Since people want to discuss this. Here is a starting point.
CNN Money ACA Replacement
Ryan's A Better Way: Healthcare
CNN Money ACA Replacement
Ryan's A Better Way: Healthcare
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21 comments:
Please note that Ryan's site has a great deal detail on the links at the bottom of the page.
Ryan's plan is a bunch of nonsense. There's a reason he hasn't sent it to be scored by the CBO: because it's going to reduce the number of people covered and cost more than the ACA. His policy papers are full of unsubstaniated nonsense like claiming that the ACA cut benefits for Medicare recipient (nope) or that the ACA will cost 2 million jobs (not true). By giving tax credits to everyone, it's a handout to the rich and provides less help to those who really need it. It claims on one hand to strengthen states' rights to regulate insurance while on the other hand telling people they can buy health insurance from an insurer in another state. (Good luck suing your Delaware-based insurance company if things ever go pear-shaped!) The medical liability data in there is just wrong. The protection for pre-existing conditions has a gigantic asterisk attached to it. It destroys the contraception mandate. It subsidizes inefficient Medicare Advantage plans before whacking Medicare altogether.
As the Democrats told the Republicans ~6 years ago...
"Find something to like about it since it is likely coming..."
Well that and "you can finish reading it after it is passed..." :-)
Republicans made their choice to not attempt to solve the problem in 2009/2010. Now they own it, and I wish them the best of luck.
But I fear the damage their policy choices will create.
Better Off Before Obamacare?
Apparently the answer is yes if you are healthy...
And no if you are unhealthy and/or poor...
Sounds about right...
I was looking to see what about ACA supposedly slowed the growth of healthcare costs, since most of it's features should have increased costs. (ie covering pre-existing condition customers, covering children longer, mental health benefits, free birth control, the tens of Billions to set up, staff and advertise the market places, etc)
Ideas?
Health care is pretty simple really. We want to cover preexisting conditions. That's expensive, so how do we pay for it? The argument is about that. We can debate all sorts of plans, but inevitably the burden is going to fall on someone and they are going to be unhappy about it. It as simple as that.
--Hiram
Here is the deal. People want choice. They don't want to pay for stuff they don't use.
What this means is that old people don't want to pay for young people stuff, and young people don't want to pay for old people stuff. The result is, neither old people stuff nor young people stuff is paid for. So how does it get paid for?
Republicans have promised a bunch of stuff. Let's look at some of their promises.
1. Patients will not be turned away. That means your doctor has to render care whether he gets paid or not. If you can't pay, he foots the bill for your care. Are we ok with that?
2. Patients will have choice. That means they can buy a cheap insurance plan that covers little, but if they have serious health issues, they can switch to a more expensive plan to pay the bills. Who pays for that? Is that something we are ok with?
3. Trump and all Republicans insist they they will keep what is in fact the heart of Obamacare, insurance of pre-existing conditions, which is the principle source of Obamacare's financial instability. So how are they going to pay for that?
Bear in mind that we have now elected a president who doesn't himself pay taxes. We all know that next April Americans every where are going to be asking why they should pay taxes when the president doesn't. So in a world where tax paying is only for unlawyered schmucks, how are we going to pay for anything at all?
--Hiram
At the heart of it ACA was definitely logical...
- Everyone must carry at least some base level of insurance for their whole adult life. (ie pay into the pool they may need)
- The pool must keep offering people reasonably priced coverage even when something bad happened.
The devils are definitely in the details. (ie mandatory birth control in base package, men/women same rates, legal "mandate", etc)
Actually I think the correct statement is that tax paying for those who actual have "positive income". Not sure what that means about Trump's capabilities if he can not turn a profit...
Of course it takes a lot of profits to make up for a ~1 billion dollar loss...
I think the correct statement is that tax paying for those who actual have "positive income".
If negative income makes one a billionaire, why would anyone want positive income? Negative or positive, a dollar will always be a dollar.
Of course it takes a lot of profits to make up for a ~1 billion dollar loss.
