Heartland Radio

Here’s a quick dispatch from Real America: I listened to a few minutes of a call-in radio show about the ACA this morning. The CEO of the local Blue Cross/Blue Shield was being interviewed and was taking calls, and it was refreshingly dull. The host was spinning scenarios about an imaginary small business and its uninsured employees, the callers were inquiring about the details of their situations, and the CEO was answering the questions with a “here’s how it’s going to be” tone.

This was a commercial radio station, not NPR, in a R+10 state in the middle of the morning. When you start talking implementation details instead of Freedom, Death Panels, Medicare reductions and all the other happy horseshit that’s been spewing out of every unhinged maw for the past couple of years, this thing is over.

137 replies
  1. 1
    shortstop says:

    Great post. It is over.

    But I still want us to work as hard as possible to erase misinformation about the act’s contents. As with Medicare, once people really see the benefits they will never want to go back–but first they have to see them. I’m not talking about the 27% that are beyond reality, but the ones who just aren’t well informed, thanks to our precious media and their own lack of interest in policy and politics.

  2. 2
    The Moar You Know says:

    The healthcare people have know for decades that something like this was coming. They planned for it and instituted everything internally once ACA passed. The only thing the CEO has to do at this point is staff up a bit to handle the influx of customers.

    The very last place in America you were going to see hysteria yesterday was inside of any American health insurance company. And the hospitals, who’ve been eating the burden of all the uninsured for so many years, probably had a party.

  3. 3
    amk says:

    Yup. The screamers can GFT. This is ovah. The insurance cos. know it.

  4. 4
    gbear says:

    NPR is probably still interviewing the very serious people who are talking about death panels. Just to provide balance, you know.

  5. 5
    David in NY says:

    “this thing is over”

    Do hope so.

  6. 6
    BGinCHI says:

    I said this the other day here in comments: best case is that the SCOTUS decision frees us from the “what if?” and allows us to talk about policy and, um, healthcare.

  7. 7
    hueyplong says:

    Hey, isn’t Kennedy a Manchurian Obamobot as well? Not a word about the death panels in his dissent. And as Fat Tony will tell you, “irrelevance to the precise issue at hand” is no excuse for failing to fire out something spittle-flecked about Obama and his nefarious motivations.

    What has become of freedom in this once proud land?

  8. 8

    The next step is to use this as a stake through the heart of the “shrink government until it’s small enough to probe a vagina drown in a bathtub” crowd. Make it 100% clear that all the good stuff people like about ACA will go up in smoke if they put the crazy douchebag Republicans in charge. Take Bill Kristol’s thing about HCR making people dependent on government and afraid to shrink it out of existence and make the wingnuts it for the rest of fucking eternity.

  9. 9
    eric says:

    Let’s root for the South giving a big middle finger to the exchanges so that the feds can set up one exchange to handle the south so that the other states figure out that it is better for all of them if the feds do it and voila : $OCIALI$M.

  10. 10
    BGinCHI says:

    @eric: Maybe we can call it The Confederacy Exchange.

  11. 11
    SatanicPanic says:

    @The Moar You Know: And I’m sure they would LOVE to have to go through and redo all their paperwork if the Republicans repeal the ACA. The repeal constituency is going to be limited to people already on Medicare.

  12. 12
    chopper says:

    it would have helped if it was a fat lady giving the answers in song.

  13. 13
    Xecky Gilchrist says:

    The thing that makes me think maybe there’s been a sea change is that the Daily Kos Reedy Nasal Whine Comix Page hasn’t attacked Obama in like a WEEK.

  14. 14
    KS in MA says:

    @The Moar You Know:

    “The only thing the CEO has to do at this point is staff up a bit to handle the influx of customers.”

    … Are you saying that this thing is going to (gasp!) create jobs?

  15. 15

    @The Moar You Know:

    And the hospitals, who’ve been eating the burden of all the uninsured for so many years, probably had a party.

    Most hospital management company stock prices rose yesterday, so yes.

  16. 16
    MattF says:

    Note that no one ever claims Medicare takes away our Freedom. It’s just part of the scenery– when you get to 65, the gummint magically becomes responsible for paying the hospitals and the doctors, and that’s the way it’s always been.

  17. 17
    eric says:

    @MattF: People count the days until they turn 65 just because of Medicare.

  18. 18
    JCT says:

    When you start talking implementation details instead of Freedom, Death Panels, Medicare reductions and all the other happy horseshit that’s been spewing out of every unhinged maw for the past couple of years, this thing is over.

    And yes, of course this is why all the wingers have been squealing like pigs stuck under a door since yesterday. Now that the “education” phase about the new benefits people actually have been granted takes over from the “your life will be a living hell if this is implemented” dis-information campaign — a big part of their reason for existing disappears.

    Tossed into the dustbin of history where it fucking belongs. Now as soon as they get old and die off we can keep working towards that better society that we all deserve.

  19. 19
    Rorgg says:

    I tuned into Chicago righty radio this morning for some tasty Schadenfreude and happened to catch the hourly Fox News national report, and it was much the same… a pretty evenhanded “this is what’s already in, and now, this will happen” kind of thing. I mean, it left out what I’d consider some moderately relevant details (most notably, you can just refuse to pay and… then that’s it) but that could reasonably have been considered outside the scope.

    And if THAT is the reporting? Yeah, it’s done.

  20. 20
    Bulworth says:

    The host was spinning scenarios about an imaginary small business and its uninsured employees,

    But, but, but IRS thugs will arrest everyone if they don’t buy Obamacare! Argh!

  21. 21
    fuzed says:

    apologies if posted elsewhere but this (h/t Wonkette) is priceless http://www.buzzfeed.com/daves4.....-obamacare

  22. 22
    shortstop says:

    @chopper: Nice.

