Patterico's Pontifications

3/13/2017

The CBO Scores Obamacare Repeal [UPDATE]

Filed under: General — JVW @ 4:31 pm



[guest post by JVW]

The Congressional Budget Office released its analysis of the GOP’s plan to “repeal and replace” ObamaCare (also known as the Affordable Care Act) with a plan they have named the “American Health Care Act.” Predictably, the major news outlets are already framing this as the end of health care in America, with the Washington Post announcing that 14 million fewer people would be uninsured and the New York Times unsurprisingly upping the ante to 24 million people who will be now be uninsured. Fox News, God bless ’em, at least balances the news about the rise in uninsured with the projection of $337 billion in budget savings over the next ten years under the proposed new bill.

So, is it really a matter of millions of Americans who are starving for health insurance suddenly finding that it is about to be denied to them? Well, not quite. Here is the CBO’s explanation for the drop in the numbers of insured (emphasis added):

CBO and JCT [the Joint Committee on Taxation] estimate that, in 2018, 14 million more people would be uninsured under the legislation than under current law. Most of that increase would stem from repealing the penalties associated with the individual mandate. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

So how about that? The huge uptick in uninsured will largely be people who choose to be uninsured, not people who suddenly find that health insurance is unaffordable as we know happened when Obamacare was implemented. Yes, people who voluntarily go without healthcare can be a burden on the system as they often consume emergency medical services and never end up paying for them. But to say that mandated coverage a la the ACA or the even more fanciful single-payer plans would reduce emergency room visits actually flies in the face of the data, which shows that ER visits actually increased in Massachusetts after the implementation of Romneycare and in the rest of the country after the implementation of Obamacare.

So we are going to be hearing a great deal of noise from the left suggesting that the GOP’s plan is going to “take away” health insurance from a number of people who only have it thanks to the beneficence of the ACA. This argument is grossly overstated. No doubt there would be people who stand to lose their health insurance under AHCA, just as there were people who lost their health insurance under the ACA. But for the most part, the people who would end up uninsured under the AHCA are projected to be people who choose to be uninsured, and that’s a key difference.

It’s also worthwhile to point out that the CBO’s projections for Obamacare did not quite match the realities of that legislation, so there are limits on the ability of the CBO’s crystal ball to forecast the future. The AHCA may not be a great bill, and it may not be what opponents of Obamacare were expecting from a unified GOP government, but let’s not fall prey to the manufactured hysteria which is bound to be a hallmark of conventional news opinion over the coming days.

[Update:] Over at Powerline, Paul Mirengoff finds another interesting tidbit in the CBO report:

The report is here. This passage (at page 3) jumped out at me:

Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease premiums. . . .

(Emphasis added)

I was also struck by the fact that the budgetary savings posited by the CBO are weighted heavily towards the period beginning in 2020.

That is in in fact very curious if the GOP is front-loading the fiscal pain and leaving the budgetary benefits for down the road. It’s certainly the opposite of Obamacare, which was essentially “let’s promise everything up front and then implement the tax and cost-control system to pay for it down the road.” But as Mr. Mirengoff points out, it assumes that the GOP will still be running the show come 2020, and there is simply no guarantee of that. Imagine if they were to be honest enough to do the hard work up front, only to see Democrats come in and take credit for the benefits later (and of course, Democrats would very quickly “reinvest” those savings back into expanded health services).

– JVW

102 Responses to “The CBO Scores Obamacare Repeal [UPDATE]”

  1. If you take a moment to read some of the “analysis” pieces at the WaPo and NYT you will get a pretty good insight on the smug condescension that the elite news media has towards the GOP. If you knew nothing about Obamacare before reading their articles, you would be led to believe that it is largely popular and only requires some minor tweaks to function at full efficiency.

    JVW (2b202c)

  2. People will “choose” to no longer have insurance because it will become unaffordable to them. Especially older people.

    Davethulhu (fab944)

  3. People will “choose” to no longer have insurance because it will become unaffordable to them. Especially older people.

    This is your way of announcing that you are too lazy to read the CBO report, which pretty much refutes that argument, right Dave?

    JVW (2b202c)

  4. I am waiting for the FIRST person who can verify the last time that the CBO made a future economic estimate that turned out to be accurate.

    Phu Bai Phat (f35c80)

  5. The objective of the American healthcare system is to make money, not deliver cost-effective healthcare to the citizenry. Once that mind set shifts, the United States will adopt a single payer or two-tiered system, and join the 21st century before it ends.

    DCSCA (797bc0)

  6. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

    I dunno, seems to match my assertion.

    Davethulhu (fab944)

  7. I hardly call this a refutation

    , and some people would forgo insurance in response to higher premiums.

