Some Thoughts on ACA and BCRA
I’m not sure if this is worth posting here, but I have some thoughts on health care reform reform.
The Republican arguments have become absurd in interesting ways.
HHS secretary Price said something which makes no sense: “the Senate health care bill strengthens and secures Medicaid for the neediest in our society,” putting the program, which serves more than 70 million low-income people, on “a path to long-term sustainability.”
Republicans regularly describe cuts to Social Security pensions or Medicare benefits as needed to “strengthen and secure” those programs. In those cases, the argument isn’t absurd, because OASDI and Medicare plan A have trust funds which might run out. It makes no sense in the case of Medicaid which is financed by general revenues. I think the dedicated financial streams and trust funds make Social Security and Medicare vulnerable. It is possible to convince people that the trust funds reaching zero will cause something like the bankruptcy of a firm (and also people tend to assume that claims on bankrupt firms are worthless when historical recovery ratios average around 70 cents on the dollar).
The argument for dedicated taxes and trust funds, which I have read here among other places, is that otherwise the programs are like welfare and would be unpopular. The massives support for Medicaid demonstrated now that Republicans are trying to cut it undermines this argument.
Also in the same article Sen Cornyn flat out lies “Mr. Cornyn acknowledged that “there’s uncertainty about what the final outcome will be.” Asked what would happen if the bill did not pass, he said: “I assume we’ll keep trying. But at some point, at some point, if Democrats won’t participate in the process, then we’re going to have to come up with a different plan.” Of course Democrats have begged to participate in the process and have been excluded by Republicans. Robert Pear quoted the lie without noting that it is false. I think this is bad journalism. Also Cornyn is hinting that they might have to (shudder) try bipartisan negotiation. His statement would only make any sense if it were rephrased “If Democrats will participate in the process”. “Keep trying” means keep trying to pass a bill while completely excluding all Democrats. Cornyn is admitting that it was a mistake to be 100% partisan. He wants to blame the Democrats. The result is not just a lie, it is garbled nonsense based on a lie.
Finally Rand Paul is insane. He actually said “it keeps the fundamental flaw of Obamacare. It keeps the insurance mandates that cause the prices to rise, which chase young, healthy people out of the marketplace and leads to what people call adverse selection, where you have a sicker and sicker insurance pool and the premiums keep rising through the roof.” This is so crazy that I can’t think of a reply. All the claims are false — the BCRA would lead to adverse selection, because they eliminate the mandates. The idea that mandates cause selection is plainly insane. It is hard to understand how the statement could be generated by a human brain. And the ACA might survive because of that nutcase. Insane extremism causes sane policy in Bizarro World.
Robert, I know you’ve been around long enough to know that people lie (distort truth) when it’s serves their objectives. Politician’s are right up there with used car salesman, and door-door encyclopedia salesmen of times gone by. If they’re not under oath why shouldn’t they lie and distort truth if there’s no downside and a very likely upside for them?
If the ends justify the means?
“Robert Pear quoted the lie without noting that it is false. I think this is bad journalism”
Pear is no stranger to bad journalism, he may well be the biggest hack writer on healthcare issues in the world, especially considering he writes for the NY Times. He has been doing the same thing on the healthcare front for decade, and does not let his total ignorance bother him at all.
“What Does Robert Pear Do For a Living?
February 8, 2010 By Jonathan Zasloff
Apparently, he and David Herszenhorn moonlight for the Republican National Committee, and got some of their copy mixed up. Either that, or someone from the RNC spun them so hard they don’t know which way is up.
My God, where do you start? Well, how about: “it is not clear that Republicans and the White House are willing to negotiate seriously with each other.” Except, of course, that both the House and Senate plans are based on Republicans ideas, and the Senate process ground to a halt for months over the Gang of Six process.
Or this: “Congressional Republicans have laid out principles and alternatives that provide a road map to what a Republican health care bill would look like if they had the power to decide the outcome.” Except that, you know, the Republicans had the power to decide the outcome for several years and did nothing because essentially the system is fine by them.
Or: “The Republicans rely more on the market and less on government.” Unless, of course, you count things like tax sheltered health savings accounts, subsidies to Pharma under Medicare (dis)Advantage, federal pre-emption of state insurance regulations.
Or: “it is clear that they would not provide coverage to anything like the number of people — more than 30 million — who would gain insurance under the Democrats’ proposals. But Republicans say they can make incremental progress without the economic costs they contend the Democratic plans pose to the nation.” Yes, but are they right when they say that? Does such an assertion even pass the laugh test? Given that both the House and Senate bills are fully paid for — a fact nowhere mentioned in the piece and not a facet of, say, any GOP policy initiative during the Bush years — maybe some analysis and fact-checking of GOP claims is warranted?
Or: “Republicans would provide federal money to states to establish and expand high-risk pools, for people with chronic illnesses who cannot find private insurance at an affordable price.” Yes — and many states already have them, and they have done exactly nothing to increase affordability or access?