  23. 23
    Cap'n Magic says:

    Obviously The Louisiana Governor didn’t get the message:

    “Here in Louisiana we have not applied for the grants, we have not accepted many of these dollars, we’re not implementing the exchanges,” Jindal said. “We don’t think it makes any sense to implement Obamacare in Louisiana. We’re going to do what we can to fight it.”

    Then perhaps it makes more sense to start drumming States out of the Union and cut them off from the Federal Teat. The South wants to seceede-I say let ’em. Let them set up their own money, treaties and borders with Mexico and the US. Just think-Delta Airlines becomes the flag carrier of the new Confederated States Of America and will need to apply to the FAA for landing rights to their other hubs. And Bank of America will become the CSA’s problem-not the Federal Reserve.

  24. 24
    Steve in the ATL says:

    @eric:

    Let’s root for the South giving a big middle finger to the exchanges so that the feds can set up one exchange to handle the south so that the other states figure out that it is better for all of them if the feds do it and voila : $OCIALI$M.

    Already happening here in Georgia! Let’s race Mississippi and Alabama to the bottom!

  25. 25
    shortstop says:

    OT, yay, rain!

  26. 26
    Mike E says:

    It’s never over! Wolverines!

    Listening to Diane Rehm this morning, I have to concur with the assessment that NPR will always ride that pony down both sides of the issue. Splitters.

  27. 27
    bemused says:

    David Frum’s piece, “Repeal is a Fantasy” is quite good. Imagine they actually did attempt a 1-page repeal bill with a Republican president and control of House and Senate. Frum doesn’t think they would have the stomach to face townhalls overflowing with enraged senior citizens and justify to them why SS/Medicare has to pay for tax cuts to the 1%.

    It really is no wonder the rightwingers are totally freaked out..They know they are boxed in a corner.

  28. 28
    BudP says:

    Look at the DOW!! Obamacare rally, animal spirits, the market has spoken.

  29. 29
    NonyNony says:

    @Rorgg:

    I mean, it left out what I’d consider some moderately relevant details (most notably, you can just refuse to pay and… then that’s it)

    What exactly do people mean by this? My understanding is that if you “refuse to pay” the penalty then the IRS will garnish it from your refund check at least – and future refund checks if you happen to not have enough to pay it this year. I would assume also that, since it’s now been settled that this IS a tax, if you don’t pay it you could face the same penalties the IRS levies against people who don’t pay other taxes.

    Right? Where is this idea that the penalty is “optional” coming from? The penalty being “optional” doesn’t make any sense because if it’s an “opt-in” penalty THEN IT ISN’T ANYTHING LIKE A FUCKING MANDATE AT ALL.

    I’ve seen this LOTS of places and it’s driving me crazy. Can anyone explain it?

  30. 30
    Splitting Image says:

    Good to hear. It will do people a lot of good to hear some boring wonky-talk about health care than what they have evidently been hearing.

  31. 31
    BC says:

    @gbear: It’s not the death panels, it’s the fact that ACA passed by reconciliation which is the latest outrage reported by NPR. Heard it on Talk of the Nation yesterday.

  32. 32
    Rommie says:

    @Steve in the ATL: Perhaps the Feds should approve a statue of one WTS in Atlanta if we are playing the middle finger game then. Savannah works too, but then they’d want the maximum number of people to see it.

    Or just call the combined federal exchange for all the former rebel states opting out the Sherman Exchange and rub their noses in it good and hard.

  33. 33
    Steve says:

    @NonyNony: They can deduct it from your refund, but they can’t use a tax levy or any of the other things the IRS normally does to collect unpaid taxes. It was specifically written into the law that way to defuse the “IRS is coming to get you!” argument.

  34. 34
    bemused says:

    @BudP:

    Will Maria Bartiromo call this an Obama bump?

  35. 35
  36. 36
  37. 37
    Steve says:

    @BC: You know what else was passed by reconciliation? Both Bush tax cuts. They really need to come up with some new outrages, the old ones are boring.

  38. 38
    Martin says:

    @amk:

    Yup. The screamers can GFT. This is ovah. The insurance cos. know it.

    I guess I can’t say this often enough – the insurance companies aren’t the target here. The care providers are. The insurance companies were the partner in this. They were on board from the start. Hell, look at how many of them implemented parts of the policy early.

    It’s not a sweetheart deal for the insurers, but it’s not a raw deal either. What they gain in this is stability – which is what they want most. The 80/20 rule is mostly a unilateral disarming move. It means the not for profits don’t need to build up their marketing budgets to compete with the for-profits. They’re fine with this so long as it applies to everyone. They’ve been terrified about the shrinking member base – that trend was going a long way to the consolidation we’ve seen in recent years. There’s a lot of up-front fixed costs to running an insurance company, and with fewer people each year to cover those costs, it was becoming a problem.

    Selling the insurance companies on this only became a problem in summer 2009 when the teatards and firebaggers made it politically toxic – that’s when some of them lost their nerve.

    All the real pain of PPACA falls on the care providers, as it should. They’re 93% of our medical costs. Only 7% is insurance. We’ll deal with the 7% later.

  39. 39
    Female on the Beach says:

    I saw idiot bumper sticker: “When Obama went into office, gas was $1.80 a gallon”

    It reached $4.00 a gallon during the Bush presidency and it is now at $2.84 here and falling.

  40. 40
    Steve says:

    @Martin: Very good comment.

  41. 41
    GregB says:

    You libtards don’t know what you have done with this Obama ruling.

    You have awakened a sleeping giant, or at the very least you have aroused a napping drunken uncle.

    Wait till November!

  42. 42
    rlrr says:

    @Steve:

    You know what else was passed by reconciliation? Both Bush tax cuts.

    “That was different because, SHUT UP!”
    — Fox “News”

  43. 43
    Citizen_X says:

    I can’t wait till the 2014 elections, when the Teabaggers will be screaming, “Tell Obama to keep his gubbmint Muslin hands off my Obamacare!”