    The problem lies in this: some people will decide insurance is an unnecessary expense for something they don’t need, just like before Obamacare, and some will decide they need it but can’t afford it.
    The CBO estimate includes both, but it is really only the second category which is important. As far as I know, no one has tried to quantify that figure (how many are in category 2). It may be impossible to quantify.

    kishnevi (417b3c)

  8. Probably so, but their analysis is as threadbare as the dhs finding which was based on the crowdstrike report.

    narciso (d1f714)

  9. Both these political parties want to preserve a system where a doctor in an office will charge a patient $22 for a single, OTC 500 mg Tylanol tablet, which cost pennies to manufacture knowing it will be billed through insurance. Yet that same tablet along with 199 others in a bottle can be purchased at retail in a drug store for $8, and likely less for a generic brand of same.

    DCSCA (797bc0)

  10. They can’t calculate what the average premium will be in 2020, so its little more than a ouija board.

    narciso (d1f714)

  11. The LA Times featured a grossly untruthful front-page article Sunday which listed all kinds of ways people would lose coverage or be forced to pay more. All of their examples featured people deep in the subsidy well of Obamacare.

    It was only in the last paragraphs of the three-page article where they admitted that people who were making just above the knife-edge cut-off of the subsidies would be paying less.

    In the examples they used, a 60yo person making $30K/year in Los Angeles would have to pay about $1500 more per year (premiums themselves being equal). In an example they forgot to use, a 60yo couple making $65K/year would pay about $8000 less as they would not be subject to the absolute $62K/year subsidy cut-off.

    Kevin M (25bbee)

  12. In short, this is the same old game they MSM plays with tax cuts: look for all the extreme examples, then publish the ones that argue for your case, while making them seem like mainstream cases.

    Kevin M (25bbee)

  13. Paraphrasing Stalin, one person losing their health insurance is unremarkable. 14-24 million losing their health insurance is a mathematical error.

    Bill H (383c5d)

  14. Remember when Trump promised that his magical replacement for Obamacare would give people “such great healthcare at a tiny fraction of the cost”?

    And people actually believed him?!

    Dave (711345)

  15. You live in a country that has prisons for profit, and warming up your own car in your own driveway will cost you a $128.00 fine. Just keep on browsing, sheep, and be grateful for anything your masters let trickle down on you.

    nk (dbc370)

  16. In short, this is the same old game they MSM plays with tax cuts: look for all the extreme examples, then publish the ones that argue for your case, while making them seem like mainstream cases.

    Most people kept their insurance plans and doctors under Obamacare, too. Does that make Obama’s infamous promise truthful?

    The Secretary of HHS just told the country that NOBODY would be worse off under the new plan.

    And Trump promised that EVERYONE would have “such great healthcare at a tiny fraction of the cost”.

    Dave (711345)

  17. Some of those people would choose not to have insurance because they chose to be covered by insurance under current law only to avoid paying the penalties, and some people would forgo insurance in response to higher premiums.

    Again, from the report: “Most of that increase would stem from repealing the penalties associated with the individual mandate.” Yeah, I acknowledged that there are people who will suddenly find health insurance less affordable, but that same thing happened during the implementation of Obamacare when people who previously had health insurance insurance saw their premiums rise steeply but didn’t qualify for subsidies. And there will now likely be other people who suddenly find that they can afford more reasonable plans, now that the requirement to pay for maternity coverage and full-blown prescription plans and gender-reassignment surgery and all the other little Easter eggs promised under Obamacare disappears. So I think what CBO is acknowledging is the hard truth that Obamacare’s supporters desperately try to ignore: there are a whole lot of people out there who can afford health insurance but choose not to purchase it.

    JVW (5de783)

  18. Remember when Trump promised that his magical replacement for Obamacare would give people “such great healthcare at a tiny fraction of the cost”?

    And people actually believed him?!

    People always believe what they want to believe out of the mouths of politicians, whether it be about to efficacy of the Iraq occupation, or about the economic stimulus abilities of massively increasing debt, or about bringing manufacturing jobs back from low-wage countries. Basing policy on the stupid campaign promises made to the gullible American voter is a good way to get nowhere fast. But at the very least the folks in Washington can try to undo much of the damage that has previously been done.

    JVW (5de783)

  19. A spoonful of sugar makes the medicine go down. The bitter pill is that you need lots and lots of healthy people in an insurance group to pay for the sick ones. It works when your group is limited to “employees” (people healthy enough to work) or college students. For a group of uninsureds off the street, without the mandate and the penalty plus lots of scare tactics about the perils of being “uninsured”, you won’t get them.

    nk (dbc370)

  20. nk is exactly right. Which is why we need a single payer system that includes the entire population.

    nillary klinton (dbc370)

  21. nk is exactly right. Which is why we need a single payer system that includes the entire population.

    If you guys want to argue for single payer then by all means do so, but at least be honest and level with the American people what single payer entails: higher taxes for everyone (including for the poor), rationing of care, long waits for medical procedures, fewer specialists, less time spent with actual physicians, and a group of unaccountable government bureaucrats deciding that you don’t get the medical procedure that you feel you need. Have the good grace not to pretend that single payer is a win-win where everyone benefits, because that’s not what other countries have experienced.

    JVW (5de783)

  22. When even far-left Vermont can’t figure out how to afford single payer health care, that should be a strong sign that it’s a progressive pipe dream.

