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Saturday, March 24, 2012

Also, It's Not as Much a "Mandate" as It Is an "Incentive," but then, Democrats Have Always Sucked at Framing Their Issues

Posted by on Sat, Mar 24, 2012 at 9:31 AM

I've got no particular data to back me up, but since the majority of Americans already purchase health insurance, it seems reasonable to presume that the majority of Americans who oppose the "individual mandate" provision of the Affordable Care Act are people who already purchase health insurance (usually through their employer), and thus people for whom this mandate would have little or no impact.

Curious.

And really, the mandate is the only actual provision of the ACA to which most Americans can voice any specific opposition. There are generalized concerns that the ACA doesn't do enough to reign in rising health care costs, or that it adds too much to the federal budget, or, you know: "Gov'mint!" But I don't see many people protesting in defense of, say, kicking young adults off their parents' policies, or for maintaining exclusions for pre-existing conditions.

The ACA is imperfect, no doubt. Republicans ignore this in touting their anti-ACA polls, but a good chunk of the negative opinion out there is due to the perception that the ACA didn't go far enough toward a public option or even single-payer system. But the reforms we got through are a huge step in the right direction toward greatly reducing the health care insecurity that plagues much of low- and middle-income America.

Yet somehow, an awful lot of voters have been snookered into believing that it would be better to throw themselves at the mercy of the nation's health insurance companies than to brook a "mandate" that they'd never willingly choose to opt out of. Again, curious.

 

Comments (21) RSS

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Max Solomon 1
man date? ahm agin' them deth panuls.
Posted by Max Solomon on March 24, 2012 at 9:48 AM
2
You're problem, Goldy, is like so many other rightwingers from Philadelphia, or Indiana, or Texas, or California, who have relocated to Seattle and the Puget Sound Region and call yourselves "democrats" (as in a Maria Cantwell dem, with her 100% anti-worker voting record and 100% pro-war voting record), is that you ignore or avoid the facts.

The point is this is for the health insurance companies and pharmaceuticals and that, like Mitt Romney's Massachusetts' plan, does nothing to address actual cost containment.

Instead, it acts to criminalize the uninsured, through the privatization of taxation, which works to the long-range benefit of Wall Street and the banksters.

At the end of the day, those few provisions which actually aid the citizenry and women, will eventually be voted down or rendered impotent by the US Sleaze Court, while that legal verbiage aiding and abetting Wall Street continues on.

Single payer was the ONLY way to go, which was why the entire farce was framed as "a gov't takeover" by the stooges, and the possibility for a "public option" by the faux crats (and recall again, that Senators Cantwell and Murray voted down the public option offered by the Dorgan Amendment).
Posted by sgt_doom on March 24, 2012 at 10:33 AM
3
@2 unfortunately, single payer or a public option were never going to happen because of conservative ( republican, tea party) opposition. The "mandate" was put in to appease the insurance companies and the politicians they own....err... support... No healthcare reform would have passed without it.
So it's easy to poke at it now but people tend to forget where we were in this debate 2 years ago. As if the left had any choice but to end up like the Clinton administration- empty handed.
Posted by Realistic on March 24, 2012 at 10:42 AM
bleedingheartlibertarian 4
I'm pretty agnostic on the ACA myself, but I'm similarly puzzled by why it seems to be the mandate that sets people off. Especially conservatives, who at least proclaim to value personal responsibility, and fret over moral hazard and the notion that they might have to pay for someone else's bad decisions and/or luck.

Right now, if you choose to be uninsured, but have an emergent health crisis, you will get care. You will probably get billed for it, but you could always declare bankruptcy, or otherwise get out of paying for it.

If there's a mandate, everyone has to pay into some pool for some minimal degree of coverage.

