What she said:

I’m in between OMG got to get things done deadlines right now, so I just want to refer to a great post by Adriana McIntyre:

I’ve argued in the past that delaying the individual mandate for a year wouldn’t provoke a full death spiral; it would be an uncomfortable hiccup, but it’s not enough time for the whole market to unravel. More importantly, there are deep-in-the-weeds protections baked into the Affordable Care Act: risk adjustment, reinsurance, and risk corridors.

These programs—collectively called the “three Rs”—aid insurers if they wind up enrolling a population that is sicker and more expensive than projected. They do a crucial bit of policy work: we want plans competing on efficiency and quality, not their ability to attract the healthiest patients.

The programs have related functions, but risk corridors will play the biggest role if the individual mandate does get delayed. Their entire purpose is to stabilize premiums during the first three years of Obamacare, when it’s especially difficult for insurers to price plans.

Here’s how it works: exchange plans (QHPs) projected how much their risk pool would cost overall in 2014, their “target” cost. If they’ve significantly miscalculated—or, say, if a mandate delay causes adverse selection that they couldn’t have predicted—HHS will take action:

The risk corridor mechanism compares the total allowable medical costs for each QHP (excluding non-medical or administrative costs) to those projected or targeted by the QHP. If the actual allowable costs are less than 97 percent of the QHP’s target amount, a percentage of these savings will be remitted to HHS (limiting gain). Similarly if the actual allowable cost is more than 103 percent of the QHP’s target amount, a percentage of the difference will be paid back to the QHP (limiting loss).

There are transfer systems in place to compensate health plans that have very sick populations with funds from both health plans that have very healthy populations and the general fund (this was one of the taxes batted around but not changed during the debt default end game). This will keep health plans in business if the mandate does not work too well the first year. There are some loopholes that create perverse incentives for health plans that I’ll outline in a later post.






69 replies
  1. 1
    Baud says:

    The biggest problem with delaying the first year mandate would be the freakout from hair-on-fire liberals.

  2. 2
    NonyNony says:

    Does this suggest that the individual mandate is actually unnecessary in the grand scheme of things and could be ditched altogether and the insurance companies would make do? Or am I misreading this post and this really just a “it wouldn’t matter for the first year or so but long term it would kill us” sort of thing?

    Also this:

    There are some loopholes that create perverse incentives for health plans that I’ll outline in a later post.

    frightens me to the core of my being. Any system is going to have some perverse incentives, but unfortunately it will probably be a decade or more before any perverse incentives in the ACA can be corrected. I hope that the ones that have already been identified are minor ones that aren’t going to screw with individuals and their ability to pay for medical care.

  3. 3
    Tractarian says:

    Speaking of freakouts from hair-on-fire liberals, I just read Ezra Klein’s post from Friday on how “Obamacare’s problems go much deeper than the Web site”

    I’ve read it three times, and I still can’t figure out what the non-website-related problems supposedly are. Everything that is touted as a “problem” stems from the fact that the website is f*cked up.

    In other words, yes, a functioning website is necessary to the viability of the law, but the problems that everyone is freaking out about will take of themselves once the website is fixed.

  4. 4
    Belafon says:

    @NonyNony: Long term it would kill us. The health care market needs to have healthy people to balance out the not-so-healthy. So there has to be some incentive to get people on the market. Plus, the mandate covers the “I didn’t buy insurance, so I’m just going to show up at the emergency room” group.

    Also, don’t get frightened so easy.

  5. 5
    Baud says:

    @Tractarian:

    It’s about the clicks the title will generate. Nothing more, nothing less.

  6. 6
    piratedan says:

    @Tractarian: i’d argue that the 1800 number and having people located at community medical providers to handle the paperwork as paperwork will reach far more folks that need the ACA than pundits like Ezra would ever know since we’re all working under the assumption that the internet and access to it is everywhere which is simply not true.

  7. 7
    LanceThruster says:

    Enact public option and/or single payer to smooth out the bumps.

  8. 8
    kindness says:

    Those that are against anything an Obama President brings forth would be only too happy to delay the individual mandate for a year. Then another year. Then another. See where this goes?

    The haters, the folk that aren’t Democrats? Death by 1000 cuts is fine for them. Delaying this mandate would be a couple dozen cuts right there.

