Heeeeeeere's Obamacare!

[Unabogie]

Better is a rather subjective word, especially when you include the cost of something along with that something. I suppose Obama would think that a Ferrari is better than my Honda CR-V, but I don't think so if I have to buy it and maintain it myself. It's also not too useful for driving the kids' carpool in the snow.

By the way, your 1% number is a few percentage points low. And that's before the mess which will ensue if and when Obama lets the employer mandate kick in (as he was legally required to do this year).

Sorry, but that's silly. A better plan is a plan that covers more of your costs when you get sick. For instance, I got a "better" plan which went from a $2500 deductible to a $500 deductible, covers much more of expenses, and costs slightly less than I was paying before the ACA. That's "better" under any criteria.

And we've already discussed where the 1% number comes from. If you have other numbers, read this thread and post your own.

http://www.motherjones.com/kevin-dr...hock-probably-affects-about-1-percent-country

So that means about 1.3 million people had their policies canceled and had to pay full freight for a new policy. Since the error bars on this estimate are fairly large, that comes out to somewhere in the neighborhood of 1-2 million people. In other words, less than 1 percent of the country, mostly made up of people with incomes that are higher than average.

 

[sunmaster14]

And this is why the discussion isn't going anywhere.

The discussion isn't going anywhere? It's going down, at least in my browser. I don't really expect to change anybody's mind here. There's too much partisanship and intellectual lock-in. I could be persuaded on some points I think, but I doubt you'll believe that.

Most of us seem to be of the opinion that the Republican lies on this topic have been worse, because of their magnitude and distance from accuracy. You say that Republicans are not lying at all, because they honestly believe they will be called before a panel, where they will have to justify their productivity level in order to receive healthcare.

Well, I think the slippery slope argument in general is a reasonable one, and it is a much greater concern on the right than the left because the right distrusts government so much more. The same dynamic exists with gun rights (with which I agree) and the war on drugs (with which I don't). I think the left has embraced slippery slope arguments from time to time, although I can't actually think of a good example off the top of my head (right to privacy perhaps?).

<snip>

I will point out that your defense of death panels makes little sense. Medicare predates the ACA. If the existence of Medicare necessitated the creation of death panels, where are they? And what does that have to do with the ACA?

You're right. Medicare didn't have "death panels," which is why the program costs have been spiraling out of control. There is bipartisan agreement that something had to be done to rein in those costs, and the Democrats have decided that that something is the "death panel." Good for them for at least trying. My preference would have been to slowly raise the retirement age and phase out benefits for wealthier seniors, but at least something is happening to address it. Of course, many Republicans are demagoguing the issue for partisan reasons, but is that really lying? The Democrats would have done the same, and I think you know it.

 

[TheSapient]

You're right. Medicare didn't have "death panels," which is why the program costs have been spiraling out of control. There is bipartisan agreement that something had to be done to rein in those costs, and the Democrats have decided that that something is the "death panel." Good for them for at least trying. My preference would have been to slowly raise the retirement age and phase out benefits for wealthier seniors, but at least something is happening to address it. Of course, many Republicans are demagoguing the issue for partisan reasons, but is that really lying? The Democrats would have done the same, and I think you know it.

This is really quite the load of nonsense. Your evidence for the existence of death panels is your belief that Medicare can't exist without death panels. When it is pointed out that Medicare existed for a long time before the ACA, you see that as further evidence that the Democrats created death panels.

Seriously, the IPAB doesn't decide who can get health care. It recommends changes to Medicare payments. Just as you just did. If you honestly believe that IAPB is a "death panel", you must also believe you are a murderer.

 

[sunmaster14]

This is really quite the load of nonsense. Your evidence for the existence of death panels is your belief that Medicare can't exist without death panels. When it is pointed out that Medicare existed for a long time before the ACA, you see that as further evidence that the Democrats created death panels.

Seriously, the IPAB doesn't decide who can get health care. It recommends changes to Medicare payments. Just as you just did. If you honestly believe that IAPB is a "death panel", you must also believe you are a murderer.

I used scare quotes around "death panel" specifically because I don't actually consider it a death panel. But it will ration care, which for old people and very sick people will mean shorter life expectancies than otherwise. I would not call this murder.

 

[johnny karate]

The discussion isn't going anywhere? It's going down, at least in my browser. I don't really expect to change anybody's mind here. There's too much partisanship and intellectual lock-in.

Yes, if only we could get everyone on board with the totally reasonable and not at all partisan belief that only Democrats lie.

By the way, did you post your evidence that Obama lied yet?

Because I must have missed it.