  44. 44
    Steve in the ATL says:

    @Rommie:

    call the combined federal exchange for all the former rebel states opting out the Sherman Exchange

    Well played, sir!

  45. 45
    amk says:

    @Xecky Gilchrist: Give them some time.They are shell-shocked just like the baggers are.

  46. 46
    NonyNony says:

    @Steve:

    They can deduct it from your refund, but they can’t use a tax levy or any of the other things the IRS normally does to collect unpaid taxes. It was specifically written into the law that way to defuse the “IRS is coming to get you!” argument.

    Excellent – thank you. I was about ready to go tear into the text of the bill to find it. I didn’t realize that they wrote a special exception into the law for it. And I’ve been following these goddamn cases so you’d think that that would be something I would have heard at some point.

    So it isn’t even actually a mandate at all, provided you want to put the effort into avoiding it you can avoid it. There’s no teeth to this at all.

    So basically this case before the Supreme Court was EVEN STUPIDER than the assumption I was making that this was an argument over the semantics of the word “tax”. There wasn’t even a test here at all since the law doesn’t “force” anyone to do fucking ANYTHING, so long as they’re careful about withholding for their taxes they can still be a free rider on the system.

    Jeebus. No matter how stupid I think this world is reality proves me wrong. I need a drink.

  47. 47
    Martin says:

    @NonyNony: Well, for many people the penalty is less than the cost of the insurance. So if the cost of the mandated insurance is what’s bothering you, then don’t buy it – pay the penalty instead.

    Its worth noting that as the % of Americans covered by insurance goes up, the ability of collection agencies to recover unpaid medical bills will go up as well. The people that don’t buy insurance aren’t going to be able to get out of paying very easily.

    The plan is set up so there are enough other incentives to buy the insurance (from subsidies, to exchanges, etc.) that anyone going for the penalty route is really just plain stubborn and stupid.

    The other thing that should result from this whole thing once implemented is the consumer caught in the middle problem getting mostly solved. With hospitals etc, having to have a set price for procedures (required in PPACA) consumers should be less likely to find themselves with an $8000 bill and an insurer only willing to pay $3000, with the consumer footing the bill for the rest. There’s quite a bit in PPACA to patch that together a lot better than it is now.

  48. 48
    Villago Delenda Est says:

    As I pointed out in an earlier thread, this was never actually about the provisions of ACA.

    It was about defeating the Democratic, melanin enhanced usurper in the White House.

  49. 49
    amk says:

    @Citizen_X: LOL. It’s a distinct possibility with these nutzos.

  50. 50
    Raven says:

    @NonyNony: Yea, when they passed the law they gutted the enforcement. What else do you need to know?

  51. 51
    rlrr says:

    @Female on the Beach:

    And gas was $1.80 a gallon because the economy tanked while Bush was President.

  52. 52
    El Cid says:

    That CEO was clearly responding under duress, because you know very well his family was targeted for an ACORN / New Blank Panther Party death squad just like John Roberts’ was.

  53. 53
    hueyplong says:

    The $1.80 a gallon price for gas was paired with the Dow at about half of where it is now. There probably wasn’t room for that on the bumper sticker.

  54. 54
    Mike E says:

    @GregB:

    aroused a napping drunken uncle

    I resemble that remark.

  55. 55
    rlrr says:

    @Villago Delenda Est:

    Exactly. I maintain if the exact same act was signed by a Republican President, these very same people would be declaring it a brilliant market based solution to the healthcare problem.

  56. 56
    Brachiator says:

    @mistermix:

    Here’s a quick dispatch from Real America: I listened to a few minutes of a call-in radio show about the ACA this morning. The CEO of the local Blue Cross/Blue Shield was being interviewed and was taking calls, and it was refreshingly dull.

    Thanks for the straight-up reporting on this.

    I would imagine that there are a ton of pragmatic people who just want to find out how ACA works who get pushed aside by the conservative talk radio hosts who want to flog the wingnut agenda.

  57. 57
    Haydnseek says:

    @eric: Are you kidding? I count the MINUTES!

  58. 58
    hueyplong says:

    Right wingers are some narcoleptic sumbitches. Every time there is a single, halting step forward, it awakens the yet-again-sleeping giant to full fury and the hurried creation of misspelled signs.

  59. 59
    NonyNony says:

    @Martin:

    Well, for many people the penalty is less than the cost of the insurance. So if the cost of the mandated insurance is what’s bothering you, then don’t buy it – pay the penalty instead.

    For myself, I’d prefer it if you could pay the “penalty” and once you’ve done that you get default minimum coverage under Medicaid (actually, I’d personally prefer it if everyone just had default minimum coverage under Medicaid assumed and insurance companies were there to sell us the supplemental bronze, silver, gold, etc. policies, but I am not yet Supreme Dictator Of Reality so I takes what I can gets).

    But no – the part that bothers me is that for all of this chatter about the government “forcing” people to buy private insurance or pay a penalty nobody seemed to make it clear that the enforcement of this provision was toothless – that it was purposefully set up to be toothless. On either side of the aisle – not from the Freedom Warriors who were worried about the government next mandating that broccoli be shoved down their throats or from the Marxist Anarchists who were concerned about the government next telling us which private companies we’d be forced to buy pet food from whether we owned a dog or not.

    If there’s no actual enforcement then there’s no mandate. It’s a “pretty please buy some insurance or please choose to pay a penalty” request. Not a jackbooted enforcer from IRS who shows up at your door to trot you off to the FEMA camps because your insurance check bounced.

    I’m mostly angry at myself about this. I thought I was staying relatively well informed about this whole thing and this bit of news has knocked me off balance. I knew this whole narrative was playing various sides against each other, but I’m feeling like I got played too and it pisses me off.

  60. 60
    Mike E says:

    @MattF: I work a part time job with said Medicare recipients and the righties don’t hesitate to claim it while deploring the rest of the freeloaders who somehow shouldn’t be eligible because, well, just, BECAUSE dammit!

