Author Topic: What comes after the ACA?  (Read 956720 times)

Roadrunner53

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Re: What comes after the ACA?
« Reply #5400 on: March 30, 2019, 03:32:39 PM »
I don't see a problem with that, though. Either way, you're trying to make other people pay for your health insurance when you are perfectly capable of providing it for yourself. Healthcare costs should be factored into the decision to retire.

Wouldn't this problem be made much simpler if we just forced everyone to pay for minimal health coverage, through taxes?  We already do this with OASDI taxes, and I think millions of Americans would be better off if we raised those taxes in exchange for "free" basic health insurance through an extended federal program that covered people under 65 too.

That way, no one has to go without health insurance for any reason, and people who genuinely don't have any money don't have to die in the streets.  I mean we already provide basic emergency coverage to those folks, but right now the rest of us pay for it with increased rates instead of everyone contributing to their own good health.

It's always struck me that the republican's "personal responsibility" narrative was somehow shoehorned into a system that encourages freeloaders.  Universal coverage, paid for with taxes, would make every individual responsible in a way that our current system does not.

Sol, I like your idea! However, not sure they would ever be able to tax people enough to pay for coverage. I suppose it would work similarly as Obamacare with the young not getting as sick as the older people. Would Medicare be eliminated or would it be part of the 'system'?

pecunia

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Re: What comes after the ACA?
« Reply #5401 on: March 30, 2019, 06:10:55 PM »
The problem is the Republicans tried and failed to change the law.  So "rule of law" goes out the window and they try to add conditions (work requirements) that don't exist in the law through a waiver process.  This is an abuse of what a waiver is for, to try out new things that will help the ends of Medicaid program.  Something designed to take away coverage from people is not helping the ends of the program, it is arbitrary, capricious and unlawful.  States do not have to expand Medicaid, but if they do, they must abide by law.  The Feds pay 90% of the costs of the expansion group.  States are not saving much after they factor in all the added administrative costs of a work requirement scheme.

 "Something designed to take away coverage from people is not helping the ends of the program, it is arbitrary, capricious and unlawful."

I think you've got these guys figured out.  It's really crazy when a potential solution is staring them right in their eyeballs and they pretend not to see it.  The potential solution is to simply copy the system in one of the other countries where medicine is not so fouled up.  The Republicans have long been on record as the conservative party.  Most of the systems in other countries provide service for all at about half the price per capita as what we have in the US.  Do they embrace this more resource favorable system?  Do they embrace this system which is financially more efficient?  Do they embrace changes to the system which the majority of people have shown they want in many polls?  No!  They fight it tooth and nail.  As I said, I think youve done a pretty good job figuring these guys out.

waltworks

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Re: What comes after the ACA?
« Reply #5402 on: March 30, 2019, 07:15:53 PM »
It's funny, I think this is actually an area where there is the potential for Trump to do a lot of good. At this point he basically owns the republican party, and the MAGA-hat crowd will go along with whatever he says. He could propose some sort of Medicare-for-all plan and drag a decent portion of the GOP along.

The William F Buckley types' heads would explode, of course, but those guys haven't been a meaningful part of the GOP in years now. Trump's got the potential to do some populist stuff that could never have flown a few years ago, just because 50% or more of the GOP base will support him if he declares Saddam Hussein's birthday a national holiday.

Now, I'm not expecting this. But the potential is there.

-W

Exflyboy

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Re: What comes after the ACA?
« Reply #5403 on: March 30, 2019, 07:27:45 PM »
The problem is the Republicans tried and failed to change the law.  So "rule of law" goes out the window and they try to add conditions (work requirements) that don't exist in the law through a waiver process.  This is an abuse of what a waiver is for, to try out new things that will help the ends of Medicaid program.  Something designed to take away coverage from people is not helping the ends of the program, it is arbitrary, capricious and unlawful.  States do not have to expand Medicaid, but if they do, they must abide by law.  The Feds pay 90% of the costs of the expansion group.  States are not saving much after they factor in all the added administrative costs of a work requirement scheme.

 "Something designed to take away coverage from people is not helping the ends of the program, it is arbitrary, capricious and unlawful."

I think you've got these guys figured out.  It's really crazy when a potential solution is staring them right in their eyeballs and they pretend not to see it.  The potential solution is to simply copy the system in one of the other countries where medicine is not so fouled up.  The Republicans have long been on record as the conservative party.  Most of the systems in other countries provide service for all at about half the price per capita as what we have in the US.  Do they embrace this more resource favorable system?  Do they embrace this system which is financially more efficient?  Do they embrace changes to the system which the majority of people have shown they want in many polls?  No!  They fight it tooth and nail.  As I said, I think youve done a pretty good job figuring these guys out.

And they have convinced their base they are "making America great again".. riight.

soccerluvof4

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Re: What comes after the ACA?
« Reply #5404 on: March 31, 2019, 04:52:27 AM »
I don't see a problem with that, though. Either way, you're trying to make other people pay for your health insurance when you are perfectly capable of providing it for yourself. Healthcare costs should be factored into the decision to retire.

Wouldn't this problem be made much simpler if we just forced everyone to pay for minimal health coverage, through taxes?  We already do this with OASDI taxes, and I think millions of Americans would be better off if we raised those taxes in exchange for "free" basic health insurance through an extended federal program that covered people under 65 too.

That way, no one has to go without health insurance for any reason, and people who genuinely don't have any money don't have to die in the streets.  I mean we already provide basic emergency coverage to those folks, but right now the rest of us pay for it with increased rates instead of everyone contributing to their own good health.

It's always struck me that the republican's "personal responsibility" narrative was somehow shoehorned into a system that encourages freeloaders.  Universal coverage, paid for with taxes, would make every individual responsible in a way that our current system does not.

Sol, I like your idea! However, not sure they would ever be able to tax people enough to pay for coverage. I suppose it would work similarly as Obamacare with the young not getting as sick as the older people. Would Medicare be eliminated or would it be part of the 'system'?



And/or will the tax be used for what its being taken out for. Both sides have a tendency to raid money from government funded programs to use elsewhere. I dont know if I am just getting grumpier in my old age but I hate politics more than ever . So many things , most things that seemingly have a simple fix are just about who wants there side to put there name on it. Its exhausting and destroying this country.

former player

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Re: What comes after the ACA?
« Reply #5405 on: March 31, 2019, 05:12:58 AM »
It's funny, I think this is actually an area where there is the potential for Trump to do a lot of good. At this point he basically owns the republican party, and the MAGA-hat crowd will go along with whatever he says. He could propose some sort of Medicare-for-all plan and drag a decent portion of the GOP along.

The William F Buckley types' heads would explode, of course, but those guys haven't been a meaningful part of the GOP in years now. Trump's got the potential to do some populist stuff that could never have flown a few years ago, just because 50% or more of the GOP base will support him if he declares Saddam Hussein's birthday a national holiday.

Now, I'm not expecting this. But the potential is there.

-W
Trump is theoretically in the place you suggest: that he could take the Republican party along with meaningful and useful healthcare reform that would increase coverage and decrease costs.  The problem is that because Trump is who he is there is no practical possibility of that happening.  Trump has demonstrated no ability to understand the issues or provide solutions (remember: no-one knew how complicated health policy is?).  Nor has he demonstrated any leadership ability of the kind that means he can appoint knowledgeable and well-intentioned people to do that policy work for him, to draft appropriate legislation, and to get Congress to pass that legislation.  Nor is there any chance that Trump would take up sensible policy and legislation proposed by the Democrats: he's not the sortof person who would allow them to take any credit for improvements.