 

[TheSapient]

I used scare quotes around "death panel" specifically because I don't actually consider it a death panel. But it will ration care, which for old people and very sick people will mean shorter life expectancies than otherwise. I would not call this murder.

The ACA specifically forbids the IPAB from rationing or otherwise restricting Medicare benefits.

Maybe you are right. Maybe Republicans really do believe that Medicare can't exist without death panels, despite the fact that it always has. Maybe they really do believe that a committee that can't ration medicare, the one program they can make recommendations for, is actually rationing health care for everyone.

Maybe we give Republicans far too much credit when call them liars.

 

[sunmaster14]

The ACA specifically forbids the IPAB from rationing or otherwise restricting Medicare benefits.

Here's what one knowledgeable doctor wrote about the IPAB last year (unfortunately, it's behind a paywall):

One major problem is the so-called Independent Payment Advisory Board. The IPAB is essentially a health-care rationing body. By setting doctor reimbursement rates for Medicare and determining which procedures and drugs will be covered and at what price, the IPAB will be able to stop certain treatments its members do not favor by simply setting rates to levels where no doctor or hospital will perform them.

 

[Unabogie]

Here's what one knowledgeable doctor wrote about the IPAB last year (unfortunately, it's behind a paywall):

Since I can't get through the paywall, I googled the quote to see if there were more context to that quote. Unfortunately, every link I found were to extremist sites like Townhall and Breitbart. I'd love to see more of what Dean said, since I doubt he'd agree that this makes the IPAB a "death panel".

But indeed, there's a good deal of pushback against Dean for what he wrote, since he seems to acquired a conflict of interest here:

http://swampland.time.com/2013/07/30/howard-dean-defends-his-work-for-lobbying-firm-after-backlash/

Indeed, Dean’s work for McKenna, Long and Aldridge (MLA) has cast a long shadow over his public health care views—especially when they seem to run counter to his previous public stances. Dean was a huge supporter of health care reform’s ill-fated “public option,” a government-run insurance plan that would have competed with private insurers and which was beloved by liberals. IPAB, which Dean wrote in his Journal op-ed should be eliminated, is another Obamacare provision favored by liberals. The board would be charged with keeping Medicare spending growth within certain parameters, tied to inflation. If Medicare spending grows too fast, IPAB will be empowered to reduce Medicare reimbursements to physicians.

Dean says IPAB is a “rate-setting” board that would ration care by reducing Medicare physician reimbursements so drastically certain medical services would no longer be available. “If you had to go see a physician and make some complicated decisions about a serious illness, would you want a board in Washington making the decisions about what you could have and couldn’t or would you rather have your physician making those decisions?” asks Dean.

One of the most powerful interest groups vehemently opposed to IPAB is the American Medical Association. Asked if he wrote his Journal op-ed on behalf of the AMA or MLA clients, Dean said, “To the best of my knowledge the AMA is not a client of our firm. “ (MLA did not return a request for comment about its client list.) Deans says he is paid a flat annual fee by MLA for “giving political advice to whoever wants it.”

And does MLA have clients who dislike IPAB? “I’m sure we do,” says Dean. “What annoys me is that everything you say comes down to who’s paying you to say it. You can talk like that if you want to but I don’t think it helps the general discussion. We ought to argue on the merits.”

 

[TheSapient]

Here's what one knowledgeable doctor wrote about the IPAB last year (unfortunately, it's behind a paywall):

Medicare has always had price controls. So does every insurance policy. So does every person's limited wealth. Health care itself is non-infinite, and of that non-infinite resource, individuals only get a fraction. If we are now going to a definition of "rationing" that is so broad as to lose all meaning, at least be consistent about it. If the IPAB is a death panel, then it is just one of millions that have been death paneling for your entire life.

Hell, every time you access the health care system, you lesson other people's ability to do the same. You, yourself are rationing health care.

But we are far down the rabbit hole. Killing non-productive disabled children is just honest hyperbole for describing committees who kill off people for other reasons, which is just honest demagoguery for the fact that Medicare can't exist without government rationing, which is just a truthful exaggeration of Obamacare's new Medicare board, which, yes, is forbidden from ratinoing health care, but it does deal with prices.

The fact of the matter is that the death panel claims are untrue. And not just vaguely or technically untrue. There is no nuance here. Profound untruths. Now I tend to think most of these people lying. It's sad, but I prefer that thought to the idea they could really be this wrong about anything. But let's disabuse ourselves of the notion that there is any justification for these ideas, be they lies or some sort of politically crazed stupidity.

