Relevant and even prescient commentary on news, politics and the economy.

Krugman: If you don’t like the mandate, why not support single payer?

Bill Gardner at The Incidental Economist offers a rather decorous, mild reply to the people making [the argument that guaranteed health insurance is an assault on America’s freedom]. I’d put it more forcefully: the pre-ACA system drastically restricted many people’s freedom, because given the extreme dysfunctionality of the individual insurance market, they didn’t dare leave jobs (or in some cases marriages) that came with health insurance. Now that affordable insurance is available even if you don’t have a good job at a big company, many Americans will feel liberated — and this hugely outweighs the minor infringement on freedom caused by the requirement that people buy insurance. (Also, if you don’t like the mandate, why not support single payer?)

— Paul Krugman, Insurance and Freedom, NYTimes.com, today

I’ve said now here at AB too many times to count, but most recently five days ago, that the highlighting of Obamacare horror stories–real or fabricated–is really an argument for single payer. Every single horror-story problem–real, fabricated, or predicted down the road–would be cured by single payer.  But, to my knowledge, no one else was writing this in print for public consumption.  Now, Paul Krugman has done that.

But why aren’t the Dems pointing out that what the Repubs appear to actually be complaining about is the absence of a public option, or that the ACA didn’t establish single payer?  Maybe sometime before the election, they will–if others who have a wide readership make the point, as Krugman did there.

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George Will Comes Out for Single-Payer Healthcare Insurance! Again! (This time, though, it’s the Constitution’s ‘origination’ clause that made him do it.)

Updated below.

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If the president wants to witness a refutation of his assertion that the survival of the Affordable Care Act is assured, come Thursday he should stroll the 13 blocks from his office to the nation’s second-most important court, the D.C. Circuit Court of Appeals. There he can hear an argument involving yet another constitutional provision that evidently has escaped his notice. It is the origination clause, which says: “All bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other bills.”

Obamacare’s doom, George F. Will, Washington Post, May 2

Hmmm. And y’all thought it was the antidisestablishmentarianism clause in the ACA that was going to be Obamacare’s doom, after reading that column of Will’s back a few months ago that said so. But, he promised!

Oh, well, doom is doom, whatever the sound of the death knell. So, not to worry, Chuck and Dave. Will explains:

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Scott Brown Comes Out for a New Hampshire State Healthcare-Insurance Public Option. In the Name of Freedom. Cool!**

[Annotation added below.]

I’ve written here on AB, extensively now, about the invidious co-opting of the word “freedom” by the political far-right.  I’ve addressed this mainly in the context of the conservative Supreme Court justices’ neat trick of disconnecting the word from any relation to actual physical freedom as long as it is a state court (in criminal cases and in a variety of civil cases, e,g. adult-guardianship and conservatorship cases, as well) or a state or county prosecutor’s office rather than the federal government that violates federal constitutional rights in order to remove physical freedom.  This is done in the name of federalism as allegedly envisioned by James Madison.

And on Saturday, I addressed it in the context of the Cliven Bundy matter, which includes the support he’s received from the likes of Nevada Senator Dean Heller.  The immediate occasion for that post was to note that this bizarre appropriation of the word “freedom” to justify doing whatever the invoker of “freedom” wants to do–which, for the Supreme Court’s invokers, includes obsessively requiring that state courts, but not state legislatures, be entitled as “sovereigns” to violate individuals’ federal constitutional rights; I really can’t stress this enough–is finally, thanks to Bundy, being recognized by actual professional pundits. Specifically, by New York Times columnist Gail Collins in her Saturday column.  Paul Krugman used his bi-weekly Times column this morning to highlight it.

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The OTHER big ACA case being argued today (albeit not at the Supreme Court) concerns the statute’s alleged Disestablishment Clause

Obamacare faces two separate court challenges on Tuesday, but only one could deliver a major knockout blow to the law.

