In the House today, Republicans are arguing for a repeal of the Affordable Care Act. A few points:
1) The Republicans want to leave up to 129 million Americans with pre-existing conditions without protection.
According to the Department of Health and Human Services, up to 129 million Americans (not counting the elderly) have pre-existing conditions that could prevent them from getting health insurance on the individual market. Most of those Americans are getting insurance through their workplaces, but many of those folks are in effect trapped in their jobs by their health, distorting the job market. Up to 30 million simply can’t get health insurance.
Especially in today’s job market, “it’s okay if you can get a job” is not a reasonable response to the problems of people with pre-existing conditions. The Republicans used to have a viable plan to deal with this problem — Romneycare, otherwise known as the individual mandate. But now, for reasons of partisan convenience, the Republicans are passionately opposed to the one good idea they’ve ever had on health care. And as a result, they’re against sick people having affordable insurance coverage that will provide decent care.
Under the Affordable Care Act, insurance companies can’t refuse to help sick people, and can’t drop coverage because someone becomes ill. Republicans want to repeal that protection, and they don’t have any coherent plan to help those people.
2) The Republicans are voting against letting a real competitive market lower prices.
Beginning in 2014, anyone on the individual market (with or without pre-existing conditions) will have access to Health Insurance Exchanges, where insurance companies will be forced to compete in a clear, easy-to-understand format online for health insurance premiums. Unlike the status quo — where people rarely have the ability to choose between many health plans, and health insurance companies are allowed to do everything they can to misstate their plans’ true costs and benefits — this allows actual competition to flourish and bring down costs.
3) The Republicans are voting to add $230 billion to the deficit.
The Congressional Budget Office estimates that repealing the Affordable Care Act will add $230 billion to the deficit just in the next decade — and it would probably be worse the decade after that.
To this, the Republicans claim that the CBO is lying, but their claims don’t stand up to examination.
4) The Republicans are voting to leave 32 million Americans without health insurance. From Ezra Klein:
In 2019, there will be 32 million Americans who don’t have health insurance, but would have had it under reform: There are a lot of questions about how the Affordable Care Act will work in practice, but this is the part we know for certain: Tens of millions more Americans will have health insurance. About half of the newly insured will get coverage through Medicaid, and about half will get it by purchasing subsidized private insurance on the exchanges. But they’ll get it. Under the status quo, they won’t.
5) The Republicans are voting to eliminate the only structure the US has to reduce health care costs.
In the long run, only one things matters to the federal budget deficit, and that’s the increasing costs of health care. Compared to that one item, everything else is small.
It’s much easier to make technical changes to existing legislation than to pass new legislation from scratch (look at how much effort and political capital passing even a very mild and limited health care reform has cost the Democrats). The Affordable Care Act provides that base, and nothing the Republicans have proposed serves the same function with even close to the same scope.
Quoting health economist Henry Aaron:
As things now stand, the future of the Affordable Care Act is highly uncertain. Yet, its success is of critical national importance. The reason, paradoxically, is the promise of the very provisions that have been subject to most criticism—those related to cost control. …The bill contains, at least in embryonic form, virtually every idea for cost control that any analyst has come up with:
• The bill retains health savings accounts.
• It adds pilots and demonstration programs to develop accountable care organizations and medical homes.
• It contains provisions to test the practicality of bundled payments and to develop value-based health insurance.
• It contains additional funding for comparative-effectiveness research. It spurs the introduction of health information technology.
• It directly curbs growth of Medicare spending and establishes a commission to recommend further reforms (although the Commission’s powers are undesirably limited).
• It contains a significant expansion of preventive care, although the cost-reducing potential of preventive care is often greatly exaggerated.This menu includes all available ideas on how to control the growth of health care spending within the next few years. The most practical cost-control strategy that is now available to Congress is to accelerate the implementation of these provisions, not to stymie them.
The vote (which will probably take place tomorrow) is a simple up-or-down vote. You either want the status quo, or you want the Affordable Care Act. No third alternative is being offered by the Republicans.1 And when it comes down to it, every Republican in the House will probably be in favor of more Americans lacking insurance, less rights for sick people, higher deficits, and doing nothing to address skyrocketing health care costs.
The Democrats were doomed in the 2010 election cycle regardless (due to the combined effects of the economy, mid-term voting patterns, and having more vulnerable seats). But there’s reason to believe that they’ve also paid a cost for supporting the Affordable Care Act, especially since the Republicans have lied about its effects at every turn (“death panels,” et al). Nonetheless, it was worth it.
The Affordable Care Act is a compromised and altogether too mild health care reform, but even so it’s enormously better than the status quo. At some point, politics should be about doing long-term good, not just winning short-term elections by any means necessary. But judging by this vote, Republicans have not reached that point.
- On Thursday, the Republicans plan to hold a vote to throw the question to a hodgepodge of committees to come up with alternative plans whenever they get around to it, no deadline attached — in other words, they don’t intend to come up with a serious alternative plan at all. [↩]
Oh, where to begin?
Republicans don’t have a coherent plan?
John Mackey, founder of Whole Foods offered 8 reforms (sorry, no link, because I do not know if it would get through the spam filter), many of which have been espoused by different Republicans (most notably, the ability for companies to compete across state lines and the tax treatment of premiums paid by individuals).
Insurance companies will be “forced” to compete. Only competitors can force competition. They can only compete if they can provide a product and still make a profit. Those that can’t will go away (either leaving the market or going bankrupt). And, the competition would not change prices, unless the Government fixes the prices. Unfortunately, the Government does not understand this; it has a monopoly and believes (so far) that it never has to operate within a budget.
They are voting to add 230 Billion to the deficit? That is only if you trust the CBO. Granted, it is non-partisan. However, the Government’s record on projected costs of its programs is quite poor. The initial projection for Medicare over 25 years was off by Billions (IIRC believe the initial projection was 9 Billion and the actual amount was 109 Billion); Medicare D, which Republicans excoriate Bush and the old Republican leadership for, went over CBO estimates within the first few years (and I believe it is still getting worse). The CBO can not predict the future and must base its predictions on the assumptions it is given. Garbage in, garbage out.
