 many leading Republicans — including John Boehner, were predicting that more people would lose coverage than gain it. And everyone on the right was predicting that the law would cost far more than projected, adding hundreds of billions if not trillions to budget deficits.
So, What actually happened?
1. There was no rate shock: average premiums in 2014 were about 16 percent lower than projected.
2.There is no death spiral: On average, premiums for 2015 are between 2 and 4 percent higher than in 2014, which is a much slower rate of increase than the historical norm.
3. The number of Americans without health insurance has fallen by around 15 million and the overall cost of the program is coming in well below expectations.
4. a new survey by J. D. Power, the market research company, finds that the newly enrolled are very satisfied with their coverage.
I skimmed through your links and my impression is they were generally more supportive of Krugman's points than refuting them.
Conservatives can go ahead and keeping hating the ACA because they don't believe in providing affordable health care to low income people, but they could at least acknowledge they were wrong in predicting the many ways the law would fail.
Are you willing to trust.
Politifact
Fact Checker
WP
As soon as Krugman starts pointing out the pro-ACA failures, I will consider him a rational voice. Until then he is just another Liberal ACA salesman sitting in a glass house tossing rocks at the anti ACA's glass house.
For me ACA seems fine, though I think it is costing me a significant amount of money with no benefit. Maybe I will appreciate it when I retire early and am living off savings with little taxable income. Then all those working folk can help pay for my insurance...
One thing that does frustrate me is that pro-ACA people are using Medicaid expansion as one way that ACA is reducing the number of uninsured.
It is pretty easy to get everyone insured by giving away insurance and having the tax payers pay for it... And they could have done this without ACA.
By the way, in one of those fact checks Obama got the biggest Lie awards for his "you can keep your plan/Doctors" statements. Another whopper is the your bill will be cut by $2500.
I am still waiting to here him admit that he was lying back them. Maybe he will come clean when the anti-ACA folks do.
By the way, another point from the links. Everything with ACA is going slower than it was supposed to. So there is still time for good and bad predictions to come true.
By the way, in one of those fact checks Obama got the biggest Lie awards for his "you can keep your plan/Doctors" statements. Another whopper is the your bill will be cut by $2500.
But now it's Republicans who want to take away insurance from people. Who indeed have never had a problem with taking away health insurance from individuals.
--Hiram
to me the "failures" you have pointed out seem pretty insignificant compared to the predicted failures that have not occurred. I think any fair analysis thus far would rate the law largely a success.
Laurie,
I could be wrong, but I think your success criteria may be bit different from those of many other citizens.
I think you are pretty indifferent to costs, who is paying them, who lost their previous policies, who lost their previous doctors, etc as long as there are some number of fewer "uninsured" at the end.
I think you would probably be overjoyed if Medicaid was expanded to cover people into the lower middle class, even if all of the rest of us had to pay for their premiums.
Am I correct?
as I have explained before success means the law has worked as it was intended. People who would rather not provide affordable healthcare to low income people are still free to hate it.
I do think it would be a good idea to reduce the number of the uninsured even more and expanding medicaid sounds likethe best way to do it.
So I thought of this while doing yard work.
So if you could eliminate the uninsured by raising the taxes on people like me by $5,000/year, would you do it?
For perspective, the "progress" ACA has made so far is costing my family ~$2,000 per year.
It's fine to poke holes in the ACA. What is your plan, though, and how is it better?
It's fine to poke holes in the ACA. What is your plan, though, and how is it better?
Speaking as an ACA supporter, I can say there are lots of ways it can be improved. Just about every day, I read articles in the op ed page of the Wall Street Journal discussing various problems with ACA and in just about every case, I think this is an issue that can be addressed with a relatively minor fix. The problems isn't that ACA isn't need of fixes, the problem is that the people who complain about it don't want to fix it.
I should note and as I have discussed elsewhere, lots of the stuff complain about aren't specific to Obamacare. The market place for example has had it's problems. Well, anytime you construct a market place from scratch to sell a complicated product you are going to have problems. It's a problem having to do with the way we construct markets, not with what we sell in them. It's like saying you shouldn't buy stocks because the trading floor of the NYSE doesn't have enough bathrooms.
--Hiram
1. Deport all people who do not have the legal authorization to be in the country. That will apparently eliminate half of "our uninsured". And should open up a lot of jobs and raise wages.
2. Return to treating "Uninsured People" on an as needed basis.
What do you see happening if keep providing free food, free healthcare, free housing, free daycare, etc to those who have more children than they can afford?
What do you see happening if we keep taking money from hard working people who live below their means to do so?
