They failed to get the entire new program stricken down, so there's still a decision whether to opt in. Since the most coercive aspect of the program is gone, it's now a harder decision to make.
The federal government will pick up the entire cost of the expansion for the first three years. After that, it will pick up 90% of the cost and leave the remaining 10% to states. While that leaves only a small share for states, many have argued even that's too much given their tight budgets.So the truly heavy-handed coercion is gone, but the enticement that is left is still highly persuasive.
Several states said Thursday that, despite the ruling, they have no plans to opt out of the expansion. Washington state, which was a plaintiff in the Supreme Court lawsuit, said it will likely take the new federal money and expand its Medicaid program to about 500,000 residents in 2014. "That is the best bargain one can buy," said Democrat Gov. Christine Gregoire, who objected to the state Republican attorney general's decision to join the lawsuit. "I can't imagine who would say we aren't going to do this new Medicaid program."
Posts
142 comments:
A better idea is for those states to opt out of Medicaid altogether and force the issue of having the federal government either rebate back to the states the Medicaid FICA taxes collected in those states for those states to administer the program as they see fit or rebate the money directly back to the taxpayers in those states.
People without insurance and their families see this as good news.
Can a state opt out of Medicaid?
It's the same old dirty game. Washington took the bit in it's teeth several generations ago. This business of taking money from states and giving it back with strings works better than anything you would call coercive. The states compete for larger shares and sent congressmen to DC whose primary concern is to bring money back. It drives the whole sorry show better than a strong whip hand could.
It's hard to turn down other people's money.
Word of the day: Coercion
You could buy a lot of high-speed rail with that money.
"People without insurance and their families see this as good news."
People who pay for those people just just put some more straw on their backs.
Wm F. Buckley and more recently William Voegeli have noted that liberal economics relies on turning "the skies black with criss-crossing dollars," intentionally obscuring the process.
Voegeli (emphasis mine): "As more and more dollars fly around, the confusion about where all of them start out and end up increases. The dollars often arrive ostentatiously (Social Security checks in the mailbox) but depart surreptitiously (payroll withholding and employer “contributions” to Social Security). This contrast makes it easy for each household to regard itself as a net importer rather than a net exporter of the dollars that make up this green tornado. The ultimate goal is to leave people believing an impossibility: that an enormous but nevertheless finite number of dollars can be vacuumed up and airdropped in such a way that the vast majority of people wind up gaining more than they lose."
All those states' attorneys general are in their libraries boning up on tax law and history of the English speaking peoples. This thing has just begun.
That's old "Landslide Christine"?
Free money!
I turned off NPR in disgust this morning at the naked, corrupt wheedling from politician after politician on the subject. "But it's so much free money!"
Truly vile.
"Free money!"
Hedge Fund Manager's motto.
Annie, do you want some candy?
"So the truly heavy-handed coercion is gone, but the enticement that is left is still highly persuasive."
Isn't this the difference between rape and seduction, between perpetrator and victim and a marriage made in heaven?
I live in the land of transfer payments. State pols love making it rain federal dollars. However, the state budget is tapped. So...where do we come up with the 10%? Who do you want to lay off to pay for "free" health care for the middle class? Police? Fire? Teachers? Pick.
Cook: or between an office rapist and the eventual defendant in a richly deserved workplace sexual harassment suit?
"Cook: or between an office rapist and the eventual defendant in a richly deserved workplace sexual harassment suit?"
That's inapt. Sexual harrassment is still coercive, whereas seduction is persuasive.
The American Republic will endure, until politicians realize they can bribe the people with their own money.
harrogate said...
People without insurance and their families see this as good news.
6/29/12 8:16 AM
Well maybe its sucks to you but I have better things to do with my money than supporting you. If a hundred plus million people that work and pay taxes can solve their problems, those folks should solve their own. Besides in reality most able bodied people on entitlements do work, off the books.
harrogate said...
People without insurance and their families see this as good news.
6/29/12 8:16 AM
Well maybe its sucks to you but I have better things to do with my money than supporting you. If a hundred plus million people that work and pay taxes can solve their problems, those folks should solve their own. Besides in reality most able bodied people on entitlements do work, off the books.
What sense does it make to require that dollars go to Washington dc and come back as 70 cents?
Pretty soon the states are going to realize that they can get rid of the federal government and do it all themselves better.
Especially now that the whole thing is a tax, not commerce clause power.
Qualye...correct. People don't realize that the gov't retains a 30+% administrative fee to run all programs.
We get a new tax...say that generates $100M. The gov't keeps $30M of that, leaving only $70M in free money.
A good non-profit keeps 10% to administer a program.
The republicans if they win a trifecta in November they should modify the withholding taxes as follows:
1-show the employer portion of FICA as part of the employees gross before deduction.
2-show of those funds the % allocated to medicaid, medicare and s.s disability. Folks should know what they are paying for.
3-Other than the national debt, the military,the police and judiciary and the ministerial functions such as the treasury and dept. of state which would still be withheld, the rest is to be no longer automatically deducted but rather to be paid quarterly by the taxpayer. Lets see how popular most government spending really is when people have to write the check. Even better have them check off a non binding list of the things they prefer to pay for or not pay for. The compiled list of preferences should be also broken down by congressional districts and by states. That would bring a reality check for members of congress.
I can't imagine a state that would say we aren't going to do this new Medicaid program
Imagine a state with a number of citizens that won't be eligible for the exchange subsidies- people below the 133% of poverty threshold. Those people will get dumped in to Medicaid. Now imagine that state already pays over 20% of it's budget supporting Medicaid. They will have a hard time supporting the expansion even though they only have to come up with 10% on their own. It's a budget buster for them. They won't have a 'choice'- SC, MO, and others might fall into this trap...
Is this a one-way opt-in? Once the state opts in, does it have to stay in? If so, then even those states who opt out now will opt in , one-by-one, as soon as a Democratic governor is elected.
Everyone is talking about what a great opinion Roberts delivered regarding the Commerce and Spending Powers. Anyone who believes that is a fool. Another Supreme Court opinion can wipe this away with the stroke of a pen, and don't believe that the four liberal justices would think twice about discarding Robert's opinion as precedent if they got a fifth vote on their side.