Romneycare is the best idea Republicans have? How is that going? My understanding is that Romneycare increased medical costs in Mass. It should be abandoned. But, I am not from Mass. If they want it, they can have it. Just keep me out of it.
“The Affordable Care Act is a compromised and altogether too mild health care reform”
Compromise? Huh? Oh, that’s right. A compromise between liberal Democrats and moderate Democrats.
“but even so it’s enormously better than the status quo.” I am not convinced. I cannot tell the future, but “the devil you know” …and all that. Right now, I can afford to pay 100% of the health insurance premiums for my employees (even with the annual increases). If the cost of insurance goes to high, I will drop insurance coverage (heck, the government will take care of us), or go out of business (if the cost of staying in business makes profit impossible).
-Jut
John Mackey, founder of Whole Foods offered 8 reforms
Oh that’s a good one.
I worked for John Mackey for two years in one of his stores. I got to see from the inside how “Mackey-care” works.
One of the features I particularly liked was that WFM used “self-funded” insurance rather than a conventional insurance company like United Health Care or Blue Cross. This provided them the advantage of being able to evade a number of federal, state, and local laws regarding insurance. Like the Mental Health Parity Act. So how much coverage for any kind of mental health care (medication, assessment, or therapy) did our insurance provide?
NONE WHATSOEVER.
At the time, the biggest risk to my ability to show up and do my job on a daily basis was a relapse into clinical depression brought on by a combination of a recent divorce, severe economic stress (see: working for $12.50 an hour while ABD with two MA degrees, recent divorce), and my fantastic genetic pre-disposition to mood disorders. But even when I had worked the *YEAR* it took to get qualified for benefits, I could not so much as see a psychiatrist to help me figure out whether to continue the medication I was taking (and paying for out of pocket) or switch to something else. I had to throw a dart and hope my GP was vaguely qualified to help me out.
Mackey is a self-interested Libertarian jackass who makes a living off progressives whose values he mocks. I hate that guy and everything he stands for.
So what you’re saying is that they tend to underestimate?
1) According to the Department of Statistics I Just Made Up, 300 million Americans are at risk of being run over by semis on the highway. Nearly everyone drives, nearly every highway has semis on it, and accidents happen – my logic is impeccable.
But in reality not everyone, or close to everyone, dies on the highway from semi crushing. We address real problems, not potential problems, and “maybe these people will have this problem someday” is not a reasonable basis for action from a limited government with other things on its plate.
2) Yeah, I’m sure you and the Democrats are real heartbroken that free market competition is being so ruthlessly crushed by Republicans. If you actually want a market in insurance, stop distorting the market system with fifty kajillion government rules and regulations and subsidies and programs. Getting a workable market is not an exercise in ADDING government, it’s an exercise in making sure that government provides the basic structure (courts, contracts, rule of law) and then gets the !%!@ out of the way.
3) The CBO’s projections are simply not credible. Ezra Klein is a nice man but he is in a tiny minority of analysts and thinkers. The CBO must statically score, and you know as well as I do that it is not a static world and incentives matter.
4) So pass a limited law that extends health insurance to those 32 million people and pay for it with honest taxes, instead of putting together this enormous freedom-crushing, insurance-industry-killing abortion of a health care boondoggle.
5) Please. Laws can be passed in the future, and there are some very simple policy changes that can be done with one-page laws that can readily curb our exploding health care costs: Hint: means-test Medicare, and the majority of the deficit you’re suddenly worried about disappears like the morning dew.
Republicans can build an alternative health care law, if the country demands it; they’ll wait until the current Democratic hangers-on move on to new careers and Mr. Obama starts his new job as an embittered law professor somewhere.
It’s rather revealing that the GOP is not presenting its own health-care plan, with the opening salvo that said plan entirely repeals and replaces the Affordable Care Act.
This isn’t really about health care or the deficit; it’s about getting a Republican into the Oval Office in the next election, period. Obama got a piece of legislation passed. If it actually sort of works, there goes a talking point. Kill it now!
And I love the ‘courts and rule of law’ bit. Because the first goddamn thing that will happen when you sue your insurance company? “No law says we can’t do that. Plus, there’s no government regulation saying we can’t do that, and if the government thinks it’s OK, what’s the problem?”
Plus, the GOP is busy trying to make sure the courts are reserved for corporations and the wealthy, not for ordinary bumblefucks who can’t even pay for their own lawyers out of petty cash and dare to sue their betters. The bankrollers of the think-tanks and institutes pushing this agenda? Gosh, three guesses.
I’m having a hard time understanding why anyone is worried about this.
In the first place, the Republicans only won control of the House, right? For this to have any effect it would have to be passed in the Senate as well. If the Democrats can’t manage to prevent passage of something that undoes something they passed, then they really are incompetent. Look at how the Republican minority has ham-strung Democrats’ efforts in so many areas. How can anyone believe the Republicans could get this through the Senate?
Beyond that, if both houses of Congress were to pass something, then it would be subject to rejection by Obama. Obama is certainly not everything I’d want in a president, but I can’t believe that he’d ever go along with an attempt to undo one of the major pieces of legislation that he had worked so hard to get passed in the first place.
So all of this is just posturing and name-calling by the Republicans hoping to drum up support for whatever disaster they plan to run for office in 2012. Of course, the media is playing along because this spectacle makes good theater and so it generates lots of interest, but really it is a tempest in a teapot, isn’t it?
Oh, where to begin?
John Mackey isn’t the Republican party; that he’s proposed some reforms doesn’t change the fact that the Republicans haven’t actually proposed anything. The Republican bill is a straight-up choice: The ACA or the status quo.
You wrote:
Medicare was created in 1965. The CBO didn’t exist until 1975.
It’s true that a non-expert House committee — lacking the resources and expertise of the CBO — massively lowballed the cost of Medicare in 1967. The CBO was created so that Congress wouldn’t keep on making mistakes like that again. Far from proving that the CBO can’t be trusted, your example shows why the CBO is so necessary.
Medicare Part D has been nearly 40% cheaper than the CBO predicted in 2003.
