Posts Tagged ‘Obamacare’

Repealing and replacing Obamacare

September 22, 2017

Two Democrats—Senator Bernie Sanders [1] of Vermont and Rep. John Conyers of Michigan—have proposed bills to do something that President Donald Trump promised to do, but can’t and won’t do.

That is, they would repeal and replace Obamacare with something better.

I applaud what they’re doing, and I think Sanders deserves credit for making universal health care politically possible.

Tom Price

I don’t think Sanders or Conyers can get their bills through Congress at the present time, and I think President Trump would veto them if they did.

That’s just as well.   Implementation of both programs would require the cooperation of Tom Price, the current Secretary of Health and Human Services.   He is an opponent of traditional Medicare, which he would replace with a voucher system, and favors cutbacks in Medicaid.

But under both the Sanders and Conyers bills, he would appoint the administrators of the new program, and, under the Sanders bill,

The Secretary is … directed to develop policies, procedures, guidelines, and requirements related to eligibility, enrollment, benefits, provider participation standards and qualifications, levels of funding, provider payment rates, medical necessity standards, planning for capital expenditures and health professional education, and regional planning mechanisms.

Source: Health Affairs Blog

I’m pretty sure that neither Sanders nor Conyers intends to give Secretary Price the power to sabotage and discredit their plans.   Their proposals are talking points to rally support for universal health care and encourage thinking about how to make their bills better.

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Medicare for all and its alternatives

July 28, 2017

The downside of Medicare for All is that government spending will increase.   Various studies  indicate that overall spending will be less.

The health hazard of being uninsured

June 26, 2017

Obamacare is a flawed system.   It gives for-profit insurance companies a captive market.   It fines people for not buying insurance that they can’t afford, or that does them no good because of the large co-pays.

It is more expensive than the obvious alternative, which is a single-payer system, otherwise known as Medicare for all.

But the Congressional Republicans reject the obvious alternative.  What they’ve come up with is worse.

This chart is based on estimates by health researchers as to how many people die each year as a result of lack of health insurance, plus estimated by the Congressional Budget Office of how many people will be uninsured under the House Republicans’ American Health Care Act versus the Democrats’ Affordable Care Act.

It’s a cumulative chart.  The estimated number of deaths are the same year by year.

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Republicans ready to kill Medicaid expansion

June 13, 2017

I hadn’t realized that more Americans are enrolled in Medicaid, the health-insurance program for low-income Americans, than in Social Security, Medicare or any other federal benefits program.

And the increase in the number of Americans with health insurance under Obamacare—the Affordable Care Act—is due more to the expansion of Medicaid than to signups of people under the health insurance exchanges.

But Senate and House Republicans have reportedly agreed on a plan to dial back the Medicaid expansion.

Kevin Drum of Mother Jones reported that there are 68 million Medicaid enrollees, making it a bigger program than Social Security (61 million), Medicare (55 million), food stamps (44 million), unemployment insurance (6 million at the height of the recession), the earned income tax credit (26 million) and temporary aid to needy families (about 4 million).

Medicaid was created to provide health insurance for Americans earning poverty-level wages.   Under Obamacare, eligibility was increased to Americans earning 138 percent of a poverty wage.  This would be $16,394 for an adult, according to CNBC News.

The program is administered by state governments.   President Obama’s plan pays states nearly all the costs added by the expanded plan, and then a progressively lesser amount sliding down to 90 percent.  The Supreme Court ruled that state governments cannot be compelled to accept the expanded plan, and 19 state governments, all with Republican governors, opted out.

CNBC reporter Dan Mangan reported that Medicaid has added 15 million enrollees since Obamacare went into effect, a figure which includes some people who would have been eligible under the old rules.   That’s nearly 4 million more than signed up for health insurance under the Obamacare exchanges.

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Doug Muder on how health insurance works

March 13, 2017

Poor People Need BETTER Insurance Than the Rest of Us, Not Worse by Doug Muder for The Weekly Sift.

Trump moves fast to strike at Obamacare

January 21, 2017

President Donald Trump, in his first day in office, issued an executive order to cripple the administration of the Affordable Care Act.

trumppositionThe order (1) forbids administrators to issue any new order or regulation that imposes new costs on states and (2) authorizes administrators to suspend any order or regulation that imposes undue costs on individuals or states.

