The PPACA - Implementation Phase I

[St. Clown]

Re: The PPACA - Implementation Phase I

I forgot...there are some people who watch It's a Wonderful Life and think Potter is the good guy.

In what way could this possibly have ties to It's a Wonderful Life? At what point does either Bailey or Potter make comment on government spending? As best I could tell, George Bailey's doing everything he can with is customers to keep his S&L open, not petitioning the government.

[Rover]

In what way could this possibly have ties to It's a Wonderful Life? At what point does either Bailey or Potter make comment on government spending? As best I could tell, George Bailey's doing everything he can with is customers to keep his S&L open, not petitioning the government.

Puhleeze. Instead of picking himself up by his bootstraps Bailey relied on the largesse of the public to fund his incompetence, which will only encourage even more risk taking on his part.

This is fun! My favorite was the parody Mad Magazine did about if Ronald Reagan had written A Christmas Carol.

[LynahFan]

Re: The PPACA - Implementation Phase I

The point of Obamacare from its supporters wasn't that you'd be seeing lower costs year over year. This is a false argument and frankly an impossible task. The point was to bend the cost curve so that health care expenditures got more in line with the growth in inflation, i.e. a sustainable rate. Healthcare costs aren't there yet, but even the CBO has downgraded the expected future increases in projected health care expenditures.

http://thinkprogress.org/health/2013...pending-drops/


The key to all of this is delivering the care more efficiently, not random cuts (or for that matter random tax hikes). Obamacare to its credit and something we don't always see out of govt policy is forward looking as it seeks to change the way care is delivered on a patient by patient basis instead of billing by procedure. That as well as getting people out of the ER for routine care is what will continue to bend the cost curve.

In which case, ObamaCare can't fail, because you're measuring it against a ghost. No matter how bad things get, all you have to say is, "well, they would have been worse." That's a cold comfort when the unsolved problem is still sitting squarely in our laps.

[FreshFish]

Re: The PPACA - Implementation Phase I

This.

The entire premise of Obamacare is that if everyone is covered, people will stop using emergency care and people will get preventive/early care, so total costs should come down. There are two major "sources" of health care spending: government subsidies (i.e. the portion of our taxes that go to pay for healthcare) and premium payments by those who are covered. If total costs were really coming down, then one or both of those entities (government and premium payers) should be spending *less* than they were before. So far, I've seen precious little evidence that this is occurring or will occur in the near future.

The way PPACA is structured, it nearly "requires" a spiraling premium structure: they have made it abundantly clear that they are overcharging the young, which would discourage the young from joining. Worse than that, they outlawed the one thing that makes insurance affordable, which is high deductibles (they also want to outlaw stop-loss coverage for self-insured groups, which is more insanity from novices with an overabundance of enthusiasm and a dire shortage of knowledge).

What really stinks is how Congress wrote into the law that Members and their staffs were required to participate in exchange-sponsored coverage, without any subsidies (due to their income levels), just like everyone else....except now that they've seen what that entails, they ran as fast as they could to get exemptions for themselves.

If the law as written requires them to obtain exchange-sponsored coverage, and they want an exemption from that requirement so badly, what does that tell you about their perceptions, eh?

I'm sure the Chief Cheerleader here will find a way to gloss over that one with some witty quip that totally evades a serious answer. sigh.

[Rover]

The way PPACA is structured, it nearly "requires" a spiraling premium structure: they have made it abundantly clear that they are overcharging the young, which would discourage the young from joining. Worse than that, they outlawed the one thing that makes insurance affordable, which is high deductibles (they also want to outlaw stop-loss coverage for self-insured groups, which is more insanity from novices with an overabundance of enthusiasm and a dire shortage of knowledge).

What really stinks is how Congress wrote into the law that Members and their staffs were required to participate in exchange-sponsored coverage, without any subsidies (due to their income levels), just like everyone else....except now that they've seen what that entails, they ran as fast as they could to get exemptions for themselves.

If the law as written requires them to obtain exchange-sponsored coverage, and they want an exemption from that requirement so badly, what does that tell you about their perceptions, eh?

