True Patriots Are Happy to Pay the Price of Freedom

Kevin Drum runs the numbers on Obamacare premiums, and they’re essentially the difference between no insurance and affordable insurance for families in the gap between Medicaid eligibility and jobs that generally include employer-sponsored insurance:

What follows is back-of-the-envelope stuff, but I think it’s in the right ballpark. Let’s take a family of four where the policyholder is age 35 and has an income of $40,000. How much would insurance cost them? According to this handy calculator from Kaiser, here’s what that family would have to pay (converted into a monthly premium):

* Premium cost: $925
* Federal tax credit: $760
* Net cost of policy: $165

However, this overstates things because it’s based on the cost of a “silver” policy. But you don’t have to buy a silver policy. You can pay more and get a gold or platinum policy, and more importantly, you can pay less and get a bronze policy. Bronze policies don’t provide great coverage, but they do provide the basics and they also cover health emergencies. It’s a reasonable option for someone who just can’t afford more. By my rough calculation, a bronze policy would cost about $125 less than a silver policy. This means that the net monthly premium for our family of four would be about $40. […]

Drum’s point is that, overall, the ACA is probably such a good deal that a mandate will be unnecessary in practice. That’s why we needed two years of screaming about socialism and all the other boogity-woogity bullshit that’s going to culminate in tomorrow’s unbiased, disinterested ruling from the apolitical Supreme Court. Republicans had to convince their group of base voters who would benefit from the ACA that this is such a good deal that they should be ashamed to take it.

Also, too: singles under 30 will get a catastrophic care policy for nothing or next to nothing. Remember that next time someone under 30 asks you why they should vote for Obama a second time.






71 replies
  1. 1
    negative 1 says:

    It is such a good deal that it won’t need a mandate given current rates. Fixed.
    And if you think that the rates will stay the same after the law forces insurance to pick up sick people but doesn’t require healthy ones to buy in, you’re more delusional than Rick Santorum.

  2. 2
    c u n d gulag says:

    GOP POV:

    Yeah, yeah – all that sounds nice.

    But it doesn’t include the cost everyone’s got to pay for the “Death Panels.”

    Killing Grandma and Grandpa won’t come cheap!

  3. 3
    gene108 says:

    I’ve never understood the resistance to universal healthcare coverage in this country.

    Most folks are a job loss away from losing their insurance coverage and know this, yet they hate the idea of having some level of security with regards to their healthcare, regardless of their employer.

  4. 4
    kay says:

    @negative 1:

    It is such a good deal that it won’t need a mandate given current rates. Fixed.

    The mandate drops out if the rates exceed “affordable”. In other words, the mandate is conditioned on “affordable”. That’s the check on rate increases. If the policy doesn’t remain affordable, as a percentage of income, there is no mandate, because there is no (federally qualified) policy that is “affordable”.

    States do the same thing for medical support orders, which are part of child support, and they’ve been doing that since 2005 under a federal rule change. States use “reasonable” but it’s all based on percentage of income.

  5. 5
    kay says:

    @negative 1:

    Anticipating the next objection, the check on what the policy covers is “federally qualified”. To be qualified, the policy has to cover a list of services and procedures.

    So they have them coming and going. Mandate drops out if rates exceed a certain percentage of income, ability to sell on the exchange drops out if they cut coverage.

  6. 6
    JPL says:

    If the mandate is over-turned, why not wait until it is medically necessary to acquire insurance?
    As much as I hate the idea, congress would have to repeal EMTALA and have a waiting period in which to buy insurance. Of course Congress could pass a public option. hahahahahahahahahhahahahahahahhahahahhahahahahahahahahahahaha

  7. 7
    MattF says:

    Ahhh, facts-shmacts. And there’s even those number-things. Ha ha, tee hee, as if any of that matters. And, as a counter argument, may I add, blackety-black?

  8. 8
    PeakVT says:

    Real ‘Murkins know that only when people are free to have their lives crushed by catastrophic medical costs are they truly free.

