Tag: ACA

As a measure of affordability, we calculated potential Marketplace premiums as a percentage of family income among families with incomes of 401–600 percent of poverty. In 2015 half of this middle-class population would have paid at least 7.7 percent of their income for the lowest-cost bronze plan; in 2019 they would have paid at least 11.3 percent of their income. By 2019 half of the near-elderly ages 55–64 would have paid at least 18.9 percent of their income for the lowest-cost bronze plan in their area.

Back in 2009 I wrote:

My current belief is that what will be passed will mandate everyone buy insurance but because of inadequate cost controls and subsidies will leave ordinary people forced to buy insurance which will increase in price faster than wages.

I also wrote:

..get ready to pay out for insurance you can’t afford, with co-pays so high you can’t afford to use it even after you’ve been forced to cough up for it.

This only half a “I told you so” because it was obvious. Anyone who didn’t know, who was paying attention, was an idiot, but most of those who said otherwise were liars.

Obamacare was always intended primarily as an insurance company bailout. The expectation was always that it would look OK for a few years, then prices would spiral.

There are a few ways to do healthcare that make sense, they all involve universal healthcare. The simplest is single payer. Cleaning up US healthcare requires more than that, since there are a lot of bad actors using oligopoly power to jack prices up artificially, but a single payer can force-set prices and drive companies out of business who won’t play.

The majority of Americans want universal health care, it’s not at all contentious. The reason Americans don’t have it is that part of the rich don’t want it, because it makes some of them wealthy, and they can afford to pay the inflated prices, so it isn’t a personal problem to them.

What the majority of Americans want is irrelevant, and as the Princeton study found, has zero impact on whether anything becomes government policy. This is as true when Democrats are in charge as when Republicans are.

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That Tax Cut Talking Point

By Mandos

On June 24, 2017

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(MANDOS POST – YOU KNOW THE DRILL)

The Republicans are working hard to pass an amendment to the ACA called the AHCA. Assuming it succeeds, which I wouldn’t take for granted, it would take Obamacare, with all the latter’s deficiencies and faults, and make it even worse. Meaning: It will probably kill a lot of people through health care denial due to pre-existing condition denials and the reinstatement of lifetime coverage limits. If they fail to pass it, it would be because Obamacare is designed to make itself hard to retract; as Obamacare contains the bare minimum required to improve the status quo ante, anything significant they take away from it renders it unworkable. If it passes, it would be because they had decided that it was the closest to the status quo ante that they could achieve.

The status quo ante was terrible, but contrary to the beliefs of many, it wasn’t “unsustainable” in some sort of fundamental way. It could be contained by gradually excluding more and more people from insurance coverage, and therefore, down the line, care. This is not a debate about health care, but about how to pay for health care. It is about austerity, and the status quo ante was ultimately just a slow ratcheting-up of austerity. (Yes, I know, Obamacare is a ratcheting-up of austerity, but it is a slower one.)

One of the talking points against the AHCA is that it appears to be designed to give the rich a tax cut. However, the tax cut is, in proportion to many of its beneficiaries, quite small, even as it dwarfs the incomes of many. It’s not a giveaway that in itself should raise the political passions of its beneficiaries. Many of them won’t spend it or won’t notice the effect on their lives or wealth planning. Even the insurance industry is skeptical of key portions of the bill, and they’re not prone, as they say, to altruism.

The Republicans have invested a lot of political capital in the idea of undoing Obamacare. Instead of that small a tax cut, if they were rational political actors, they could easily have come up with a bill that targeted large swathes of their constituencies for a substantial improvement in their (bad) standard of coverage, even if they wanted to target Democratic constituencies for tribal reasons. They could have done this without even instituting single payer (aka public monopsony) and ruining their constituents among the insurance and corporate medical sector. It doesn’t appear that this is on order.

The picture only makes full political sense if you see the cutting of health insurance coverage as a political goal in itself, if not some kind of fundamental ideological “end.” Or for the symbolic appearance of trading coverage for a token tax cut, in a way that is likely to create further damage to the US economy. And that successful Republican politicians think that they can expel millions of people from the ability to pay for health care, including their own constituents, is a sign both of the significance of that symbolic appearance and the cultural limits of the US health insurance debate.