I'm sure the Chief Cheerleader here will find a way to gloss over that one with some witty quip that totally evades a serious answer. sigh.

I'll just let the truth do the talking Fishy:

http://www.newrepublic.com/article/1...t-lie-wont-die

Seems you've been playing a little fast and loose with the facts, no?

[Rover]

In which case, ObamaCare can't fail, because you're measuring it against a ghost. No matter how bad things get, all you have to say is, "well, they would have been worse." That's a cold comfort when the unsolved problem is still sitting squarely in our laps.

As the sole reasonable conservative on the board Lynah, I'm a bit surprised you've taken this tact. Plenty of people get paid lots of money to do what the CBO does, which is forecast out future expenditures. As best I can tell, they had historical growth rates to project out healthcare spending 10 years hence. Then the last two years expenditure growth has come down quite bit (maybe from a general 8% increase down to 4%). So, like any good analyst they've adjusted their #'s, bringing down projected expenses by 500Bn over that time.

I don't remember what you do for work, but if two years ago you made an honest projection of what your department would spend, then as a result of some actions you took and some outside factors you went back to your bosses and told them that you'd been able to cut the growth rate of expenses in half, I would hope you'd be rewarded for that effort instead of having them tell you "well you're comparing it to a ghost". Same thing here unless you're of the thought that the CBO is really a communist infiltrated organization affilated with ACORN to prepare the Earth for an alien colonization.

[LynahFan]

Re: The PPACA - Implementation Phase I

As the sole reasonable conservative on the board Lynah, I'm a bit surprised you've taken this tact. Plenty of people get paid lots of money to do what the CBO does, which is forecast out future expenditures. As best I can tell, they had historical growth rates to project out healthcare spending 10 years hence. Then the last two years expenditure growth has come down quite bit (maybe from a general 8% increase down to 4%). So, like any good analyst they've adjusted their #'s, bringing down projected expenses by 500Bn over that time.

I don't remember what you do for work, but if two years ago you made an honest projection of what your department would spend, then as a result of some actions you took and some outside factors you went back to your bosses and told them that you'd been able to cut the growth rate of expenses in half, I would hope you'd be rewarded for that effort instead of having them tell you "well you're comparing it to a ghost". Same thing here unless you're of the thought that the CBO is really a communist infiltrated organization affilated with ACORN to prepare the Earth for an alien colonization.

I'm not disputing (nor endorsing) the CBO's numbers - certainly not knowledgeable enough to know either way. As long as health care spending rate increase exceeds inflation, it will, by definition, continue to grow as a share of our GDP. I recognize that there's a difference between being 4x the rate of inflation vs. 2x, but neither of those is a long-term solution to the problem of health care costs gobbling up the economy.

I'm in aerospace/defense, where my bosses would tell me, "meet your specification, period." Rational or not, being 0.01% over a spec limit can literally cause 100s of millions of dollars to be spent or entire programs to be outright canceled.

[Priceless]

Re: The PPACA - Implementation Phase I

In what way could this possibly have ties to It's a Wonderful Life? At what point does either Bailey or Potter make comment on government spending? As best I could tell, George Bailey's doing everything he can with is customers to keep his S&L open, not petitioning the government.

The evil redistribution of wealth!

[FreshFish]

Re: The PPACA - Implementation Phase I

As long as health care spending rate increase exceeds inflation, it will, by definition, continue to grow as a share of our GDP. I recognize that there's a difference between being 4x the rate of inflation vs. 2x, but neither of those is a long-term solution to the problem of health care costs gobbling up the economy.

The fact that the rate of increase in health care spending exceeds the (reported) inflation rate is not necessarily a problem. It might merely indicate rising prosperity.

For example, one measure of poverty is infant mortality. If more infants survive, then we'd expect health care spending to increase faster than inflation, because there are now more children making visits to pediatricians, (hopefully) getting vaccinated, etc.

Similarly with many semi-elective procedures. A poor person with a bad joint suffers a lot of pain, nowadays it's not uncommon for a person with median income to have hip replacement or knee replacement.

Another factor related to rising health care costs is improved diagnostics. People who used to suffer fatal heart attacks are now being treated for heart problems before they become lethal. Would anyone seriously argue that we should just let them die instead, in order to keep healthcare costs down??