    JVW (5de783)

  23. So let me see if I get this straight, this tax that many were exempted from paying, because it was costly yet less expensive than the policy will cause a collapse in enrollments in parg

    narciso (d1f714)

  24. Sigh. I’m not arguing for it. It’s what Obamacare was meant to accomplish. Get people used to the idea that everyone should have health insurance, paid for by the government where applicable; then make it “painful” to go to any way other than single payer like we’re seeing now.

    nk (dbc370)

  25. So by not forcing people to buy insurance OR ELSE, less folks buy it.

    Tastes like freedom.

    Blah blah (8bfae7)

  26. CBO is so dishonest ….

    Blah blah (8bfae7)

  27. Pelosi has done a 180 degree shift. She now wants to know what’s in the bill before it is passed.

    AZ Bob (f7a491)

  28. They really out did themselves this time,

    narciso (d1f714)

  29. Keeping 26-year-olds on their parents’ policy and requiring preexisting coverage are the hallmarks of Obamacare. If these stay, then we have Obamacare-lite.

    AZ Bob (f7a491)

  30. If people are not forced to buy car insurance and less car insurance is purchased that does not equate to millions LOSE car insurance.

    That equates to millions stop buying car insurance.

    Ayyyyyyy dios mio.

    Blah blah (8bfae7)

  31. Guaranteed issue is my only real issue with this new bill. So strike that and that 30% penalty and we are good to go.

    Oh and block grants for Medicaid while allowing States to decide who gets Medicaid.

    Blah blah (8bfae7)

  32. AZBob, I know more than a dozen people who voted for Trump who will love those provisions. Working families, with kids of college age, and at least one person with a pre-existing condition in the family, not qualifying for Medicaid or Medicare.

    nk (dbc370)

  33. our friend dave is still angry that hillary lost to mr donald

    Cruz Supporter (102c9a)

  34. Oddly they don’t calculate those variables into the analysis, so ouija board

    narciso (d1f714)

  35. AZBob, I know more than a dozen people who voted for Trump who will love those provisions.

    Yep. The new populist right doesn’t seem to have too big a problem with government entitlement programs as long as they think they can get more out of them than they pay into them. They just get mad when people they don’t like take advantage of the system too.

    JVW (5de783)

  36. Thirty-two of the thirty-three developed nations on Earth have universal healthcare, with the United States being the lone exception.

    DCSCA (797bc0)

  37. @21. That’s disingenuous. Single payer does work. (So does two-tiered.) Lived in the UK five years under the NHS and it worked fine when needed for family of all ages. Harley Street doctors no less. Provided timely, quality and cost-effective care. And yes, you pay for it through taxation but when you need the care, it’s there. And all the more amusing was when, as Americans, we tried to PAY for some medical services– and were told no payment was accepted.

    DCSCA (797bc0)

  38. Thirty-two of the thirty-three developed nations on Earth have universal healthcare, with the United States being the lone exception.
    DCSCA (797bc0) — 3/13/2017 @ 7:32 pm

    **********************

    Are you counting Cuba?

    Rae Sremmurd (2fd998)

  39. Lived in the UK five years under the NHS and it worked fine when needed for family of all ages. Harley Street doctors no less.

    **************

    The US does not equal the UK. What is the rate of emergency room visits due to gang violence?

    How many illegals does your country provide health care for?

    What about the cost of medical malpractice insurance?

    Rae Sremmurd (2fd998)

  40. Also–why do all of your Brit rock stars move to the United States?

    What percent of your wage do you pay in taxes?

    No fair–excluding your VAT taxes–what is that running at these days–something like 20%?

    Yeeee Aaaaarrrgh!

    Rae Sremmurd (2fd998)

  41. Here is the list of “developed countries”. Cuba is not included but Andorra, The Faroe Islands, Monaco, Malta, the Holy See, and Turkey are. San Marino, Iceland, Bermuda and Liechtenstein too.

    You are free to snicker at will.

    nk (dbc370)

  42. Lived in the UK five years under the NHS and it worked fine when needed for family of all ages.

    Ok, but don’t pretend for a moment that you get all the health care your heart desires in the UK, because our British cousins openly use the word “rationing” when describing their health care delivery. And British health care has muddled along as long as Britain has been able to import doctors from India, Pakistan, Egypt, and other parts of the former empire, but what’s going to happen now that the pipeline of those physicians is drying up? And finally, just like the Canadians do, a lot of British citizens who can afford it venture outside of the UK for various health procedures (with here being a popular destination) in order to avoid the waiting lists and other limitations that single-payer systems impose. Where are Americans going to go when we implement single payer? Costa Rica? It’s going to be pretty crowded there, what with all of the other citizens from single-payer countries beating a path to San Jose to have stints placed in their hearts or hips replaced. But thanks for proving my point about the populist right.

    JVW (5de783)

  43. And why is the CIA publishing a world fact book?

    nk (dbc370)

  44. Here is the list of “developed countries”. Cuba is not included but Andorra, The Faroe Islands, Monaco, Malta, the Holy See, and Turkey are. San Marino, Iceland, Bermuda and Liechtenstein too.
    You are free to snicker at will.