So...while the mandate is not without problems (see @2 and others) it at least does more to address the freeloader problem than the current system does. I don't understand why conservatives aren't on board with that.
Posted by bleedingheartlibertarian on March 24, 2012 at 10:45 AM
Goldy 5
@2: The ACA does not "criminalize the uninsured." It imposes a tax penalty on individuals above a certain income level who choose not to purchase health insurance.

The only way to eliminate exclusions for preexisting conditions is to incentivize healthy people to purchase insurance, rather than waiting until they are sick to do it.
Posted by Goldy on March 24, 2012 at 10:48 AM
6
Only 9% of the populace directly purchases health insurance. Most get their insurance through their employers, whether they're in the private or public sector. http://aspe.hhs.gov/health/reports/05/un…

This distinction matters, as when people lose their jobs the mandate will be there, making them purchase insurance when they might otherwise prefer to spend their diminished resources on something else. The ACA will make coverage for these gaps in employment more affordable, but there will always be some who would choose to avoid continuing their insurance, and even more might feel that way when told that they must (or face a penalty).
The other people this mandate would affect, who might be upset about it, are mostly young, poor, childless adults, people who see paying for insurance as a gamble they aren't currently willing to take. People never like to be forced to own the externalities of their collective choices.

The ACA is definitely an improvement over what came before for the country as a whole, but it will negatively impact some individuals.
Posted by dirge on March 24, 2012 at 10:49 AM
Original Andrew 7
The problem is that it forces us the buy insurance from the goddamn, parasitic, sadistic health insurance industry--which itself is largely responsible for the huge costs of for-profit healthcare--rather than simply eliminating the age restriction on Medicare, which would actually provide affordable health care for everyone.
Posted by Original Andrew on March 24, 2012 at 10:50 AM
Goldy 8
@6: There is no penalty for insurance gaps of three months or less, and the penalty is waived based on an affordability formula. The mandate is structured to incentive people who can afford to purchase health insurance to do so, not to punish the poor.

And sure, I'd prefer just being able to buy into Medicare, but the Republicans are fighting to eliminate Medicare, not expand it, and until we have a majority in the House, a Democrat in the White House, and 60 votes in favor in the Senate, were not going to get what we want.
Posted by Goldy on March 24, 2012 at 11:01 AM
9
@5, Goldy,

I stand by my comments, and you said,

"..is to incentivize .."

"Incentivize" -- the fav word of the fraudsters......

Strong-arm tactics or bribery, stick to the proper English usage, please.

Single payer, not going with the private insurance/pharmaceutical industry agenda!
Posted by sgt_doom on March 24, 2012 at 11:12 AM
10
The only real positive comment one can say about the ACA is that it is at least an improvement on that complete and utter abomination of Hillary and Bill Clinton's, when they held those close-door sessions with the health insurance and pharmaceutical industries during the Clinton Administration.

BTW, Hillary has pushed and succeeded, in the resumption of military aid to the Egyptian-military-ruled government.

Posted by sgt_doom on March 24, 2012 at 11:15 AM
11
@9
The old "carrot and stick".
Not to mention that you (the consumer) really do not know what you've purchased until you need to use it.

And your usage will (usually) vary based upon your age.
Someone who is 18 will (probably) not have the same medical expenses as someone who is 58.

And the insurance companies will continue to try to make a profit from this. And they'll want that profit to trend upwards over the years. So cutting costs or raising prices will happen.

Even with all of that this is an improvement (with some negatives) over the existing system. But it needs a lot of work.
Posted by fairly.unbalanced on March 24, 2012 at 11:23 AM
Xenos 12
Goldy, I think the fact that this administration has expended next to no sweat in defending the ACA against the conservative attack machine is A.) kind of sad and B.) a testament to its poll numbers. As others have pointed out, if you dice the ACA into its provisions, the public loves it, as a whole, it receives a decisive eh. I chalk this up to lackluster marketing.

