Painful Facts

Yesterday there were some questions in the comments about how big the vouchers would be under the Ryan plan. I had tossed off $15,000 as the number, but some people thought it was $8,000. I asked our resident non-lazy blogger, Kay, because, well, I’m lazy. Kay pointed me to the CBO letter to St. Paul Ryan [pdf]:

The payment for 65-year-olds in 2022 is specified to be $8,000, on average, which is approximately the same dollar amount as projected net federal spending per capita for 65-year-olds in traditional Medicare (that is, the program’s outlays minus receipts from the premiums enrollees pay for Part B and Part D, expressed on a per capita basis) under current law in that year. People who become eligible for Medicare in 2023 and subsequent years would receive a payment that was larger than $8,000 by an amount that reflected the increase in the consumer price index for all urban consumers (CPI-U) and the age of the enrollee. The premium support payments would increase in each year after initial eligibility by an amount that reflected both the increase in the CPI-U and the fact that enrollees in Medicare tend to be less healthy and require more costly health care as they age. (For example, projected net federal spending per capita for all people age 65 and older in traditional Medicare would be about $15,000 in 2022, CBO estimates, in comparison with about $8,000 for 65-year-olds.)

After all the sound and fury from the serious people, just let that paragraph sink in. Eleven years from now, the first year that this new “Medicare” program starts, the average 65-year-old will get a payment that couldn’t buy him or her a decent private insurance plan on today’s open market. I called this political suicide back when I first heard the $15K number. I hadn’t realized the real number is a little more than half of that. $8,000 is ritual, premeditated group political suicide, and Paul Ryan is Jim Jones, not the second coming of St Ronald.

I don’t get paid to read CBO reports, but David Brooks, Andrew Sullivan, Joe Klein and the rest are supposed to dust these fucking things off and delve into them. Hell, Kay, who’s busy doing real work, does it. That report is 26 pages of big type. It’s been out for 7 weeks. It could be read during one or two trips to the can. Instead of that, I guess they were beating off to pictures of Paul Ryan. Idiots.






122 replies
  1. 1
    rob! says:

    I guess they were beating off to pictures of Paul Ryan

    I think that’s what Cheney was referring to the other day. Though how you beat off inside the coffin Cheney climbs into every night is beyond me.

  2. 2
    Hawes says:

    Journamalism is HARD!

    Math is HARD!

    Eating fiber is HARD!

  3. 3
    Villago Delenda Est says:

    David Brooks, Andrew Sullivan, Joe Klein and the rest are supposed to dust these fucking things off and delve into them.

    You’d think.

    But they’re lazy, entitled assholes. All of them. Which is why when The Revolution comes, they’re dead meat.

  4. 4
    PurpleGirl says:

    As I mentioned in one comment yesterday, from my reading of Ryan’s plan, it seemed that the “premium support” would also be means tested. IOW, the more money you had in retirement, the lower the subsidy would be. And it looked the support would a tax credit and not actual payment of money. Bad ideas all around.

    ETA: I searched the PDF for “premium support” and “voucher”. “Premium support” did not yield results; “voucher” did but not in relation to payment of a insurance subsidy.

  5. 5

    Thanks for responding to the question, mm. yesterday or today, kthug used the L word to describe Ryan (lying), so hopefully some of the VSPs will pay attention.

  6. 6

    @arguingwithsignposts: Yes, no doubt the VSPs will be sure to note how shocked they are by Krugman’s shrillness and incivility.

  7. 7
    Culture of Truth says:

    Ideally, it would be nothing. For the Ryan acolytes, $8,000 is a generous compromise.

  8. 8
    PurpleGirl says:

    @arguingwithsignposts: No, they won’t because Krugman is Shrill.

  9. 9
    RossInDetroit says:

    Since the voucher is pathetically inadequate to purchase insurance, many of them will never be used.
    I wonder if the GOP worked all of those unredeemed vouchers into their cost savings estimates.
    They certainly didn’t give a thought to all of the retirees who will have paid into the program their entire working lives and got so little back that it was effectively zero.

  10. 10
    Professor says:

    And who told you that David Brooks, Andrew Sullivan, Joe Klein etc work for you? They are paid to disinform you by misinformation. They have to put the fear of gloom in you so that you agree to be screwed by them. That is they way it is!Before you wise up you will be ‘Hewers of wood and drawers of water’. Do you think you have a democracy? Think again!

  11. 11

    @Hawes:
    Serious Psychopaths are HARD for the Paul Ryan budget.

  12. 12

    And in her comment you can see the reason for the confusion.

    $8000 now, which is expected to be $15,000 in ten years due to inflation and aging of the population.

    The 8 is guaranteed, the 15 is estimated.

    $750 per month to get a plan that covers:
    – 80% after a $162 annual deductible on office visits, outpatient hospital, some home health care, durable equipment;
    – all but $1132 of the first 60 days of hospital stay (annual), all but $283 per day for next 90 days, all but $566 for the next 60 days;
    – the weird part D for drugs: you pay $310 deductible, 25% of the next $2530, 100% of the next $3,607, and finally 5% of anything more than that.

    Simplifying: $160 deductible office visits then 20% copay, $310 deductible for drugs then 25% copay, $1130 deductible for hospital no copay for 60 days, all for $750 per month?

  13. 13
    RossInDetroit says:

    @arguingwithsignposts:

    kthug used the L word to describe Ryan (lying), so hopefully some of the VSPs will pay attention.

    Yeah, I saw that though it didn’t really stand out in the post. Dr. K gets pretty blunt when there are Facts involved and someone is intentionally misstating.
    Thank FSM that someone with credibility and an audience is willing to stand up to the GOP’s barrage of obfuscation in the media.

  14. 14
    A Farmer says:

    Slightly OT, but the CBPP is blasting McArdle for being slow. It’s an easy target, but funny anyway.

  15. 15
    Davis X. Machina says:

    You’re looking at the math like it’s math. They’re looking at the math because it makes their case, it supports their creed:

    Everything private is better than anything public; there exists nothing that cannot be bought or sold; and so long as one of us, somewhere, is covered by a collective bargaining agreement, none of us, anywhere, is truly free.

    This is fundamentally a theological argument.