  9. 9
    Ash Can says:

    @piratedan: THIS. Considering the fact that there are four conduits for enrollment — of which the Internet is one — and the probability that uninsured people seeking coverage are at least as likely to have phone coverage as opposed to Internet access, hysteria over the web site looks pretty ridiculous. This isn’t to say that I think none of the concerns over the site’s functionality are valid. Quite the contrary; I believe along with everyone else that the problems need to be fixed ASAP for the benefit of everyone involved. But to run around shrieking about “failure” and “disaster” and claiming that the web site problems are undermining the entire ACA is silly.

    And I’m thoroughly confused over Ezra Klein’s reaction to the site problems. I wouldn’t have expected him to turn on the entire ACA like this. What exactly is his agenda?

  10. 10
    Ash Can says:

    @LanceThruster: For sure. But who’s going to enact it?

  11. 11
    Lol says:

    @Ash Can:

    Klein has decided to carve out a space as a contrarian liberal these days, as evidenced by his new found love for Broder and his willingness to take Ryan and other conservative “thinkers” seriously.

  12. 12
    Baud says:

    @Lol:

    He’s starting to remind me of Michael Kinsley.

  13. 13
    fuckwit says:

    The whole delay propaganda putsch is more Koch foundation right wing bullshit.

    Their PR goal is to ramp up hysteria about the fucking website and then use that to try to push to delay/defund it. Come on, this isn’t hard. It isn’t even a secret. Don’t buy into the hype.

    I’m dead set against any delay. 100 years is too goddamned long already. This is it, we’re doing this, and the time for bullshit is over.

    We’re not delaying this. It’s happening.

    And yeah, I’d much rather have single-payer. But this is the hand we got dealt. So onward, to mandate, to competition, to choices, to lower prices for everyone, to people like me finally being able to have insurance again.

  14. 14
    Mnemosyne says:

    Anya linked to this in one of the threads below:

    Thousands line up in Dallas for health insurance info

    Their biggest complaint? That they weren’t allowed to sign up on the spot. Not sure why that decision was made — because a single insurer was the sponsor? Because Texas doesn’t allow healthcare navigators?

  15. 15

    @Ash Can:

    And I’m thoroughly confused over Ezra Klein’s reaction to the site problems. I wouldn’t have expected him to turn on the entire ACA like this. What exactly is his agenda?

    To ensure his membership among the permanent courtier class that is the Village. His wife is at it in the NYT this morning, concern-trolling the ACA.

  16. 16
    Baud says:

    @fuckwit:

    I agree. There won’t be a delay.

  17. 17
    Mnemosyne says:

    Rick Perry blocked healthcare navigators from doing their work in Texas. So you have thousands of people willing to stand in line to hear about their new health insurance options, but Perry is actively blocking his own citizens from being able to sign up for those new options.

  18. 18
    LanceThruster says:

    @Ash Can:

    If Obama can round people up and put them in FEMA camps, he can declare himself dictator for life and use that “Unitary Executive” ploy Dubya was always on about, nu?

  19. 19
    Yatsuno says:

    @fuckwit:

    I’m dead set against any delay.

    This. For fuck’s sake Bismarck figured this shit out 150 years ago. It ain’t rocket science people.

    And yeah, I’d much rather have single-payer. But this is the hand we got dealt.

    This should scare conservatives more than anything. Every country needs to transition to a single payer system over time because it’s such a fundamental change to old business practice. But ACA gets that ball moving that was supposed to start with Medicare in 1965. But Johnson took what he could get then Nixon couldn’t get past Ted and it was never brought up again until 1993. We’re already heading down the path though, thanks to Vermont. If another big state follows (looking at you CA) the game is essentially over.

    @Mnemosyne: SMALL GUBMINT CONSERVATIVES!!! Unless it interferes with our agenda. Then gubmint is gonna be all up in your grill! It’s for your own good you know.

  20. 20
    Violet says:

    If you have health insurance through your employer you’re already “on Obamacare.” Employer-provided health insurance is an acceptable form of health insurance so long as it meets the new ACA requirements. All the media whiners are already “on Obamacare.” So is everyone else with employer-provided health insurance. I wish somebody would point that out to our media overlords.