  61. 61
    Steve says:

    What is an “exchange”? No, seriously, what is it?

    My understanding is that it is basically a website where you or anyone else from your state can go and shop for insurance coverage. There will be a variety of plans and you can read up on them.

    How many people have any idea about this?

  62. 62
    Amanda says:

    @BC: But it didn’t pass by reconciliation. The House passed the Senate bill. That was the whole point about PTDB.

  63. 63
    amk says:

    @Martin: Weren’t the insurers paying out the care givers even before ACA and therefore would have been trying to cut their costs to preserve their bonuses to themselves under the guise of ‘operating costs’ ? Now that their margin has been cut down to a bare minimum of 20%, they would put the caregivers under pressure to cut their prices still further. So, in effect, the insurers will be playing the role of bean counters for the caregivers.

  64. 64
    gene108 says:

    @Roger Moore:

    Take Bill Kristol’s thing about HCR making people dependent on government and afraid to shrink it out of existence and make the wingnuts it for the rest of fucking eternity.

    That’s how politics used to work, which is why so much of what Republicans stood for was wrapped in euphemisms or “compassionate conservatism”.

    Right now the Republican base really wants to undo everything that’s been done, since the New Deal.

    Businesses want to do this to make more money.

    I have no clue what’s motivating anyone else.

  65. 65
    Raven says:

    @Amanda: I doesn’t matter. Cantor was on Joe this morning droning on and on about how they can do it. It doesn’t have to be true to be a win for them.

  66. 66
    El Cid says:

    @Mike E: Because every single conservative is a fucking Biblical-grade model of the virtues of Hard Work and Tough Choices and Saving Money, endless Wal-Mart’s just filled with Ben Franklin clones, and all of the world’s problems are caused when people take money away from these demigods of Protestant Work Ethics and hand that stolen money to the lazy, grubbing hordes who don’t do anything and live in other neighborhoods and occasionally get in their way in the checkout line.

  67. 67
    Rorgg says:

    @hueyplong: So I looked up average gas price, as memory on that kind of thing is iffy. Interesting.

    The week of July 11, 2008, the national average hit an all-time high of $4.12 per gallon. I’m sure some douche from Fox asked W if he was making it high on purpose to push clean energy, right?

    It then took a moderate dip, and then starting in mid-September, fell quickly to a low of $1.61 in December … after the election, but before the inauguration.

    It then started to rise unevenly but fairly consistently, peaking around $3.90 in May 2011 and April 2012, with a dip in-between to about $3.10. It’s something like $3.37 now.

    So, yeah… gas was even $1.61 under W. But it was also $4.12

  68. 68

    @BGinCHI:

    Maybe we can call it The Confederacy Exchange.

    Or “The Peculiar Institution”.

  69. 69
    Steve says:

    @NonyNony: The “toothless” thing actually worked out pretty well in terms of getting the law upheld. Roberts’ opinion cites a lot of that stuff favorably in determining that this was really a tax and not a punitive measure.

    I think the reality is that the drafters of the law wanted to take it slow and see what happens. The belief is that most people will take advantage of the affordable insurance under the ACA and choose to buy it even though the mandate is “toothless.” If a couple years go by and there’s a real problem because a significant number of people are opting out, then it’s easier politically to ratchet up the penalty because everyone can see the problem. I’d much rather see it done this way than to put in harsh penalties from day one that get demagogued and maybe cause the bill to fail altogether.

  70. 70
    karen marie says:

    I found it interesting when last night an internet friend of mine who knows I follow this stuff closely was quizzing me on ACA. Her big concern was “won’t there be a lot of confusion when it’s implemented all at once.” I explained all the things that are already in effect and she said, “Oh, but that was already (pre-ACA) the law.” She was surprised when she learned that it was law because it was part of ACA and relieved that the entire bill was a slow rollout of changes so that there wouldn’t be a lot of confusion. She was also under the impression that the tax penalty was an annual premium providing a person with automatic healthcare.

    It may be over but there’s a long way to go.

  71. 71
    Davis X. Machina says:

    @Steve: Looks like this.

  72. 72
    KXB says:

    @Cap’n Magic:

    I suspect Jindal will probably change his tune when the insurance companies start providing more expensive coverage to those states which do not implement ACA. Insurance may be a boring industry, but they are powerful.

  73. 73
    Smedley the Uncertain says:

    @The Moar You Know: Saw a report last night that hospital corporation stocks are substantially up. However, Medical insurance stocks are down. Hospitals are looking forward to more PAID bills…
    Insurers concerned about greater pay outs as a percentage of revenue.

  74. 74
    Villago Delenda Est says:

    @Steve:

    Roberts’ opinion cites a lot of that stuff favorably in determining that this was really a tax and not a punitive measure.

    The entire purpose of that was to go after ‘free riding’ on an individual basis, just as it does for employers of 50 or more people who don’t offer health care coverage to their employees. Think Wal-Mart and other parasitical outfits.

    What this does is change the topic of the conversation to health care costs and the stubborn refusal of market forces to actually do anything about them, because you’re not dealing with pins, broccoli, cars, big screen TVs, or many other things that have price points beyond which people won’t touch them. You can’t go shopping around for lab work as a patient. You can’t go shopping around for patent protected medications. There’s a lot of anti-market stuff that goes on in health care that the health care providers don’t want to change, because it will cut into their lucre.

  75. 75
    Yutsano says:

    @KXB: Piyush is basically daring the feds to do all the hard work for him. Why does Piyush want the good people of Louisiana to suffer under federal tyranny?

  76. 76
    Mike E says:

    @El Cid: I kinda get in their way at work, with a wink and a smile. A couple of them don’t talk to me anymore, I’m such a librul…when a lady mentioned Michelle Bachmann way back in the primaries, and I said, “She’s a crazy idiot, but you should vote for her, except she won’t make it on our state ballot, so, not so much!” that was the end of our casual work relationship. I don’t grieve.