Meanwhile, we are left with this turd legislation that continues to damage the economy and undermine medical innovation.
Roberts chose a very political course of action, and I think he overestimated the long-term effects of what he was trying to accomplish, while ignoring the real, lasting damage to this country caused by this legislation.
Finally, his twisting of the statute to find that the penalty is a "tax" will invite all sorts of legislative shenanigans that could have been avoided if the Court adopted the reasonable rule of construction that it takes Congress at its word.
Yeah, Quayle.
According to the rules of Obamacare, $1 in insurance premiums will come back as $0.80 and flow from childfree to breeder, young person to senior, veggie to smoker, male to female, worker to bum.
The person who makes out like a bandit is the Octomom. The sucker who pays is the Silicon Valley geek.
Flood insurance pays some $0.65 on the premium $1, but at least it is not so discriminatory.
Wow, yesterday was great! Lots and lots of comments for Althouse, and she deserves it. She attracts the best commenters. I learned so much from you all. I of course, started out disappointed, but as great arguments were made both ways, I went back and forth, but my comments stuck pretty much to the "Roberts sucks" variety. In truth, I was seeing it both ways and people convinced me this way or that all day long.
The one thing I'm glad about is that despite the extensive efforts to push this piece of crap through with every trick, in the end, the voters will have their input as directly as we ever do in a republic, and we will get that chance, after finally knowing what's in it.
Thank you all for the education that yesterday was, and thank you Althouse for the classroom.
Stay thirsty, my friends.
I don't have a problem covering healthcare for the poor or those that don't have the funds to pay for major medical coverage.
I am not a stingy conservative.
But I want it done the most effective way, and I have a hard time believing that the most effective way for anything, is for Washington DC to do it.
Not sure employer co-funded private healthcare is either.
Local is always better.
I oppose all this Obama care crap on the grounds that it is the most expensive, and least efficient and effective way to do it.
"Wow, yesterday was great! Lots and lots of comments for Althouse, and she deserves it. She attracts the best commenters."
Why, thank you, bagoh20!
Great post Bagoh.
I concurr!
Yes, even you too Cookie. You are one of the essential spices in the Althouse sauce. It gives me heartburn, but I love it.
Well played, RC.
In fact, as a Mormon, a religion with a very strong collectivist theology, I am convinced that it is impossible to effectively care for the poor without a spiritual and lifestyle framework that fosters self-restraint and devotion to others.
So, for example, I oppose most of the current gay rights movement because it is self indulgent and ultimately lessons our ability or inclination to take care of the poor.
I oppose any 'rights' demanding movement because to demand is to break the social emotional structures that enable us to effectively care for the poor, and enable the able bodied poor to do the very best they can.
Same for coercive confiscation of property which breeds enmity.
No just and merciful society that cares for the poor will ever be built on enmity.
But nobody thinks about how these things work together - how each commandment of the ten are cross-support to the others.
"I don't have a problem covering healthcare for the poor or those that don't have the funds to pay for major medical coverage.
"I am not a stingy conservative.
"But I want it done the most effective way, and I have a hard time believing that the most effective way for anything, is for Washington DC to do it."
Washington DC won't be doing it; healthcare will still be handled as it has been, by private providers paid for by insurance (or out of pocket, by those who can afford it).
All Obamacare does is require those presently without health insurance to buy health insurance.
"Not sure employer co-funded private healthcare is either.
"Local is always better."
What does this mean? You seem to be conflating/confusing how medical care is paid for with delivery of medical services.
"I oppose all this Obama care crap on the grounds that it is the most expensive, and least efficient and effective way to do it."
Except for the system we currently have, which Obamacare won't do a thing to ameliorate.
We need to remove the private insurers from our health-care system altogether, and put in place, yes, a single payer system.
After the election all those states should simultaneously opt out of medicaid and refuse to pay for federally unfunded mandates. President Romney should take a turn from Obama and refuse to enforce those laws like Obama did with DOMA and immigration. Then lets see how Roberts squares that circle.
The republicans should introduce an amendment binding on the US and the states and local governments defining what is a tax, penalty and fine and any legislation that does not define how its funded and defines what the fine or penalty is for is presumed to be invalid unless otherwise ruled by the courts to be valid. This would eliminate to a large degree the poor,vague and sloppy legislation that the norm at all levels of government. Imagine that, legislators would actually have to think through what they are legislating and would be forced to hire competent counsel to review the legislation to insure that passes muster.
Yo Quayle,
Do you also oppose sex and breeding among heterosexuals as self-indulgent? How about owning a dog, cat or tiger?
Shouldn't you be more worried about the theft of other people's liberty and property that socialism encourages?
Try reading the Fountainhead or Atlas Shrugged to get your mind straightened out.
"harrogate said...
People without insurance and their families see this as good news."
This one's a pathetic one-trick pony, isn't he?
Sure, people today without something would love to have it handed to them. Why don't we ask the people living 150 years from now how they feel about giving up 150 years worth of medical innovation?
Of course they can't vote for Obama, so why would leftists give a shit?
"Robert Cook said...
"So the truly heavy-handed coercion is gone, but the enticement that is left is still highly persuasive."
Isn't this the difference between rape and seduction, between perpetrator and victim and a marriage made in heaven?"
No, this is the difference between rape at gunpoint and date rape.
As I understand, state governors can and will opt out because it will be too costly not to do so.
Medical Assistance is a costly mess for states.
Keep in mind, the quote in the post title is from Christine Gregoire, Dr Evil's Governor.
harrogate said...
People without insurance and their families see this as good news.
harro obviously has never known anyone on Medical Assistance.
The care is minimal.
"Try reading the Fountainhead or Atlas Shrugged to get your mind straightened out."
Oy vey iz mir!
All Obamacare does is require those presently without health insurance to buy health insurance.
Of all the things Obamacare actually does, this is not one of them.
It does, however, incentivize employers to dump their employees into the "exchanges". Which means financing premium subsidies for lots and lots of people who formerly paid their own way.
Great way to deal with the cost-shifting problem!
