Krugman weighs in with Reform or Else.

Originally Posted by Bob Butler 54

Krugman weighs in with Reform or Else.

Intendedly or not, Krugman casts the entire health-care debate as a zero-sum game based on age: To cut benefits to the old so we can cover the young, or not.

He also, almost certainly unintendedly, highlights the continued political power of the generation - indeed, generations - moving beyond elderhood: The Silent and even the G.I. remnant, who are not only far more numerous than the Progressives/Gilded remnant were at this point in the last saeculum, etc., but vote way out of proportion to their numbers.

Of course this dynamic is also driving "culture war" issues like gay marriage, the role of Christianity (and by extension, all religion) in American life, etc., as I have already pointed out - and if the left doesn't wake up to this reality, they are going to blow it, and the return to a paradigm of linear time - the subject of a thread I've just started in "The Book and Theories Of History" forum - could very well be the price that they, and all of us, will pay.

Action from Aetna.

Originally Posted by Sam Stein

Health insurance giant Aetna is planning to force up to 650,000 clients to drop their coverage next year as it seeks to raise additional revenue to meet profit expectations...

..."The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering," said chairman and CEO Ron Williams. "We view 2010 as a repositioning year, a year that does not fully reflect the earnings potential of our business. Our pricing actions should have a noticeable effect beginning in the first quarter of 2010, with additional financial impact realized during the remaining three quarters of the year."

Aetna's decision to downsize the number of clients in favor of higher premiums is, as one industry analyst told American Medical News, a "pretty candid" admission. It also reflects the major concerns offered by health care reform proponents and supporters of a public option for insurance coverage, who insist that the private health insurance industry is too consumed with the bottom line. A government-run plan would operate solely off its members' premiums.

So they made a profit off of these people, just not a high enough of one to meet Wall Street expectations.
The passing 3T has been about the commoditization of the American consumer. The mythical middle American has just about been financially sliced and diced every which way possible. I don't know if healthcare will breakdown the system, or another stock market crash, or a sudden unexpected resource shortage or if it will be something else. But this 4T is largely going to be about sustainability and sustainability is a bad word on Wall Street. We have a long way to go in the next 15-20 years.

So much of this reminds me of the debate about regulating public utilities a century ago. That took a while also to take hold. We forget now that one of the burning issues of the first quarter of the previous century was regulation of utilities and the rates they could charge and the way they could operate. In the end, it was decided in the favor of the public interest over the unlimited profits of the private corporation.

I would expect that, sooner or later, the issue of health insurance and health care will go much the same way.

Originally Posted by haymarket martyr

So much of this reminds me of the debate about regulating public utilities a century ago. That took a while also to take hold. We forget now that one of the burning issues of the first quarter of the previous century was regulation of utilities and the rates they could charge and the way they could operate. In the end, it was decided in the favor of the public interest over the unlimited profits of the private corporation.

I would expect that, sooner or later, the issue of health insurance and health care will go much the same way.

I too see the concept of public utilities as an evolving one. In the days before Edison, Tesla and Bell, the only public utilities were the postal service, village greens and communial water sources.
After about the year 1900 life expectancy gradually increased from about 45 to nearly 80 today partly as a result of public utilities. I recall reading about how the life expectancy of women in appalachia increased by about ten years after the TVA made it possible to eliminate a lot of the drudge work such as ironing and laundry that was almost literally a backbreaking chore before electrical appliancies came along.
Today medical advances are making possible a longer quality of life for those who can get them. Why should we choose policies that limit who can be productive and contribute their creativity and life experiences to only those who meet a corporate profitability profile?

Senate Dems: Deal near to drop public option

WASHINGTON - After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a government-run insurance option from sweeping health care legislation

The Medicare age is being dropped to 55 however, so at least the boomers still get theirs

(and the Dems can count on their continued suport)

Well that's lovely. Free medical for the richest segment of society, monthly insurance bills for the rest of us, and no help for the poor as the medicaid expansion has been cut out as well. This is your government; of, by, and for the rich. Way to go, Selloutcrats.

No, but I'm sure we'll get some fantastic rationalizations by the morning.

Originally Posted by independent

The Medicare age is being dropped to 55 however, so at least the boomers still get theirs

(and the Dems can count on their continued suport)

Wait for it , wait for It....I told you so.