  21. 21
    Steve Crickmore says:

    As a commenter on another post said everyone (at least every liberal) on this blog would much rather see a single-payer system, but failing that, it seems sensible ‘ to get a half a loaf rather than no loaf’, or does it? Are liberals heading down the wrong path with such a strong, robust defense of ACA, simply because all ACA critics are conservative neanderthals? After all it was their plan to begin with, and the caveat of defending such a program is that…

    “Instead of being a simple, universal program like Social Security or Medicare, the Affordable Care Act system is designed as if to illustrate Steven Teles’ notion of “kludgeocracy” or needless, counterproductive complexity in public policy. By using means-testing to vary subsidies among individuals and by trying to match individuals with private insurance companies…the worst features of Obamacare are the very features that conservatives want to impose on all federal social policy: means-testing, a major role for the states, and subsidies to private providers instead of direct public provision of health or retirement benefits. This is not surprising, because Obamacare’s models are right-wing models — the Heritage Foundation’s healthcare plan in the 1990s and Mitt Romney’s “Romneycare” in MassachusettsIn doing so, progressive defenders of Obamacare may inadvertently be digging the graves of Social Security and Medicare.

    If Obamacare — built on means-testing, privatizing and decentralization to the states — is treated by progressives as the greatest liberal public policy success in the last half-century, then how will progressives be able to argue against proposals by conservative Republicans and center-right neoliberal Democrats to means-test, privatize and decentralize Social Security and Medicare in the years ahead?

    .

  22. 22
    Yatsuno says:

    @Steve Crickmore: Name one country that went from private health care to single payer overnight. I’ll wait.

  23. 23

    @Violet: I have been on employer sponsored health insurance and health insurance via Common Wealth Care in Mass, with the exception of Harvard Pilgrim none of these websites were all that easy deal with. It took sometime to figure out how to access specialists and other benefits.

    ETA: I have no idea in which world these people live.

  24. 24
    MomSense says:

    @Yatsuno:

    This. For fuck’s sake Bismarck figured this shit out 150 years ago. It ain’t rocket science people.

    Ok, that cracked me up. Totally unexpected and awesome.

  25. 25
    Omnes Omnibus says:

    @Steve Crickmore:

    Are liberals heading down the wrong path with such a strong, robust defense of ACA

    No. The most important thing about the ACA is that it helps cement in the public consciousness that healthcare is a right. Once that happens, universal coverage is ultimately inevitable.

  26. 26
    Mnemosyne says:

    @Steve Crickmore:

    Please name a country that was able to switch from a private insurance system to a single-payer system with one piece of legislation. Canada couldn’t do it. Great Britain couldn’t do it. France couldn’t do it. South Korea is hailed as making the fastest transition, and it took them 15 years to do it.

  27. 27
    Ash Can says:

    @Steve Crickmore: Given the realities of lawmaking in the United States — especially on the national level — damned right it’s a liberal public policy success.

  28. 28
    Chyron HR says:

    @Steve Crickmore:

    If Liberals argue in favor of moving health insurance forward, how can they argue against moving Social Security and Medicare backward?

    And if only Obama had outlawed all existing health insurance plans and every single American citizen had to sign up for Obamacare by January 1, the rollout would have been so much smoother.

  29. 29
    Elizabelle says:

    @Tractarian:

    And he’s tag-teaming with his WIFE.

    From Annie Lowey, aka Mrs. Ezra Klein:

    Health Site’s Woes Could Dissuade Vital Enrollee: the Young and Healthy

    The top-recommended reader comments call her out for the concern-trolling.

    From JM in the Midwest:

    Why is the New York Times running a “oh no, it’s a disaster” article every day and ignoring the fact that the website is running much better and you can apply by phone or mail? To serve the public, the phone number could be on the front page daily. Instead, it seems the Times is determined to tell us the sky is falling. That’s not responsible.

    From Bill in New Hampshire:

    Speculation. Pure speculation, with a negative twist.

    Why do older people always assume young people are clueless?

    In my experience, most young people are VERY aware of the risks of being uninsured. …

    Up until now there hasn’t been much they could do about medical risks because of the sheer cost of insurance. Now there is, and many will take advantage of it — not because of the mandate, but because they know somebody who has been sick or hurt, and suffered enormously by not having any insurance.

    Don’t know about the risk? Don’t care? You gotta be kidding!

    From David Gifford in New Jersey:

    This type of article is the reason people give pause to everything in newspapers today. What is this OpEd piece doing in the reporting sections. This article does nothing to help anyone it is all opinion and conjecture. A year or so from now, we should see how Obamacare is progressing and make the necessary changes but now we need to allow time to get the program up and running. This means allowing the program to actually have the time to flower. All these “boy who cried wolf” accusations are in no way helpful, even if they do come under the guise of real reporting.

