March 25th, 2010

A big F-ing deal: the distinguishing characteristics of the HCR bill

We keep hearing that the passage of HCR was historical—or, in the immortal words of the great Joe Biden, “A big F-ing deal.”

But “historical”—or even “big F-ing deal”—has no moral valence. It doesn’t mean “good” or “bad.” It just means “big and memorable” and perhaps even “unprecedented.”

World War I was historical, for example. World War II was exceedingly historical. The Great Depression likewise. But no one would call these events good.

We don’t yet know what the ultimate effects of HCR will be, although we can guess. But we do know what’s been historical about it so far.

For starters, it represents the culmination of nearly a century of liberal/progressive/leftist (take your pick) longing (I wrote about this phenomenon here). Now Noemie Emery offers a fine summary of some of the other characteristics that have made HCR so historical:

The bill passed is a historical change, and a massive expansion of government. It was also the first major bill to be passed against the will of the country, to be passed by only one part of one party, and in the face of a wave of public revulsion, expressed over 10 months in such different outlets as mass demonstrations, three big elections, and polls.

It was not only not bipartisan, but it was less than one party, in the sense that the great war of passage was the attempt by the leaders to force their members to vote in a way that outraged their constituents, by way of threats, ultimatums and bribes.

It is the first bill whose supporters say they have to sell it now after passage, as they failed so spectacularly to sell it the first time. It is the first whose passage was greeted with cries for repeal by so many mainstream and respected political leaders, the first to be challenged in court right off the bat by two different state governments, with thirty-plus more in the wings.

I would add to that list the fact that this bill affects people’s lives in the most intimate way possible—their access to health care—and (despite promises to the contrary) the majority of them are concluding that it will ultimately take away from them more than it will give. They judge that it will take not only more money from them, but their present access to medical choice, something most are quite satisfied with now. They calculate that it will take away the high standards of medicine and particularly medical innovation they have come to expect in this country. And it may even take away the country’s solvency, already highly compromised.

All this has been done by the government without their consent—unless you believe that, once an election has occurred, anything that government chooses to do is by definition done with the people’s consent, even if the government’s plans had been misrepresented before the election.

Arguments that Obama campaigned and was elected on this particular bill are ludicrous (worse than ludicrous: transparently duplicitous). The centerpiece of his campaign was a new bipartisanship and transparency, and some general sort of health care reform was going to be part of it. But the specific provisions of this bill (including, for example, the individual mandate, which he had explicitly disavowed) most certainly were not, nor was this process of bill passage. His most oft-stated promise—that you could keep your current health plan if you like it—has become another joke (unless you understood that the promise came with an expiration date of a year or two).

No, there has never been another bill like it. Historical. The comparisons to Social Security or Medicare are laughable as well. Yes, there was some opposition to both among conservatives of the time. But they were very much minority voices and did not carry the day even within the Republican Party. Both bills were hugely popular with large majorities of Americans, and passed with overwhelming bipartisan support in Congress. No one had to go out afterwards to “sell” them like a snake-oil pitchman; they had already sold themselves.

The process by which the bills passed was the normal one, as well. And, more importantly (even though we see the enormous fiscal costs now), they were mostly seen at the time as “win-win” situations by the American public. Nearly everyone paid into them and everyone would be getting something out of them, and for the vast majority of Americans they did not replace better benefits that were already in place.

In contrast, the current bill is seen as taking from the many to benefit (theoretically, at least) the few, as threatening mightily to endanger the economy of the entire country, and was rammed through against the will of the American people. That’s the sort of “historical” we could have done without.

Big F-ing deal, indeed.

102 Responses to “A big F-ing deal: the distinguishing characteristics of the HCR bill”

  1. Dan Says:

    I want someone to tell me I’m wrong. I was reviewing parts of the HCR reconcilitation bill, and I came across, on page 1167, a section on the Public Health Option–the part everyone’s been saying wasn’t going to be included. Here’s the link :http://budget.house.gov/doc-library/FY2010/03.15.2010_reconciliation2010.PDF

    Is there another, more up to date version? WTF is going on around here?

  2. Adrian Says:

    To whatever degree it was a part of his election campaign, Obama argued on the other side of a healthcare mandate with Hillary Clinton (Rush Limbaugh has the video), the very issue on which states are now filing lawsuits, contesting as unconstitutional.

  3. mezzrow Says:

    Since the government takeover of Chrysler, a special team of theirs has been asssigned to explain to the public the benefits of the new healthcare plan and how it will make the lives of all Americans better in every way. Here is an example of some of the best work from this group, and we look forward to seeing what they have prepared for us in the future. Your tax $ at work.

    http://www.youtube.com/watch?v=MXW0bx_Ooq4

  4. Mitsu Says:

    If the HCR law does end up causing problems for the economy, then I will concede that you were right, Neo. However, the status quo was certainly going to cause a disaster for the economy (it already was).

  5. SteveH Says:

    The loss of cutting edge medical innovation is the big picture. I’ll bet there are brilliant 17 year olds in these last few days rethinking that dream they had of going into medicine. Of course it will all be mean old conservatives fault when the incompetence starts shining through.

  6. neo-neocon Says:

    Mitsu: you will never concede I am right, even if my rightness comes up to you and slaps you upside the head.

    If the entire economy fails, you will blame it on something else. Or you will say if the Republicans had been in charge it would have failed even worse.

  7. Mrs Whatsit Says:

    SteveH, when our family doctor recently heard that our son, who had previously considered becoming a doctor, had become a veterinarian instead, he said, “Well, at least he’ll get paid!”

  8. michaele Says:

    A caller on Rush made the pithy observation that Biden was only two thirds right in his description of it being
    “a big f…ing deal”.

  9. Mitsu Says:

    >you will never concede I am right

    I’m sorry you feel that way, Neo. I don’t have a similar feeling about you; unlike many of your commenters I’ve always felt you had some sense of empiricism about your political position.

    My view is that the HCR law will likely reduce the growth of health care costs relative to what they would have been, by which I mean the growth should be less than the twice-the-rate-of-inflation levels we’ve seen. My only concern is the penalties for not purchasing insurance are too low; this could upset my prediction. I predict health insurance companies will survive. I also predict there will need to be tweaks made to the law in future years (perhaps to adjust penalties for non-compliance and/or provide different incentives for people to purchase coverage), but I believe the law will, on balance, be a plus for the insurance companies and for cost containment.

    Wall Street seems to agree, so far: health insurance stocks are doing fine as they have been during the whole debate. I think analysts are predicting this bill will either be neutral or a net positive for insurance companies as they gain millions more customers to offset the regulatory reforms that increase costs. That’s also the CBO’s estimate and the estimate of many other analysts I’ve read so far.