What was cool about some of the threads yesterday was that there were truly competing arguments between commenters who normally agree in general sense. There were emotional arguments and cool mechanics-based ones, philosophical versus strategic. Some were just very disappointed by the travesty on display in the ACA, and others were working to convince them it was actually a good ruling to get rid of it.
Maybe it's a little heady, but it reminded me of how some of the founders might have argued in some pub in ancient Boston or Philly, going back and forth between the hearts and the minds of patriots, working out the ideas, through disagreement, within a common cause.
There were left-sided points of views thrown in here and there, but that level of dispute just was not the interesting venue yesterday.
Well done.
Whether the Federal Government picks up 100% of the tab or 10%, the taxpayers are ultimately on the hook for it on a state or Federal level. Half of us anyway.
Marshall, I was watching local news last night (out of the Twin Cities) and they did the same thing. Talk about how great this was for people who need free stuff. No mention on who is going to pay for this nor about gov't control.
And get this.....they interviewed some college students who are very happy to be on their parents insurance until age 26. One said..."and by age 26, we should be able to go out on our own".
"Robert Cook said...
"I don't have a problem covering healthcare for the poor or those that don't have the funds to pay for major medical coverage.
"I am not a stingy conservative.
"But I want it done the most effective way, and I have a hard time believing that the most effective way for anything, is for Washington DC to do it."
Washington DC won't be doing it; healthcare will still be handled as it has been, by private providers paid for by insurance (or out of pocket, by those who can afford it)."
____________________________
Washington has already set itself up as the arbiter of what the insurance plans will cover, with a committee set up to enforce government policy. So in typical government fashion it makes the decisions others have to perform. Incomprehensibly the left believes this result means government is not involved?
It's unbelievable how the left closes its eyes and wishes itself to FantasyLand.
Tattoo, is that you?
Why is everyone convinced our broke govt. will have the ability to pay that 90% in the future? Like the High Speed Rail I am bearish on any long term committments the govt would be promising me if I was a governor.
RC besides the fact that single payer is impossible for even Roberts to justify as permissible there is the problem that won't work unless the providers are required to accept only the compensation given by the provider. As as is the case now with more and more doctors refusing to take on medicare and medicaid patients the coverage will become a meaningless fiction if the providers won't accept the single payers compensation. Then what? Force the providers to accept the offered compensation or get out of the profession?
That certainly would not induce the best and the brightest to incur huge debt, 10 plus years of school and residency training. So unless the goal is to cut costs by implementing a huge new H1B program for third world doctors and nurses to come to the US to work for the compensation single payer pays that will destroy the health care profession as we know it and works well enough for 85% of the population. You get what you pay for. We have a shortage of doctors as it is, do we really want to worsen the problem the supply of new entrants dry up? Do we really want to lower the standards just to increase the number of providers?
Besides if you can cap doctors incomes, why stop there? Why not the incomes of everyone else?
Remember people, this is the same gov't that just banned traditional mini-golf nationwide.
And they want to control our health care.
RC besides the fact that single payer is impossible for even Roberts to justify as permissible there is the problem that won't work unless the providers are required to accept only the compensation given by the provider. As as is the case now with more and more doctors refusing to take on medicare and medicaid patients the coverage will become a meaningless fiction if the providers won't accept the single payers compensation. Then what? Force the providers to accept the offered compensation or get out of the profession?
That certainly would not induce the best and the brightest to incur huge debt, 10 plus years of school and residency training. So unless the goal is to cut costs by implementing a huge new H1B program for third world doctors and nurses to come to the US to work for the compensation single payer pays that will destroy the health care profession as we know it and works well enough for 85% of the population. You get what you pay for. We have a shortage of doctors as it is, do we really want to worsen the problem the supply of new entrants dry up? Do we really want to lower the standards just to increase the number of providers?
Besides if you can cap doctors incomes, why stop there? Why not the incomes of everyone else?
Finally, his twisting of the statute to find that the penalty is a "tax" will invite all sorts of legislative shenanigans that could have been avoided if the Court adopted the reasonable rule of construction that it takes Congress at its word.
No, even that's a trap.
The ruling allows liberals to lie about something being a tax...but gives the GOP a clear example to call the Dems out on the lie. If the Dems continue to lie about it, Roberts' ruling allows anyone to bring a lawsuit against the tax, since lying about it being a tax eliminates the Anti-Injunction Act shield.
So the only way for Dems to pass a tax and make it stick (immunize it from lawsuits) is to call it a tax from the beginning. That will significantly limit Democrats' ability to enact their agenda in the future.
Moreover, don't forget:
the GOP has a huge advantage in state governors and a large advantage in state legislatures. It has never been easier to get an originalist-supporting Constitutional Amendment passed. We need to do that now.
The time is right/ripe for a States Rights battle. Make Democrats defend the bloated, inefficient, heartless central govt control of citizens' lives.
The Dems lose badly under that scenario.
"Try reading the Fountainhead or Atlas Shrugged to get your mind straightened out."
-- Look, I'm somewhat sympathetic to the idea behind those books (that people should be free to benefit from their own labors). But, unless you're trying to solve a ticking bomb situation, no one should ever be threatened with having to read them.
Anybody take a good look at that map?
Several of the states that wanted to opt out are on the short list of states to go red this Fall.
Chuck66 said...
Marshall, I was watching local news last night (out of the Twin Cities) and they did the same thing. Talk about how great this was for people who need free stuff. No mention on who is going to pay for this nor about gov't control.
Not to mention how much "free stuff" turns out to be worthless.
PS gk1 makes the other point. If the government goes belly up and you're dependent on it for your medical care, what happens to you when you sick, or hurt?
A piece of real estate 6x6x4?
Private providers will be gone. Those who can afford it will be gone. There will be no recourse except the federal government. History should tell you this.
Look to the future!
Any state that expects the ratio to remain 9:1 indefinitely is run by idiots. Why wouldn't a future Congress later move it down further to reduce the Federal deficit, eventually locking it into the same FMAP formula used for the rest of Medicaid?
Everyone assumes that if the insurance system breaks, that we go to single payer.
Why wouldn't we go to Self-Pay, Medical Savings Accounts + catastrophic coverage?
The medical system was working pretty well 3 decades ago, before the Dems thought up the HMO system as a consolation prize for failing to enact Hillary!Care.