So no, although Trump on your analysis has an opportunity to take action, he doesn't have the personal qualities that would enable him to take advantage of that opportunity.

pecunia

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Re: What comes after the ACA?
« Reply #5406 on: March 31, 2019, 07:11:49 AM »

- SNIP -

  The problem is that because Trump is who he is there is no practical possibility of that happening.  Trump has demonstrated no ability to understand the issues or provide solutions (remember: no-one knew how complicated health policy is?).  Nor has he demonstrated any leadership ability of the kind that means he can appoint knowledgeable and well-intentioned people to do that policy work for him, to draft appropriate legislation, and to get Congress to pass that legislation.  Nor is there any chance that Trump would take up sensible policy and legislation proposed by the Democrats: he's not the sortof person who would allow them to take any credit for improvements.

So no, although Trump on your analysis has an opportunity to take action, he doesn't have the personal qualities that would enable him to take advantage of that opportunity.

He is an example of a guy who was born with a silver spoon in his mouth.  Do you think the man has ever had to shop for groceries or even cook his own meals?

F Scott Fitzgerald quote:

“Let me tell you about the very rich. They are different from you and me. They possess and enjoy early, and it does something to them, makes them soft where we are hard, and cynical where we are trustful, in a way that, unless you were born rich, it is very difficult to understand. They think, deep in their hearts, that they are better than we are because we had to discover the compensations and refuges of life for ourselves. Even when they enter deep into our world or sink below us, they still think that they are better than we
are. They are different. ”

It kinda seems to fit him, Trump that is.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5407 on: March 31, 2019, 11:30:26 AM »
I don't see a problem with that, though. Either way, you're trying to make other people pay for your health insurance when you are perfectly capable of providing it for yourself. Healthcare costs should be factored into the decision to retire.

Medicaid work requirements are designed to bury people under complicated paperwork to either prove they can't work or prove that they're working enough. They are kafkaesque rules that wash people out of the system that are eligible for coverage but can't complete the absurd amounts of paperwork for whatever reason. These programs typically cost more to implement than they save in direct costs. Add in the indirect costs of people delaying care because they don't have coverage and ending up in the ER where they can't pay the bill and work requirement polices make zero sense. These polices are designed to hurt people. Full stop.
Can you be more specific about the paperwork required to prove employment/training/etc?  What exactly is required that is so onerous?

Wouldn't this problem be made much simpler if we just forced everyone to pay for minimal health coverage, through taxes?  We already do this with OASDI taxes, and I think millions of Americans would be better off if we raised those taxes in exchange for "free" basic health insurance through an extended federal program that covered people under 65 too.
...
It's always struck me that the republican's "personal responsibility" narrative was somehow shoehorned into a system that encourages freeloaders.  Universal coverage, paid for with taxes, would make every individual responsible in a way that our current system does not.
You're not answering the question.

As for "responsibility," it's important to distinguish between personal responsibility and collective responsibility.  Universal coverage, by definition, is expressly not about the individual, because it divorces to a significant degree an individual's choices (e.g. eating habits, lifestyle) from the consequences (i.e. paying for one's healthcare).

Threshkin

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Re: What comes after the ACA?
« Reply #5408 on: March 31, 2019, 11:37:12 AM »
It's wonderful to see such a balanced discussion in this thread.

EscapeVelocity2020

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Re: What comes after the ACA?
« Reply #5409 on: March 31, 2019, 12:24:05 PM »
It's wonderful to see such a balanced discussion in this thread.

It all comes down to, 'I love my dog, she's my best friend' but 'my dog chews up my shoes from time to time'.  There is no balance, per se.  Sometimes she is a dog that adds to the day's great import (and I'd argue, any day that we just enjoy passively is incredible for innumerable reasons).  And sometimes she is destroying something important.

protostache

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Re: What comes after the ACA?
« Reply #5410 on: April 01, 2019, 09:26:35 AM »
Can you be more specific about the paperwork required to prove employment/training/etc?  What exactly is required that is so onerous?

Most of these state systems require you to log work hours by visiting a website. This is easy, trivial even, for those of us who are internet-literate, own various devices that make it easy, and can afford the ongoing monthly cost of maintaining an internet connection. The people who are receiving Medicaid strictly because of their income are, by definition, likely to lack at least one of those. They're also far less likely to be able to take time away from their job or family to get to a place with internet access like a public library. Once they're there they have to remember a login and password that's probably something weird. Then they have to accurately report their work or training hours.

They have to accomplish this seemingly trivial act once a month, every month, for the entire time they're receiving Medicaid. If they miss a few months, no matter the cause (sick, injured, taking care of family, car broke down, whatever), they're kicked off and then have to re-enroll and wait out a waiting period to start receiving benefits again.

Not to mention they have to know and understand these requirements, which means having a stable home address, access to mail, etc.

Oh, and if you're a seasonal employee who works a ton for a few months in the summer and gets laid off or has very few shifts in the winter (example: service workers in Michigan's upper peninsula)? Tough luck. You're willing and able to work but there are no shifts available so therefore you cannot prove you worked 80 hours, therefore you're kicked off the program.

protostache

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Re: What comes after the ACA?
« Reply #5411 on: April 01, 2019, 09:38:36 AM »
I don't see a problem with that, though. Either way, you're trying to make other people pay for your health insurance when you are perfectly capable of providing it for yourself. Healthcare costs should be factored into the decision to retire.

Wouldn't this problem be made much simpler if we just forced everyone to pay for minimal health coverage, through taxes?  We already do this with OASDI taxes, and I think millions of Americans would be better off if we raised those taxes in exchange for "free" basic health insurance through an extended federal program that covered people under 65 too.

That way, no one has to go without health insurance for any reason, and people who genuinely don't have any money don't have to die in the streets.  I mean we already provide basic emergency coverage to those folks, but right now the rest of us pay for it with increased rates instead of everyone contributing to their own good health.

It's always struck me that the republican's "personal responsibility" narrative was somehow shoehorned into a system that encourages freeloaders.  Universal coverage, paid for with taxes, would make every individual responsible in a way that our current system does not.

Sol, I like your idea! However, not sure they would ever be able to tax people enough to pay for coverage. I suppose it would work similarly as Obamacare with the young not getting as sick as the older people. Would Medicare be eliminated or would it be part of the 'system'?

There are a whole raft of proposals that involve something like this. Some of them leave traditional Medicare alone and add a new Medicare option for people under 65. Some outlaw private insurance entirely and some leave the option of private insurance in place. Some build upon ACA and some replace it.

I really like this proposal. Like your employer sponsored health insurance? Keep it. Don't get it, don't like it, or not good enough? You get the heavily subsidized public option.

sol

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Re: What comes after the ACA?
« Reply #5412 on: April 01, 2019, 09:48:26 AM »
There are a whole raft of proposals that involve something like this. Some of them leave traditional Medicare alone and add a new Medicare option for people under 65. Some outlaw private insurance entirely and some leave the option of private insurance in place. Some build upon ACA and some replace it.

I have yet to see any proposals that actually "outlaw private insurance".  That would seem both politically unpopular and untenable.

protostache

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Re: What comes after the ACA?
« Reply #5413 on: April 01, 2019, 09:54:57 AM »
There are a whole raft of proposals that involve something like this. Some of them leave traditional Medicare alone and add a new Medicare option for people under 65. Some outlaw private insurance entirely and some leave the option of private insurance in place. Some build upon ACA and some replace it.

I have yet to see any proposals that actually "outlaw private insurance".  That would seem both politically unpopular and untenable.