Again, your example proves my point, not yours.
Similarly, in the 80s, the CBO predicted that a change in how Medicare paid hospitals would save the government $10 billion; it actually saved nearly $30 billion. The Balanced Budget Act of 1997 reduced Medicare costs tens of billions dollars more than the CBO predicted.
It’s true that sometimes the CBO has been wrong in the other direction (for instance, the Medicare Home Care Benefit cost more than the CBO projected). But the Republican claim that the CBO predictably underestimates the costs of Medicare and overestimates projected savings is simply not true. If anything, the CBO has shown a slight pattern of underestimating savings.
Finally, you say that the ACA is bad because if the ACA is passed, health insurance rates might go up, leading you to drop coverage of your employees or go out of business. But that’s what’s already happening in the status quo! The status quo is that health insurance costs have been rising at a much faster rate than inflation, and business owners can barely afford to cover employees anymore. (Also, take-home wages for employees are being depressed.)
Sticking to the status quo is just guaranteeing that nothing changes — which is to say, health care costs will keep rising until you can’t afford them anymore. How is that outcome any worse than what you’re afraid the ACA will cause?
Maybe the ACA won’t work. But maybe it will. Sticking to the status quo, on the other hand, is guaranteed failure. Something that has a chance of working is better than guaranteed failure.
Uninsured Americans with pre-existing conditions is a real, present problem, not a hypothetical problem; if you can’t acknowledge that, you can’t discuss health care intelligently at all.
Democrats want to address the problem. Republicans, as you’ve just demonstrated, prefer to pull a blindfold over their eyes and pretend the problem doesn’t exist.
I’m a pragmatist. I favor markets where they work; this is a case where a regulated market (not a free market) would work much better than the status quo.
I note that you don’t provide a single logical argument why the Exchanges would be a bad idea. Am I wrong to say that in the current market, it’s difficult for many non-expert consumers to know exactly how ten different insurance products compare? Am I wrong to say that consumer choice would logically tend to drive prices down in a market in which prices and benefits had to be stated clearly, understandably, and in easily-comparable units?
That’s pretty much what I’m talking about. The difference is, you think the basic structure shouldn’t include anything that enables ordinary consumers to meaningfully compare and contrast different insurance products, because… well, you don’t say why.
It’s not like the Exchanges make it illegal for people to buy insurance outside of the Exchanges. If any consumers PREFER to buy insurance where they can’t make direct comparisons, and where insurance companies are allowed to use confusing language and 20 pages of incomprehensible fine print to avoid actually having any meaningful obligations in exchange for taking our money, they’d be absolutely free to. But in practice, virtually everyone would prefer buying through the Exchange, if they had the opportunity. Which is why Republicans are so determined to make sure Americans don’t have that opportunity.
The last time Republicans said this, they were claiming that the CBO was wrong to predict that Bush’s tax cuts would inflate the deficit. How’d that turn out?
Do you have any actual arguments for why you don’t think the CBO’s projections are credible?
This covers 32 million people and and pays for it with a combination of reduced expenditures and raising taxes. What’s dishonest about that?
As for the rest, please get a grip. Sheesh.
It’s easy to make airy proposals without any numbers attached. In the real world, means-testing Medicare either saves an insignificant amount of money (compared to the scope of the problem), or would involve huge cuts in Medicare benefits not just for the well-off, but also for folks earning $27,000 a year.
Means-testing can save a little bit of money (and the Affordable Care Act includes means-testing, by the way), but the idea that it’s a magical wand making all the problems go away is ignorant.
(Nor does just cutting what the US government pays for, without addressing the problem of ever-rising costs, logically do anything more than put off the deficit problem.)
It is indeed a tempest in a teapot, but it is also telling that the Republicans remain the party without a positive agenda.
Tell it to the Republicans! They now control the house, but I don’t see any sign of them proposing to pass anything that bears any resemblance to that (I’m trying to imagine the current Republican House proposing tax increases… Nope, can’t imagine it, unless the tax increases on the poor are more than offset by tax decreases for the rich, as they demanded and got when they replaced the Making Work Pay tax credit with the SS tax holiday).
Means testing medicare pretty much necessarily couldn’t save much money.
Rich people don’t use medicare substantially more than poor people, and probably not any more than middle income people (poor people have shortly lifespans than the rich, but I think the middle class is like the rich in lifespan). So if we exclude the top 10% of the population from medicare, we could cut medicare costs by 10%. Go down much below the top 10%, and you get into imposing substantial costs (private health insurance for someone over 65? Expensive! Individual insurance at 62 will run you $12,000+/year if you are healthy) on people who aren’t that fantastically wealthy. If you means tested medicare so only the top 10% paid for insurance (cutting medicare costs in half), 90% for people over 65 is <$100,000, so $12k+ (and it would be way plus by the time you reach 75, and incomes drop as you get older) for insurance would be more than 10% of their income, a substantial hit in living standards. At the median income for people over 65 (50% savings in medicare costs), it would be more than a quarter of their income. At the median income for 75 year olds, it would be half their income (but the actual insurance costs would be far higher than $12k at 75 years old in the private market).
Ampersand: “Medicare Part D has been nearly 40% cheaper than the CBO predicted in 2003.
Again, your example proves my point, not yours.”
I am not sure about that. In 2005, the CBO had to revise its initial baseline projections upward by 41 Billion. We may not be comparing apples and apples.
And, yes, I know the CBO was not around until 1975. I agree that the CBO is a good thing (a non-partisan group that projects the future costs), but its analysis is only as good as the assumptions it is given.
No, I think the ACA is bad because insurance rates WILL go up. You simply cannot increase demand, maintain the same supply, and expect price not to increase. Furthermore, as insurance is simply pooled risk, you can’t require that insurance be given to riskier people and not expect that to be reflected in increased premiums.
At the same time, having a government safety net makes it easier simply to drop into it. That is one thing the government probably does not anticipate. They look at 32 million uninsured and think that is all there is. If it is cheaper to go to the government plan than to try to provide it to employees, people will respond by dropping coverage. That 32 million will only be the beginning; they will find that they could be dealing with twice that amount very easily. And, the governmental costs will be much more than projected.
