I’ve made a conscious decision to reduce the volume of my posting on the PPACA until after the end of the month. I’ve largely said my piece and won’t have much meaningful to say until after the deadline for Healthcare.gov’s “working for the vast majority of users” set by the president. If the site is obviously not working at that point, he’ll set another deadline and take whatever other remedial action is necessary, e.g. issuing waivers, pushing back dates, etc. He really has no other alternative.
I did want to point out the Wall Street Journal’s article about the future hurdles the law faces even if its entry portal is fixed. Here’s their list:
- Technology woes beyond Dec. 1.
- More cancelled health plans.
- Small business insurance disruption.
- The viability of the exchanges.
- Rate shock round two.
- The viability of the exchanges.
- You can’t even keep your ObamaCare plan.
- . . . or your Medicare Advantage plan.
- And maybe not your doctor.
- Physician dissatisfaction.
November 30th won’t mark the end of a process but, under the very best of circumstances, the beginning of one. The PPACA’s timeline goes right through 2020 and there are bound to be revisions to the regulations that have been promulgated, revisions to the revisions, and so on. The only way that November 30th will mark the end of a process is if Healthcare.gov falls on its face again. That prospect has been maximized by the tight timeframe that’s still in place and the unrealistic expectations that have been placed on the site.
If Healthcare.gov flops again, the level of panic in the Congress we’ve seen to date will pale by comparison with the panic that will ensue. So we’re all but certain to be faced with substantial disruption in healthcare insurance if not the healthcare system for the foreseeable future. Sadly, it’s not the disruption we need. That is yet to come.
The other story is that some states are doing quite well. California just rejected the extension because we don’t need it. Covered California appears to work well and we have an upgrade coming soon. 80,000 enrolled thus far, and it’s accelerating, not slowing. And of course Kentucky is setting the pace for the states.
I can’t find a way to link directly to this, but from NPR:
As a sidebar, it ends up making a bit of a case for the notion of states and incubators of ideas. Or at least beta testers of websites.
I have said it before, I guess I’ll say it again. Scrap the whole damned thing and start over. Its perhaps the biggest cluster – Fluke (heh) government program I’ve seen in my adult life. (I know, I know, never happen. More on that in a second.)
Deal with arbitrary cancellation, deal with portability and deal with the free riders. The first two are painfully simple. The latter a real birtch. But in general contours it would require a sort of sliding scale insurance program along the lines of “when you are young you buy a relatively modest premium, catastrophic coverage plan; as you age your coverage and premiums increase in sympathy with the reality that your health care issue incidence will increase.”
This would require BigBrass b… because some people will be irresponsible and tend to not buy but then throw themselves upon the mercy of society if they need care……….and society will provide it. But we enforce auto insurance. The second big problem I see is “how do premiums paid to the XYZ insurance company get transferred to the ABC insurance company to maintain lifetime fidelity to actuarial realities in the event the XYZ company goes out of business or a person transfers?” Perhaps this is one of those few areas where regulatory impositions on capital strength or an overnight bank-like “clearinghouse” makes sense.
In any event, the current system is just bizarre.
As much as I like to joust with Michael, I have no reason to believe his motivations are not pure. The current faults in health care insurance are real. He just believes in a big government program. I don’t. Guess who is winning that argument, empirically, now?
I have a different view of the politicians. They hung so many ornaments on this tree its despicable. Exemptions for political favorites, subsidies, taxes, voter registration and info gathering and on and on. And the gd billing section doesn’t even exist yet. You couldn’t make this shirt up. They are doing nothing but positioning a system to create permanent voting blocs. Its just about power, and the people be damned. A pox on them.
The WSJ failed to mention the shock Amerikans will experience when they find out that, no matter the premiums they’re paying, NO Obamacare will be available overseas, and they will be on the hook for all bills.
California has seen one million policy cancellations, as of a week ago. Of that million, no one has said how many people are covered under each policy. Of the “80,000” new enrollments how many were medicaid sign-ups, and what were the demographics of those enrolling — young versus old? Raw numbers don’t mean much, as to the ACA’s viability, until you break them down to see just who comprises the people signing up.