The Sanders M4A proposal effectively does, as far as I understand. Private insurance can only cover things not covered by M4A and M4A covers basically everything.

pecunia

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Re: What comes after the ACA?
« Reply #5414 on: April 01, 2019, 12:01:17 PM »
I've worked for a lot of private utilities.  I see their rates and I see the lower rates when the power is delivered by a city.  I see the same thing for cable TV.  I sure don't like it when a private company takes over a toll road.  It costs more.  Private garbage collection costs more unless they pay the garbage collectors peanuts.

Let people have the option of keeping their old insurance.  Let the government have the option of providing that same service.  One works for all the profit they can gouge out of you.  The other works as public servants like firemen, police or school teachers.

Bring it on!  Let the market decide and watch the market share for those insurance companies shrink.  The only way they will honestly be able to survive is to provide some sort of substantially superior service.  Cool!  Since they will have to compete with the basic service provided by my Uncle Sam, they will need to innovate.  These innovations can then be adopted by the Uncle Sam insurance making that service better.  And so it goes.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5415 on: April 02, 2019, 02:11:48 PM »
I've worked for a lot of private utilities.  I see their rates and I see the lower rates when the power is delivered by a city.  I see the same thing for cable TV.  I sure don't like it when a private company takes over a toll road.  It costs more.  Private garbage collection costs more unless they pay the garbage collectors peanuts.
It's important to keep in mind that overhead costs (HR, payroll, accounting, legal, etc) for government-run programs are often folded into other departments, which has the effect of making Program X appear to be less costly than it actually is.  The actual cost of the program might still be lower than privatizing it, or it might be more expensive once you add those costs back in.

Can you be more specific about the paperwork required to prove employment/training/etc?  What exactly is required that is so onerous?
Most of these state systems require you to log work hours by visiting a website...<explanation snipped for brevity>
Thanks for explaining it!  It sounds like the objections are:
1) reduced access to an internet connection
2) remembering a login
3) consequences of missing a reporting period
4) understanding of requirements
5) if willing and able, but no work is available, you can't report work

I personally don't think any of those issues are unworkable.
1) If a person is willing and able to put forth the effort to work and sign up for Medicaid, I don't think it's unreasonable to expect that they can also get to a working internet connection once per month.
2) This shouldn't be an issue for anyone
3) Good point!  The reporting requirements should allow some flexibility in when you report.
4) This should happen when they sign up for benefits
5) All the programs I've heard of require either work or attempt to work, so I don't see an issue here

Now, if the process is arbitrarily obtuse, then yeah, I'm with you.  But "logging into a website to report your hours" is about as convenient as you can get these days.

beltim

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Re: What comes after the ACA?
« Reply #5416 on: April 04, 2019, 05:32:47 AM »
Thanks for explaining it!  It sounds like the objections are:
1) reduced access to an internet connection
2) remembering a login
3) consequences of missing a reporting period
4) understanding of requirements
5) if willing and able, but no work is available, you can't report work

I personally don't think any of those issues are unworkable.
1) If a person is willing and able to put forth the effort to work and sign up for Medicaid, I don't think it's unreasonable to expect that they can also get to a working internet connection once per month.
2) This shouldn't be an issue for anyone
3) Good point!  The reporting requirements should allow some flexibility in when you report.
4) This should happen when they sign up for benefits
5) All the programs I've heard of require either work or attempt to work, so I don't see an issue here

Now, if the process is arbitrarily obtuse, then yeah, I'm with you.  But "logging into a website to report your hours" is about as convenient as you can get these days.

In one year almost a quarter of Medicaid beneficiaries in Arkansas subject to the new reporting requirements were kicked off the program. 1

Regarding the bolded point 5, you're incorrect.  In Arkansas you need to work 80 hours per month or be enrolled in a study program.  There is no credit given for trying to work, or looking to work.  If you're employed 50% and one shift a month gets cancelled, that's sufficient to disqualify you for that month. 

Arkansas has the lowest household internet access rate of any state in the country (~71%2).  What's worse, the web site shuts down every day between 9PM and 7AM.  You literally can't log your hours over 40% of the possible hours. 


1  https://ccf.georgetown.edu/2019/01/18/arkansas-staggering-health-coverage-losses-should-serve-as-warning-to-other-states-considering-medicaid-work-reporting-requirement/
2  https://nces.ed.gov/programs/digest/d17/tables/dt17_702.60.asp?current=yes

protostache

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Re: What comes after the ACA?
« Reply #5417 on: April 04, 2019, 06:33:09 AM »
Now, if the process is arbitrarily obtuse, then yeah, I'm with you.

Of course they’re going to be arbitrarily obtuse. The point is to kick undeserving people off the Medicaid rolls to save the state money. Beltim illustrates the Arkansas situation. The Michigan system is not as well defined yet because it doesn’t go into effect until next year, but I don’t believe it gives any credit for trying to work.

pecunia

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Re: What comes after the ACA?
« Reply #5418 on: April 04, 2019, 11:04:15 AM »
Here's a link to the Michigan situation:

https://www.freep.com/story/news/local/michigan/2019/01/10/michigan-medicaid-work-requirements/2537407002/

I think that they should make it so all those big wigs receiving their corporate welfare should have to prove they work 80 hours a month.  Wouldn't that be fun to see?  It would not be permissible for them to hire people to do the work for them.  Isn't it odd that no requirements are assigned for them to receive their welfare checks?

Corporate Welfare: (Article is a little Old)

https://www.taxpayer.net/budget-appropriations-tax/4-examples-of-corporate-welfare-in-action/


zolotiyeruki

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Re: What comes after the ACA?
« Reply #5419 on: April 04, 2019, 01:29:14 PM »
In one year almost a quarter of Medicaid beneficiaries in Arkansas subject to the new reporting requirements were kicked off the program. 1

Regarding the bolded point 5, you're incorrect.  In Arkansas you need to work 80 hours per month or be enrolled in a study program.  There is no credit given for trying to work, or looking to work.  If you're employed 50% and one shift a month gets cancelled, that's sufficient to disqualify you for that month. 

Arkansas has the lowest household internet access rate of any state in the country (~71%2).  What's worse, the web site shuts down every day between 9PM and 7AM.  You literally can't log your hours over 40% of the possible hours. 
Wow, citations and everything.  You're better than 95% of the internet commentators! :)

What's preventing the person from getting a second part-time job to fill some of those missing hours, or sign up for a study program alongside their part time job?

The website shuts down from 9PM to 7AM?  Ok, I'm with you there--that's ridiculous, and I would *love* to hear the justification for that.

Of course they’re going to be arbitrarily obtuse. The point is to kick undeserving people off the Medicaid rolls to save the state money. Beltim illustrates the Arkansas situation. The Michigan system is not as well defined yet because it doesn’t go into effect until next year, but I don’t believe it gives any credit for trying to work.
I think you're right, the point *is* to kick undeserving people (specifically, those who can work/study but choose not to) off the rolls.  And I'm not sure why I should object to that.  Allowing them to stay on the rolls is pretty much the definition of Economic Outpatient Care.  Certainly there are those who genuinely cannot support themselves, and even flint-hearted old me doesn't have a problem with that.

protostache

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Re: What comes after the ACA?
« Reply #5420 on: April 04, 2019, 01:34:53 PM »
In one year almost a quarter of Medicaid beneficiaries in Arkansas subject to the new reporting requirements were kicked off the program. 1

Regarding the bolded point 5, you're incorrect.  In Arkansas you need to work 80 hours per month or be enrolled in a study program.  There is no credit given for trying to work, or looking to work.  If you're employed 50% and one shift a month gets cancelled, that's sufficient to disqualify you for that month. 