The case getting the most attention is tomorrow’s Supreme Court challenge to the health care law’s requirement for employers to provide birth control to their workers. At the same time Tuesday morning, the District of Columbia’s Circuit Court of Appeals will consider whether Obamacare allows premium subsidies to flow through federal-run health insurance exchanges. That case has been called “the greatest existential threat” to the survival of the health care law by one of Obamacare’s staunchest supporters.

The contraception case is big, but another challenge could really hurt Obamacare, Jason Millman, Wonkblog, Washington Post, yesterday

Ah. And to think that so many people think the big Obamacare cases to be argued in a federal court today are the contraceptive-mandate ones.  But not regular AB readers! That’s because y’all read this post of mine and then this one.  And you remember those posts!

But to refresh your memories about the details, I’ll quote Millman further:

The law’s opponents argue that Congress never authorized subsidies in federal-run exchanges, and they claim this was done on purpose. They say Congress wanted to incentivize states to run their own exchanges, an option that only 14 states and the District of Columbia chose in 2014.

The law’s supporters argue that the law doesn’t differentiate between federal-run and state-run exchanges, so people should be able to receive subsidies no matter who’s administering the insurance marketplaces. Further, they say the broad purpose of the law is to expand access to affordable insurance regardless of who runs the exchange.

There are four pending cases in federal court challenging the subsidies. In Tuesday’s case, Halbig v. Sebelius, a lower federal court in January upheld the IRS rule allowing subsidies in federal-run exchanges.

“The Court finds that the plain text of the statute, the statutory structure, and the statutory purpose make clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges,” District Court Judge Paul Friedman wrote in his decision.

Well, of course, Judge Friedman found that the plain text of the statute, the statutory structure, and the statutory purpose make clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated Exchanges. Sure, he’s a Reagan appointee, but I published the first of my two posts deconstructing The Antidisestablishmentarianism Theory of Obamacare Illegality seven weeks before he issued his opinion agreeing that the ACA does not in fact have a disestablishment clause.  And since he’s undoubtedly an avid AB reader, he didn’t even have to read the government’s brief deconstructing the disestablishment-clause theory.  Well, maybe he did anyway, but he already knew that that clause in the ACA did not really disestablish the statute’s federal tax credits in 36 states.

So he wrote:

Looking only at the language of 26 U.S.C. § 36B(b)-(c), isolated from the cross-referenced text of 42 U.S.C. § 18031, 42 U.S.C. § 18041, and 42 U.S.C. § 300gg-91(d)(21), the plaintiffs’ argument may seem the more intuitive one. Why would Congress have inserted the phrase “established by the State under [42 U.S.C. § 18031]” if it intended to refer to Exchanges created by a state or by HHS? But defendants provide a plausible and persuasive answer: Because the ACA takes a state-established Exchange as a given and directs the Secretary of HHS to establish such Exchange and bring it into operation if the state does not do so. See 42 U.S.C. §§ 18031(b)-(d), 18041(c). In other words, even where a state does not actually establish an Exchange, the federal government can create “an Exchange established by the State under [42 U.S.C. § 18031]” on behalf of that state.  [Italics in original.]

Friedman’s opinion, which gets into the “Chevron deference” doctrine–don’t ask; I might tell you–illustrates just how hypocritical it would be for the Supreme Court’s conservative majority to buy these plaintiffs’ argument once this case (or one of the other three being litigated in other regional federal courts) arrives there.

Which is not to say that that is necessarily a determining impediment to their doing so; we all know better by now than to think that it.  But I do think there is a point at which this type of thing becomes so clear that it penetrates the awareness of enough people to be of fairly widespread concern.  And although the justices themselves as yet seem unconcerned, there may come a time, fairly soon, when they conclude that that unconcern is untenable as a matter of social acceptance.  Then again, I’m not sure they will care.

 

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Obamacare plans bring hefty fees for certain drugs? Really? Well … it depends on what the meaning of “bring” is.

MIAMI (AP) — Breast cancer survivor Ginny Mason was thrilled to get health coverage under the Affordable Care Act despite her pre-existing condition. But when she realized her arthritis medication fell under a particularly costly tier of her plan, she was forced to switch to another brand.