For instance, if these numbers reflect a sizable faction of people engaging in the exchange sign-ups, who are also younger and the less sickly, then I would say that the ACA is functioning in a way consistent with how the government envisioned it to be. If, however, the majority of that number are sick, older people signing up for the expanded ‘free’ medicaid HC, then it becomes another social program not meeting it’s cost projections — something which will eventually be foisted on the taxpayer to make ends meet.
As for that November 30th promise — it makes no difference how well the federal government’s website is actually working, as they will describe it as working “much better,” and that will suffice (in their government-speak) as meeting their deadline expectations. It’s all about a bureaucrat’s definition, their whims and will, not the layman’s own experience, as to what counts and what doesn’t.
Furthermore, the enumerable hurdles still facing the PPACA are real and daunting for those who don’t have rose-colored viewpoints of this law. It remains a piece of legislation buoyed by good intentions and weighed down by snarls of bad regulations and laws. However, avid partisans, like Michael and especially Steve, will continue to harp on the benefits for the uninsured (many who will voluntarily stay uninsured even with the PPACA in tow), while totally dismissing the grief incurred by the vast majority, who were previously insured under policies and premiums that met their needs.
IMO, social manipulation, as depicted in the PPACA architecture, offers social justice polices that are damaging, proving to be unsatisfactory, in the long run, for the whole of society. They wreck havoc on the human spirit, arbitrarily legislating what is ‘right’ and ‘wrong,’ in their attempts to control the functions and ultimately the destinies of it’s citizens, in what was once considered to be only Orwellian science fiction.
Jan:
You’re a Californian. You don’t face innumerable hurdles. Go to: https://www.coveredca.com/ Easy.
Red and Jan:
Read this. You’ll learn something. http://www.huffingtonpost.com/linda-tirado/why-poor-peoples-bad-decisions-make-perfect-sense_b_4326233.html
Michael,
I read Linda Tirado’s piece. While I found it compelling, there was nothing new learned. Minus having kids at an early age, my own life ran a similar course –> functioning on a shoe-string budget, working double shifts, and then going to a second job after that; having no money for any extras such as new or used clothes, movies, eating out. My furniture was 2nd hand for many years, some salvaged out of alleys. Tired? I would sometimes fall asleep writing notes in nursing charts, after experiencing an extra busy night where there was no time for breaks during my 4PM to midnight shift. I’ve scraped paint and grease off walls, plastered rooms, swept out garages, chased roaches off when I was working late, at my other job. I know many people in similar circumstances, and they survived — some making it to higher plateaus (I did), and others not. That’s why today, my husband and I are generous tippers, and pay for peoples’ meals, discretionary wishes they can’t afford, as we’ve been there, experienced hard times, as well as acts of kindness, giving us memorable moments of reprieve from an otherwise day of drudgery. We also frequently contribute to another’s “saving’s jars” they keep to acquire something needed in their lives — most recently a woman who didn’t have a bed, as well as someone else needing money for medical treatment.
A good friend of ours used to say, “Life is hard, then you die.” That’s the routine and fate of many in this space we call existence. It also creates home-schooled lessons of natural give-and-take, treating others as you would like to be treated, all experientially available to those who have lived a life rich in not-having-it-great — not because we are told or mandated to, but rather we understand the cycle of “salad days” and deprivation, and thus want to give and help others, feeling only gratified and privileged, afterwards, in finally being of service and able to do so.
You’re a Californian. You don’t face innumerable hurdles. Go to: https://www.coveredca.com/ Easy.
Michael,
My life is relatively secure at the moment, barring the unexpected. However, I don’t count and weigh innumerable hurdles based solely on how I’m doing, but rather on how people generally are doing around me. What I’m seeing and hearing, people are not doing that well.
When I think further about Linda Tirado’s struggles, I wonder where she finds the time to be an activist and essayist. Having enough time to manage just the all-consuming essentials of family life, work, school, etc. is hard enough, let alone having the time to mull over, lament, and then write about it. I know I certainly never had such a luxury until maybe 7 years ago.
Jan:
She wrote a single thousand word piece. That’s it.
By the way, you know what I make to put down a 1000 words? More than she’ll earn in three months. If you can’t see that there is something fundamentally wrong with that you’re hopeless.
Meanwhile your party wants to make sure she doesn’t get Medicaid or a minimum wage increase.
