Obamacare - Confessions of an MIT Bunko Artist, Jon Gruber

[dismal]

Wrong-a-mundo. Health care costs are heavily concentrated among a relatively few sick people. You will generally see numbers like 3% of Medicaid recipients account for 50% of the spending.

Where do you see these numbers? Less than a third of Medicaid is spent on long-term care, and even long-term care spending is spread across multiple categories.

ETA: Never mind, I found the source:
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7576-02.pdf

Medicaid long-term care users accounted for 6 percent of the Medicaid population in 2007, but nearly half of total Medicaid spending

http://theincidentaleconomist.com/wordpress/you-just-cant-see-this-often-enough/
http://www.washingtonpost.com/blogs...have-medicaids-cost-problem-completely-wrong/

 

[bigfield]

Where do you see these numbers? Less than a third of Medicaid is spent on long-term care, and even long-term care spending is spread across multiple categories.

ETA: Never mind, I found the source:
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7576-02.pdf

Medicaid long-term care users accounted for 6 percent of the Medicaid population in 2007, but nearly half of total Medicaid spending

http://theincidentaleconomist.com/wordpress/you-just-cant-see-this-often-enough/
http://www.washingtonpost.com/blogs...have-medicaids-cost-problem-completely-wrong/

Thanks for the links. The NIHCM report cited by the blog was very informative.

Note that those people already represent an existing public expenditure: every American taxpayer has forced into the metaphorical homeowner's insurance pool with them. There is no scenario where you get out of paying towards their care.

 

[dismal]

Where do you see these numbers? Less than a third of Medicaid is spent on long-term care, and even long-term care spending is spread across multiple categories.

ETA: Never mind, I found the source:
http://kaiserfamilyfoundation.files.wordpress.com/2013/01/7576-02.pdf

Medicaid long-term care users accounted for 6 percent of the Medicaid population in 2007, but nearly half of total Medicaid spending

http://theincidentaleconomist.com/wordpress/you-just-cant-see-this-often-enough/
http://www.washingtonpost.com/blogs...have-medicaids-cost-problem-completely-wrong/

Thanks for the links. The NIHCM report cited by the blog was very informative.

Note that those people already represent an existing public expenditure: every American taxpayer has forced into the metaphorical homeowner's insurance pool with them. There is no scenario where you get out of paying towards their care.

Right, but again, one of the features of obamacare that was not found before is you can't be denied for having a pre-existing condition. Hence it can expect all of the people with pre existing conditions to flock to it, and have disproportionate numbers of the high expense people in the pool.

That's why the G-rubes must be forced and/or deceived into joining the pool. If they don't the insurance is very expensive.

 

[Jarhyn]

So I see two things here: one, where the regressionists decry 'death panels', where some panel somewhere decides that the state won't cover a condition, and then those same regressionists claiming that helping people who are already sick is going to cost them too much.

So in the end the question becomes what the fuck are we supposed to do for people who are sick? if the answer is "let them die" they are filthy fucking hypocrites for talking about death panels. If the answer is 'help them', they are filthy fucking hypocrites for complaining about sick people taking driving up expenses for the healthy.

So either way, anti-obamacare regressionists are filthy fucking hypocrites.

 

[bigfield]

Right, but again, one of the features of obamacare that was not found before is you can't be denied for having a pre-existing condition. Hence it can expect all of the people with pre existing conditions to flock to it, and have disproportionate numbers of the high expense people in the pool.

That's why the G-rubes must be forced and/or deceived into joining the pool. If they don't the insurance is very expensive.

OK, I see what you mean. 'Join, because you'll save money', is a better sales pitch for the ACA than 'join, because if you don't it won't actually be affordable for those who do.'

They probably should have gone with 'Medicaid comes out of your taxes, anyway, so you might as well join and get something for your money.'

 

[dismal]

Right, but again, one of the features of obamacare that was not found before is you can't be denied for having a pre-existing condition. Hence it can expect all of the people with pre existing conditions to flock to it, and have disproportionate numbers of the high expense people in the pool.

That's why the G-rubes must be forced and/or deceived into joining the pool. If they don't the insurance is very expensive.

OK, I see what you mean. 'Join, because you'll save money', is a better sales pitch for the ACA than 'join, because if you don't it won't actually be affordable for those who do.'

They probably should have gone with 'Medicaid comes out of your taxes, anyway, so you might as well join and get something for your money.'

