Four is more than three

I know this is almost nutpicking, but the Wall Street Journal editorial page either can’t do basic subtraction or is suffering from amnesia:

The health-care law was generated by an administration promoting government as the solution to inequality, yet the greatest irony of ObamaCare is what will undoubtedly follow as a long-term, unintended consequence of the law: a decidedly unequal, two-tiered health system. One will be for the poor and middle class, and a separate system will be for those with the money or power to circumvent ObamaCare.

With the Affordable Care Act, the government has dramatically expanded its authority as final arbiter over health insurance and consequently over access to medical care. After the law’s Medicaid expansion and with the population aging into Medicare eligibility, the 107 million under Medicaid or Medicare in 2013 will skyrocket to 135 million five years later, growing far faster than the ranks of the privately insured.

Besides the fact that I love how he elides the aging of the population into Medicare as a bad thing, the thing I love about this excerpt is the assumption that the United States had a one tier system of healthcare pre-Obamacare. 

Bullshit. 

We had a four tier system with some caveats and carveouts in 2009.  We are moving towards a three tier system with some caveats and carve-outs under Obamacare.

In 2009 and 2014, the first tier was the tier for the rich and very well insured.  Senator Ted Cruz’s $40,000/year family policy that his wife is the primary contract holder for is an example of this tier.  He can go to whatever provider he wants without worry, and his wait times will be minimal.  If he blows out his elbow while pulling his head out of his ass, the distinguished Senator from Texas can go to Dr. James Andrew, the Tommy John specialist for a repair.  If his kids get cancer, they can go to whatever clinic they want to in the United States and get top line treatments that cost more than my family’s annual income for an extra three or four months of life.  This type of insurance is fundamentally the same between 2009 and 2014.  The big difference is that some of the premiums will be taxed in the near future due to Obamacare instead of being entirely tax free.

The second tier of 2009 coverage was solid employer provided group insurance and solid individual coverage.  It was possible to have solid individual coverage, you just had to be lucky.  This tier of coverage has some limitations, it has some deductibles and co-insurance and it is the most common tier of coverage.  Employer provided insurance also has massive explicit (employer provider) and implicit (tax advantages) subsidies.  In 2009, this tier was a shrinking share of coverage even as it is the dominant share of coverage for people under 65.  Now the Exchanges and the threat of the employer mandate is growing this tier of solid, private market coverage.

The third tier in 2009 was government insurance provided through a variety of programs. The big programs are Medicare, Medicaid, CHIP and the VA.  Medicaid was income, asset, and “deserving” poor status limited.  Working adults without insurance and low incomes were out of luck in most states for Medicaid. CHIP had expanded but was not all inclusive for all kids.  Medicare and VA were functioning reasonably well. 

Now, Medicaid in half the states is neither asset nor “deserving” poor status dependent; it is just income dependent.  CHIP was expanded in the winter of 2009.  VA has not been significantly altered.  Medicare’s drug benefit has been enhanced, and Obamacare is equalizing the risk adjusted payment rates for traditional fee for service Medicare and Medicare Advantage as well as engaging in massive experimentation on new payment models.

The fourth tier in 2009 was the “You’re on your own” tier.  This was for people who either had no insurance or had insurance that was so skimpy it could not protect people from financial ruin from a moderate size medical event much less a major medical problem. 

The fourth tier is being phased out in half the states.  The long run goal is for most of the people in this tier to move to either the third tier via Medicaid or CHIP or the second tier by enabling community rated non-medically underwritten policies to be sold on the Exchanges. The first tier will shrink due to the Cadillac excise tax, and the fourth tier is larger than it should be due to the sadists on the Supreme Court and sociopaths in the Republican Party, but the long term goal and program design is to move towards a three tier instead of four tier system. 

 

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47 replies
  1. 1
    Villago Delenda Est says:

    WSJ editorial board:: vile mouthpieces of the parasite overclass who need tumbrel rides ASAP.

  2. 2
    SiubhanDuinne says:

    If he blows out his elbow while pulling his head out of his ass

    Full of win.