-Jut
http://www.cbo.gov/ftpdocs/61xx/doc6139/03-04-BartonMedicare.pdf
Uninsured Americans with pre-existing conditions is a real, present problem, not a hypothetical problem; if you can’t acknowledge that, you can’t discuss health care intelligently at all.
Surely. But you didn’t start your post with “the White House released a study showing that XX million people with pre-existing conditions cannot get insurance and are going without medical care” – it started with an assertion that Republicans want to take away “protection” from 129 million Americans.
That’s hypothetical, not real. There aren’t 129 million Americans trying to get insurance and failing because of the mean insurance companies. There aren’t 12.9 million Americans trying. There aren’t 1.29 million Americans trying. Megan McArdle, who totally stole my car accident analogy, notes that a grand total of 8,000 people have applied for the high-risk insurance meant exactly for this group of people – out of the 400,000 who were thought to qualify/need the program.
I note that you don’t provide a single logical argument why the Exchanges would be a bad idea. Am I wrong to say that in the current market, it’s difficult for many non-expert consumers to know exactly how ten different insurance products compare? Am I wrong to say that consumer choice would logically tend to drive prices down in a market in which prices and benefits had to be stated clearly, understandably, and in easily-comparable units?
Not at all. Pass a unitary bill that establishes these exchanges and provides tax or regulatory incentives for companies to join them.
But the confusopoly is not the source of much health care expense growth, if any.
Do you have any actual arguments for why you don’t think the CBO’s projections are credible?
Their former director says the deficit savings scored by the original bill are nonsense. Accounting maneuvers, double-counting, etc.
This covers 32 million people and and pays for it with a combination of reduced expenditures and raising taxes. What’s dishonest about that?
It doesn’t take however many thousand pages to broaden Medicaid and create a subsidy and raise a few taxes. This bill is not about extending insurance to those people, it’s about a massive injection of the Federal government into a huge sector of the economy. That’s the dishonesty part.
Let me ask you this. You think means-testing Medicare wouldn’t save much money. OK, if REDUCING the number of people whose care the government has to pay for doesn’t save MUCH money, how is it that EXPANDING the number of people whose care the government has to pay for is going to SAVE money?
Robert @12: You cannot seriously be quoting McArdle as a reliable source. For anything.
What’s wrong with Megan McArdle?
That’s the nice thing about the Internet, isn’t it? You don’t have to worry that the totally-innocent-why-Miss-Maybelle-I-don’t-know-what-you’re-talking-about look is gonna be difficult to pull off.
Here’s another piece about the deficit impact of repeal, by some former CBO and OMB people.
http://online.wsj.com/article/SB10001424052748703954004576089702354292100.html
Mythago, I don’t know what you’re talking about. I am sure you disagree with McArdle about a lot of things; she writes about a lot of things from a relatively libertarian perspective.
But a quick search of Alas archives reveals Amp linking to her a bunch, arguing with her, debating with her, occasionally positively mentioning something she’s said as being worth reading, etc. But nothing that shows up as “Megan McArdle: Murderer of Kittens” or whatever it is you think that I should know that’s so obvious that me not knowing it must be disingenuous.
An organization called the NCPA has listed 10 legislative changes they think will work in the health care system. Here they are.
Discussion of the problems that these steps propose to solve are at the link.
This isn’t really about health care or the deficit; it’s about getting a Republican into the Oval Office in the next election, period. Obama got a piece of legislation passed. If it actually sort of works, there goes a talking point. Kill it now!
There’s no way to tell if this thing works by the 2012 election campaign. In fact, all of its provisions don’t even go into effect until 2014. So that’s unlikely to be the reason for their opposition. I think the more likely reason is that they actually don’t think it’s going to work, that despite what the CBO says they think it will increase the deficit, and in a lot of cases – especially in those districts that switched from the D to the R column in the House (and especially especially in those that can be described as having switched back from D to R) the current incumbent ran on a platform of voting to repeal this act.
It seems that too often on the left (and on the right as well at times) people are quick to attribute a nefarious conspiracy motive to people’s actions instead of considering that these people honestly don’t think this is a good idea and that it’s not going to work.
Ron, have you read this?
http://www.slate.com/id/2281588/
Do you care to comment?
Does anybody have any idea how long it’s going to be before one of the State’s cases against this act reach the Supreme Court?
The whole premise of American goverment when it was formed was that the government only had those powers explicitly granted to it, and that all other powers resided in the States or the people. If the Federal government has the power to require individuals to buy health insurance against their will, what is there – other than a direct contradiction of a provision of the Consitution such as in the Bill of Rights – that the Federal government cannot force States and people to do? Anything that the House, Senate and President conclude is in accordance with the “general Welfare” of the country?
Ron, it was less than ten years ago that Republicans were proposing ideas extremely similar to Obamacare. I agree that it’s a mistake to think that all policy preferences are partisanship and nothing more, but it’s also a bit ridiculous to expect us to believe that partisanship had NOTHING to do with Republicans suddenly discovering that they hate an idea they invented and quite recently argued for.
By the way, it’s hardly a conspiracy theory to say that Republicans — like Democrats — are considering the 2012 elections when they decide what issues to make big public cases about. That’s particularly true in a case like this one, when the bill they’re pushing obviously has no chance of becoming law, so there’s little to it other than trying to get on the news.
Yes! For example, the nine members of the Supreme Court probably have a good idea. I don’t have a clue, myself.
We’d save a lot of time if we could just ask Justice Kennedy today and let that settle the matter.
Actually, the argument is that it has to be related to interstate commerce. But that’s pretty broad, since we’ve already determined that me growing pot in my basement for my own use is related to instate commerce (a ruling that most conservatives and “moderates” favored).
Anyhow, Ron, a constitutional law professor addresses this argument here.
So why do you think the government hasn’t raised the income tax to 100%, since there’s nothing specifically written in the Constitution preventing them from doing so?
Slate seems to be having trouble today; I wasn’t able to access G&W’s link. But you can still read it on google’s cache.