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

 

[Jarhyn]

OK, I see what you mean. 'Join, because you'll save money', is a better sales pitch for the ACA than 'join, because if you don't it won't actually be affordable for those who do.'

They probably should have gone with 'Medicaid comes out of your taxes, anyway, so you might as well join and get something for your money.'

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

So what do you suggest? We leave sick poor people to die? Welcome to the death panel!

- - - Updated - - -

Let's be honest here, dismal, what would you see happen to sick poor people?

 

[dismal]

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

So what do you suggest? We leave sick poor people to die? Welcome to the death panel!

- - - Updated - - -

Let's be honest here, dismal, what would you see happen to sick poor people?

Have you ever heard of Medicaid? My understanding is that it existed before Obama was even president.

I don't have a problem with some sort of social safety net for the very poor.

That's not what Obamacare is.

 

[Jimmy Higgins]

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

So what do you suggest? We leave sick poor people to die? Welcome to the death panel!

- - - Updated - - -

Let's be honest here, dismal, what would you see happen to sick poor people?

Have you ever heard of Medicaid? My understanding is that it existed before Obama was even president.

I don't have a problem with some sort of social safety net for the very poor.

That's not what Obamacare is.

No. Obamacare is a health care program for the lower to middle class between the ages of 18 and 60ish. Unsubsidized health care insurance is very expensive.

 

[dismal]

Yes. But according to Gruber, you can't pass a law by telling people they are going to pay more to cover the sick people. This is the issue he is talking about here:

“Mark [Pauly] made a couple of comments that I do want to take issue with, one about transparency in financing and the other is about moving from community rating to risk-rated subsidies. You can’t do it politically. You just literally cannot do it, okay, transparent financing…and also transparent spending.” Gruber said. “In terms of risk-rated subsidies, if you had a law which said that healthy people are going to pay in—you made explicit that healthy people pay in and sick people get money, it would not have passed, okay. Lack of transparency is a huge political advantage. And basically, call it the stupidity of the American voter or whatever, but basically that was really, really critical for the thing to pass…Look, I wish Mark was right that we could make it all transparent, but I’d rather have this law than not.”

So what do you suggest? We leave sick poor people to die? Welcome to the death panel!

- - - Updated - - -

Let's be honest here, dismal, what would you see happen to sick poor people?

Have you ever heard of Medicaid? My understanding is that it existed before Obama was even president.

I don't have a problem with some sort of social safety net for the very poor.

That's not what Obamacare is.

No. Obamacare is a health care program for the lower to middle class between the ages of 18 and 60ish. Unsubsidized health care insurance is very expensive.

So is subsidized health care insurance.

 

[Jimmy Higgins]

No. Obamacare is a health care program for the lower to middle class between the ages of 18 and 60ish. Unsubsidized health care insurance is very expensive.

So is subsidized health care insurance.

When I ran the numbers, unsubsidized health care premium for my family of 2 adults, 1 child would have roughly rivaled my mortgage payment. My actual employer subsidized out of pocket is notably lower. Sure, in the end, it is the same relative cost, but the out of pocket is less with the employer subsidization. And if I don't choose my employer's plan, it isn't as if I get the cash equivalent instead.

And it is a shame that something more UHC'y was done in a reform bill, but Christ, you folk are shitting yourselves over RomneyCare. I can't imagine the pant sale boom had the ACA created a UHC system.

Regardless, that was a nice goalpost move.

 

[dismal]

So is subsidized health care insurance.

When I ran the numbers, unsubsidized health care premium for my family of 2 adults, 1 child would have roughly rivaled my mortgage payment. My actual employer subsidized out of pocket is notably lower. Sure, in the end, it is the same relative cost, but the out of pocket is less with the employer subsidization.

And it is a shame that something more UHC'y was done in a reform bill, but Christ, you folk are shitting yourselves over RomneyCare. I can't imagine the pant sale boom had the ACA created a UHC system.

Regardless, that was a nice goalpost move.

wat

My comment had no meaning other than to point out that subsidies must be paid for. They don't lower the cost of healthcare at all.

 

[maxparrish]

An interesting confessional from a Democratic activist, former hospital insurance coordinator, and two time voter for Obama...

This Democrat is Giving Up on Obamacare...