By the way, you know what I make to put down a 1000 words? More than she’ll earn in three months. If you can’t see that there is something fundamentally wrong with that you’re hopeless.
Did you even read my first post discussing her article? Somehow, everything is skewed to you, Michael, your earnings, and your often mistaken assumptions of other people. Tirado’s days are full, but familiar to those of us who have been there ourselves. So, while her days are challenging, it’s not necessarily that novel, in lieu of the multitude of disadvantages/struggles inherent in so many people’s lives — especially when they’re young and trying to find a better way forward.
Of course it’s not novel, that’s the problem. It’s the story of most of the people who flip burgers and stock shelves and clean toilets. (Three jobs I’ve held.) The American dream is dead for people like that. When the majority no longer has hope for the future we’re screwed as a country. Americans aren’t a people, we’re a dream. When the dream dies we’re no longer anything special in this world.
Michael
I never envisioned you as a pessimist. The American Dream is not dead, it has been thwarted by government putting people on the dole, government captured by big government interests and making it that much more difficult to succeed. You may have cleaned toilets (by the way, so did I in high school) but I also run with entrepreneurs hell bent on breaking through and saddened by all that your policy notions put in their way. Declaring the American Dream dead is different from constructing or advocating the self fulfilling antecedents.
1) Drew is pushing for a decrease in adverse selection, trying to make insurance payments approximate what people actually pay for care. If you remember health care demographics, you can see that this has problems. It means that people who actually need health care will nto be able to afford it.
2) I am interested in the claims of physician dissatisfaction. Not seeing effects here yet, if there are any.
3) If the exchanges end up not being viable, then most of the plans envisaged by the right are also not viable.
Steve
What a load of sanctimonious bullshit. The Wal-Mart heirs own more than every poor and working person in this country put together. They screw their employees and treat them like sharecroppers and whine when they’re asked to pay a tax or raise the minimum wage or god forbid provide basic benefits.
Every time Democrats try to improve the lot of regular people, greedy, self-righteous pricks like you start race-baiting and yelling socialism! You and your ilk broke the unions, cut taxes, pushed against medicaid, welfare and unemployment insurance, wrote laws to give yourselves all the sweet tax breaks your creep of a presidential candidate exploited so relentlessly, while crying like babies because you can’t pay your employees less than it takes them to feed their families.
Make a list of every nation on earth where people are happy, Drew. Every single country without a single exception where people have a good life. You know what they all have in common? Progressive taxation, regulation of business, unions, a social safety net — all the things rapacious, self-interested swine fight tooth and nail. Every single one, Drew, every single god damned one is to the Left of you.
You and your “entrepreneurs.” Go start a business in Somalia, see how that goes for you. Open a Jimmy John’s in Congo — it’s wonderfully laissez-faire. No gubmint at all. Try it in any country where the government doesn’t take some of your money to give you the opportunity you then claim is all your hard work. You’re a child. You’re a thoughtless, immature, self-centered, greedy little toddler who doesn’t give a shit about anyone but himself and his country club golfing buddies, and who can’t stand the fact that the government that makes it safe for you to get rich also may want to occasionally care for others.
steve
Not really. That’s not the way insurance works, or exists. Its the one product I know of where you hope you don’t break even. Its not a return on investment. Few understand this. Its a return on catastrophic economic events avoided. Otherwise you are talking a maintenance contract. Wayyyyyyy different concept.
Michael
Put the glass of Scotch down.
I’m sorry, but the simple facts (Census and BLS data abound) that consumers (who are both wage earners and consumers) capture the vast majority of the benefits of investment and productivity increases. And studies have it at something like 20 to 1. I’m sorry you live in a world of envy and hatred of successful capitalists, especially in that despite my constant sniping of you for sport I think you mean well. You just don’t have understanding. You are an author, not an economist, investor, credit extender or real businessman. You have Matt Damon syndrome. A specialist who thinks he knows what he doesn’t.
Wal-Mart has been the savior to millions of people who consume. Millions. You can’t help millions, by screwing the Waltons. You can only satisfy your personal demons.