  77. 77

    The fat lady sang yesterday at 1100 EDT. Now, on to fixing this thing and moving it toward Medicare-for-all.

  78. 78
    Redshift says:

    @Steve: The important thing about the exchanges (in addition to information) is that to be listed, plans will have to meet fairly strong regulatory requirements. They’ll be grouped in levels (bronze, silver, gold), which will have mandated levels of coverage. So they’ll be able to compete on additional features, but you won’t have to pore over all the details of the policies to compare the most important stuff.

  79. 79
    lamh35 says:

    Not linking to Politico, but they have a headline that says


    Obama campaign: We’ve outraised Romney”

    So OfA says they have raised mroe, but aren’t giving figures. I suspect because they are still on the not wanting to “spike the football” BS.

    Still I’d love to hear the total. I don’t doubt that they have.

  80. 80
    kd bart says:

    The real clever part of the whole ACA fight is how it has distracted everyone from Obama’s ultimate goal to confiscate all of the guns. I mean this real 11th dimension chess.

  81. 81
    JGabriel, Statist Minded Ideologue of the Left says:

    __
    __
    Glenn Beck is selling T-shirts with John Roberts image captioned “Coward”.

    Take a gander. What I love most about this shirt is that it looks like just the kind of thing you would imagine the serial killer wearing in a redneck slasher flick circa 2030.

    .

  82. 82
    schrodinger's cat says:

    OT: Sully is congratulating himself for not having a comments section. Apparently a time waster and a discourse poisoner. Seems like he is projecting. Smug Sully is Smug.

  83. 83
    Brachiator says:

    @NonyNony:

    But no – the part that bothers me is that for all of this chatter about the government “forcing” people to buy private insurance or pay a penalty nobody seemed to make it clear that the enforcement of this provision was toothless – that it was purposefully set up to be toothless

    Not necessarily true. And the Massachussets plan went through a number of variations in how it enforced its individual mandate.

    I don’t see much point in worrying about this until it actually kicks in.

    As an aside, not everyone is required to file a tax return, but presumably would still need to pay their individual mandate somehow, so a number of details on the IRS enforcement thing have yet to be worked out.

  84. 84
    Villago Delenda Est says:

    @kd bart:

    You have to wonder if Boner is in the tank for him, scheduling that contempt vote without having absolute certainty that ACA would be ruled unconstitutional.

    Because that won the day’s news cycle, not the vote on Holder, which of course was gun related.

    So, yes, the gun-grabbing agenda gets subsumed in Roberts voting to uphold and turning himself into the new swing vote on the court, as he desperately tries to insure his legacy is not like Taney’s or Rehnquist’s.

  85. 85
    Mino says:

    I just don’t see a resurgence of unions able to win benefits for all Americans. I wish I did.

    Working stiffs will increasingly have to look to the federal government to protect them from corporations who themselves have federated, for all intents. A weak reed, indeed.

  86. 86
    Yutsano says:

    @Brachiator: Almost all people who would not be required to file a return should qualify under the Medicaid expansion. So that could be a moot issue.

  87. 87
    schrodinger's cat says:

    I find Jindal particularly pathetic, I wonder whether selling his soul was worth the entrance to halls of power. BTW isn’t he an anchor baby according to the GOP mouth breathers? I don’t think his parents weren’t citizens when he was born.

  88. 88
    Villago Delenda Est says:

    @schrodinger’s cat:

    He just wants to be assured of an early tumbrel when the time comes for his just desserts.

  89. 89
    Bulworth says:

    David Frum’s piece, “Repeal is a Fantasy” is quite good. Imagine they actually did attempt a 1-page repeal bill with a Republican president and control of House and Senate. Frum doesn’t think they would have the stomach to face townhalls overflowing with enraged senior citizens and justify to them why SS/Medicare has to pay for tax cuts to the 1%.

    I hope Frum is right but I’m not sure why he would think there’d be townhalls overflowing with enraged senior citizens in the event of a repeal attempt. The ACA does close the Medicare D donut hole. Maybe that’s what he has in mind. But other than that I don’t see where opposition to the repeal would come from and if there was an opposition, the GOP just wouldn’t do any townhalls or anything else that forced them to face the public.

  90. 90
    bemused says:

    @JGabriel, Statist Minded Ideologue of the Left:

    Blah colors, rather ugly, but will coordinate well with camo pants.

  91. 91
    ShadeTail says:

    mistermix: Any chance you can link us to a recording or a transcript? It would be interesting to see first hand.

  92. 92
    Mino says:

    @Villago Delenda Est: Interesting theory around that Roberts is offended by the unseemliness of Scalia rampant.

  93. 93
    Villago Delenda Est says:

    @Mino:

    Scalia seems to have just dropped the pretext of being anything but Franciso Franco’s idea of a proper jurist.

  94. 94
    Valdivia says:

    I like Kay’s idea of sending a Social Security like benefit sheet to everyone. It would go a long way to killing the disinformation. I hope anyone who know anyone in OFA starts talking this up, it might get to the right pair of ears.

  95. 95
    Mike E says:

    @schrodinger’s cat: but, how will Sully know when the thread is dead?

  96. 96
    artem1s says:

    @BudP:

    JP Morgan is still down, can’t imagine why

  97. 97
    Martin says:

    @amk:

    Weren’t the insurers paying out the care givers even before ACA and therefore would have been trying to cut their costs to preserve their bonuses to themselves under the guise of ‘operating costs’ ? Now that their margin has been cut down to a bare minimum of 20%, they would put the caregivers under pressure to cut their prices still further. So, in effect, the insurers will be playing the role of bean counters for the caregivers.