By BURKE BEU
Nov. 13, 2014 6:00 p.m. ET
544 COMMENTS

I grew up in a Democratic family. I have been a registered Democrat since age 18, a Democratic candidate for statewide office in Colorado and a party precinct captain in that caucus state. I’ve volunteered for numerous Democratic candidates and contributed to party causes and campaigns. The 2014 election results were extremely disappointing for me, but hardly a surprise.

I voted for Barack Obama in 2008, then lost my job in the Great Recession. I was lucky; my brother lost his job and his house. I survived on part-time jobs while paying out-of-pocket for my health insurance.

I voted for President Obama again in 2012, then received a cancellation notice for my health insurance. This was due to ObamaCare, the so-called Affordable Care Act. However, I couldn’t afford anything else....

Fearful that doing nothing was worse than doing the wrong thing, Democrats gave up on Medicare for the masses and opted for a drastic alternative. ObamaCare is an outrageous combination of private-market inflation, government bureaucracy, excessive mandates and a ridiculously delayed implementation schedule. When the thing finally kicked in, it hit hard—and there is plenty more pain on the way.

ObamaCare is a failure. For anyone who thinks this is a misprint because no Democratic activist would make such a comment, let me add that it is too big, too complicated and too expensive. Without a public option within its network of exchanges, ObamaCare is a giant blank check to the insurance companies that pushed it through Congress. It punishes responsible consumers like me and treats younger individuals as fools who are expected to pay the bills while not paying attention.

Now we learn in videos that came to light this week that Jonathan Gruber, MIT economist and a key architect of the Affordable Care Act, proudly relied on his perceived “stupidity of the American voter” as the basis for designing ObamaCare. Such comments, along with the program’s notoriously dysfunctional website and false assurances that people can keep their previous health plans, are insults to every citizen regardless of party.

Contrary to Medicare, which was quickly accepted at a time of economic vitality as a meaningful complement to Social Security, ObamaCare was the sequel to an overpriced economic stimulus package that didn’t stimulate very much. Those least affected by the recession benefited the most from the stimulus. I think that’s called “trickle-down economics” when Republicans do it, and the economy continues to struggle for good jobs and a real recovery. ObamaCare is part of the problem, not a solution.....

http://online.wsj.com/articles/burke-beu-this-democrat-is-giving-up-on-obamacare-1415919619

 

[Loren Pechtel]

No. Obamacare is a health care program for the lower to middle class between the ages of 18 and 60ish. Unsubsidized health care insurance is very expensive.

It's also for those in the middle class who have health problems and simply can't get insurance otherwise.

 

[ZiprHead]

What Gruber did is what is called on Madison Avenue "advertising".

 

[Jimmy Higgins]

No. Obamacare is a health care program for the lower to middle class between the ages of 18 and 60ish. Unsubsidized health care insurance is very expensive.

It's also for those in the middle class who have health problems and simply can't get insurance otherwise.

Those people would likely be included in the group Middle Class 18 to 60ish that I noted above.

 

[maxparrish]

Did I mention that number 6 video was discovered today?

 

[ksen]

An interesting confessional from a Democratic activist, former hospital insurance coordinator, and two time voter for Obama...

This Democrat is Giving Up on Obamacare...

By BURKE BEU
Nov. 13, 2014 6:00 p.m. ET
544 COMMENTS

I grew up in a Democratic family. I have been a registered Democrat since age 18, a Democratic candidate for statewide office in Colorado and a party precinct captain in that caucus state. I’ve volunteered for numerous Democratic candidates and contributed to party causes and campaigns. The 2014 election results were extremely disappointing for me, but hardly a surprise.

I voted for Barack Obama in 2008, then lost my job in the Great Recession. I was lucky; my brother lost his job and his house. I survived on part-time jobs while paying out-of-pocket for my health insurance.

I voted for President Obama again in 2012, then received a cancellation notice for my health insurance. This was due to ObamaCare, the so-called Affordable Care Act. However, I couldn’t afford anything else....

Fearful that doing nothing was worse than doing the wrong thing, Democrats gave up on Medicare for the masses and opted for a drastic alternative. ObamaCare is an outrageous combination of private-market inflation, government bureaucracy, excessive mandates and a ridiculously delayed implementation schedule. When the thing finally kicked in, it hit hard—and there is plenty more pain on the way.

