It’s in the Bag!

by Dave Schuler on April 17, 2014

If you’re convinced that searching for metrics for the performance of the PPACA is a sure sign of a concern-trolling Republican hack, you might want to take a look at this post from Lambert Strether at naked capitalism:

When you force people to purchase a crapified product under penalty of IRS enforcement, it’s entirely natural they’ll resent it, and think ill of the people and the institutions that forced compliance on them. If Krugman were the sort of New Deal Democrat who put all that good will on the Party balance sheet for Obama to piss away, that’s what he’d be focusing on: Not the sign-up metric, but metrics that show whether concrete material benefits are being delivered to citizens by public policy. Instead, he’s epater-ing le Republicans and beating the tribal pom poms.

{ 13 comments… read them below or add one }

jan April 17, 2014 at 1:12 pm

There’s wonderfully creative language in this piece — “crapified product” taking the Oscar for the “Descriptive Best.”

As for Paul Krugman, who is highlighted in the Naked Capitalism comments, City University of New York has just tapped Krugman for a “distinguished professorship” paying $25,000 a month, or a cool quarter million a year! Ironically, Krugman’s job description is:

to “play a modest role in our public events” and “contribute to the build-up” of a new “inequality initiative.”

Why is it that so many social progressives seem to have personal jobs and incomes that are completely opposite to what they politically preach and support. It’s a “do as I say, not as I do or live” kind of hypocrisy, that repeats itself at all levels of government. It reminds me of certain social conservatives, preaching family values, as they engage in immoral acts in their own lives.

steve April 17, 2014 at 2:43 pm

1) Krugman is a hack. He puts his party/goals first. You expect him to try to find a way to support whatever Obama is doing.

2) Strether is, AFAICT, just another pundit writing on health care. When it hits hi radar, he writes about it w/o having the benefit of following it for the last 10-20 years. If he had been following it he would have known that no one thought you could get 40 million people signed up the first years. Realistic expectations were set. it will take a while to find out if we have met them. It looks like it will be close just from preliminary numbers.

On a side note, this did inspire me to finally go to healthcare.gov. My group has grown too large to qualify for the under 50 rates right now, but they are projecting this will expand to companies with up to 100 employees. If I were to retire right now, I could get family coverage on the exchange for $3000 less than what I am paying for each employee right now, with a lower deductible. If I can buy as a group and get the same rates they offer now for 50 and less, I will save more than that. With over 70 employees now, that adds up.

Steve

jan April 17, 2014 at 3:04 pm

Amidst unverified enrollment numbers, meeting the WH’s original projection hopes, surfaces a more sobering analysis pointing out the unfolding fiscal disaster behind the ACA enrollment figures.

It is quite possible that the ACA is shaping up as the greatest act of fiscal irresponsibility ever committed by federal legislators. Nothing immediately comes to mind as comparable to it. Certainly no tax legislation is, because tax rates rise and fall frequently, such that one Congress’s tax cut can be (and often is) undone by a later tax increase. The same is true for legislation affecting appropriated spending programs. But the ACA is a commitment to permanently subsidize comprehensive health insurance for millions who could not otherwise afford it, which the federal government has no viable plan to finance. Moreover, experience shows that it is very difficult to scale back such spending once large numbers of Americans have been made dependent on it.

IOW,once all the confetti drops to the ground, the grave realities of this social program, ranging from how to fund it to how much it will add to our already out-of-control debt, replaces exclamation with question marks.

Steve,

Most of your comments are anecdotely-based — dealing with your own medical group and immediate circle of professional cohorts. While I always read your posts, ingesting their positive nature, there are hosts of other anecdotal experiences which are contrary to your’s. I’ve even read, from various blogs, where others comment on a wide variation of pricing affixed to premiums — differences which often don’t make sense, as to why some are so high and others so low. It makes one question how insurers are coming up with their prices, are some of these prices just ‘teasers,’ will they hold or go up once the market has become more settled and the WH stops changing deadlines/requirements of the law? Basically, I simply don’t see any rhyme or reason to the opening implementation of this low. It keeps shifting it’s requirements, dates of implementation, where it’s cutting from etc..

So, while I take your case of premium cost reductions with a thumb’s-up for you, I don’t take it necessarily as a constant or universal metric for what is going on overall for others in sorting through their own PPACA experiences.

michael reynolds April 17, 2014 at 4:16 pm

Jan:

Now you’re doing comedy. A ‘sobering analysis’ from. . . wait for it. . . a Koch, Olin and Scaife funded “think tank.”