    Consider the difficulties that arise when historians look at the Gospels, without taking into account what the authors of the Gospels were doing. They weren’t writing history, they were proclaiming The Good News to an audience who were already mostly believers.

    Thus Republicans, and budgetary stuff.

    Actual mathematical coherence isn’t the point — they’re proclaiming the Good News to believers.

  16. 16

    @RossInDetroit: Actually, it wasn’t a post. It was in his column (just correcting for anyone who might think it was in a blog post).

    Savor the shrill:

    If anyone is lying here, it’s Mr. Ryan himself, who has claimed that his plan would give seniors the same kind of coverage that members of Congress receive — an assertion that is completely false.

  17. 17
    shortstop says:

    Nice post, and glad to see well-deserved compliments for Kay.

    @Davis X. Machina:

    This is fundamentally a theological argument.

    Excellent observation. We get so frustrated when people won’t do the simple arithmetic, but they’re arguing from a completely different set of…well, it’s overly charitable to call them “premises,” but for lack of a better word…

  18. 18
    Cat Lady says:

    Paul Ryan is Jim Jones

    You’re right, but for Sully all that means is some blogger at BJ gets a Moore Award.

  19. 19
    General Stuck says:

    $8,000 is ritual, premeditated group political suicide, and Paul Ryan is Jim Jones,

    Yup, mind blowing, ain’t it. Or the sounds of a diseased and dying political movement, with nothing but failed policies under their belts for the past 30 years. Propped up by lies and crazy people to win a low turnout midterm.

    The only question is will it be a simple pol suicide, or a murder – suicide if they cause a default on our debts, and take the entire country, and world with them. If Mitch Mcconnell’s all in or else words didn’t send a chill up your spine, then you are in a waking coma.

  20. 20
    Jazz Superluminar says:

    David Brooks, Andrew Sullivan, Joe Klein and the rest are supposed to dust these fucking things off and delve into them

    I like you mm, but sometimes you are really, really naive.

  21. 21
    LosGatosCA says:

    But, he’s such a nice boy who got good grades in school. I don’t know why everyone is calling him nasty names and saying mean things about him.

    He’s very polite and has a word of encouragement for everyone. Why just the other day our 85 year old neighbor was complaining about her doctor and her Medicare. Paul listened attentively and then helped her understand the coming improvements by explaining how things were going to change.

    More choices but with less money so she’ll be able to contribute to making society more productive even at her age. Soon she’ll be able to help the rich people who will have lower taxes create more jobs for her great-grandchildren. So her pain will end soon and then more jobs will be created. It’s a classic win-win.

    It wasn’t his fault she wasn’t receptive to his explanations. She just seemed to focus on her own selfish needs and couldn’t stay positive and constructive like Paul.

  22. 22
    Davis X. Machina says:

    @General Stuck: Doomsday-trolling a financial apocalypse is entirely consistent for these people — eschatological speculation comes easily to the religiously committed. The ‘religion‘ here, let me be clear, isn’t a spiritual one.

  23. 23
    MonkeyBoy says:

    I think the Glibertarian thinking goes as follows:

    1) The Federal Gov is wasteful in its programs and freeing up the money to individuals MIGHT allow the really smarter ones to use the money more efficiently.

    2) If an individual doesn’t have the ability to use the freed money well then they really don’t deserve it and craftier people will take it away which is the natural order. Having the money controlled by a Federal program can put up needless barriers to 3rd party access to the money.

  24. 24
    WereBear says:

    @RossInDetroit: Since the voucher is pathetically inadequate to purchase insurance, many of them will never be used.

    That’s the sick brilliance of it!

    It’s also worth noting that I’m sure none of the Ideological Idiocrats are considering the impact on themselves with this plan.

    Don’t they have parents and grandparents and aunts and uncles? Sure, they might have their government health care, but their older relatives do not. And who is going to pay for that?

  25. 25
    birthmarker says:

    @RossInDetroit: This is an interesting point, because it’s illegal for the hospitals to not treat you regardless of ability to pay. So why not just not get insurance at all? Of course the debt will attach to your estate upon death (I presume), but it seems the goal is to leave everyone destitute at death anyway.

    On a positive note, the only way it will work is to have some serious cost controls built in, which will lead us to a much more sensible plan eventually.

  26. 26
    RossInDetroit says:

    @General Stuck:

    The only question is will it be a simple pol suicide, or a murder – suicide if they cause a default on our debts, and take the entire country, and world with them. If Mitch Mcconnell’s all in or else words didn’t send a chill up your spine, then you are in a waking coma.

    That was pretty astonishing. The GOP is so desperate over their political screwup that they’re willing to endanger the country’s credit standing unless the Dems swallow the same poison pill that they eagerly gobbled. Politics over policy every time, no matter the consequences.
    When I read about it on TPM I was literally dumbfounded. Speechless.

  27. 27
    General Stuck says:

    @Davis X. Machina:

    They have convinced themselves that liberals spending money on the poor is an original sin against good commerce, and they must make us all drink the kool aid, lest we are all dirty sinners to the Gawd of Profit. And must pay the price.

    Or, if the scheduled Apocalypse is late, make yer own.

  28. 28

    @MonkeyBoy:

    I think the Glibertarian thinking goes as follows:

    I got mine, fuck you. That’s what the libertarians are thinking.

  29. 29
    Cat Lady says:

    Unless every single one of these GOP motherfuckers put their money where their mouth is, they should just STFU. I just don’t understand why the point isn’t hammered home over and over again that we just want the health care that Paul Ryan has. Why can’t we the people have what you, the servant of the people, have? Why?

  30. 30
    PeakVT says:

    @Jazz Superluminar: MrMx is not being naive. He’s merely stating the nominal purpose of a pundit, which is they take facts, synthesize them, and present their interpretation of them in a concise format. That’s not the real purpose of most pundits, of course.

  31. 31
    Citizen_X says:

    @RossInDetroit:

    Since the voucher is pathetically inadequate to purchase insurance, many of them will never be used.

    Perhaps they’re factoring in a rise in desperate seniors blowing their brains out. A little bit grim, perhaps–but think of the savings!