How can this end well?
"1. Deport all people who do not have the legal authorization to be in the country. That will apparently eliminate half of "our uninsured"."
Illegal immigrants are not eligible for the ACA.
"2. Return to treating "Uninsured People" on an as needed basis."
OK, but before the ACA, there were a lot of uninsured people who weren't getting the care they needed. What's your plan for them? Spare me the moralization, give me a plan.
1. I understand however people keep counting them as uninsured.
2. Moralization? I am simply discussing natural consequences of an "idealistic moral policy".
The policy that says "every person standing on American soil deserves good food, clothing, housing and healthcare no matter what decisions they make, effort they show, etc."
Since I think you support that policy, I want your view as to where you think the policy leads us.
Oops. Forgot the link.
KFF Unisured
"Since I think you support that policy,"
I'm not sure where you've gotten that opinion, other than your own colorful stereotypes of liberals. In fact, the ACA does more than pre-ACA system to collect from those who weren't contributing to the cost of their own healthcare before.
Source please...
Please remember that those folks were often paying cash for health care since they did not have insurance.
Just because some are paying for health insurance with their own money does not necessarily mean they are paying more.
Remember that a large percentage of the reduction in uninsured is due to medicaid expansion. (ie like ~50%?) And as far I know they don't pay any premiums.
"colorful stereotypes of liberals"
Are you telling me that you are okay with children being reliant on their Parent's efforts and Private charity to get housing, food, healthcare, clothing, etc?
Or do you think the government/tax payers should write checks to ensure the children are fully provided for?
I know it is politically incorrect and dehumanizing, but I have this vision of rabbits in a valley with lots of food provided by someone, and no predators... That someone better keep working harder...
"Please remember that those folks were often paying cash for health care since they did not have insurance."
Or, more likely, they were getting free care from the hospital or none at all. If you're not familiar with how the ACA works to collect from those who previously free-rode on the system, you should do some research.
I recall from one of our previous conversations that you claimed not to know much about the mechanics of the ACA, yet you continue to come on here and make sweeping pronouncements about how it's so terrible.
The fact that you can't provide anything approaching something semi-specific that you would do differently is telling. You're trying to cloak your fundamental unseriousness on this issue in pseudo-moralistic babble.
"Are you telling me that you are okay with children being reliant on their Parent's efforts and Private charity to get housing, food, healthcare, clothing, etc?"
There's a difference between children and adults.
"how it's so terrible": I don't think I have said anywhere here that ACA is terrible or that it should be undone. I have said that pro-ACA people only see the good, and anti-ACA people only see the bad. I see benefits and costs.
My simplistic understanding is that most people who really were low income were on Medicaid and/or are not required to buy insurance under ACA. That is why ACA relied on expanding Medicaid (ie single payer) to reduce the number of uninsured people. And since many States didn't swallow that bitter pill, the uninsured remains higher than intended.
The upper poor and lower middle income folks had income, so if they visited a doctor I am pretty sure the clinic/hospital sent them bills and followed up with bill collectors. At least they did with my brother in law. Probably causing some uncollectibles and / or bankruptcies. Then there were also the charity clinics and hospitals that helped to care for these people.
I think these were pretty clear:
1. Deport all people who do not have the legal authorization to be in the country. That will apparently eliminate half of "our uninsured". And should open up a lot of jobs and raise wages.
2. Return to treating "Uninsured People" on an as needed basis.
"There's a difference between children and adults."
Yes and No. As long as you are going to pay irresponsible Mothers / Parents to ensure their kids are fed, clothed, housed, and get medical care, the irresponsible people will continue having kids. Look at the fun they have been having in Baltimore.
"2. Return to treating "Uninsured
People" on an as needed basis."
You're just asserting ideology, not describing a policy.
Which of the uninsured people get assistance? All? None? Some? If some, then how do you decide who does and who doesn't?
How are you going to pay for it? Like we did pre-ACA (which left lots and lots of people in the lurch)? Something else? If so, what?
"Yes and No. As long as you are going to pay irresponsible Mothers / Parents to ensure their kids are fed, clothed, housed, and get medical care, the irresponsible people will continue having kids."
The correlation there is in part due to the fact that it's hard for poor women to get access to long-term reversible contraception, something which the ACA does much to address.
Nonetheless, I don't see a need to punish children for what their parents have done.
I don't know if I am contributing any $ towards Obamacare or not. It feels to me like I don't. If I am I am happy to do my part.