The limitations are that the change has to be permitted by law and that there have to be advance note and public comment on the changes if the law requires it.

That may sound relatively harmless, but the ACA is so complicated that it is hard to make it work and easy to make it cease functioning—like removing a couple of bolts from a highly complex machine.

Here are some of the things reporters said could happen under Trump’s executive order:

  • Delay indefinitely enforcement of all the individual and state mandates to buy or provide health insurance.
  • Expand hardship exemptions under the individual requirement to buy health insurance so that they cover virtually everybody.
  • Extend the option of state governments to approve health insurance plans that don’t meet all the requirements of the ACA, including refusal to refuse insurance to people with pre-existing conditions.

Another thing the Trump administration could do is to stop defending a lawsuit by the House of Representatives challenging the legality of a program to reimburse insurers for providing subsidies for low-income patients.   The program was authorized by law, but no money was ever specifically appropriated for it.   The U.S. District Court agreed the program is illegal; the case is now on appeal to the U.S. Court of Appeals.

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Will the GOP repeal the Affordable Care Act?

January 18, 2017

Update 1/19/2017.  It seems that in fact the Congressional Republicans do have an alternative of sorts to Obamacare.  A link has been added to this article.

The top video from Vox is about Kathy Oller, who lives in southeastern Kentucky and has a job signing people up for the Affordable Care Act.  It tells why many people in her area think the cost of the ACA is too high, and why they voted for Donald Trump.

The bottom video is about an interview of President Barack Obama by Vox reporters on the topic of health care.  Kathy Oller came along.  Her question to President Obama and his answer begin at the 37th minute and take about eight minutes.

President Obama is right in saying Republican leaders are irresponsible in proposing to repeal the ACA without having a replacement plan in place, and in challenging them to come up with a better plan.

It’s apparent that the Republican leadership doesn’t have such a plan..

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Health care costs and the U.S. middle class

September 2, 2016

Economics professor David Ruccio points out that, since the previous recession, the American middle class has been cutting back on spending—on everything except medical care.

healthcare.na-cl366_medspe_16u_20160825163913

The Affordable Care Act was supposed to not only make medical care more widely available, but to make it affordable.   This hasn’t happened.  I think this is partly due to opposition by Republican governors and congressional representatives, but largely due to flaws in the law itself.

It’s a well-known fact that we Americans pay more for medical care and get less benefit than citizens of any other industrial nation.

ftothealthexp_pc_usd_long-1

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How many Americans still lack health insurance?

April 4, 2016

 

2016_total_coverage_pie_chart

Source: Charles Gaba’s Blog

Hat tip to Avedon’s Sideshow

A blogger named Charles Gaba has figured out that, under Obamacare, slightly over 294 million Americans now have health insurance, but 29 million are still without—about 9 percent of the population.

The striking thing to me is how much work he had to do to come up with a plausible estimate.  I would have thought that the U.S. Department of Health and Human Services  had that figure on a web site somewhere.

I would have thought that, in general, President Obama would do more to ensure careful management of his signature reform, given how complicated it is and given how determined his Republican political enemies are to make it fail.

Click on Charles Gaba’s Blog for a detailed breakdown of the figures and an explanation of how he arrived at them, and a larger, higher-resolution version of the chart.

The fatal flaws of Obamacare

February 17, 2015

obamacare_screw_o_1When the Affordable Care Act was enacted five years ago, I was aware of its flaws, but I thought it represented an advance over what we had before.

Obamacare did give access to health insurance to millions of Americans, including people with pre-existing conditions, who otherwise wouldn’t have been able to get it.   The tradeoff was that it created a captive market for the health insurance companies to provide bad insurance.

My e-mail pen pal Bill Harvey sent me a link to an article by a Dr. John P. Geyman for the International Journal of Health Services which, in my opinion, sums up the problems with Obamacare very well.

  1. Health care “reform” through the ACA was framed and hijacked by corporate stakeholders.
  2.  You can’t contain health care costs by permitting for-profit health care industries to pursue their business “ethic” in a deregulated marketplace.
  3. You can’t reform the delivery system without reforming the financing system.
  4. The private health insurance industry does not offer enough value to be bailed out by the government.
  5.  In order to achieve the most efficient health insurance coverage, we need the largest possible risk pool to spread risks and avoid adverse selection.

