Originally posted by astralis
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To be Truly ignorant, Man requires an Education - Plato
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from Krugman's blog.
https://krugman.blogs.nytimes.com/
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So now we know what Republicans have to offer as an Obamacare replacement. Let me try to avoid value judgments for a few minutes, and describe what seems to have happened here.
The structure of the Affordable Care Act comes out of a straightforward analysis of the logic of coverage. If you want to make health insurance available and affordable for almost everyone, regardless of income or health status, and you want to do this through private insurers rather than simply have single-payer, you have to do three things.
1.Regulate insurers so they can’t refuse or charge high premiums to people with preexisting conditions
2.Impose some penalty on people who don’t buy insurance, to induce healthy people to sign up and provide a workable risk pool
3.Subsidize premiums so that lower-income households can afford insurance
So that’s Obamacare (and Romneycare before that): regulation, mandates, and subsidies. And the result has been a sharp decline in the number of uninsured, with costs coming in well below expectations. Roughly speaking, 20 million Americans gained coverage at a cost of around 0.6 percent of GDP.
Republicans have nonetheless denounced the law as a monstrosity, and promised to replace it with something totally different and far better. Which makes what they’ve actually come up … interesting.
For the GOP proposal basically accepts the logic of Obamacare. It retains insurer regulation to prevent exclusion of people with preexisting conditions. It imposes a penalty on those who don’t buy insurance while healthy. And it offers tax credits to help people buy insurance. Conservatives calling the plan Obamacare 2.0 definitely have a point.
But a better designation would be Obamacare 0.5, because it’s really about replacing relatively solid pillars with half-measures, severely and probably fatally weakening the whole structure.
First, the individual mandate – already too weak, so that too many healthy people opt out – is replaced by a penalty imposed if and only if the uninsured decide to enter the market later. This wouldn’t do much.
Second, the ACA subsidies, which are linked both to income and to the cost of insurance, are replaced by flat tax credits which would be worth much less to lower-income Americans, the very people most likely to need help buying insurance.
Taken together, these moves would almost surely lead to a death spiral. Healthy individuals, especially low-income households no longer receiving adequate aid, would opt out, worsening the risk pool. Premiums would soar – without the cushion created by the current, price-linked subsidy formula — leading more healthy people to exit. In much of the country, the individual markets would probably collapse.
The House leadership seems to realize all of this; that’s why it reportedly plans to rush the bill through committee before CBO even gets a chance to score it.
It’s an amazing spectacle. Obviously, Republicans backed themselves into a corner: after all those years denouncing Obamacare, they felt they had to do something, but in fact had no good ideas about what to offer as a replacement. So they went with really bad ideas instead.There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov
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Originally posted by astralis View Postfrom Krugman's blog.
https://krugman.blogs.nytimes.com/
====
So now we know what Republicans have to offer as an Obamacare replacement. Let me try to avoid value judgments for a few minutes, and describe what seems to have happened here.
The structure of the Affordable Care Act comes out of a straightforward analysis of the logic of coverage. If you want to make health insurance available and affordable for almost everyone, regardless of income or health status, and you want to do this through private insurers rather than simply have single-payer, you have to do three things.
1.Regulate insurers so they can’t refuse or charge high premiums to people with preexisting conditions
2.Impose some penalty on people who don’t buy insurance, to induce healthy people to sign up and provide a workable risk pool
3.Subsidize premiums so that lower-income households can afford insurance
So that’s Obamacare (and Romneycare before that): regulation, mandates, and subsidies. And the result has been a sharp decline in the number of uninsured, with costs coming in well below expectations. Roughly speaking, 20 million Americans gained coverage at a cost of around 0.6 percent of GDP.
Republicans have nonetheless denounced the law as a monstrosity, and promised to replace it with something totally different and far better. Which makes what they’ve actually come up … interesting.
For the GOP proposal basically accepts the logic of Obamacare. It retains insurer regulation to prevent exclusion of people with preexisting conditions. It imposes a penalty on those who don’t buy insurance while healthy. And it offers tax credits to help people buy insurance. Conservatives calling the plan Obamacare 2.0 definitely have a point.
But a better designation would be Obamacare 0.5, because it’s really about replacing relatively solid pillars with half-measures, severely and probably fatally weakening the whole structure.
First, the individual mandate – already too weak, so that too many healthy people opt out – is replaced by a penalty imposed if and only if the uninsured decide to enter the market later. This wouldn’t do much.
Second, the ACA subsidies, which are linked both to income and to the cost of insurance, are replaced by flat tax credits which would be worth much less to lower-income Americans, the very people most likely to need help buying insurance.
