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GOP Debate Candidates Can’t Answer Fla. Woman Who Asks for Health Insurance

8:31 pm in Politics, Republican party by Scarecrow

Don't ask Mitt how to solve Florida's uninsured problems (photo: Gage Skidmore/flickr)

During Thursday night’s GOP debate, a woman from Florida told the candidates she’d lost her job and with it her health insurance.  What would each of the candidates do to get her covered or otherwise provide the health care she needed?

You had to listen carefully, but the effective answer they all gave her was, “this is your problem, not ours.”

Let’s first recall that this woman is not alone.  Millions of Americans have lost employer-provided health insurance.  That was happening before the recession but has become much worse during the recession.  That may be because they lost their jobs and can’t afford COBRA coverage, and the government’s stimulus subsidies for COBRA have expired, or because, even if they still have jobs, their employer stopped providing coverage because of its rising costs.  Or they may have lost effective coverage, because even if they have a job, their employer-provided coverage is so weak or so costly with deductibles, exclusions, and co-pays that they’ve effectively lost affordable, meaningful coverage. In the meantime, those on the individual “markets,” which are dominated by highly concentrated oligopolies, are confronted with insurance premiums they simply cannot afford.

As FDL’s Jon Walker has noted, America now has the highest percentage of uninsured in decades, and that’s not going to change unless/until the Affordable Care Act kicks in by subsidizing private insurance and providing millions with access to expanded Medicaid. So unlike many of the debate topics, this woman’s question was extremely relevant to literally tens of millions of Americans.

The answers she/we heard cannot have been reassuring.  Mitt Romeny said he’d adopt policies that would lead to her getting a new job.  Okay, maybe that happens in a couple years or so, or maybe not.  But even when, pre-recession, we had much lower unemployment, we still had tens of millions of people without insurance, and those who thought they had insurance were often ambushed by insurance company rescissions, exclusions, denials and then refusals to re-insure those with pre-existing conditions.  Millions of people faced these problem before the ACA and before the recession.

Moreover, if these Republicans were successful in repealing the ACA and block-granting Medicaid, as the GOP-Ryan Plan they all eventually suppported provides, then the woman would not be able to get either subsidized private insurance on a health care exchange or government-provided Medicaid.  In Florida in particular, the Governor and state legislature have been particularly vicious in cutting funding for hospitals and providers that treat Medicaid patients, and the GOP-stifled Congress has refused to consider expanded Medicaid beyond the original stimulus, so it would be even less likely this woman could get coverage there.

What’s left?  Read the rest of this entry →

ObamaCare vs. RyanCare: Scarecrow Gets Confused With “Serious” Strawmen

5:02 pm in Economy by Scarecrow

Ever since Jon Walker and I pointed out the real and superficial similarities between Paul Ryan’s proposed RyanCare for future seniors and the Affordable Care Act (ACA) structure for non-seniors, numerous pundits have been trying to deny either the similarities or the differences.

For example, Ryan’s supporters are in denial that RyanCare requires a mandate, even though he admitted — just as the logic suggested — that he’d require future seniors to purchase a private health insurance plan from a government-overseen exchange. And ObamaCare supporters are in denial that their ACA insurance exchanges rely on pretty much the same faith in the ability of a mostly free private insurance market to sufficiently control health care costs and hence insurance premiums.

We’ve tried to categorize and distinguish Medicare, RomneyCare, ObamaCare and RyanCare — see, e.g., here, here, here, and here — some have tried to grapple with the distinctions, and others have tried to fuzz it all up to serve whatever agenda they had.

The latest effort to make something out of the similarities is from the Washington Post’s Steve Pearlstein, who provokes Paul Krugman into describing Pearlstein as a Very Serious Person, — i.e., someone who gets it wrong.

Krugman and DeLong (responding to Mankiw) address the question, “are non-seniors better off under the ACA/ObamaCare’s subsidized exchanges than they would be without the ACA?” If those are the only choices, their answer is “yes,” though I don’t think they’ve confronted the numerous “affordability” arguments Marcy Wheeler made when ACA was being debated. But let’s assume they’re correct. That still leaves the large question about how well the exchanges can control costs unanswered.