  32. 32

    the thing that scares me about the ryan plan, in 20 years it might be the sensible compromise, as the republicans goal is to turn everything to shit anyway.

    look at the hcr we just passed, as many people as hated the gop ideas as they were proposed in the 90s, what happened a generation later?

    they already have a bunch of under-40s talking about how they never expect to collect social security anyway, so at some future point, those folks won’t see a proposal to get rid of it as all that unexpected.

  33. 33
    Suffern ACE says:

    @PeakVT: I read Brooks this week that the political culture in the UK is such that people might actually be able to read their papers and find the issues of the day explained clearly for them. I found that amazing. I mean, not only do our pundits put their thumbs on the scales, but sometimes appear not to actually understand the topics they are writing about. How do the brits survive with all that compentent analysis-it must drive them insane.

  34. 34
    Carol says:

    $8,000? and then a copay, on a fixed income?

    Sometimes I think the Republican plan is to have poor seniors, the ones who can’t bequeath them millions, to die quickly. Of course that means the younger, browner generations come to power quicker, which means they will vote out all those heartless Republicans to begin with. This is smash and grab economics, designed to make money for their patrons and to permanently tilt the playing field in their favor (so they think) before the brown tidal wave.

  35. 35
    Davis X. Machina says:

    @birthmarker:

    This is an interesting point, because it’s illegal for the hospitals to not treat you regardless of ability to pay.

    For now. But a for-profit hospital — and there are fewer of the other kind every day as the chains snap up what used to be charity endeavors — to be mandated to take a loss? I’m sure you could break that in court with an appropriate interpretation of the Takings Clause…

  36. 36
    loretta says:

    @Kirk Spencer: Actually, the Part A deductible occurs every 60 days, so someone could be hospitalized 2, 3, 4 times a year 60 days apart and pay that $1134 each time.

    The point is, right now private contracted insurance companies (Wellpoint [BC/BS], Aetna, Humana, et al) get between $800-$1000 per month per member of their Medicare Advantage plans. That’s in 2011 money.

    There is no way that will cover someone in 10 years. We have seen 30 – 40% cost increases in health care in less than a decade.

    Basically, Medicare was never designed to be 100% of your coverage, but between it and supplements, employer plans and Medicare Advantage, it works pretty well. To turn it all over to privatization would be the manifestation of Alan Grayson’s famous line: Don’t get sick, and if you do get sick, DIE QUICKLY.

  37. 37
    shortstop says:

    @birthmarker: Because the debt doesn’t wait for your death, but starts attaching the second you leave the hospital — with increasingly aggressive collection measures that lead to court judgments, wage garnishment, surrender of assets, etc.

    This is why there are so many medical bankruptcies (upward of 1 million a year in the U.S.), and why so many people lose their entire savings, houses and everything else when faced with expensive illnesses. It’s also why wingers who tell the poor to “just go to the ER” for regular healthcare are in a criminal level of denial. The poor get a hospital bill just like everyone else does, and hospitals try very, very hard to collect just like every other creditor does.

  38. 38
    RossInDetroit says:

    Seniors who have some income and don’t have expensive medical conditions will be able to use the vouchers to offset their costs of private insurance, but the poor and sick will be effectively SOL. This is the perfect GOP plan: if you have money you get government benefits and if you don’t you can go die in a hole for all they care. Pay in, get nothing out.

  39. 39
    Davis X. Machina says:

    @General Stuck:

    Or, if the scheduled Apocalypse is late, make yer own.

    There is a small but noisy minority among Roman historians who take seriously the proposition that the AD 64 Great Fire in Rome was at leas in part the result of early Christians doing precisely that — maybe not starting the fire, as Nero’s propaganda machine maintained, but ‘helping’ it, so as to usher in the End of Days.

  40. 40
    BGinCHI says:

    On NPR yesterday I heard that stupid cocksucker David Brooks trot out figures of why Medicare has to end (I mean “be reformed”).

    He said, “the average American pays in 150K and takes out 350K, and that’s just too much free money.”

    Free money.

    Now, if someone can fact check that I’d like to know where he gets his numbers.

    But beyond that, NO consciousness of what health care for profit is doing to the whole system. He wants to save money, but won’t admit that it’s the system that’s eating up those dollars, not sick and dying people.

    Goddamn him.

  41. 41
    Ash Can says:

    @WereBear: Who says they care about their older relatives?

    The talk in this thread of libertarianism being a religion is bang-on. The grandiose justification of self-centerdness that is libertarianism holds such profound appeal to sociopaths and the emotionally/socially stunted that they hold it above everything else. Sacrificing older relatives to the cause would simply be a necessary evil.

  42. 42
    PurpleGirl says:

    @birthmarker: No, hospital EMERGENCY ROOMS have to stabilize you, not treat you. If you go in with burst appendix, yes will do the operation; if you show up with pain from a cancer tumor, no you won’t get chemotherapy but maybe one day’s medication to stop the pain. I went to an ER needing certain medications. They gave me that day’s drugs, and a prescription of 2 days drugs to hold me until I went to the clinic appointment they made for me. They could not give me a regularly monthly prescription.

  43. 43
    Josie says:

    @shortstop: I think you could say that they are arguing from a completely different paradigm.

    I tried to do the block quote and fix it for you, but couldn’t figure out how to do the strikeout. Computers, how do they work?

  44. 44
    shortstop says:

    @Josie: Sister, can you paradigm?

  45. 45
    MonkeyBoy says:

    @Roger Moore:

    I got mine, fuck you. That’s what the libertarians are thinking.

    I think you are being too charitable. For many Libertarians their creed is also Social Darwinism. Their slogan might be “I’ve got mine and Its my right to fuck you over (i.e. take yours if you are not strong enough to hold on to it)”

    Transferring Government control over funds to individuals makes it much easier to scam away the funds.

  46. 46
    grandpajohn says:

    @Villago Delenda Est:

    David Brooks, Andrew Sullivan, Joe Klein and the rest are supposed to dust these fucking things off and delve into them.

    Why? Shit they don’t have to worry about Medicare providing their health care in old age That for the peons to worry about not the special people like them

  47. 47
    trollhattan says:

    @ mistermix

    This post is letter-perfect.

    That is all.