  3. 3
    Cyan says:

    …the thing I love about this excerpt is the assumption that the United States had a one tier system of healthcare pre-Obamacare

    But it was one-tier! …in the sense that “The law, in its majestic equality, forbids the rich as well as the poor to sleep under bridges, to beg in the streets, and to steal bread.”

  4. 4
    MomSense says:

    Life in the fourth tier sucks. Life is so much better in the second tier which had become unobtainable for me and my family before ObamaCare.

    So suck it WSJ editorial page deatheaters.

  5. 5
    Baud says:

    One will be for the poor and middle class, and a separate system will be for those with the money or power to circumvent ObamaCare.

    The bolded part is the part they hate.

  6. 6
    japa21 says:

    Definitely not nutpicking, Richard, or did you mean nitpicking.

    Besides the obvious errors (probably deliberately made) there is one other aspect of the article that is deliberately meant to incite.

    “The health-care law was generated by an administration promoting government as the solution to inequality…”

    For the WSJ class the term “inequality” is very emotionally laden and the unspoke word “income” or “wealth” is definitely implied.

    The whole premise is that the Obama administration is trying to use government to force equality, which of course is stupid, but it reinforces the belief among the 1% that Obama is coming for your money, just like the NRA reinforces the equally nonsensical belief that the Obama adminsitration is coming for your guns.

  7. 7
    different-church-lady says:

    I know this is almost nutpicking, but the Wall Street Journal editorial page either can’t do basic subtraction or is suffering from amnesia is flat-out bullshitting, and they know it.

    Nobody could have possibly written that “two-tier” paragraph without knowing perfectly well they were full of shit.

  8. 8
    Belafon says:

    So, basically, we’ll end up with the kind of health care system that most of the rest of the industrialized world has. Basic care for everyone, but you can buy additional if you can afford it.

  9. 9
    gussie says:

    I’m a writer. Last year, I made about $5,000. The cost of my ACA coverage for my family of three was $17/month.

    This year, I’m on track to make $100,000. (Ah, the life of a writer.) So I just called to update my ACA information.

    I’m now paying $670/month! $8,000 a year for the same coverage!

    I got all bent out of shape before I remember that next year I’ll be making $5,000 again, and this is exactly how it’s -supposed- to work.

  10. 10
    barry says:

    This same editorial page cheered the Taliban take over Afghanistan in 1995. The more things change, the more they stay the same. In this WSJ is always wrong.

  11. 11
    Lurking Canadian says:

    @Baud: exactly. Nobody can “circumvent Obamacare”. People can buy more than the minimum, but that is not the same thing.

  12. 12
    David Hunt says:

    I know this is almost nutpicking, but the Wall Street Journal editorial page either can’t do basic subtraction or is suffering from amnesia:

    You’ve left out the far more likely explanation that they’re lying douche-bags.

  13. 13
    Mnemosyne (iPad Mini) says:

    @gussie:

    You can also think of it this way — you’re paying a little more this year so another couple of $5K a year writers can get their low-cost insurance. Or is that more competition? ;-)

  14. 14
    pseudonymous in nc says:

    What kind of insurance, perchance, does the WSJ offer its staffers? Somehow I don’t think it’s going to be the “sucks to be sick” plan.

  15. 15

    I’m pretty sure the WSJ editorial board are rich people so out of touch with life in the 99% that they actually think anybody can get good insurance if they work hard enough (which isn’t even all that hard, because they think their easy job is the standard of hard work).

  16. 16
    gussie says:

    @Mnemosyne (iPad Mini): Yeah, that makes it worse! Clearly other writers should suffer. What kind of idiot tries to do this for a living? Dirty moochers.

  17. 17
    humanadverb says:

    That second tier, of employer- (and now exchange-)provided healthcare was definitely shrinking. We’re in that group at my job now: coworkers are canceling their insurance because costs keep going up, and a shitty contract from 2006 means we pay for *all* of the increases. I do hear grumbling because Obamacare doesn’t really do much for us, but that employer mandate that is coming is the only incentive our bosses have to do right by us (unless we strike). …unless you work less than 30 hours a week.