    From Boo in East Lansing:

    This is crazy talk. Young people get sick, get injured on the job or playing sports, 20-year-olds get in car crashes, young women get pregnant and have babies, and unfortunately young people of all ages, genders and races get shot (sometimes accidentally by themselves, a friend or a family member). Why is the GOP peddling the falsehood that young people don’t need health insurance?

    From Linda in Brooklyn:

    really?… this would be the same demographic that will line-up at apple stores days before the release of their latest toy; and the opinionators are all convinced that a temporarily buggie website will dissuade them from purchasing insurance.

  30. 30
    piratedan says:

    @Steve Crickmore: Steve, will you take your concern trolling ass over to RedState where you can stand out as the voice of reason amongst the ooga booga or maybe you can just watch us tell you to take your lame ass arguments to town trying to explain away the logic if means testing is applied to every fucking thing then there’s no reason at all not to put the heads of the GOP up on pikes out on the fence around the White House because it can plainly been shown that the most successful America that there ever was were tied to FDR’s New Deal which showed government as a primary mover in the job markets making infrastructure for the benefit of all and Eisenhower’s tax rates of up to 90% on the wealthiest Americans and expanded availability to education.

  31. 31
    Mnemosyne says:

    @Omnes Omnibus:

    This is what I don’t get — how on earth does someone think we go from “getting everyone covered” to re-privatizing everything? What’s the mechanism involved?

  32. 32
    Yatsuno says:

    @MomSense: Of course Bismarck was trying to head off a possible Communist takeover of his country. But instead of responding with the violence of the state* he co-opted the Communist positions on social issues like leave, child care, and health care. Germany has been under universal health care for a very long time. Trust me they won’t give that up easily.

    *It wasn’t all peace and roses. Bismarck did have violent clashes with Communist agitators, but undercutting most of their complaints was much more effective at calming the Communist insurgency.

  33. 33
    Yatsuno says:

    @Mnemosyne:

    This is what I don’t get — how on earth does someone think we go from “getting everyone covered” to re-privatizing everything? What’s the mechanism involved?

    Invisible Hand and the Magic of the Free Market. Natch.

  34. 34
    Elizabelle says:

    @Yatsuno:

    Yesh. I gots a soft spot for old Chancellor Bismarck.

    PS: did I tell you I loved your comment, some days past, welcoming a delurked commenter with a “salted dicks gift basket”? Perfect.

  35. 35
    Hill Dweller says:

    If the votes for single-payer are there, how does Obamacare prevent it from happening?

  36. 36
    Yatsuno says:

    @Elizabelle: I got his first “Fuck You!” out of the way as well. I am nothing if not accommodating.

    @Hill Dweller: It doesn’t. Ask Vermont. All they needed was a waiver to use other funds to start their program. They got it. I saw an article concern-trolling the start-up the other day but I can’t find it now.

  37. 37
    GRANDPA john says:

    @Mnemosyne:
    Thousands huh ? Hell that sounds like more than enough to hold a good ol’ Texas vigilante meeting at the nearest tree with an appropriate size limb , if somebody just brings the rope.

  38. 38
    Steve Crickmore says:

    @Yatsuno: This is the incremental way of doing politics, when there is stiff opposition. I know Canada successfully experimented ‘medicare’ / universal coverage in one province, Saskatchewan first, before trying it federally. Maybe that was the key; i.e pick two Democratic States for example. say Vermont and Illinois as pilots. It just seems like an incredibly difficult process and battle with so many procedures, deductibles, co-payments. still not covered, plus a further shift to the employers. and private insurers. We will see.

  39. 39
    Hill Dweller says:

    @Elizabelle: When will her article attacking Obama for not enough women enrolling in Obamacare be published?

  40. 40
    Belafon says:

    @Steve Crickmore: Obamacare is not built on means testing. It does not keep people from getting insurance; exactly the opposite, in fact. What it does do is means test subsidies.

    If the Republicans want to argue about means testing subsidies for Social Security, I’m all for it.

  41. 41
    Fair Economist says:

    @Mnemosyne: Well, in the US, we had Medicare and Medicaid in what, 1965? And they’re half the cost of healthcare in the US. Given that they are more efficient that the private insurance and medical extortion provisioning, they’re more that half the care. So we’re already in a hybrid system for nearly 50 years, and so it would hardly have been one-step if Obamacare had been some single-payer system.