  48. 48
    Davis X. Machina says:

    @Ash Can: Not just a necessary evil, but a positive good, showing the intensity of your commitment to the faith.

    We’re close to the Masada era of movement conservatism, where the surrounded, doomed few, after a heroic resistance, sacrifice their own loved ones, maybe not literally, but certainly offering up their loved one’s health, their education, their prospects of future employment — rather than let them live in a world dominated by Islamo-Keynan Socia1ists godless Romans, and are consoling themselves with the conviction that they will be honored after the fact.

  49. 49
    shortstop says:

    @Davis X. Machina: How very Magda Goebbels of them.

  50. 50
    PurpleGirl says:

    @BGinCHI: And no idea of how insurance works. It’s a bet that you pay a premium and may or may not need a benefit. For a number of years I paid apartment insurance against things like floods from neighbors, a theft, etc. I never made a claim. The company kept all my money. for those years I was glad I was covered, though, because the cost to pay for cleanup or replace stolen things would have been much more expensive than the insurance. (In Keith Olbermann’s voice: David Brooks is an idiot.)

  51. 51

    @Kirk Spencer:

    all for $750 per month

    Which, when deducted from my Social Security, would leave about enough to buy groceries for a week. No money for the rest of the month, no housing, no clothing, no transportation, no . . . . . .

  52. 52
    AlladinsLamp says:

    The CBO analysis fails to dynamically score the cost savings from Grandma’s shopping around for the best deals on Grandpa’s hip replacement.

  53. 53
    loretta says:

    I hate to keep saying this, but this idea is a non-starter. There is not one single insurance company lobbying for fully privatized Medicare in 2025. Again, if they were behind it even in a stealth way, I would know.

    Fully privatized Medicare would be unacceptably unprofitable.

    But, the fact that the Galtians suggested it points to their hubris, tone-deafness and immorality. All malignant narcissits are virtuoso self-saboteurs, thank spaghetti monster for that.

  54. 54
    Josie says:

    @shortstop: If it’s anything technical, probably not.

  55. 55
    Davis X. Machina says:

    @shortstop: All chiliasts are basically the same deep down inside. This present world is too debased for them.

    It’s the better world to come for them, or no world at all.

    Revolutionary socialism can go down this path, too. It’s bi-partisan.

  56. 56
    BGinCHI says:

    @PurpleGirl: And, tragically, an idiot with a platform.

    May he fall off it and break his lily white neck.

    In other news I had a very vivid dream last night that our Provost got fired (finally) and we hired David Gregory.

    Seriously. And I found this out while I was on an Arctic cruise, with said Gregory and others.

    I may have to start taking pills. The booze isn’t working.

  57. 57
  58. 58
    Josie says:

    @shortstop: lol. I finally got it after I posted. I have no excuse other than that I am old and slow. Well, not terribly old, but slow.

  59. 59
    shortstop says:

    @Josie: It’s not the funniest thing I’ve ever said.

    Speaking of funny, gotta see a vet about vaccinating a boberman. Everyone have a lovely jump into this holiday weekend.

  60. 60
    BC says:

    I still haven’t heard any insurance company wanting to be in this “exchange” that Ryan’s bill sets up. Doesn’t matter how high the premiums are, the bill selects a group of people who are at risk of heart attacks, strokes, diabetes, cancer, hip/shoulder/knee replacements, ad infinitum. All these things cost a lot more money than the run-of-the-mill colds, flus, etc., that the general population is more prone to having. So, even with the copays and deductibles, what insurance company is going to insure these people, when one or two percent will wipe out all the premiums they have collected? We might as well characterize Ryan’s plan as the “bankrupt the health insurance companies” plan.

  61. 61
    Dennis SGMM says:

    One of the many deceptions that are the foundation of the Ryan Plan is the use of average Medicare spending as the basis for reimbursement: he’s using the costs of a non-profit government program as a basis for setting the amount that an enrollee would be paid to purchase a policy from the for-profit HMOs. The reason for that is completely understandable; had he used the cost to a senior of purchasing a Medicare equivalent policy his plan would have been obvious bullshit rather than a Very Serious road map to reducing entitlement costs.

  62. 62
    lol says:

    @shortstop:

    You’re forgetting that you’re supposed to lie about your name and contact information when you go to the ER. So it’s free!

  63. 63
    Ash Can says:

    And throughout this whole discussion is the underlying fact that this Medicare “reform” would force seniors to buy insurance from companies whose financial self-interest calls for selling to the fewest elderly and infirm as possible. As it is now, we don’t really have a feel for how reluctant insurance companies are to sell policies to the elderly because Medicare is covering them. Private insurers minus Medicare plus tens of millions of uncovered seniors equals train wreck. U.S. life expectancy would plummet. Numerous hospitals, nursing homes, and assisted living facilities would close. Economic productivity would erode with more younger people having to care for their elderly relatives. And the Republicans would all be happy to see the nation come that much closer to a state of ideological purity.

    (Edited to correct spelling fail.)

  64. 64
    Davis X. Machina says:

    @BC:

    We might as well characterize Ryan’s plan as the “bankrupt the health insurance companies” plan.

    This is precisely why the ACA is set up the way it is — as Nye Bevan said when asked how did he get past the MD’s objections to the NHS, so too Obama and the insurance companies…”We stuffed their mouths with gold.”

  65. 65
    Dennis SGMM says:

    @AlladinsLamp:
    Yes, shopping around will almost invariably find the best price. The sticking point is the cost of flying Grandpa to India, or China, or the Dry Tortugas, or wherever the hip replacement is cheapest.

  66. 66
    celticdragonchick says:

    Everybody here seems to be utterly assured that Andrew Sulli9van has been backing the Ryan Plan.

    Uh…no, he has not. He rejected it as cruel and heartless, even if he did give needless props to Ryan for making a “serious” budget suggestion to begin with.

    Case in point:

    On may 26, Sullivan points out exactly the same thing that Mistermix writes about today while blaming Sullivan for not writing about it.

    Before making accusations, it is best to double check.

    I know most of you have a deep seated and somewhat pathological hatred of Sullivan, so I will not bother to say much more, except here is the link.

    http://andrewsullivan.thedaily.....-plan.html

    He has been making similar statements for several weeks, but many of the folks here would rather get their snark on and make fucked up jokes about him rather then try to find out if the criticism is even warranted to begin with.