The United States desperately needs to re-connect cost to price in the medical system. The collapse of the current medical "insurance" system would make that possible.
No?
Yes, Mr. Roberts left in the enticement. Cruel neutrality or pandering?
As for the poor, they will always be with us, as Jesus said. We should provide for their care. But the poor are treated now, by hospitals and by clinics run by hospitals, among other private methods. I would rather my local hospital run a clinic in the barrio or treat my friend's diabetes than some faceless army of bureaucrats, asleep at their desks in DC. And now that's what we will have. Thanks to Mr. Roberts, who, being an elite Harvard man, knows better than us.
PPS Now that the consequences of the decision are being understood and it's seeping in that the Demos may have a tougher row to hoe this Fall, notice how thew trolls have gone from, "Eat it, bitches", to, "Well, it really is for the best".
Besides if you can cap doctors incomes, why stop there? Why not the incomes of everyone else?
I have an idea about where to start. (Shameless self-linkage alert)
I think Cook will like it.
I read on one of the infinite number of posts on this topic yesterday that while the initial cost to the states for expanding Medicaid is 10%, it rises to 50% in 2020, a poison pill that will break every state's budget (except places like CA, IL, NY where they do accounting magic tricks instead, while awaiting Obama's next public employee union bailout.)
The penalties under the "mandate" that has now been transformed via NewSpeak into a "tax" are similarly designed to lull those who currently have no insurance into thinking that the penalty will be cheaper than buying a policy. However, the penalty, er, tax, goes up rapidly until it is higher than the cost of a policy.
"The penalties under the "mandate" that has now been transformed via NewSpeak into a "tax" are similarly designed to lull those who currently have no insurance into thinking that the penalty will be cheaper than buying a policy."
-- It was a decision whether what you call something determines what it is or whether what something actually amounts to determines what it actually is. I can see arguments either way; I don't like that the same thing is a tax for one purpose but not a tax for another, which is a legitimate quibble. But that's it; both decisions are rational ones. I just would have preferred an "actual words" ruling because, hey, it would be dead then.
Try reading the Fountainhead or Atlas Shrugged to get your mind straightened out."
Oy vey iz mir!
Wasn't the lead character in Fountainhead modeled after a real life child serial killer? Would explain much about the philosophies of people like Paul Ryan and Clarence Thomas.
What will Governor Oops do in Texas? He is known to blow hard and then take the money!
He will be up for re-election in
'14 and is suggesting that he will run again!
I employ a bunch of people and I don't understand why anyone would want me in between them and their health insurance. Most people don't understand anything about this very crucial part of their own life and expenses. They don't know what things cost, what their options are, what's covered or not,or even if they want what they pay for. That's a recipe for a bad market with high costs. I think any solution that hopes to control costs need to get consumers in control of what they are buying, and give them choices. Health care is more individual than almost any other purchase we make, yet nobody really gets to shop for what they want.
Imagine if your Iphone was provided through such a system, highly regulated by the government. This is what you would get:
C-Phone
My blog reading has been pretty spotty over the last few months, but I'm encouraged to see that whatever illness afflicted the Progs during the Walker recall election seems to have passed. Nary a peep from them on election night. Glad to have you back! Not as glad as bagoh though. I was super-pissed as a honey badger yesterday, and I'm still as pissed as a honey badger today.
"Would explain much about the philosophies of people like Paul Ryan and Clarence Thomas."
-- They're not the ones in the party that thinks Roman Polaski is A-OK. But, go ahead. Tell us how it is about the children.
I no longer care if I'm repeating myself. To the extent anyone voting for the ACA actually knew what the bill actually said, they understood it was going to lead to a single payer system, sooner rather than later. Mission accomplished.
EMD said...
Look to the future!
6/29/12 9:58 AM
Brits with money can also buy private health insurance so those Brits pay twice for medical care. In addition there are a lot of British medical tourists.
"garage mahal said...
Wasn't the lead character in Fountainhead modeled after a real life child serial killer? Would explain much about the philosophies of people like Paul Ryan and Clarence Thomas."
It's sad how small garage is.
Both states and the federal government can borrow money. However, because of constitutional or market limitations, states can't borrow directly to fund operating deficits. Or they can't do it for long.
The federal government, on the other hand, presently has the capacity to borrow vast amounts of money. This is partly because of the country's affluence and historic creditworthiness. In present times, it is also because the United States, despite the gigantic deficits, is more credit worthy and liquid than other borrowers--the best house in a bad neighborhood syndrome.
This situation will not last indefinitely. At some point interest rates on federal debt, held artificially low by the federal reserve now to keep the economy afloat, must rise. When they rise, the interest portion of the debt will explode. This will crush the already stretched federal budget, and in the worst case could bring fear of American default or actual default.
One way or another the gravy train will grind to a halt. It's a train with too little engine pulling too many cars. The cars will be put on a siding and left there to rust.
The "federal money" the states are receiving is all borrowed. All of it. The feds are no longer taking money from the states and then sending it back. The entire process is a mirage and one day it will disappear. Poof! It's gone! Where are we now, really?
"Wasn't the lead character in Fountainhead modeled after a real life child serial killer? Would explain much about the philosophies of people like Paul Ryan and Clarence Thomas."
Expand on this, please. As it stands, it appears you are accusing conservatives of being just like a child killer entirely because of their political viewpoint, none of which parrellels that of killing children. Which would be a hackish thing to do and would be something only a asshole would say.
I feel kind of bad going so low to dismiss garage. But, on the other hand, I don't.
Federal appropriations cannot be done 3 years in advance. Will money be added to budget to fund expansion? nope
Wasn't the lead character in Fountainhead modeled after a real life child serial killer?
I think you're thinking of Dreams From My Father. And it wasn't the lead character or a child serial killer. It was the writer and he was a domestic terrorist.
How are the states and the feds going to round up all the uninsured and force them to pay their fine or premium anyway?
"The federal government, on the other hand, presently has the capacity to borrow vast amounts of money."
A capacity that is fast disappearing. Do you know who the largest lender is to the federal government now, by far larger than the combined total of all the others? China? Japan? Germany?
It's us - the Federal Reserve Bank, which will have to be paid back by us, unless Obama bails us out too.
