The insurance companies finally got around to telling the Republicans what they want to see in any revision or repeal of the Affordable Care Act and I think Kevin Drum’s reaction is spot-on:
Here’s the case for laughing: the insurance industry says it’s OK with repealing Obamacare, but we should maintain the pre-existing conditions ban, the individual mandate, the subsidies for low-income families, and the Medicaid expansion. Needless to say, that is Obamacare.
Here’s the case for crying: “The market has already been a little wobbly this year,” Tavenner said. If it looks like any of these four provisions are going to be repealed with nothing to replace them, insurers will simply pull out of the market at the “next logical opportunity.” That would be about six months from now.
And as I’ve mentioned before, there’s a good chance this doesn’t just mean pulling out of the Obamacare exchanges. If the mandate and the subsidies go away, but the pre-existing conditions ban stays in place, insurers might very well pull out of the individual market entirely. Republicans are playing with fire here, and it’s not clear if they even know it. Someone in the insurance biz really needs to have a come-to-Jesus meeting with them.
The Affordable Care Act is a structure with pillars and support beams, and you can’t just go around knocking pieces out and think that it will remain standing. If you make the insurance companies cover people who are sick and will likely use more health care than they pay for, then you must offset that by forcing healthy people to buy more coverage than they’re likely to use. If you’re going to force people to pay premiums, you need to subsidize the payments for people who cannot afford to make them. If you’re going to use Medicaid as part of the system, you need to give a bunch of money to the states so they can afford to expand their Medicaid programs.
In preserving private individual health insurance plans as the primary way that people pay for health care, you’re committed to making it profitable to give people insurance, and if that means you have to provide price supports and mandate that people get coverage, then that’s the system you have to create and maintain. If you have to insure the insurance companies by giving them a hedge against failure, that’s going to need to be included, too.
The Republicans say that they want and expect the Democrats to participate in the dismantling of Obamacare, but it’s doubtful that they’ll get any if they go ahead with their plan to repeal the law now and figure out the details later.
It would be one thing if the Republicans were willing to kick people under twenty-six off their parents’ plans, or if they recognized the need for Medicaid expansion, or if they were okay with kicking every diabetic or cancer patient to the curb. But they’re either in denial about what’s required to keep people from losing their insurance or they’re unwilling to let those people lose their insurance. Between the two, they have no solutions.
They’re the dog who caught the car, and now they want to pretend that they had a plan for the car.
They cannot do what they’re hoping to do, and they’ll wind up building something that looks almost exactly like Obamacare. The reason for this is that Obamacare isn’t some ideological overreach but actually the result of many unhappy but forced compromises. President Obama campaigned against the individual mandate because, he said, the problem isn’t that people don’t want insurance but they can’t afford it. How do you force people to buy insurance they can’t afford?
But he discovered that you can do that by subsidizing the payments and that you need the healthy people who would otherwise gamble on their continued good health if you’re going to be able to get the sick people covered. Why would an insurance company offer fire insurance to someone whose house is already on fire at a cost that is less than the price of repairing the damage? That’s doesn’t make sense, and neither does offering a plan to someone who is going to need dialysis or chemotherapy. To make it work, you need to compel all the people whose homes are not on fire to get plans, too. So, Obama didn’t want an individual mandate but he needed one.
A lot of us think that health care should be covered rather than insured, and avoiding crazy legislative contraptions like a politically unpopular mandate coupled to a sure-loss requirement to cover sick people is one of the reasons why. But if you want to preserve our system and cover almost everyone, these contraptions are not optional.
The insurance companies will now begin pointing this out with renewed vigor and urgency, but they’ll discover what the rest of us already know, which is that you can’t cure stupid and you can’t reason with the modern conservative movement.
“you can’t cure stupid and you can’t reason with the modern conservative movement”
Pretty much sums it up. There’s no fix for that.
