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The Same as MA Healthcare Premiums, the ACA Premiums are too Costly . . .

by Run75441

The Same as MA Healthcare Premiums, the ACA Premiums are too Costly . . .

Chicken Little, Courtesy of “EW.Com Entertainment Weekly”

I have listened to many  stating the MA subsidies do not go far enough in alleviating the costs of healthcare for a family not covered by an Employer Subsidized Healthcare plan. Even with my pointing out the subsidies in the ACA exceed that of the MA plan, there still has been quite a bit of doubt.

Maggie Mahar at the resurrected Health Beat Blog pointed to a new Kaiser Family Foundation subsidy calculator in her article as well as other informative points; “What Will the Supreme Court Decision Mean In November?” The ACA Premium Calculator is found here: Healthcare Reform Subsidy Calculator.

Using the KFF Calculator, a person can calculate what they will pay in premiums under the ACA in 2014. Further on down this post, there is a short discussion of the Mandate and a link to another KFF site to determine what the mandated penalty might be per year for an individual and a family. The last chart by “The Incidental Economist” touches upon the relative size of the Mandate in comparison to taxes historically. As a mandated penalty, Obamacare is a middle of the pack tax.

With the KFF calculator, assuming we are discussing Median Household Income, and making an addition assumption Household Median Income increases from the ~$51,000 in 2011 to ~$55,000 in 2013, this is what a family of 4 might pay in 2014:

– Income (family of 4) $55,000 (235% of Poverty)
– Policyholder Age: 45
– ESI: None Available
– Regional Cost Factor: Median
– Unsubsidized Healthcare Premium: $14,425
– Government Tax Credit: $10,110
– Out of Pocket Premium: $4,125
– 2014 Maximum Out of Pocket Expenses: $6,250

Mandate/Tax Penalty is huge? And what if an individual does not buy insurance from the state insurance exchanges; the individual would pay a Mandate Penalty in 2014 of $95/adult and $47.50 per child (or 1% of income, whichever is greater). In 2016, the mandate would be $695/adult and 50% for children (or 2.5% of income, whichever is greater). “The Requirement to Buy Healthcare Coverage” For those who wish to argue Mandate versus Tax, please remember all laws are open to interpretation which does not change the initial intent of the Act passed by Congress.

ACA is the Biggest Tax Ever? It does not even come close to the tax Truman passed to cover WWII costs or even the Reagan Tax Increases of 1982. Incidental Economist “Obamacare is the Biggest Tax Ever, If You Ignore History”


Austin Frakt, The Incidental Economist,Obamacare is the biggest tax increase in history … if you ignore history

Maybe the sky is not falling with SCOTUS declaring the ACA is constitutional?

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"No payment — no access code — no participation — lower final grade."

by Run 75441 

“No payment — no access code — no participation — lower final grade.”

Illustration by Jake Parker;

Now the use of textbooks and the sharing of a new textbook can be stopped with the sale of a yearly access code to engage in discussion boards by students with instructors. The Publishing Industry with the help of one Economics Professor has found a way to stop the sharing of text books amongst students and the sales of old text books to the next incoming classes. New students will be forced to buy a new text book or buy a special code allowing them to use the book new or old. The press release describing the new invention put it in this manner:

“In the case of a used book or pirated download, the student pays for the access code,” according to the press release. “No payment — no access code — no participation — lower final grade.” Professor Patents way . ..

Grades of Students Who Pirate Would be Docked Under Prof’s Plan

Maybe it is just me, but an education which is increasingly  expensive and restrictive as the ways to shave a few dollars off of it are closed to those who only wish to achieve it  from using old text of which more times than naught are out of date after one year. The world and its knowledge turn much faster leaving students to beg for the obsolete education resources paid for by a hefty tuition.

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Healthcare reform op-ed

The current uptick in ‘medical inflation’ in private sector health industry is worth a separate post. The Standard and Poor Healthcare Economic Indices can be found here.
Lifted from a note from Run 75441 on the link I sent on healthcare reform.