    If these predictions don’t come to pass I’ll certainly concede that I was wrong and you were right; I’ll buy you dinner (you don’t have to suffer through my company; I can send you the money)!

  10. SteveH Says:

    Neo, that brings up another point i’ve thought about. This thing with liberals looking at medicare, medicade, social security…All those saving graces of society, as if there was never another alternate and better way any of it could have went down. The truth is they were all terribly planned and executed.

  11. Perfected democrat Says:

    “If the entire economy fails, you will blame it on something else.”

    It’s not going to be the end of the world, but just the beginning of, maybe, the mother of all inflation cycles in America’s history; like the mortgage derivitives were gasoline on the underlying balloon mortgage episode we still haven’t recovered from, these trillion dollar deficit spending “binges”, one on top of another in too short order. It reminds you of the behaviour of compulsive gamblers with easy credit. Ever notice how stoned Pelosi’s eyes look?

  12. neo-neocon Says:

    Well, Mitsu, glad to hear you’ll acknowledge mistakes. But I guess we’ll see. And remember, you’ve gone on record here with your predictions :-).

    But all the “tweaking” may render the predictions moot. I personally hope the bill will be tweaked right out of existence, and be replaced by much better things: portability, tort reform, and another way of dealing with the problem of pre-existing conditions (national partly subsidized high-risk pool? Maybe someone can come up with a better idea than that, since I’m not an insurance expert.)

    As for the CBO scoring—sorry, but it’s utterly and completely meaningless. I’ve written several posts on that very subject. Surely, you yourself know that the CBO is constrained by the assumptions in the bill , especially those about the future, which are not required to be tethered to much reality and are more in the nature of carny fortune-telling than anything else (sorry, carny fortune-tellers; I fear I’ve just grievously insulted you).

  13. S.Graham Says:

    Since Social Security will be unfunded in 2030 and Medicare in 2017, I don’t know how anyone can think that another entitlement is a good idea until we fix the predicted short fall with the other two.What am I missing?
    And I will always remember the Dems laughing when, at the State of the Union speech, George Bush admitted that he couldn’t get SS fixed.Like that was a victory for them.Unserious people.With my money.

  14. Martyn of England Says:

    “Arguments that Obama campaigned and was elected on this particular bill are ludicrous …”

    No-one could have been under any doubt what Obama campaigned on: Iraq withdrawal, health care, energy and environment, troop increase in Afghanistan, education, economic class divisions and economy, etc.

    Asked by the Washington Post what his top three overall priorities were if elected, Obama said:

    “My top priority as president will be ending this war in Iraq … Providing universal health care to the 47 million Americans who currently do not have it will be another top priority of my administration, as will combating global warming and putting our country on the path toward energy independence.”

    Can it get much plainer?

    He was elected. He’s carrying it out now. That’s the way it works.

  15. SteveH Says:

    The Donald on Fox saying theres no way American companies can stay competitive with this HCR. I’m betting Barak has doubled his cigarettes since he signed that bill.

  16. neo-neocon Says:

    Martyn: I think there is something wrong with your reading comprehension. Or else you are being purposely misleading. Perhaps both.

    This is what I wrote in the post above [I have added highlights in bold to help you out with your reading comprehension and make things even more crystal clear]:

    Arguments that Obama campaigned and was elected on this particular bill are ludicrous (worse than ludicrous: transparently duplicitous). The centerpiece of his campaign was a new bipartisanship and transparency, and some general sort of health care reform was going to be part of it. But the specific provisions of this bill (including, for example, the individual mandate, which he had explicitly disavowed) most certainly were not, nor was this process of bill passage.

    He was elected on false pretenses. That’s the way it’s worked, and the “it” he’s carrying out now is quite different than the “it” people voted for. He is a doctrinaire partisan leftist ideologue and he campaigned as a bipartisan moderate.

  17. Martyn of England Says:

    Neo

    Yes, I read it before I posted – twice. I noted the use of ‘particular,’ as well, but that’s being, for want of a better word, pedantic. He tossed the health care to congress right from the start (that’s bi-partisanship I’d say) and what did they come up with?

    That this bill is a compromise is not denied. Many of those in the opinion polls who have voiced opposition to this bill have done so because it doesn’t go far enough. You’ll note in the Washington Post interview I cited he refers to 47 million Americans, and this bill falls short in that regard.

    “The centerpiece of his campaign was a new bipartisanship and transparency …”

    That’s about style – not policy. The top policies were clear. Absolutely clear. He’s been elected – in free and fair elections. That some are unhappy about his election, I don’t doubt. That’s always the case with elections. But he is your elected President, and he is fulfilling his promises. It makes a refreshing change for politicians to actually do what they promise on the campaign trail.

  18. Martyn of England Says:

    I forgot to link to the Washington Post interview I cited.

    http://projects.washingtonpost.com/2008-presidential-candidates/issues/candidates/barack-obama/#top-priorities

    (just noticed on the link, it even says ‘top priorities’)

  19. Mitsu Says:

    We shall see, Neo. I think if this bill turns out to be the disaster conservatives predict, it will be pretty clear relatively quickly. I suspect, however, that the Wall Street yawn reaction to it is far more realistic and likely to be the effect on insurance companies in the long run.

    It seems to me that characterizing Obama as a “leftist ideologue” is quite a stretch, if this all comes down to whether or not the health care bill has an individual mandate in it or not (and note: the Wyden Amendment allows states to opt out of the mandate if they can find another way to extend coverage to a comparable number of people), and when most of the provisions of the bill are based on relatively conservative Republican proposals in prior years. If you read the left wing sites (I know, why would you do that, you ask!) you’d see a lot of disillusionment from the left with Obama.

    Regarding CBO, I’m aware of the relatively artificial assumptions they have to make. However, this can also work in the bill’s favor, as the CBO did not factor in any cost savings from many of the pilot programs and other features of the bill intended to save money over the longer term. Consider this article in Health Care Finance News:

    http://www.healthcarefinancenews.com/news/study-cbo-may-have-underestimated-savings-health-reform-bills

    ‘Jon Gabel, a senior researcher at the National Opinion Research Center in Washington, D.C., argues that the CBO’s reliance on historical precedent in estimating costs of reform often leave little room for estimating savings, especially when major incentives have been added. “Too often, a lack of information is taken to mean zero savings, but zero is not a logical estimate,” he said.’

  20. Artfldgr Says:

    I’ve heard you talking about one of the “benefits” of Obamacare being the ability to add dependents to insurance until they are 26 years old. This has been the law in Illinois since June 2009. There is a catch to this. If the dependent you are adding doesn’t qualify as an “IRS qualified dependent” this is considered a taxable benefit for the individual that owns the insurance. So, for those employees who fall into this category, each payday, we have to add imputed income to their payroll that equals the monetary value of the insurance. The recommended imputed income amount is equal to the full cost of individual coverage. That means we add that dollar amount (for us it’s about $500) to the employee’s payroll, taxes are calculated and withheld, and the $500 is then removed from the employee’s payroll. Bottom line is the IRS, State, Social Security and Medicare all receive taxes on the value of the insurance benefit. Bittersweet deal.