Dr. Geyman thinks the answer is a single-payer health system, financed by taxes which covers everyone.  Such a system would be cheaper for most people than a private system because it simplifies administration and subtracts the need for profit.

One reason why such a system wasn’t considered in 2010, in addition to the entrenched power of pharmaceutical and health insurance lobbyists, was that many Americans were satisfied with their existing insurance and didn’t want to risk an unknown system.

Now private insurance has changed for the worse for most people.  Unfortunately, it will be very natural for people to see the inadequacies of Obamacare as an argument against any government health insurance plan at all.

LINK

A Five-Year Assessment of the Affordable Care Act: Market Forces Still Trump the Common Good in U.S. Health Care by John P. Geyman for the International Journal of Health Services.   (Hat tip to Bill Harvey)

The passing scene: Links & comments 8/15/14

August 15, 2014

Policing Protests Like Soldiers Makes Everyone Less Safe—Even Police by Conor Friedersdorf for The Atlantic.

Turning Policeman Into Soldiers: the Culmination of a Long Trend by James Fallows for The Atlantic.

People in the military, as one officer once put it, are trained to kill people and break things.  This is the opposite of the job of the civil police, which is to protect lives and property.

Troopers are supposed to kill or subdue the enemy.  That is their mission.  The mission of the civil police is to take people into custody when there is reasonable cause to believe they have committed a crime, which is very different.

The arming of the police as if they were a military force, and recruitment of police out of the military without further training, generates a police force whose mission is not to protect and serve the civil population, but to cow it into submission.  I would like to believe this is unintentional.

Why Did the Americans Get the Drugs? by Josh Marshall of Talking Points Memo.  (via Mike the Mad Biologist)

Two American doctors got a potentially life-saving drug for the Ebola virus from which hundreds of Africans already have died.   This looks bad, but Josh Marshall pointed out this is not necessarily because American lives are regarded as more valuable than African lives.   The experimental drug may not work,  it may have lethal side effects and Africans have bad memories of pharmaceutical companies testing dangerous drugs without informed consent.  Better for American physicians, who understand the risks, to use themselves as guinea pigs rather than Africans.

What Would Hamas Do If It Could Do Whatever It Wanted? by Jeffrey Goldberg for The Atlantic.  (via Mike the Mad Biologist)

Lest we forget, Hamas is an anti-Semitic movement, whose exterminationist rhetoric and belief that Jews secretly control the world is an echo of European fascism of the 1930s.  But what Hamas would do to the Jewish people of Israel if it had the power is not much different from what the Israeli government is doing to the Arab people in Palestine in reality.

Here are the job descriptions for Gannett’s newsroom of the future by Jim Romenesko.  (via Naked Capitalism)

I worked for the Democrat and Chronicle, the Gannett newspaper in Rochester, NY, for 24 years.  I’m glad I was able to retire when newspaper reporters were still thought of as “journalists” rather than “content providers”, and when there was still a separation between the newsroom and the marketing department.

Getting Sucked Into Obamacare Is a Lot Like Being on Probation by “Lambert Strether” on Corrente.

I would have thought President Obama would have taken the trouble to ensure that his signature policy would work well, but evidently not.

Why is the GOP afraid of Obamacare?

July 24, 2014

obamacare&alternative

I’ve long been of two minds about  Obamacare.   Sometimes I think it is a complete mess and sometimes I think that, despite its complexity and obvious flaws, it will be of net benefit to the American public.

There is one group of people who’ve made up their minds about it, and that is the Republicans who are determined to prevent implementation of the Affordable Care Act by any means necessary.

If they believed the law is as terrible as they say they do, the smart political strategy would be to allow the law to go into effect, allow the public to see how bad it is and then move to repeal or amend.

The only explanation is that they don’t dare let this happen because they think that, once Americans experience the new law in operation, they will embrace it and vote for Democrats forevermore in gratitude.

Lies vs. BS: why BS is worse

April 11, 2014

The philosopher Harry Frankfort wrote that there is an important difference between lies and BS.

The liar knows what the truth it, but chooses to tell falsehoods.