Recently, Matt Stoller claimed Obama had a 61 vote majority in the Senate and enough to secure either Universal or Single Payer Healthcare. We all forget the one Senator from Aetna stand which killed any other options an Medicare for those starting at 55. President Obama did not have a filibuter proof 61 votes in the Senate for any other healthcare options muchless the ACA. The Blue Dogs (Nelson(s), Bacus, Bayh, Cantwell, Feinstein, Lincoln, Pryor, Widen, Conrad, etc) wouldn’t move for any healthcare plan unless they brought home the bacon as Nelson attempted to do for Nebraska. Just plain ordinary obstructionism to block whatever this President would attempt to do. Senator Lieberman killed anything beyond the ACA. 

Former Editor of the New England Journal of Medicine and others should be sorry if the entire ACA is struck down or dismembered as we will go another decade before a President and a Congress take up the issue again and heathcare costs (for which healthacre insurance is a reflection) will again rise faster than inflation. Because of the power of Medicare, it has been able to rein in rising healthcare costs so far at less than 3% than that of the commercial market at about 9% %. Standard and Poors Healthcare Economic Indices .

The last time healthcare reform was attempted was under Clinton and costs have increased multiple times. A failure to allow the ACA to go forward will allow the overall Healthcare Industry to again implement inflationary costs in a market which has no restraints. Certainly, I can not conjur up what SCOTUS will do. The kings in black robes will decide what is best for us as Congress lacks the will power to represent those who placed them there with the exception of ALEC, Koch(s), and Norquist.

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United Citizens and Wisconsin

by Run 75441

United Citizens and Wisconsin

Heading into the Tuesday vote Mayor Barrett with ~$4million in election funds of which 26% is drawn from out of state sources faces off with the under siege Governor Walker having ~$30 million in funds with 2/3rds coming from out of state sources. Again the Koch Bros are kicking in with a sizeable contribution of $1 million as well as the multi-billionaire owner of the Sands, Sheldon Adelson, with another sizeable sum ($1 million?). The unions and citizens of Wisconsin are hard pressed to support Barrett in a similar fashion. So much for payroll wages versus corporate profits. Tuesday election may be a bellwether for the Democrats and the November elections as the 99-percenters and labor take on corporate interests and the “1-percenters’ who are both investing heavily in Walker intending to sway the state into the Red column.

Tuesday’s recall election of Republican Gov. Scott Walker is the most expensive in Wisconsin history. More than $63.5 million has been spent by candidates and independent groups, the overwhelming majority underwritten by out-of-state sources.

The record spending total was made possible thanks to the Citizens United U.S. Supreme Court decision — which had the effect of invalidating Wisconsin’s century-old ban on independent expenditures by corporations and unions — and a state law that allows unlimited contributions to the incumbent in recall elections.” Election a national referendum on public sector unions

Having amassed a sizeable war chest directly resulting from United Citizen’s opening the donation flood gates for corporate interests and a state law allowing recalled Governor Walker unlimited contributions, Walker has a slight lead and is favored to win. While this may end the recall efforts by angered unions and others, Walker’s troubles may not be over as he faces indictment over fundraising efforts by aides and his choice for Lieutenant Governor Brett Davis. There is quite a bit of speculation how this will all play out and it is not the first time the former Milwaukee County Executive has found himself in trouble for questionable activities.

Kelly Rindfleisch said she was hired to campaign illegally for Scott Walker on taxpayer time,’ Democratic Party of Wisconsin Chair Mike Tate said Tuesday. “With his admission that Rindfleisch was hired to do what ‘she was expected to do,’ has Scott Walker now implicated himself in the criminal conspiracy that was central to his rise to political power? 

Is Scott Walker Facing Indictment And Does It Really Matter To Walker’s Wisconsin Supporters?  Forbes

John Doe Judge Grants Immunity to Walker’s Former Spokeswoman  WUWM Public Radio

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Opposition to the Mandate

So, one thing has continually troubled me throughout the health care debate, and this is the consistent polling showing opposition to the individual mandate. It’s taken me a while, but I think that I have finally figured this out.

THIS article reviewing data from the AFLAC Workforces Report shows that we are doing a terrible job in educating our public on health concerns.

six out of ten workers (62 percent) think it’s not very or not at all likely they or a family member will be diagnosed with a serious illness like cancer, and more than half (55 percent) said they were not very or not at all likely to be diagnosed with a chronic illness, such as heart disease or diabetes.

 But of course, this is not reality. This fundamental disconnect as the article notes, is more than simply problematic..