    They’ve been trying to cut costs, but it hasn’t been working. Some is that they just weren’t trying very hard. Some is that they don’t have enough leverage. Drug companies don’t normally negotiate with insurers. They normally negotiate with countries. Your local blue cross/blue shield has no way to get the same kind of deal on blood pressure meds as Canada or France. Same goes for many equipment suppliers. The world has decided that this is a game for nations, not companies, and we’ve been hamstringing ourselves.

    Another side of the problem is that we simply have too few doctors – at least too few in the more important areas. They’re paid too much but there’s almost no way to increase the supply of doctors. Most medical schools and teaching hospitals are attached to public universities which are gutted – and the cost of hiring more teaching physicians is extremely high because of the demand. Further the resident program is largely paid for by Social Security, and increasing that funding has been nearly impossible to get through Congress. 50% of the nations health care costs are physician salary. There’s nothing the insurers can do to change that. They can’t pressure salaries lower if its an inelastic market. You need some unemployed doctors for that to work, and by and large, there are no unemployed doctors.

    The places where the insurers have been most successful are in states where they have effective local monopolies (where there is only one seller of a good). The insurance commissioner may or may not reign in that monopoly power toward consumer prices, but the monopoly also creates a monopsony – a market where there is only one buyer. So hospitals have to deal with that insurer – they’re out of business if they don’t. That gives insurers a reasonable amount of leverage to negotiate prices. It’s also why so many insurers have been going to HMO models in larger states, building their own hospitals and employing their own doctors so they can bypass the problem.

    Health care isn’t like other markets. Your local hospital has a very local monopoly on care. If you get sick, the ambulance takes you there whether you like it or not. The insurers have to deal with the fact that their ability (as well as yours) to negotiate price is nonexistent in that situation. There is no competition at that level. Go up a level to the insurers, and you have a similar problem. Go up another level to the drug companies, and you have a similar problem if Glaxo is the only source for a specific medication. And so on. I can’t say this often enough:

    Free markets require that both buyer and seller can opt out of the market to function. If you can’t reasonably refuse to buy the service and they can’t reasonably refuse to provide the service, then it’s not a free market and pretending that free market rules ought to apply is just magical thinking. They may work in limited senses, and you can probably regulate enough around the edges to make it appear to work like a free market (which is what PPACA does), but it never, ever, ever will be one. Ever. And there’s nothing that you can do to change that.

  98. 98
  99. 99
    Martin says:

    @Yutsano: Good point. There’s lots of clever little bits like that in this bill.

  100. 100
    schrodinger's cat says:

    @Mike E: Some of his threads never die, View from your window, True conservatism, Meaning of Religion, and some of his other hobby horses come to mind. Besides he is not interested in a conversation but talking down to the unwashed masses in his superior manner, complete with an accent.

  101. 101
    David in NY says:

    @NonyNony:

    if you don’t pay it you could face the same penalties the IRS levies against people who don’t pay other taxes.

    Right?

    Wrong. You said it yourself. Roberts’ opinion doesn’t change the law — the only thing anybody can do is levy against tax overpayments. If you manage to underpay slightly on your withholding every year, NO PENALTY!

  102. 102
    NonyNony says:

    @Brachiator:

    Not necessarily true. And the Massachussets plan went through a number of variations in how it enforced its individual mandate.I don’t see much point in worrying about this until it actually kicks in.

    Exactly my point. There was much wailing and gnashing of teeth about the idea that the gubbmit was going to “force” us to buy private health care both from the Left and from the Right. I congratulated myself for realizing early on that this was basically nonsense because the way it was implemented it’s like saying the gubbmit is “forcing” us to put mortgages on our homes because there’s a mortgage deduction in the tax code.

    I’m pissed at myself because the analogy isn’t even correct – the government “forces” us to put mortgages on our homes FAR MORE than the PPACA is “forcing” us to buy health insurance if there’s no way for the IRS to actually collect the penalty.

    This whole thing has been a bunch of street theater trivial bullshit nonsense. I knew that from the start but damn, I’m pissed that I didn’t realize just how trivial the bullshit really was.

  103. 103
    Villago Delenda Est says:

    @Martin:

    These people talk about free markets, but they do not have the slightest fucking clue as to what a free market actually is.

    Meanwhile, The Wealth of Nations sits on their bookshelves, gathering dust.

  104. 104
    kd bart says:

    Who cares about ACA. The Cruise/Holmes marriage is over!!!

  105. 105
    Davis X. Machina says:

    @Valdivia:

    I like Kay’s idea of sending a Social Security like benefit sheet to everyone.

    They’ve only just stopped doing that as a cost-savings measure.

  106. 106
    Kay says:

    @NonyNony:

    But no – the part that bothers me is that for all of this chatter about the government “forcing” people to buy private insurance or pay a penalty nobody seemed to make it clear that the enforcement of this provision was toothless – that it was purposefully set up to be toothless.

    The mandate is partly an enrollment mechanism. Think about how misinformed people are now about the law, and then imagine how many people simply won’t know what they’re eligible for, whether they’re eligible, if the exchanges are up and running, all of it. People who are eligible for Medicaid NOW don’t enroll, because they don’t know they’re eligible, and they just don’t encounter anyone who knows.

    It’s a way to get people in the door and covered, but to recognize that one would have to look at the PPACA as something other than an evil scheme to rip people off or force them to do things, which is how conservatives have portrayed universal coverage.

    They WANT you to get covered. Not because they’re huge humanitarians, but because it won’t work unless everyone (mostly) is “in”.

  107. 107
    Villago Delenda Est says:

    @kd bart:

    Oh noes!

    Does this mean that Tom needs to find a new beard, stat?

  108. 108
    amk says:

    @Martin: Thanks for the details. Couldn’t they sort out the issue of shortage of doctors by importing them ? Or does that open a new can of worms ? Amazing that the wealthiest of the nations is short of doctors.

  109. 109
    IowaOldLady says:

    Do the exchanges provide any sort of group pressure on individual insurance prices? Right now, people buying individual insurance are at a big disadvantage compared to companies buying a group policy for their employees. Will the exchanges help that?