    *********************

    The damn kiddos at Reddit are bragging about Cuba because their brain trust hero Bernie! says essentially– “Cuba is the bomb!”

    I didn’t have the energy to dive in there and ask them why boat loads of people–have been desperate to leave there.

    Wonder why these reddit smugs won’t just pick up and move to Bernie’s Wonderland–aka–Cuba.

    Rae Sremmurd (2fd998)

  45. Better examples than you’ll see:

    A 64-year-old couple making $61K/year will pay the same under the GOP plan as Obamacare (assuming no change in plan costs). The subsidy is about $8000 in either case.

    A 64-year-old couple making $63K/year will pay $8000 less under the GOP plan as Obamacare. There is no subsidy for them under Obamacare.

    Kevin M (25bbee)

  46. The damn kiddos at Reddit are bragging about Cuba because their brain trust hero Bernie! says essentially– “Cuba is the bomb!”

    Tell them that in Cuba kids are chosen from school at something like age 12 after taking an aptitude test and forced by the state into the medical profession. So if they like the Cuban system, imagine that instead of getting to spend six years in college smoking weed and participating in “anti-fascism” rallies while leisurely pursuing a degree in Political Art, they were plunked down into Organic Chemistry, Microbiology, and Anatomy & Physiology and told they better buckle down and learn or dad would lose his job with the street sanitation crew.

    JVW (5de783)

  47. AZBob, I know more than a dozen people who voted for Trump who will love those provisions.

    Yep. The new populist right doesn’t seem to have too big a problem with government entitlement programs as long as they think they can get more out of them than they pay into them. They just get mad when people they don’t like take advantage of the system too.
    JVW (5de783) — 3/13/2017 @ 7:30 pm

    I agree, JVW. And by the way, voting for Trump doesn’t automatically make you right.

    AZ Bob (f7a491)

  48. The country with the most doctors per capita is Israel. Totalitarian Communist dictators can’t hold a candle to Jewish mothers who want a “my son, the doctor”.

    And don’t believe anything Communists tell you.

    nk (dbc370)

  49. There is that, btw herr Gruber denounced the plan as a scam, that the hellmouth didn’t open right then and their,

    The best comps they can arrange are countries like Germany who have 1/5 our population

    narciso (d2854b)

  50. Ok, but don’t pretend for a moment that you get all the health care your heart desires in the UK

    You get what you need. =sigh= ‘Muddled.’ ‘rationing.’ The usual conservative code words to plant the ol’socialist fears [a la Social Security and Medicare] and protect a business model designed to enrich insurance companies, not deliver cost-effective healthcare. Social Security and Medicare. And that’s a mind set for putting profits ahead of delivering cost-effective care.

    Their system works so don’t knock it until you’ve tried it. Our family has. And it’s impressive because it works and you get what you paid for: good care in a timely fashion.

    _____

    @41. Oy Vey. Snicker away. Then chuckle at how many of these nations survive to thrive under the security blanket of American defense expenditures. ‘Course none of them have to pay for $13 billion aircraft carriers and $2.5 billion B-2 bombers. But they do have affordable, cost-effective healthcare and some even flaunt nifty, neat-o infrastructure systems too.

    1. Israel.
    2. Switzerland.
    3. Singapore.
    4. Hong Kong.
    5. Iceland.
    6. South Korea.
    7. Spain.
    8. Greece.
    9. Cyprus.
    10. Portugal.
    11. Italy.
    12. Ireland.
    13. Australia.
    14. France.
    15. Luxembourg.
    16. Denmark.
    17. Slovenia.
    18. Finland.
    19. United Arab Emirates.
    20. Austria.
    21. Netherlands.
    22. Canada.
    23. Brunei.
    24. Bahrain.
    25. Sweden.
    26. Kuwait.
    27. United Kingdom
    28. Belgium.
    29. Germany.
    30. Japan.
    31. New Zealand.
    32. Norway.

    source– WHO.

    DCSCA (797bc0)

  51. [Update:] Over at Powerline, Paul Mirengoff finds another interesting tidbit in the CBO report:

    The report is here. This passage (at page 3) jumped out at me:

    Starting in 2020, the increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of several factors that would decrease premiums. . . .

    (Emphasis added)

    I was also struck by the fact that the budgetary savings posited by the CBO are weighted heavily towards the period beginning in 2020.

    That is in in fact very curious if the GOP is front-loading the fiscal pain and leaving the budgetary benefits for down the road. It’s certainly the opposite of Obamacare, which was essentially “let’s promise everything up front and then implement the tax and cost-control system to pay for it down the road.” But as Mr. Mirengoff points out, it assumes that the GOP will still be running the show come 2020, and there is simply no guarantee of that. Imagine if they were to be honest enough to do the hard work up front, only to see Democrats come in and take credit for the benefits later (and of course, Democrats would very quickly “reinvest” those savings back into expanded health services).