Americans may be overly optimistic when it comes to thinking they won’t ever be diagnosed with a serious illness or experience an accident. According to the American Cancer Society, Cancer Facts & Figures 2012, one in three women and one in two men will be diagnosed with cancer at some point in their lives, and the National Safety Council, Injury Facts 2011 edition, says that more than 38.9 million medically consulted injuries occur in a year. The American Heart Association, Heart Disease & Stroke Statistics 2012, show that one in six deaths in the U.S. was caused by coronary heart disease. “The fact that American workers aren’t aware of their medical risks and the potential financial impact of those risks is a very real concern that is only compounded when workers don’t take full advantage of available benefits options or adjust their savings strategies to be more prepared,” said Audrey Boone Tillman, executive vice president of Corporate Services at Aflac. “Now, more than ever, people need to understand that well-being means more than just good health—it’s being prepared for the reality of whatever life may bring and taking the necessary measures to protect themselves and their families.”

I think that this explains this. Certainly some people are fundamentally opposed to government mandates of any sort, but they would hardly constitute a plurality, let alone a majority, but pure ignorance, or a magical suspension of disbelief I think explains it. I cannot think of any other explanation.

Having watched several relatives go through illness that resulted in death, and having a chronic condition myself, I simply cannot help but wonder how people have reached this conclusion. The simple fact that they don’t understand this is likely more troublesome than a rejection of the mandate itself.

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Drug shortages and the mythical market

by Michael Halasy

Drug shortages and the mythical market

I read an interesting article by Gehrett in the January issue of JAMA.

In response to the increased utilization of generic drugs (currently about 70% of drugs used in the US), a fact which should be applauded, we have seen a frightening increase in drug shortages. In Emergency Medicine, three of them have affected me directly as they are commonly used drugs. One, metoclopramide is useful for headaches, nausea, and gastric motility. Another, etomidate, is a useful sedative that is the staple drug in RSI (Rapid Sequence Intubation) kits across the country, and used on EMS ambulances extensively. There is a reason. Etomidate has lower cardiopulmonary depression than other sedatives like diprivan aka propofol. Another drug that is in shortage is Compazine, aka prochlorperazine, which is extensively used for migraines, as well as benign vertigo. In fact, it remains one of my favorite “staple” drugs.

Per the article, in 2005, the Center for Drug Evaluation and Research only noted 62 shortages through the year. 2009 saw 157 shortages, 2010, 178. 2011 had estimates of between 200 and 300. 75% in 2010 were sterile injectables. Ya know, The medications most frequently used in hospital settings. Many of these drugs are made at one site, by only one company, which limits supply and increases the chances of disruption.

While Gehrett does note that 80% of raw materials come from foreign countries, there does not seem to be any shortage of raw materials that have been documented or noted.

The only single, commonality, is that all of the medications we have seen in shortage status are off patent, generic medications, that are harder to formulate than some others, and have a definable shelf life.
President Obama has signed legislation that will give the FDA more latitude in heading off shortages, but this problem plainly reports to a market problem. Demand exists…supply is stable, but profits are not high on these medications. This would suggest that companies are simply avoiding injectable generics, and focusing on more profitable patented medications.

Meanwhile, cancer trials have been put on hold, while companies focus on profit margins. Headache patients suffer and receive other medications that may be suboptimal for them. This situation is only worsening with time, and should be cause of concern for all Americans.

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Michael Halasy to write for Angry Bear

Michael has written for Angry Bear in the past (see two of many Prometheus and Bundled Payments and Medical Tourism, separating facts from fiction).  He is

a practicing PA in Emergency Medicine. My undergraduate education started with economics. I function as a health policy analyst for a couple of national organizations and as a health services researcher, working in a collaborative role on OR/SE projects and workforce/value studies as well.

Michael will be writing on healthcare, health insurance, US healthcare system economics and issues of policy.

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Congressman Ryan’s Health Care Booby Trap

by Michael Halasy

Congressman Ryan’s Health Care Booby Trap

Much has been said about “repeal and replace” it has become almost as much a part of GOP lexicon as “drill baby, drill”. The GOP despite having been supportive of the framework for the ACA previously, wants badly to discredit the administration and claim a victory in the name of “freedom”. Too bad history shows that the Heritage Foundation and VP Stuart Butler supported a plan almost virtually identical to the ACA.