In the deal between Liberals and Moderates, it appears a tentative deal where private insurance that is administered by the Federal Agency for Employee Health benefits to allow ordinary Americans (Yes, you and me) to purchase. Damn I am good for calling that one.

Ah, all these crocodile tears for the public option - truly amazing.

Reminds me of the teabaggers' "No socialized medicine and hands off my Medicare!"

Or, the Repugs' "I'll fight to protect your Medicare!"

Gee, in six years (maybe only 3-4 after the law gets implemented) the first Xers will be 55 and eligible for the FULL ride - but let's not mention that and spoil the fun. Its those selfish Boomers again! All of them, not just the conservative ones we Xers keep reliably returning to office every election - no, no, that would be just taking too much responsibility for our lives so terribly scared by all that slam dancing that our parents made us do back in the mean old 80s.

Jeez, I thought you'd at least try to justify this corporate money-grab on its own "merits" but I guess its easier to blame the fairly irrelevant minority party!

I figure 2/3 of Americans are covered under their employer's plans and never have to actually deal with the costs themselves. A majority of them probably don't have much need for medical services outside of regular checkups, and so they're probably pretty happy with what they've got.

When this bill forces a bunch of small business employees, sole proprietors, and independent contracts to buy individual plans without the bulk discounts, it will probably actually help flatten the costs for people who are already covered. (By flatten, I mean slow down the rate of increase from like 10% / yr to 8%)

So yeah, who cares about the huge private insurance overhead? Who cares that we spend more for a lower quality product? Who cares that the private insurance model puts a profit incentive on symptom management over cures? Let's just get everyone on board at the threat of penalty and blame the Republicans if anyone complains!

Tell me, pw,

have you dropped trou for them already, or are you going to wait until they actually start to bend you over to loosen your belt for them?

you seem so eager for the insurance companies to get their big pay-off, after all...

Originally Posted by Justin '77

Tell me, pw,

have you dropped trou for them already, or are you going to wait until they actually start to bend you over to loosen your belt for them?

you seem so eager for the insurance companies to get their big pay-off, after all...

What I'm interested in is moving towards affordable health care for all my countrymen. I see the current bill getting through as just a start, but absolutely necessary to lay the foundation. On this, I tend to agree more with Ezra Klein's policy pragmatism than Daily Kos progressive politics although I'm sympathetic to the latter's tactical considerations. In agreement with Ezra, I too would be more than happy with a provision in the bill that results in every heatlh insurance CEO running out of gas and getting a flat tire on the way to work and having to freeze his ass off waiting for the tow truck, but I'm willing to forgo that if we can at least get a good start toward my desired objective.

It's a little to easy to blame it on Obama or the filibuster; done so mostly by those who don't pay attention to the actual legislative/politcal process. What is really at the root is that we don't have a healthy and effective voice from the Right. Instead, it has become idiotic and cartoonish as best explained recently from someone from the Right -

http://www.frumforum.com/the-cost-of-no-deal

The Cost of No Deal
Two reports last night of what the GOP’s “No, no, no” policy has wrought:

1) Instead of a healthcare reform to slow cost increases, Democrats in the Senate seem to be converging upon an expansion of Medicare to include age 59-64 year-olds and an expansion in Medicaid up to some higher multiple of the poverty limit. You might wonder why they didn’t do this before: expanding existing programs is always easier than creating new ones. So now instead of a new system that attempts to control costs, we’re just going to have a bigger and more expensive version of the old system, with a few tinkers around the edges. Republicans could have been architects of improvement, instead we made ourselves impotent spectators as things get radically worse. Plus – the bad new Democratic proposal will likely be less unpopular with voters than their more promising earlier proposal. Nice work everybody.

2) House and Senate conferees last night rejected a proposal to deny EPA funds to enforce its new powers over greenhouse gasses. So instead of an economically rational approach to carbon abatement – a carbon tax or even a cap-and-trade system stripped of the abuses and boondoggles attached to it by House Democrats – we’re going to have the least rational approach: bureaucratic enforcement.

The furious rejectionist frenzy of the past 12 months is exacting a terrible price upon Republicans. We’re getting worse and less conservative results out of Washington than we could have negotiated, if we had negotiated.