  9. 9
    waynski says:

    @gene108: The problem is that most people who have insurance think they’re totally covered until they get sick. And the people who can’t afford it know they can go to the emergency room and skip out on the bill. There’s just enough healthcare in this country that people don’t see the immediacy of the problem.

  10. 10
    Raven says:

    @JPL: But the “mandate” is bullshit. The only thing it does is levy a $100 fine that cannot be collected.

  11. 11
    lol says:

    @kay:

    STOP STOP STOP WITH THE FACTS.

    WHY CAN’T YOU UNDERSTAND OBAMA IS A HUGE SELLOUT AND THAT THE ACA IS THE WORST THING TO HAPPEN IN THE HISTORY OF LIBERALISM?

    THIS IS THE NARRATIVE, PLEASE CONFORM.

  12. 12
    Lawnguylander says:

    I’ve wondered whether the mandate is practically necessary since it became an issue in 2008. You’d be hard pressed to find a less responsible 20-something than I was and I still bought health insurance despite never having had a more serious health issue than the flu because the prospect of being without the safety net was so scary. And now the product we’ll be buying will be greatly improved by law so there’s less reason to go without. I’d bet that the percentage of people who have been wanting the law trashed and who don’t have health insurance, whether they’re yelling about death panels or not wanting to buy the “CEO of Aetna a third house in the Cayman Islands,” is close to less than single digits. They’ve got theirs and they’re too evil or too stupid to look beyond their resentments and see how the law benefits them too.

  13. 13
    aimai says:

    The entire thing is just bizarre, to me, as bizarre as the workaround that created the Medicare Part B boondoggle. I mean, I don’t fault Obama and the Dems for coming up with it but in reality the people at the bottom of the heap–between Medicaid and actual jobs with insurance–are in no state to negotiate a new set of demands and paperwork. At the time of teh Medicare Part B thing there were innumerable articles explaining how “easy” and “reasonable” and “sensible” it would be for your elderly relatives to “choose among all the formularies” and plans to make sure that their medical needs were covered. In reality, of course, it was impossible. First of all you had to review hundreds of competing plans each determined to screw you in different ways. Second of all your medical needs might change.

    There is zero reason to believe that people should have to choose between a “bronze” plan and a “silver” plan. Maybe we can’t afford platinum for everyone but for fuck’s sake an impoverished family of four earning 40,000 a year probably needs more insurance coverage for alcoholism, asthma, obesity, autism, dental than a wealthy family of two earning 250,000 a year. The people who need the most should be in the most comprehensive plans automatically–not forced to guesstimate their needs in the future while paying up in the present.

    aimai

  14. 14
    WereBear says:

    @waynski: I cannot believe that by this time, they, or anyone they know, hasn’t dealt with the difficulties of actually using their insurance. I had a cancer scare and a procedure and overnight in the hospital.

    Because it was short notice, I was driven crazy on the phone by them “approving” my doctor setting up a not-emergency-but-we’re-not-waiting-either operation. Because they pay 80%, I still had a whopping bill to pay on my own. Because I’m in a small town, they let me pay it off a chunk every month (which took care of the tiny bit of discretionary dough we did have at the time.) I understand that in most places they would simply slam me into collection.

    And this was a relatively cheap thing, WITH insurance, and a happy ending.

    And it sucked.

  15. 15
    Rommie says:

    True Patriots know how to manipulate the laws of probability, so they always avoid accidents, never catch an illness, never get cancer, etc. etc. Those that do get all that icky stuff offended the Baby Jesus somehow, and therefore DESERVE DESERVE DESERVE the pain and suffering.

    And since money comes from showing the proper respect to God Almighty, it’s the heathen’s fault if they are too poor to afford medical care.

    Sadly, those two paragraphs are only around half-snark, I know people fully on-board that those statements are truly the gospel. So they do not need that Near Guy telling them otherwise.

  16. 16
    Face says:

    You’re assuming they’ll only jettison the mandate. My money is on them killing the whole thing.

  17. 17
    JPL says:

    @Face: That’s my gut feeling. My guts track record is pretty bad though at calling the outcomes of situations so there is that.