  67. 67

    @Davis X. Machina:

    the Masada era

    I watched a history program about the original Zealots, from the same area and the same time. I came to realize why “Zealot” is an insult.

    On the other hand, the current crop of Republicans have a lot in common with the Zs.

    The Z group killed many more Jews than they did Romans. They killed people who weren’t pure enough in their devotion to Judaism. They killed people who weren’t pure enough in their devotion to The Cause. At the end, when they were trapped inside of Jerusalem along with thousands of ordinary people, they became even more intent on obtaining theological purity. They fought among themselves. They set fire to the grain stores of other folks, even other Zealots who disagreed with them. They tried to kill everyone who tried to leave Jerusalem.

    In the end, Zealot-induced starvation and fear of their neighbors did them in.

    In the present situation, the Tea Party represents the Zealots.

  68. 68
    Violet says:

    @RossInDetroit:

    Since the voucher is pathetically inadequate to purchase insurance, many of them will never be used.

    Of course they’ll be used. The health insurance companies will come up with some form of crap coverage that is the exact amount of the vouchers. It won’t cover much of anything, but they’ll include something like one free doctor’s visit a year and sell the hell out of that. Then they’ll market it as, “for your peace of mind” or some other meaningless comment. And it will sell. Why? Because it’s better than nothing.

    You really think health insurance companies are going to leave that sweet, sweet government voucher money on the table?

  69. 69

    @celticdragonchick: Maybe if sullivan wasnt such a gop shrill, i’d pay attention to what that insufferable tory twit said.

  70. 70
    Davis X. Machina says:

    @Violet:

    The health insurance companies will come up with some form of crap coverage that is the exact amount of the vouchers

    Charter ‘schools’ and vouchers, all over again.

    The real providers increase their tuition by the amount of the vouchers, zeroing out their value, and the prosperous, who don’t need the vouchers, pay the new retail, and either don’t notice, or content themselves with a bit of grumbling.

    And the vultures move in for the rest of us.

  71. 71
    Dennis SGMM says:

    @Violet:

    The health insurance companies will come up with some form of crap coverage that is the exact amount of the vouchers.

    We have a winner! The coverage will consist of one free doctor visit. If the doctor finds that you are very ill then the coverage will also include one free dose of cyanide.

  72. 72
    Davis X. Machina says:

    @Linda Featheringill: Talk of a party committing ‘political suicide’ does make one think…

  73. 73
    BGinCHI says:

    @Dennis SGMM: And one shovel.

  74. 74

    @Davis X. Machina: I refer to it as a Gideonesque principle instead of masadan.

    See, Masadan says we’re outnumbered, we can’t win, we shall not be defeated. Gideonesque says outnumbered is immaterial if you’re pure enough – if your cause is pure and you truly believe.

    I suppose I could start calling it tinkerbellish – same basic idea.

  75. 75
    Davis X. Machina says:

    @Kirk Spencer: Whatever you call it, you’re not dealing with rational actors, who are weighing costs and benefits in any normal way, and it’s important to keep that in mind when negotiating, or more usually, discovering you can’t negotiate. Their incentives aren’t different from you, so much as 180º the other way round.

  76. 76
    Violet says:

    @celticdragonchick:

    Uh…no, he has not. He rejected it as cruel and heartless, even if he did give needless props to Ryan for making a “serious” budget suggestion to begin with.

    It took him quite awhile to get to the point of seeing that the plan is not a good one. From April 5:

    Ryan’s proposal, whatever you think of it, is serious. His proposal for Medicare looks to me like an extension of the Romney/Obama healthcare exchanges. His proposal for Medicaid – block grants to the states – will inevitably cut down on sky-rocketing healthcare spending.

    Yes, that Medicare thing is just like Romey’s and Obama’s plans! Both sides do it! The Medicaid thing, you know, the one that realistically will put old people on the street, that’s just a great way to control costs!

    And then on April 6 he links to Tyler Cowen who praises the plan as creating a “real debate. Finally!” and includes this gem of a quote:

    The more the Democrats criticize this plan, the more it helps Ryan and the more it hurts the Democrats. It reframes sticker shock, and the entire debate, simply to argue about $6 trillion in budget cuts.

    Yes, yes. I’m sure those GOP folks who poured all that money into the NY-26 agree that the more Democrats criticize the plan, the more it hurts them.

    And while we’re at it, he gives Debbie Wasserman-Schultz the Moore Award for this quote:

    “This [Ryan] plan would literally be a death trap for seniors,” – incoming DNC chair, Debbie Wasserman Schultz.

    Sully did not reject the Ryan plan outright as “cruel and heartless.” He may finally have come around to that, but he’s been dragged to his current opinion.

  77. 77
    Violet says:

    Okay, I went into moderation in my comment, probably because of too many links, so I’m going to break it up into two comments.
    @celticdragonchick:

    Uh…no, he has not. He rejected it as cruel and heartless, even if he did give needless props to Ryan for making a “serious” budget suggestion to begin with.

    It took him quite awhile to get to the point of seeing that the plan is not a good one. From April 5:

    Ryan’s proposal, whatever you think of it, is serious. His proposal for Medicare looks to me like an extension of the Romney/Obama healthcare exchanges. His proposal for Medicaid – block grants to the states – will inevitably cut down on sky-rocketing healthcare spending.

    Yes, that Medicare thing is just like Romey’s and Obama’s plans! Both sides do it! The Medicaid thing, you know, the one that realistically will put old people on the street, that’s just a great way to control costs!

  78. 78
    Violet says:

    And part two of my comment that went into moderation:

    And then on April 6 he links to Tyler Cowen who praises the plan as creating a “real debate. Finally!” and includes this gem of a quote:

    The more the Democrats criticize this plan, the more it helps Ryan and the more it hurts the Democrats. It reframes sticker shock, and the entire debate, simply to argue about $6 trillion in budget cuts.

    Yes, yes. I’m sure those GOP folks who poured all that money into the NY-26 agree that the more Democrats criticize the plan, the more it hurts them.