Further expounded upon by Ezra -
http://voices.washingtonpost.com/ezr...saying_no.html

To paraphrase Omar, if you come at the bill, you'd best not miss. It's one thing to actually kill the legislation. It's a whole other to unsuccessfully oppose it. The result there is a bill that you had no influence on, except to make it more liberal and politically cautious by scaring the majority away from making any hard decisions.

The upside to this strategy may be that you pick up some seats. or maybe you don't, at least as compared with a world in which you acted like a party of grown-ups. Either way, the other party's achievements remain, and you may even be left defending them. As Frum concludes, "even if we gain seats in 2010, the actions of this congressional session will not be reversed. Shrink Medicare after it has expanded? Hey -- we said we’d never do that."

It is possible to wish to hasten the day for the demise of what now passes as the GOP and yet still mourn the loss of thoughtful conservatism.

Now, I need to go check my insurance plan to see if it covers 'bending over.'

Originally Posted by playwrite

What I'm interested in is moving towards affordable health care for all my countrymen. I see the current bill getting through as just a start, but absolutely necessary to lay the foundation. On this, I tend to agree more with Ezra Klein's policy pragmatism...

I don't usually quote myself -- its so Glick-ist -- but I wanted to give an example -

http://voices.washingtonpost.com/ezr...l?hpid=topnews

Meanwhile, the Medicare buy-in lets people in the broader insurance market see what national bargaining power can do for individual premiums. Right now, Medicare's rates are largely hidden, as no one pays the full premiums, and so no one can really compare it to private offerings. But if the premiums become visible, and Medicare's superior bargaining power is capable of offering rates 20 to 30 percent lower than its private competitors can muster, we'll see how long it is before representatives begin getting calls from 50-year-olds who'd like the opportunity to exchange money in return for insurance as good as what 55-year-olds can get.

Those 50 year olds will be Xers looking at the great deal that older Xers and Boomers are getting; lets see what happens. Then there are those Millies moving inot their late 20s and early 30s and have to cover their kids, lets see what they do.

I am rather disturbed of the suggestions I am hearing about ditching the PO and allowing people 55 and older to buy into Medicare. This smacks of a slap in the faces of Xers and Millies.

Didn't S&H say that if the Boomers try to screw over Millennials in this way while giving themselves stuff that the Boomers would get their *sses handed to them?

Originally Posted by Odin

I am rather disturbed of the suggestions I am hearing about ditching the PO and allowing people 55 and older to buy into Medicare. This smacks of a slap in the faces of Xers and Millies.

Didn't S&H say that if the Boomers try to screw over Millennials in this way while giving themselves stuff that the Boomers would get their *sses handed to them?

Stop, put thinking cap on.

Without any change, Boomers have already started entering Medicare as of 2008. With the change, Xers will start to enter 36 months after the new eligibility is established.

With the change, more older people come out of the private insurance pools; since older people generally need more health care, private pools become more healthy and costs should go down. The question is will the savings be past on to the insured?

Under the new program 90% of every dollar of private health premiums HAS to go to actual health care - that, and other regulatory aspects of the new bill, means a high chance that the savings of lower-cost pools will have the private insurers lowering rates relative to what they would have been.

Those going into Medicare before 65 have to pay the premium (whether subsidized or not). For the first time, the premium for Medicare will be plainly visible. Most believe it will be 20 to 30% cheaper than equivalent private insurance. The wingnuts will try to say it is cheaper because the program is subsidized by the government, but that will be a lie. It is subsidized only for those over 65; the premiums from those 55-64 have to pay for the program (individuals may be subsidized based on income levels, but their subsidy can go to either the new Medicare option or to the one of the private insurers). As the cost differential becomes clear, the pressure is going to mount on the private insurers; perhaps much more so that any Public Option the liberal Dems could have put in place. The pressure will mount as well on further opening up eligibility to younger and younger folks. It lays the path for the Millies.

The Medicare approach uses Medicare rates. This deals with the substantially much larger share of the cost of health care - its not the insurers, its the providers. Compare costs in an area where there is only one hospital against one where there are many. Cost/bed is not a continuous linear line, it looks like quantum physics, and depends almost entirely on the degree of competition - or lack of. Huge inefficiencies in non-competitive areas - this approach will begin to change that.