 

[johnny karate]

Medicare has always had price controls. So does every insurance policy. So does every person's limited wealth. Health care itself is non-infinite, and of that non-infinite resource, individuals only get a fraction. If we are now going to a definition of "rationing" that is so broad as to lose all meaning, at least be consistent about it. If the IPAB is a death panel, then it is just one of millions that have been death paneling for your entire life.

Hell, every time you access the health care system, you lesson other people's ability to do the same. You, yourself are rationing health care.

But we are far down the rabbit hole. Killing non-productive disabled children is just honest hyperbole for describing committees who kill off people for other reasons, which is just honest demagoguery for the fact that Medicare can't exist without government rationing, which is just a truthful exaggeration of Obamacare's new Medicare board, which, yes, is forbidden from ratinoing health care, but it does deal with prices.

The fact of the matter is that the death panel claims are untrue. And not just vaguely or technically untrue. There is no nuance here. Profound untruths. Now I tend to think most of these people lying. It's sad, but I prefer that thought to the idea they could really be this wrong about anything. But let's disabuse ourselves of the notion that there is any justification for these ideas, be they lies or some sort of politically crazed stupidity.

Great post.

 

[sunmaster14]

Since I can't get through the paywall, I googled the quote to see if there were more context to that quote. Unfortunately, every link I found were to extremist sites like Townhall and Breitbart. I'd love to see more of what Dean said, since I doubt he'd agree that this makes the IPAB a "death panel".

Old articles are usually accessible through the Google cache. Try googling "howard dean ipab wsj" and on the first link look for the little down arrow to the right of the link. Clicking on that arrow brings up a menu where you can click on "cached".

But indeed, there's a good deal of pushback against Dean for what he wrote, since he seems to acquired a conflict of interest here:

http://swampland.time.com/2013/07/30/howard-dean-defends-his-work-for-lobbying-firm-after-backlash/

Well, I'm certainly not going to vouch for Howard Dean's credibility, but he nicely articulates the fundamental truth that cost control is a euphemism for rationing.

 

[sunmaster14]

Sorry, but that's silly. A better plan is a plan that covers more of your costs when you get sick. For instance, I got a "better" plan which went from a $2500 deductible to a $500 deductible, covers much more of expenses, and costs slightly less than I was paying before the ACA. That's "better" under any criteria.

Your plan sounds objectively better, so I guess you're one of the "winners." But other people "lost" even though they moved from what you call a crappy plan to a more comprehensive plan.

And we've already discussed where the 1% number comes from. If you have other numbers, read this thread and post your own.

http://www.motherjones.com/kevin-dr...hock-probably-affects-about-1-percent-country

Skepticism is warranted for two reasons. First, the poll on which that is based had a 5% response rate, which is extraordinarily low. Second, the poll results indicate that there were roughly 2.6MM cancellations even though the media reported (using data directly from health insurers) that cancellations were over 2x that.

Another problem I have with Kevin Drum's 1% number is that it excludes people who are eligible for subsidies, as if that very fact should make one happy with a new plan. There is no analysis of whether the net cost is actually lower, or if the networks in the new plan are more restricted so that these people have to find a new doctor or are no longer able to go to the most convenient hospital.

 

[Blue Mountain]

You're right. Medicare didn't have "death panels," which is why the program costs have been spiraling out of control. There is bipartisan agreement that something had to be done to rein in those costs, and the Democrats have decided that that something is the "death panel." Good for them for at least trying. My preference would have been to slowly raise the retirement age and phase out benefits for wealthier seniors, but at least something is happening to address it. Of course, many Republicans are demagoguing the issue for partisan reasons, but is that really lying? The Democrats would have done the same, and I think you know it.

What evidence do you have that the costs have been spiralling out of control? Please try to factor out Medicare Part D, a sugar-daddy clause inserted by the drug lobby that specifically forbids Medicare from negotiating on drug prices.

 

[sunmaster14]

What evidence do you have that the costs have been spiralling out of control?

Actually, I don't believe that Medicare costs are spiraling out of control in the sense that that would imply some sort of financial catastrophe on the horizon. The costs have just risen much faster than predicted, and the program is out of balance. Medicare taxes do not cover Medicare expenditures, as they were designed to do. Furthermore, not only are Medicare's costs covered in part from general tax revenue, but some of Medicare's costs bleed over into the private insurance sector. Medicare is in part subsidized by higher costs for privately insured health care services.

Are Medicare costs, or health care costs generally, some big crisis? Meh, not really in my opinion. It's a growing inefficiency and a growing drag on our standard of living and the quality of health care we could be receiving, but it is offset by economic growth and technological advancement. So, no biggie really. But as long as we're trying to optimize health care policy, we should be implementing free market reforms in my opinion rather than more government price controls.