Or: “Republicans also contend that changes in state medical malpractice laws could lower costs and slow the growth of premiums. However, some of these proposals — like federal limits on damages for pain and suffering and punitive damages — are potentially in conflict with the Republicans’ emphasis on federalism and state autonomy.” Also however — these proposals do virtually nothing to actually reduce costs, as has been shown by study after study for years and years. (Which isn’t to say tort reform isn’t a good idea on it’s own basis).
Or: “Many Republicans want to expand the role of private insurance companies in Medicare. Insurers already manage Medicare’s prescription drug benefit, and Republicans see that as a model.” Yes — it’s a model of how to reward Big Pharma and getting nothing in return. Can’t Pear and Herszenhorn be bothered to cite to the studies showing how inefficient it is?
This isn’t journalism: it’s stenography. Pear has been on this beat at least since 1993, and apparently hasn’t learned anything since then: little wonder that his work served as Exhibit One in James Fallows’ diagnosis of what is wrong with contemporary reporting.”
I heard Rand Paul interviewed in a different venue where he also discussed this – if you replace “insurance mandates” with “essential health benefits”, it gets closer to my interpretation of what he was trying to get across.
I stopped reading at your comments re Social Security “trust funds might run out… bankruptcy..”
You don’t seem to know what you are talking about. And given how hard I have tried to educate the people on this blog, I take it personally.
The SS Trust Fund has not a damn thing to do with Social Security finance. And since SS doesn’t owe anyone any money, and can’t borrow any money it cannot be “bankrupt.” It has a dedicated funding stream… your FICA taxes, and unless the politicians can convince you to let them stop that funding stream, SS cannot run out of funds.
The only way the argument could be “not absurd” would be if Congress cut the funding and the people who have been paying thier “tax” never got the benefits they were paying for. That could happen, but “bankruptcy” is not the word. That would be theft.
and then Robert said this:
“The argument for dedicated taxes and trust funds, which I have read here among other places, is that otherwise the programs are like welfare and would be unpopular. The massives support for Medicaid demonstrated now that Republicans are trying to cut it undermines this argument.”
he may have read it here, but he didn’t understand it. SS is paid for by the workers who will get the benefits. That’s what “dedicated taxes” means. And the Trust Fund is what keeps the taxes dedicate… that is, the money has to be spend on SS, not “fungible” to other programs.
Welfare is not popular among those who pay for it: that is “the rich” who pay general (not dedicated) taxes. Of course it IS popular among those who get the benefits. So your reasoning, if not “insane” is at least inadequate.
Turning SS into welfare (general taxes, no dedicated funding, no trust fund) would make it wildly unpopular among “the rich” who would be the ones paying for it. Whether it would be unpopular among those who get … or would have gotten… the benefits would depend on whether they understood what was happening to them.
Given your comments, and about 99% of other comments I have heard here and elsewhere, my guess is they would have no clue.
At first, the “progressives” would think they had won a great victory: “yea, the rich are paying for our retirements.” but then a few years later when the rich said.. we need to cut benefits because we don’t have the money to pay for them… it wouldn’t look like such a great victory after all, because then the workers would no longer be able to say “but we pay for it ourselves.”
Not that anyone remembers that anymore.
M.Jed yes and if you replace what he said with “1+1=2” then it’s not absurd and is actually true. But you can’t replace what someone said with something else completely and then claim he was coherent.
1) on the trust fund I claimed it was as political weakness. I did not claim that the argument that the SSA could go bankrupt as a private firm might is a valid argument. I claimed it is a politically effective argument.
2) Medicaid if funded from general revenues and it is very popular. Medicare plan A has a dedicated funding stream. Medicare plan B is funded from general revenues. Almost no one knows this and no one cares. The evidence amounts to proof beyond reasonable doubt that your argument that OASDI and Medicare plan A aren’t welfare is politically irrelevant. Many people make that argument. Very few make it consistently.
3) we are discussing debate, political argument & how to convince people. You say people *should* agree with you. This is a different issue.
4) I firmly believe that you have not begun to address my criticisms.
Coberly is discussing SS, exclusive of Medicare and Medicaid. And yes few people know Medicare is also funded from general funds. If we own SS, it becomes hard for Congress to reduce it although they could threaten the funding of it like Trump and Congress is doing with the ACA.
I would argue Medicaid is not as popular at the state level. States do desire to exclude all able-bodied adults who according to Trump and Kellyanne are quite capable of getting a job which has employer sponsored insurance (ESI). Of course, why didn’t the Medicaid eligible think of it before? States have excluded single adults from Medicaid if they were not working. They have limited what married adults could get on Medicaid if not working. In many bonehead states like Michigan, this was wildly popular so as to limit the costs of Medicaid and supposedly force them back to work.