  21. neo-neocon Says:

    Mitsu: it didn’t work in the CBO’s favor. I could list a thousand links that assert as much with great force and logic. I’m not going to bother.

    But I just want to say that if you think this HCR reform bill is the reason I say Obama is a leftist ideologue, that’s not it at all. I’ know you haven’t been around here for a while, but I’ve written a ton of posts on the subject in the last year and a half.

  22. Gray Says:

    Here is the part I don’t get:

    If some mope is sitting on his couch watching TV and sponging off his mom, he doesn’t pay taxes ‘cuz no income; doesn’t have a car so no car insurance; doesn’t own property so no property taxes….

    But because he is sitting on his ass not buying healthcare insurance, he’s breaking some kind of law?

    Seems unamerican.

  23. Mitsu Says:

    >it didn’t work in the CBO’s favor

    Well, I’d be happy to read some of those links. But my point is that in the past (as noted in the link I posted) the CBO has *underestimated* savings from incentives in new legislation, because they had no way of estimating those incentives. They did that with health care laws passed in 1983, 1997, and most recently 2003. So while I’m sure there are factors that would cause the CBO to underestimate costs, there are other factors that cause them to underestimate savings.

  24. Gray Says:

    Dear Mitsu, since you know so much about Healthcare Reform:

    Starting which year will it be advantageous for my family to drop all coverage and just pay the penalty? (I can always just buy back in if anyone, God forbid, gets really sick)

    Thanks in advance, Gray.

  25. Mitsu Says:

    The preexisting conditions law takes effect in 2014, if that’s what you mean, Gray. However, there is still an incentive to have insurance, which is that if you get into a catastrophic situation (let’s say, you get into an auto accident) and you don’t have insurance — while you could get insurance after the accident, whatever costs are incurred in your emergency treatment would not be covered, obviously, though your rehabilitation would be. If that’s a risk you’re willing to take, I suppose you could go ahead and pay the penalty.

  26. neo-neocon Says:

    Martyn: bipartisan? Don’t make me laugh. You apparently have no idea how true bipartisanship works in this country.

    Transparency and bipartisanship are not styles, either—they are procedures and/or processes. And they were the absolute centerpieces of Obama’s entire campaign. Through bipartisanship and transparency, a very different bill would have emerged. The American people were promised those things.

    They were also promised certain details of health care policy that were quite different than what they did get—and they were promised there would be no individual mandate, which they did get.

    And they know they were betrayed, and are angry about it. The betrayal about procedure and process is at least as deep as the other betrayal, IMHO.

  27. Gray Says:

    However, there is still an incentive to have insurance, which is that if you get into a catastrophic situation (let’s say, you get into an auto accident) and you don’t have insurance — while you could get insurance after the accident

    Wait a minute.

    If I am too incapacitated to purchase health insurance, how could I consent to the treatment and be held responsible for the costs?

  28. jon baker Says:

    En regards to comments about Wall Street: I have this theory that Wall Street is now heavily tilted towards the short term, not the mid or long term. Too many “investors” who buy and sell stocks on a short term basis for a quick profit, if possible. Also, I wonder if these various retirement accounts are skewing the system as well. People placing money into these accounts for someone else to invest-they have to invest it somewhere- right? So even if all the debt looks bad- they still invest in what looks best compared to the rest.
    Just my theory……

  29. jon baker Says:

    Who can ride the next bubble the longest- and get off just before it pops- that short term mentality-I think it skews the market as a predictor.

  30. jon baker Says:

    What was the National debt before this bill passed? $40,000 per person? (I have never been clear if that includes social security obligations or not) $40,000 a person and Wall Street is not concerned?- Something is terribly wrong.

  31. Ilíon Says:

    Square Deal

    New Deal

    Fair Deal

    Big F***in’ Deal

  32. Artfldgr Says:

    Well there you have it, Castro and Mitsu are in agreement…

    Cuban revolutionary leader Fidel Castro on Thursday declared passage of American health care reform “a miracle” and a major victory for Obama’s presidency, but couldn’t help chide the United States for taking so long to enact what communist Cuba achieved decades ago.

  33. Artfldgr Says:

    I’m sorry you feel that way, Neo.

    now where have I heard that kind of verbiage..

    http://halsim.ytmnd.com/

  34. rickl Says:

    I was complaining the other night on another thread that everybody, even conservatives, was calling it “the healthcare bill” which I considered intellectual laziness and gave the proponents an advantage.

    I’m glad that now we have a better name for it: “The Big F***ing Deal”. That’s appropriate on more than one level.

  35. Martyn of England Says:

    Neo

    Well, I’m pleased I made you laugh – it’s good for your health – apparently.

    I’m leaving the congressional procedures aside because they’re not always pretty. Someone once said, paraphrased, ‘watching what goes into the legislative process is a bit like watching what goes into making sausages; it puts you off your appetite.’ I heard Karl/Carl Meyer? of the NYT say it around 1990, though I don’t think he was the originator.

    Look back to the primary issue; what to do about about 20% of the population who are not insured. No matter where you sit on the political spectrum, it’s an issue. If nothing else, it’s a health risk for the 80% that are insured; who does the cleaning, who works in food outlets, who packs personal consumer products?

    If you wanted to keep ‘the state’ out of health care, the obvious solution for those working, but unable to afford healthcare, would be to pay a higher minimum wage so that they can afford to buy reasonable health insurance. Why isn’t that a proposal? Something is wrong if those on low wages, and may always be on low wages their whole lives, cannot have access to reasonable health care. There is also something wrong, very wrong, when people are made bankrupt because of limitations or exclusions on their insurance policy.

    Something had to be done. Can we agree on that? Or were you happy with the status quo? I don’t think so – reading back in your archives. You may well have your own ideas, but the problem is that you don’t sit in congress. The way I see it, Obama was elected on an HCR pledge, and soon after inauguration gave the issue to congress. The elected representatives, your elected representatives, had it for a year or so. They had ample opportunity to shape this bill, and basically, they failed. (That’s not me criticising USA, because it could just as easily happen in UK on another issue.) What does the President, any president, do in those circumstances? He, or she, has been elected on a pledge. He – or she – has an obligation to deliver and not to turn around to the electorate and say, “Sorry, I won’t be honouring my campaign pledge because keeping to congressional custom is more important.”