  18. 18
    JPL says:

    @Raven: Is that all it is? Wow, I had no idea. I knew it was low but thought it was based on income.

  19. 19
    Thymezone says:

    Over a 7 year span, my household medical bills at the walk in rate, for two people, amounted to around $500k. I am not destitute, thanks to very good insurance that I paid dearly for. But … 100% of those medical bills covered unexpected health emergencies and accidents, and not a penny of it was discretionary or elective. It was all basically do-this-or-be-dead-or-screwed, sign here, we’re off to surgery.

    Anyone who doesn’t think that ACA is a thousand thousand times better than the situation we had before ACA is a fucking lying or stupid idiot who should be removed from the gene pool and die in an oil fire. Nobody without insurance can afford to be without it. Nobody. Period.

  20. 20
    waratah says:

    @aimai: I was thinking the same thing, a bronze option should not be there.

  21. 21
    kay says:

    @aimai:

    I think the preventive services w/no co-pay or deductible addresses a lot of those concerns.

  22. 22
    kay says:

    @aimai:

    One gets a sense that the Battle Over Birth Control was really a battle over not wanting to cover a long list of preventive services w/out co-pays or meeting a deductible.

    Birth control was the one thing they could demonize, and use politically. They weren’t going to make a big fuss over diabetes screening, now where they? :)

  23. 23
    waynski says:

    @WereBear:

    I cannot believe that by this time, they, or anyone they know, hasn’t dealt with the difficulties of actually using their insurance.

    Good point. I should have also mentioned that the President is nearing.

  24. 24
    mai naem says:

    @Face: Who knows but I think Ginsburg would have sound pissier in that little speech/talk she had last week and,also, while I don’t remember exactly what she said that hit me this way, but, just to me she seemed to imply that part of the law was struck down not the whole thing.

    Also, RIP Nora Ephron but jeebus does Morning Ho have to go on and on about one “their” people’s greatness when they die. Ugghh.

  25. 25
    Belafon (formerly anonevent) says:

    mm, you left out the screaming from the left about the government forcing people to give their money to private companies.

  26. 26

    @Rommie:

    True Patriots know how to manipulate the laws of probability, so they always avoid accidents, never catch an illness, never get cancer, etc. etc. Those that do get all that icky stuff offended the Baby Jesus somehow, and therefore DESERVE DESERVE DESERVE the pain and suffering.

    We live in a culture where the majority believes that the Creator of All the Universe will tweak the very laws of space and time… to help Tim Tebow throw a fucking football in the right direction. So your half-snarky observation probably shouldn’t surprise us.

    It’s amazing just how few Americans have risen above the mental level of their feudal peasant ancestors.

  27. 27
    Richard R says:

    The mandate stinks. But nobody has the courage to deal with the real alternative if single payer is excluded from the conversation.

    Everyone is already insured. Minimum health care is guaranteed to all. It’s just that the “uninsured” have crappy coverage, go bankrupt if they need to use it, and have it payed for by premium payers.

    The alternative to the mandate is to refuse any care to the uninsured. Let them go somewhere private to suffer and maybe die.

    If this is unacceptable then the mandate is a terrible way to deal with it. But if you are against both the mandate and single payer, then this is the alternative.

  28. 28
    negative 1 says:

    @kay: So why wouldn’t the conservative objection actually be true in this case? Why wouldn’t I wait until I was sick to buy the policy?
    A little bit of anticipation on my part, wouldn’t the insurers then be able to show a much larger percentage of the premiums going towards care, and thus be justified under the current ACA formula in raising the rates?

  29. 29
    joes527 says:

    @gene108: Security for the serfs leads them to not show proper respect to their betters.

  30. 30
    kay says:

    @negative 1:

    A little bit of anticipation on my part, wouldn’t the insurers then be able to show a much larger percentage of the premiums going towards care, and thus be justified under the current ACA formula in raising the rates?

    I don’t claim to be an expert, but I did read the law and I don’t know why the MLR (percentage of premium going to medical care) would have anything to do with the “affordability” analysis. The affordability part is a straight calculation of percentage of income versus price of policy. I don’t think they can say “this policy is more valuable, so we can exceed that percentage and still remain in the mandate realm”.

