The PPACA - Implementation Phase I

[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.

 

[LynahFan]

Re: The PPACA - Implementation Phase I

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.

You're right - should be framing this on a per capita basis to normalize for population growth, and you're right that I'm assuming that the Fed roughly does its job so that the rate of inflation is not terribly different from GDP growth rate.

I'm definitely not sold on your technology/productivity point, though. I think there are currently ~9 milllion people (3% out of 300M) involved in agriculture (don't quote me on that, but let's go with it for now). What if our farming became so efficient that only 1M people were needed to supply food for the entire country? If food prices (initially) remained the same, then those 1M people would be raking in all of the profits that used to be distributed among 9M people, and the total size of the economy would not change. However, there are now 8M people out of work, who have less purchasing power. They'll scrimp and save - and buy less food than before - so the demand for food will fall and the 1M remaining producers will have to lower their prices. All else being equal, then, the net size of the economy will shrink, not grow.

 

[FreshFish]

Re: The PPACA - Implementation Phase I

I'm definitely not sold on your technology/productivity point, though. I think there are currently ~9 milllion people (3% out of 300M) involved in agriculture (don't quote me on that, but let's go with it for now). What if our farming became so efficient that only 1M people were needed to supply food for the entire country? If food prices (initially) remained the same, then those 1M people would be raking in all of the profits that used to be distributed among 9M people, and the total size of the economy would not change. However, there are now 8M people out of work, who have less purchasing power. They'll scrimp and save - and buy less food than before - so the demand for food will fall and the 1M remaining producers will have to lower their prices. All else being equal, then, the net size of the economy will shrink, not grow.

Reminds me of a famous story, I wish I could remember which economist told it. I think his last name starts with a Z. Maybe we should shift to the Business & Economics thread for it? I'll post it later.

 

[Rover]

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.

Fishy you're missing the point. Lets say you have a pre-existing condition (you beat cancer in the past or have high blood pressure, etc). Yes, there's a chance if you get hired at a company you can get coverage when you enroll for next year's coverage. The problem which you're either being disingenous or stupid about is if you aren't fortunate enough to get a new job. What is your solution to that little issue, especially when you consider how many people 1) go through periods of unemployment, 2) work for themselves, or 3) work for companies that don't offer coverage. Many people have to leave the workforce to deal with an injury. What would you do with them?

 

[Rover]

Re: The PPACA - Implementation Phase I

Hey remember when knuckledraggers were trying to tell us that doctors were all ditching Medicare patients? Turns out that was BS. Yet another example of why conservatives have the credibility and popularity of a steaming pile of turds....

http://www.thefiscaltimes.com/Columns/2013/09/04/Are-Doctors-Really-Ditching-Medicare

 

[FreshFish]

Re: The PPACA - Implementation Phase I

Fishy you're missing the point. Lets say you have a pre-existing condition (you beat cancer in the past or have high blood pressure, etc). Yes, there's a chance if you get hired at a company you can get coverage when you enroll for next year's coverage. The problem which you're either being disingenous or stupid about is if you aren't fortunate enough to get a new job. What is your solution to that little issue, especially when you consider how many people 1) go through periods of unemployment, 2) work for themselves, or 3) work for companies that don't offer coverage. Many people have to leave the workforce to deal with an injury. What would you do with them?

I've already answered this question more than once. You just choose not to listen because you have your preferred narrative and no amount of data or evidence to the contrary will be allowed to threaten your zealous belief that you've found your Savior. There's no point in responding to you any further since you refuse to listen to a reasonable alternative.

If anyone else, new to the discussion, wants a practical, workable answer to Over's question, and doesn't feel like scrolling backwards to find it, just let me know and I'll answer you. I've had it with him. His disconnect from reality has finally worn out my patience.

 

[joecct]

Re: The PPACA - Implementation Phase I

Going to cross post this on the GWOT part IV thread

If you gave the administration a choice between PPACA and Syria, which one would they choose?

 

[unofan]

Re: The PPACA - Implementation Phase I

Going to cross post this on the GWOT part IV thread

If you gave the administration a choice between PPACA and Syria, which one would they choose?

Is that a serious question? Because that's like asking, "If you had a choice between sex with a supermodel or dying a slow, painful death, which would you choose?"

 

[FreshFish]

Re: The PPACA - Implementation Phase I

Because that's like asking, "If you had a choice between sex with a supermodel or dying a slow, painful death, which would you choose?"

Given some of his speeches lately, it sounds like Obama might choose "death by having sex with the supermodel so frequently that he'd expire from exhaustion."

 

[FlagDUDE08]

Re: The PPACA - Implementation Phase I

Oh, but nothing will change with employment.

http://news.investors.com/politics-...mandate-a-list-of-cuts-to-work-hours-jobs.htm

 

[Rover]

Re: The PPACA - Implementation Phase I

Apparently not Flaggy!

http://economix.blogs.nytimes.com/2...-and-part-time-work/?partner=rss&emc=rss&_r=1