If I was going to expand medicare to further reduce the # of uninsured I would raise taxes on people with higher incomes than me. The little bit of $ I don't spend check to check goes towards my children's college tuituion. I like to be able to contribute a little.
about irresponsible people,
- if poverty were simply a matter of values, as if the poor just mysteriously make bad choices and all would be well if they adopted middle-class values. Maybe, just maybe, that was a sustainable argument four decades ago, but at this point it should be obvious that middle-class values only flourish in an economy that offers middle-class jobs.- from your favorite commentatot Paul Krugman
John Blake at Lord of the flies link seems to agree somewhat with Krugman.
Sean,
A national governmental policy is only really necessary if you believe the national government needs to address an issue. Pre-ACA, people worked their best at local levels to meet the needs of local individuals. That is good enough for me.
Condoms and the pill are readily available and easy to use. I hope you like rabbits. By the way, I do not have a good answer to how to address the kids issue, but I think it involves irresponsible broke Parents losing their parental rights and their cute cuddly babies to forced adoption.
If you can't afford to feed and raise them well...
Hi Laurie,
"I would raise taxes on people with higher incomes than me"
Thank you for being an honest Liberal.
Though I am not too excited about additional taxes and bills that will make it harder for me to pay for the college years and weddings of my three daughters. Especially to give stuff to people who didn't try hard in school, pursue a skilled trade, spend on gambling, smokes or alcohol, or had more kids than they could afford to care for.
I was listening to some folks talk about the Baltimore community where the riots occurred. Apparently we and they have invested a whole lot of money in trying to help them. And yet that community still has no grocery stores and 15+ bars...
1st link I Found
I think they should raise tax revenue from people who won't miss the $. Once I give son number 2 as much help as I can with college I need to save a bit more for my retirement, $15,000 won't last me long. Do you think I should pay more in taxes.
I think the 1% has $ to spare.
btw, I saw your latest link is from a viewpoint opposite my own so I dismissed it immediately, as is the custom around here
"Pre-ACA, people worked their best at local levels to meet the needs of local individuals. That is good enough for me."
You think that was working?
"Condoms and the pill are readily available and easy to use."
LARC is far more effective than condoms or the pill. It also has the side effect of cutting the number of abortions roughly in half if you get just 10% of the population to use them.
Ouch... I think it was I who posted the link that led to Krugman's ACA article...
And I don't disagree with what he wrote. I just think he was being very one sided...
LARC
I would happily encourage and pay for young, foolish, poor and/or irresponsible women to be on LARC, however the last phrase below will give those on the religious right some heart burn.
"Both types of IUDs work mainly by preventing fertilization of the egg by the sperm. The hormonal IUD also thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg, and keeps the lining of the uterus thin, which makes it less likely that a fertilized egg will attach to it."
My totalitarian side would force women and men to be on LARC until they could pass a parenting test and show proof of financial capability.
"however the last phrase below will give those on the religious right some heart burn."
Well, they're not required to use it.
They seem to have an issue with paying for it. Though pacifists have to pay taxes that support armies...
Maybe we can call it the war against irresponsible parents propagating their ineptitude...
Do you think the pre-ACA means of providing poor people with health care worked?
Yes I think the State and Local communities were capable of determining how they wanted to care for their own neighbors.
I don't think the people of MN and Massachusetts need to force their idea of moral on the folks from Mississippi.
Remember: I believe the Federal government's primary roles are supposed to be national defense and inter-state commerce /regulation. I don't support the Democrat's goal to turn us into a Progressive National Democracy. There are a lot of benefits to being a Republic of Independent States.
"Yes I think the State and Local communities were capable of determining how they wanted to care for their own neighbors."
Well, that says a lot.
Does that mean you support the USA being converted to a national democracy?
An entity where States have little to no power to adopt local standards and laws?
One where the majority dominates the minority?
Where every State must adopt the Liberal views of the most Liberal States?
Democracy vs Republic
I was referring to the fact that you want to return to a system that was objectively a failure in terms of health outcomes and money spent.
That sounds very judgemental of people who believe differently from you. I assume this means that you want the Progressives to rule the country, no matter what the folks in SD and ND believe.
I want this country to have a health care system that works. I don't care who provides it. We spend far more than any other country on health care, yet, before the ACA, millions of citizens were left without reliable access to the health care system.
You can continue to try and deflect the point all you want, but that's the system you say you want to go back to, because not offending the delicate sensibilities of people in the Dakotas is more important than, you know, actually providing health care.
"I want this country to have a health care system that works. I don't care who provides it."
Who provides it isn't necessarily the primary issue. The question is who pays for it.
"The question is who pays for it."
A question that I asked you 24 hours ago and remains unanswered with any specificity.