Not if the loss was suffered by someone else. Trump's losses were incurred with that wonderful thing OPM, Other People's Money. This was actually one of the first things I learned about capitalism and how it works, and I learned it from the movie "The Wheeler Dealers". Arrange your affairs so that you keep the profits and the losses are suffered by someone else. Because Trump can do that and you can't, is why Trump is a billionaire and you are not.
--Hiram
"Republicans have promised a bunch of stuff. Let's look at some of their promises."
As Hiram points out, the promises are largely incoherent. Which means that they're either going to produce an incoherent bill that won't work or they're going to have to give up on some of their promises.
Republicans had the luxury of criticizing Obamacare from both sides. In the nature of these things, every time Obamacare got further from the rock, Republicans would accuse it of getting too near the hard place. You can do this much more easily when you don't have a plan of your own. For Republicans, the additional challenge is that Obamacare is so much like a Republican plan that any plan they do produce which is consistent with their principles will be similar and subject to the same criticisms they make against Obamacare. To point to one example, under no Republican plan will your doctor be required to keep you as his patient. In this instance, Republicans are attacking Obamacare for not delivering something they, in no way, can deliver themselves.
--Hiram
To me, one of the most unreal aspects of the recently concluded is how the Republican Party who accuses Democrats of providing free stuff, seem so completely unaware that the vast and hugely expensive promises they make must somehow be paid for. Donald Trump, a man who, let's not forget, has not paid taxes in decades with either positive or negative, has has promised vast amounts of new spending, and the extension vast spending programs while at the same time removing their funding.
--Hiram
Hiram,
You are confusing net worth and income. Many of us have a significant net worth because the tax code allows us to defer taxes until an income event occurs. (ie distributions for 401k / IRA, selling an asset, etc)
Sean,
Time will tell who wins and loses in the new ACA... I know some folks who will be happy to stop paying into this wealth transfer device.
"To me, one of the most unreal aspects of the recently concluded is how the Republican Party who accuses Democrats of providing free stuff, seem so completely unaware that the vast and hugely expensive promises they make must somehow be paid for."
They'll be paid for by selling the Chinese billions of dollars in T-bills. That's how Republicans roll.
You are confusing net worth and income.
I am not sure how that particular distinction is relevant. Where someone like Trump is concerned, net worth is a largely meaningless concept, because he an assign any net worth he wants to his businesses and his brands. We know little about his income because he doesn't release that information, but he acts like someone who is cash starved. He doesn't make charitable donations, and since his bankruptcies, he has involved himself with a lot of cash generating schemes. That works especially well for him because he has those giant carry forward losses he is still in the process of using up.
--Hiram
Time will tell who wins and loses in the new ACA.
For winners, my money is on those who can afford to hire lobbyists. For losers, my money is on those who can't.
But the burden will be placed somewhere.
--Hiram
"Time will tell who wins and loses in the new ACA... I know some folks who will be happy to stop paying into this wealth transfer device."
So Trump is going to get rid of HSAs? Because that's what they are -- a tax shelter for the healthy and wealthy.
So Trump is going to get rid of HSAs?
One way of addressing the cost issue is to make it more difficult to assess costs. Complexity is a politician's friend. In the case of HSA's, this aided by Republicans long argued view that tax savings are not tax expenditures, that they are free. So in this view, HSA's which save on taxes are free money, precipitated out of thin air.
--Hiram
"You are confusing net worth and income. Many of us have a significant net worth because the tax code allows us to defer taxes until an income event occurs. (ie distributions for 401k / IRA, selling an asset, etc)"
I used to see this guy in the skyway selling pencils for a million dollars a pencil. In the box, he had about 50 pencils and I assume they all belonged to him, so my back of the envelope calculation was that he could claim a net worth of at least 50 million dollars. By that measure, he was a remarkably wealthy man. Unfortunately, he couldn't sell pencils for a million dollars each so he did have something of a liquidity problem. But the upside was that since he didn't have any income, he didn't have to pay any taxes despite being a millionaire. He might very well have learned that tax avoidance technique from Donald Trump, possibly at one of Donald's real estate seminars.
--Hiram
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