Actually, this thing provides the grounds for much bigger and more fundamental change that the original Public Option. I actually don't see how this can survive once the wingnuts figure all this out.

Originally Posted by playwrite

Stop, put thinking cap on.

Without any change, Boomers have already started entering Medicare as of 2008. With the change, Xers will start to enter 36 months after the new eligibility is established.

With the change, more older people come out of the private insurance pools; since older people generally need more health care, private pools become more healthy and costs should go down. The question is will the savings be past on to the insured?

With only the expensive demographics covered by a government program, insurance profits should be through the roof. How awesome would it be to dump all your expensive customers onto the government while forcing healthy and younger people to buy the for-profit product?

If you don't see who wins here, you're seriously missing the forest.

Under the new program 90% of every dollar of private health premiums HAS to go to actual health care - that, and other regulatory aspects of the new bill, means a high chance that the savings of lower-cost pools will have the private insurers lowering rates relative to what they would have been.

No - this would happen under an Al Franken amendment that hasn't even been voted on or seriously considered. The loophole is even more obvious than most, as well, since they've got mandatory purchases in effect the insurance companies can simply raise the compensation for various procedures until 10% equals an acceptable amount of profitability. What are all the 18-55 year olds going to do, drop coverage so they can pay higher taxes for absolutely nothing in exchange?

Those going into Medicare before 65 have to pay the premium (whether subsidized or not). For the first time, the premium for Medicare will be plainly visible. Most believe it will be 20 to 30% cheaper than equivalent private insurance. The wingnuts will try to say it is cheaper because the program is subsidized by the government, but that will be a lie. It is subsidized only for those over 65; the premiums from those 55-64 have to pay for the program (individuals may be subsidized based on income levels, but their subsidy can go to either the new Medicare option or to the one of the private insurers). As the cost differential becomes clear, the pressure is going to mount on the private insurers; perhaps much more so that any Public Option the liberal Dems could have put in place. The pressure will mount as well on further opening up eligibility to younger and younger folks. It lays the path for the Millies.

The Medicare approach uses Medicare rates. This deals with the substantially much larger share of the cost of health care - its not the insurers, its the providers. Compare costs in an area where there is only one hospital against one where there are many. Cost/bed is not a continuous linear line, it looks like quantum physics, and depends almost entirely on the degree of competition - or lack of. Huge inefficiencies in non-competitive areas - this approach will begin to change that.

So even with a publicly run plan, we're going to keep medicine as a flat or possibly regressive tax.

Actually, this thing provides the grounds for much bigger and more fundamental change that the original Public Option. I actually don't see how this can survive once the wingnuts figure all this out.

Actually, this thing provides more corporate handouts than anything Bush ever came up with. Sure, he wasted trillions of dollars, but he never made a law forcing us all in to Wall Street (think SS privatization).

So yeah, screw the pathetic 'liberals' in Congress who want to 'compromise' with the insane Republicans without gaining a single vote. Screw anyone who expects a penny of mine to go to the private insurance business. I'll see you in court!

For the equivocators that this first ever is OK, try saying this in front of a mirror a few times:


"It is Constitutional for the government to force you to buy something from a for-profit monopoly exempt from anti-trust laws under penalty of fine or incarceration."

Originally Posted by independent

With only the expensive demographics covered by a government program, insurance profits should be through the roof. How awesome would it be to dump all your expensive customers onto the government while forcing healthy and younger people to buy the for-profit product?

If you don't see who wins here, you're seriously missing the forest.



No - this would happen under an Al Franken amendment than hasn't even been voted on or seriously considered.

No Franken is in the Senate bill but, unfortunately, it was made much less restrictive that originally proposed -

http://behavioralhealthcentral.com/i...ster-minn.html

Even so, both of Minnesota's senators are claiming success in getting some of their proposals incorporated into the Senate bill.

Sen. Al Franken managed to get a provision in the bill that would require insurance companies to spend a set portion of their insurance premium dollars on actual health-care services. He had proposed requiring 90 cents of every premium dollar go toward health care. In the end, he reached an agreement for a slightly lower rate -- 80 cents for group insurance plans and 75 cents for individual plans

That's not much better than the current MLRs, but it was put in there as a placeholder, to be improved upon either for a floor amendment in the Senate or in conference with the House.