    JVW (5de783)

  52. Canada has 1/10th our population do they not, NorwAy is even smaller a country.

    narciso (d2854b)

  53. Their system works so don’t knock it until you’ve tried it. Our family has.

    Yeah, I’m not going to throw out our existing system because of your experiment conducted on a sample size of one family. Let me counter your point: I’ve been in the U.S. health care system my entire life and I have had nothing but fantastic care at very reasonable rates. And I’m willing to bet that most of my family and extended family would report similar satisfaction. Does that mean that our system is perfect? Of course not. But the Canadians and Brits and Cubans and whoever says socialized medicine is the way to go just because they personally like it have no more credibility on this point than you or I do. Again, if you want to push for single payer then feel free to do so, but don’t be surprised if you get a lot of pushback.

    JVW (5de783)

  54. =yawn= Rationing… ‘course the best example debunking that myth in America is the late, great Mickey Mantle, jumped to the front of the transplant line and given a new liver in a day– and it bought him all of 4 months.

    It’s fruitless wasting electrons about this. Free market healthcare solutions are like commercial space exploration– without a ROI to investors within a reasonable time frame in a quarterly driven marketplace, it cannot be sustained. That’s why governments do it for BEO ops and subsidize LEO ops.

    The United States will have a single-payer and/or two-tiered system by the end of the century. It is inevitable.

    DCSCA (797bc0)

  55. Canada has 1/10th our population do they not,

    They do indeed, yet at one point over 50,000 Canadians were leaving Canada each year to seek medical treatment that they somehow can’t get in a timely manner (if at all) in socially enlightened Canada. Estimates are that at least 80% of whom were coming to the U.S. despite our nasty health system dominated by greedy insurance companies and rapacious hospitals and doctors.

    JVW (5de783)

  56. =yawn= Rationing… ‘course the best example debunking that myth in America is the late, great Mickey Mantle, jumped to the front of the transplant line and given a new liver in a day– and it bought him all of 4 months.

    Yeah, the story of the well-known celebrity who received preferential treatment eighteen years ago totally makes your point valid.

    JVW (5de783)

  57. @54: JVW, see #9. You’re arguing to sustain that system. And that system is what is killing coverage in the United States. The objective of the American healthcare system is to make money, not deliver cost-effective healthcare to the citizenry. Once that mind set shifts, the United States will adopt a single payer or two-tiered system, and join the 21st century before it ends. It’s just inevitable.

    Then, we’ll go metric. 😉

    DCSCA (797bc0)

  58. You’re arguing to sustain that system.

    Ah yes, the old “if you don’t support single payer then you are for the current system” canard. Where have I heard a similar piece of nonsensical malarky before?

    JVW (5de783)

  59. @60. $22 for a 500 mg Tylanol from a doctor that costs $8 retail for 200 is not just malarky, it financial rape… and why the politicians of both parties whose campaigns are financed by the pharma and insurance industries want to protect the sweet set-up they’ve got.

    DCSCA (797bc0)

  60. Single payer is loved by the healthy but hated by the sick. Which begs the question of WTF is the point of medical care if not for the sick?

    Also the USA over paying for care subsidizes those 30 plus free loaders. Our Government should squeeze more out of our national IP in medicine. But anyway…

    Blah (158466)

  61. JVW, upthread you said

    higher taxes for everyone (including for the poor), rationing of care, long waits for medical procedures, fewer specialists, less time spent with actual physicians, and a group of unaccountable government bureaucrats deciding that you don’t get the medical procedure that you feel you need.

    Replace “higher taxes” with “high premiums and deductibles and prescription drug costs”, substitute “insurance company bureaucrats” for “government bureaucrats”, and you get an accurate picture of what most of the people I know experience.

    In theory, insurance companies are accountable, but in practice, not so much. For a person who gets insurance through a large employer, the choice is made for them by HR personnel who have to take into account the cost to the employee as a major, sometimes only, factor in deciding what insurer to pick. And almost always, the discovery that the insurer will not cover a procedure is made far too late to allow picking a different insurer.

    IOW, your experience of fantastic care at reasonable rates is not necessarily the norm.

    BTW, I have dealt with numerous Canadians as customers over the years, mostly snowbirds from Quebec and Ontario. The subject does not always come up, of course, but when it has, none have thought US medical care better than Canadian, and several have told me they return to Canada for any serious medical care (except of course actual emergencies). Routine matters are handled with local doctors who accept the Canadian insurance.

    kishnevi (158466)

  62. DCSA, only reason you get charged 8 bucks for Tylenol is the Govt rules .. especially how Medicare works and State Insurers try to insurer they get most favored nation status while screwing the uninsured.

    Blah (158466)

  63. @63. Well said, kishnevi. A ‘bureaucrat by any other name… eh…” Insurance companies are accountable to their stockholders.

    You hang in there.

    DCSCA (797bc0)

  64. @65- no, blah, you buy 200 at retail for $8 but handed one by the doctor in his in office costs $22 and insurance pays that. That’s the problem.