    HCR was a campaign pledge. It was in the top three promises. The 44th President was elected on those promises, and is endeavouring to honour those promises, albeit with some compromises to push it through congress. Like it or not, that’s democracy. Yes, I know you’re a republic, but you’re also a democracy that has elections. You may have given up eating sausages – I know I have – but I don’t think you’re going to give up democracy.

  36. ethos Says:

    Campbell reports that the new tax on unearned income for Healthcare applies to reportable capital gains from selling your house.

  37. Mitsu Says:

    >how could I consent to treatment and be held responsible for costs?

    Right now, today, if you show up at an emergency room unconscious they’ll treat you and still send you a bill. I suppose you could refuse to pay it, but I’m not sure what the legalities are there.

    However, you could certainly show up at an emergency room conscious; I don’t think in a situation like that you’d stop to try to apply for health insurance before they treated you. Or maybe you would, but if it were your spouse, your child? Somehow I doubt that.

  38. Mitsu Says:

    Another note on this topic: I tried to look this up but I don’t have the full information on it — whether the law allows insurers to require a waiting period after application. I did determine that the maximum waiting period for group plans would be 90 days starting in 2014; but I’m not sure whether this applies to plans sold on the exchanges. If it does, of course, then there’s significant incentive to purchase insurance; if an insurer can force you to wait 3 months for coverage, for example.

  39. Oblio Says:

    What the heck? I go on vacation for a week and return to find a troll infestation.

    Martyn, please go back to the Guardian site, and take your rubbish with you. 20% of the population are not uninsured, and this law doesn’t close the gap that exists, and it doesn’t do what it claims to do anytime soon. If Obama had made that his campaign promise he would have been laughed off television,always assuming you could have found news producers willing to do their jobs. A promise so vague can’t be shown to be “kept” in any meaningful way.

  40. betsybounds Says:

    Some here (Martyn and Mitsu, for example) seem stuck on the idea that no one should have to pay medical bills. This is the source of the notion that health insurance should cover everything, and its attendant evolution into being a payment plan. But whatever else that is, it’s not insurance.

    When our kids were little, we hadn’t much, and what we had didn’t include the means to pay for health insurance. So we got what we could afford–a high-deductible health and accident policy. For the rest, we paid ourselves. What a novel idea! We had a family doctor, who was very fine. We went to see him when we were sick, and we paid the bills for those office visits ourselves. Imagine that. If the bill plus necessary tests and treatment amounted to more than a modest amount, we paid over time. It wasn’t always easy, but it was never impossible and we never wanted for access to high-quality care. It would have seemed strange to me to think we should have done it any other way. And yet most people of limited means never seem to think of such a possibility. I really don’t understand that. There’s instead a notion that no one should have to pay for health care. I’m struck by Mitsu’s statement that, if you show up in an emergency room unconscious, you receive treatment and are sent a bill. Well, Duh! I know of no reason why you should not be sent a bill under such circumstances.

    I continue to maintain that it would be possible to provide assistance to the truly or marginally needy without nationalizing the entire system (except of course for the system’s masters, who have their own gold-plated system those under their thumbs cannot hope to access).

  41. neo-neocon Says:

    Martyn: What happened with this bill was not sausage-making as usual. In fact, the fact that this was unusual is the subject of my entire post. If you don’t get that, it’s a waste of time for me to explain it again. This wasn’t sausage that was made, it was excrement, made in a plant that was in violation of the health care codes.

    In addition, Obama let Congress handle the drafting of the bill. That was not what he was elected to do. He was elected to provide leadership, and there are many ways a president can guide Congress. He could have submitted his own proposals and policies, for starters. He could have condemned the things they proposed that he thought were a bad idea. He could have had his own bipartisan meetings and also insisted on the transparency he had promised, and he should have condemned Congress when it did not. He did none of those things he should have.

    In fact, what he did was to “leave it to Congess” (wink wink). However, I don’t think for a minute he and Pelosi and Reid were not in close touch all the time. His own particular personal sausage-making game was to pretend he was above it all and watch them make offal, and pretend he had nothing to do with it, no input, and no power to stop it or even comment on its errors or excesses. And then, with practically a laugh, he rejected one of the most basic principles he is supposed to stand for as president and defender of the Constitution (not to mention “professor” of con law), he said to Brett Baier on national TV that he didn’t “worry” about procedural matters.

  42. betsybounds Says:

    Martyn,

    It’s true that HCR was a campaign pledge. But the pledge differed in some important respects from the product we have now (just for starters, the pledge that no one with income under $250,000/year would see a tax increase has been shattered). Obama never presented a plan. He turned the entire enterprise over to the House and Senate, and for a long time–indeed, up until passage–many in the Congress and virtually no one in the population-at-large had a clue what was in the bills–yes, there were multiple bills. As I’ve mentioned before, it was a big shell-game, and part of the point seemed to be hiding what was really going to end up being in it. We knew some things, and the things we did know were distinctly, firmly opposed by the American people. It’s legitimacy is therefore called into serious question, and the fact that people are not going to just sit down and shut up about it should surprise no one. In fact, it would be more surprising were that NOT the case.

  43. jon baker Says:

    Cuba, the country from which people get in overcrowded boats, risking their lives to try to get to America. In this AP article I link to below, Fidel Castro praises the US for the so called Health Care reform. You can tell this article was written by one of our many Communist from within however, for instance “Cuba pr…ovides free health care and education to all its citizens, and heavily subsidizes food, housing, utilities and transportation, policies that have earned it global praise. “:
    http://finance.yahoo.com/news/Cuban-leader-applauds-US-apf-124808403.html?x=0&.v=1

  44. neo-neocon Says:

    betsybounds: The problem is that, because costs have risen so dramatically in recent years (for many, many reasons) even catastrophic insurance can be very expensive and not reasonable at all, especially for people who for one reason or another are not covered through group insurance at work and who must buy individually underwritten insurance. If they have pre-existing conditions, catastrophic insurance can go through the roof. That’s fine if a person or couple have good jobs or are fairly wealthy. Or if a person is really poor, he/she can usually get Medicaid.

    If not, there can be big trouble. It’s hard to generalize, because the rules and prices are different state by state (again, for a number of reasons), so that catastrophic insurance for such a person might be somewhat affordable in one state but unaffordable in another.

    In some states, for example, even the highest deductible individual coverage allowed can be extremely expensive for individuals who have pre-existing conditions, even if the conditions they have are fairly minor and common. The insurance costs plus the deductible (which that person must pay in full, including all medication costs, up to the deductible) can easily run to 13K a year per person out of pocket (young people would be less, of course). Remember, that’s before catastrophic would kick in.

    This does not mean that the present HCR bill is the answer. I think it will make matters worse for most of us. But there is a very real problem for a fairly small group of people who fall into the category I have described, and probably some other categories as well.