  42. 42
    Mnemosyne says:

    @Fair Economist:

    At least three different pieces of legislation were passed in Great Britain before the NHS was formed in 1948. So, if anything, we’re probably at least two more pieces of legislation out from having single-payer.

    We’re actually further behind the ball than we were in the early 1990s because most health plans are now for-profit — in the 1990s, the majority were still non-profit. So, as with so many things that were touted as great, free-market ideas, we’re worse off than we were 20 years ago.

  43. 43
    gogol's wife says:

    NewsMax is outdoing itself today.

    “Reagan’s Daughter: Why Am I Losing My Healthcare?”

    “Palin to Piers: No Interview, I’m Hunting Bear”

  44. 44
    FlipYrWhig says:

    @Steve Crickmore: Seems to me that would leave far more people out in the cold — everyone who had a reliably Republican state government, for instance, which is a lot of people. Did people say, “desegregation, it’s just too complicated, can’t someone else pilot it first?”

  45. 45
    Richard Mayhew says:

    @NonyNony: Not really, the corridors are a temporary stabilizing mechanism — they work okay, but nowhere near as well as having a really big and mostly representative risk pool sample.

  46. 46
    FlipYrWhig says:

    @Fair Economist: But you have to smooth out some of the kinks in the Medi- programs too, like finding savings by doing comparative effectiveness research and so forth. Because they’re so big, small changes go a long way in making savings materialize, and then that’s billions to be used on other priorities.

  47. 47
    Fair Economist says:

    I’m suspicious about the claims that the Obamacare systems problems are profoundly difficult to solve. They apparently are mostly driven by data interchange incompatibilities on semi-standardized forms. Well, I’ve had data interchange issues crop up over and over again at various projects I’ve worked on for the past 30 years or so and I haven’t found them to be profoundly difficult. They’re tedious to solve, but with an intermediary layer I find them pretty straightforward except *sometimes* in the case of missing data. In addition, it tends to be a highly divisible problem – the team handling interchange to Aetna doesn’t need any connection at all to the team doing interchange to Blue Cross. One month to get most of the interchanges working sounds like a very reasonable target to me. I’ve been able to write interchanges to get complex data out of graphical web displays in less time than that, and that’s much harder than pulling it out of databases with variant field definitions (which I’ve also done).

    The claim that there’s some urgency to delaying the mandate is also bogus. The penalty doesn’t have to be paid until 2014 taxes are due, which is in 2015. Even if the current system completely fails, it would be trivial to say the penalty is waived with a signup for insurance in 2015, because that’s has to happen before the 2014 taxes are due. And I guarantee the site can be up by October 2014.

  48. 48
    Belafon says:

    @gogol’s wife:

    “Reagan’s Daughter: Why Am I Losing My Healthcare?”

    Because you’re Reagan’s daughter? Ask your dad why mine lost his SSDI (disabled veteran) back in the 80s.

  49. 49
    Steve Crickmore says:

    Yes,hard to believe that the US spends more of its percentage of tax dollars on health care than Canada, percapita which has free, universal heath care coverage for practically every procedure from the cradle to the grave. Payment of healthcare is non issue for the individual citizens, because they have no idea of the costs of the procedures or hospitalization. Employees, if I’m not mistaken pay about 1% of their wages, employers maybe 2% of their total income to the provincial health care plans in the provinces they reside, the self employed pay zilch. The rest of the costs come out of general revenue, provincial and federal but still less per capita than in the US. But America has great innovation.and that is true.

  50. 50
    Mnemosyne says:

    @Fair Economist:

    In addition, it tends to be a highly divisible problem – the team handling interchange to Aetna doesn’t need any connection at all to the team doing interchange to Blue Cross.

    As I understand it, it’s not the interchange to the insurance companies that’s the problem — it’s the interchange to the states. The 21 states that declined to form their own exchanges nevertheless have to provide information to the feds, and that seems to be where the problem is.

  51. 51
    Librarian says:

    @Yatsuno: By “Communist” I believe you mean “Social Democrat”, which is not exactly the same thing.

  52. 52
    Fair Economist says:

    @Mnemosyne:

    As I understand it, it’s not the interchange to the insurance companies that’s the problem — it’s the interchange to the states. The 21 states that declined to form their own exchanges nevertheless have to provide information to the feds, and that seems to be where the problem is.