ObamaCare is a failure. For anyone who thinks this is a misprint because no Democratic activist would make such a comment, let me add that it is too big, too complicated and too expensive. Without a public option within its network of exchanges, ObamaCare is a giant blank check to the insurance companies that pushed it through Congress. It punishes responsible consumers like me and treats younger individuals as fools who are expected to pay the bills while not paying attention.

Now we learn in videos that came to light this week that Jonathan Gruber, MIT economist and a key architect of the Affordable Care Act, proudly relied on his perceived “stupidity of the American voter” as the basis for designing ObamaCare. Such comments, along with the program’s notoriously dysfunctional website and false assurances that people can keep their previous health plans, are insults to every citizen regardless of party.

Contrary to Medicare, which was quickly accepted at a time of economic vitality as a meaningful complement to Social Security, ObamaCare was the sequel to an overpriced economic stimulus package that didn’t stimulate very much. Those least affected by the recession benefited the most from the stimulus. I think that’s called “trickle-down economics” when Republicans do it, and the economy continues to struggle for good jobs and a real recovery. ObamaCare is part of the problem, not a solution.....

http://online.wsj.com/articles/burke-beu-this-democrat-is-giving-up-on-obamacare-1415919619

I agree with max that a public option should have been included.

 

[Loren Pechtel]

It's also for those in the middle class who have health problems and simply can't get insurance otherwise.

Those people would likely be included in the group Middle Class 18 to 60ish that I noted above.

I was taking your list to be those who couldn't afford insurance.

There are also those of us who can afford the insurance but simply can't buy it without the ACA.

 

[Sabine Grant]

And what proof do you have that the way the State allocates resources to our health care system in France causes our medically needy to die?

I don't know the first thing about the health system in France. However, if they don't have some ability to limit the healthcare resources spent on people who are dying that would be really, really stupid.

You realize I said earlier that I view death panels as a plus? We need to limit the amount of resources we spend on the dying that do not improve outcomes?

If you are saying the French system does not do this you are saying the French system is flawed.

I have never claimed that any patient on their death bed is going to be able to demand and receive life saving treatments. Death bed indicates patients who are in their process of death and the result of a terminal prognosis. However, they will receive what is commonly known as palliative care and/or pain management care. And the decision to withdraw life support measures such as respiratory support (vent) or hydration/nutrition support (G Tube/IV) is not in the hands of a "death panel". It rests with the patient on life support devices. If the patient is mentally incapacitated and unable to make those decisions, it rests with their next of kin or/and legal medical custodian.

Let's rewind to the BEFORE the AHCA : people facing a catastrophic illness who could not afford an adequate insurance plan were basically left without access to medical treatments and procedures designed to PREVENT a death bed outcome. Considering that a great variety of such ailments are treatable and if treated will result in a positive prognosis versus a fatal outcome. Meaning that your health care system was profoundly flawed and certainly not delivering based on the more medical needs, the more access.

Versus what you refer to as "big government health care" and my citing the French health care system as an example of a health care system who will deliver treatments and procedures intended to prevent a death bed situation or fatal outcome. The fact that ALDs category ailments are covered 100% indicates efforts deployed to address treatable ailments and prevent a fatal outcome versus before the AHCA in the US where treating such ailments was dependent on whether the affected person could afford an insurance plan covering the cost of the said treatments. Cancer being under the ALD category in France, covered 100%.

Meaning that a Martine Dupont in France diagnosed with stage 1 breast cancer will benefit of treatments/procedures prompting not only remission but preventing her cancer from evolving to advanced stages and resulting metastases. Versus Jane Smith in the US who, prior to the AHCA, if unable to afford an insurance plan covering the cost of the said treatments/procedures was facing the prospect of her breast cancer evolving to advanced stages and resulting metastases. Where Martine's chances of survival were definitely elevated because treated in early stages, it certainly did not apply to Jane.

I have related twice now my case and how I found myself prior to the AHCA facing rejection after rejection solely based on my diagnosis. Though my type of lymphoma responds positively to treatments and a fatal outcome can be on a long term basis prevented while I remain maintained in remission, perfectly able to work, having an excellent quality of life, I would consistently be rejected by insurance companies.Again, the only access to health care and mediocre and certainly not adequate was via my husband's employer "crumbs" Group Plan, keeping me from 2009 to January 1st 2014 in the status of under insured.

Versus a "big government health care system" where I would be given access to the said treatments and consistent medical monitoring (imaging tests etc..) and without my having to be concerned about accumulating medical debts.

The above should not be difficult to comprehend, dismal.