    And while we’re at it, he gives Debbie Wasserman-Schultz the Moore Award for this quote:

    “This [Ryan] plan would literally be a death trap for seniors,” – incoming DNC chair, Debbie Wasserman Schultz.

    Sully did not reject the Ryan plan outright as “cruel and heartless.” He may finally have come around to that, but he’s been dragged to his current opinion.

  79. 79
    RossInDetroit says:

    @Violet:

    You really think health insurance companies are going to leave that sweet, sweet government voucher money on the table?

    You may be right but in this case I do think they won’t touch it. They’d have a large number of very pissed customers on their hands. Something that insurers avoid.
    I worked for life and health insurers for 13 years in premiums and ratings. They have to account for a large proportion of premiums as services delivered and they’re regulated on that basis by the states.

  80. 80
    Jazz Superluminar says:

    @celticdragonchick
    meh. I’m more upset that his newly-discovered Wheat allergy means he can’t enjoy “petite vanilla bean scones” any more. I’m literally crying over here. With laughter, but I’m crying, I tell ya.

  81. 81
    Violet says:

    @RossInDetroit:
    If Medicare as we know it goes away, then what are seniors going to do? They can buy the crap insurance with their voucher or go without, unless they’re lucky and have insurance in retirement from their employer. That’s pretty much going the way of the dodo, though, so not many people can count on that. So they’ll buy the crap insurance. Health insurance companies will say that whatever the crap they offer is the “only thing they can afford and still meet their shareholder’s expectation” and that’s that.

    Seniors may have a lot of power in the polls but they’ve got crap power with companies. How will they convince health insurers to change their ways? They won’t. They need politicians to do it for them.

    You may be right but in this case I do think they won’t touch it. They’d have a large number of very pissed customers on their hands. Something that insurers avoid.

    Will the customers be more or less pissed if they can’t afford anything with their voucher because nothing is available? And it’s not just grandma that’s going to be pissed off, adult children trying to help their senior parents sort through this mess are going to be just as annoyed.

    All it takes is one crappy insurer to cross the line and start accepting the vouchers and then all the others will fall in line behind them.

  82. 82
    patrick II says:

    Republican/Fox/Limbaugh lying has been driving me nuts for years. But their confidence in the technique my have been overstretched by lying about something that is contradicted by too many people’s personal experience.
    Repubs can lie about war, or blacks, or gays, or unions and each one of those lies is contradicted by the personal experienced by only a minority of people — leaving the majority of people susceptible to their own worst instincts uncurbed by personal reality.
    However, it seems the repubs have crossed the rubicon with medicare and perhaps medicaid. Everyone counts on medicare in their old age and nearly everyone already has a parent or an uncle or someone already counting on it.
    The republicans have gotten away with lying about most things, but this one is contradicted too directly by too many people’s personal experience with the truth of the good medicare does for the health of the elderly.

  83. 83
    Tim, Interrupted says:

    Instead of that, I guess they were beating off to pictures of Paul Ryan.

    In the case of Andrew Bareback Sullivan, I’m pretty sure you can take that guess straight to the sperm bank. He routinely supports policies being championed by public figures that move his willy.

    During the run up to the Iraq War, he posted blurbs debating which was the hotter “daddy:” Rumsfeld or Cheney.

    Jesus, what a toad.

  84. 84
    Davis X. Machina says:

    @RossInDetroit:

    They have to account for a large proportion of premiums as services delivered and they’re regulated on that basis by the states.

    This is the reason for the present drive for cross-border purchase of health insurance. A state just needs to become what Delaware or South Dakota are to credit cards, and completely de-regulate medical-loss ratios. In short order, 90% of the insurance any of us carry will be written there. (Link is pdf.)

  85. 85
    Brother Shotgun of Sweet Reason says:

    @Fucen Pneumatic Fuck Wrench Tarmal: When I was under 40 in the wrecked economy of the 70s, I didn’t expect to collect Social Security either. The math on it was worse than it is now. And here I am, just a few years away from it. Maybe this is just the natural skepticism of Youth.

  86. 86
    Davis X. Machina says:

    However, it seems the repubs have crossed the rubicon with medicare and perhaps medicaid.

    When Caesar crossed the Rubicon, he went on to win.

  87. 87
    RossInDetroit says:

    @Violet:

    You may be right about limited insurance plans for seniors that consume the whole voucher and provide little payout.
    Thinking in terms of plan design, it could be capped annually and have copays and deductible.
    Insurance companies are very averse to taking on unknown risks, but if they can limit their exposure through benefit capping it could work. And by ‘work’ I mean screw large numbers of people for a little profit.
    As I said I used to work for insurance companies. They’re not evil people in my experience but in the present environment the economic incentives push them farther and farther away from providing their customers’ real needs in an effective way.

  88. 88
    Barb (formerly Gex) says:

    @Violet: And there’s the fact that the right makes a tremendous amount of hay by shouting lies early and often and whispering corrections later when no one is listening.

    Sullivan is a champ at that. Spread the lies, then think about the issue.

  89. 89
    Nutella says:

    To summarize the Ryan MediCare plan:

    At 65, you have been paying hefty premiums for 45 years into the MediCare not-for-profit insurance plan. Now that it is time to collect on that insurance policy you will get, not the coverage you paid for, but a small amount of money to use to try to buy commercial insurance. Now wehn you’re old and most likely sick.

    These are the same people who think that lowering tax rates increases government revenue. It’s voodoo economics.

  90. 90

    @Davis X. Machina: Agreed. the thing is there are many 180 degree positions – it’s multidimensional, doncha know.

    Knowing what they are helps determine what they’ll do at the crisis point. Masadans will take the path of Jonestown and Heaven’s Gate. Gideons (zealots) will fight to the last man with utter viciousness.

  91. 91
    grandpajohn says:

    @Davis X. Machina:

    The real providers increase their tuition by the amount of the vouchers, zeroing out their value,

    Same thing that happened to schools during the “sputnik”era when the government decided to throw money into science education with title III within 3 years the price of science equipment and supplies for classroom or laboratory use had doubled, effectively negating the title III money

  92. 92
    Violet says:

    @RossInDetroit:

    As I said I used to work for insurance companies. They’re not evil people in my experience but in the present environment the economic incentives push them farther and farther away from providing their customers’ real needs in an effective way.