    I think there are a number of solutions—for example, tort reform, and having larger pools of high-risk people (perhaps across state lines: portability), allowing companies to offer more choices in catastrophic policies for everyone which should help in lowering premium costs.

  45. Mitsu Says:

    Neo, I’m very glad to read your last comment, above, because I think at least now we’re talking substantive policy and it’s here where a fruitful discussion can take place. I’ll say more in a moment, below.

    betsybounds: I am certainly not stuck on the idea that no one should have to pay anything for medical care. I mean, there’s no such thing: even if one were to completely nationalize health care, we’d all still be paying for it via taxes. Health care is simply not free. However, our system, as it exists currently, is not only not free, it’s extremely expensive. The most expensive, by a huge margin, in the world.

    As I’ve argued before, I believe there is a good case to be made for keeping health insurance private, to encourage innovation. And that’s the core of the HCR plan that just passed: it’s not nationalization of health care, at all. There’s no national health insurance. It’s just a set of regulations intended to deal with problems of cost control, rescission (where insurers arbitrarily cancel policies when you get sick, on technicalities), unaffordability and/or unavailability of coverage for those with preexisting conditions, and so on.

    The basic template for the reforms is, as I’ve been arguing, based primarily on conservative, not liberal, ideas. The idea of health insurance exchanges to broaden the risk pools for individuals came from conservative think tanks, and was one of the centerpieces of both Nixon’s proposal and the Republican counterproposal to Clinton’s attempt to do this in the 90’s.

    In essence the idea here is, basically, to broaden the risk pool. HCR basically says: include those with preexisting conditions along with lots of other people in large risk pools (the exchanges) so that coverage is affordable for everyone. Can this work? It has been proven to work in other countries. Will it work in this case — I think so, but it remains to be seen.

  46. Mitsu Says:

    And — just to reiterate — I agree that tort reform is a good idea and should likely be done.

  47. Mitsu Says:

    Oh — one other point. If you prevent insurance companies from using preexisting conditions for underwriting (the law prevents them from using them either to deny care or to set premiums), this also helps on the rescission front, because technicalities such as leaving off a doctor appointment or a chiropractic appointment, etc., from your application could no longer be used against you for rescission, since it could not affect either the coverage decision nor your premiums. Therefore the insurance companies can’t use it as an excuse for rescission, since that information would be moot — and this would close a major loophole many insurers had been using to cancel policies when people got sick.

  48. Martyn of England Says:

    betsybounds

    I appreciate your point, but health care costs have risen dramatically since your kids were little. While you may have been able to meet medical costs on a pay-as-you-go basis, that may be because you were fortunate not to have a major illness or condition. Did you see the post yesterday from someone who was born with a heart condition which required surgery costing $100,000? Despite eating well, taking regular exercise, health is still very much like a lottery. Insurance spreads the risk, but it needs to be continuous insurance cover, otherwise people get caught at vulnerable stages.

  49. Martyn of England Says:

    betsybounds

    Further – some people believe they are covered by their insurance policies for years, only to find the insurance company has a different interpretation on the small-print when a claim is made. We can’t all be lawyers.

  50. neo-neocon Says:

    Mitsu: you are picking and choosing a few trees from the HCR bill and saying they are the forest. But they are not.

  51. neo-neocon Says:

    Martyn: catastrophic insurance—which is generally available, although expensive—would cover that 100K operation. That’s what catastrophic insurance is for. Most states, as I’ve said many times, have high-risk pools to offer catastrophic coverage for people with pre-existing conditions. And if a person is poor enough, Medicaid kicks in.

    Somehow I feel I’m repeating myself.

  52. Martyn of England Says:

    Neo

    I understand what’s gone on. I understand the purpose of your narrative at the top of the page. I saw what he said to Brett Baier. I pretty much agree with all of your post at 8.43pm. As you say, Obama did “leave it to congress,” – I described it somewhere that he, “tossed it to congress.” So – he hasn’t followed convention – he hasn’t behaved according to expectations. But – he hasn’t broken the rules – the Constitution is still intact. He has, however, converted his pledge into some sort of a bill, and he has managed to get it through congress – just. I don’t suppose he’s entirely happy with the final bill(s) either, or the process. I disagree that it’s excrement though; an irregular sausage, maybe.

    We are all lucky. We were born in a democracy where policies can be argued, debated and voted upon and where it isn’t necessary to kill your opponents in order to determine a winner. Don’t forget that being in a democracy means – the loser gets to fight another day.

  53. Gray Says:

    However, you could certainly show up at an emergency room conscious; I don’t think in a situation like that you’d stop to try to apply for health insurance before they treated you. Or maybe you would, but if it were your spouse, your child?

    The hospitals aren’t stupid; they aren’t going risk losing money on people paying the penalty and showing up sick. The hospitals will include insurance sign-up forms with the consent forms!

    I don’t think you’ve really thought this thing out….

  54. Gray Says:

    I’m leaving the congressional procedures aside because they’re not always pretty. Someone once said, paraphrased, ‘watching what goes into the legislative process is a bit like watching what goes into making sausages; it puts you off your appetite.’

    That’s not sausage! Those are turds! Hey, that’s not even a sausage grinder!

  55. Otiose Says:

    Replace, Repeal, Reform

    Replace every possible Democrat including eventually Obama

    Repeal the Health Bill

    Reform – fix the health care system

  56. Gray Says:

    Oh — one other point. If you prevent insurance companies from using preexisting conditions for underwriting (the law prevents them from using them either to deny care or to set premiums), this also helps on the rescission front, because technicalities such as leaving off a doctor appointment or a chiropractic appointment, etc.,

    Yep. That’s why hospitals will be able to include sign-up forms with the consent forms to ensure they get paid.

    Which makes it possible for me to drop all coverage, pay the penalty only and sign up if anyone in the family goes to the hospital.

    F the insurance companies. Right?

  57. Martyn of England Says:

    Neo

    Ref catastrophic insurance and other similar cover.

    Yes, I’m aware that there are clever, sensible people who have continuous, steady careers and prioritise their spending in perfect order throughout their whole lives. Somehow, it doesn’t always work out that way though. And not everyone is as clever as they need to be, nor can they do anything about it. They’re at full their potential.

    Thanks for your replies, Neo. I’m not expecting a reply, but I wouldn’t want you waiting for a further response, so out of politeness, and not in anyway to be rude, I have to go now.

  58. ELC Says:

    @ Ethos 7:56 pm. Campbell reports that the new tax on unearned income for Healthcare applies to reportable capital gains from selling your house.
    I guess it’s a good thing the housing market is in the tank.

  59. Martyn of England Says:

    Correction: They’re at their full potential.

  60. Gray Says:

    Yes, I’m aware that there are clever, sensible people who have continuous, steady careers and prioritise their spending in perfect order throughout their whole lives.