  18. 18
    jl says:

    Thanks for the useful post, and I agree with commenter above that RM is not nutpicking. The myth that the U.S. has the best health care system in the whole wide world for ALL of its citizens is a pernicious one that probably has been a major factor in limiting public support for any kind of health care reform.

    It has been infuriating to see people comb through hundreds of health statistics and pick out a few measures, often inappropriate ones, that show that the U.S. is totally number one, and parade them around to mislead people.

    Also, interesting to note that the WSJ editorial page has discovered at this late date, that the Heritage Foundation twenty years ago was a nest or reds who pumped out commie economic reform plans to expand the government.

  19. 19
    some guy says:

    @barry:
    Remind us again which North American intelligence and military agencies made a Taliban victory possible, if not inevitable?

  20. 20
    JPL says:

    The WSJ needs to be sold at the grocer checkout, right next to that fine publication, National Enquirer.

  21. 21
    jl says:

    Looks like GOP House staff is admitting that their survey on ACA premium payment rates was methodologically flawed, and not worth much. And their other efforts at ACA debunkery are not producing much dirt. I see another story on TPM that Boehner is setting up a special committee on B * G * ZZZI !!!. So, I guess the Senate GOP leadership knows when to cut its losses.

    GOP Went Fishing For Bad Obamacare News And Came Up Empty
    TPM

    and

    #busted
    TPM
    http://talkingpointsmemo.com/e.....gus-survey

  22. 22
    Ruckus says:

    @JPL:
    Put the WSJ next to the Enquirer? Won’t that diminish the standing of the Enquirer? By a substantial margin I should add.

  23. 23
    Cacti says:

    Republicans everywhere shed angry tears that Obamacare enrollment numbers have hit 17.8 million.

    Includes: Exchange enrollments, Medicaid and CHIP expansion, and young adults on their parents’ policies under extended age eligibility.

    If so many red states weren’t having a tantrum over Medicaid, it would probably be closer to 20 million.

  24. 24
    Trollhattan says:

    @gussie:

    Suggest you get a whiplash rider. Also, too, congrats on your 2014.

  25. 25
    Higgs Boson's Mate says:

    If he blows out his elbow while pulling his head out of his ass…

    It would take a team of draft horses.

  26. 26
    NorthLeft12 says:

    I think the worst part about the WSJ Op Ed is how many people will be nodding in agreement and in a few years those same people will reminisce about how great things were under Dubya.

    You know, even up here in Canada we have a two tier system. The rich fly/drive down to the US and pay their way through your system. The rest of us work with the system we have. I have no problem with that.

  27. 27
    NorthLeft12 says:

    I think the worst part about the WSJ Op Ed is how many people will be nodding in agreement and in a few years those same people will reminisce about how great things were under Dubya.

    You know, even up here in Canada we have a two tier system. The rich fly/drive down to the US and pay their way through your system. The rest of us work with the system we have. I have no problem with that.

  28. 28
    Roger Moore says:

    I know this is almost nutpicking, but the Wall Street Journal editorial page either can’t do basic subtraction or is suffering from amnesia:

    1) Quoting something on the WSJ editorial page isn’t even close to nutpicking.

    2) This isn’t a failure of math or memory. It’s outright propaganda and a fine example of “The Big Lie” at work.

  29. 29
    different-church-lady says:

    @jl:

    B * G * ZZZI !!!

    What is the sound of the GOP scandal machine short-circuiting?

    The Wile E. Coyote Method for $600, Alex.

  30. 30
    Roger Moore says:

    @jl:

    Also, interesting to note that the WSJ editorial page has discovered at this late date, that the Heritage Foundation twenty years ago was a nest or reds who pumped out commie economic reform plans to expand the government.

    This isn’t really true. The Heritage Foundation twenty years ago was full of upstanding Conservatives who put out a sham proposal intended to provide talking points about why Clinton’s healthcare proposal shouldn’t be implemented. They never seriously intended for any kind of healthcare reform to be implemented, which is why they opposed what was substantially their own proposal when it was put forward as PPACA. If you deny True Conservative® status to anyone who made a sham proposal as an excuse for not supporting whatever the Democrats want, only to see the Democrats adopt it in the hopes of getting their votes, there wouldn’t be any True Conservatives® left.