Very amusing.

michael reynolds April 17, 2014 at 4:19 pm

Jan:

By the way, if there a “host” of reliable sources counter to Steve – who is actually doing what you’re only reading about and therefore is not providing ‘anecdote’ but first-person testimony – I’m sure you’ll provide links. Surely the Kochs have a list.

steve April 17, 2014 at 4:54 pm

jan- I also provide frequent links to what is going on in the field. (I actually make it a point to not deluge the place with citations. I have a tendency to overdo that.) That said, I find that pundits on right and left seem to have very little knowledge about what is actually going on at the retail level in medicine. While that may vary a lot from area to area, and practice to practice, I think it is helpful if people know what some of us are doing and how things are really affecting us. More important than the specifics of what we are doing, and to be honest a lot of docs I know are engaging in the ostrich approach to change (had dinner a few nights ago with a group like that), I think it is important that people with a long term interest in this area know that for the first time there is a real push on for medicine in general to do something about costs.

Blahous is actually a pretty bright guy, but he did serve on Bush’s NEC and is a Mercatus guy. He has strong biases. That said, he has no long term interest or expertise in the area of health care. His numbers are far out of line with those most others use. Where I would agree with him is, I think I have said this at least a hundred times here, that controlling health care costs is the most important part of controlling our future debt. The bad part of the ACA is that it is weak on cutting costs. It has some parts that might work, and conservatives in particular should hope they do. If competition on the exchanges fails, then your whole market theory about competition is shot. You guys have nothing left to offer. But I digress.

The ACA is a bit of a gamble. In the rest of the world gaining universal, or near universal access, has been the first step to lower costs. We have taken that first step. We need to take the second. Without that, we are in trouble. Maybe we should have gone for costs first, but no one really knew how to do that in a politically feasible way. The GOP has been unwilling to try to do either step. That left us with the ACA. Yes. it has faults. I hope they get fixed, but it is a framework that can let us do a lot of things we need to do. Things that were not going to get done with your party in charge.

Steve

michael reynolds April 17, 2014 at 7:37 pm

I’m sure the GOP plan for an alternative to O-Care will be along any minute now. It’s only been 5 years. And they have been very busy voting 50 times to strip older children off their parent’s plan, to throw people with pre-existing conditions off insurance altogether, to allow recision on a whim, to allow for fraudulent hollow policies to be sold.

Very, very busy as well with refusing Medicare to the poor in red states. Millions more would have health insurance right now, today, but the GOP and people like Jan only care about scoring ideological points and sick poor people are invited to fuck off and die in a ditch.

Today, thanks to Obama, if you buy a health insurance policy it’s a real policy. It will actually take care of you.

Even you, Jan.

jan April 17, 2014 at 11:36 pm

Steve,

Thanks for your reply. You made some good and reasoned points. My problems with the ACA, though, not only involves it’s complexity, the administrative incompetence demonstrated, lop-sided benefits to people, vague documentation of numbers, and overall divisiveness, but all the long-term fiscal effects yet another entitlement program will have on this country. I just don’t see how we will be able to adequately fund everything we promise people! HC subsidies has only raised the ante of obligations, which include unfunded long-term liabilities of SS, medicare, medicaid, pension funds, let alone all the borrowed money and it’s compounding interest. Now we have passed this HC plan that, in many cases, is robbing Peter to pay Paul’s health care. I just don’t see how all the puzzle pieces are going to fit together in the future.

Michael,

You really don’t listen to people who take different stances than you do . Instead you parse and parrot your responses in ideological rhetoric, bring up the poor for purposes of unrelated guilt trips, and then chat about how good it’s all going to be when following your way of seeing something. Sure the PPACA is a partisan issue. However, there are lots of people who have real reservations about it, having nothing to do with being a D or an R. There are also lots of people who are less than thrilled about how the PPACA has effected their own HC insurance preferences, premium costs, as well as access to services and drugs they once enjoyed having. This has been a less than perfect piece of legislation with lots of bugs, ploys, dishonest claims. For once in your life can’t you possible put your glibness on hold and view the landscape of opinions from a more neutral POV!

steve April 18, 2014 at 6:35 am

” I just don’t see how we will be able to adequately fund everything we promise people! ”

We couldnt do that even before the ACA. With the ACA, maybe some of the pilot programs will work. It lets states band together if they want so you can have insurance that functions across state lines. It has the IPAB. It lets states experiment. The exchanges allow for open competition on the basis of price. Maybe someone comes up with an EHR that actually works. Maybe not, but at least there is a chance. If not, it has a framework that is easy to modify.