    States don’t do that now, with medical support orders. It’s “how much does it cost, and how much do you make?”

  31. 31
    Raven says:

    @JPL: Lawrence O Donell went through it all last night.

    http://www.msnbc.msn.com/id/45.....54#VpFlash

  32. 32
    slippy says:

    @Richard R:

    It’s just that the “uninsured” have crappy coverage, go bankrupt if they need to use it, and have it payed for by premium payers.

    I have news for you — people with six-figure salaries have crappy coverage, and go bankrupt if they need it, too. Just ask me.

    This is rapidly becoming a problem for everyone, not just mid to lower-income folks. The problem is that the insurance industry is now peddling total junk.

    Which is why the ACA is just the first step to full-on socialized medicine whether certain factions of this country are ready for it or not.

  33. 33
    Raven says:

    @negative 1: The “conservative objection” has nothing to do with the fucking law itself.

  34. 34
    gelfling545 says:

    @aimai: My big gripe is the lack of dental care. I am doing some work this year for a NPO that provides permanent housing for folks (veterans & the disabled) who have recently been homeless. Many get Medicaid or VA care but, as far as dental care, both will pay to pull teeth but not to reconstruct/replace. Thus half the tenants are basically toothless which leads to a whole assortment of other health problems starting with the inability to eat properly. For some reason dental care is considered a frill instead of a basic necessity for good health. I suspect it will be the same under ACA or whatever bastardized version of the program we end up with.

  35. 35
    WereBear says:

    The truly truly sick thing here is that the ACA is vital to the economy. We must have a functioning workforce. We can’t have all the money tied up in unproductive things like crushing debt. And shifting huge chunks of our net worth into health care does not make money for anyone but that fraction at the top who have too much money already.

    We have a situation where one person in the family has an eating disorder and as soon as the groceries come home they lock themselves in the basement and eat it all. Everyone else is starving. This is the economy when the rich hog all the money for themselves and don’t let it out to make the economy function.

    The Republicans are the last people on earth I’d ask to make a sandwich; much less run a powerful nation.

  36. 36
    shortstop says:

    @WereBear: Nice analogy!

  37. 37
    chopper says:

    @negative 1:

    OTOH, if the mandate drops but everything else stays there’s going to be tremendous pressure to get congress to add new legislation forcing the insurance companies to keep rates low. of course, that would bankrupt them and goopers in congress won’t exactly be excited to do anything to add to the law much less choke out the insurance companies. plus the GOP gets to see their favorite two things – the working class goes bankrupt and obama takes the blame for shit.

    of course, then they’re on record as opposing keeping insurance rates affordable for people right before an election. but that sort of troglodytic horseshit has never stopped them before.

  38. 38
    chopper says:

    @kay:

    ah, that makes sense. so the mandate is basically a rock hanging over the insurance companies’ heads.

  39. 39
    negative 1 says:

    @kay: That’s not really what I meant – what states do (or at least RI, and I would guess others) is mandate that a certain percentage of collected premiums goes toward healthcare, so the more money they make in the form of premiums (the more healthy people sign up) the more they have to spend on healthcare, or conversely the lower the rates need to be based on how much they put out for care. If you take away a pool of the uninsured, it stands to reason the rates would skyrocket, thus kneecapping the affordable rates Drum highlights. That is my argument for the importance of the mandate, and what I don’t like Drum’s response for.
    @Raven: It does, actually, it’s the reason for the mandate. I like single payer too, but I live next door to Mass, did taxes when their version of this was passed, and watched it work first hand. It helped a LOT of the working poor, but it needed the mandate to work. However, it should be noted that it was originally up here a conservative plan. Their objection was that without the mandate, the rates would soar as I was talking about above (originally, then the whole negotiation became a clusterf^&k under Rmoney but that’s a different story).

  40. 40
    negative 1 says:

    @chopper: I don’t disagree, but pressure doesn’t mean incentive and they will tell everyone to go to hell and jack the rates through the roof. That’s just speculation, but it fits the pattern.