Now, along comes Congressman Ryan, despite being rebuffed last year for the “Roadmap”, he has come along with a v 2.0. Unfortunately, he is making headway. I won’t comment on the other aspects of the new and improved Roadmap, but it seems to be just as much of a disaster as the previous one. The House has already passed it of course, and Romney, aka etch a sketch, has enthusiastically received the Congressman’s endorsement and has endorsed Ryan’s plan as well.

So we know that the GOP, primarily the Tea Partier’s, despise the individual mandate as a violation of their freedom. Ezra Klein had a great article last week about the hidden mandate in the Ryan bill , but does not discuss the fact that it will essentially eliminate employer based insurance. Now, Ryan’s plan assumes that the state based exchanges (sound familiar?) will produce a lot of savings, and he assumes that market forces will do even more. To that end, he offers a couple of tax credits. But, oh by the way, you LOSE employer based coverage under Ryan. It severs it completely. So an individual gets a 2,300 dollar tax credit (family is 5,700) to buy insurance. I can tell you now, that the average per the Kaiser Family Foundation for a single individual is much higher than 2,300.

Family plan premiums are $15,073 on average, while coverage for single employees is about $5,429.

Workers contributed an average of $921 toward the premium of single coverage and $4,129 for family plans.

What this means, is, that under the Ryan plan, your single insurance premium will cost you 2,208 MORE per year out of your own pocket at current cost. Family plans will cost you 5,244 MORE per year out of your own pocket.

That’s the repeal and replace plan folks…..That’s what the House voted on and passed…..That’s what Romney endorsed….THAT’s the GOP plan…

It’ll save businesses money, and it’s great for corporate America. However, it is not so great for the average small family living on 40-45k per year combined income.

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"The Treadmill and the Poor Law are in full vigour, then?”

by run 75441

The Treadmill and the Poor Law are in full vigour, then?” A Christmas Carol, Charles Dickens

That’s Baloney” stated Rep. Micky Hammon, R-Decatur, Alabama; the immigration bill cosponsor, told the Huntsville Times.

It’s clear the study over estimates the negative and under estimates the positive to skew the result toward an agenda,” Hammon said. “If 40,000 illegal workers leave the state, they free up jobs that homegrown Alabamians are happy to have.”
 The Cost of Alabama Immigration Law (H.B. 56) Disputed.

Alabama has the lowest unemployment rate among seven southeastern states,” the spokeswoman for Governor Robert Bentley said.

I recently completed a quip to Senator Levin of Michigan who was commenting on the fall of the unemployment rate in Michigan and his plan to jump on the deficit reduction bandwagon at the same time. I thought by now most states and the relative “pols” would know a drop in U3 state wide or nationally does not necessarily mean an increase in employment. If the Civilian Labor Force drops in numbers because people give up looking for work, than it is possible for U3 to decrease. This is precisely what has happened in Alabama.

People are dropping off unemployment rolls because they’ve become discouraged by not being able to find a job and have stopped looking, according to an analysis by Arise Citizens’ Policy Project. Alabama’s labor force shrank by more than 6,000 workers in October, and the labor force has been shrinking since June. Economists say a shrinking labor force makes it easier for a state to post an unemployment rate decline, even if job growth is small.” …Analysis shows a steep drop in the state’s unemployment rate isn’t because of Alabama’s overreaching immigration law”
Birmingham News

It appears kicking the illegal immigrants out of Alabama doesn’t do much for getting people back to work. Maybe those UAW jobs which did not require more than a high school education and a good work ethic were not as bad as some Senators made them out to be?

“Are there no prisons? Are there no workhouses?” A Christmas Carol, Charles Dickens

It appears those students who went to Law School, shelled out $100,000 or more to get the exclusive Juris Doctorate, and as a result expected to make the big bucks. They were sadly disappointed when they could not find a job even with the best of credentials. So what does a newly minted attorney to do? Of course, sue the School of Law which they attended for false advertising.

“Adam Bevelacqua graduated from Brooklyn Law School last year with $100,000 in debt but high hopes for his future. He passed the bar on his first try in New York and had internships to highlight on his resume. And, according to his research, the school’s job placement rate for new graduates was between 90 to 95 percent. But Bevelacqua, 29, is no longer as optimistic.