Sorry Robert, but “insurance mandates’ which is what he said, versus “mandated coverage”, which is what he meant, don’t strike me as so far afield from each other during a conversation. If he had written a policy paper or op-ed that was edited and proof-read or if he debating ACA in a formal environment where he would’ve clearly prepped, then I’d concede your point.
I love the idea of a conversation over what someone said vs what he meant that contains no proof of what he meant, while it is obvious that what he said, and RW quoted, is what he meant. I mean seriously, what part of this statement is unclear?
PAUL: I think the longer the bill is out there, the more conservative Republicans are going to discover that it’s not repeal, and the more that everybody is going to discover that it keeps the fundamental flaw of Obamacare.
It keeps the insurance mandates that cause the prices to rise, which chase young, healthy people out of the marketplace, and leads to what people call adverse selection, where you have a sicker and sicker insurance pool, and the premiums keep rising through the roof.”
Now, if you want to provide some proof that Paul also thinks that “mandated coverage” is another problem, feel free. But it is beyond obvious what he meant in this actual proof of what he said.
Oh, and by the way, it is a batshit crazy belief.
In a quick search, aside from the quote above-referenced, the weakest direct-from-the source comment from Paul supporting my interpretation is:
Continuous Coverage Requirement – The continuous coverage requirement of the BCRA, which imposes a mandatory 6 month waiting period for individuals with a lapse of 63 days or more in coverage, simply appears to be a Republican version of the individual mandate. This continues the top-down approach that has led to increased premiums and has not changed behavior of the young and healthy who are priced out of the market, and those who game the system to purchase insurance after they become sick. I urge you to remove the mandate and simply allow insurance companies to impose a waiting period.
Beyond that, Paul has said the following, in support of my interpretation are the following:
”By imposing a variety of requirements on what plans can cover and how much they pay out in claims, Obamacare significantly increased premiums. By eliminating Obamacare’s essential health benefits requirement, and other restrictive coverage and plan requirements, low-cost insurance options will again be available to American consumers.”
“If you can get insurance after you get sick, you will,” Sen. Rand Paul, R-Ky., told NBC’s Today Show. “And without the individual mandate, that sort of adverse selection, the death spiral, the elevated premiums, all of that that’s going on gets worse under this bill.”
“Mandates on insurance cause prices to rise and young, healthy people then say ‘Ill wait until I get sick [to buy insurance].’ And then the insurance pool gets sicker and sicker — it’s called adverse selection, we also call it the ‘death spiral,’” Paul said. “
“The Republican plan doesn’t fix the death spiral of Obamacare, it simply subsidizes it,” Paul explained.
Sen. Paul said that the president understands that regulations drive up prices and that the Obamacare insurance mandates are making insurance premiums unaffordable and causing the death spiral in insurance markets. Paul characterized President Trump as receptive to his suggestions on how to improve the bill, telling Cavuto “I didn’t get strong objections from him.”
I got one instance where he is not talking about the individual mandates.
The second one:”b eyond that, Paul has said the following, in support of my interpretation are the following:
”By imposing a variety of requirements on what plans can cover and how much they pay out in claims, Obamacare significantly increased premiums. By eliminating Obamacare’s essential health benefits”
everything else is about the mandates. And everything else is batshit crazy.
Oh, and this gem that is about what plans can cover is bordelrine batshit crazy. Yeah, I got it. Cover less things and premiums go down, but the idea that requiring premiums to be tied to payments for healthcare does not make premiums go up except if healthcare is provided.
Which is sort of the idea of the whole thing. Paul wants us to go back to the past where insurance companies could charge premiums not tied to healthcare provided.
Makes you wonder what the people of Kentucky are smoking.
Oh, by the way. In none of your links does he come close to saying essential benefits is, in his opinion, the “fundamental flaw of Obamacare’>
I have to admit I have never paid any attention to Rand Paul at all. I did to his father, but only because, like slowing down to see an accident on the highway, I was curious as to how someone could be so disconnected from the world.
But after this contact with Rand Paul’s thoughts on healthcare, I am confused. I did not think it was possible for anyone to know less about healthcare than Donald Trump.. Now I am not so sure.
your logic is like saying that because SOME people like water, that is proof positive that no one could reasonably object to turning wine into water.
i tried to say in my comment that of course SOME people like Medicaid (welfare) but the people with the money who pay for it and the power to write the laws DON’T like Medicaid and would not like it if Social Security were changed from “paid for by the workers who will get the benefits” to “paid for by us”… that is paid for by the people with the money and power to write the laws.
I also tried to say that finding the Trust Fund (dedicated funding) a “weakness” politically seems strange when for eighty years Social Security was called “The third rail of American politics — touch it and you die,” while welfare as we knew it was destroyed by a simple vote in congress and a wink by a Democratic president.
Political power in America does not generally lie with the people who like welfare.