Under the plan, her Celebrex would have cost $648 a month until she met her $1,500 prescription deductible, followed by an $85 monthly co-pay.

Thus begins a deeply (but apparently unintentionally) confusing, yet very important, Associated Press article titled “Obamacare plans bring hefty fees for certain drugs,” published yesterday.  (The title may be Yahoo News’s, rather than the AP’s; it’s not clear.)

“‘I was grateful for the Affordable Care Act because it didn’t turn me down but … it’s like where’s the affordable on this one,’ said Mason, a 61-year-old from West Lafayette, Indiana who currently pays an $800 monthly premium,” Kelli Kennedy, the AP writer, continues.

Where, indeed, is the affordable on this one?  The essence of the article is that many people who have chronic serious illnesses, including, as Kennedy says, cancer, multiple sclerosis and rheumatoid arthritis–and who, because of a preexisting condition,had had no access to any healthcare insurance or who, like Mason (as Mason explained to Kennedy), had insurance that did not cover treatment for preexisting conditions, are being hit by a specific of their ACA-compliant plan that they did not know about when they bought the plan: an apparently relatively new gimmick insurance companies are using, by which the company categorizes some high-cost drugs as “specialty-tier” drugs and by quietly including in their individual-market plans a 50%- “co-insurance” rate for “specialty-tier” drugs.

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Julie Boonstra Tells the Detroit News Why Her New Healthcare Plan Doesn’t Work for Her: It Requires Her to Read the Policy or Ask Blue Cross a Few Basic Questions In Order to Learn What the Plan Actually Covers and What Her Expense Cap Is.

Oh, dear. I won’t summarize this for you; you really have to read it in full.  (Or maybe just read Glenn Kessler’s article about it posted today.)

And to think I had thought Julie Boonstra’s only comprehension problem was with basic math.  Turns out she also has a problem with reading comprehension and with understanding explicit short answers to oral questions posed to, say, a Blue Cross representative. Or maybe just with recognizing that she could learn the specifics of her plan simply by doing one or the other of those things.

Hey, she could have done both!  But first she’d have to have figured out that reading her plan or asking a Blue Cross representative might provide that information.

Yep.  The Republican Party really is the party of stupid. Then again, maybe she knew all along, but thought everyone else is stupid. Okay, I’ll give in and quote this, from Kessler’s post:

Boonstra’s response to this report was that it “can’t be true” because she was worried about high expenses early in the year and because she thought one of her prescription drugs was not covered. A spokesman for Blue Cross told the News that all of her prescriptions are covered and her co-pays on the drugs would help with meeting her out-of-pocket maximum.

It can’t be true, because the truth exists not in reality but instead in her mind. Hopefully, this woman doesn’t fear a nuclear attack by Martians.  Or by the Koch brothers, although that might be prescient, if the attack is to be on, say, Nancy Pelosi’s congressional district.

Seriously, folks.  Does anyone really think this woman had no idea what her plan provided, if not when she purchased it, then sometime shortly afterward?  This new information brings into question the truth of her back-story about being unable for nearly three months to access the Michigan link at healthcare.com and gain information about available plans.  (It also raises questions about whether she is in fact receiving subsidies for her new in-any-event-lower monthly premiums, although of course there is no way to learn that.)

Let’s hear it for Detroit News reporter Marisa Schultz.  And, for those of you who are unfamiliar with the Detroit newspaper market: Detroit has two longtime mainstream newspapers, the Free Press, which leans Democratic, and the News, which leans Republican, but both papers’ reporting staffs are journalists in the old-fashioned sense. They’re real journalists, not propagandists.

Yes, folks. The Detroit News leans Republican.

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Julie Boonstra Continues to Play (Ridiculously) Dumb, as Americans for Prosperity Now Concedes She’s Looking a Gift Horse in the Mouth

In post-initial-ad interviews with fact checkers and with her hometown newspaper, [Boonstra] claimed that the problem was the uncertainty now of not knowing month-to-month what her out-of-pocket expenses will be, whereas she had always reached the low monthly out-of-pocket expenses, and budgeted for that amount monthly.