    The “economic incentives” are that health insurance companies are for-profit entities at all. They should be heavily regulated utilities. They provide a service that is essential for almost everyone at some point in their lives. How they are allowed to be for-profit entities is beyond my understanding. It makes no sense at all.

    Our current setup allows health insurance companies to make money off the backs of sick people. The immorality of it is breathtaking.

  93. 93
    RossInDetroit says:

    @Violet:

    I would say rather that health care, and not insurance, is an essential service. I favor single payer and I think we’ll end up there somehow. Insurance is just the exchange of a definite payment against an indefinite future expense. To me that’s a different business from directly providing health care, which is what we should be doing.

    My grandma is 93. Never worked a day in her life at a paid job and still has Grandpa’s generous retiree health care even though he died in 1993. That still happens but it’s vanishingly rare and it’s not going to happen for dad’s generation or mine.

  94. 94
    patrick II says:

    @Davis X. Machina:

    Yeah, lousy analogy. I meant republicans have once again committed to a strategy of lying but this time, because of the breath of people’s personal experience, the strategy of lies may not work out as well as it has previously.

    Thanks, though. That is an analogy I will use differently in the future.

  95. 95
    Violet says:

    @RossInDetroit:

    I would say rather that health care, and not insurance, is an essential service.

    I agree. There is no reason why we should have health insurance vs. another way of delivering or providing health care.

    I’m not necessarily for single payer, although I think it has benefits. Having family in the UK has opened my eyes to living with single-payer, its advantages and disadvantages. It seems with the NHS in the UK there is a two-tier system where everyone has NHS coverage but those who can afford it get private insurance and get treated better/sooner/with more up-to-date equipment, etc. That’s not necessarily the model I prefer.

    I like the model in The Netherlands. It uses private insurers, but they are heavily regulated. People have a very high rate of satisfaction with their health care, costs are low, life expectancy high. You have some choice in picking your insurer, but the government makes sure everyone has coverage and the insurers are regulated enough that they don’t leave people bankrupt or without coverage.

  96. 96
    Mike G says:

    @MonkeyBoy:

    Transferring Government control over funds to individuals makes it much easier to scam away the funds.

    Exactly. The goal isn’t to deliver equal-quality-but-less-expensive healthcare, it’s to setup a system where fatter profits can be made, patients be damned.

  97. 97
    RossInDetroit says:

    @Violet:

    One of the insurers I worked for administers plans for large unions. The insurer provides a large range of critical management functions like fraud prevention, claims processing, eligibility, education, etc. The insurer has purchasing power to drive service and product costs down through volume. The union pays the claims costs and a fee to the insurer. That works well because it uses the insurer’s best skills to perform critical functions on a large and efficient scale.

  98. 98
    Violet says:

    @RossInDetroit:
    So long as the insurers are heavily regulated so they don’t gouge people and deny people necessary care, I think that sort of thing works fine. Every party should use their best skills rather than trying to, say, make an IT company try to become an expert in health care. That kind of thing is stupid and not a good use of skills.

  99. 99
    Yevgraf (fka Michael) says:

    I don’t know why y’all are upset. I’m 49 and will lose under Ryan’s plan. Given the fact that I know people in their 50s and early sixties who are paying 1700 per month for their current insurance, I know what my chances are in the post Medicare world.

    This place will look like Argentina or Brazil, especially now that a Federal Judge in Virginia has taken the locks off of direct campaign contributions from corporations, which will do wonders in local races.

    Forewarned, once my Medicare is gone, I’m hoping that I don’t acquire any terminal condition while I’m young enough and healthy enough to avail myself of a list of pundits and former officeholders to pursue my Second Amendment remedies against.

    Oh, and PS – somebody above mentioned the struggle of balancing monthly premiums against fixed incomes. That won’t be a problem – the Republicans are getting rid of those fixed incomes, so that you my have the freedom of your investments in the awesomeness of the free market, rising and falling according to your choices.

  100. 100
    fasteddie9318 says:

    @shortstop:

    Excellent observation. We get so frustrated when people won’t do the simple arithmetic, but they’re arguing from a completely different set of…well, it’s overly charitable to call them “premises,” but for lack of a better word…

    First Principles.

  101. 101
    fasteddie9318 says:

    @Violet:

    Having family in the UK has opened my eyes to living with single-payer, its advantages and disadvantages.

    The UK isn’t single-payer, it’s nationalized health care. Or if you want to be Wikipedia about it, which I think is wrong, the UK is single-payer plus nationalized health care. Canada is single-payer with private health care; private health-care for which the government is the sole basic insurer. Different animals. You can buy supplemental insurance in either system.

  102. 102
    fasteddie9318 says:

    @Dennis SGMM:

    We have a winner! The coverage will consist of one free doctor visit. If the doctor finds that you are very ill then the coverage will also include one free dose of cyanide.

    Said dose hopefully exchangeable for a can of gasoline, a match, and directions to the best spot in DC to self-immolate in order to start a riot.

  103. 103
    harlana says:

    @Yevgraf (fka Michael): The freedom to choose between medicine and food!

  104. 104
    celticdragonchick says:

    @Tim, Interrupted:

    In the case of Andrew Bareback Sullivan, I’m pretty sure you can take that guess straight to the sperm bank. He routinely supports policies being championed by public figures that move his willy.
    During the run up to the Iraq War, he posted blurbs debating which was the hotter “daddy:” Rumsfeld or Cheney.

    Getting real close to outright homophobic hate on that one.

  105. 105

    It’s even worse than what you see there.
    The federal government gives the State that $8k, and the State can do whatever it wants with it, because it’s a block grant. It can take that $8k to pay for more tax cuts for the rich, new stadiums, pay down bonds, bail out failed re-development efforts, build more prisons, or give grants to “faith-based” groups that always seem to be selective about the people they choose to “help”.

    It’s a virtual guarantee that the State will take a cut of that $8k. Not all, but some. And the State can also apply their own means testing on top of what the federal government will already apply.

    That $8k of “premium support” is a best-case scenario.

  106. 106
    celticdragonchick says:

    @Violet:

    He may finally have come around to that, but he’s been dragged to his current opinion.