    DCSCA (797bc0)

  65. I can’t imagine the Queen of England takes a number and waits her turn at NHS. So, are there different grades of plans based on your occupation like Greece has, or are boutique doctors and facilities charging cash outside, or in addition to, the system allowed?

    nk (dbc370)

  66. Kishnevi,

    Your sample leaves lots to be desired. Healthy Canadians love Canadian medicine because they think it free and since it demands very little of their system. Unhealthy Canadians know better and come here for a reason to get diagnostics and some procedures, especially the wealthy when time is of the essence.. Reason more Canadians don’t come here is that in patient coverage using their national system does not cover care here … so since they have to pay that out of pocket, most can’t and don’t.

    Blah (158466)

  67. DCSA, reason why out patient care should not be covered by insurance while in patient should be.

    Blah (158466)

  68. kishnevi, all valid points, but here is my major problem with single payer. When the government steps up and declares that they are going to provide health care to the citizenry, it opens that Pandora’s box for them to start to regulate your lifestyle through ways both large and small. For instance, we all know that obesity is a bad problem here in the U.S. A free marketer would respond by saying that the citizen has an obligation to take good care of themselves through diet and exercise, and if they fail to do so then they will suffer the consequences of those decisions. Once government steps in and says that they will take care of the medical bills, that person no longer really has any financial incentive to take better care of themselves, even if they may have health reasons to do so. So the government is going to respond in the way that governments always respond: they are going to try to regulate more and more of our everyday lives. That’s where you see the higher taxes on tobacco, and soda pop, and fatty foods, and candy, and alcohol, etc, as the government inexorably involves itself in lifestyle regulation. And those taxes are regressive and fall the most heavily on the poor, so guess whatL the government is then going to feel obligated to increase welfare subsidies to poor families to make up the difference. It’s a vicious circle, and the net result is always more government interference in our lives.

    I am for people taking care of their own health needs. I am for health insurance being actual insurance, which you tap into when you have long-term hospitalization or if you have someone in your family with special needs. I am not for health insurance being used for annual checkups, or subsidized prescription drugs, or free birth control for college kids, or all of the various lab tests that we’re subject to. Let the consumer determine how important those things are and decide whether or not he or she is willing to pay for them. (And for the record, I am with those who believe that the purported benefits of “preventative care” are largely oversold.)

    I’m not saying that there are easy answers. The AHCA strikes me as being a bit incomplete but, on balance, an improvement upon the ACA. I think single payer would lead to a decline in the quality of medical treatment in this country, and I think it will stifle innovation much in the same way as it has in countries that have implemented it.

    JVW (5de783)

  69. Blah, the Canadian system covers at least some care here. Perhaps the local doctors are paid by special arrangement…but the Quebecois tell me their insurance covers it.

    kishnevi (158466)

  70. So, are there different grades of plans based on your occupation like Greece has, or are boutique doctors and facilities charging cash outside, or in addition to, the system allowed?

    Speaking for Canada, there was a big scandal in the aftermath of the SARS scare several years back. While patients were being tended to on gurneys in the hallways of urban hospitals and while a third patient was being crammed into a two-person room, it turned out that the major hospital in Ottawa had an entire floor of hospital rooms left unused, because they were traditionally reserved for politicians, or hockey stars, or entertainers, or major industrialists. So yeah, even in a “fair” health care system the well-connected are given special privileges.

    JVW (5de783)

  71. @68- Aside from being worth a half billion dollars, her ‘household’ staff- which likely includes a resident royal physician, and various royal land holding around the planet receive annual government subsidies. Hell, she’s their tourist attraction.

    DCSCA (797bc0)

  72. 72, in patient versus out patient matters. Also many carry travel insurance. Out patient care is the smallest part of the spend. Pharma and In Patient are where the money evaporates. i know of not one payment in my 13 years from the Govt of Canada but I have not submitted a HCFA in the last 12.5 …… migght be certain ways and methods of extracting money but I never learned how to.

    Blah (158466)

  73. https://www.youtube.com/watch?v=XGWbRonIBGg

    Jietai Iraku Fukkou Shiengun

    I sometimes think we don’t do enough to honor our allies.

    Steve57 (0b1dac)

  74. I guess you did kind of answer my question. With single payer, we’ll have County Hospital and VA for the hoi polloi, Walter Reed and Massachusetts General for the nomenklatura, and private insurance and boutique care for the 1%. So be nomenklatura or 1%. Isn’t that the American dream after all?

    nk (dbc370)

  75. I love Poland.

    https://www.youtube.com/watch?time_continue=8&v=4ojHcGAWmbA

    Polish Coalition Forces visit Schools in Iraq

    Steve57 (0b1dac)

  76. A rookie cop stopped Amri in Milan. I’d buy him not a glass but a Jeroboam of wine.

    Steve57 (0b1dac)

  77. He was patrolling Sesto San Giovanni.

    Steve57 (0b1dac)

  78. Way to break him in. I traveled to Italy and the Italian cops all looked like extras from The Good, The Bad, and the Ugly.