The Administration, Democrats and ACA supporters insisted the exchanges would work to control health care costs because competition within the insurance market would control prices while maintaining quality care and service. But I understand Paul Ryan to be making the same argument for RyanCare: his private insurance market exchanges will make health care affordable, he claims, because future seniors exercising choice when shopping in the insurance exchange markets will benefit from private market competition. Both rely on a mostly free market theory.

Either this claim and its faith in markets are plausible or they’re not. My concern is that when Paul Krugman (or DeLong citing him) talks about the merits of Medicare versus RyanCare, there’s a reminder that ever since Ken Arrow, economists have known the competitive market argument doesn’t work in this industry.

Even ignoring the already huge concentration in the insurance industry, and increasingly so in the hospital and other provider sectors, none of the elements required to make an industry amendable to effective competition and efficient market pricing exist. Therefore, RyanCare can’t achieve the cost savings Ryan claims. But government-sponsored systems like Medicare, because they can reduce administrative costs, and because they can exercise single-buyer market power that individuals in the exchanges will not have, can do better — and have done better, here and in Europe.

If that’s true, then it’s not enough for economists and other ACA supporters to argue the ACA should be better than not having insurance at all; they need to explain why Arrow’s analysis and real-world experience do not apply to the market-based claims for the ACA exchanges, just as they do to RyanCare. And if this is a fatal flaw for RyanCare, isn’t it also a fatal flaw for the exchange structure of ACA?

Ezra Klein Says Government Health Programs Work, So Why Not Expand Medicare?

8:17 am in Uncategorized by Scarecrow

I’m a little confused by Erza Klein’s mostly helpful post showing, once again, the US paying much higher public and private costs than OECD countries for health care. Congress and the Administration should be reminded of that every day.

Klein is surely correct in noting that other developed nations rely much more on government-sponsored plans than purely private systems. As a result, they achieve not only lower total health care costs, as a percentage of GDP, but more universal coverage (and equal or better care) than does the US. The lesson to draw is fairly obvious: we need to move towards Medicare for all or some variation of a government-sponsored single-buyer model. But curiously, it’s not clear that’s what Ezra means.

I think Klein inadvertently muddles the point when he compares Paul Ryan’s plan to replace Medicare with its increasingly inadequate voucher system to buy private insurance with the Democrat’s plan — in the Affordable Care Act — to preserve Medicare in its present form but make it more cost effective. The comparison is valid, and I share the condemnation of what Ryan is proposing. But what Klein has done is to switch in mid-post from talking about universal coverage/care systems to talking only about what we do for the elderly.

What I’d like to have seen is Klein dealing with the alternative proposals for how to provide affordable, quality care for everyone else. Because here I think he’s lost his own point.
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How Will Mitt Romney Explain Why Paul Ryan’s “ObamaCare for Seniors” Is Okay?

2:06 pm in Uncategorized by Scarecrow

Now that FDL’s Jon Walker has done the deliciously dirty work of exposing Paul Ryan’s anti-Medicare proposal to force America’s seniors to accept the same flawed mandate and voucher system as ObamaCare, I can’t wait to hear Mitt Romney explain why he thinks this is a terrific idea.

As Jon so subtly hints, a pig is a pig, even if it has Mitt Romney’s lipstick on it. For the affected groups, the basic outline of RomneyCare is the same as the basic outline of ObamaCare is the same as the basic outline of StupidRyanCare. Let’s review the features:

1. Force everyone in the affected group to purchase private health insurance. We’ll call that a “mandate.”

2. Require the private insurers to accept all eligible customers but do little to prevent them from discouraging/screening out sick people via poor service and marketing. Call this “the business plan.”

3. Deprive the customers of any lower-cost public alternatives, like Medicare for all, a public option, etc. Call that “choice” or “keeping the insurers honest.”

4. Allow insurance companies to become so concentrated that in 80-90 percent of the country, only one or two mega insurers control the local market and set prices, while providing minimal oversight to ensure quality of service. Allow the antitrust, anti-price fixing regulators to wither. Call that “free market competition.”

5. Require the affected group to select between this one or two insurers on an “exchange” website that allows them to find the websites for the few eligible private insurance plans. We call this, “using teh Google.”

6. Having stripped consumers of the ability to bargain collectively (via Medicare, a union, an employer) for better, cheaper, more honest private insurance, send individual consumers, including the sick and the elderly, out on their own to “bargain” with the insurance giants. Call this, “leveling the playing field.”