It has pumped many trillions of make-believe electronic dollars into the system in the last 4 years, which has to lead to economic collapse or runaway inflation at some time in the relatively near future.
From what I understand, Medicaid is, fundamentally, an awful program. And this nonsense of "earn < 133% of the poverty level, you're in medicaid; earn => 133%, you're in exchanges" is a pretty brutal dividing line. For some Medicaid recipients, it's a great deal -- go to the ER whenever you want and get free stuff. (There were stories of women getting pregnancy tests at the ER because they didn't want to pay the $5 at the drugstore, going around the internet a while ago.) For others, it's a struggle to find doctors who will accept the coverage, as the lousy reimbursement levels drive providers away. And more and more of the Medicaid budget is getting used for long-term care for the poor elderly, and those who have carefully "spent down" their wealth by hiding it/giving it to their kids.
My take on healthcare? Vouchers, vouchers, vouchers!
http://www.janetheactuary.blogspot.com/2012/06/letter-to-editor-on-healthcare.html
" Chip S. said...
All Obamacare does is require those presently without health insurance to buy health insurance.
Of all the things Obamacare actually does, this is not one of them.
It does, however, incentivize employers to dump their employees into the "exchanges". Which means financing premium subsidies for lots and lots of people who formerly paid their own way.
Great way to deal with the cost-shifting problem!"
Chip S, that is an excellent article at the link. The guaranteed issue rules are a disaster and one wonders if they are there to kill off health insurance. There is a way to deal with pre-existing conditions. The French system has coverage for certain diagnoses, like cancer and diabetes, that is specific for that diagnosis only. If you have diabetes, as my son does, the care of diabetes is covered but unrelated diagnoses are under the rules for the rest of the program, such as payment first and deductibles.
I know its futile to talk about what real reform would look like because this is all political and no one can see where it will lead. I can say that it is bad and will get worse unless the election works miracles.
We need to remove the private insurers from our health-care system altogether, and put in place, yes, a single payer system.
I'm pretty sure that even the Europeans and their so called universal health care still have private insurers who provide stop gap coverage.
Yes, Single Payer is almost inevitably accompanied by private insurance for those who have the means -- depending on the country, the upper-middle-class only, or all white collar employees. It gets you access to private clinics or the private-pay section of government hospitals, to avoid waiting lists. So, take heart -- Single Payer isn't the end of insurance companies, though it may mean that U.S. insurers go bankrupt during the transition, and non-U.S. multinationals move in based on models they've developed elsewhere.
Something else about non-U.S. systems, by the way: the move in the U.S. towards all-private-room hospitals? No such thing abroad -- the standard room covered under State healthcare is a ward room. I'm not sure how many people to a room; in Germany, the norm was 3 for public-insurance patients; private insurance patients could opt for a private room, though.
Frank Lloyd Wright was a serial killer? Who knew.
Expand on this, please. As it stands, it appears you are accusing conservatives of being just like a child killer entirely because of their political viewpoint,
Which is ironic when its the Democrat Party that wholeheartedly supports murdering unborn children under the guise of 'reproductive rights'.
For a party whose one consistent battle cry is "think of the children!" they certainly support preventing them from coming into existance either before or after conception.
But they're thinking about them!
Thinking of them as inconveniences, perhaps, but thinking about them nonetheless.
The new Medicaid expansion will further divide the country into rich and poor. The 80 million people on medicaid will get low quality care.
There won't be enough money in medicaid for doctors to make any money with it. The only way to make a business with medicaid is to have an entire medicaid practice, where everything is designed to offer the lowest care profitable. Patients will be shuffled in and out through programs designed to eek out the minimum of profit. The "good" doctors and "good" nurses and the quality practices will be in the non-medicaid area.
This will result in another round of litigation with the supreme court as liberals try to force doctors and health practicioners to treat medicaid patients.
This eventual result is enough reason for state governors to oppose expanding the program. Why condemn your state's citizens to this kind of inequality. Better to just try to make insurance affordable rather than put middle class people on a government program.
States should band together and reject the program not only for the future fiscal health of the country but to force the goverment to come up with a more reasonable program.
Everything I needed to know about the Brit NHS Benny Hill covered in a skit. I don't think he meant it the way I took it, tho.
Sloanasaurus said...
A better solution would be to make a take off on pro bono work for doctors. Assume that the average weekly income for a fee for service doctor and or private insurance doctor is X divide that by 5 (along with the average patient load) and let that doctor(if they choose to) take the one day for medicare and medicaid assignment patients as a 150% tax credit. It would simplify things significantly as there will be no issue of billing charges etc. And less administrative cost for the government.
On of the problems with single payer is that like in Canada the doctors annual income is capped so whether its on day one or day 364 when the doctor hits his or her income cap they stop working. Canadian doctors try hard to estimate when they will hit their cap so they can arrange with other doctors to cover their patients. It sort of works but results in long waits for virtually anything that isn't an acute emergency. A dog can get a faster MRI in Toronto than a human patient absent an acute emergency. Why do you think so many Canadians cross the border for care?
I can completely understand the desire by many for a generous welfare state in which everyone recieves free health care, education, housing, retirement at 55. It's a lofty goal and I'm sure it is appealing to many. The problem is that you need a significant portion of the country that are willing to be productive and innovative when the government is handing out so many 'free' things.
@Bagoh,
"They don't know what things cost, what their options are, what's covered or not,or even if they want what they pay for. That's a recipe for a bad market with high costs."
Exactly. It never ceases to amaze me how many patients expect me to know all that stuff about their insurance coverage when they don't know it themselves. The patient/consumer needs to be brought back into the loop. Charging third parties has distorted the market badly.
Ann:
You are missing the bigger story: your governor has decided to hold off on establishing the Insurance Exchange for Wisconsin becuase he thinks Romney will be elected. Good decision?
The big losers in this clusterf*ck, the people who will be really hurt are the middle class working suckers.
The incentive is for the employer to drop his/her company sponsored health plan or to lay off employees to get below the magic number of 50. Probably do both. I would. It just makes fiscal sense and being in business is not a charity. You want big daddy to take care of you....fine ask the government. Another alternative is to break up your existing company into smaller units to be under the 50 magic number.