By the way, it’s hardly a conspiracy theory to say that Republicans — like Democrats — are considering the 2012 elections when they decide what issues to make big public cases about. That’s particularly true in a case like this one, when the bill they’re pushing obviously has no chance of becoming law, so there’s little to it other than trying to get on the news.
And when, you know, the actual title of the bill was “A bill to repeal the job-killing health-care law.”
(I personally think a more accurate transcription would be “A bill to repeal the !!!!JOB-KILLING!!!!! ZOMGLEVENTY (SOCIALIST) health care law,” but for some reason I can’t seem to get hired taking notation for Congressional sessions.)
R0bert: it’s really not that she’s a libertarian. (Although I think she’s more of a privilegetarian.)
RonF: Pointing out that the GOP might perhaps be planning ahead for next year’s elections is a conspiracy theory?
I am absolutely against the repeal of the whole bill. Every normal person understands that many of the already existing provisions are beneficial to the ordinary people such as the one saying: No child can be denied insurance coverage because of a pre-existing condition. There should be more discussion about the bill but its complete repeal is simply wrong.
Mythago,
That was one of the worst fiskings I’ve ever seen. Paragraph after paragraph of trash talk and insults followed by some footnotes that don’t clearly demonstrate that she was wrong.
So why do you think the government hasn’t raised the income tax to 100%, since there’s nothing specifically written in the Constitution preventing them from doing so?
Because it would destroy the economy and ensure that none of the people who voted for it would every hold public office again
Actually, I doubt that the Supremes have any better idea about when a case will actually reach them than any informed observer of the legal scene. I know that more than half the States are pursuing court cases against the healthcare act. What I don’t know is what level those cases are at and how long it’s expected for any of them to work their way through the various levels of appeal to get to the SCOTUS.
It’s very hard for me to type that acronym. I keep typing “Scouts” ….
I won’t contest that at least some of the House GOP members are looking towards the 2012 elections. But the statement I was commenting on seemed to include all of them and left no room for any of them to be opposing it on principle.
Did you mean “instate” or “interstate”? I’ve seen plenty of GOP members oppose getting rid of Federal controls over intrastate commerce in things such as marijuana, but there are a number of conservatives who think the Feds have no business being involved in this even if they favor the “War On (Some) Drugs”.
I haven’t done the reading I’d need to challenge this (although I do not challenge that you say this in good faith). But in any case I’ll wager that it was to the great distress of many of their constituents and that accusations of “RINO”s flew. Things like that – and not a desire to violently overthrow the government – are the main cause of the rise of the Tea Party movement and the reason why the GOP and the House have both shifted to the right.
Yeah, that was pretty weak sauce. I’m all for a bit of the snarky but 99% “wit” and 1% indifferently-compelling data is not much of an argument. The higher the snark factor, the more the “ideological disagreement” explanation gains weight.
I favor the repeal of the whole bill because nobody even knows what all is in it – I think it was obscene for the Speaker of the House to stand up in front of the American public and tell us with a straight fact that “we have to pass the bill so you can find out what’s in it”. For any law, never mind something that affects so many people in so many ways as this does. For that alone the bill should be repealed in it’s entirety. And this would also get rid of the usual lot of clauses that were completely unrelated to the purpose of the bill but were thrown in there either to get someone’s vote or because it was on someone’s agenda and this looked like a good way to get it passed under the radar. An example would be the changes to the student loan program. Is that a good idea? Maybe so, maybe not, but it should stand on its own rather than be snuck in like this.
However, I will agree with you all that the GOP in addition should stand up and say either “We think the health care system is fine and doesn’t need any changes” or “We think the health care system needs changes but that’s the State’s job” or “Here’s our alternative health care bill.” I don’t think that repealing this mess should be dependent on that, though.
GiW, I did read that. The President claims that 129 million Americans could be denied coverage wihtout the health reform law. But Front Page Magazine notes that a) that protection doesn’t begin until 2014, b) based on the analysis the President quotes the number is 50 million to 129 million, so picking the number at the top of the statistical distribution is quite misleading and that’s a pretty big standard deviation anyway, and c) that’s not actually going to happen.
Check out that whole link.
Crap. Amp/mod, can you fix that for me? I’m sorry ….
Ron, the low denials aren’t great proof of much.
If a company publicly states it won’t give you insurance if you have red hair, you may not apply at all. in that case, you wn’t be denied. “denials” also may or may not account for practical financial denial, such as “oh sure we’ll insure you if you have red hair, but it’ll be $2100/month instead of $400/month.” Are those folks “denied?” Technically no; practically yes.
Also, the article I linked specifically addresses the non-employment context, while the article you linked deliberately gets its “facts” from the employment context. I put “facts” in quotes deliberately, because (unlike mine) your linked article doesn’t really say much about facts, at least not specific ones. There are a lot of concepts, some links to fairly complex datasets, and not much analysis at all.
But what interests me most is that you are usually sort of a facts guy. Yet you don’t seem to be especially responsive to about the actual, highly specific, facts and methodology cited in my link.
Cite it. Quote it. Take it apart piece by piece; I speak that language. But don’t send me to some BS opinion piece and expect it to speak for you.
here, I’ll start. Following are a list of conditions used to obtain the 50 million figure. As far as i can tell, the main defense provided by your article is that “so long as you can avoid treatment for 6 months some insurers may not be able to exclude you on that basis.”
Here’s the list.