Arkansas has the lowest household internet access rate of any state in the country (~71%2).  What's worse, the web site shuts down every day between 9PM and 7AM.  You literally can't log your hours over 40% of the possible hours. 
Wow, citations and everything.  You're better than 95% of the internet commentators! :)

What's preventing the person from getting a second part-time job to fill some of those missing hours, or sign up for a study program alongside their part time job?

The website shuts down from 9PM to 7AM?  Ok, I'm with you there--that's ridiculous, and I would *love* to hear the justification for that.

Of course they’re going to be arbitrarily obtuse. The point is to kick undeserving people off the Medicaid rolls to save the state money. Beltim illustrates the Arkansas situation. The Michigan system is not as well defined yet because it doesn’t go into effect until next year, but I don’t believe it gives any credit for trying to work.
I think you're right, the point *is* to kick undeserving people (specifically, those who can work/study but choose not to) off the rolls.  And I'm not sure why I should object to that.  Allowing them to stay on the rolls is pretty much the definition of Economic Outpatient Care.  Certainly there are those who genuinely cannot support themselves, and even flint-hearted old me doesn't have a problem with that.

They’re not undeserving, is the thing. According to the law as passed by Congress and affirmed by the Supreme Court multiple times, people in Medicaid expansion states qualify for Medicaid solely based on income. The states have to ask for a waiver for these work requirements. Waivers are being granted based on extremely flimsy, unscientific, not financial sound justifications.

seattlecyclone

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Re: What comes after the ACA?
« Reply #5421 on: April 04, 2019, 02:36:12 PM »
In one year almost a quarter of Medicaid beneficiaries in Arkansas subject to the new reporting requirements were kicked off the program. 1

Regarding the bolded point 5, you're incorrect.  In Arkansas you need to work 80 hours per month or be enrolled in a study program.  There is no credit given for trying to work, or looking to work.  If you're employed 50% and one shift a month gets cancelled, that's sufficient to disqualify you for that month. 

Arkansas has the lowest household internet access rate of any state in the country (~71%2).  What's worse, the web site shuts down every day between 9PM and 7AM.  You literally can't log your hours over 40% of the possible hours. 
Wow, citations and everything.  You're better than 95% of the internet commentators! :)

What's preventing the person from getting a second part-time job to fill some of those missing hours, or sign up for a study program alongside their part time job?

I don't know. Maybe, just maybe, suppose that there might exist an area where there aren't enough jobs available for every adult human living there to get employed at least half-time.

ysette9

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Re: What comes after the ACA?
« Reply #5422 on: April 04, 2019, 05:29:28 PM »
Tying healthcare to employment is a terrible idea and we’ve known that for a long time. Among other things it ties employees to employeurs when they might otherwise look for a different or better job, volunteer, care for family members, or be entrepreneurial. It also prevents people from retiring when they are able, which one can argue ties up jobs that could go to other people, reducing opportunities. I just learned that the tax treatment of employee-sponsored health plans is the biggest tax expenditure, bigger than the mortgage interest deduction.

https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html

More importantly in my mind, tying health care to work creates this awful catch-22 where you lose the critical coverage you need to stay alive at the very moment that you need it most. Because if you fall really sick and really need care then you likely aren’t able to work to keep your coverage. To me that feels cruel, kicking someone when they are down. If we are okay with that as a society then I think that exposes a very ugly part of our collective nature.

pecunia

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Re: What comes after the ACA?
« Reply #5423 on: April 05, 2019, 05:15:19 AM »
Tying healthcare to employment is a terrible idea and we’ve known that for a long time. Among other things it ties employees to employeurs when they might otherwise look for a different or better job, volunteer, care for family members, or be entrepreneurial. It also prevents people from retiring when they are able, which one can argue ties up jobs that could go to other people, reducing opportunities. I just learned that the tax treatment of employee-sponsored health plans is the biggest tax expenditure, bigger than the mortgage interest deduction.

https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html

- SNIP -

Good Article:  I guess people don't see that this type of health care cuts their pay.  Form the article:

"The system also induces people to spend more money on health insurance than other things, most likely increasing overall health care spending. This includes less employer spending on wages, and as health insurance premiums have increased sharply in the last 15 years or so, wages have been rather flat. Many economists believe that employer-sponsored health insurance is hurting Americans’ paychecks."

How much control does the average person have over the type of health care offered by their employer?  Would this really be worse if the government offered the health care options?   Maybe, there would be more affordable options.

MonkeyJenga

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Re: What comes after the ACA?
« Reply #5424 on: April 05, 2019, 05:42:16 AM »
In one year almost a quarter of Medicaid beneficiaries in Arkansas subject to the new reporting requirements were kicked off the program. 1

Regarding the bolded point 5, you're incorrect.  In Arkansas you need to work 80 hours per month or be enrolled in a study program.  There is no credit given for trying to work, or looking to work.  If you're employed 50% and one shift a month gets cancelled, that's sufficient to disqualify you for that month. 

Arkansas has the lowest household internet access rate of any state in the country (~71%2).  What's worse, the web site shuts down every day between 9PM and 7AM.  You literally can't log your hours over 40% of the possible hours. 
Wow, citations and everything.  You're better than 95% of the internet commentators! :)

What's preventing the person from getting a second part-time job to fill some of those missing hours, or sign up for a study program alongside their part time job?

I don't know. Maybe, just maybe, suppose that there might exist an area where there aren't enough jobs available for every adult human living there to get employed at least half-time.

In addition, even if the jobs are there, it can be difficult to schedule two shift jobs. You don't necessarily know in advance what your hours will be each week, so adding another PT job with unpredictable hours would lead to conflict. A study program that requires in person attendance would have the same problems, and an online course is dependent on consistent access to the internet and computer literacy.

Someone might also have family obligations that only allow for half hours. I'm sure there are more possible reasons that I have never thought of, because I've never had to rely on PT jobs.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5425 on: April 05, 2019, 08:31:14 AM »
They’re not undeserving, is the thing. According to the law as passed by Congress and affirmed by the Supreme Court multiple times, people in Medicaid expansion states qualify for Medicaid solely based on income. The states have to ask for a waiver for these work requirements. Waivers are being granted based on extremely flimsy, unscientific, not financial sound justifications.
I'm sorry, it looks like there are two different definitions of "undeserving" in play here.  There's 1) legally undeserving (based on income), and 2) "morally undeserving IMO because they're unwilling to put forth the effort to support themselves."  I'm not sure which meaning you had originally when you said "The point is to kick undeserving people off the Medicaid rolls," but it sounds like you meant meaning #2, because meaning #1 wouldn't make sense.

MonkeyJenga and seattlecyclone - you're right that there are some rare cases where it's not ideal.  But here's the thing: there will *always* be corner cases where someone will fall through the cracks.  We can chase down the ever-diminishing corner cases forever, but in the process, we run the risk of creating perverse incentives and moral hazard while piling up ever-more-complex sets of rules.

Mr. Green

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Re: What comes after the ACA?
« Reply #5426 on: April 05, 2019, 08:55:26 AM »
They’re not undeserving, is the thing. According to the law as passed by Congress and affirmed by the Supreme Court multiple times, people in Medicaid expansion states qualify for Medicaid solely based on income. The states have to ask for a waiver for these work requirements. Waivers are being granted based on extremely flimsy, unscientific, not financial sound justifications.
I'm sorry, it looks like there are two different definitions of "undeserving" in play here.  There's 1) legally undeserving (based on income), and 2) "morally undeserving IMO because they're unwilling to put forth the effort to support themselves."  I'm not sure which meaning you had originally when you said "The point is to kick undeserving people off the Medicaid rolls," but it sounds like you meant meaning #2, because meaning #1 wouldn't make sense.