    And if you keep squeezing them to pay for the ne’erdowells, nincompoops and slackers, all you will have is a nation of ne’erdowells, nincompoops and slackers drinking lager, watching ‘football’ all day and singing “Rule Britainnia.”

    Oh, wait….

  61. Mitsu Says:

    >picking and choosing a few trees

    Am I? It seems to me the central feature of this HCR law that makes it so problematic for Republicans seems to be the individual mandate. But the mandate is necessitated, it seems to me, by the attempt to combine everyone with preexisting conditions together by outlawing medical underwriting. I mean, if there’s some other way to do it, then I think that ought to be considered, but it seems as though this is a fundamental problem.

    The rest of the bill, including various cost control ideas, experiments with bundled payments (also a Nixon idea), incentives to modernize health care IT, subsidies for low income and small business, allowing children to stay on their parents’ plans longer, preventing arbitrary rescission, and so on, are all ideas which seem relatively uncontroversial and I’ve heard Republican support for many if not most of them. What else in the bill is problematic for you?

  62. mikemcdaniel Says:

    Hmm. I’ve been pondering why, of all the potential candidates, Obama chose Joe Biden for the VP job. After all, Biden didn’t deliver Delaware–it was solidly in Obama’s pocket. And yes, Biden was and is a solid leftist who has been desperately wrong on every significant issue, internal and foreign, for as long as anyone can remember.

    But perhaps I’ve hit on the primary reason: Biden poses no threat to Obama in any way or form. Narcissists cannot abide criticism or conflicting ideas, and Biden certainly won’t provide any, if he’s allowed within 500 feet of Obama outside the rare public appearance. By comparison to Biden, Obama appears a genius, yet it’s clear to see that Obama barely tolerates Biden, even in public. I find myself even feeling sorry for Biden, but I always feel far more sorry for America.

    Those leftists who claim the right is interested in committing violence against the one are completely off the mark. If anything happens to Obama, despite the lunacy of his policies, we’d have President Biden? ! And if anything happened to Biden, President Pelosi?! No conservative in his or her right mind would do anything to put those two in the seat of ultimate power.

  63. neo-neocon Says:

    Mitsu: What else is problematic? Are you kidding? Have you not read my posts? Have you not read the comments of hundreds of people here?

    In the case of the individual mandate, not only are you picking a tree rather than the forest, but it’s the wrong tree. Yes, conservatives don’t like the individual mandate, but they focus on it not because it’s their biggest objection (it is not), but because it’s the simplest and clearest to attack in terms of (a) its unconstitutionality; and (b) the fact that it goes against something Obama explicitly campaigned on. It’s one of the trees, but hardly the biggest or most important.

    Much bigger trees that conservatives see are (a) the fact that the whole thing is likely to drive private insurance out of business (and probably was designed to do so while promising not to do so, and therefore is a sort of scam); (b) the destructive effect on our entire economy, ultimately; (c) the lack of effective cost-reduction; (d) the negative effect it will have on larger and/or more lucrative businesses and jobs creation (except, of course, for those thousands of IRS hires) (e) the unfairness of the special fixes (f) the hidden and rushed way it was done (g) the restriction of personal choice (h) the increasing intrusion of government into medical decisions (i) the income redistribution aspects (j) the way the American people’s will was ignored and overridden; (k) it will drive doctors out of the field; (l) it will reduce medical innovation.

    That’s hardly an exhaustive list, but it will do.

    As for smaller things—I would say that most conservatives and Republicans take a lot of umbrage at the idea that 26-year olds should be defined as”children.”

    I don’t mean to be rude, but I probably won’t be replying to you at length anymore on the issue of HCR. I haven’t got the time.

  64. neo-neocon Says:

    mikemcdaniel: I’m in complete agreement with you. I would like to add, however, that it’s interesting to think of the contrast with Bush’s choice of Cheney. Cheney was certainly controversial in his own way, but Bush was no narcissist who had trouble with a mega-smart VP who would challenge him and bring a great deal to the table on his own. He welcomed it.

    Obama, who is indeed a narcissist, wanted a VP who would make him look good in contrast, and who would never threaten his power. An amiable buffoon who would also be on board in terms of whatever policy Obama wanted to pursue.

  65. Gray Says:

    don’t mean to be rude, but I probably won’t be replying to you at length anymore on the issue of HCR. I haven’t got the time.

    Nope…. But he’s an expert on Global Warming.

    (WAAAHAHAHAHAHA!!!!)

  66. Baklava Says:

    Mitsu,

    You’ve got a lot of reading to do. You don’t understand conservatives ONE BIT.

    Meanwhile Mitsu and Obama are responsible for stealing from two daughters .

    You’d think he’d get to reading…

  67. Mitsu Says:

    If you don’t want to engage in a dialogue with me, that’s fair enough, Neo. However, I’ll do my best to reply to your post as well as I can.

    The main point I have in response to your list is that, for the most part, you’re not listing elements of the law you object to, but rather things you think the law is going to do, or effects you predict the law will have. But obviously nearly everyone would agree that if the law actually did most of those things that would be a bad thing — the question I have for you is *why* you think the law would do these things, i.e., how do you think the law is going to create these effects, what elements of it will have those effects.

    >(a) the fact that the whole thing is likely to drive private
    >insurance out of business (and probably was designed to
    >do so while promising not to do so, and therefore is a
    >sort of scam)

    The law allows a medical loss ratio of 80% in the small/individual market and 85% in the large market. As I noted earlier, Aetna currently operates with a loss ratio of just over 85%, and it is profitable. While the law does mandate insurers cover people with pre-existing conditions, it also should add millions to the rolls of the insured, offsetting the additional cost. In any event, even if costs rise as a result of HCR, insurers are allowed to raise premiums as long as they are at least as efficient as Aetna. Under what scenario would insurance companies go out of business?

    >(b) the destructive effect on our entire economy, ultimately

    Why will HCR destroy the economy? You assert this but I don’t understand what your theory is. (I’m not saying you don’t have a theory, I just don’t understand what it is).

    >(c) the lack of effective cost-reduction

    There are a number of cost control ideas in the bill; here’s a quick list:

    http://voices.washingtonpost.com/ezra-klein/2009/12/five_cost_controls_in_the_sena.html

    What else would you propose?

    >(d) the negative effect it will have on larger and/or more lucrative businesses and jobs creation (except, of course, for those thousands of IRS hires)

    Is your theory here that the government is a more inefficient job creator than the private sector? I will point out that most of the spending under this bill does not go to government jobs, but rather simply gets sent to low-income people and small businesses to help them pay for health insurance, as well as Medicaid which goes ultimately to private doctors (also note that Medicaid payments are increased under HCR). This money gets injected straight into the private health insurance industry, which then gets sent into the private health care industry, which presumably is more efficient than government.