It was put in the bill that came to the floor for debate and before the recent compromise that jettison the PO and expanded Medicare eligibility. Hopefully, this will get tighten back up to the 90% level in the Senate or in Conference with the House. Latest news is here -

http://tinyurl.com/ykhj342

Note that they got blue dog, Blanche Lincoln, as a co-sponsor.

Some more background here -

http://www.prwatch.org/node/8747

Originally Posted by independent

The loophole is even more obvious than most, as well, since they've got mandatory purchases in effect the insurance companies can simply raise the compensation for various procedures until 10% equals an acceptable amount of profitability. What are all the 18-55 year olds going to do, drop coverage so they can pay higher taxes for absolutely nothing in exchange?

What loophole are you talking about. The 80/75 (hopefully returned to the 90/90) is applied to their total revenue; they can't piecemeal it out.

Originally Posted by independent

So even with a publicly run plan, we're going to keep medicine as a flat or possibly regressive tax.

I don't get this. For those over 65, even teabaggers love Medicare. For the new group (55-64), their premiums are projected to be 20-30% lower than what they could get on the private side - I don't think they'll be complaining particularly the ones who would have otherwise been uninsured. For those under 55 and paying, we may or may not see their premiums go down (relative to what they are currently projected) and there's a host of people that will have insurance that would not otherwise have it, with or without pre-conditions. But, I'll be honest, once this is all it place, I hope they complain big time. As we've seen with teabaggers and Repugs in Congress defend a Medicare bloated on Part D, the expanded group (including an increasing number of Xers) are going to become big defenders as well. The eligibility age will be chipped away and, shhh, don't tell anyone, but we're headed to SP.

Originally Posted by independent

Actually, this thing provides more corporate handouts than anything Bush ever came up with.

Bullshit.

Originally Posted by independent

Sure, he wasted trillions of dollars, but he never made a law forcing us all in to Wall Street (think SS privatization).

There's really two parts to your complaint. One is government making you do something; the other is money going to the insurers. For the latter, I see it as a means to an end, and that end includes the eventual demise of the insurers.

For the former, even if I had never crossed swords with you before, your moniker alone tells me I'm not going to have much headway with convincing you that government hasn't much more to offer than as a thing to drown in the bathtub.

As any good Concord Coalition-sympathizing Xer can inform you, two things about Social Security/Medicare need to be addressed:

First, the age for receiving partial Social Security payments should be going up in concert with the age for receiving full benefits (66 2/3 for those born in 1958, for example), but it isn't. Why isn't it? (In the above example, that would raise the eligibility age for partial benefits for the 1958 cohort to 63 2/3).

Estimated savings = ?

Second, the age for Medicare eligibility should be tied to the age for full SS eligibility, for those born after 1939 or wherever the upward trend starts.

Estimated savings = ?

You could probably fund a Utah-style safety-net program for the uninsured in the entire country on what you save from making these two changes alone.

Originally Posted by playwrite

No Franken is in the Senate bill but, unfortunately, it was made much less restrictive that originally proposed -

The 80/75 (hopefully returned to the 90/90) is applied to their total revenue; they can't piecemeal it out.

80/75 is a joke. What other country tolerates 25% bureaucratic overhead in medicine? What other country mandates people buy a product in a way that only 75% of their cost goes to the actual product?

If you can answer those two, try this one: Why the hell are individual buyers subject to an extra 5% overhead margin? The blatant favoritism we show to big business is part of what's ruining this damn country. "Too big to fail" or even compete on the level the rest of us have to. What ever happened to economies of scale? Why aren't these big groups already enjoying an advantage, why do they need further advantage from the government unless they're acting in a predatory and monopolistic manner?

I don't get this. For those over 65, even teabaggers love Medicare. For the new group (55-64), their premiums are projected to be 20-30% lower than what they could get on the private side - I don't think they'll be complaining particularly the ones who would have otherwise been uninsured. For those under 55 and paying, we may or may not see their premiums go down (relative to what they are currently projected) and there's a host of people that will have insurance that would not otherwise have it, with or without pre-conditions.

Me: Its corporatism/corruption

You: Bullshit.