The BSer doesn’t know or doesn’t care about the distinction between truth and falsehood.  The BSer is much more dangerous than the liar.

For me, the most scary thing about the totalitarian governments of the 20th century was that they destroyed the distinction between truth and lies.   As in George Orwell’s novel, 1984, truth was whatever Big Brother said it was.  But this also was a fatal weakness, because totalitarian rulers lose contact with reality.  

Reality continues to be whatever it is, whether you recognize it or not.  As the philosopher Ayn Rand once said (I paraphrase): It is possible to ignore reality, but it is not possible to ignore the consequences of ignoring reality.

Democracy, the free-market system and the scientific method constitute an immune system against losing touch with reality.  People won’t vote for you if you don’t serve their interests.  People won’t buy your product if it isn’t any good.  And people won’t believe your theory if your experiment doesn’t work.  All this constitutes a reality check.  But the reality check no longer seems to be working.

The disturbing thing about the George W. Bush administration is not that it was founded on lies, but that it was founded on BS.   A Bush administration official, widely believed to by Karl Rove, mocked the journalist Ron Suskind for being a member of the “reality-based community.”  The Bush administration was creating its own reality, he said.   We know how that ended.

I hoped, when I voted for Barack Obama in 2008, that there would be a return to reality, but this isn’t happening, as is shown in the three links below, the first having to do with Ukraine policy and the second two with the Obamacare fiasco.   Surrealpolitik is a good name for this.

http://www.informationclearinghouse.info/article38183.htm

http://www.correntewire.com/obamacare_clusterfuck_obama_throws_sebelius_under_the_bus_brings_in_a_rubinite

http://www.nakedcapitalism.com/2014/04/wont-believe-what-10-democrats-said-obamacare.html

American exceptionalism in health care

January 28, 2014

1. prices_intl_nyt

Jon Perr explained for Daily Kos why Obamacare does not fix the dysfunctional U.S. health insurance system.

On January 1, 2014, the Affordable Care Act went fully into effect.  But for all of the furious fighting over the law these past five years, Obamacare was always an evolutionary reform grafted onto the existing American health care system.  The Medicaid public insurance program has been extended to roughly four million lower income Americans so far.  About two million more people have purchased private insurance, many of them aided by subsidies from Uncle Sam.

And while many (though not all) of the worst abuses that let insurers pad their profits by denying or dropping care for the sick have been banned, the edifice of private insurance remains largely intact.

Far from a “government takeover of health care,” Obamacare preserves all of the hallmarks—private insurance companies, private hospitals, private doctors, and the patchwork of different systems for veterans, seniors, workers, and the poor—that define the American model of health care provision.

Click on Why the U.S. should treat health care like a utility, not a market to read Perr’s full article.  Hat tip for to Bill Elwell for the link, which is the source of the charts.

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Obamacare is not Heritage Foundation plan

December 7, 2013

Liberals like to point out that the Affordable Care Act’s individual mandate is the same as a proposal by the right-wing Heritage Foundation.  That is, everybody has to buy insurance from for-profit companies, but insurance in theory becomes affordable because the cost is spread out over a whole population of rich and poor, sick and healthy and old and young.

I, too, sometimes fall into the trap of saying President Obama’s plan as a whole is a warmed-over Republican plan, but, as Scott Limieux pointed out on his Lawyers, Guns and Money blog, this is not really so.

ACA2-300x278

Of course it remains to be seen whether there really will be strict, federally enforceable consumer rights, or whether the ACA will simply create a new captive market for the health insurance industry.

And the historic expansion of Medicaid, which was a key part of the ACA, was sabotaged by the Supreme Court and Republican state governments, although that is not Obama’s fault and may eventually be overcome.

The important thing about the ACA is that there is no longer any point in speculating about its impact.  It is the law and will remain law until at least 2016, and that will be plenty of time to see whether it does more good than harm.

Where was President Obama’s due diligence?

November 27, 2013

Not long after I voted for Barack Obama in 2008, I came to realize that his priorities were different from what I thought they were.  And I soon saw that his health reform plan was deeply flawed and hard to implement.  But I nevert, until now, thought that he was incompetent.

butwewon'tThe Affordable Care Act is President Obama’s signature domestic achievement.  Compared to Medicare for all (single payer) or his own proposal for a public option, it is hugely complicated.  Moreover there are political enemies in state governments that want to make it fail, and special interests in the pharmaceutical and health insurance industries that want to milk it for their own benefit.