    >(e) the unfairness of the special fixes

    The Nebraska fix was removed from the bill in reconciliation, and the Medicaid unfairness was handled by changing the bill so all states are helped (all Medicaid increases are funded).

    >(f) the hidden and rushed way it was done

    I actually agree to some extent with this criticism. I think they should have tried longer to get Republican support. However, I also believe Republicans took a position of opposition to the bill no matter what was in it, based on political calculations that this would benefit them more than cooperation.

    >(g) the restriction of personal choice

    The bill preserves the private insurance industry pretty much as is. Aside from the mandate (which you already stated was not the big issue), what restriction of personal choice is there? You are free to choose which insurance to buy, etc. (Admittedly there are new requirements on coverage and out of pocket expenses).

    >(h) the increasing intrusion of government into medical decisions

    Again, I don’t see what specific parts of the law you have in mind here. Since the entire healthcare system remains private, there’s no “intrusion” going on — health care decisions remain private. I might add that if you don’t have insurance, today, you don’t have much in the way of freedom to make any health care decisions other than going to the emergency room.

    >(i) the income redistribution aspects

    Okay, there’s clearly some disagreement about how much subsidy ought to be given poor people and small businesses, etc. This is a longstanding disagreement between the two “sides”. I personally feel strongly that poor people ought to have access to health care, even if it means some “income redistribution”, for many reasons, not the least of which is that being poor ought not to be a death sentence, and also because I think the costs associated with having poor people not get preventive care, having poor people use the ER for everything, etc., drives up health care costs for everyone.

    >(j) the way the American people’s will was ignored and overridden

    As I’ve stated before, polls show nearly every aspect of this bill is popular if you ask people about specific provisions of the law. The fact that the law as a whole is unpopular seems to be because people don’t realize what is actually in the law.

    >(k) it will drive doctors out of the field

    If the law functions as I predict, I see no reason why this would occur. Doctors will get paid, health care costs will stabilize, and patients will continue to be seen. There’s no government intervention in health care decisions. Of course, if the economy collapses as you predict, then it will drive everyone out of every field, not just doctors! I still don’t see specifically what in the law would drive doctors out of the field, unless you simply mean the law will cause the whole economy to collapse.

    >(l) it will reduce medical innovation.

    Again: system remains private. What aspect of innovation will be reduced as a result of this law? The law doesn’t even cap premium increases; it only provides for a specific efficiency level for insurance companies.

  68. Darrell Says:

    Neo, you hit on an old adage which is apropos, a smart leader surrounds himself with people who are smarter than he/she is, then enables them, lets them go and appears the hero through very little effort, the skill really is in recognizing this, exploiting, nurturing, growing it. They make you look good

    It is incredibly telling when the supposed leader is threatened by smarter people. Kind of says it all.

  69. ELC Says:

    @ Mitsu 2:23 am. >(c) the lack of effective cost-reduction

    There are a number of cost control ideas in the bill; here’s a quick list:

    And here’s an argument that more than a dozen components of the law will actually increase costs:

    http://www.thelibertypapers.org/2010/03/22/obamacares-immediate-impact/

    The real problem is this: nobody, absolutely nobody, understands the real ramifications of a 2,400-page law. It is not possible to do so. Few people (including the members of Congress who voted on it) actually know what’s in it, let alone understand how it all would, at least in theory, supposedly work together.

    I know this: the founders of this country would be appalled at the idea that a legislature would pass a 2,400-page law. They would be horrified at the notion that a legislator would vote for a bill the contents of which he simply cannot know let alone understand because… it’s 2,400 pages long.

    Who the hell would sign a 2,400-page contract? But that’s exactly what Congress has done: they have signed a 2,400-page contract that binds every last one of us.

    We ought to be appalled and horrified too. I’d like to call what the Democrats in Congress have done malfeasance, but really, it’s more like lunacy.

  70. csimon Says:

    Neo, great post; even more telling, back & forth comments from Martyn and MeToo (sorry Mitsu…just couldn’t resist). Could feel your growing ah…frustration at Martyn and Mitsu’s inability to grasp what has just occurred here in America, and it’s not the utopian vision they seem eager to embrace. They seem to see us as immutable, dumb obstructionists with no sympathy for our fellow man, not to mention ingrates regarding the great gift Obama has shoved down our collective throat, because we wouldn’t take it like good little Socialists (or, maybe I shouldn’t have used that “S” word. Is Liberal or Progressive more acceptable? Whatever. Fact is that when he and the Dems. couldn’t muster the requisite number of votes to pass their dream HCR bill — even with their formidable majorities — they were going to get it done no matter what it took (Martyn and Mitsu — are either of you familiar with Nurse Ratched from “One Flew Over the Cuckoo’s Nest?” You ought to read some of Neo’s recent posts throughout March. Particularly the ones (around Mar. 16 or so when it becomes clear that the Dems are gonna give this to us — however they have to! Americans MUST HAVE the system THEY, being much smarter, know we need.

    I started posts numerous times in response, but I eventually realized that no matter what I wrote, it would be useless, to point out endless the mandates, obscene new taxes (I guess technically they don’t “raise taxes;” they just impose newer ones and collect the old and the new to pay for this monstrosity), imposition of more than 150 layers of bureacracy to start (to say nothing of staffing them!) — the special deals…er, bribes, in the bill to buy votes (and if one more person says “well, that’s how things are done in Washington,” I say it’s time to say NO MORE!

    Martyn and Mitsu seem to have no understanding of the breadth of the takeover this new law achieves, and the REAL loss of freedom that will result. Neither seem to understand that a) Insurance companies are for-profit businesses in a capitalist economy, and operate to return a profit (albeit via one of the smallest profit margins in any segment of industry today). They also do not seem to understand that this bill is NOT Healthcare Reform, but, rather, INSURANCE reform designed to very quickly destroy that industry (Mitsu, do you not understand at all how insurance companies are structured and why they assign premiums and rates as they do? Have you ever heard of actuarial tables?…..) Well, what we do know is that our current President does not want to know from actuarial tables or real life medical history. Mr. Magic Mouth explains out of one side of his mouth that he wants to incentivize preventive care which will, in turn make us all healthy, and need less medical attention, medicine, and state of the art devices — so guess what? We will spend less! Hey, Martyn and Mitsu, Obama’s next best accessory besides the Teleprompter, are the chain of cigarettes hanging from the other side of his mouth. But so what if he’s a hypocrite? So what if he and Congress are exempting themselves from the mandates that apply to all others in this country.