  110. 110
    Yutsano says:

    @amk:

    Amazing that the wealthiest of the nations is short of doctors.

    Everywhere is short of doctors. Countries poach each others’ medical staffs all the time. If you’re a doctor you can live anywhere in the world as long as you pass the country’s medical board.

  111. 111
    Kay says:

    @NonyNony:

    I heard John King misinforming people about the mandate yesterday. He was describing the mandate breathlessly saying “that’s where the money comes from!”. It’s just stupid. He doesn’t understand the thing. The money comes from a lot of places, for PPACA. 500 billion dollars came from stopping private insurance companies from ripping off Medicare (the public funds) under Medicare Advantage (the privatized part of Medicare), but I guess John King can’t say that, because privatizing 1/5 of Medicare was the big conservative health care savings Idea in 2002, which failed. The private plans cost more than the public program. “The money”, vast majority, isn’t going to come from penalties paid under the mandate.

  112. 112
    Martin says:

    @Yutsano: Right.

    One of the things they really need to investigate is how to minimize the risk to doctors for taking on the high cost of medical school by making it more attractive to become a GP (earning less, making it harder to pay off the bills) vs a cosmetic surgeon or some such.

    They need the equivalent of the education programs that forgive college loans for teaching in inner city schools by paying off medical school costs if you go into the more in-demand and lower-paid medical fields. The cost of medical school is really damn high to an individual, but not to society relative to what we’re paying in excess wages. We’d come out way ahead with a system that would lower wages and create more GPs in exchange for free education.

  113. 113
    David in NY says:

    @IowaOldLady: I think it’s supposed to work like this: All the gold, or silver or bronze, plans must offer comparable benefits in the most important aspects; may have other bells and whistles. You can just choose the cheapest bronze plan, say, and know basically what you’re getting and the price you’ll pay. If you want to look at the bells and whistles, to see if they’re worth a little more, you can do that too. But there should be pressure for everybody to meet the lowest price in each category, because that will get you the major features for the least cost, and everybody will have to find some way to compete.

  114. 114
    lgerard says:

    @gnomedad:

    The Michael Lind book mentioned in the article was excellent, he was on to this some time ago.

  115. 115
    Brachiator says:

    @Martin:

    50% of the nations health care costs are physician salary

    Where do you get this figure from? A USA Today article I saw claimed the following:

    And with physicians’ take-home pay accounting for just 10% of national health care costs, reducing earnings will do little to drive down America’s health bill.

    They also note some of the problems that the US and other countries have in matching physicians with medical needs:

    When medical complications arise, Japanese patients fare far worse than Americans. Japanese are twice as likely to die from heart attacks, even though heart attacks are one-quarter as common in Japan. One reason? Japan has one-third fewer doctors than the developed-world average. Doctors see as many as 100 patients a day and work up to 100 hours a week….
    __
    [In America] Primary-care physicians are in short supply. Only three of every 10 doctors practice general medicine. And that ratio is worsening. The American Academy of Family Physicians has warned that by 2020, the United States will be short 40,000 primary-care doctors.

    Medical education costs appear to be higher in the US than in some other industrialized countries, etc.

    Lots of issues that need to be dealt with to try to get control of health care costs and care disparities.

  116. 116
    Shana says:

    @Martin: Interesting comment. Just one question though: doesn’t the VA negotiate drug costs? I think I read somewhere in a discussion of Part D that they did.

  117. 117
    JCT says:

    @Martin: There are actually a number of these programs in place, they are just limited in scope. They run the gamut from joining the military to practicing in underserved areas to pursuing both an MD and PhD (so that new docs will choose to become academics). I chose the latter route.

    They are all highly sought-after and should be expanded but uh-oh, that requires more govt $$.

    But yes, relatively few new medical graduates can afford to go the primary care route as post medical school debt (especially if they also have undergraduate debt) can be crippling. Interestingly, compounding the problem is the more recent development of doctors marrying fellow doctors — doubling the debt issue.

    When you couple this to the mind-rending bureaucracy involved in being a general practitioner it’s a very tough sell.

  118. 118
    Martin says:

    @Brachiator:

    Where do you get this figure from?

    McKinsey. They estimate that total healthcare spending could be cut by 10% just by reducing US physician salaries to the levels of other nations that also still have high-earning physicians. That’s the first order savings. The US pays doctors double or more of what any other nation pays, relative to the general population. Increasing the number of doctors no only allows salaries to come down but also expand access to care – particularly in rural areas which is particularly problematic in the US. That would reduce medical transportation costs and reduce costs in other areas by getting earlier treatment to many people. So there are a lot of secondary cost saving as well.

  119. 119
    Martin says:

    @Shana: VA does, Medicare and Medicaid do not, by law. That was courtesy of Medicare D. To route around this, Obama directly negotiated prices with Pharma. Not ideal, but that provision was never going to get in PPACA, but we needed to make some headway on it. That’s another fight for later.

  120. 120
    karen marie says:

    @Martin: Exactly. It has long baffled me that the high cost of medical education and the widespread negative effects never seem to get addressed.

  121. 121
    Martin says:

    @JCT: Yeah. I don’t think the goal is to promise to make GPs rich – just to give a reasonable assurance they won’t be poor. Just wiping out the debt should be enough of an incentive. You get get out of medical school, buy a house, and live a normal life. For any field that is in-demand in the nation and would carry social benefits, that should be a no-brainer.

  122. 122
    Xantar says:

    @NonyNony:

    I think the thing is it actually served both sides to pretend the Individual Mandate was stronger than it really was. Obviously the right wingers wanted to make it sound like jack-booted government thugs stepping on your neck and forcing you to buy insurance. However, I also don’t think the Obama administration really wanted to admit that it was a totally toothless enforcement mechanism. For one thing, they’d look awfully silly for deliberately hamstringing their own enforcement mechanism. And secondly, if it became widely known that you could just refuse to pay the penalty, you’d probably have quite a lot of people deciding to do just that and the ACA would lose some of its effectiveness.