An approach developed by the Lewin Group was replicated and identified conditions reported by five or more of the 19 pre-Affordable Care Act state high-risk pools as indicating automatic eligibility for enrollment in the pool.17 This list included the following conditions: alcohol and drug abuse, chemical dependency, acquired immune deficiency syndrome (AIDS), Alzheimer’s disease, angina pectoris, anorexia nervosa, aortic aneurysm, aplastic anemia, arteriosclerosis, artificial heart valve or heart valve replacement, ascites, brain tumor, cancer (excluding skin), cancer (metastatic), cardiomyopathy/primary cardiomyopathy, cerebral palsy/palsy, chronic obstructive pulmonary disease (COPD), chronic pancreatitis, cirrhosis of the liver, congestive heart failure, coronary artery disease, coronary insufficiency, coronary occlusion, Crohn’s disease, cystic fibrosis, dermatomyositis, diabetes, emphysema/pulmonary emphysema, Friedreichs’s disease/ataxia, hemophilia, active and chronic hepatitis, HIV positive, Hodgkin’s disease, hydrocephalus, intermittent claudication, kidney failure, kidney disease, and kidney disease with dialysis, lead poisoning with cerebral involvement, leukemia, Lou Gehrig’s Disease/amyotophic lateral sclerosis (ALS), lupus erythematosus, disseminate, and lupus, malignant tumors, major organ transplant, motor or sensory aphasia, multiple or disseminated sclerosis, muscular atrophy or dystrophy, myasthenia gravis, myocardial infarction, myotonia, paraplegia or quadriplegia, Parkinson’s disease, peripheral arteriosclerosis, polyarteritis, polycystic kidney, postero-lateral sclerosis, psychotic disorders, silicosis, splenic anemia, True Banti’s syndrome, Banti’s disease, rheumatoid arthritis, sickle cell anemia and disease, Stills disease, stroke, syringomyelia (spina bifida or myelomeningocele), tabes dorsailis, thalassemia (Cooley’s or Mediterranean anemia), ulcerative colitis and Wilson’s disease
2005 was before they know what the actual costs would be; it was a revised estimate (based on new rules having been written), not an actual cost. So your point in no way contradicts the fact that when the actual costs came in, they were 38% cheaper than the CBO had predicted.
You say “you’re not sure about it.” Well, I linked to a Kaiser Policy Report; are you saying that Kaiser Policy reports aren’t legitimate sources of statistics? That’s a pretty incredible claim; where’s your evidence?
Kaiser, in turn, cited the testimony of a professional actuary from HHS, specializing in Medicare, in testimony before Congress. Are you suggesting that the actuary doesn’t have legitimate expertise, or that he decided to commit a federal crime by lying in his testimony before Congress? Either way, that’s an extraordinary claim — where’s your fucking evidence backing it up?
Either acknowledge that you were mistaken and Medicare Part D has in fact been cheaper than the CBO estimate indicated; or provide links to factual sources showing that the sources I linked to, which were both nonpartisan and expert, were wrong on the facts.
But saying, in effect, “I don’t like the facts, they disagree with my right-wing beliefs, so they must not be true!” — which is what you’re really saying here — isn’t debate, it isn’t intelligent, and it’s a fucking waste of my time. Please don’t do that again.
Robert linked to two op-eds, both written by former CBO director Holtz-Eakin (now the head of a right-wing think tank). I don’t think I can fairly be expected to respond in detail to every single claim Holtz-Eakin made, so I’ll just reply to the two claims Robert singled out, since presumably those are the claims that Robert thinks are strongest: “accounting maneuvers” and “double-counting.”
(Also worth noting, since Robert emphasized Hotlz-Eakin’s past CBO cred: Two former CBO directors have said they favor the bill.)
Hotlz-Eakin wrote:
This is an exaggeration; some of the new taxes won’t start until 2014, and some of the new subsidies have already begun.
Hotlz-Eakin’s implication is that the projected reduction in the deficit is an illusion; if the CBO had projected ten years of revenue and ten years of spending, then they would have found that the Affordable Care Act (ACA) added to the deficit. But the truth is, the CBO’s estimate for the second decade — when there will be 10 years of both spending and revenue — found even larger reductions of the deficit.
I know that Republicans don’t believe in paying for legislation they want; there is only one method Republicans use to pay for major bills, and that’s adding it to the deficit so that our kids and grandkids can pay it. Since that’s the only way of paying for major bills Republicans have, Republicans assume that’s the only way anyone can pay for any bill. But there’s nothing tricky or dishonest about reducing expenses and increasing revenues so that you can pay for something you want.
But the actual administrative cost over the first 10 years is predicted to be $10-20 billion, not $114 billion. Conservatives reach the $114 billion figure by including $86 billion “for activities that were already being carried out under prior law or that were previously authorized.”
I assume these are the “accounting maneuvers.”
Robert claims the CBO “double-counted,” a claim that isn’t supported by either op-ed Rob links to. Holtz-Eakin did write that “ACA’s advocates are double-counting this fictional savings, claiming it can pay both for the ACA’s entitlements and Medicare solvency too.”
Note that Holtz-Eakin doesn’t claim that the CBO estimate double-counted — he sure left that impression, but he didn’t actually say it. Holtz-Eakin knows perfectly well that the CBO didn’t double-count. To use that argument as a claim against the CBO’s estimate, as Robert did, is in effect an admission of ignorance.
Quoting factcheck.org:
More from Robert:
Blah, blah, blah. Yes, Robert, people who disagree with you are eeeevvviiiiiilllll and run conspiracies, etc.
The bill is about more than extending health coverage to people who don’t now have it; it’s also about increasing protections, about demonstration programs aimed at bending the cost curve in a huge number of ways, about making alternatives available to states that want alternatives, about creating markets where Americans can buy insurance in a comprehensible way without being bilked by wealthy corporations, and yes, about paying for all of the above. It’s a huge bill.
But all of those things are things that Democrats want to do, and have wanted to do for years, and have said so in public, and said so during both the primary and the main elections in 2008. Anyone who bothered to follow the debate knows that. I don’t think any bill in my lifetime has been more closely followed, reported on, or analyzed. Nothing about this bill is secret.
Conspiracy theories like yours are ridiculous. Full stop.
Now, let’s talk about the bill length issue. (I don’t recall you objecting when President Bush proposed thousand-page plus bills, by the way.)
You can either think that it’s reasonable for the minority party to use filibuster threats to create an effective supermajority requirement for every bill of any consequence. Or you can think that it’s wrong for the majority to put a lot of ideas into one bill (which is why bills get long).
But it’s completely unreasonable to hold both beliefs. Overturning a filibuster takes 11-15 business days — let’s call it two weeks. The Senate is in session less than 30 weeks a year. Do the math, kids.