True. But they have convinced us that government is inefficient and unable to run things properly – like the VA. Best to make it small and let the imdividual take care of his own needs. The so called free market will sort it all out. And we have all bought into neoliberalism and the goodness of profits and the inherent efficiency as opposed to Big Brother Governmemt. Never mind that the overall cost might be the same. The individual is responsible.
Curious, does your brother think they will manage to implode the whole health insurance sector?
My hope is we are witnessing the death of wonk led politics.
Consider this sentence:
In the late 70;s and throughout the 80’s there was a “new found appreciation for the markets” among some liberals. This stemmed in part from the perceived failure of nationalized industries, but it had other origins as well. This trend accelerated after the Soviet Union fell.
Simultaneously over this period the tax revolt, which came to prominence with Prop 13 in California, began to effect liberal thinking. Mondale’s pledge to raise taxes and Bush’s broken tax promise took broad based taxes off the table, and they have remained off the table since.
So we wind up with complicated proposals with even more compicated funding mechanisms.
And the result is bad policy and even worse politics.
I was talking to a pretty senior field director who offered me the following comparison:
Clinton Canvasser walks up to the door. As he walks up he passes a 16 year old girl on her way out.
The Canvasser knocks, and the 45 year old mother after some conversation says she is worried about paying for college.
Oh says the canvasser – Clinton has a detailed plan for college funding.
Great the mother says, how does it work?
So the problem starts right here – because the Clinton plan is so fucking complicated that the canvasser probably can’t explain it. But lets say we have an unusual canvasser.
She replied: “well it increases pell grants”
The mother replied: “What is a pell grant”
If you didn’t go to college you probably don’t know what a pell grant is – I know that sounds amazing to the readers here….
So the canvasser explains.
The mother asks “well do I have to apply? Are there a bunch of forms I have to fill out”
Well of course the answer is yes to that too.
And the conversation goes downhill from there.
To make matters worse Clinton didn’t feature the plan in her own advertising, and doesn’t explain it in her speeches.
Now lets take the Bernie Canvasser. First of all one of the reasons she is for Bernie in the first place is probably for free public tuition. So when she sees the daughter she brings it up.
Oh and the canvasser training for Bernie made it a point of bringing it up if you see teenagers around.
So she knows on the door.
“Looks like you have a teenager about to go to college”
“yes but I don’t know how to pay for it”
“Oh well Bernie is going to make public university education free”
So this gets to my point.
Free public university education doesn’t need explanation. But the Clinton plan sure as hell does.
THE COMPLEXITY THAT IS SEEN IN POLICY LIKE THE CLINTON HEALTH PLAN AND OBAMACARE MAKE THEM DIFFICULT TO DEFEND POLITICALLY, AND A NIGHTMARE FROM A POLICY PERSPECTIVE.
They are NOT designed as egalitarian, either.
Sure as hell get that. But when you say it is free, they say how will you pay for it? Now what?
So you say we will raise taxes. Right. But how much? Or you say we have a ” special tax”. So now you lost much of your audience.
I think the pay for or the tax bridge needs to be addressed. And I doubt it is a two minute conversation. Maybe you start with something like we are already paying for it. But the cost falls on the few who can least afford it. So we want to make it easy for,everyone.
It is true the the three trillion or so we spend on health care is already a national expense. If it is treated as a national cost, it is the same for everyone. It is like a fire department or a police department. The cost is shared by everyone. That is what this is really about. What should government provide?
It was paid for by a tax on Wall Street Transactions – the tobin tax – which is pretty easy to describe too.
It held the audiance.
The problem with single payer is much harder. You need broad based taxes.
But if you don’t confront that issue, you will never get the policy right.
IMO trying to blame Wall Street for all the ills on the country is a loser. They can fight back too. But YMMV.
Worked for Bernie. But Hillary was in no position to make such an argument.
Although he vacillates, flip/flops & wig/wags constantly, Trump has indicated that he’d like to save those things from the ACA… which essentially are Obamacare, as indicated.