    Well, that should be technically solvable as well. It Is* possible for the states to sabotage this. That’s something to look for in a couple months – is it working in some federal exchange states but not in others? But this would still hardly make Obamacare a failure – it would be working for perhaps 2/3ds of the population. I also think that situation would end up be politically catastrophic for the recalcitrant states by 2016, and for that reason I don’t anticipate much sabotage, for the same reason that most red-state governors have ended up pushing for Medicaid expansion.

  53. 53
    Yatsuno says:

    @Librarian: Bismarck very much was fighting a surging in popularity Communist Party precisely because they were arguing for social benefits that Bismarck for the most part ended up enacting. The Social Democrat Party in modern Germany may indeed be a descendent of the old Communists, but in the 1840s the Communists labeled themselves as such. Germany is a hybrid strong Chancellor/Westminster system, so there are still lots of individual parties both now and then.

  54. 54
    Baud says:

    @Yatsuno:

    but in the 1840s the Communists labeled themselves as such.

    When was Marx writing? I thought it was later?

  55. 55
    Omnes Omnibus says:

    @Baud: The Communist Manifesto was published in 1848.

  56. 56
    Baud says:

    @Omnes Omnibus:

    Thanks. Earlier than I had realized.

  57. 57
    fuckwit says:

    @Baud: @Omnes Omnibus: Interestingly, I remember reading that Marx was embarassed at that little broadsheet pamphlet he wrote for a friend. He liked writing intellectual books, in-depth (i.e. Das Kapital) with analysis, and didn’t like writing superficial screaming political bombast. The Manifesto, however, was just that, a manifesto, and he apologized for it for the rest of his life.

    If that’s true, it reminds me kind of like a band that makes many albums of deep, serious music, and gets famous for that one huge hit they made the time where they just got really stoned and threw together something silly and superficial and derivative.

    It was trendy. 1848 was The Year of Revolutions all over Europe. Monarchies were getting overthrown all over the place. The time was right for the manifesto.

  58. 58
    Mnemosyne says:

    @Fair Economist:

    It probably will be solved, but not until a great deal of childish whining and foot-dragging about how hhhhaaaarrrrrddddd it all is happens. From what I’ve heard, if you have a group of users who don’t want the change you’re proposing, it’s going to take much longer to accomplish the change than if you have people who are on board with it.

  59. 59
    GHayduke (formerly lojasmo) says:

    @LanceThruster:

    Sort of already there, ad Yutsano has pointed out. Medicaid eligibility is assumed when anybody visits the hospital as of J1 (IIRC)

  60. 60
    fuckwit says:

    @Yatsuno: THE INVISIBLE HAND IS JERKING ME OFF! And that really should be a tag.

  61. 61
    fuckwit says:

    @Mnemosyne: Yep, that fact-on-the-ground is what caused me to become less shrill in 2009 and accept my insurance corporation overlords, and pull back from the Firebaggers and become an ACA supporter. However, I would have liked a public option. REALLY liked one, like… lowering Medicare age to like, having no age limit. We’ll get there. One step at a time. I’m on board with the liberal agenda.

  62. 62
    Yatsuno says:

    :@fuckwit: It took everything I had to not laugh my ass off at that. Bravo good sir!

    @GHayduke (formerly lojasmo): I don’t think people realise how sneaky presumptive eligibility really is. Medicaid will pay the bill and sign you up until another eligible option is found. And then you’re signed up one way or another. I imagine quite a few folks who are resistors aregonna find themselves ggetting their medical bills paid for and decide it wasn’t worth the fight.

  63. 63
    Mnemosyne says:

    @fuckwit:

    ACA is basically designed to make it unprofitable to insure everyday health care. As that happens, companies will either go non-profit (or create non-profit arms) or get out of the health insurance business.

    What really needs to be tackled next is providers and how much they (over)charge.

  64. 64
    EriktheRed says:

    @Baud:

    No.

  65. 65
  66. 66
    EriktheRed says:

    @MomSense:

    What did Bismark figure out?

    (sorry, but I’m lazy)

  67. 67
    EriktheRed says:

    @EriktheRed:

    Ok, replying to my lazy self:

    Erik, read more of the comments before you ask questions. That way you’d know Bismark started Germany’s national healthcare system.

  68. 68
    Joel says:

    @Steve Crickmore: Horse-trading and policy concessions are part and parcel of democratic (small d) politics. You don’t just get to wish for a best of all worlds scenario. The ACA represents a much better situation than the previously established alternative.

  69. 69
    LAC says:

    @Ash Can: his agenda would be continued snuggle time with his doom and gloom wife, nytimes vocal fry expert Anne lowery.

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