MonkeyJenga and seattlecyclone - you're right that there are some rare cases where it's not ideal.  But here's the thing: there will *always* be corner cases where someone will fall through the cracks.  We can chase down the ever-diminishing corner cases forever, but in the process, we run the risk of creating perverse incentives and moral hazard while piling up ever-more-complex sets of rules.
I might think everyone is morally undeserving of taking the mortgage interest tax break because they aren't willing to put forth the effort to restrain their spending and afford the home they bought, or the child tax credit because people can't afford their children. Morals aren't laws, and people are going to use our system of laws the way they are written, not based on any one person's morals.

protostache

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Re: What comes after the ACA?
« Reply #5427 on: April 05, 2019, 12:04:23 PM »
They’re not undeserving, is the thing. According to the law as passed by Congress and affirmed by the Supreme Court multiple times, people in Medicaid expansion states qualify for Medicaid solely based on income. The states have to ask for a waiver for these work requirements. Waivers are being granted based on extremely flimsy, unscientific, not financial sound justifications.
I'm sorry, it looks like there are two different definitions of "undeserving" in play here.  There's 1) legally undeserving (based on income), and 2) "morally undeserving IMO because they're unwilling to put forth the effort to support themselves."  I'm not sure which meaning you had originally when you said "The point is to kick undeserving people off the Medicaid rolls," but it sounds like you meant meaning #2, because meaning #1 wouldn't make sense.

MonkeyJenga and seattlecyclone - you're right that there are some rare cases where it's not ideal.  But here's the thing: there will *always* be corner cases where someone will fall through the cracks.  We can chase down the ever-diminishing corner cases forever, but in the process, we run the risk of creating perverse incentives and moral hazard while piling up ever-more-complex sets of rules.

I was sarcastically using the second of your definitions. I apologize for not making that clear.

pecunia

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Re: What comes after the ACA?
« Reply #5428 on: April 05, 2019, 12:59:30 PM »
Medicaid is a joint federal-state program that provides health coverage or nursing home coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care.

Are there no debter's prisons.  Are there no work houses?  The reason I bring this up is that people in prison do get medical treatment.  Any of these people in Arkansas that the state thinks are cheating to get treatment for their various illnesses should have the wherewithal to do what any sensible person would do.  Attempt to rob a bank and sit until the cops show up.  This will bypass all of the onerous paperwork and have the bonus of three hots and a cot to sleep in.

It's been done before:

https://abcnews.go.com/Health/Wellness/nc-man-allegedly-robs-bank-health-care-jail/story?id=13887040


zolotiyeruki

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Re: What comes after the ACA?
« Reply #5429 on: April 05, 2019, 03:10:40 PM »
Medicaid is a joint federal-state program that provides health coverage or nursing home coverage to certain categories of low-asset people, including children, pregnant women, parents of eligible children, people with disabilities and elderly needing nursing home care.

Are there no debter's prisons.  Are there no work houses?  The reason I bring this up is that people in prison do get medical treatment.  Any of these people in Arkansas that the state thinks are cheating to get treatment for their various illnesses should have the wherewithal to do what any sensible person would do.  Attempt to rob a bank and sit until the cops show up.  This will bypass all of the onerous paperwork and have the bonus of three hots and a cot to sleep in.

It's been done before:

https://abcnews.go.com/Health/Wellness/nc-man-allegedly-robs-bank-health-care-jail/story?id=13887040
Heh, there's even a movie (and a remake) with that plot!

pecunia

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Re: What comes after the ACA?
« Reply #5430 on: April 05, 2019, 05:52:38 PM »

- SNIP -

Heh, there's even a movie (and a remake) with that plot!

Must be a genuine problem for people if it commanded that much attention.  I think you could give people healthcare, but the work thing could be applied to the genuine freeloaders.  You can't control when you are sick and I think it is quite easy for modern medicine too see if you are faking it.  I don't like going to doctors and don't consider medical treatment a free lunch.

DavidAnnArbor

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Re: What comes after the ACA?
« Reply #5431 on: April 09, 2019, 06:57:27 PM »
It's important to keep in mind that overhead costs (HR, payroll, accounting, legal, etc) for government-run programs are often folded into other departments, which has the effect of making Program X appear to be less costly than it actually is.  The actual cost of the program might still be lower than privatizing it, or it might be more expensive once you add those costs back in.


This is clearly incorrect. Any basic government accounting course reveals that all the HR,payroll, accounting and legal has to be taken into account when calculating expenses for a governmental unit such as a program.

Threshkin

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Re: What comes after the ACA?
« Reply #5432 on: April 09, 2019, 08:58:19 PM »
It's important to keep in mind that overhead costs (HR, payroll, accounting, legal, etc) for government-run programs are often folded into other departments, which has the effect of making Program X appear to be less costly than it actually is.  The actual cost of the program might still be lower than privatizing it, or it might be more expensive once you add those costs back in.


This is clearly incorrect. Any basic government accounting course reveals that all the HR,payroll, accounting and legal has to be taken into account when calculating expenses for a governmental unit such as a program.

I agree David.  Back when I was a government contractor we had to account for all overhead costs.  Generally as a percentage of payroll

sol

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Re: What comes after the ACA?
« Reply #5433 on: April 10, 2019, 12:09:05 PM »
It's important to keep in mind that overhead costs (HR, payroll, accounting, legal, etc) for government-run programs are often folded into other departments, which has the effect of making Program X appear to be less costly than it actually is.  The actual cost of the program might still be lower than privatizing it, or it might be more expensive once you add those costs back in.


This is clearly incorrect. Any basic government accounting course reveals that all the HR,payroll, accounting and legal has to be taken into account when calculating expenses for a governmental unit such as a program.

I agree David.  Back when I was a government contractor we had to account for all overhead costs.  Generally as a percentage of payroll

In a broader sense, overhead costs for private for-profit companies are ALSO rolled into other government programs.  Deliberately and with purpose, the government funds things like power plants and highway systems that benefit private companies because they benefit the economy as a whole.  The US Navy defends oil tanker shipping lanes from pirates, at a cost of billions of dollars per year that oil companies could pay for themselves.  The government leases drilling and mining rights on public lands, spending millions in overhead costs just so that private companies can reap all of the profit from draining our natural resources.  The superfund program exists for the sole purpose of taking care of catastrophic pollution left behind by for-profit businesses that chose not to pay for their own waste disposal, transfering that cost to taxpayers while they got rich.  GPS, fiber optic telecommunication lines, power grids, all of this stuff is subsidized by the government, for the purpose of helping companies make money (because our quality of live improves as they do so).

Healthcare is just one example among many on this list.  In our current arrangement, the government gives tax breaks to corporations that provide health care for workers, which is a huge subsidy to profit-making enterprises.  They could, instead, have spent those same dollars on expanding medicaid and medicare to cover more people, if there weren't political ideologies so firmly opposed to helping people.  Just like highways and GPS satellites, there is an opportunity here for the government to spend money to help companies make money in order to help American citizens.  And yet here we are, accusing our government of accounting fraud instead?

"Privatizing" industries is an age-old conservative's dream.  It hardly ever works out to everyone's benefit, though a few very rich people tend to get richer in the process.  Just look at what happened when we privatized Conrail, or Sallie Mae.  These formerly government programs went horribly awry after being sold to private investors, costing the government far more money than they raised and drastically reducing their efficacy as drivers of national growth. 