Taken together, these moves would almost surely lead to a death spiral. Healthy individuals, especially low-income households no longer receiving adequate aid, would opt out, worsening the risk pool. Premiums would soar – without the cushion created by the current, price-linked subsidy formula — leading more healthy people to exit. In much of the country, the individual markets would probably collapse.
The House leadership seems to realize all of this; that’s why it reportedly plans to rush the bill through committee before CBO even gets a chance to score it.
It’s an amazing spectacle. Obviously, Republicans backed themselves into a corner: after all those years denouncing Obamacare, they felt they had to do something, but in fact had no good ideas about what to offer as a replacement. So they went with really bad ideas instead.
http://money.cnn.com/2017/02/15/news...-death-spiral/
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Asty, JAD, anyone else willing to give an insight,
How is DOS doing these days? Over here, we are very confused.
We receive messages from carrier diplomats, but we also read that all they do is drinking coffee.No such thing as a good tax - Churchill
To make mistakes is human. To blame someone else for your mistake, is strategic.
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Wooglin,
As if the ACA was a great idea to begin with, fulfilling all it was promised to. Instead, premiums have been soaring while coverage shrinks, and people lost those plans they were promised they wouldn't lose, insurance companies are getting out of the market, and the bulk of new enrollments came from the expansion of medicaid. It is a monstrosity that is already collapsing.
if the ACA were in such utter disrepair as you describe, it is funny how it is now the most popular it has been since it first started, and how enrollments hit a near record for 2017.
and if all of this is fake news, then the GOP would simply need to just wait until the entire market collapses and then come in with their own plan.
as it is, the GOP plan is essentially Obamacare-lite: it is the same structure, just with fewer benefits covering less people... -AND- significantly fewer cost controls. so tell me, how does the GOP plan solve the shortfalls of the ACA?There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov
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Originally posted by Wooglin View PostAs if the ACA was a great idea to begin with, fulfilling all it was promised to. Instead, premiums have been soaring while coverage shrinks, and people lost those plans they were promised they wouldn't lose, insurance companies are getting out of the market, and the bulk of new enrollments came from the expansion of medicaid. It is a monstrosity that is already collapsing.
http://money.cnn.com/2017/02/15/news...-death-spiral/
Wooglin,
You might want to keep a tighter leash on that attitude toward Obamacare, just for safe keeping. There’s a bunch of nasty old facts around here that could chew it up real bad.
“Trump said that “Obamacare premiums nationwide have increased by double and triple digits,” giving the average 116 percent increase in Arizona as an example. But that state was the only one to have a “triple digit” average increase in premiums on the ACA exchange, for individuals who buy their own insurance. As we’ve written before, the average nationwide change was a 25 percent increase from 2016 to 2017 among the 38 HealthCare.gov states. Ten of those states had single-digit increases or a decrease in the average second lowest-cost silver plan. And it’s worth noting that 84 percent of the 10.4 million Americans with marketplace coverage in the first half of 2016 received tax credits that limit the amount those individuals have to pay toward premiums.,” FactCheck.org, March 1, 2017. http://www.factcheck.org/2017/03/tru...s-to-congress/
“Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too,” NPR, October 24, 2016.
http://www.npr.org/sections/health-s...o-do-subsidies
“The truth about those rising health insurance premiums”, CNN October 25, 2016
http://edition.cnn.com/2016/10/25/op...premiums-jost/
Key point: increases in premiums this year are because plans were under priced in 2014-16, and the increase merely brings prices up to where they were expected to be back when ACA was being shouted down, I mean “debated” in Congress.
According to the report, Congressional Budget Office projections from 2009 suggested average 2017 premiums of $5,538; HHS is projecting average premiums of $5,586. Indeed, premiums in many states are still below the cost of employer coverage.
and,
“Slower Premium Growth Under Obama,” FactCheck.org, February 6, 2015
http://www.factcheck.org/2015/02/slo...h-under-obama/
Like I said, very nasty things those facts.
Very nasty.Trust me?
I'm an economist!
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Originally posted by DOR View PostMassachusetts is a blue state because of how it votes in presidential elections; that doesn’t mean it is California blue, where every state official comes from the Democratic Party.
DOR simple yes or no is California bluer than Massachusetts in elective representation in non presidential elections?
You are right the Republican Gov and the Republican Lt Gov of Massachusetts were elected by the majority vote in despite all 9 state districts being democratic controlled. How did REDMAP, ALEC and CrossCheck and gerrymandering make this possible?