So now you have a worker without health insurance who will NOT qualify under the expanded welfare program and who is going to be penalized/fined/taxed for not getting insurance. Suddenly that free $1000 a month in health premiums paid for by the employer will be a monkey on HIS back and he won't be able to afford the hit to net income.
Suck it up middle class. You voted for this asshole. Eat it.
The patient/consumer needs to be brought back into the loop.
It sounds an awful lot like your holding individuals responsible for making informed decisions about their health care. Radical.
Federal poverty guidelines
Read em and weep for the working middle class. A family of four with an income (adjusted I assume) over $30,657 who is not covered anymore by the employer's plan will have to go find insurance, most likely at least $600 to $800 or more a month or be fined. Yep. That extra $9600 out of pocket expense for insurance PLUS deductible .....not gonna hurt at all, is it?
So, what is the likelihood that this person will actually buy insurance or just pay the penalty?
In Germany, the healthcare system relies on private insurance, with the result that if you earn enough money, you can elect to be "freiwillig versichert."
As an independent contractor there, I earned enough to become "freiwillig unversichert," something not possible under Obamacare. Young childfree techies could thrive working in Germany!
By the way, do y'all know that the Amish and the Muslims do NOT have to respond to the insurance mandate? It's hard to be Amish, what with all the buggies and washing by hand, but, hey, now's the time to become Muslim, especially if you can give up pork and booze, or pretend to.
Yo Dust Bunny,
It's even worse than that. An Amerikan expatriate (tourist, student, businessman or temporary resident overseas) will have to pay insurance premiums or the Obamacare tax while getting NO covered medical care, which is what our expatriates on Medicare have been getting: zilch.
Yo Sydney,
I gather that you are work for a medical provider. If you do, you are part of the screwed-up system that defrauds the patient/consumer by hiding all the information regarding pricing, options, outcomes, etc.
On the day of the revolution, we will come looking for you first.
The WHINEFEST continues.
As usual.
And what's interesting is that every single person commenting on this site about how HORRIBLE this is...will take advantage of the benefits, will have friends take advantage of the benefits, and of course, will have all kinds of family members (especially seniors) take advantage of the benefits.
I suggest that anyone who feels this is HORRIBLE...make damn sure they opt out of any future benefits related to the Affordable Healthcare Act.
Send your letters TODAY!!
One of the few individuals who worked on health care reform under both Mitt Romney and President Barack Obama said on Friday that the controversial individual mandate provision was virtually identical in the bills signed into law by each of them.
"They are very similar," said Jonathan Gruber, a Professor of Economics at the Massachusetts Institute of Technology, in an interview with The Huffington Post. "They aren't the same exact mandate, but they have the same basic structure."
In Massachusetts, the Department of Revenue is in charge of enforcing the penalty. For the Affordable Care Act, the responsibility would rest with the IRS.
"The size of the penalty in Massachusetts is an amount that depends on your income," Gruber said. According to the Associated Press, in 2012, "those making more than three times the poverty level –- $32,676 for an individual –- pay the highest penalty of $105 per month, or $1,260 per year."
Nationally, added Gruber, "they do a similar thing. It would be whatever is bigger: $695 or 2.5 percent of your income."
*A rousing .007%
As governor, Romney initially opposed including an individual mandate as part of health care reform. Under pressure from legislators, he ended up signing one into law. Since then, Gruber relayed, the policy has worked well. In the first year alone, 98 percent of tax filers "got it right." A total of 44,000 residents in a state of 6 million paid a penalty.
"I will say that the fines have gone down," current Massachusetts Gov. Deval Patrick said Friday morning on MSNBC, "because more and more people, as the statistics you cited indicate, have taken up insurance."
Love,
I really don't see a President Romney supporting Obamacare. And besides, it will be up to a Republican congress to repeal and replace it.
Also, I can live with Massachusetts having this, but not a federal program that eventually leads to gov't run healthcare.
YOu gotta LOVE this:
A top Obama administration official, meanwhile, said that if Romney were to argue that Obamacare included a massive tax hike, the president was prepared to respond that, by logical extension, Romney raised taxes in Massachusetts.
A request for comment from the Romney campaign was not immediately returned.
"I suggest that anyone who feels this is HORRIBLE...make damn sure they opt out of any future benefits related to the Affordable Healthcare Act."
Sure, as long as I get my tax money back that supports Obamacare. Kind of like a school voucher.
Chuck - We both know that you yourself will take advantage of the benefits of this act. (If not already.)
And we both also know that you have friends and relatives that will, too.
Right now, if your kids are under 25...they can still be covered via your own policy.
No pre-existing condition turned down for coverage.
Cheaper drugs for seniors.
Are you saying you know no one, and are related to no one...who is taking advantage or will be taking advantage...of any of just these three elements?
No retired parents? No retired friends? No kids?
Chuck - The tax money you threw into the mix covers all kinds of government administered programs.
Are you saying we should be able to opt out of whatever we choose?
Stop whining and give the program time to either prove itself to be a success or a failuer.
*And why do you think it can work so effectively in one state (and be so popular with the citizens), but not work just as well nationally?
What do you base that on?
Love, and magical unicorns fly out of the sky, sneeze glitter, and give us all kinds of free stuff.
Love, what do you think about that $100,000,000,000,000 (that's 100 trillion) of unfunded liabilities in Big Entitlement? Do you think health care will magically fund itself so eveyone gets cool free stuff?
Love, please give me $1,000. I will give you $700 back. And you know damn well you will take that $700.
Love: You are exactly right. I will get many benefits from the new law. First, no more insurance for my few employees. Next, I am a very healthy guy with a very healthy family and a solid bank account. I can save around two grand a month on my family's insurance by going the self insurance route. If someone gets a bad biopsy or develops a terrible disease we will sign up for insurance immediately. What a great system!
Excellent program and you are right to defend it.
And we both also know that you have friends and relatives that will, too.
Right now, if your kids are under 25...they can still be covered via your own policy.
My daughter is 34 and works at a University with good benefits provided by the institution.
No pre-existing condition turned down for coverage.
I don't have any pre-existing conditions.
Cheaper drugs for seniors.