However, and I can't believe I am writing these words, Sgt. Doom has one teensy point that the ACA will not necessarily slash the cost of procedures and drugs. This is one area that liberals have every right to be disappointed, since the ACA completely punts on the issue of price negotiation. (This makes us roughly the equivalent of a guy who thinks you pay MSRP for a new car.)

There is a silver lining, however. The ACA does require that providers publish data on costs, etc. So at the very least, we'll have a better idea of just how many inches of shaft we're getting compared to our counterparts in the developed world. Hooray!

I support Obamacare because it's about damn time.

Posted by Xenos on March 24, 2012 at 11:57 AM
Xenos 13
And as for who moans loudest over the law-specifically the mandate? Take a wild guess.

The one group in this country that was spared slavery through the 1800s, disenfranchisement through the 1920s and 60s, and unlawful detainment in the 1940s; the very same group that has held the majority of offices in our nation's history. It is this privileged group-which faced none of these trails-that aspires so ignorantly toward a concept of individual liberty that has been dead for over a century. A pitiful group in which I myself reside, I speak naturally of non-poor, white, men.

Call it ridiculous, call it ironic, call it tradition.
Posted by Xenos on March 24, 2012 at 12:09 PM
Phoebe in Wallingford 14
@13: Isn't a woman's right to choose 'individual liberty'? The concept is fundamentally bipartisan.

Essentially, I'm for a public option and I don't why conservatives have an issue with it as it would facilitate growth in private free enterprise.
Posted by Phoebe in Wallingford on March 24, 2012 at 12:35 PM
rob! 15
@4, "Right now, if you choose to be uninsured, but have an emergent health crisis, you will get care..."

It's more accurate (because of the bolded word's multiple meanings) to say that if you're uninsured and have an acute health crisis or accident, you can go to an emergency room without insurance and get treatment that stabilizes you and if you're lucky, starts you on the path to healing on your own.

However, if you need an organ transplant or have a chronic condition that needs expensive remedies, you're essentially SOL. That's why, in my small rural town, there are barbecues and other fundraisers almost every week to help uninsured people who need new kidneys or who have become paralyzed in a "Hey, watch THIS!" stunt. But those who don't belong to one of several large and tight-knit church groups are much less likely to benefit from community action.
Posted by rob! http://www.youtube.com/watch?v=QZBdUceCL5U on March 24, 2012 at 1:08 PM
gloomy gus 16
It's always fun to see how many words it takes to recognize a puddle of upchuck as the product of sgt_doom.
Posted by gloomy gus on March 24, 2012 at 1:10 PM
Xenos 17
@14 Given that Ron Paul, tireless advocate of liberty he is, has zero compunction over restricting abortion rights, should tell you just how much stock I put in individual liberty as a political argument.

White guys want to pretend that every man is an island in the year 2012, while they simultaneously enjoy government regulated and approved boner pills that cannot be denied to them based on the moral convictions of others. I guess myopia is the white man's sickle-cell.
Posted by Xenos on March 24, 2012 at 1:57 PM
18
Goldy, nice analysis. One quibble: it's spelled, "gubmint."
Posted by Corydon on March 24, 2012 at 4:40 PM
19
PPACA's (ObamaCare's) limits on rescission and medical underwriting are great. So are first-dollar coverage of preventive care, expanded access to Medicaid, and young adults being able to stay on their parents' policies a bit longer. But PPACA has literally none of the key features shared (for the most part) by the health-care systems of our peer countries, e.g.:

* Uniform, monopsonistically bargained price schedules for medical products and services

* A substantially universal network of nationally licensed providers

* A substantially universal pool of insureds with lifetime coverage

* A comprehensive, largely uniform benefits package, administered according to substantially uniform administrative rules and procedures

* Centralized or harmonized claims and payment processing systems

* A ban on profit-making on mandatory insurance coverage (with minor exceptions for the wealthy in a few countries)

* A high level of minimum mandatory coverage and a low cap on out-of-pockets

* A ban on direct-to-consumer advertising of prescription medications

When you add these features up, they result in much less administrative waste and skimming, much less profiteering, much greater patient protection against financial destitution, much greater equality of access and treatment, less medically unnecessary care, and better preventive and maintenance care. In short, they lead to much lower overall costs, greater financial security, and better overall health outcomes.