Under these circumstances, wouldn’t you think that he look for the smartest and most capable information technology manager he could find and give that person complete authority?  With his connections in Silicon Valley industry, he wouldn’t have had trouble finding such a person.  But evidently not.

President Obama’s right-wing opponents accuse him of creating “czars” to oversee government programs, but this was a case where a “czar” was necessary and sadly lacking.

And wouldn’t you think that he would check on the progress of the program early and often? The President, after issuing a non-apology apology, said, “I was not informed directly that the web site would not be working the way it was supposed to.”  This is a statement worthy of George W. Bush.  Why was he not informed.

During the George W. Bush administration, I blamed President Bush, Vice President Dick Cheney and Karl Rove for mistaking campaigning for governing, and public opinion polls for reality.  But when individuals so different in background and personality as George W. Bush and Barack Obama exhibit the same flaws, I have to think there is something deeply wrong with the U.S. political culture that goes beyond the character traits of individuals.

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Matt Bors on the Obamacare fix

November 18, 2013

1_matt_bors_-_united_media_605

But what if the National Security Agency software system functions as badly as the Affordable Care Act system?  We’d have no way of knowing.

Click on Matt Bors – Medium and Archive | Matt Bors for more of his cartoons.

America needs something better than the ACA

November 11, 2013

blog_poll_kaiser_obamacare_november_2013Many more Americans want to keep the Affordable Care Act or make it stronger (47 percent) than want to repeal it or replace it with a Republican alternative (37 percent).  I do not venture to predict how they will think a year from now when the technical problems will (presumably) be resolved and the law will go into force.

House Speaker Nancy Pelosi was right.  We won’t really understand what’s in the law until it goes into operation.   I am sure that lives will be saved by forcing insurance companies to cover people with pre-existing conditions, and I hope that a lot more people will benefit financially than will be hurt.   But even if things work out for the best, Obamacare at best is deeply flawed.

New Medical Gatekeepers.   The ACA makes for-profit insurance companies the gatekeepers between physicians and patients.  The only way to have a doctor of your choice is to find an insurer that has that doctor on its roster.

Insurance companies get even greater leverage than they have now in imposing a corporate business model on physicians.  A physician who spends too much time on sick and needy patients will not be cost-effective from a business standpoint, and may be dropped from the roster.  This isn’t new, but Obamacare locks it in.

Controlling the Wrong Costs.   President Obama is cutting Medicare reimbursements to health care providers.  At the same time he has locked for-profit insurance companies into the system, and declined to negotiate with pharmaceutical companies to lower drug prices.

This is a typical example of how things work in American life nowadays.  The people who do things that create value are being squeezed.  The people who extract profits from what others create are left untouched.

It may well be that health care providers are overcharging Medicare.  I don’t have the facts and figures to express an informed opinion either way.  It does seem to me that, for example, $800 is a lot to charge for an ambulance ride.  But I might think differently if I knew what it cost to pay for and maintain a fully-equipped ambulance, to pay for and maintain the ambulance station, and what it costs to train and pay ambulance crews and keep them available 24 hours a day 7 days a week.

But it is obvious that there is no public benefit in going through a for-profit insurance company to get a benefit mandated by government, or in paying more for a drug than foreigners pay for the same drug.

Complexification.   One of the problems with the American health care system—a mixture of employer-based insurance, individual insurance, Medicare, Medicaid and veterans’ benefits—was its complexity.   The Affordable Care Act makes it more complicated, and I think that is the main reason why the Exchanges and sign-up system don’t work.

There would not be any problems in signing up if Congress had enacted a single-payer plan (Medicare for all) or, if that was not feasible, simply expanded Medicare or federalized and expanded Medicaid.  The voluntary public option proposed by Senator Barack Obama in 2008 would have been more difficult, but still simpler than what was advocated.

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Obamacare: conservatism as the new liberalism

October 24, 2013

obamacare-sure-is-unpopular

Even though I think the Affordable Care Act is a bad law, I’m opposed to most of the people who oppose the law.