I don't take ANY drugs. I pay cash for all of my check ups and any other injury type treatments. The last time I saw the doctor for anything other than an annual physical was in 2009.
My father is already covered under a retirement insurance plan through his union and also doesn't take any drugs.
I have no idea about my friend's medical issues or insurance status except for one friend who is retired California Hwy Patrol with kickass benefits. I'm certainly not going to ask them.
SO there you go.
We make too much money to qualify for the 'free' coverage. I will admit that my husband does have a pre-existing condition but we do not plan to 'take advantage' firstly because we make too much money and we can't. But also since we can pay cash for his medicine and semi annual check ups the cost of insurance is not worth it. It doesn't pencil out. Since Obama has made a catastrophic insurance plan illegal and that is all we need, until Medicare eligible. Then we will get a plan to supplement the Part A & B, assuming Obama hasn't made a supplement illegal too.
If someone gets a bad biopsy or develops a terrible disease we will sign up for insurance immediately. What a great system
Bingo. Michael's situation sounds very much like ours.
Wait until we get really sick THEN get insurance. In the meantime save the premiums.
Right,
Love and others rely on charging folks with "whining" whenever they can't think of a counterargument.
I am perfectly capable of gaming Obamacare to my advantage, just as I now game Medicare and Medicaid.
But I think of all those younguns who will be screwed in perpetuity unless they emigrate. Singapore would be a great choice. You'd just have to renounce your USSA citizenship like Eduardo Saverin and 1800 other smart Amerikans did last year.
Assuming this is accurate
"As governor, Romney initially opposed including an individual mandate as part of health care reform. Under pressure from legislators, he ended up signing one into law"
and that the Mass bill was veto-proof. Why should I blame Romney for that? Should he have made some kind of "signing statement"? I thought that was an evil thing for Repugs to do.
"The medical system was working pretty well 3 decades ago, before the Dems thought up the HMO system as a consolation prize for failing to enact Hillary!Care."
Oh? Then why did Harry Truman want to enact a comprehensive health care program over six decades ago?
Who says the Dems "thought up" the HMO system? (And the origins of HMOs date much farther back than three decades.)
Assuming this is accurate
"As governor, Romney initially opposed including an individual mandate as part of health care reform. Under pressure from legislators, he ended up signing one into law"
and that the Mass bill was veto-proof. Why should I blame Romney for that? Should he have made some kind of "signing statement"? I thought that was an evil thing for Repugs to do.
The problem with healthcare everywhere is that everyone wants a miracle, and they cost well beyond the ability of most people to pay for them.
It's like if everyone needed a Ferrari to survive. The government can't fix that. The only solutions are:
1)nobody gets a Ferrari
2)only those who can afford them do
Nothing else is sustainable.
Why don't we all have Ferraris?
Dust Bunny Queen - "Wait until we get really sick THEN get insurance. In the meantime save the premiums."
Of course you can do that...but only if you're currently healthy ...and of course you'll pay your "tax" for not having insurance every year.
Everybody can do that...correct?
But is everybody healthy enough that they can afford to take that risk?
And then...you'll dig right into the benefits you're whining about right now.
"And then...you'll dig right into the benefits you're whining about right now."
The benefits sound great, it is that damned arithmetic of sustainability that bothers us.
Why not make the minimum wage a million dollars an hour? We could all retire after a day's work, couldn't we?
Someone explain why we're the only industrialized country in the world that doesn't have some kind of national health care system in place?
Are you actually saying that all of these other countries are wrong...and we're right?
And , please, no more drivel about how much better our medical system is compared to others in the world.
1. We're ranked #1 in terms of health care spending per capita
2. Ranked 39th for infant mortality
3. Ranked 43rd for adult female mortality
4. Ranked 42nd for adult male mortality
5. Ranked 36th for life expectancy
And our spectacular overall ranking: #37
Oh, and this is how unpopular the healthcare plan is...while the Mittster served as Governor while implementing:
The poll by Market Decisions, a research and consulting group, found that 84 percent of residents are satisfied with the Massachusetts plan, which requires most adults to have health insurance.
ONLY 84% are satisfied.
Duh.
MikeinAppalachia As to the Massachusetts Plan:
"Why should I blame Romney for that?"
Once again: The poll by Market Decisions, a research and consulting group, found that 84 percent of residents are satisfied with the Massachusetts plan, which requires most adults to have health insurance.
Really. Why blame him for being forced into implementing something...so popular?
Duh.
Love,
I can explain. Amerikans are far more religious and superstitious and far less grounded in reason and science than those in Japan, Germany, Holland, Switzerland and other developed countries.
On the otherhand, thanks to the wisdom of our founding fathers, we have a strong commitment to speech and religious freedom, as well as sanctity of life, liberty and property than any of them do. You still can't buy Mein Kampf in Germany and they still have state churches in most of Europe and you pay taxes to support them!
Of course you can do that...but only if you're currently healthy ...and of course you'll pay your "tax" for not having insurance every year.
Everybody can do that...correct?
Let's see. Medical costs of less than $500 a year....versus insurance for a woman my age at approx $500 a month. Savings in the bank if I don't get insured now $5,500 annually. Hubby's costs are about 2500 a year. Cost of insurance through the Calif pool for un-insurables is $550 a month. Still a good savings to just pay cash and pocket the premiums. Total saved $9,600
Tax Percentage of individual taxable income: fixed percentage of household income in excess of tax filing threshold – 1% in 2014; 2% in 2015; 2.5% in 2016.
For example (again courtesy Blue Cross Blue Shield): An uninsured, non-exempt individual with household income of $50,000 would be forced to pay 1 percent of the difference between $50,000 and the tax threshold (let’s say $10,00 for an individual in 2014), or roughly $400. Since $400 is greater than $95, this individual would have to pay $400.
So a tax of 1% of household income assuming $50,000 for married couple like us. I'm assuming we both have to pay as individuals so probably have to divide the income in half. I'm not clear on that. So an annual penalty of $500. Even in 2016 the penalty would be 2.5% of income.. $1,250. Big freaking whoop compared to out of pocket insurance costs of over $10,000.
And the beauty of the Obamacare plan where if we do get deathly ill.....we can just sign up for insurance using the money we have saved all these years.