Originally posted by DOR View PostCharlie Baker, the GOPer Governor, ran as a social liberal and a fiscal conservative, sort of like me. Sort of like a whole lot of people who are so disgusted at the GOP that they don’t think it can be salvaged.
Originally posted by DOR View PostNevada turns blue after holding its breath for too long. The state voted for every successful presidential candidate for nearly 100 years, with very few (2? 3?) exceptions. That’s a bunch of Dems and a slew of GOPers. Governor Brian Sandoval, ex-Gaming Commission Chair, is Hispanic. He ran against None of These, the top vote-getter in the Democratic Primary (30%). Well, actually it was Bob Goodman, with 25%.
Originally posted by DOR View PostThen again, did you read up on REDMAP, ALEC and CrossCheck?
I didn’t think so.
"These statehouse wins were not solely a byproduct of Southern partisan realignment -- Republicans also took active, strategic measures to win at the state level across the country. Since the 2004 election, the Republican State Leadership Committee has raised over $140 million to help accomplish this. The Democratic Legislative Campaign Committee, the RSLC’s counterpart, raised less than half that amount in the same period. While other groups also contributed significant amounts to these races, these numbers highlight the emphasis the GOP has put on state legislature elections in recent years.
Republicans also spent money on the right races at the right moment. In 2010, they funneled over $30 million into the Redistricting Majority Project, also known as REDMAP. REDMAP funds helped the party candidates win a majority in Ohio, Pennsylvania, North Carolina and elsewhere, giving the GOP greater control over the decennial congressional and state-level redistricting process."
Translation inspiration Democrats should pay attention to key races and come up with a strategy. You can always try a https://en.wikipedia.org/wiki/Califo...tion_14_(2010)Last edited by Dazed; 08 Mar 17,, 09:53.
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Originally posted by DOR View PostWooglin,
You might want to keep a tighter leash on that attitude toward Obamacare, just for safe keeping. There’s a bunch of nasty old facts around here that could chew it up real bad.
“Trump said that “Obamacare premiums nationwide have increased by double and triple digits,” giving the average 116 percent increase in Arizona as an example. But that state was the only one to have a “triple digit” average increase in premiums on the ACA exchange, for individuals who buy their own insurance. As we’ve written before, the average nationwide change was a 25 percent increase from 2016 to 2017 among the 38 HealthCare.gov states. Ten of those states had single-digit increases or a decrease in the average second lowest-cost silver plan. And it’s worth noting that 84 percent of the 10.4 million Americans with marketplace coverage in the first half of 2016 received tax credits that limit the amount those individuals have to pay toward premiums.,” FactCheck.org, March 1, 2017. http://www.factcheck.org/2017/03/tru...s-to-congress/
“Rates Up 22 Percent For Obamacare Plans, But Subsidies Rise, Too,” NPR, October 24, 2016.
http://www.npr.org/sections/health-s...o-do-subsidies
“The truth about those rising health insurance premiums”, CNN October 25, 2016
http://edition.cnn.com/2016/10/25/op...premiums-jost/
Key point: increases in premiums this year are because plans were under priced in 2014-16, and the increase merely brings prices up to where they were expected to be back when ACA was being shouted down, I mean “debated” in Congress.
According to the report, Congressional Budget Office projections from 2009 suggested average 2017 premiums of $5,538; HHS is projecting average premiums of $5,586. Indeed, premiums in many states are still below the cost of employer coverage.
and,
“Slower Premium Growth Under Obama,” FactCheck.org, February 6, 2015
http://www.factcheck.org/2015/02/slo...h-under-obama/
Like I said, very nasty things those facts.
Very nasty.
Here's another nasty fact... those guys campaigning on getting rid of obamacare won overwhelmingly in 2016, at all levels. Chew on that a bit.
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Originally posted by astralis View PostWooglin,
lol, the ACA has been "already collapsing" since its creation, what is new?
if the ACA were in such utter disrepair as you describe, it is funny how it is now the most popular it has been since it first started, and how enrollments hit a near record for 2017.
and if all of this is fake news, then the GOP would simply need to just wait until the entire market collapses and then come in with their own plan.
as it is, the GOP plan is essentially Obamacare-lite: it is the same structure, just with fewer benefits covering less people... -AND- significantly fewer cost controls. so tell me, how does the GOP plan solve the shortfalls of the ACA?