  123. 123
    Brachiator says:

    @Martin:

    Increasing the number of doctors no only allows salaries to come down but also expand access to care – particularly in rural areas which is particularly problematic in the US.

    Doctors don’t necessarily want to practice in rural areas, urban areas, etc. Let’s call it the Northern Exposure Syndrome. Increasing the number does not necssarily do much to solve this problem.

  124. 124
    wrb says:

    @Martin:

    I know that when I was in school and people were picking their futures it appeared that
    medicine would attract plenty of top talent even if doctors’ incomes were modest.

    It is a field that is absolutely recession proof, one in which you can be quite independent (need not live in fear fear a boss), is intellectually challenging, is interesting, and in which you can feel daily that your work is meaningful and benefits others.

    It is only the artificial constrains on the supply of doctors that keeps prices high.

    In fact if those who were only entering medicine to cash in were replaced by people seeking meaning, the stock of doctors might be improved.

  125. 125
    wrb says:

    But yes, relatively few new medical graduates can afford to go the primary care route as post medical school debt (especially if they also have undergraduate debt) can be crippling.

    Grant citizenship and a medical license to foreign-trained doctors who want to immigrate.

  126. 126
    schrodinger's cat says:

    @wrb: It is very difficult for a physician trained in another country to immigrate, they need to redo their residency for starters, take the USMLE. That said there are immigration related incentives for medical graduates from other countries if they serve in rural areas.

  127. 127
    Mnemosyne says:

    @wrb:

    I know that when I was in school and people were picking their futures it appeared that
    medicine would attract plenty of top talent even if doctors’ incomes were modest.

    Well, sort of — if you know you’re going to graduate with $200K in debt, you’re going to be a hell of a lot less likely to choose a speciality where you’ll make $75K a year instead of $500K a year.

    I do think that more debt forgiveness for people who choose primary care specialties is the way to go. Given the current crisis in primary care, you probably wouldn’t even need to restrict it to people who agreed to set up shop in poverty-stricken urban or rural areas. Even nice suburbs are having a hell of a time finding GPs, pediatricians, and OBGYNs these days.

  128. 128
    NonyNony says:

    @wrb:

    Grant citizenship and a medical license to foreign-trained doctors who want to immigrate.

    Really? That’s your answer?

    I’d go with “find a way to make it so that med school doesn’t lead to crippling debt for folks who want to be GPs” rather than “outsource medical education to another country” myself.

  129. 129
    feebog says:

    I think we start with the premise that most people would purchase health insurance if they could. Sure, there are plenty of 30 something knukleheads who think they are invincible, but there are also plenty of families who simply do not have access to an affordable policy. ACA exchanges will change that. And even some of the knukleheads will get married, start a family and realize, hey I better get me some of that health insurance.

  130. 130
    JCT says:

    @schrodinger’s cat: Not only that — they often need to re-do their residency/fellowship training. More foreign-trained MDs in the US is not the answer.

    Uncoupling the decision to be a primary care physician (this actually includes general surgery by the way…) from being driven by personal debt load is a perfectly attainable goal. When combined with an expansion in medical school slots we can start to make a dent in this problem.

  131. 131
    Brachiator says:

    @Yutsano:

    Almost all people who would not be required to file a return should qualify under the Medicaid expansion. So that could be a moot issue.

    Good point. Also, ironically enough, a lot of these issues have already been dealt with in various ways in the Massachusetts health care program, and I presume that the Obama administration looked at that in setting up the mechanism for dealing with the individual mandate.

    So, for example, the MA Tax site notes:

    Under the Act, a resident is required to indicate whether he or she has health insurance on his or her Massachusetts personal income tax return. A resident who has access to affordable coverage but who does not obtain the coverage, and to whom an exception does not apply, is subject to penalties … which will be imposed through the individual’s personal income tax return

    There are further instructions for people who are exempt, who don’t have to file, etc.

  132. 132
    Lee says:

    Make sure you send this one to your wingnuts as well.

    This is in 1956 Ike signs HUGE socialist program that we are still paying for.

    Keep twisting the knife. Their tears are worth it.

  133. 133
    The Lodger says:

    @Martin: The insurance companies were definitely negotiating drug prices with pharmacies about five years ago. I had had no health care and was just getting into a health insurance policy with prescription benefits. My pharmacy gave me a statement over a few years and I could see a substantial difference between what they charged me as an uninsured person, what they charged my insurance provider, and my co-pay. There was no comparison. My feeling was that the insurance companies had a lot more leverage on prices than thousands of uninsured individuals.
    BTW, in terms of sheer volume, Cigna or Blue Cross in the U.S. probably outranks Belgium.

  134. 134
    The Lodger says:

    @Kay: John King can’t say anything accurate about Medicare Advantage because the Medicare Advantage companies buy ads on talk radio. Pretty much the same reason you’re not going to hear anything really critical of Romney on Major Commercial Media – no one wants to P!$$ off the big advertisers between now and November.

  135. 135
    Bill Arnold says:

    @Martin:
    That is an elegantly concise summary of the healthcare “market”, thank you.

  136. 136
    john fremont says:

    @Judas Escargot, Acerbic Prophet of the Mighty Potato God: or the Exchange of Yankee Aggression

  137. 137
    Julia Grey says:

    Well, for many people the penalty is less than the cost of the insurance. So if the cost of the mandated insurance is what’s bothering you, then don’t buy it – pay the penalty instead.

    AND THEN pay the full retail price of all your medical care when those bills come due — which they inevitably will.

    See, fellas, there’s this thing called “false economy…” or, “penny wise but pound foolish” or…

    Oh, never mind. I guess I shouldn’t waste my time trying to exhort people to do the sensible thing. Their first multi-thousand hospital bill will have to be their education.

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