The point is how they take the expensive patients out of the private pool and force profitable patients in their place. If we're all going to subsidize the expensive patients anyway, why the hell don't we just put everyone on a public plan in the first place? The answer, of course, is the nuance of "political reality," which in this case means we have a lobbyist-written bill that's been through five more lobbyist-written compromises.

There's really two parts to your complaint. One is government making you do something; the other is money going to the insurers. For the latter, I see it as a means to an end, and that end includes the eventual demise of the insurers.

Demise nothing. Let me put this in a way you can understand.

The mayor just signed a law into place saying everyone in town has to buy season tickets to your theater. You are only required to spend 75% of the ticket proceeds on the production of the plays, and you're allowed to charge whatever you want for the tickets so long as the costs are relatively the same for seats in the same section. Front row and center stage tickets have an extra 40% tax added on. Old and poor people will get discounted tickets because the government is paying part of their bill, but you still get the full price for their tickets. Of course, if someone sees "more than a reasonable amount" of shows, you can kick them out.

How much are those tickets going to end up costing and how is that going to put you out of business?

For the former, even if I had never crossed swords with you before, your moniker alone tells me I'm not going to have much headway with convincing you that government hasn't much more to offer than as a thing to drown in the bathtub.

Ain't no bathtub big enough to take down the Pentagon, DHS, Justice Department, and the Federal Reserve.

So here's what we're calling reform:

• Average annual premiums in the private pool around $7,000
• A 40% tax on premiums over $8,400 (how long will it take the average to rise to this level? At the current rate, about two years or before the law even goes into effect)
  
• "Reasonable" annual coverage limits
• Puts most of the cost directly on small businesses and individuals
• Does nothing to address the incentive structure of profit based medicine (maximize volume = maximize profit)
• Leaves as much as a 25% administrative overhead that doesn't even go toward providing medical services

You say I'm biased against government solutions or whatever, yet you put this up as an example of government done right. Hmmm... If this is what a good government looks like, I'll take anarchy any day.

Originally Posted by '58 Flat

As any good Concord Coalition-sympathizing Xer can inform you, two things about Social Security/Medicare need to be addressed:

First, the age for receiving partial Social Security payments should be going up in concert with the age for receiving full benefits (66 2/3 for those born in 1958, for example), but it isn't. Why isn't it? (In the above example, that would raise the eligibility age for partial benefits for the 1958 cohort to 63 2/3).

Estimated savings = ?

Second, the age for Medicare eligibility should be tied to the age for full SS eligibility, for those born after 1939 or wherever the upward trend starts.

Estimated savings = ?

You could probably fund a Utah-style safety-net program for the uninsured in the entire country on what you save from making these two changes alone.

Thirdly, the wage cap - the level of salary above which one need not contribute to Social Security - should either be abolished, or earners above that cap should not receive benefits. After all, why should they get and not give? Isn't that accepting the unearned?

That would also bring a lot more money into the fund.

"Reform consists in taking a bone away from a dog."

Time we remembered that. This is a start, but not a very good one. If the public option were retained, then it would have been a much better one. It may yet happen, since a publicly-managed but private-non-profit system of health insurance would meet the same test -- or so it seems to me. We'll see. I suspect I'm missing something since I doubt the insurance lobby would, and they don't seem to be pressing as hard to kill that idea.

Originally Posted by Brian Rush

"Reform consists in taking a bone away from a dog."

Time we remembered that. This is a start, but not a very good one.

Umm.. Which dog do you think this bill is taking what bone away from?

It seems to me that it's skinning what's left of us and then tossing our bones on the pile the dog already has!

Originally Posted by The Grey Badger

Thirdly, the wage cap - the level of salary above which one need not contribute to Social Security - should either be abolished, or earners above that cap should not receive benefits. After all, why should they get and not give? Isn't that accepting the unearned?

That would also bring a lot more money into the fund.

Since when have I ever not supported that too?

There is also Ross Perot's "nuclear option" of means-testing SS/Medicare benefits.

Originally Posted by '58 Flat

Since when have I ever not supported that too?

There is also Ross Perot's "nuclear option" of means-testing SS/Medicare benefits.

Oh. OK. It's just hat it wasn't mentioned so I thought I would.