To put things in perspective, the country with the second most expensive health-care system in the world, after us, is Switzerland.* They use non-profit private multi-payer with an individual mandate. Provider prices are monopsonistically negotiated on a canton-by-canton basis (which results in higher prices than if they did it nationwide, same as will happen here if we ever do uniform price schedules state by state rather than nationally**). Underwriting is limited to three broad age categories (children, young adults, and adults); medical underwriting and sex-based underwriting are banned. Around 2/3 of Swiss insureds get federal premium subsidies, their policies' actuarial value is relatively high, and the cap on out-of-pockets is reasonably low. This system covers 99.5% of the population, gets just about the best health outcomes in the world, and costs around 12% of GDP.

Currently, we provide coverage ranging from skeletal (catastrophic) to very good to around 80% of the population, get close to the worst outcomes amongst OECD member countries, and spend around 18% of GDP on health care. Under PPACA, we will be providing coverage ranging from inadequate (bronze) to excellent (platinum) to around 91% of the population, our health outcomes will likely improve somewhat, and we will be spending over 20% of GDP on health care. That's over a trillion dollars a year more that's being sucked out of our economy than if we could match the Swiss system. (And since Switzerland's per-capita GDP is lower than ours, they're actually spending a lower percentage of a proportionally lower GDP to get significantly superior coverage and results.)

Long story short, some people who object to PPACA's individual mandate do so because they object to being ... "incentivized" ... to pay tribute to a protection racket that's skimming a trillion a year, several billion of which will be plowed back into advertising, advertising-leveraged media influence, conclusion-driven think-tank studies, lobbying, revolving-door legislative staffers, campaign contributions, and other forms of political subversion to ensure that our state and federal politicians keep the racket running for as long as possible. What I'm talking about is the behind-the-scenes maneuvering we saw in the run-up to PPACA -- what PBS Frontline revealed in Obama's Deal is only the tip of the iceberg -- only it will be even better funded next time round, and without the restraints on direct corporate advertising that predated Citizen's United.

It's not inconsistent to acknowledge that PPACA has some good features while maintaining that its individual mandate and its shoring-up of a fragmented, profiteering, administratively bloated and wasteful kludge system are a grievous mistake. Under RomneyCare, Massachusetts now has the highest per-capita health-care costs of any state in the country. "Medical" bankruptcies have only fallen from around 57% of all personal bankruptcies to around 51%. (I'd bet however, that provider claims effectively discharged in bankruptcy have gone way down.) It's a preview of what we can expect to happen under ObamaCare. Bronze-level policies with relatively high out-of-pocket caps are still going to leave a lot of people compelled to file after they've fallen ill. (Not that they'll get much of a fresh start from doing so, thanks to the Bankruptcy Reform Act of 2005 that both of our current US senators helped pass...)

Tell you what, Goldy. Let's say all of us national single-payer proponents are completely deluded and that no amount of public outrage will overcome the stranglehold that Big Health has on Congress and the media in our lifetimes. How about state single-payer as an intermediate step, or a compromise? I think it would be useful for a political reporter such as yourself to check out the Washington Health Security Trust Act (http://www.healthcareforallwa.org/whst-p…). That reporter might then look to see if the WHST bill has ever been voted out of committee, and if not, why not. Teresa Mosqueda of the Washington State Labor Council might be able to point you in the right direction. The best someone like me can do is to check out campaign financing analyses at VoteSmart.org and then make some educated guesses. (I'm not saying the fact that Speaker Chopp's number-one campaign contributor is the for-profit health sector proves that Big Health owns him -- even at number one, it's nickel-and-dime amounts compared to Max Baucus's $4 million -- I'm just saying it's a little troubling.) Help me out.