"Nationalizing" industries in the US, by contrast, has been relatively successful.  Look at the post office, or GM under the TARP program, or Merck during WWI.  Fannie Mae was privatized back in the 60s, and had to be nationalized again during the great recession in order to survive.  I suspect we're headed down a similar pathway in health insurance in this country, where eventually it just gets to be so expensive and unavailable that the government has to step in on behalf of the nation.  Some might argue that the ACA is exactly that step, unfolding in slow motion.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5434 on: April 11, 2019, 08:20:09 AM »
It's important to keep in mind that overhead costs (HR, payroll, accounting, legal, etc) for government-run programs are often folded into other departments, which has the effect of making Program X appear to be less costly than it actually is.  The actual cost of the program might still be lower than privatizing it, or it might be more expensive once you add those costs back in.


This is clearly incorrect. Any basic government accounting course reveals that all the HR,payroll, accounting and legal has to be taken into account when calculating expenses for a governmental unit such as a program.
You know what?  I stand corrected.  I've gone back and tried to figure out where I heard that, and wasn't able to find a source.

In a broader sense, overhead costs for private for-profit companies are ALSO rolled into other government programs.  Deliberately and with purpose, the government funds things like power plants and highway systems that benefit private companies because they benefit the economy as a whole.  The US Navy defends oil tanker shipping lanes from pirates, at a cost of billions of dollars per year that oil companies could pay for themselves.  The government leases drilling and mining rights on public lands, spending millions in overhead costs just so that private companies can reap all of the profit from draining our natural resources.  The superfund program exists for the sole purpose of taking care of catastrophic pollution left behind by for-profit businesses that chose not to pay for their own waste disposal, transfering that cost to taxpayers while they got rich.  GPS, fiber optic telecommunication lines, power grids, all of this stuff is subsidized by the government, for the purpose of helping companies make money (because our quality of live improves as they do so).

Healthcare is just one example among many on this list.  In our current arrangement, the government gives tax breaks to corporations that provide health care for workers, which is a huge subsidy to profit-making enterprises.  They could, instead, have spent those same dollars on expanding medicaid and medicare to cover more people, if there weren't political ideologies so firmly opposed to helping people.  Just like highways and GPS satellites, there is an opportunity here for the government to spend money to help companies make money in order to help American citizens.  And yet here we are, accusing our government of accounting fraud instead?

"Privatizing" industries is an age-old conservative's dream.  It hardly ever works out to everyone's benefit, though a few very rich people tend to get richer in the process.  Just look at what happened when we privatized Conrail, or Sallie Mae.  These formerly government programs went horribly awry after being sold to private investors, costing the government far more money than they raised and drastically reducing their efficacy as drivers of national growth. 

"Nationalizing" industries in the US, by contrast, has been relatively successful.  Look at the post office, or GM under the TARP program, or Merck during WWI.  Fannie Mae was privatized back in the 60s, and had to be nationalized again during the great recession in order to survive.  I suspect we're headed down a similar pathway in health insurance in this country, where eventually it just gets to be so expensive and unavailable that the government has to step in on behalf of the nation.  Some might argue that the ACA is exactly that step, unfolding in slow motion.
Hang on, there, cowboy.  I'd like to inject a few points of sanity into that rant:
1) The government receives money for those leases, and takes in lots of tax revenue from the profits made by the oil companies.  From 2005 to 2015, ExxonMobil paid $110 billion in US taxes, for a profit of $85 billion.
2) GPS was developed for the military.  Civilian use is a free side effect.
3) You're cherry-picking a few failures of privatization and ignoring the multitude of failures of government-subsidized programs, while ignoring the cost those privatized programs imposed on the taxpayer while they were subsidized.  For example, I think you'd be hard-pressed to find a health insurer that has as bad a track record as, say, the VA.

sol

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Re: What comes after the ACA?
« Reply #5435 on: April 11, 2019, 09:28:31 AM »
You know what?  I stand corrected.  I've gone back and tried to figure out where I heard that, and wasn't able to find a source.

It's totally understandable, though.  There are some media outlets that consistently harp on this point, and others similar to it, to convince the population that their government is corrupt and horrible and backwards.  But in my experience, our government is mostly run by career administrators, people who have devoted their lives to trying to make their agencies provide better service at lower cost.  There are always some political appointees mucking things up, but they tend to come and go.  Behind those public faces lies an army of dedicated and hard working bureaucrats who will never be rich or famous.

Quote
1) The government receives money for those leases, and takes in lots of tax revenue from the profits made by the oil companies.  From 2005 to 2015, ExxonMobil paid $110 billion in US taxes, for a profit of $85 billion.

I really think that oil leases are a losing argument for conservatives.  Yes, the US government receives tens of billions of dollars per decade from leasing public lands, but oil companies make trillions of dollars over that same time period.  Why do you think the US government gives away 90%+ of the value of those leases?  Because they want oil companies to be hugely profitable, that's why.  It's the same reason they spend billions protecting oil tanker shipping lanes, instead of allowing the industry to shoulder it's own costs of protection.

Quote
2) GPS was developed for the military.  Civilian use is a free side effect.

If you know anything about the history of the GPS system, you know that your government spent a lot more money than was necessary in order to make it widely available to the civilian market.  A military-only positioning system would look very different.  It was definitely not free to develop, and it was definitely not free to open up to public use, including by our adversaries.

You could have made an identical argument about the internet, which was also "developed for the military" and yet of huge economic benefit to the world.  I don't think that anyone believes that the civilian internet "is a free side effect" of ARPANET.  The modern civilian version bears only a passing resemblance to the military version.

Quote
3) You're cherry-picking a few failures of privatization

That was not my intention, but I do note that you've completely failed to address the specific high profile examples I provided, while failing to provide any counterexamples.  If you believe Conrail and Sallie Mae were successful examples of privatization, I'd love to hear you defend that position.  If you have other examples of formerly government run programs that were privatized and went on to be successful, I'm all ears.  They are few and far between.

Meanwhile, I can add to the list of successful nationalizations off the top of my head.  The Pony Express was privately owned and operated, but the US mail service is not.  Fire and police used to be privately operated, too.  Also schools, before the government took up public education as a public good.  We used to maintain private militias for national defense, before the proper US military.  Private libraries, private scientific research, private highways, these things are not unheard of today but I don't think anyone believes they are better for the country than the public versions.  Better for individual rich people, maybe, but not better for the nation.  I believe healthcare belongs on this list, and should be nationalized just like education, defense, research, and other vital pieces of our economic infrastructure.

Quote
ignoring the multitude of failures of government-subsidized programs, while ignoring the cost those privatized programs imposed on the taxpayer while they were subsidized.

Not ignoring them, specifically discussing them.  Conrail was a government-funded bailout of failing private businesses, which rescued those lines for the national good.  It was eventually sold back to private investors, and then celebrated as a "success of privatization" by Reagan-era conservatives, except that even a cursory reading of its history since then reveals what a terrible idea that was.  GM followed a very similar pathway, unable to survive without massive government bailouts, then stabilized and recovered by the US government and then sold for a fraction of the new value, because (like I've been saying all along) the government wants private businesses to be profitable.  It's part of the deal. 

Quote
For example, I think you'd be hard-pressed to find a health insurer that has as bad a track record as, say, the VA.

It seems only a tangentially relevant example, because the VA has never been privatized.  But they have tried expanding private care providers for vets, starting under Obama in 2014.  Unfortunately, they didn't provide additional funding and it didn't help vets get better or faster care, and did waste lots of money helping lots of private contractors get rich.  Vets are a uniquely difficult group to insure and care for, being the worst kind of risk pool, and they would have been much better served by MORE funding for the VA, not less.  Expanding private care options only spends the VA's limited resources on more expensive private doctors, resulting in fewer people getting care overall.  If you follow this issue at all, you know that veteran's service organizations and advocates are publicly opposed to privatizing the VA because they believe it will make things much worse, not better.