    Sniping at people who have come around to our position does us little good, no?

    Sully is not our enemy on this. He is posting things that actually help us. We need to keep our eyes on the ball.

  107. 107
    Yevgraf (fka Michael) says:

    Hey, does anybody know where these Koch/DeVos douchies (or their retainers among the pundit class) hang out for fun? How about their progeny?

    The least they should have to do is shell out for personal protection squads for themselves, their spouses, their lovers, their kids, their siblings and their pets, something which should be increasing as they continue to get their way over and again. If they want the circumstances and class divisions of a Latin American kleptocracy, they should at least suffer some of the fears of random bombings, kidnappings and extortion schemes and have to deal with that.

  108. 108
    Yevgraf (fka Michael) says:

    @harlana:

    The freedom to choose between medicine and food!

    Obviously, we’ll now need a flag burning amendment.

  109. 109
    Tim, Interrupted says:

    @celticdragonchick:

    Getting real close to outright homophobic hate on that one.

    But I’m sure you’ll let me know when I’ve crossed the invisible line in your head, amirite?

    I have a clue for you: Just like some straight people, SOME homo’s are douchebags, some are hypocrites, some are lying faux-religious barebackers who spout anti-gay rhetoric depending on which right winger they are currently in love with.

    Andrew Sullivan is all of the above.

    I am gay, just like Andrew Sullivan, but that’s pretty much all he and I have in common. Please explain to me how my original comment in any way (other than in your mind) reflects on ALL gay people and as such constitutes homophobia.

    I look forward to your response. Thank you.

  110. 110
    Fluffy says:

    Ross & Violet: thanks for keep the topic alive. An existing analogy to think about when people insist the private health insurance industry will adjust & take federal vouchers from seniors — HSAs. They were supposed to help us pay for health care with pre-tax money that could be saved in tax-deferred accounts. Very few exist, compared to the IRA & 529 plan analogs they were patterned on. The incentive isn’t there for banks & mutual fund co.s to offer them in varied, attractive vehicles.
    Same thing is likely with under-funded voucher program for seniors. 10 years down the road, they’ll still be struggling with very few, mediocre plans.

  111. 111
    Yutsano says:

    @celticdragonchick: @Tim, Interrupted: The gay man vs the trans woman. This should be fascinating. I’ll make popcorn.

  112. 112

    @Brother Shotgun of Sweet Reason:

    i hope so, but it really seems like there is a long view, such as with unions, that they can lower people’s expectations and win incrementally.

  113. 113
    Ruckus says:

    @Violet:
    He may finally have come around to that, but he’s been dragged to his current opinion.

    As always. On the few times he ends up on the correct side of an issue it’s because he was dragged kicking and screaming. Sounds like a petulant 4 yr old.

  114. 114
    Ruckus says:

    @RossInDetroit:
    The way they act as companies and as individuals that run those companies is what makes them evil. The fact that they do it with the blessing of or instance of investors is beside the point. They could have fought for better regulation of the insurance industry so that competition would be regulated and then they could provide a good product, like a few countries in europe have and still make money. But they went the other way and put profits ahead of everything else. That’s what makes them evil.

  115. 115
    celticdragonchick says:

    @Tim, Interrupted:

    But I’m sure you’ll let me know when I’ve crossed the invisible line in your head, amirite?

    Being gay gives you some special dispensation to use verbal imagery that is harmful to other gay people? Possibly you meant it to be “edgy” instead.

    Just wondering. Maybe it’s sort of a “African Americans can say N****r, so that makes it okay” kind of thing.

    Carry on.

  116. 116
    celticdragonchick says:

    @Yutsano:

    Don’t bother. I’m done with it. Tim has his schtick and I am not really interested in it.

  117. 117
    Joe Brown says:

    Let’s not forget the outright lie of the Ryan Plan: massive tax breaks for the wealthy on the back of the middle class, justified by vague references to ending ‘loopholes’. As if.

  118. 118
    Triassic Sands says:

    @RossInDetroit:

    I wonder if the GOP worked all of those unredeemed vouchers into their cost savings estimates.

    Unredeemed voucher money would shift automatically to the tax cuts for the needy wealthy fund. Killing Medicare, as with all other GOP initiatives, is not about saving money, but about larger tax cuts for the wealthy.

  119. 119
    Evolved Deep Southerner says:

    @birthmarker:

    Of course the debt will attach to your estate upon death (I presume), but it seems the goal is to leave everyone destitute at death anyway.

    DEATH TAX!

  120. 120
    El Cid says:

    If you’re talking about some sort of moral obligation, then, yes, highly paid columnists with the most powerful billion-dollar media organizations are supposed to know what the fuck they’re talking about and not lie about it.

    If you’re talking about what their employers hold as professional standards, then, no, what they ‘are supposed to do’ is the opposite.

    In order to favor the views that their employers want propagated.

  121. 121
  122. 122
    Lurker says:

    @Fluffy:

    An existing analogy to think about when people insist the private health insurance industry will adjust & take federal vouchers from seniors—HSAs. They were supposed to help us pay for health care with pre-tax money that could be saved in tax-deferred accounts. Very few exist, compared to the IRA & 529 plan analogs they were patterned on. The incentive isn’t there for banks & mutual fund co.s to offer them in varied, attractive vehicles.

    Expanding on this comment…I think the difference is that almost any American who earns income can park money an IRA. Any American with a child can contribute to a 529. That’s a lot of Americans.

    However…only Americans covered by HSA-compatible health insurance can contribute funds to an HSA. With the vast range of health coverage already in place for insured Americans (Medicare, Medicaid, non-HSA-compatible employer plans, VA, TRICARE), there’s no way the HSA-eligible group can compete with the size of the IRA/529-eligible group.

    Right now I keep my HSA parked at Alliant Credit Union because of its reasonable interest rate and no fees. In the beginning I considered saving enough to invest in Vanguard funds/ETFs, but I later decided against treating my HSA as a retirement account. For my situation, it’s better to treat an HSA as a tax-sheltered emergency fund. I’m now using my HSA to pay for prescriptions, eyeglasses, out-of-pocket dental, lab tests and co-pays…but I’m not treating it as a supplement to my IRA anymore.

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