In other words, her entire complaint is that she might spend the additional $550 a month as soon as she gets it, on something unrelated to her medical care, and then her out-of-pocket expenses totaling an annual maximum of her yearly savings of about $500 on her monthly premiums will become unaffordable.

Julie Boonstra’s Follow-Up Ill-Woman-Who-Cries-Wolf AFP Ad Is Here!, me, yesterday

Weirdly, in an article by Cameron Joseph on The Hill blog yesterday and updated today, AFP President Tim Phillips concedes that Boonstra’s real problem is that she can’t do simple math and therefore can’t budget from one month to the next.  Joseph reports:

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Julie Boonstra’s Follow-Up Ill-Woman-Who-Cries-Wolf AFP Ad Is Here!

Hmm.  Leukemia patient Julie Boonstra and Americans for Prosperity are up with a new ad in Michigan, Boonstra’s home state.  This time, she thinks people are too stupid to wonder why a healthcare plan that costs her less annually than her cancelled plan for identical care “doesn’t work for [her].”  And too stupid to wonder why she originally claimed that that plan is “unaffordable” even though her earlier plan for slightly more money annually was affordable.

“My plan doesn’t work for me,” she says, dramatically.  She just doesn’t say why.  Which is understandable, since we all know by now that her plan works just fine for her.

That’s right; her plan works just fine for her.  She just doesn’t want people whose plan doesn’t work fine for them, or who have no access to a plan at all, to have one that works for them.

She says early in the new ad that it was painful to her that Rep. Gary Peters, the Dem Senate candidate in November, challenged her credibility after her last AFP ad, in which she claimed that her new ACA-compliant plan was unaffordable because of higher out-of-pocket expenses than her own plan, and implied that she would be unable to continue to see the specialist she’d been seeing.

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FOLLOW-UP TO: “What Glenn Kessler–and I–Missed Earlier In Emilie Lamb’s Claim: That She SAYS Obamacare Caused Her Hospital and Doctors to Stop Gratuitously Forgiving Her Medical Expenses Above $1,000. That’s Palpably False.”

On Saturday I posted a lengthy post with an almost-as-lengthy title:

What Glenn Kessler–and I–Missed Earlier In Emilie Lamb’s Claim: That She SAYS Obamacare Caused Her Hospital and Doctors to Stop Gratuitously Forgiving Her Medical Expenses Above $1,000.  That’s Palpably False.

Following are two comments to it from readers Mike Myer and Mark, respectively, and my (lengthy) response to it in the Comments thread:

MIKE MEYER:

What if Lamb is telling the TRUTH?

MARK:

Ms. Mann, check one more aspect of this story which might explain some of the discrepancies. I have psoriatic arthritis which requires some of the same medications as lupus. I take an infusion every five weeks and the negotiated cost is about $6000 of which I pay 20%.

My out of pocket max is $5000, so after 4 treatments I’m good for the year. However the drug company has a rebate program which pays all but $50 of my out of pocket expenses, most of which are the medication. There are several different rebate and subsidy programs. I suspect that in this case the doctors and hospital aren’t forgiving anything, the woman is in one of these programs and either doesn’t realize it or doesn’t understand how it works….

ME:

Mike and Mark, here’s the problem: This woman claims (1) that she was happy with her now-cancelled plan, even though that plan had NO out-of-pocket cap and had an annual total-coverage cap of $25,000; (2) that she was happy with that plan because–and ONLY because–her hospital and her doctors had agreed, year after year going back to 2007, to forgive all her uninsured costs totalling more than $1,000 annually; (3) that because of Obamacare she had only these options: a Bronze or Gold plan for about the same monthly premium cost to her but that has a $10,000 annual out-of-pocket cap and no annual coverage cap and that, unlike when she had her old plan, she would be forced to actually PAY that amount, and a more expensive Platinum plan with a $6,000 annual out-of-pocket cap and no annual coverage cap, and that unlike unlike when she had her old plan, she would be forced to actually PAY that amount.

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