Other Republicans, however, are simply itching to repeal the whole thing 100%, and have it been repealed completely on January 21 – no waiting period, no phase out, just gone, baby, gone. As with the other elebenty bazillion times the R-Team put forwarded their repeals, they have never, ever, ever provided their replacement for Obamacare. It’s only ever been: repeal it. The end.
So I guess Trump voters will soon learn how that pans out for them personally, but given how conservatives seem ever willing to endure less than optimal outcomes as long as they’re dished out to them by conservatives, they may be all very happy campers. Time will tell.
Wonder if this will give them pause?
Why No One Will Even Try to Tame the US Healthcare Monster
by Wolf Richter * Dec 4, 2016 * 142 Comments
Though it cannibalizes the rest of the economy.
The numbers, when it comes to healthcare costs in the US, are always stunning, and the report by the Department of Health and Human Services, published by Health Affairs, doesn’t disappoint. In 2015, healthcare spending surged 5.8% to $3.2 trillion: nearly $10,000 for every person in a population of 324 million. Healthcare spending rose from 17.4% of GDP in 2014 to 17.8% in 2015.
“The report pointed out a number of reasons behind that surge in spending. But what it didn’t point out is the simple fact that without the surge in healthcare spending, GDP in 2015 would have essentially stalled. And without the secondary industries feeding off the healthcare boom, such as the construction boom of healthcare facilities, GDP would have looked even worse
http://wolfstreet.com/2016/12/04/why-no-one-will-tame-u-s-healthcare-costs/
We send about twice as much as other countries on health care. And, importantly, it is not universal. And the cost for premiums , copays and deductibles strangles many. That money and the lower health care costs as a whole under government funded single payer could be used to,fund growth in the economy. It is also true our economy suffers from under investment and stagnation. That begs the need for government spending and investments. The real unemployment rate – the U6 rate – is still over 9%. If we want GDP to grow there is the path – free up money from individual spending on health care ( which fall most severely on working class people) , lower the overall cost of it to the economy, and put the excess labor to work or to free education for more value added to the economy. We might then see that some loss of blue collar jobs to trade are not crushing us. Doing nothing means we stay right here. Maybe this is the appeal of Trump. He promises to do something.
Typo. Sb spend twice as much.
Not talked about much, but Obamacare did stimulate HC spending and in turn led to jobs…
But how many of those jobs were Indian pharmacists and Filipina nurses?
This is all pretty simple.
It seems to me that this is simply all about showing President Obama who’s boss.
They’ve been promising mouth-breathers that ACA was bad from day one regardless of the facts. They’ve been voting to repeal ACA since the day it passed and haven’t been able to do it, so they are going to be petulant babies and repeal it on day one.
They don’t care about the consequences of repealing it; they just want to able to say they repealed it, even if the “replacement” is basically Obamacare.
It’s nuts.
IOW, the insurance companies just want the profit controls off.
Makes sense. Guaranteed customers, no limit profit.
There are clearly many Republicans who want Obamacare dead and don’t care about the consequences. It’s just part of their religion that government shouldn’t provide shit to poor or even middle-class folks.
Still, I wonder if there are 50 Senators willing to do the deed. Even for members of the House in safe Republican seats, the reality of this isn’t going to be pretty and I’m not sure it will be possible when the realities begin hitting home. For Senators who have to run state-wide, I don’t see how someone like Susan Collins can follow McConnell’s orders. Unfortunately, when one gets past Collins, who else is vulnerable? McCain was just reelected and probably doesn’t plan to run again. Murkowski’s in a state about as red as they come. Same for Hatch.
The reality is brutal and I think that’s going to become obvious. We’re looking at millions of angry voters losing access to health care plus news stories that write themselves and will jump off the page. Children dying of easily curable illnesses. Older folks with conditions like diabetes losing coverage also facing death. A return of the medical bankruptcy. At the same time, the Republican base is angry and doesn’t give a shit, and the pressure to cave to their demands will be enormous.