  41. 41
    shortstop says:

    @chopper: This is my fear as well. I think people who see the loss of only the mandate as a shining path to single payer are forgetting how big insurance and the GOP work.

  42. 42
    General Stuck says:

    OT

    The truth about the Fast and Furious scandal

    Must read before the contempt vote tomorrow for Eric Holder/Obama witch hunt. Per usual, truth belies the heart of right wing deception. Not to mention NRA fubarring the operations and funding of government agencies, and their ludicrous conspiracy theories about ‘Fast and Furious’ as a liberal plot to outlaw guns. As well as the insane laws allowing anyone over 18 and can pass a quick test on criminal history, to buy as many guns as they can carry out of gun stores, and do whatever they want with them.

    Seems that the Fast and Furious operation, though still dubious, was far from what Issa and the wingnuts have painted it as.

  43. 43
    El Tiburon says:

    Drum’s point is that, overall, the ACA is probably such a good deal that a mandate will be unnecessary in practice

    So is the theory we are working on is that eventually ACA will cause the costs of premiums to go down?

    What’s the point if Big Insurance continues to rake in billions of our money? We are still subsidizing private jets and yayo parties.

    Color me skeptical.

  44. 44
    liberal says:

    @Thymezone:

    But … 100% of those medical bills covered unexpected health emergencies and accidents, and not a penny of it was discretionary or elective.

    This is but one of many reasons why the economics of health care imply that a “free market” cannot possibly avoid market failure.

    Right-wingers constantly hold LASIK up as an example of something that “works” when “consumers can shop”, but it’s fundamentally not like most health care.

  45. 45
    kay says:

    @negative 1:

    IMO the mandate got way too much attention. I think it’s a good example of how conservatives drive media coverage.

    The PPACA is a lot of things. It’s a federal regulatory scheme for health insurance that will eventually cover all health insurance, so benefit everyone who has health insurance, now. It’s a huge expansion of Medicaid, the biggest since SCHIP, and it’s a regulatory scheme for large employers.

    The mandate won’t apply to the following people: those under 133% of poverty level, those who are on Medicare, Medicaid, or any other federal program, and those who have employer-sponsored health insurance. Yet, it got ALL the attention.

    When I started to realize we were going to exclusively discuss the mandate, I thought that was bad, because it’s such a small piece of the law, but I’ve come around to thinking it’s good we completely ignored the rest of the law, because that keeps media and conservatives from demonizing and misinforming on the vast majority of the law. If the law remains in place, people will have a chance to evaluate it on its own terms, and according to their own situation. That may be the best I’ll get.

  46. 46
    Ruckus says:

    @aimai:
    That would be a sane world, no?

    And we all understand the level of sanity in a conservative world. Zip, zero, none.

  47. 47
    El Tiburon says:

    @JPL:

    If the mandate is over-turned, why not wait until it is medically necessary to acquire insurance?

    Last year I became self-employed, therefore I left a rock-solid insurance that covered my entire family plus pregnancies. The premiums were, I believe, in the $1,200.00 range. I paid 1/2 of the premium.

    Now, my premiums are about $700 for the family of four with no pregnancy covered. (Evidently it is next to impossible to get pregnancy insurance on your own.)

    But with the $700 premium, the deductible per person is $2,000.00 or $4,000.00 total. When that is reached, the insurance pays 1/2 of all medical bills up to a certain threshold, then at some point it kicks in for 100%

    Bottom line for me: I pay a minimum of around $8,000.00 just for the insurance. But would have to pay closer to $10,000.00 in one year just to get insurance to pay 1/2. I think I then need to spend $12,000-$14,000 to get insurance to pay %100.

    So, yeah. I’m beginning to think it is better to pay all medical bills out of pocket until hit with something huge. But I am sure there will be some deal where you have to wait 90 days for coverage to kick in.

    Fucking racket, and although ACA is a mighty fine band-aid that might lead to something worthwhile, I still see it as a bad deal in the end.