WINNING!!! Thanks Dems.
I don't care about everybody. That seems to be your job.
And , please, no more drivel about how much better our medical system is compared to others in the world.
You're completely ignorant of the facts about health care.
You can cite all the life-expectancy data you want, but it will still be the result of the interaction among genetic markers, lifestyle choices, and the health-care system.
To isolate the effect of the health-care system, you need to look at health outcomes that are conditional on having become ill. On that score, the US has the world's best system by a wide margin.
Note: That isn't our household income. I would never put that information on the internet. It is a hypothetical.
The US has the highest life expectancy in the world, when all nations are adjusted to eliminate the effect of murder and accidents i.e, comparing just relative health care effectiveness.
This study doesn't do it, but if you further adjusted out the fact that we are a bunch of fatties , we would even further out perform the rest of the world in health care effectiveness. But even with being a bunch pizza eaters, we are still the best.
Via Wall Street Journal:
U.S. has highest life expectancy
Love said...
Someone explain why we're the only industrialized country in the world that doesn't have some kind of national health care system in place?
Are you actually saying that all of these other countries are wrong...and we're right?
And , please, no more drivel about how much better our medical system is compared to others in the world.
1. We're ranked #1 in terms of health care spending per capita
2. Ranked 39th for infant mortality
3. Ranked 43rd for adult female mortality
4. Ranked 42nd for adult male mortality
5. Ranked 36th for life expectancy
And our spectacular overall ranking: #37
Sigh.
The primary reason is that we will go through any measures to keep our patients alive. Including invitro surgery. No other nation goes through what we go through to save a patients life or keep them alive. This is reflected in the mortality figures. in many european countries its simply racked up to natural causes.
Most of the best doctors in the world were trained here.
Bunny - Health cost average over $1,000 a month for American families and it's gone up over 60% in the past ten years.
You can spin this any way you want, but health care costs a fortune, and over 60% of personal bankruptcies are directly related to health care costs.
Being healthy and never needing care is wonderful, but eventually, you'll need it.
Whining about this being passed is pure right wing bullshit...and every one of you will eventually use some element of the plan...if you're not already.
Rusty - "The primary reason is that we will go through any measures to keep our patients alive."
That's bullshit.
Show me any statistic or measure of health care in any country that has a national health care program that illustrates the fact that they don't go through the same measures we do to keep people alive.
Ridiculous right wing drivel.
Rusty - "This is reflected in the mortality figures."
America:
1. Ranked 39th for infant mortality
3. Ranked 43rd for adult female mortality
4. Ranked 42nd for adult male mortality
5. Ranked 36th for life expectancy
Sigh....you're full of shit.
Chip S.- "You're completely ignorant of the facts about health care."
1. Ranked 39th for infant mortality
3. Ranked 43rd for adult female mortality
4. Ranked 42nd for adult male mortality
5. Ranked 36th for life expectancy
"Love said...
You can spin this any way you want, but health care costs a fortune, and over 60% of personal bankruptcies are directly related to health care costs."
This, like everything Love writes, is a lie. The statistic is generated by counting all bankruptcies with more than 2k in medical creditors as "directly related to health care costs", regardless of any other factors.
It's sad to see so much effort spent learning talking points by someone with so little interest in understanding them. Sad but not surprising. If leftists understood their talking points there would be far fewer of them.
Show me any statistic or measure of health care in any country that has a national health care program that illustrates the fact that they don't go through the same measures we do to keep people alive.
Liverpool Care Pathway
Otherwise called euthanasia not a commonly used medical technique (YET) in the United States but common enough in England
Love, I have a parrot that can repeat himself like that.
He knows as much about health care as you do.
Maybe Love can answer me this:
1-Now that Roberts has declared the 'mandate' a tax, I know that I have to pay the penalty to The United States Treasury but to whom am I paying the tax?
2- Has Roberts and the democrats turned United Health, Etna, Blue Cross Blue Shield and Human into private governments with taxing powers?
3- What kind of tax am I paying? Is it an income tax? An excise tax?
A capitation tax?
4-How can one be penalized for not paying a tax but unlike any other tax penalty for non payment that requires that the tax be paid this unique tax doesn't require the tax payment in addition to the penalty. How can one be obligated to pay a penalty for non payment of tax without also paying the tax? So does the IRS now become the collection agency for United Health?
4-Any other form of tax such as an income tax, excise tax, capital gains tax requires an action to occur to trigger the tax. This one penalizes one for failing to perform an action, paying the tax to United Health. Its like taxing and penalizing an unemployed person for being unemployed and thus not paying income taxes.
5- Since we don't know what kind of tax it is, Roberts didn't tell us and Obama, Reid and Polosi are either too stupid to tell us or being duplicitous can't honestly tell us, maybe Love can enlighten us, how do we know its a permissible tax?
On second thought Love is too much a Hack like Garage to answer the above.
Maybe if the republicans can't get their act together, they can sue to stay enforcement pending Mr. Roberts explanation of what kind of tax it is and if it is a permisible tax.
There is no money go get. There is no federal money. There is only debt. It's like annuities that allow you to borrow your own money and charge you interest and make it sound like you're getting a real bargain. You are paying interest to have access to your own money. Fed money is your money and you pay interest up the ying yang to get it back.
People there is no money...there is only debt.
"over 60% of personal bankruptcies are directly related to health care costs."
I don't think this is true; the figure of 60% represents the number that have medical costs in their debts.
http://www.factcheck.org/2008/12/health-care-bill-bankruptcies/
this site Casviar give us the very much nice information..."People without insurance and their families see this as good news."..
e said...
Rusty - "The primary reason is that we will go through any measures to keep our patients alive."
That's bullshit.
Show me any statistic or measure of health care in any country that has a national health care program that illustrates the fact that they don't go through the same measures we do to keep people alive.
Ridiculous right wing drivel.
Britains NHS admission that they let approx. 130,000 people die each year because they cannot care for them under the NHS.
My English grandmother was Liverpooled. We don't know what she died of. They wouldn't diagnose and treat her. Ah well, she had a good run.
BTW Mad smart scheme to save Social Security and OAP Medicare! Kill gramma! Her non-care pays for itself!
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