Let me summarize something. (serious Drew, now, not just cutting up) The Paul Krugman’s of the world actually know what I just said is true. The vast majority of the benefit of investment, risk taking and innovation goes to consumers. A handful of people may become rich on the ownership side, but millions and millions benefit on the consumer side. The law of large numbers if you will. But the Krugmanites therefore conclude that the value of investment should be controlled by government, because its so powerful for the masses. Well; see the fabulous success of Obamacare.
My view, the opposite view, because I am one of the people controlling investment and traffic in people who do same – is that because the leverage is so great, you fuck with investors, and you can have a ginormous effect on the masses. Invariably it is bad. Capital providers don’t have to put up with being fucked with. Are banks lending?
It is boneheaded to think that government should, through regulation or taxation control or throttle the risktaking and investing class. Its self defeating. Born of jealousy and misconception, it only hurts the Average Joe.
I know you disagree, but how’s it going lately? Growth is a substandard 2%, and the real unemployment rate is 9-11%. The stock market is nothing more than a creature of QE and disproportionately helping the well off, at the expense, by the way, of the vaunted saver and the elderly. Wait until the tax of ObamaCare really hits the consumer. This is not going well. Deny if you want. Curse the Waltons if you want. Curse me if you want. The positions you advocate are no friend of Joe Blow, they are just self congratulatory, feel good nostrums. You really, really ought to ponder that.
And in a nod to the sameness of so many debates here: The Song Remains the Same
http://www.youtube.com/watch?v=CcYZlRWWxO0
Red Barchetta: I’m sorry, but the simple facts (Census and BLS data abound) that consumers (who are both wage earners and consumers) capture the vast majority of the benefits of investment and productivity increases.
Engines make the car move, but engines are not cars. The most productive economies in the world are mixed systems, with strong government sectors *and* robust markets.
I agree with that. Right now there are considerable trends pushing us in the direction of stronger government sectors and weaker markets. Is that the right direction?
Dave Schuler: I agree with that. Right now there are considerable trends pushing us in the direction of stronger government sectors and weaker markets. Is that the right direction?
If experience is any guide, the government sector has to be less than half the economy. That leaves room for markets to drive growth. Generally, the government should be divested of ‘ordinary’ industries.
Sweden’s government has been reduced somewhat, but the Swedes still maintain a strong safety net, including universal healthcare and pension systems, have a very robust market system, and still have low deficits and debt. Their fiscal discipline, ability to control their own currency, and strong automatic stabilizers, allowed them to ride out the financial crisis relatively unscathed. For instance, when workers are unemployed in one sector, they are trained for another, while being provided a basic income. This allows great flexibility when confronting changing market conditions.
The U.S. keeps stumbling, and political disfunction means they have troubles confronting the rapidly changing global system, but the Americans have by far the greatest resources of any major country; particularly their highly educated, creative and motivated workforce; so once they regain their footing, they should continue to prosper going forward. Indeed, everyone would want to have their problems!
As I’ve suggested before, it’s a lot easier politically to maintain a “strong safety net” in an environment of strong social cohesion (like Sweden) than it is here. I note that the Swedes’ willingness to maintain their own system of social services has eroded as the proportion of recent immigrants has increased.
The social contract is dead in the US. A few bits of evidence: Big Finance getting bailed out to the tune of “Whatever It Takes!” Meanwhile the elites tell workers that too many of them have jobs and make too much money. And so those elites plan to import vast numbers of foreign workers to make certain unemployment stays high and wages get suppressed, and to further erode all social norms and cohesion.
…: And so those elites plan to import vast numbers of foreign workers to make certain unemployment stays high and wages get suppressed, and to further erode all social norms and cohesion.
Darn those Irish immigrants!
Zachriel:
Presumably, your comment is intended to evoke the reactions of American nativists to the 19th century immigrants. There’s a major difference between now and then. Throughout the 19th and early 20th centuries, real wages grew in the United States. The linked paper suggests that immigration prevented wages from growing even faster.
Today real wages, except in very rarified areas, e.g. the top .1% of income earners, workers in healthcare and education, are flat or even declining. Unemployment in science, technology, engineering, and mathematics is too high to suggest a labor shortage. The Mark Zuckerbergs of the world complain about labor shortages not because there’s a shortage but to push wages farther down.