Most opponents of the law are against it because they don’t agree with having the government guarantee a minimum level of medical care to all.  I’m opposed to the law because I don’t think it will come anywhere near to accomplishing that purpose.

Defenders of the Affordable Care Act point out that it originated as a conservative Republican plan, drafted by the right-wing Heritage Foundation and first implemented by Mitt Romney as governor of Massachusetts.

From my standpoint, that is the problem. I am a liberal Democrat who voted for Barack Obama in 2008, and I did not vote for him in order to advance a conservative Republican agenda.

I’m pretty sure that the Heritage staff did not offer up their plan because they felt an urgent desire to assure health insurance for everybody.  I think they proposed their plan as a way to avoid enacting Medicare-for-all, aka a single-payer plan.

The chief merit of the Obama / Heritage plan from the right-wing point of view is that it locks the for-profit insurance companies into the system and gives them a captive market, even though they add no value to medical care.  The threat of a universal system would be that there would be no role for the insurance cmpanies.

Back in 2008, the single-payer plan was the mainstream Democratic position. Both Hillary Clinton and John Edwards advocated it in their presidential campaigns.  Barack Obama offered a moderate compromise, a public option in which an affordable government insurance plan would be made available, which at the time that seemed reasonable to me.

But as soon as President Obama took office, he embraced the Heritage / Romney plan.   His staff ridiculed anybody who took his campaign promise seriously.

If Obama thought that this would bring the Republicans on board, he was sadly mistaken.  They reverted to what they really wanted all along, which is to do nothing or take away what we have.

In five years, the former mainstream liberal position has been taken off the table for discussion. The former mainstream conservative position has been redefined as the liberal position.  The extreme right-wing position which was not then on the table has been redefined as the mainstream conservative position.

Nobody really wanted Obamacare.  It was originally proposed as a lesser evil from the conservative point of view,  and it was enacted as being a lesser evil from the liberal point of view.   The right-wing Republican goal is to get rid of it altogether.   The liberal Democratic goal should be to replace it with something adequate.

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The U.S. can do a lot better than Obamacare

October 24, 2013

obama.v.GOP.health.plan

The Affordable Care Act is a bad plan.  It may be a lesser evil than the system we had before, just as the system we had before was better than nothing at all, but it falls short of what Americans have a reasonable right to expect.

Obamacare creates a captive market for the for-profit insurance companies, which in themselves contribute nothing to the availability or quality of medical care.

It is a form of privatization of social insurance, which creates a bad precident—especially ominous in the light of President Obama’s repeated statements about the need to cut Medicare and Social Security.

By design, it does nothing to control some of the main things that make health care so expensive in the United States.  In addition to locking the insurance companies into the system, it allows pharmaceutical companies to charge Americans more than what they charge Canadians and Europeans for identical products.  And it complexifies the needlessly complex existing system.

Instead of providing a universal system, it creates a means-tested system where different people give different levels of health insurance, and some are still outside the system.

While the ACA provides subsidies to low-income citizens who can’t afford health care premiums, these may in the long run turn out to be mere pass-throughs that enable insurance companies to raise their rates, just as the Pell grants to college students eventually become mere pass-throughs to the colleges.

And while it assures insurance to many people who previously were denied it, I seriously question whether either competition or federal regulation will guarantee insurance premiums are affordable. Even if government regulators are serious about keeping insurance affordable, there are many ways for companies to game the system, by providing lower levels of care, asking higher deductibles and simply making it difficult to file claims (I have personal experience with the latter).

I do recognize that Obamacare has helped many people and even saved lives.   I don’t advocate wiping it off the blackboard and going back to the previous system.  But we Americans shouldn’t accept that this is the best we can do.

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The not-so-Affordable Care Act

October 15, 2013

Double click to enlarge.

The cartoon tells how the Affordable Care Act is supposed to work.  Insurance companies are mandated to give health insurance to everybody who needs it.  Everybody is mandated to sign up for health insurance rather than waiting until they are sick.  The government will subsidize insurance for those who can’t afford it.

The problem is that Mr. Insurance Company can game the system.  He can raise premiums on Bob, Sam, Dave and Mary.  If premiums are limited, he can raise the deductible or restrict coverage—following the principle of raising the price of cereal by putting less cereal in the box.