All of these factors are part of Howard Dean's scathing indictment of the Independent Payment Advisory Board (posted earlier, it also was printed in The New York Times about two weeks ago but I didn't re-post it then. I suppose I should have, so that progressives could have read it from their Bible from one of their own Prophets).


Rising health care costs are not necessarily a problem, they may very well be a good thing. One of the virtues of individual choice is that people, unless constrained otherwise by an intrusive government, can decide to spend a larger share of their income on improved healthcare if they want. So my parents gave us braces instead of crooked teeth, and we gave our kids Invisalign instead of wire braces. It was optional, but to us well worth the extra money.

The libertarian critique of PPACA is that it makes options illegal and forces everyone into a Procrustean bed instead.

[Rover]

Re: The PPACA - Implementation Phase I

This sums it up pretty well. One has to wonder why so many "the market solves all problems" conservatives are against the ACA?

It Takes A Government (To Make A Market)
Lots of reporting on the new Kaiser Family Foundation analysis of what we know so far (pdf) about premiums under Obamacare. It definitely looks as if there will be a mild “rate shock” — in the right direction.

While premiums will vary significantly across the country, they are generally lower than expected.

What’s going on here? Partly it’s a vindication of the idea that you can make health insurance broadly affordable if you ban discrimination based on preexiting conditions while inducing healthy individuals to enter the risk pool through a combination of penalties and subsidies. But there’s an additional factor, that even supporters of the Affordable Care Act mostly missed: the extent to which, for the first time, the Act is creating a truly functioning market in nongroup insurance.

Until now there has been sort of a market — but one that, as Kenneth Arrow pointed out half a century ago, is riddled with problems. It was very hard for individuals to figure out what they were buying — what would be covered, and would the policies let them down? Price and quality comparisons were near-impossible. Under these conditions the magic of the marketplace couldn’t work — there really wasn’t a proper market. And insurers competed with each other mainly by trying to avoid covering people who really needed insurance, and finding excuses to drop coverage when people got sick.

With the ACA, however, insurers operate under clear ground rules, with clearly defined grades of plan and discrimination banned. The result, suddenly, is that we have real market competition.

In an alternative universe, conservatives would be celebrating this good news as a vindication of their views. See, the Heritage Foundation — which actually developed the original version of this plan! — was right! You don’t need single-payer, just a properly set up market system. (For the record, I believe that single-payer would be better and cheaper, and it’s still a goal we should seek).

But in this universe, conservatives claim that creating a real market for health insurance, and making sure that everyone can afford it, is the moral equivalent of slavery.

[LynahFan]

Re: The PPACA - Implementation Phase I

The fact that the rate of increase in health care spending exceeds the (reported) inflation rate is not necessarily a problem. It might merely indicate rising prosperity.

You are completely begging the question (in the true meaning of that phrase). Your premise is that people could be accumulating more and more discretionary dollars that they can choose to spend on health care. Where did all those discretionary dollars come from? A growing economy. So your premise relies on an assumption that the economy is growing faster than health care costs - which is exactly where I said we need to be. We need the rate of increase of health care costs to be less than the growth rate of the economy, or to state it your way, we need the growth rate of the general economy to be faster than the growth rate of health care costs.

[LynahFan]

Re: The PPACA - Implementation Phase I

This sums it up pretty well. One has to wonder why so many "the market solves all problems" conservatives are against the ACA?

It Takes A Government (To Make A Market)
Lots of reporting on the new Kaiser Family Foundation analysis of what we know so far (pdf) about premiums under Obamacare. It definitely looks as if there will be a mild “rate shock” — in the right direction.

While premiums will vary significantly across the country, they are generally lower than expected.

What’s going on here? Partly it’s a vindication of the idea that you can make health insurance broadly affordable if you ban discrimination based on preexiting conditions while inducing healthy individuals to enter the risk pool through a combination of penalties and subsidies. But there’s an additional factor, that even supporters of the Affordable Care Act mostly missed: the extent to which, for the first time, the Act is creating a truly functioning market in nongroup insurance.