Preferably the recipient of the health care.
In other words.
If you're poor...too bad, so sad.
"Preferably the recipient of the health care."
And if a person working a minimum wage job with no benefits gets cancer, then what?
Are we back to the Liberal idealistic policy?
"The policy that says "every person standing on American soil deserves good food, clothing, housing and healthcare no matter what decisions they make, effort they show, etc."
You criticized me for this earlier, yet again you demand that government / tax payers must care for everyone. That society bear the burden of the choices of individuals. By the way, if the person was poor they should be able to get medicaid?
So I will ask again, I want your view as to where you think the policy of protecting people from natural consequences and making others pay for it will leads us?
No, I'm not asking you about philosophy. I'm asking you a specific policy question, which you apparently can't answer.
"By the way, if the person was poor they should be able to get medicaid?"
Under the current system, yes.
But the question is how would you like the system to look? You said you don't like the ACA and preferred how it was before. You've expressed disdain for Medicaid previously as well.
So I'm trying to figure out, then, how you would do it. You don't seem to have any specific policy ideas to solve the problem, instead choosing to drive around in circles bloviating about philosophy and shooting holes in everyone else's ideas.
When have I dissed Medicaid?
I am all for helping the truly unfortunate, however I want to figure how to get these folks out of the public trough?
Do you disagree or agree?
Ayn Rand novels, YouTube videos and philosophizing don't get people off of welfare. Specific policies do, and you have none to offer.
So you want people paying for their own healthcare but now you're defending Medicaid? I'm confused. Where do you draw the line, then?
I believe I have posted a specific policy at least twice here:
1. Deport all people who do not have the legal authorization to be in the country. That will apparently eliminate half of "our uninsured". And should open up a lot of jobs and raise wages.
2. Return to treating "Uninsured People" on an as needed basis.
Maybe I need to be clearer on point 2. Go back to the pre-ACA policy of using medicaid where appropriate.
As for our difference of method.
Being a project / process management person, I always work with my teams to define what success looks like before digging into the specific policies, tasks, changes, etc we are going to implement.
I believe that a country, company, or team needs to know what they are aiming for before they spend a great deal of time, money, effort, etc pursuing something elusive where the people are not aligned.
That is why I keep asking what your dream America looks like, does it seem sustainable, what unintended consequence may result, etc?
"Being a project / process management person, I always work with my teams to define what success looks like before digging into the specific policies, tasks, changes, etc we are going to implement."
I do similar work in my job, and I completely agree that is essential in the business world. Government isn't a business, though.
Government has a distinctly different purpose than business, and as such you can't treat it as a business. Most critically, you've got two groups in charge of the government engaged in a zero-sum game for control of those institutions.
Beyond that, philosophy only gets you about 5% of the way to actual, usable policy. In Washington D.C., House Republicans the last few years unanimously voted to support the Paul Ryan budget framework, but failed to produce a single appropriation bill to carry out that framework.
Their alignment on philosophy meant nothing. We've seen the same thing here in the DFL, with Tom Bakk and the Senate DFL stepping out of line from the governor and House DFLers.
And even if you're not aligned on philosophy, you can come to an agreement on policy. Mitt Romney and Massachusetts Democrats aren't aligned on philosophy, but they were able to agree on Romneycare because it produced policy outcomes that they both liked.
If I had a magic wand, I'd probably favor having single-payer healthcare. But I don't, and the transition from where we are today to single-payer would be incredibly disruptive to the economy. So I look for policies that take our existing system and make it better.
I'd rather not spend my time chasing my tail talking about utopian fantasies that have no chance of ever being true, and working on solutions that actually have a chance of being implemented.
"Government has a distinctly different purpose than business."
This an interesting statement, I think it will become a post in a couple days.
All you took from that was half of one sentence? Great.
I'll put your whole comment in the future post, and we can go from there.
"Government has a distinctly different purpose than business."
Business has many purposes and sod does government. Some of them overlap, others do not.
What is a business? One way to look at it is as a community of interests, of stakeholders. There are a number of ways of doing that, but here is one to try. A business is composed of it's owners, managers, and customers. Who are the owners, managers and customers of government? If you think of government in those terms, does it operate differently from business? Does it have a different set of purposes?
--Hiram
I don't disagree that there is some overlap, and you can certainly apply some management techniques towards running government.
A business's purpose is to produce a financial return for its shareholders.
Government doesn't produce a direct financial return per se, it fulfills the duties set forth under law. Strictly speaking, does a park produce a tangible ROI for citizens? Maybe, maybe not.
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