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Originally posted by astralis View PostWooglin,
lol, the ACA has been "already collapsing" since its creation, what is new?
if the ACA were in such utter disrepair as you describe, it is funny how it is now the most popular it has been since it first started, and how enrollments hit a near record for 2017.
and if all of this is fake news, then the GOP would simply need to just wait until the entire market collapses and then come in with their own plan.
as it is, the GOP plan is essentially Obamacare-lite: it is the same structure, just with fewer benefits covering less people... -AND- significantly fewer cost controls. so tell me, how does the GOP plan solve the shortfalls of the ACA?
Republican plan is a non-plan, has zero possibility of getting passed. Still better than ACA in that it doesn't continuously shovel money into a black hole, but it doesn't do anything to arrest the ongoing death of the individual market (it just speeds them up).
Which means in the long-term MORE reforms needed for the individual markets and more money shoved in there somewhere, because the failure of individual markets is not an option (either politically or policy).Last edited by GVChamp; 08 Mar 17,, 15:22."The great questions of the day will not be settled by means of speeches and majority decisions but by iron and blood"-Otto Von Bismarck
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GVChamp,
Rise in Obama-care popularity=status quo bias
Republican plan is a non-plan, has zero possibility of getting passed.
Still better than ACA in that it doesn't continuously shovel money into a black hole, but it doesn't do anything to arrest the ongoing death of the individual market (it just speeds them up).
so in essence you would see an initial decline in people on health insurance as the new system is implemented, and then another wave when the market declines or collapses.
if the goal of the GOP was to create a new conservative healthcare system, that is curious because they took the old structure of the ACA. if the goal is to reduce taxes on the wealthy, the GOP would have done better to not touch the ACA and just propose a new tax cut for the wealthy to counteract the effects of the ACA.
good luck with that deficit though.There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov
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Private money getting shoved into pointless healthcare is not a government problem. The ACA and current healthcare is a continuous outflow of government spending. My understanding is that the new GOP plan is effectively capping the Medicaid spending and the refundable tax credits. So the Federal Government isn't exposing itself to effectively unlimited losses.
Projected outwards, it's less fiscally dangerous than the ACA.
Politically, projecting outwards, the death of the individual markets guarantees single payer.
There only way to get to a conservative health insurance policy market at this point is to strip down the mandates on the health insurance plans and impose mandatory savings for first-dollar coverage, and backstop insurer losses for the sickest patients. That's the only way to get there from here.Last edited by GVChamp; 08 Mar 17,, 16:41."The great questions of the day will not be settled by means of speeches and majority decisions but by iron and blood"-Otto Von Bismarck
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GVChamp,
My understanding is that the new GOP plan is effectively capping the Medicaid spending and the refundable tax credits. So the Federal Government isn't exposing itself to effectively unlimited losses.
remember, Republicans promised a system where premiums would go down, everyone will have coverage and nothing is mandatory. they're just missing a pony and a chicken in every pot.
Projected outwards, it's less fiscally dangerous than the ACA.
even if you were to replace the ACA or the AHCA with a single-payer health system (which from my POV would be good in the long-term), in the short-term you'd suffer a significant amount of disruption in the healthcare and insurance industries.
There only way to get to a conservative health insurance policy market at this point is to strip down the mandates on the health insurance plans and impose mandatory savings for first-dollar coverage, and backstop insurer losses for the sickest patients. That's the only way to get there from here.There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov
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Right, any of the feasible solutions are political fire-bombs. Mandatory savings is an even bigger problem than the mandate and the backstopped losses are a huge liability equivalent to our current program.
But the Republicans need to suck that up and get over it if they want a conservative health financing system, and set up mechanisms to limit the losses. There's not really a way around it (except, of course, just killing the individual insurance market totally).
Them's the way the cookie crumbles."The great questions of the day will not be settled by means of speeches and majority decisions but by iron and blood"-Otto Von Bismarck
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GVChamp,
i don't get it, though. what is it about mandatory savings/backstopped losses that would make it a conservative health financing system? we seem to be saying the same thing, that in concept both ideas are pretty similar to what already exists in the ACA. which shouldn't be a surprise to anyone because the ACA -is- the conservative position on healthcare, as JAD pointed out earlier.
in any case that's not what is up for discussion, and if this plan really is dead in the water i'm not sure what alternatives conservatives have. no one will go for the Freedom Caucus plan, which is essentially to undo the ACA and hope for the best.
as it is, this is becoming quite amusing for me to watch because this ACA 0.5 will ensure that the GOP eats an enormous public backlash over what is essentially a relatively small $600 billion tax cut for the wealthy-- and making singlepayer that much more likely.There is a cult of ignorance in the United States, and there has always been. The strain of anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that "My ignorance is just as good as your knowledge."- Isaac Asimov
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