Instead of shutting down much of the government, Congressional Republicans who oppose Obamacare would have been better advised to let it take its course.

The rollout of Obamacare has been a mess, but, because of the shutdown crisis, this has received little news coverage.  Cartoonist Ted Rall wrote last week in his syndicated column about his six-hour struggle to sign up for Obamacare on-line.   But the real problem was the Exchange’s menu of choices.

Talk about sticker shock.

NOT affordable.  Not, as Obama said, lower than your cellphone bill.

For this 50-year-old nonsmoker, New York State’s healthcare plans range from Fidelis Care’s “Bronze” plan at $810.84 per month to $2554.71 per month.  I didn’t bother to look up the $2554.71 one because if I had $2554.71 a month lying around, I’d buy a doctor.

$810.84 per month. $10,000 a year.  After taxes.  Where I live, you have to earn $15,000 to keep $10,000.

Not affordable.  Did I mention that?

The plans offered by New York State do not allow you to go “out of network” for healthcare.  In other words, you have to use a doctor in each private insurer’s list, or they don’t pay a cent of reimbursement.

Even worse, the plan “deductibles” — the amount you pay out of pocket each year before your insurer has to cover you for anything at all — are outrageously high.

Fidelis Care Bronze has a $3000/year deductible per person.  I’m in pretty good health; it’s a rare year I spend that much on doctors.  This is what used to be known as a catastrophic plan: OK if you get hit by a bus but useless for most people living typical lives.

After the $3000/year deductible, Fidelis would pay 50% of your bills. So if you rack up $5000/year in medical bills, you pay $4000 and they pay $1000. Crappy.

via Ted Rall’s Rallblog.

One good part of Obamacare was the expansion of Medicaid, the government health insurance program that serves poor people.  But because of a decision by the Roberts Supreme Court, conservative state governments are in a position to block implementation to those who need it most.

Medicare works.  It delivers health insurance for less overhead than for-profit plans.  If it were up to me, I would replace Obamacare with Medicare for everyone (a single-payer plan).  If that wasn’t feasible, I’d lower Medicare’s age limits year by year.

But one of President Obama’s stated goals is to cut spending on Medicare, as well as on Social Security.  The net result is leave patients even more at the mercy of the for-profit insurance industry.

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States block health insurance for millions of poor

October 4, 2013
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Double click to enlarge

The New York Times reported that, thanks to the Supreme Court’s Medicaid loophole and the actions of the governments of 26 mostly Southern states, millions of poor people will be excluded from Obamacare.  The article said:

A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.

Because they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.  The federal government will pay for the expansion through 2016 and no less than 90 percent of costs in later years.

Those excluded will be stranded without insurance, stuck between people with slightly higher incomes who will qualify for federal subsidies on the new health exchanges that went live this week, and those who are poor enough to qualify for Medicaid in its current form, which has income ceilings as low as $11 a day in some states.

[snip]

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers.  About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides.

via NYTimes.com.

Barry Ritholtz on The Big Picture provided this map showing the overlap between those who want to block health insurance for poor people and those who want to shut down the government.

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Double click to enlarge

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Crisis in government: Links & comments 10/4/13

October 4, 2013

Shutdown Standoff: One of the Worst Crises in American History by John B. Judis for the New Republic.

What’s at stake is whether a political bloc has the power to bring the American government to a halt in order to get its way.   If the Tea Party Republicans get their way, Judis warned, the U.S. government could become unable to function, leading to the rise of extremist parties of the right and left.  I don’t think he exaggerates.

Debt Ceiling Chicken and Trench Warfare by “Yves Smith” for Naked Capitalism.

The United States may be in for a longer and more destructive political siege than anyone expected.  Not only are there no plans for the two sides to meet, nothing is being done to prepare for discussions.  The problem is that this is an either-or situation not subject to compromise.  Either you recognize that a political faction has the right to crash the government, or you don’t.

Republicans Are No Longer the Party of Business by Joshua Green for BloombergBusinessWeek.

The government shutdown creates economic uncertainty and hampers the economic recovery.  That’s why the U.S. Chamber of Commerce is opposed to it.