Which is not to say the VA is perfect.  They have real and depressing issues dealing with a population of people who have known injuries and problems, and a disconcerting lack of resources to deal with those problems.  But I challenge you to find a vet who wishes the VA didn't exist so they could just have private insurance instead.
« Last Edit: April 11, 2019, 09:38:19 AM by sol »

pecunia

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Re: What comes after the ACA?
« Reply #5436 on: April 11, 2019, 03:28:21 PM »

-SNIP -

I am going to try very hard to criticize the message and not the man:

@zolotiyeruki , without a point by point refute of this post, you do not know what the FUCK you are talking about.

How did I do?

Kinda nasty and it was unnecessary so not very well.


radram

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Re: What comes after the ACA?
« Reply #5437 on: April 11, 2019, 05:05:34 PM »

Kinda nasty and it was unnecessary so not very well.

Agreed, and removed.

I can't tell you how many times I have written something, waited, and then deleted it. This time I did not, and should have. All I can do is apologize, and try to do better. Sorry @zolotiyeruki 

Have a great day all.

ysette9

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Re: What comes after the ACA?
« Reply #5438 on: April 11, 2019, 05:07:19 PM »
What a nice échange. Thank you to everyone for doing their part to make this a good corner of the internets.

FIREstache

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Re: What comes after the ACA?
« Reply #5439 on: April 14, 2019, 01:46:17 PM »
It looks like a lot off topic stuff is getting posted in this thread, which is very long as it is.

After the ACA is overturned as unconstitutional and upheld by the higher courts,  I wonder how long it will be until we have a replacement.  Based on what I hear from republicans, and even some democrats, it sounds like they are throwing out one phrase "pre-existing conditions", but that alone would be one poor replacement for the comprehensive solution we currently have called ACA.  Remember that the ACA also includes the Medicaid expansion.  If you take away the Medicaid expansion and ACA subsidies, how are people going to be able afford health insurance, regardless of any pre-existing conditions that may be protected under future legislation?  And when it comes to any helpful solution, there are too many people that can't wait for years of legislative negotiating for something decent to come along that might actually provide affordable coverage.  They need it now.  Some democrats are talking about Medicare for All, but as some of the previous posters in this thread stated, Medicare can be much more expensive than ACA subsidized plans or certainly more than Medicaid expansion healthcare out of pocket expenses that low income people are currently able to take advantage of.  I think I have to agree with Nancy Pelosi on this - protect and improve the ACA.
« Last Edit: April 14, 2019, 10:47:42 PM by FIREstache »

pecunia

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Re: What comes after the ACA?
« Reply #5440 on: April 14, 2019, 06:41:39 PM »
" I think I have to agree with Nancy Pelosi on this - protect and improve the ACA."

I suspect that will happen.  As for the cost.  Many of the people posting on this Subject have pointed out again and again that the people in the United States are paying much more money than the people in other countries.  Some have pointed out by both personal anecdotes and by the use of statistics that these other countries provide as good or better health care than what is being provided here.  Canada calls their medical system medicare.  It costs less than what we pay.  Why should an expanded US medicare program increase costs to people?  Minimizing the role of insurance companies if cutting out the expensive middle man.  That works in lots of businesses.

 

waltworks

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Re: What comes after the ACA?
« Reply #5441 on: April 14, 2019, 10:03:05 PM »
Look, you can't just say you'll cover pre-existing conditions absent any other requirements. Individuals in that situation will just wait until they're sick to get insurance, insurance companies will all go belly-up, and you'll end up with either:

A) Everyone pays cash for all medical care, probably up front. If you can't pay you die, though EMTALA might mean most of the hospitals would have to go out of business first unless that (Ronald Reagan!) law is struck from the books.
or
B) Medicare for all in some form.

It's sort of hilarious watching people refuse to deal with those problems intellectually. It would at least be logically consistent (if, say, you were very libertarian) to say that we should just get the gov't out of health care entirely. No laws about pre-existing conditions, no EMTALA, no preferential tax treatment for benefits, no Medicaid or Medicare. Let the market set the prices. It's at least both workable and consistent. Hell, just getting rid of the benefits tax treatment would go a long way. Having health care tied to jobs is retarded no matter what your political leanings.

There's really not much tenable ground between that scenario and pretty thoroughly "socialized" medical care like we have now (though we're doing a bad job of it). As soon as you start treating destitute pregnant ladies bleeding out at the steps of the hospital, you've really made the decision, as a society, that you're going to provide medical care to people even if they can't pay for it. The rest is details.

-W
« Last Edit: April 18, 2019, 04:41:44 AM by FrugalToque »

FIREstache

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Re: What comes after the ACA?
« Reply #5442 on: April 14, 2019, 11:24:58 PM »
Why should an expanded US medicare program increase costs to people?

Not all people, just the people I mentioned, such as those getting maximum subsidies or on the Medicaid expansion.  For those people not currently getting subsidies and paying unsubsidized marketplace ACA premiums for silver plans, a Medicare for All may be less expensive.  It depends on the plan details.  I'm just using current Medicare costs (for full coverage) as a guide.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #5443 on: April 15, 2019, 05:21:36 AM »
Why should an expanded US medicare program increase costs to people?

Not all people, just the people I mentioned, such as those getting maximum subsidies or on the Medicaid expansion.  For those people not currently getting subsidies and paying unsubsidized marketplace ACA premiums for silver plans, a Medicare for All may be less expensive.  It depends on the plan details.  I'm just using current Medicare costs (for full coverage) as a guide.

Bernie says his version of Medicare for All would be essentially free to the end user.  So what he's pushing isn't really Medicare at all, it's more like Canadian style single payer, only even freer than that.  So the costs would be in the taxes, not in premiums, deductibles, or co-pays.  In theory, the taxes should be substantially lower than what society as a whole is currently paying in premiums (including employer contributions), deductibles, and co-pays, because of the removal of all the middlemen and ridiculousness that they spawn.  Personally, I don't think his plan has a chance in hell of being enacted in the US in the foreseeable future because of the wholesale disruption it would cause in the short term, and the fact that there are too many entrenched powerful interests against it.  I think Democrats would be far better off pursuing an incremental approach, starting with shoring up and tweaking the existing ACA, and perhaps adding a public option to it.

MonkeyJenga

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Re: What comes after the ACA?
« Reply #5444 on: April 15, 2019, 05:45:07 AM »
It costs money to administer Medicare, too. There are many factors contributing to high health care costs in the US, and just saying "cut out the middleman" isn't enough to address that. There would need to be comprehensive reform affecting all players in the health care system.

Exflyboy

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Re: What comes after the ACA?
« Reply #5445 on: April 15, 2019, 12:34:01 PM »
It costs money to administer Medicare, too. There are many factors contributing to high health care costs in the US, and just saying "cut out the middleman" isn't enough to address that. There would need to be comprehensive reform affecting all players in the health care system.

Right and with the HC sector representing about 12% of the US economy I doubt comprehensive reform is going to happen any time soon.. As sad as that is.

I hope I'm wrong and I guess if it becomes a big enough issue we can collective vote down the fat cats interests. I just hope we don't have to vote for such a left wing agenda that it stifles the whole economy as a result.

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5446 on: April 15, 2019, 12:39:24 PM »
Agreed, and removed.

