washunate commented on the blog post The Three Types of Problems With the Affordable Care Act
Great post Jon. The immediate focus on the implementation flaws shows how successful the Obama camp has been over the past 5-6 years in distracting attention from the foundational issues in healthcare policy, which really just boil down to two concepts:
1) what subset of healthy living is a public good to which all citizens are entitled?, and
2) how do we pay for that portion that is a public good?
Of course, we can’t go down that path because that leads to the same point every other policy area leads to, which is that the problem is extreme wealth inequality.
washunate commented on the blog post Congress Jamming $607 Billion Defense Bill Through Before Christmas
but, austerity! and the Senate! and Republicans! how is it possible that the government spends any money in this dysfunctional, partisan town?
washunate commented on the blog post US Military Now Keeping All Information on Hunger Striking Prisoners at Guantanamo Secret
@BSbafflesbrains – This actually shows one of the real limitations they’re bumping into with the police state. They can’t come after all of us because it physically takes too much space and too much staff to imprison large numbers of people for extended periods of time.
washunate commented on the blog post Cut Off The Water: Movement To ‘Nullify’ NSA Starts In Utah
This is awesome. Eventually the authoritarians are just fighting on too many fronts to win everywhere always. It’s just unfortunate so many Democrats are on the side of trying to keep things running a bit longer.
washunate commented on the diary post A New Day, A New Danger: Temporary Workers Face Safety Hazards at Work by Michelle Chen.
If this is true, there is huge potential liability under workers’ compensation insurance and OSHA guidelines, plus perhaps EEO claims and a few other routes. I would encourage pursuing those avenues vigorously. Money talks, and big payouts for unsafe working conditions is exactly how unscrupulous employers are incentivized to change their ways (or prosecuted out [...]
washunate commented on the blog post After Helping Wall Street For Years President Obama Talks Inequality
Brilliant DSWright, just brilliant. I wish this could get cross-posted on every political, financial, and economic website in the blogosphere.
washunate commented on the blog post Reluctant Acceptance, Not Popularity, May Be Obamacare’s Best Hope
@splashoil – I think you’re a little off on Medicaid. Medicaid has never been a good system. It’s inferior to Medicare, the VA, and employer group plans. It’s just a stopgap for people who are destitute and have no other options, and in practice it is now part of the dependency problem we face with all means-tested programs. It is a classic case study in ‘lesser of two evils’ thinking.
Clawbacks in particular are nothing new; the liability one faces when enrolling in Medicaid is different from signing up for other government programs like Medicare. This doesn’t get much attention because the way we deal with poverty is largely to ignore it; the Democratic Party basically stopped caring about these issues decades ago. TANF, SNAP, and a whole host of other programs show how means-testing itself has become the problem.
That Medicaid expansion has become the most liberal thing about PPACA really speaks to how awful the legislation is, not how great Medicaid is. Any reasonable national health insurance plan would eliminate Medicaid and allow all Americans to enroll in the same, non-means tested social insurance policy.
washunate commented on the blog post Reluctant Acceptance, Not Popularity, May Be Obamacare’s Best Hope
“it will become the devil you do know”
That does seem an interesting consideration Jon, the heart of predicting how things will develop.
I think the details are too complicated to actually implement. It’s why the Administration has been adding all sorts of clarifying regulations pushing off dates into the future and scaling down requirements.
The point of PPACA was to fracture healthcare advocacy within the Democratic party, to neutralize, or at least delay, the inevitable rise of universal health insurance. And it did this quite well. But I don’t see how it actually is working in two or three years. The renewal premiums for individual insurance in 2016 and 2017 are going to be absurd relative to the wages of what actual workers make in the real economy, particularly because most healthy uninsured people today are going to remain uninsured in 2014.
Meanwhile, for those with employer coverage, every employer HR person and business leader in the country that scales back the group healthcare plan or raises employee contribution amounts or eliminates health insurance entirely is going to be screaming bloody murder that it’s all the fault of ObamaCare. What portion of the blame is ObamaCare and what portion is other factors is essentially irrelevant at that point – ACA will be this magical scapegoat upon which every ill in the system is heaped.
In fact, it already is. When educators in the navigator system give presentations to employee groups about how the marketplace works, they now explicitly say they are only doing educational presentations, so no political opinions are welcome in the discussion. No such disclaimers are needed when doing a presentation on anti-harassment policies or holiday scheduling or concealed weapons bans or no-smoking policies or the other host of things we generally label HR.
@spanishinquisition Agreed, great point.
The fun of trying to explain the craptastic nature of healthcare policy in 21st century America. There is no summary or core principles. Only the details.
One of my favorite quips from the Obamabots back in 2008 and 2009 was when people would say how good the federal system is (so no need to discuss single payer…). I never met someone who had actually read GEHA’s 100 page book, let alone engage in any substantive discussion about how healthcare actually works in practice.
This is what it takes to explain a plan offered to federal employees, something much better than what most people have:
Yeah, @DSW, there’s got to be a good series of articles in there somewhere. Doing the investigation seems the catch. [sorry, something seems to be wrong with my 'reply' function]
This won’t help the research any, but a bumper sticker came to mind:
Employer coverage for Me, ObamaCare for Thee! – Friendly Unnamed Democrat
washunate commented on the blog post Health, Not Age, is What Matters for the ACA Risk Pools
Not sure what is getting under your skin on this particular topic? How would all uninsured 45 year olds as a group be notably healthier than the general population or millions of 25 year olds be notably sicker than the general population? Not hypothetically, but in any actual model of enrollment, how would that happen? The majority of healthcare costs are incurred by a tiny minority of patients in any given 12 month insurance contract period. Most young people with such an expensive pre-existing condition are either on a parent’s employer group plan, on a government program, or unlikely to enroll in the exchange.