    Steve57 (0b1dac)

  79. Most of that increase would stem from repealing the penalties associated with the individual mandate.

    The CBO is evidently assuming that the penalty actually works in getting people to buy insurance.
    It doesn’t, because it is not affordable.

    It might work for people who get subsidized policies, but the advertising probably is more responsible for them getting insurance, and the same people will get it unless it is not affordable.

    Since they lose a free tax credit if they don’t get insurance, people on the lower end of the income spectrum ineligible for Medicaid and not getting it otherwise, will probably buy some form of (perhaps 95% useless to them) catastrophic insurance, but they will have insurance. Why not?

    Also, anyone regularly seeing a doctor will do something. People without insurance get put onto Medicaid after they go to the emergency room. This is mentioned in an op-ed piece I read in the New York Times. Incidentally that thing about ambulances asking for insurance won’t happen and the writer knows it. It’s also nonsense to say that other people will pay for people without insurance who get treatment through higher insurance premiums etc, because if someone pays for their insurance, other people will be paying for it anyway! Except they’ll be paying more, and hospitals will have no incentive to economize, and if they have insurance, they’ll be overtreated. Some people might be treated adequately when they otherwise wouldn’t be, but Medicaid is notorious for overtreating people.

    https://www.nytimes.com/2017/03/11/opinion/sunday/the-moral-failing-of-obamacare-repeal.html

    I remember a recent case, here in Pittsburgh…I was this patient’s nurse at the end of her six-week stay, after we’d successfully put a brake on her disease. She was eager to return home, and her pale face radiated a diffuse hope. Her main preoccupation was not whether her cancer would return, but how to sufficiently thank the hospital staff who had saved her life. A registered nurse care coordinator had signed the patient up for Medicaid immediately after she received the diagnosis, so she didn’t pay for her care.

    That’s how most people on Medicaid used to wind up on Medicaid. After that, a prime consideration in their financial planning was maintaining eligibility.

    Sammy Finkelman (4a6ffc)

  80. Yes, people who voluntarily go without healthcare can be a burden on the system as they often consume emergency medical services and never end up paying for them.

    And if someone paid for their insurance, or paid for any medical bills they incurred, they would not be a burden?? Now here;s the thing. Emergency medical treatment is probably the most cost effective treatment there is. It’s just not billed that way. But you have doctors on salary, and numerous patients.

    It’s a profit center used to cover hospital overhead. Now if the hospital doesn’t get paid maybe it’s not a profit center but it is still cost effective.

    Sammy Finkelman (4a6ffc)

  81. You’re arguing to sustain that system. And that system is what is killing coverage in the United States. The objective of the American healthcare system is to make money, not deliver cost-effective healthcare to the citizenry.

    Do you really not understand that providing profit incentives for suppliers to meet demand is why we have food on the shelves at the supermarket, and also why we have the highest quality health-care in the world?

    If you cap the price of something, people will offer less of it for sale. Look up “rent control” and “housing shortage” in the index any basic economics textbook – the page numbers will be the same.

    Dave (711345)

  82. the fact that the budgetary savings posited by the CBO are weighted heavily towards the period beginning in 2020

    Because that’s when Medicaid becomes a block grant, according to the bill, with the federal government’s contribution rising only at the level of inflation (which is actually 1% higher maybe than the projected rate of medical inflation, since they are orojecting it low.)

    There are budgetary savings because left alone, the CBO assumes that the number of people on Medicaid as well as the average amount billed (or services used up) per patient will keep on rising.

    The Republican bill assumes that state governments will somehow find a way to stop that without harming care.

    Actually if you want to do that, the people getting the services have to be the ones balancing the costs against results – and the tricky thing is, the amount of necessary spending varies with eveyr person, so this is very, very tricky but I think can be done by creating threshholds that people will be reluctant, but not to reluctant, to cross.

    But it is like this: If every person had to pay for asonogram, they won’t get as many sonograms as they do now.

    Sammy Finkelman (4a6ffc)

  83. One question: Does the DBO estimate assume that only Obamacare policies will be legal? ecause the Republicans intend to maybe they won’t be able to – repeal a lot of the requirements for a policy in a second bill. What that means is that few people will have no insurance, but many people might have bad, or even virtually useless insurance. (useless mainly because they will never reach the deductible, although hhere can be other bad features, too)

    What people need is a doughnut hole plus a way to fill hat doughnut hole. A doughnut hole, because expenses reasonably expected by everyone should be covered by the tax credit – I prose twp separate tax credots only one of which can be used to pay insurance premiums – and you need to get a higher fraction of costs paid for by the people allegedly benefiting from them.

    This means a much larger tax credit which should be paid for by a coonsumption tax, probably a limited carbon tax to atract Democraic votes.

    The doughnut hole is filled, in extremis, when it can’t be contributed by someone else or borrowed, by taking it out of Social Security and delaying the normal retirement age for that person – and the government should exxppect to lose money on that.

    Costs above the doungnut hole shod be paid for by re-insurance – policies should be auctioned off to the lowest bidder and the government pay the money. 100% of everything above the doughnut holeshold be aid for – at normal rates.