When filibusters become routine, long bills have to be routine as well. If Republicans want short bills, then they have to be willing to use Senate procedures that make it plausible to pass a lot of short bills instead of a few long bills.
Expanding coverage doesn’t save money — it costs money (although it also brings the per capita cost down, of course). But expanding coverage while simultaneously cutting expenses (in a bunch of ways, including some means-testing) and increasing revenue has the net effect of saving money, as long as new savings + new revenue > new spending.
This is not mysterious, Rob. If I buy a $100 monitor on credit card, that adds $100 to my household debt. But if I decide I want both the monitor and to avoid increasing my household debt, I can decide to walk instead of taking the bus, saving $75, and to take on an extra $50 illustration job. After that’s all done, I’ve got a new monitor plus an extra $25 I can use to pay down my existing debt.
Amp:
Sorry for wasting your time, but I will respond.
First off, you are being a bit disingenuous. Looking more closely at the Kaiser link, it says, “Foster testified that the 10-year cost projection for the Medicare prescription drug benefit is 37% lower than projected in 2003 when Congress approved the law that created the benefit.” I presume the 37% is where you get “nearly 40%.” Fair enough. However, you can’t say that it “has been” 40% cheaper when the testimony is about a 10-year projection and occurs in year 5 of that time-frame. You have misrepresented the testimony.
This is particularly relevant when considering my point that the CBO upped its baseline in 2005.
Here is the timeline: 2003: CBO makes its projections; 2005: CBO ups its projections because, as you say, they did not know what the actual costs would be; 2008 professional actuary specializing in Medicare says that he thinks the 10-year projection will come in 37% lower than predicted in 2003.
I have to ask: in a blog post where you are citing the CBO’s estimates of the effect of repealing the health care law, you are supporting it by saying that the CBO, who got Medicare Part D wrong in 2003, revised it in the wrong direction in 2005, and then concluded that it would be 40% cheaper than they thought back in 2003 (assuming, of course, that the 2008 testimony is any more credible than the CBO’s first 2 attempts). This scenario does not bolster my confidence in the CBO’s prescience. Quite the opposite. Like I said before, garbage in, garbage out.
Amp: You say “you’re not sure about it.” Well, I linked to a Kaiser Policy Report; are you saying that Kaiser Policy reports aren’t legitimate sources of statistics? That’s a pretty incredible claim; where’s your evidence?
No, I am not saying that. I am not familiar with the report. Frankly, I am not familiar with the foundation. They may be perfectly legitimate; they may not be. I don’t know, but I was not about to accuse you of the fallacy of an appeal to authority. But, let’s leave it at this: I have no independent basis for giving them any additional credibility based upon who they are. But, it appears that they were just reporting on testimony. I have no reason to think they reported it inaccurately; you, however, did not report it accurately. That the 10-year cost projection is lower does not mean it cost less. We won’t know what the actual cost is until the 10 years is up.
Amp: Are you suggesting that the actuary doesn’t have legitimate expertise, or that he decided to commit a federal crime by lying in his testimony before Congress? Either way, that’s an extraordinary claim — where’s your fucking evidence backing it up?
I have no idea what his expertise level is. My question is, if he is so damned smart, where the fuck was he in 2003 when they made the Medicare Part D projection? And, where the fuck was he when they moved their baseline UP 41 Billion? Was he involved in those initial guesses? Now, he comes along and says, its going to be 37% lowered than the first CBO prediction. Where is your evidence that this guy can actually predict the future with ANY accuracy? Do I think he lied? No, predictions of the future are never lies, unless you actually don’t believe what you are saying.
Amp: “I don’t like the facts, they disagree with my right-wing beliefs, so they must not be true!” I will ignore the ad hominem. But, I never said that. But, you can’t espouse predictions as facts. The point I was trying to make is that the CBO is not omniscient and just because they make a prediction about the effect of repeal will be does not mean that that prediction can be trusted blindly, regardless of your political leanings. Your analysis of Medicare Part D makes that point abundantly clear. The only thing you have convinced me of is that whatever the actual 10-year cost of Medicare Part D turns out to be, it will NOT be what they said it would be in 2003.
So, what makes you think that their prediction about the repeal of the health care bill will be any more accurate (or any less inaccurate) than its predictions about Medicare Part D?
-Jut
GaW:
But the figure of 129 million cited by the President – or even the low end of the estimate, 50 million, which is just as valid to cite – would only happen if employers stopped offering healthcare insurance at all, which is highly unlikely. The fact is that slightly over 90% of the people in this country have health insurance (31 million uninsured vs. 330 million population), and the vast majority of them get it through their employer. And HIPAA rules and employer agreements greatly restrict the actual denial of insurance for pre-existing conditions. The figure given out by the President is more a scare tactic than it is an actual reflection of reality.
The fact is that slightly over 90% of the people in this country have health insurance (31 million uninsured vs. 330 million population)
Actually, the number of people in the US that are uninsured is around 45 million, closer to 15%. The 31 million number is just those who could get it under health care reform-if it’s not repealed. Needless to say, the current law doesn’t go far enough. Or soon enough.
BTW: Off topic, but on the topic of health care, there is a nationwide shortage of critical generic chemotherapeutics in the US. I dam near had a patient die of an entirely treatable, probably curable, disease because we simply could not buy one of the drugs needed to treat him. It’s out of stock and no more expected until March. If he hadn’t happened to have had insurance and if another (private) hospital hadn’t still had some of the relevant drug and been willing to take him…that would be that.
Did I mention that the particular disease he had is completely idiopathic? We don’t know what causes it. It’s not smoking or drinking or having sex with the wrong person or eating the wrong thing or any other “fault” of the patient. You might get it at any moment. And we’re nearly out of drug for treating it in the US. Have a nice day.
joe @27: Are you reading the same article I’m reading? That’s not even a ‘fisking’. It’s a critique with quotations.