Tea party lawmakers see the culmination of years of effort in shutdown by Zachary A. Goldfarb for the Washington Post.

Since Barry Goldwater ran for President in 1964, members of the right wing of the Republican Party have seen the size of the federal government as the main threat to American freedom.  Ronald Reagan didn’t accomplish this, Newt Gingrich didn’t, George W. Bush didn’t.  Now, at long last, the Republican small-government conservatives think they can accomplish their goal.

The real reason for the government shutdown by Dean Baker for Al Jazeera America.

Baker said the Ted Cruz Republicans see this as their last chance to stop Obamacare, because it will be popular if it ever is allowed to work.

The government shutdown could end today.  All it would cost is John Boehner’s speakership by Chris Gilizza and Sean Sullivan for the Washington Post.

Seventeen Republicans have said they’d vote for a “clean” continuing resolution, which would allow the government to resume normal functioning.  They and the Democrats would be a majority in the House of Representatives.  But if John Boehner allowed that to happen, he would lose his party’s support to be Speaker.

The Shutdown in 10 Infuriating Sentences by Kevin Drum for Mother Jones.

Kevin Drum demonstrated that the shutdown is not a result of equal stubbornness on both sides, but a faction of the Republican Party that intends to rule or ruin.

Even if the shutdown ends, the government is operating under the budget sequester, which is a victory for right-wing Republican priorities in itself.

The two basic facts about the shutdown

October 2, 2013

James Fallows of The Atlantic pointed out something important:

To people who follow politics these two facts are obvious.  But they’re not part of most “tragedy of gridlock” false-equivalence stories, and I believe they would come as news to most of the public.

The two facts are:

  1. John Boehner

    John Boehner

    If the House of Representatives voted on a “clean” budget bill — one that opened up the closed federal offices but did not attempt to defund the Obama health care program — that bill would pass, and the shutdown would be over. Nearly all Democrats would vote for it, as would enough Republicans to end the shutdown and its related damage.  And of course it would pass, has already passed, the Senate, repeatedly, unless the minority dared filibuster it, and would be signed by the president. … …

  2. So far House Speaker John Boehner has refused to let this vote occur.  His Tea Party contingent knows how the vote would go and therefore does not want it to happen; and such is Boehner’s fear of them, and fear for his job as Speaker, that he will not let it take place.

These two points are why the normal D.C.-poohbah moanings about the need for compromise do not apply.   The Democratic administration, and a sufficient number of Republicans, already agree and are ready enough to compromise to solve this problem.  If the normal machinery of democracy were allowed to work, the manufactured crisis would be over.  The only reason the senseless damage is being done is that hostage-takers have terrorized members of their own party.

via James Fallows – The Atlantic.

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What does it take to enact a law in the USA?

September 30, 2013

In a country with a parliamentary system, a Prime Minister is chosen by the party with a majority in parliament, or by a coalition of parties if none of them has a majority.  The Prime Minister then proposes laws and normally they are enacted by parliament.  If parliament rejects an important bill, the Prime Minister has the option to call an election, and let the people decide which they think is right.

Here in the United States, the process is different.  In order to become law, the Affordable Care Act has to get a majority of votes in the House of Representatives and 60 out of 100 votes in the U.S. Senate.  It then had to be signed by the President and reviewed by the Supreme Court.  It seems to me that, whether or not you agree with the law, that ought to be enough.

Source: Buffalo News

Hat tip to Buffalo News.
Update: President Obama signed a law providing for continuation of pay of active-duty military personnel.

But now the Republicans in the House of Representatives are threatening to shut down the government unless the Obama administration delays implementation of the health care act.  They don’t have the votes to repeal the law, so they are using a blackmail tactic instead.

In my opinion, Obamacare is a flawed plan which is unlikely to work as intended.  But it is law, and millions of individuals and thousands of businesses have made plans based on the schedule for implementing it.   Shutting down the government would be harmful to the country, but there would be even more harm from the economic uncertainty created by doubts as to whether a law really is law even after it is enacted.

Granted, there are worse things that could happen than a temporary shutdown of government.  But it creates unnecessary disruption, unnecessary hardship and also unnecessary expense, because it is more costly to shut down and restart than to continue operations.  It is terrible way to run a government.

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