7. Minimize or neglect obvious efforts to rein in the costs of private health care providers, including hospitals, specialist cartels, and big PhRMA, who are allowed to merge and concentrate. Let them be shielded by too-long patents and non-compete agreements and exempt from market or regulatory cost controls or antitrust pressure. Then allow them to fix the prices that private insurers must cover and pass on to their captive customers, plus the insurers’ higher but hard-to-audit administrative costs and profits. Do “homes of the rich and famous” shows on the execs. Call this, “the invisible growing hand in your wallet.”

8. Collect payroll taxes and other revenues via government mandate to help subsidize premiums — we’ll call this “premium assistance” — but provide no mechanism to ensure that the assistance keeps up with rising care costs to make the premiums affordable. If you’re Ryan, make sure it doesn’t keep up (See Dean Baker and CBO on how this screws Seniors). Call that “fixing the budget by shifting the costs to vulnerable people on fixed incomes.”

9. Wait to see how many people die from this stupid system. Call that “fiscal responsibility” or just “evil.” (Note similarity to Wi. Gov. Walker et ilk in shifting budget costs to workers as a means to strip workers’ economic leverage.)
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Paul Ryan Blasts Obamacare, Calls for Government Takeover of Health Insurance

9:54 am in Uncategorized by Scarecrow

Today’s New York Times hands over a portion of its op-ed page to Representative Paul Ryan (R. Wisc) to explain what Republicans would do to replace the Obamacare, a.k.a., Armageddon and the end of American democracy as we know it. Answer: Ryan wants a government takeover of health insurance.

In Fix Health Reform, Then Repeal It, Ryan tells us the linchpin of reform is to repeal the tax exclusion for employer-based health benefits, and thus dismantle the employer-based private insurance market and replace it with individual markets.

I helped write a plan that would replace the bias in the tax code with universal tax credits so that all Americans have the resources to purchase portable, affordable coverage that best suits their needs, with additional support provided for those with lower incomes. All these ideas, though, were dismissed early on, as they didn’t fit with the government-driven plan favored by the majority. But going forward it’s important that we reconsider this regressive tax issue.

Then, when helping Americans with pre-existing conditions obtain coverage, we should focus on innovative state-based solutions, including robust high-risk pools, reinsurance markets and risk-adjustment mechanisms. I intend to continue advancing true patient-centered reforms like attaching tax benefits to the individual rather than the job, breaking down barriers to interstate competition, and promoting transparency and consumer-friendly coverage options.

We should ensure that health care decisions are made by patients and their doctors, not by bureaucrats, whether at an insurance company or a government agency. By inviting market forces into health care, we can encourage a system where doctors, insurers and hospitals compete against one another for the business of informed consumers.

So think about what he’s saying. The Republicans would effectively dismantle the mostly unregulated employer-based insurance markets and replace them with a scheme in which private insurers (never mind consumers) would be entirely dependent on federal tax credits and subsidies. If that sounds like a radical, government dominated version of Romneycare Obamacare, that’s because it is.

These now government-subsidized insurers would then compete for your business. I assume Ryan wouldn’t, Chinese-style, abolish the Google/Yahoo, so folks could search for insurance bargains over the internet and compare prices and coverage. Government watchdogs would police for false and misleading advertising, bait and switch tactics and phony insurers, as they always have. We’ll call that an "exchange."

What about those "innovative solutions" to the pre-existing conditions problem? Ryan’s solution is a mix of government mandates and regulations to create risk pools and a government-mandated and government-administered risk adjustment mechanism — again, all features of Romney/Obama/Ryan care. Or does he assume Wellpoint will voluntarily hand over to Kaiser Permanente any excess profits Wellpoint extracted from discriminatory underwriting practices?

Even sillier is Ryan’s claim he’d somehow put health care decisions in the hands of you and your doctor, "not by bureaucrats, whether at an insurance company or a government agency." So, how do you make sure that insurers don’t drive those decisions? Why, it’s via government regulations taking away insurers’ discretion on underwriting — so that insurers have to cover you and they can’t charge me more than they charge you, or you more than your spouse or us old coots much more than our kids. On planet earth, we call these ideas guarantee issue, community rating and ratios, and private market insurers don’t do these things without strong government regulation.

So watch out for that Republican health care plan. It’s a massive government takeover of health care.

And don’t forget, Paul Ryan is considered one the leading intellectual lights of the Republican Party. "And then darkness fell upon the land."