The GOP Healthcare Plan

By Ian Welsh

On March 7, 2017

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This is a good overview.

I’m not going to waste a lot of time on it. Other than the changes to state-based regulations, the removal of the individual mandate and the removal of the tax on good healthcare plans (so-called gold-plated plans), as it stands, this plan is slightly worse than Obamacare in pretty much every way.

It is not an improvement, it is not what Trump promised in his speeches, though it’s not far from what was in his policy documents. It is also not a disaster, but it certainly won’t be a win for Trump or make his followers feel better off and it was one of two ways he could, or can, do so. The other would be to improve their economy.

This matters far more to Trump’s future, and his presidency, than all the noise over immigration or Russia. He should have pushed hard for something simple that was an obvious win; something Democrats would find it hard to oppose.

This is not a win for his supporters, or for him.

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Trump Promises to Reduce Drug Prices

By Ian Welsh

On January 12, 2017

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So, there was a lot of hoopla over Trump’s press conference, most of it concentrating on the release of the oppo research file on him, containing not one proven assertion.

I decided, once again, to read the actual transcript. And found out that there was little coverage of something which should matter more to most Americans: Trump’s promise to lower Pharma prices.

We’ve got to get our drug industry back. Our drug industry has been disastrous. They’re leaving left and right. They supply our drugs, but they don’t make them here, to a large extent. And the other thing we have to do is create new bidding procedures for the drug industry because they’re getting away with murder.

Pharma has a lot of lobbies and a lot of lobbyists and a lot of power and there’s very little bidding on drugs. We’re the largest buyer of drugs in the world and yet we don’t bid properly and we’re going to start bidding and we’re going to save billions of dollars over a period of time.

The business press seem to be taking this seriously.

It is also, AGAIN, something which should have been tackled long ago. Obama deliberately refused to allow price negotiation with pharma and so did Bush. In both cases, they gave into the lobby. Insane.

Nor, as some say, will this mean that pharma prices will have to rise overseas. Pharma is a profitable industry which spends more on marketing and advertising than on drug research, which researches mostly the wrong drugs, and so on. They can just make less money–high profits to Pharma are mis-allocated resources.

Next Trump talked about the F-35 (for those who don’t keep track, it basically can’t fly and is vastly over cost.)

And we’re going to do that with a lot of other industries. I’m very much involved with the generals and admirals on the airplane, the F-35, you’ve been reading about it. And it’s way, way behind schedule and many, many billions of dollars over budget. I don’t like that. And the admirals have been fantastic, the generals have been fantastic. I’ve really gotten to know them well. And we’re going to do some big things on the F-35 program…

AGAIN something which should have already been dealt with.

Trump thinks like a deal-maker and a business man, and what he sees is that the government is vastly over-paying for services and products, and he doesn’t like that. And what he sees is that Americans are overpaying as well, because the government refuses to act on their behalf.

I’m sorry, I’m very sorry. Trump will certainly do bad things, but if he follows through on these two things (especially pharma), he’ll be doing very good things that people like Obama would not do.

This is of a piece with Trump killing the Trans Pacific Partnership, while reports have regularly indicated that getting it passed was Obama’s most important legislative priority, likely for his entire Presidency.

Understand clearly that this is the sort of stuff that Trump was elected to do, along with bringing jobs back, curtailing immigration, and so on.

The next thing to watch will be what replaces the ACA (Obamacare). I am not optimistic, because health care accounts are a terrible idea. But let’s see. (Or, alternatively, call your Congress critters and insist the ACA not be repealed. You might win.)

But right now, as I score it, Trump is more or less on track to do what he said he would do. I think his tax cuts will be disastrous, especially in the long run. I don’t like Obamacare, but I expect him to replace it with something worse. However, in a lot of areas, he’s talking about doing things that should have been done long ago.

When the people too many liberals think are “good” (like Obama), won’t do what everyone knows what must be done, they will eventually be done by people liberals consider “bad,” in ways liberals might not like.

There’s a lesson there.

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The horizon is not so far as we can see, but as far as we can imagine

Tag: ACA

The ACA (Obamacare) Has Performed As Predicted

That Tax Cut Talking Point

The GOP Healthcare Plan

Trump Promises to Reduce Drug Prices