It’s not that one is important but the other isn’t. Both age and health matter, because the whole point of pooling risk across different risk levels is that less risky participants are subsidizing more risky participants. Otherwise, community rating collapses and you’re back to paying for your particular risk.
LauraG – the general way that the law works is that health insurance is a state by state program (very similar to the set up of unemployment or workers comp or auto insurance or really most any insurance product with which you may be familiar). You do whatever your current state of residence is (which also gets tricky for out of state students whose parents aren’t lucky enough to be wealthy enough to pay for their kids to age 26…)
Anyway…the important point is to do what your current state does. If the current state is Florida, and Florida says you are not eligible for Medicaid, then you essentially have four options:
1) Ignore the individual mandate,
2) Apply for a hardship exemption (it’s essentially automatic in states where Medicaid expansion didn’t happen) to legally ignore the individual mandate,
3) Buy insurance through the exchange (er, marketplace…), again, depending upon state, whether it’s the state website or the federal one, or
4) if under 30, buy a special junk insurance plan that’s even junkier than bronze coverage for people over 30.
If you then move to another state, the general rule of thumb is you have 60 days to enroll in health insurance in that state. Health insurance is not like clothes or books that you just transfer from one place to another in a UHaul. It is a product that must be bought new in each new state of residence. So if you go to Cali and qualify for Medicaid, then you can enroll in Medicaid in California at that time.
If you don’t quality for Medicaid, you then have four options (see above…).
Jon, thanks for highlighting this.
The ‘cliff’ nature of all sorts of means-tested programs demonstrates exactly why we should eliminate all means-tested programs and replace them with simple, nation-wide, universal health insurance and unemployment insurance. The model of means testing is what is broken, and hopefully the particular failure of the ACA will reveal this in excruciating detail.
DSWright, I thought of another interesting angle to take on this story. How many prominent Democrats outside of Congress are voluntarily dropping their government or other employer benefits to buy insurance on the exchange?
Anyone who thinks Reid should kick staff off the government plan better have already kicked themselves off whatever employer plan they have.
Hey Mulp, are you aware that a Democratic convention took place in 2008 where it was the Obama camp pushing back against universal healthcare or that people protested the OFA bus tour precisely because Obama was blocking single payer discussion or that the public option became a successful sticking point that Obama couldn’t just sweep under the rug because it was already a compromise against single payer?
The problem is the Democrats, not the Republicans, and certainly not progressives failing to offer alternatives. Attacking Obama and the Democrats is precisely the correct thing to do.
Which is probably why it gets under your skin. It’s effective :)
It’s interesting wondering just how much Reid was ‘an architect and staunch supporter’. I’m not sure that’s an obvious statement. ‘Blaming the Senate’ has been a Dem game for several years now, and specifically on healthcare reform, then health insurance reform, Reid put his foot down not wanting to take the blame on eliminating the public option. He had several earlier opportunities to cave when instead he put the heat back on the White House/House/Someone Else to explain why the public option went from the most conservative safeguard to being so liberal it couldn’t pass in a final bill.
Since actual governing happens in secret, we can only speculate. But speculation can still be fun in our era of imploding Dem politics. It looks like Reid is doing what is best for his staff – a nice quality in a boss.
Public support has dropped because PPACA is a stupid piece of legislation. It’s a solution in search of a problem whose purpose is to disrupt actual solutions to actual problems. This was all quite predictable five years ago.
Thanks for the update Jon, and certainly any negotiation is better than an open declaration of war from the administration.
But I would quibble with one point. The Iranians are suffering due to the stupidity of our leaders, not theirs. The US is the aggressor, not the Iranians. Iran, not Israel, is a signatory to the NPT framework.
washunate commented on the blog post Boehner on Cocaine: One Law For Us, Another For Them
guiltybystander – I don’t think it’s likely, just possible. An interesting possibility because the drug war is such a volatile political issue, not fitting neatly into red team vs blue team tribalism.
It was quite hilarious when the Obots would pooh-pooh the idea that insurance is complicated back in 2008 and 2009. My favorite line was when they would claim that it would work just like the federal system, and after all, that’s so easy.
I doubt anyone had even read GEHA’s 100+ page book. The complexity of health insurance is precisely why the only solution is a standard, universal, national plan.
Anything else is a lie, a purposeful deception, not an actual solution.
Plus, hadn’t anyone ever tried ehealthinsurance.com? They’ve been selling insurance since the Clinton Administration. Over this newfangled technology called the web.
washunate commented on the diary post My Body Isn’t 40 Anymore: Three Faces of Retirement by Gary Cohn.
What’s going on in California is just a natural outcome of the real problem, which has nothing to do with retirement. The problem is wealth concentration, particularly the combination of stagnating wages and rising prices. When Democrats support policies that entrench class divisions and create stressful, low-wage, temporary, no-benefit jobs, all while bailing out wealthy [...]
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