TastyBits April 18, 2014 at 7:33 am

@michael reynolds

… older children …

At one time they were called adults. Soon, there will be children and old people. Nobody wants to be an adult anymore.

I do not care about Obamacare. There are so many moving parts in the healthcare industry nobody knows how the damn thing works, and trying to predict an outcome is simply a guess.

michael reynolds April 18, 2014 at 10:18 am

Jan:

You’re a full-time and utterly credulous parrot of right-wing talking points. You don’t get to lecture anyone on open-mindedness. I’ve never detected the slightest opening in your mind.

michael reynolds April 18, 2014 at 11:33 pm

Just for you, Jan:
http://www.rawstory.com/rs/2014/04/18/gop-lawmaker-agrees-its-absurd-we-never-offered-obamacare-alternative/

Speaking from the back of the room, a constituent listed features of the new healthcare law, asking Rep. Dennis Ross (R-FL) why repealing them would be a good idea.

“You’ve voted to repeal it approximately 50 times. Had zero votes on a replacement,” the unidentified man asked. “So my question is, why do you think it is so good to deny seniors on Part D to make them pay more, about $4,000 more for medicine, and people with pre-existing conditions get denied insurance, have 26-year-olds have a harder time getting insurance because they can’t get on their parents’? Why do you think those are good ideas?”

“I think one of the most unfortunate things my party did the last three years was not offer an alternative to health care,” Ross responded. “I’ve always felt that way. I think it’s absurd when I tell people that this isn’t what you should do, but I don’t have an alternative for you.”

Ross continued by explaining that he had proposed a patient healthcare bill that would cover pre-existing conditions, permit the interstate sale of insurance, and allow for health saving accounts saying, “I think these are good ideas, I would support them.”

Ross then admitted, “My party decided to not bring anything up.”

Explaining that the party’s refusal to submit a healthcare plan could impact their fortunes at the ballot box, Ross continued, saying he “wished they had an alternative.”

“I wish we had an alternative. It would make — you know what’s unfortunate? for the next six months, we’re going to go into an election knowing that we’re not going to do anything to address health care. Because we’ve gone so far in the last three years saying no, that we don’t have an alternative to say yes to, ” he said, adding, “I think the American public, when they go to vote, are going to look at credibility before they look at substance, and I think that’s going to have a play in it.”

That’s a conservative Florida Congressman from central Florida saying exactly what I’ve said: the GOP’s got nothing. They’ve bet everything on O-Care being the gates of hell. And so what else does your party stand for?

jan April 19, 2014 at 1:52 pm

A local CBS piece from SF describes something called ‘medical homelessness’ that is becoming more and more common in the after glow of the PPACA sign-ups and implementation.

“Yeah, I sign it. I got it. But where’s my doctor? Who’s my doctor? I don’t know,” said a frustrated Ong.
Nguyen said the newly insured patients checked the physicians’ lists they were provided and were told they weren’t accepting new patients or they did not participate in the plan.

Those who can’t find a doctor are supposed to lodge a complaint with state regulators, who have been denying the existence of a doctor shortage for months.

Meanwhile, the sick and insured can’t get appointments.

“What good is coverage if you can’t use it?” Nguyen said.

Experts said the magnitude of the problem is growing, and will soon be felt by all Californians. But those on the front lines, like the free clinic, are feeling it first.

More than 3 million Californians are newly insured. At the same time, a third of our primary care doctors are set to retire.

What the Obamacare creators didn’t consider were the consequences of “supply” being undercut as “demand” increased. In the meantime, back to talking about those great sign-up figures, that may end up being meaningless,in the long run of actually being able to easily access healthcare.

Michael,

The R’s have submitted numerous HC proposals, but no HC bills. Perhaps, with Harry Reid’s prospensity to table anything that doesn’t come from a democratic POV, there has been little energy to what would be a futile effort. It’s doubly so with a POTUS like Obama, who would veto anything that might magically make it by both the House and Senate. I think if the R’s, though, are able to capture control of the Senate, this is when more reasonable possibilities are afforded the R’s to submit such written legislation.

But, even with a majority, unless it would be a huge majority, there is little chance the dems would allow the R’s to one-up them on a legacy they have pursued for decades. After all, when SS and medicare reforms were being solicited by an R president it went nowhere.

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