  31. 31
    different-church-lady says:

    @Roger Moore:

    1) Quoting something on the WSJ editorial page isn’t even close to nutpicking.

    Correct — it’s not a nut, it’s an entire tree.

  32. 32
    gussie says:

    @Trollhattan: Is that actually a thing? A quick search leaves me flummoxed!

    And thanks. Been a while since I had a good year.

  33. 33
    jl says:

    @jl: Sorry. Don’t know how I got Boehner running the Senate GOP. Probably because it would not make any difference. Anyway, meant House GOP.

  34. 34
    jl says:

    @Roger Moore: Well, the sausage, it gets made.

  35. 35
    Roger Moore says:

    @different-church-lady:

    Correct — it’s not a nut, it’s an entire tree.

    Nutpicking, per the Lexicon, means “Trolling obscure internet comments to prove that an opinion is widely held, thus proving the reverse.” The editorial page of a major daily newspaper is the diametric opposite of “obscure internet comments”; you don’t get more establishment than that.

  36. 36
    Shirt says:

    Two tier is OK. 100% of doctors cannot only have 1%ers as patients.

    I once complained to my sister about the huge waste of talent occur when plastic surgeons waste it on oldster face lifts. This was in reference to an amazing work of multiple surgeries her employer had done restoring the face of a girl whose lower lip was bitten off by a horse.

    Her response: “How do you think he got so talented?” It’s a consideration but by no means the only one.

  37. 37
    Roger Moore says:

    @Shirt:

    Two tier is OK. 100% of doctors cannot only have 1%ers as patients.

    Why not? I don’t think the 1%ers would care that much about the rest of us having no care at all. In any case, that would still be a two-tier system; it’s just that the 99% tier would be “sucks to be you” instead of having access to care.

  38. 38
    Mnemosyne says:

    @Roger Moore:

    Why not?

    Not enough 1%ers to go around.

  39. 39
    Gene108 says:

    @barry:

    The Taliban, in 1995, even w/ Pakistani backing seemed like the best chance to end the civil war that erupted between various mujahideen leaders, after the USSR pulled out.

    Pakistan could have ended its refugee crisis from the Afghan-USSR war by having a stable western neighbor.

    The fact the Taliban turned out to be a bunch of thugs and Pakistan used Afghanistan to escalate its proxy war with India was not a foregone conclusion.

  40. 40
    Epicurus says:

    @Roger Moore: And we have a winner! What’s the old line about it being difficult to convince a man of something if he’s being paid to believe the exact opposite? Q.E.D. The WSJ editorial page has been a right-wing sewer for years. And, believe it or not, the NY Post was a more liberal paper before Rupert sank his claws into it. Those were the days, my friend, we thought they’d never end….

  41. 41

    […] I don’t know how much refutation is necessary for an argument this self-refuting, but Richard Mayhew does the job. […]

  42. 42
    danielx says:

    If he blows out his elbow while pulling his head out of his ass, the distinguished Senator from Texas….

    Today’s win on the internets….

    @SiubhanDuinne:

    This has been another edition of GMTA.

  43. 43
    Anna in PDX says:

    Richard I am a really loyal reader of your healthcare posts, and want to commend you on your obvious success in fitting in at Balloon Juice. Your posts have gotten increasingly testy in this past couple of months!

  44. 44
    Anna in PDX says:

    @Gene108: Well it was, if you were following this issue in the 90s from the point of view of the female half of humanity. I remember this time all too well.

  45. 45
    pablo says:

    The WSJ editorial page has been a piece of shiet for decades, but the front page main article today, like at least 10 front pages in the past 6 months has been making mountains out of the ACA molehill problems.
    This is the NEW WSJ showing the Murdoch brand. It used to be a fact that the editorial page was in the right wing gutter, but the news pages were straight journalism.
    Now we can say that its officially The Fox Street Journal!

  46. 46
    mattH says:

    That dislocation line was the absolute polish on my crappy day

  47. 47
    Steve J. says:

    I’d say there were 5 tiers with the top one being composed of those who have enough wealth to pay cash.

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