Until now there has been sort of a market — but one that, as Kenneth Arrow pointed out half a century ago, is riddled with problems. It was very hard for individuals to figure out what they were buying — what would be covered, and would the policies let them down? Price and quality comparisons were near-impossible. Under these conditions the magic of the marketplace couldn’t work — there really wasn’t a proper market. And insurers competed with each other mainly by trying to avoid covering people who really needed insurance, and finding excuses to drop coverage when people got sick.

With the ACA, however, insurers operate under clear ground rules, with clearly defined grades of plan and discrimination banned. The result, suddenly, is that we have real market competition.

In an alternative universe, conservatives would be celebrating this good news as a vindication of their views. See, the Heritage Foundation — which actually developed the original version of this plan! — was right! You don’t need single-payer, just a properly set up market system. (For the record, I believe that single-payer would be better and cheaper, and it’s still a goal we should seek).

But in this universe, conservatives claim that creating a real market for health insurance, and making sure that everyone can afford it, is the moral equivalent of slavery.

The odd thing is, I think you really are so delusional as to think a solution that involves the government meddling with both the product and its price is a "market" solution.

[Rover]

The odd thing is, I think you really are so delusional as to think a solution that involves the government meddling with both the product and its price is a "market" solution.

Putting aside your assessment of my mental health, lets explore the question at hand. Clearly a completely privatized market is an unworkable disaster. Simply put insurance would only be offered to healthy people not likely to need it. So, the only entity powerful enough to regulate against such practices is...the gubmint. Its the same concept of why we're all not allowed to drive after putting away 20 beers over an hour or two or purchase dynamite for recreational usage. Society has to say on occasion "these are the rules".

Now that we've established that the gubmint needs to be involved, meddling in the product and price is a necessity, as hard as it might be for some to come to grips with that. Given these facts, the question now becomes how best to combine the right amount of govt rule making with some free market solutions. This is what Obamacare seeks to do. You have to get insurance, so no grifting the system. Insurance has to cover certain procedures, so no only choosing the healthy uncomplicated people. Within those parameters, see who can offer the best plan in each state. Again, what's the problem?

[FreshFish]

Re: The PPACA - Implementation Phase I

Simply put insurance would only be offered to healthy people not likely to need it.

but that's NOT how health insurance worked, pre-PPACA. ALL new employees at a company can enroll in the health insurance plan when they are first hired, regardless of pre-existing conditions. For the Federal government insurance program, ALL existing employees, during an open enrollment window, can switch health insurance companies if they want, regardless of pre-existing conditions.

You stated something that is demonstrably not true.

One of the biggest problems has been that employer-sponsored insurance, association-sponsored insurance, and insurance offered to individuals have all operated under different sets of rules. We certainly did NOT need PPACA to rectify that situation.

[FreshFish]

Re: The PPACA - Implementation Phase I

You are completely begging the question (in the true meaning of that phrase). Your premise is that people could be accumulating more and more discretionary dollars that they can choose to spend on health care. Where did all those discretionary dollars come from? A growing economy. So your premise relies on an assumption that the economy is growing faster than health care costs - which is exactly where I said we need to be. We need the rate of increase of health care costs to be less than the growth rate of the economy, or to state it your way, we need the growth rate of the general economy to be faster than the growth rate of health care costs.

It sounds like you are shifting the question, or perhaps there are just two different ways that the question was framed. One person framed the question as saying that if healthcare costs grow faster than the rate of inflation, there "must be" a problem. I responded to that question by saying "not necessarily."

You are raising a different question, which is healthcare costs as a percentage of GNP. You omit the impact of technological change and of productivity improvements: if we can perform basic services more efficiently (using tractors and harvesters instead of hoes and scythes), we can feed more people more cheaply than before. A portion of those savings can then be used to finance greater discretionary healthcare spending.

In this example, healthcare spending is growing faster than the economy as a whole because gains in one part are financing spending in another part. We don't necessarily need the entire economy to be growing faster in aggregate, we merely need continued innovation and productivity improvements. A certain part of the growth in the economy comes from population growth. What we REALLY need is for the growth of the economy to exceed the growth in the population. THAT is the single key metric that drives the rest.