  48. 48
    General Stuck says:

    I think a lot of people understate, or don’t fully think through the single provision in the ACA, that is way more important than the mandate on the laws overall effect on the health care system. And that is the capping profits at 15/20 percent. Especially since it was unambiguous in its language found in the law.

    And when you think of it with an honest effort, it is really just short of nationalizing, by proxy, the private insurance industry. The government is directly regulating the prime purpose of free market capitalism, of making profit, and dictating the percent of profit to be gleaned. With excesses to those profits, not to be sent back to the government, BUT DIRECTLY BACK TO POLICY HOLDERS IN THE FORM OF CASH REBATES.

    It is hard to make a serious case that this law will certainly make private health insurance corps making out like bandits. I wouldn’t be surprised if the supreme’s tomorrow nixed this provision, rather than the mandate

  49. 49
    sparky says:

    @kay: i agree(!) with you that the other parts of the law are useful regulatory notions that are (presumably) written in a straightforward enough fashion so that the implementing regulations cannot be written so as to negate them, at least not easily. though perhaps i should not underestimate inventiveness.

    but as to the mandate, i just don’t see that working. there is no way an insurer will offer insurance that it cannot make money on–and they don’t have to. as you know there is an escape clause–if the insurer can prove they cannot make a profit then they don’t have to offer the insurance. so i don’t see how, at the end of the day, this is anything other than stake-driving to kill single-payer once and for all in the US.

    @General Stuck:no. a maximum profit rate is not inconsistent with a private enterprise. utility companies are probably the best example; they did just fine under “regulation” for decades.

  50. 50
    kay says:

    @negative 1:

    Right. That’s why they included the mandate, ostensibly, to make the pool bigger so there would be “healthy people” who would offset “sick people”.

    I have some basic problems with the assumption that people who are uninsured now are not going to use health insurance when they get it, so I don’t like the “pool theory” that much, as a liberal argument. First of all, that hasn’t been my experience. People who have NEVER had health insurance are not particularly “healthy”, what they are is “denied ordinary care”. I don’t know that they’re “healthy”. I know one who set his own broken hand. He never ever goes to the doctor, but that doesn’t mean he shouldn’t. I think what they are, mostly, is “untreated”.

    I hate it as a liberal argument, because it’s contradictory. Liberals have been saying for 30 years that people need health care coverage. We said they were dying. All of a sudden, liberals are now saying that insurance companies will be making money hand over fist because those same people will purchase health insurance that they will never use. What?!

    Did they need it or not? Why do they need it less now that they have a chance to get it?

  51. 51
    kay says:

    @sparky:

    Well, there’s a second reason for the mandate, and we saw this here with the mandate under child support. It’s an enrollment mechanism. Something like 20% of people who are eligible for Medicaid don’t sign up, because they just don’t enter the social services realm, mostly because they work. What happened with the child support mandate (which only applies to children of unmarried parents) is they enrolled tons of kids in health care coverage. They slotted them in, depending on income and situation. It was a way to get the parents in the door.

  52. 52
    Valdivia says:

    I was just walking by the tv with CNN running a story about having health insurance doesn’t make you healthier. These people are just actively dumbing america down. I wanted to shoot at the tv.

  53. 53
    kay says:

    @negative 1:

    Just so you know, I would have done this completely differently. I would have set up public primary care, and insured the rest. Community health centers for everyone, sliding scale, cash, for ordinary care, then insure the expensive stuff. If you look at the Vermont plan, one of the reasons that they were able to go to single payer is that they had a non-profit primary care delivery structure in place, with community health centers. They’re basically insuring the expensive stuff. Makes sense, in terms of insurance.

    I think people would hate my plan, because they would perceive a clinic as “lesser” than a “private” doctor, but I’d be putting it in by executive decree, immediately prior to impeachment proceedings :)

  54. 54
    General Stuck says:

    @sparky:

    no. a maximum profit rate is not inconsistent with a private enterprise. utility companies are probably the best example; they did just fine under “regulation” for decades.