Zach
I’ve never attempted to make a case for no government. But I do make the case that government gets in the way of the private sector engine, and in the context of this thread, investment. Your comment really has no content. How much government, and what sectors or how? And what tax policy, to fund what?
Pensions? Health care? Solar energy? Infrastructure?
Government, in my opinion, is really pretty much a cost to be tolerated but not advanced. Defense is exhibit A. But as growth becomes a greater issue the ability to humor governmentalists becomes more limited.
The floor is yours. Government to do what, and how much and financed how?
Dave Schuler: As I’ve suggested before, it’s a lot easier politically to maintain a “strong safety net†in an environment of strong social cohesion (like Sweden) than it is here.
Sure. The U.S. has always had the integrating immigrant populations. Even then, Social Security, then, much later, Medicare, have found a place in America; so there’s apparently at least some sense of common society in the U.S.
Dave Schuler: There’s a major difference between now and then. Throughout the 19th and early 20th centuries, real wages grew in the United States.
Strong economic growth usually attends industrialization. Since then, the U.S. has still grown though the benefits of that growth have not been evenly distributed in the last few decades.
Dave Schuler: Unemployment in science, technology, engineering, and mathematics is too high to suggest a labor shortage.
Did you mean too low? It suffices to say that workers need retraining. You can allow the market to make these decisions, but there is a large lag the training and the jobs.
Instead of adapting slowly, industries tend to muddle along until there is a disruption in the market, then they go into crisis-mode, laying off workers. Markets are generally short-sighted, so many countries have industrial policies whereby they attempt to anticipate the markets, or at least help retrain workers once they’ve been discarded. This may sometimes result in misallocation of resources, of course, but there is reason to believe that retraining workers who have been laid off from defunct industries has benefits for the overall economy.
Red Barchetta: But I do make the case that government gets in the way of the private sector engine, and in the context of this thread, investment.
Sure it can.
Red Barchetta: How much government, and what sectors or how?
We’ve already answered this. Government should avoid direct investment in ordinary business, with limited exceptions. They have a role to play in the social safety net, including healthcare, pensions, and education. They also should provide a well-regulated marketplace, and exert some reasonable control of the market cycle. Investment in basic science and technology has also been found to be efficacious. On the other hand, markets are the engine of economic growth, so competition must be allowed to flourish.
Of note, nearly every major economic power uses just such a mixed system.
Zachriel:
Both Social Security and Medicare were enacted into law at points at which the U. S. immigrant population was at historic lows.
My interpretation of events is somewhat different. I think that in a buyer’s market for labor in which the buyer can depend on a reliable stream of immigrant labor it makes sense for them to offload training expenses that once were borne by the employers onto the employees. When the imported labor can be trained to order at relatively low cost overseas and paid less than the going market value, it explains the present situation handily.
The remedy I’ve suggested is a public clearing house for the workers for which H1-B visas are being sought that would list the job, location, compensation, and required skills. Current residents who would accept the jobs would receive preference over issuing new H1-Bs. It would also provide the opportunity to determine if the wages being offered were consistent with legal requirements.
Dave Schuler: When the imported labor can be trained to order at relatively low cost overseas and paid less than the going market value, it explains the present situation handily.
If labor can be imported cheaper, it probably should be, otherwise the system won’t be sustainable over the long term. On the other hand, if Americans are competing against low wage workers, then they’re not doing it right. The U.S. should be training the next generation of workers, not the last.
Dave Schuler: Both Social Security and Medicare were enacted into law at points at which the U. S. immigrant population was at historic lows.
Sure. The other way to look at it is that they were passed after massive waves of immigration had been integrated into the larger society.
Zachriel:
I’m not sure I’d characterize the 500,000 to 1 million foreign-born and native-born Mexican Americans forcibly deported to Mexico by the Roosevelt Administration as “integrated into the larger society”.
Dave Schuler: I’m not sure I’d characterize the 500,000 to 1 million foreign-born and native-born Mexican Americans forcibly deported to Mexico by the Roosevelt Administration as “integrated into the larger societyâ€.
The vast majority of immigrants were not deported.
Certainly there were strains of social integration, but that actually supports the point. When Social Security was enacted, the U.S. was knitting huge numbers of immigrants into the culture. At that time, the U.S. population included about 12% foreign born residents, with many more second generation Americans.