“I’ve been looking for work ever since,” Bevelacqua told “The jobs aren’t really there.”
On Wednesday, Bevelacqua joined 50 other law school graduates from across the country who sued their alma maters, alleging they were misled about job prospects and burdened with huge amounts of student debt.”
MSNCB News Law schools face lawsuits over job-placement claims

The state of Alabama and Jefferson County are in need of good and cheap attorneys to defend the H.B. 56 law and to process Jefferson County’s bankruptcy. The going rate right now is $1 million per month or enough to fund a few attorneys. Maybe the law labour has to relocate and go to where the demand is? Any takers???

“Please Sir, I want some more.” Oliver,” Charles Dickens

The Center for Progressive Studies Looks at  Immigrants and the Child Tax Credit”
In order to fund the Payroll Tax Credit and instead of whacking the 1% of the taxpayers making > $500,000 annually; Congress has decided to whack the children of immigrants. Parents claiming a tax credit using the ITIN must now provide a Social Security number. Most likely, they do not have a legitimate SS number. Isn’t this like the feudal wars? Knights on horseback slaughtering the serfs and the peasants (Bruce?).

Benefits of the Child Tax Credit

2.3 million: The number of people, including 1.3 million children, who were kept out of poverty by the child tax credit in 2009.

$1,800: The average amount claimed in child tax credits by ITIN filers in 2010.

3: The number of months for which a family of four with two children could put food on the table using the average child tax credit refund under the Department of Agriculture’s “Thrifty Food Plan.”

$1.38: The amount of economic growth that results from every $1 spent on child tax credits. Not all tax cuts are created equal, though. The payroll tax holiday results in $1.25 of economic growth for every $1 spent, while making the Bush tax cuts permanent would result in $0.35 per dollar.

4 million: The number of U.S.-born children whose families would be affected by the proposed offset.

20 percent: The amount of the payroll tax holiday extension that would be offset by raising taxes on lower-income immigrant parents of American children. The payroll tax holiday extension is worth $120 billion. The proposed legislation to offset the tax cut, however, will, by conservatives’ own calculations, save a total of only $24 billion over 10 years.

About $100 billion: The amount of payroll taxes that will be contributed by ITIN filers over the next 10 years. These taxes contribute to the trust funds for Medicare and Social Security—programs from which immigrants will never recoup benefits because of their status.

$21,240: The average household income for ITIN filers claiming additional child tax credit refunds in 2010. This is less than half of the 2010 median household income in the United States of $49,445, and would mean that a family of four with two children was living below the poverty line. Latino children are more likely to be living in poverty than any other racial or ethnic group in the United States.

But injustice breeds injustice; the fighting with shadows and being defeated by them necessitates the setting up of substances to combat.” Bleak House, Charles Dickens; February 7th . . . belated Happy Birthday!

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Maggie Mahar to write for Angry Bear

Maggie Mahar has been has been showcased at Angry Bear in prior years, mainly in regards to healthcare, but has written on many topics with an economic theme. I am happy to announce she has agreed to write for Angry Bear, so please welcome her when her first post or two appears. Of course, readers, I am sure you will provide ample comment in the Angry Bear tradition. The following is a quick bio:

Maggie Mahar is the author of Money-Driven Medicine: The Real Reason Health Care Costs So Much (Harper/Collins 2006) and Bull! A History of the Boom, 1982–1999 (Harper/Collins, 2003), a book that Warren Buffett recommended in Berkshire Hathaway’s annual report.

She also narrated Money-Driven Medicine, a film based on her book, produced by Alex Gibney (best known for Enron: The Smartest Guys in the Room ) and directed by Andy Fredericks.
Bill Moyers called it “one of the strongest documentaries I have seen in years.”

From 2007 to 2011, she wrote the HealthBeatBlog, focusing on the economics and politics of heatlh care reform. The blog drew a loyal following made up of medical professionals, health policy experts, patient advocates., and others willing to take a skeptical look at our health care system.

Before beginning to specialize in health care, Mahar was a financial journalist. From the late eighties through the late nineties, she worte cover stories for Barron’s.. There, she covered both Wall Street and Washington, investigating and profiling corporate America while also writing about financial markets in the U.,S and abroad, with an emphasis on Japan and Russia.. After leaving Barron’s, she wrote a column about international markets and economics for Bloomberg.

Before becoming a journalist,Mahar was an English professor at Yale University.

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