    Much more is needed – to prevent surprise billing, and get accurate estimates – and make medical records easily transferable.

    Sammy Finkelman (4a6ffc)

  84. Sammy Finkelman, have you not noticed that Obamacare-compliant policies have high deductables?

    SPQR (a3a747)

  85. DCSCA, WHO’s “ranking” of health care systems was shown to be ideological horse manure long ago. Citing it should be embarrassing to anyone with any sense. Just as an example, 1/4 of the ranking is supposedly based on “inequality”. A nation with bad health care, but bad health care for everyone, ranks high in this measure.

    SPQR (a3a747)

  86. They can get away with the front-loaded fiscal pain because Obamacare unaltered will have a greater level of pain. Better to put the pain where Obama gets blamed for it than to have it come along while it’s your show entirely.

    Kevin M (25bbee)

  87. Kind of like why the quarter after a new CEO takes over is such a terrible quarter for a company as all the trash gets taken out.

    Kevin M (25bbee)

  88. THe thing that NEEDS to be understood is that Obamacare does not affect 80% of the population. This was by design, in the “I wasn’t a Jew, so I didn’t object” vein.

    What happened to the gainfully self-employed was that the nation’s never-insured ne’er-do-wells all got put into THEIR insurance pool and whaddaya know the pool had astronomical medical claims. And, since the aforementioned ne’er-do-wells were all subsidized up the kazoo, they made good use of this free medical care. ANd again the costs went up.

    And that small group of self-employed families — less than 5% of the population — got hit with doubly-=expensive and extra-crappy policies (they were not able to BUY policies others got for free).

    This was upsetting to them. The GOP plan, amazingly, cuts these folks a break on the way out (the Democrats call this a give-away to the rich). It is a bit troubling that the so-called Conservatives are dead-set on screwing them over AGAIN. For principle, you understand. Never mind that they failed them in 2009.

    Kevin M (25bbee)

  89. When the elected hacks have the same poison care as me, I will swallow. Until then get traitor ryan and his chamber of commerce chumps behind bars.

    mg (31009b)

  90. Never mind that they failed them in 2009.

    Wut.

    Dave (711345)

  91. To all who say that the GOP plan is subsidizing health care:

    Where do YOU get your health insurance from? Do you return YOUR subsidies out of principle?

    Kevin M (25bbee)

  92. “That is in in fact very curious if the GOP is front-loading the fiscal pain and leaving the budgetary benefits for down the road.”

    JVW,

    I believe the profligate bribes to the 31 states which increased subsidies for Medicaid do not expire until ’20. I suspect the GOP strategy is to highlight the need to elect 8-10 more Senators in ’18 in order to assure the removal of the stinking carcass of the Democrat black albatross from the electorate. I don’t see any particular political reason to hurry the healing of a gangrenous suppurating wound primarily afflicting Blue Hells. The sooner their state budgets rot out completely the better.

    Rick Ballard (1c1d4f)

  93. The issue of Medicaid, and how far up the income ladder it ought to go, is a separate issue from allowing most Americans to purchase insurance of their choice.

    Kevin M (25bbee)

  94. Look,one thing I’m sick and tired with is this argument about who pays. Everything is about who pays. Will the government pay? Insurance companies? Hospitals? Someone has GOT to pay. Who? Who?

    No one every asks, why so much? Why have health care costs been increasing faster than the rate of inflation for decades? Why have medical costs (plastic surgery, eye care) NOT covered by insurance steadily decreased? Why do doctors give discounts for people paying in cash?

    If health insurance was cheap, everyone would have it. It’s not cheap, so people try and do without. Question – why is everything else getting cheaper, but medical costs getting more expensive?

    Why?

    Fix that, put the cost curve on a downward trajectory, and all the other problems solve themselves.

    Tenn (131b65)

  95. Because the healthcare industry in the United States — from the pharmaceuticals to hospitals to doctors — is a government-protected monopolistic cartel which conspires to charge whatever it wants?

    nk (dbc370)

  96. @89. =yawn= Except it’s not. The objective of the American healthcare system is to make money, not deliver cost-effective healthcare to the citizenry. Once that mind set shifts, the United States will adopt a single payer or two-tiered system, and join the 21st century before it ends. It is inevitable.

    DCSCA (797bc0)

  97. At least one GOP senator has the courage to point out the gaping discrepancy between Trump’s plan and what he promised (“You’re going to such great healthcare at a tiny fraction of the cost”):

    GOP Senator on healthcare plan: ‘That’s not what President Trump promised.’

    Dave (711345)

  98. This alone is enough for me to want this bill ditched:

    In essence, the Preserving Employee Wellness Programs Act would allow workplace wellness programs to collect information about family health history or genetic testing of employees and their family members. Specifically, the bill would allow employers to inquire or carry out genetic testing. http://thehill.com/blogs/pundits-blog/healthcare/324087-the-cost-of-keeping-your-genetic-information-private

    I don’t want to have to submit my DNA to my employer, thank you. How presumptuous.

    Tillman (a95660)


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