RonF @37: How do HIPAA rules greatly restrict denial of care based on pre-existing conditions? Certainly employer plans tend to be more liberal about pre-existing conditions – but that’s not the same as employment-based insurance = denial of care. Insurance companies have all kinds of exciting tricks, from having proprietary billing codes (which make it more difficult for physicians to claim reimbursement, thereby allowing the insurance companies to hold onto money longer) to outright denial of claims that are covered, or stalling tactics to make it difficult for employees to actually use their coverage. (I know I’ve posted before about a co-worker of my husband’s who was required to submit a form signed by her doctor declaring her chemotherapy was not an “elective procedure”.)
Of course it’s easier to do those things on the individual market, particularly if the company plays the little game of using confusing, extremely vague application forms that can later be retconned into “Sorry, you clearly had a pre-existing condition that you lied about.”
JutGory:
You know, you’re right; the citation I used to show that you were wrong to say “Medicare D […] went over CBO estimates within the first few years” wasn’t clear. So let me give you two clearer citations.
From an overview of Medicare part D published in the New England Journal of Medicine:
The Commonwealth Fund published a much more detailed discussion of the CBO’s pattern of severely underestimating Medicare savings in their projections — pdf link. They wrote:
Yes, we can’t know about the entire 10-year projection yet, and it’s possible that any year’s spending will be driven up by a new drug that everyone needs. But the early years of spending were a lot cheaper than the CBO projected — exactly the opposite of what you claimed. Beyond any doubt, the evidence you presented in your first post was just plain wrong.
Was that your point? Gee, I misunderstood you; when your only two examples were of the government wildly underestimating costs (admittedly, in one case it wasn’t the CBO making the estimate, in the other case your “facts” were the opposite of the truth), it seemed like you intended to imply that the government has a pattern of underestimating costs.
If your only point was that the CBO is making an estimate about future outcomes, and the future is likely to differ from that estimate in some way, then I agree. I’ve never said otherwise. In fact, everyone in the world agrees with that point.
I’d argue that given the CBO’s past record with major changes to Medicare (in which they’ve consistently underestimated savings), the odds are that the CBO has underestimated the deficit-reduction effects of the ACA. But maybe they’ve overestimated it — we can’t know until it happens.
But the CBO’s estimate is the best estimate it’s possible to have at this time. It’s made by experts using extremely conservative assumptions (which is why I think the actual savings might be larger than the CBO predicts). I don’t think “hey, the CBO’s projections don’t match our partisan preferences, so let’s say they’re ridiculous” is actually a better methodology for estimating the impact of a bill than the CBO methodology — but that is the methodology the GOP is using.
But you want to know what happens if the CBO is as inaccurate on the ACA as it was on Medicare Part D. Okay, let’s say the CBO ends up being off by 50% (more than they’ve been off on Medicare part D so far). What does that mean?
Well, if the CBO overestimated by 50%, then repealing the ACA would add $115 billion to the deficit.
If the CBO underestimated by 50%, then repealing the ACA would add $345 billion to the deficit.
In neither case is repealing the ACA a smart thing to do, from a deficit-reduction perspective.
But let’s suppose that the CBO is off by an entire 100%. In the best-case scenario, repealing the ACA doesn’t actually add anything to the deficit — but it does mean we’ve given up a chance to insure 32 million currently uncovered Americans at no cost to the deficit. In the worst-case scenario, repealing the ACA adds $460 billion to the deficit. Good going!
What you don’t seem to understand is that the CBO isn’t claiming that they can predict the future with perfect accuracy. What they claim is their estimate represents the likely middle of a range of possible outcomes. If they find that a bill will substantially reduce the deficit, then that bill might reduce the deficit by less or more than what they predicted, but it’s pretty unlikely to actually increase the deficit.
I don’t think the CBO is perfect. But perfect isn’t available to us. The CBO’s estimate represents the best reasonable, non-partisan estimate we have using conservative assumptions and currently available data.
I also think a system in which both sides agree to respect CBO estimates — even when they disagree with them — is much more likely to be disciplined and rational than a system in which either or both sides decide to attack the CBO whenever it’s convenient for their partisan bill of the week. Which is what the GOP is doing right now.
Got to love the game most insurances play that specifically don’t cover “transgender procedures”, and we’re not necessarily talking expensive surgery either: shrink visits, doctor visits, lab tests to measure health while taking meds and hormone pills/creams/shots – all minor-cost stuff that they would pay if only their ‘client’ wasn’t transgender (for example, women who are menopaused can get estrogen, and covered – trans women can’t).
Suddenly, they also won’t pay for stuff that happens to “the other sex” too. You’re female and got prostate cancer? Male and you have cervical cancer? They won’t even know what to do with you – but they’ll certainly find a way to exempt their coverage. Heck they even go as far as exempt themselves for non-trans-related stuff just because their client is trans (label every procedure a trans person undergoes as trans stuff).
I’m glad this simply can’t happen here. In Quebec province, they (the basic government insurance afforded to all those without any) cover my hormones (and my lab tests, and endocrinologist visits yearly), and don’t care one iota that I’m not a menopaused woman or even legally female, while taking (relatively) high-dose estrogen. They also don’t care that I’m not 1) with prostate cancer or 2) a sex offender, while taking androcur (or its equivalent: cyproterone acetate – banned in the US btw). They do care that I’m followed by a medical professional who knows what he’s doing, but don’t care what he labels the procedure as.
Trans people don’t represent a great chunk of population, at least nowhere near millions. Trans people represent less than 1 million people in the US, and less than 100k in Canada. Let alone transitioning ones, who probably represent a fraction of this.
How does it make sense to deny coverage? And no, they don’t even use the pre-existing thing. They just say those procedures are elective and cosmetic – even if the APA has repeatedly stated it wasn’t.
That’s the problem in a free market. They’ll all deny coverage to a small group to “compete with each other better”, regardless of the actual costs incurred by covering those people, simply because it makes sense to hang onto about any reasoning to deny coverage to as many as possible – while still making them pay your insurance. Bonus points if societal climate is hostile or indifferent to those people.
A regulated market could prevent those “we don’t like you” clauses. Or mandate coverage of same-sex spouses (the same way other-sex spouses are covered). Or allow for covering people you’re with romantically, but are not married to.