    I didn’t say it was inconsistent with private enterprise. Only that is a major point of direct regulation of profit rate. Utility companies do ‘just fine’, but they don’t make a killing on the vital services they provide, that roughly has increases in rates commensurate with the public’s ability to pay for those services. With raises in rates conducted via government criteria in consideration of the effect on all sides. It is not a perfect system, as politics always, over time, finds a way to creep in, no matter what the situation or laws. But that is a tougher task when the federal government is the prime regulator. And the ACA has other provisions to suppress insurance companies from getting more profit by raising rates faster, similar to utility companies.

  55. 55
    General Stuck says:

    no. a maximum profit rate is not inconsistent with a private enterprise. utility companies are probably the best example; they did just fine under “regulation” for decades.

    This sounds like an argument FOR the ACA approach to HCR. Too funny.

  56. 56
    kay says:

    @Valdivia:

    Oregon held a lottery to get into Medicaid. People who “won” said they were healthier.

    But what do they know, those moochers, right? Ask Wolf Blitzer about uninsured people. He’ll know.

    Do you feel they print emails they get from lobbyists, entire, or is that just me and my bitterness?

  57. 57
    Mnemosyne says:

    @sparky:

    as you know there is an escape clause—if the insurer can prove they cannot make a profit then they don’t have to offer the insurance.

    Well, sort of. They have to prove that they can’t make any profit at all, and they’re still limited to the 15% profit permitted by law. So it’s not like they can claim that the insurance is unprofitable and go back to making 30 or 50% profits off it.

    As I’ve said before, the more I look at the provisions of PPACA, the more it seems designed to slowly squeeze for-profit insurance out of the exchanges because it will be harder and harder for them to meet the law’s requirements and still compete against the nonprofits and not-for-profits. I think the goal for this law is to eventually only have nonprofits and not-for-profits on the exchange, and the for-profits will turn to other markets, like supplementary insurance so you can get a private hospital room.

  58. 58
    Ruckus says:

    @General Stuck:
    And it’s a wonder that more people don’t look at health care like a utility.
    We all need both utilities and health care.
    We all are healthier with both available and cost effective.
    We have the basis, as you state, for regulation in the utility market, it just needs to be applied to health insurance.

  59. 59
    Valdivia says:

    @kay:

    to me Kay it had the feel of that contrarian bs ‘you would think having health insurance makes you healthier, surprise it doesn’t!’ I wanted to start yelling–as compared to what? someone who doesn’t have insurance? how healthy they were before? what is the point they’re comaparing to? It seemed to me he (Gupta–shame on him!) his point was something akin to: if you ven diagram the population with obesity and other health ‘epidemics’ in this country a lot of them have insurance. He is making this point about this on the day before ACA is ruled on?
    Fucking assholes!

    ETA: it must be my bitterness too because it sounds like straight from their pr dept.

  60. 60
    General Stuck says:

    @Mnemosyne:

    . They have to prove that they can’t make any profit at all, and they’re still limited to the 15% profit permitted by law.

    The more I learn about this law, it seems more like a complex work of art to close about every loophole with little wiggle room for mischief by those looking for a way to make it. I guess that’s what happens when you have very smart people pretty much dedicating their lives, for multiple generations, to write such a massive reform ,melding the private/public sector, with an undercurrent of directing us out of for profit health insurance over time. Thus avoiding the great pain of collapse of the private system, then to pick up the pieces and fit them together for a public system like single payer.

  61. 61
    kay says:

    @Valdivia:

    I don’t even get mad anymore. As I said, I ended up glad they didn’t focus on the Medicaid expansion, because they would have just used it to beat up on poor people and direct Tea Party ire in that direction. When they focus on poor people, poor people lose, is my new motto. It’s best if they concentrate on the Supreme Court and that whole (allegedly) fascinating narrative. Justice Scalia is a wit! Look at the lawyers! So smart! They don’t have any interest in the nuts and bolts of this thing, because people talk about what they’re interested in. Let’s just stipulate that and move on.

  62. 62
    Valdivia says:

    @kay:

    I completely agree, the minute they focus on the poor that would make them irate that they are given the privilege not to go broke from access to medicine!