Please try to factor out Medicare Part D, a sugar-daddy clause inserted by the drug lobby that specifically forbids Medicare from negotiating on drug prices.

Allowing Medicare to negotiate on drug prices would be tantamount to government price setting. That would be a bad idea, in my opinion. You would basically be balancing a few billion dollars per year in shareholder profits against a slowdown in the development of new drugs. Not a balance I trust a government bureaucrat to decide versus the market.

 

[jimbob]

Allowing Medicare to negotiate on drug prices would be tantamount to government price setting. That would be a bad idea, in my opinion. You would basically be balancing a few billion dollars per year in shareholder profits against a slowdown in the development of new drugs. Not a balance I trust a government bureaucrat to decide versus the market.

I love this argument.

Using bulk purchasing power to negotiate volume pricing deals is a staple of industry.

Somehow it is magically bad if governments do this.

 

[Unabogie]

I love this argument.

Using bulk purchasing power to negotiate volume pricing deals is a staple of industry.

Somehow it is magically bad if governments do this.

Gotta love that "fiscal conservatism" in which "runaway debt" is the foremost concern. Sadly, we must snatch food and medicine away from the poor because we're broke. But if you point out that we could save a boatload of money by doing something sensible to increase the purchasing power of our tax dollars, they say "Whoa, fella, let's not get carried away! There's plenty of money to spend on drugs! What, are you trying to cut Medicare? I'm telling Hannity!"

 

[Unabogie]

Your plan sounds objectively better, so I guess you're one of the "winners." But other people "lost" even though they moved from what you call a crappy plan to a more comprehensive plan.

Ah yes, the old "you're one of the winners" argument that conservatives keep making. I'm a winner, and since my plan was community rated, so is everyone else in Oregon who's my age and older, which is, you know, like a million people.

Skepticism is warranted for two reasons. First, the poll on which that is based had a 5% response rate, which is extraordinarily low. Second, the poll results indicate that there were roughly 2.6MM cancellations even though the media reported (using data directly from health insurers) that cancellations were over 2x that.

Another problem I have with Kevin Drum's 1% number is that it excludes people who are eligible for subsidies, as if that very fact should make one happy with a new plan. There is no analysis of whether the net cost is actually lower, or if the networks in the new plan are more restricted so that these people have to find a new doctor or are no longer able to go to the most convenient hospital.

You somehow neglected to explain how a high deductible, catastrophic plan would somehow have a broader network than a real insurance plan. Absent that, we're left with about 1% of the people who wouldn't be getting a much better policy for the same or less. While the people who benefit from the new policies (everyone else who now has access to care) are left out of your equation entirely.

 

[sunmaster14]

I love this argument.

Using bulk purchasing power to negotiate volume pricing deals is a staple of industry.

Somehow it is magically bad if governments do this.

Yes, it is magically bad if the federal government does it. The federal government would automatically have monopsony power and therefore be setting prices. It would be no more a negotiation than the setting of Medicare reimbursement rates. Now, if you're a proponent of single payer, where government bureaucrats frantically try to balance supply and demand in a market encompassing hundreds of millions of people, tens of billions of individual decisions and $2.5T of transactions per year, by tinkering with their spreadsheets while at the same time fending off political pressure from their elected and lobbied bosses, then you'll think that's all well and good. I am a proponent of a more free market approach, which the Medicare Part D program makes some effort to be.

 

[sunmaster14]

<snip>

You somehow neglected to explain how a high deductible, catastrophic plan would somehow have a broader network than a real insurance plan.

I don't know what these people had and neither do you. Even if the network wasn't broader by some objective measure, it still could have been different. Some of these people may still have been forced to switch doctors. But, hey, maybe their new doctor is even better.

Absent that, we're left with about 1% of the people who wouldn't be getting a much better policy for the same or less. While the people who benefit from the new policies (everyone else who now has access to care) are left out of your equation entirely.

I'm not leaving the beneficiaries of Obamacare out of the equation. If Obama had said "some of you are going to have to accept some changes to your health care so that we can get these other people some insurance, but I think it's going to be worth it" then that would be fine. But he really couldn't say that because it wouldn't fly politically. For obvious reasons, it is quite difficult to disrupt fundamentally a system with which 85% of the people are satisfied. At least it is without lying.

 

[sunmaster14]

Gotta love that "fiscal conservatism" in which "runaway debt" is the foremost concern.

I'm not concerned about the debt or the deficit, per se. As Darth Vader once said "No, I am your father." Um, wait, that's not it. I meant "Reagan proved deficits don't matter." I agree with that, roughly.

What matters is how real resources are allocated within the economy, and the less of the economy that's under the control of the government, the better.