*Luxembourg spends more per capita on health care than Switzerland, but since Luxembourg is a tiny, ultra-rich banking haven, it doesn't really qualify as a full-fledged country with a balanced First World economy. Ditto for Monaco and Liechtenstein.

**The Swiss actually pay higher prices for prescription drugs than we do, probably because their cantons have less bargaining power with respect to pharmaceutical companies than our major insurance companies do. In the US, the Veterans Health Administration has the most bargaining power of any American buyer, and they pay roughly 40% less for prescription drugs than the rest of us do.
More...
Posted by PCM on March 24, 2012 at 4:58 PM
20
@11, fairly.unbalanced's, typical rightwinger response drivel:

"And the insurance companies will continue to try to make a profit from this. And they'll want that profit to trend upwards over the years. So cutting costs or raising prices will happen."

Your moronic and ignorant response (really, either you are a professional liar or insanely ignorant) presupposes that insurance companies ARE NOT criminal organizations.

Number One:

For once in your life, do some reading and take a long look at the SEC's litigation releases regarding insurance companies over the past 10 years.

Number Two:

Let's take a look at how the largest insurance company behaved over the past decade, AIG.

AIG, just a few short years ago, had to be bailed out as they were behind the largest insurance swindle in recorded history (selling $460 billion worth of unregulated credit default swaps without the capital to back it up, and if they weren't bailed out, then the other criminal organizations, principally, JPMorgan Chase, Goldman Sachs, Morgan Stanley, Bank of America, Citigroup, Deutsche Bank and UBS would have gone under, as they deservedly should have).

Just a few years earlier, in 2005, AIG had to pay $1.6 billion to settle litigation costs in response to actions taken at the federal and state levels against other fraud they were responsible for.

Just a little while prior to that, AIG cooked their books with a $500 million fraudulent transfer payment, which they manipulated into over $1 billion of book cookery.

Several years prior to that, AIG was responsible for a bunch of other reinsurance scams, the last one involving their "finite insurance" scam, which they were penalized for.

Then, you should look into why Metlife unethically and illegitimately accessed TARP bailout funds which were supposed to be directed at the banksters.

Finally (only because my time is running short), you would wish to read the recently released GAO study deconstructing how the banksters haven't actually yet paid back those TARP bailout funds owed (as the morons who are honesty-challenged and fact-challenged like that idiotic FNARF character falsely and incorrectly claim), but instead simply accessed other government funds --- as in taxpayer funds --- to reimburse the government --- so they still owe the gov't.

And AIG (there's that insurance company, again!) paid some of what they owe in securitized notes, meaning their value is based upon future worth --- and given AIG's chronic record of dishonesty (typical for the majority of insurance corporations), those notes will probably end up being worthless.

More...
Posted by sgt_doom on March 25, 2012 at 12:21 PM
21
@4, bleedingtartcontrarian,

"I'm pretty agnostic on the ACA myself, but I'm similarly puzzled by why it seems to be the mandate that sets people off. Especially conservatives, ..."

The word you are groping for isn't "agnostic" --- it is ignorant!

You exist in a constant state of puzzled oblviousness and because you chose to, otherwise you would know that the most ardent supporters of universal healthcare have long been against this backdoor bailout for the insurance industry, with set asides for the pharmaceutical industry (both of whom are owned by the bankster, child!) which includes no public option, but mandates the usage of the IRS --- the privatization of taxation --- to penalize those who don't kowtow to the private insurance companies which have a record of predatory behavior towards the citizenry, child!

But in order to understand that, you would need to actively change your militant ignorance and obvliousness towards your surroundings.

Anything other than single payer is a scam, but that would necessitate you actually reading the legislation which was passed, which you, nor any other 11-year old (mentally, at least) commenter here, has yet to do!
Posted by sgt_doom on March 25, 2012 at 12:28 PM

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