I can't tell you how many times I have written something, waited, and then deleted it. This time I did not, and should have. All I can do is apologize, and try to do better. Sorry @zolotiyeruki 

Have a great day all.
No worries!  We all have "off" days.  I've done the whole "write a really long post, then deleted it" thing plenty of times myself. :)

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1) The government receives money for those leases, and takes in lots of tax revenue from the profits made by the oil companies.  From 2005 to 2015, ExxonMobil paid $110 billion in US taxes, for a profit of $85 billion.
I really think that oil leases are a losing argument for conservatives.  Yes, the US government receives tens of billions of dollars per decade from leasing public lands, but oil companies make trillions of dollars over that same time period.  Why do you think the US government gives away 90%+ of the value of those leases?  Because they want oil companies to be hugely profitable, that's why.  It's the same reason they spend billions protecting oil tanker shipping lanes, instead of allowing the industry to shoulder it's own costs of protection.
I think you may have missed my point earlier, specifically that the US Government gets as much (or more!) profit from oil companies (via taxes) than the oil companies themselves do, and that's on top of the cost of the lease itself, and without investing any money (or, indeed, taking any risk).  Also, profitable oil companies also mean a profitable (er, perhaps a hemorrhaging-less-money) government.  Does the government protect shipping lanes?  Sure!  But that benefit isn't exclusive to the oil industry--it applies to all shipping.  And that's what taxes are for, anyway.
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2) GPS was developed for the military.  Civilian use is a free side effect.
If you know anything about the history of the GPS system, you know that your government spent a lot more money than was necessary in order to make it widely available to the civilian market.  A military-only positioning system would look very different.  It was definitely not free to develop, and it was definitely not free to open up to public use, including by our adversaries...
Sorry, I meant "free" as in "little to no extra cost".  It doesn't take a whole lot of code to add some randomness to a timestamp :)  The fact remains that GPS (and ARPANET) were built as a military tool, and the (massive!) benefits to the civilian market were a very happy side effect.
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3) You're cherry-picking a few failures of privatization

That was not my intention, but I do note that you've completely failed to address the specific high profile examples I provided, while failing to provide any counterexamples.  If you believe Conrail and Sallie Mae were successful examples of privatization, I'd love to hear you defend that position.  If you have other examples of formerly government run programs that were privatized and went on to be successful, I'm all ears.  They are few and far between.

Meanwhile, I can add to the list of successful nationalizations off the top of my head.  The Pony Express was privately owned and operated, but the US mail service is not.  Fire and police used to be privately operated, too.  Also schools, before the government took up public education as a public good.  We used to maintain private militias for national defense, before the proper US military.  Private libraries, private scientific research, private highways, these things are not unheard of today...
I don't know that the USPS is a good choice for promoting nationalization, given their protracted woes despite monopoly power.  UPS and Fedex seem to be doing just fine.
How about public vs private schools (and homeschooling?)
There are certainly things that I agree require government control, including roads, since it entails a monopoly/right-of-way.  Private scientific research?  There's a lot of that, actually, a lot more than most people realize, but I suspect most of it is tied to more mundane pursuits, i.e. the kind that will benefit consumers.
Public libraries?  Heh, I'll take that one, too.  A couple years ago, our local public library system proudly announced that they had hit the 1-million-items-per-year mark (i.e. a million items checked out over a year).  That was on a $4.5 million budget.  Considering how many books sell for $0.01 + $3.99 shipping on ebay or half.com or amazon, this left me...underwhelmed.
As for privatizing education, that's a whole other debate.  Let's start a new thread for that one :)

I'm not familiar enough with the issues surrounding Sallie Mae to take a position on that one.
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ignoring the multitude of failures of government-subsidized programs, while ignoring the cost those privatized programs imposed on the taxpayer while they were subsidized.
Not ignoring them, specifically discussing them.  Conrail was a government-funded bailout of failing private businesses, which rescued those lines for the national good.  It was eventually sold back to private investors, and then celebrated as a "success of privatization" by Reagan-era conservatives, except that even a cursory reading of its history since then reveals what a terrible idea that was.  GM followed a very similar pathway...
Alright, let's take Conrail and GM.
Conrail:  Railroads losing money.  Gov't consolidates them.  They continue to lose money.  Gov't relaxes regulations (including exempting them from state taxes!) and they become profitable.  Gov't sells the consolidated company.  Not sure what the "national good" was here.  The deregulation that made the railroads profitable did so by allowing them to abandon unprofitable lines. 

GM:  I don't think you want to go down that rabbit hole.  The really short version is:  the government took over GM, shafted bondholders and handed greater ownership to the unions.  The government got its loan back, but all those bondholders lost out to the unions' benefit.

In both cases, we already have a legal structure designed to handle precisely this sort of situation: Chapter 11.
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For example, I think you'd be hard-pressed to find a health insurer that has as bad a track record as, say, the VA.
It seems only a tangentially relevant example, because the VA has never been privatized.  But they have tried expanding private care providers for vets, starting under Obama in 2014.  Unfortunately, they didn't provide additional funding and it didn't help vets get better or faster care, and did waste lots of money helping lots of private contractors get rich.  Vets are a uniquely difficult group to insure and care for, being the worst kind of risk pool, and they would have been much better served by MORE funding for the VA, not less.  Expanding private care options only spends the VA's limited resources on more expensive private doctors, resulting in fewer people getting care overall.  If you follow this issue at all, you know that veteran's service organizations and advocates are publicly opposed to privatizing the VA because they believe it will make things much worse, not better.
I did not claim that the VA has ever been privatized, I'm pointing to it as a comparison between a private and public healthcare systems.  You're right that veterans are notoriously hard to insure, and that they face numerous and unique challenges.  But the consistent ineffectiveness, continuing coverups, and apparent lack of accountability should serve as a stark warning.

Monkey Uncle

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Re: What comes after the ACA?
« Reply #5447 on: April 15, 2019, 02:21:10 PM »
It costs money to administer Medicare, too. There are many factors contributing to high health care costs in the US, and just saying "cut out the middleman" isn't enough to address that. There would need to be comprehensive reform affecting all players in the health care system.

Yes, I neglected to mention that government monopsony power is also a big part of controlling costs in a single payer system. 

zolotiyeruki

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Re: What comes after the ACA?
« Reply #5448 on: April 16, 2019, 09:57:59 AM »
It costs money to administer Medicare, too. There are many factors contributing to high health care costs in the US, and just saying "cut out the middleman" isn't enough to address that. There would need to be comprehensive reform affecting all players in the health care system.

Yes, I neglected to mention that government monopsony power is also a big part of controlling costs in a single payer system.
You know, that brings up an interesting point.  I've heard many times that US pharmaceutical companies charge a whole lot more for their drugs in the US than they do in many other countries.  Does that mean that the US is indirectly subsidizing healthcare in foreign countries?

waltworks

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Re: What comes after the ACA?
« Reply #5449 on: April 16, 2019, 10:51:38 AM »
You know, that brings up an interesting point.  I've heard many times that US pharmaceutical companies charge a whole lot more for their drugs in the US than they do in many other countries.  Does that mean that the US is indirectly subsidizing healthcare in foreign countries?

That depends. Once you've paid for development and research (usually piggybacking on NIH funded stuff, so there's a subsidy level there for sure) the drugs are often (though not always) super cheap to manufacture.

So in general, they are just priced to what the market will bear/pay. If you're selling the drug in Manhattan, it's $60,000. If you're selling it in DR Congo, it's $20 (I'm exaggerating... probably). You make money either way. In some cases you're selling to a national/government medical system and that entity will negotiate the price.

And yes, there's a black market/medical tourism trade that happens for lots of those drugs for that reason.

-W