    I just saw a link to a Real Clear Politics article assuring us that the whole law is going down because Roberts is writing it. I want to hide in a cave tomorrow morning.

  63. 63
    negative 1 says:

    @kay: I don’t really disagree, I only like the law in that it is better than people dying of the flu. Like I said, I liked single payer but this is better than nothing. I guess the point I was trying to make is that to me a much worse liberal argument is “even with the mandate, we’ll all be OK” because a.) I don’t think that’s true, I think the rates will rise, and rise quickly and b.) if/when that happens, people will hate the ACA and dems will own that failure, allowing rethugs to dictate what replaces it.
    IMHO, a better argument is that the conservatives took away your healthcare (they did) replaced it with nothing (they did) made our solution illegal (they did) so the only real solution now is single payer.

  64. 64
    General Stuck says:

    @negative 1:

    I think every single regular commenter on this blog is for single payer as the ideal. But if the SCOTUS strikes down ‘our’ solution, that is market based, what makes you think the GOP would help pass, let alone the high court okaying a purely government based solution, if the dems get another supermajority in the senate and run the House and WH?

  65. 65
    kay says:

    @negative 1:

    I think if we want single payer, we are going to have address for-profit, private providers and how they fit into that.
    I watched Leiberman really closely during that part of the debate, and it is my belief that he was responding to provider pressure when he scuttled the Medicare/55 deal. He gave a press conference with the AMA. Also. It doesn’t make sense that insurance companies would object to Medicare at 55, because people over 55 use most of the health care. That’s a good deal for them. They’ll insure everyone under 55, and the feds pick up the expensive people.
    I wish we spent more time on providers. It seems dishonest to ignore that whole huge piece of the puzzle.

  66. 66
    Mnemosyne says:

    @negative 1:

    I guess what kind of confuses me is that if we did implement a single-payer system that’s paid by through taxes (probably a payroll deduction like Medicare/Social Security), by definition, that’s a mandate. You would be required to pay that money into the system — mandated, even.

    Some people say they object to being mandated to pay their money to a for-profit corporation, but every exchange is going to have at least one non-profit option (like Kaiser), so now people are saying they don’t want to have to pay money to a private company at all, even a non-profit one. When we point out that they can go without insurance and pay the tax penalty directly to the government, that’s not good enough either.

    I just don’t see that making the mandated money go to the government is going to go over even better with these people.

  67. 67
    Mnemosyne says:

    @kay:

    I wish we spent more time on providers. It seems dishonest to ignore that whole huge piece of the puzzle.

    That’s going to have to be the next battle. And it’s going to make PPACA look like a pool party.

  68. 68
    negative 1 says:

    @Mnemosyne: No, by definition it’s a tax, like FICA. Unless the supremes want to declare social security illegal, and I highly doubt even Scalia is that insane (although one never knows).

  69. 69
    General Stuck says:

    @negative 1:

    Funding would be only one element of going single payer, there are all sorts of other less directly enumerated article one powers in the constitution than the tax and spend clause. That would have their own lengthy trail of SC precedents to examine for overturning. The supreme court has broad law making powers from the bench with veto power over about everything the legislature does, with the possible exception of too clear language in the founding document to tempt them. There is no express mention of right to abortion, nor affording 1st amendment protection to corporations and their cash, now designated as ‘people’ for anything goes with funding political campaigns under the cloak of free speech.

  70. 70
    General Stuck says:

    @General Stuck:

    About the only thing restraining the robed masters of the universe, is the sense of legacy they leave behind, and who really knows what they value as ‘legacy’ when the stakes are high enough?

  71. 71
    David Koch says:

    @negative 1:

    Why wouldn’t I wait until I was sick to buy the policy?

    The same reason people go to the dentist on a routine basis (biannually, annually) to keep their teeth healthy and to avoid cavities and worst. The same reason people change the oil and brake pads on their cars – to avoid major problems and breakdowns.

    I go to the dentist to avoid getting sick. I take my car to get service to retain reliability. I get a yearly physical to head off major painful issues.

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