    And Martyn and Mitsu, you delicately speak about the savings from which we will benefit…. Do you need someone to conch you on the head with the Liberty Bill to get the fact that administering this “well-intended” new system changing every way in which medical-anything touches consumers will cost an obscene amount of money WHICH WE DO NOT HAVE!!!!!!! The Dems have already spent, raised spending limits and spent some more, given private auto industries to unions and taken over a good bit themselves…., spent billions on pork-laden goody bills whose chief accomplishent has been to create a new metric called “jobs saved” as the unemployment level continues upward. (And wait until all these taxes hit the business fans! Job killing does not begin to describe the damage about to be inflicted on America!
    Neo’s right. If you want to discuss and debate — great. But get your facts, read (Neo’s posts are a great source of information as are countless other blogs, research documents and studies, and even the stuff this Administration posts online; that is, as President Obama said, AFTER the bill is passed!

    Martyn and Mitsu and all who think your prayers have been answered with the passage of this Healthcare, no, let’s call it what it is: an Insurance Reform bill (after all, since signing, even Obama uses that term now that the veil is off… — it’s not about one mandate or two, or a new tax here and there. We angry because we’ve been lied to . We’re angry because instead of fixing what’s already broken — like Medicare and Medicaid and Social Security, we’ve just had an abomination of a bill voted into law (and I use that term loosely since it wasn’t any vote as prescribed by our revered Constitution) which will effect every aspect of our lives — not just medical. If the previous obscene spending were not enough, this will lead us right off the cliff. The CBO scoring is a joke so don’t use that to back any arguments. Theirs is more like the game “Jeopardy!” where Obama and the Dems give them the answers they want, and the CBO comes up with the questions that must be asked by the Congress in order to result in numbers falling within their desired parameters. And, even, then, Congress is dishonest by pretending something very much related to healthcare, like the “doctor fix” would, uh oh, raise the costs so they couldn’t claim their bill was not only revenue neutral, but that it would reduce the deficit. (That would, indeed, be a miracle.) Since miracles are not all that common in D.C., they just take out that multi-hundred billion doctor fix which they’ll stick in some other spending bill….and you won’t notice, will ya? And, if you really get enthusiastic about reading HCR’s legalese, let us know when you get to the part that nationalizes all college student loans (which are govt. guaranteed). Why, you might ask? So the federal govt. cuts out 2000+ private businesses that have heretofore been making student loans and the govt. gets the profit –all that interest, of course. But hey, they’re not so altruistic so as to put said profits back into the loan pools thus increasing the number of loans available. Heck no! That money is grabbed for the express purposes of paying for HCR.

    Now, for a little comic relief courtesey of Kimberly Strassel of the Wall Street Journal as she explains what happens with reconciliation after Obama signed it into law: http://online.wsj.com/article/SB10001424052748704094104575144072513654904.html?mod=rss_opinion_main

  71. SteveH Says:

    “”being poor ought not to be a death sentence””

    Here we get to the crux of the issue. Why not just say being poor should not mean a person is sentenced to a life of inferior food, clothing and shelter in comparison to society’s more successful?

    Liberals are hell bent on a path for our nation of destroying incentive to be successful while rewarding life long incompetence. It’s like watching a nation wide train wreck in slow motion.

  72. Joe Biden f bomb video | What did Joe Biden say | Joe Biden big deal | tophealthplans.info Says:

    […] neo-neocon » Blog Archive » A big F-ing deal: the distinguishing … […]

  73. Mitsu Says:

    csimon: If the law actually ended up doing all the things you say it will, i.e., if it really were a huge takeover of the insurance industry, massively restricted choice, and so on, then I of course would agree with you that it’s a bad law and ought to be repealed. But my point is, why do you think this? Is it simply because it’s a large bill? What features of the law will cause all these terrible effects?

    Admittedly it’s a big, complicated bill, but I’ve read many descriptions of the bill and many criticisms of it, but so far it seems to me the biggest systemic effect is going to come from the mandate combined with the fact that insurers will no longer be able to deny coverage based on preexisting conditions. The biggest cost comes from subsidies to low income people and small business, plus increases in Medicaid. This is paid for by small reductions in Medicare spending, some payroll taxes on people making more than $250,000, and limits on employer health care tax deductions starting in 2018. The rest of the law involves things like allowing children to stay on their parents plans, cost control measures, outlawing lifetime limits on benefits, and so on. If you think there’s something in the law I’m missing which will have all these terrible effects, I would love to read them. Or, if you think what I’ve just listed will have all these terrible effects, then I’m curious to know why you think so.

    In my opinion the law is fairly comprehensive but try as I might I can’t see that it is going to have that huge or catastrophic an effect. I mean, we already have some worst case scenarios: New York State enacted some boneheaded “reforms” several years ago in which they eliminated restrictions on preexisting conditions but didn’t enact any sort of mandate to offset this. The effect was bad (premiums nearly doubled) but it wasn’t catastrophic. New York State didn’t collapse. The law that just passed seems to me to be a lot more sensible than the New York law, so even if it ends up not working well, I can’t see how it would be worse than what we’ve already seen in New York.

    I certainly can’t be sure this law is going to work. If it ends up not working as I predicted in my little wager with Neo, I’ll buy her dinner, like I said. But as I’ve said, it’s a law which is close to Republican proposals, it’s similar to a plan the Nixon proposed, similar to a plan that Howard Baker and Bob Dole proposed. I mean, sure, maybe it’s bad policy, maybe it won’t work, but socialist conspiracy? I really don’t think so.

  74. I R A Darth Aggie Says:

    My view is that the HCR law will likely reduce the growth of health care costs relative to what they would have been

    Of course. If you can’t get health care, you don’t have any costs.

    QEF’nD

  75. Artfldgr Says:

    Mitsu Wall Street seems to agree, so far: health insurance stocks are doing fine as they have been during the whole debate.

    “Not many people noticed amid the Democrats’ struggle to jam their health care bill through the House, but in recent weeks United States Treasury bonds have lost their status as the world’s safest investment. The numbers are pretty clear. In February, Bloomberg News reports, Berkshire Hathaway sold two-year bonds with an interest rate lower than that on two-year Treasuries. A company run by a 79-year-old investor is a better credit risk, the markets are telling us, than the United States government. Buffett’s firm isn’t the only one. Procter & Gamble, Johnson & Johnson and Lowe’s have been borrowing money at cheaper rates than Uncle Sam.”
    http://www.washingtonexaminer.com/politics/Bond-markets-reflect-the-true-cost-of-Obamacare-88952847.html

  76. Baklava Says:

    Mitsu,

    And taxes on women’s products.

    And a restructuring of compensation for specialists vs. general practitioners to massage costs. Need a Neo-natal specialist? Neurosurgeon? Knee specialist? They might leave their field much quicker because of frustration. 1/3rd of doctors polled said they are “done”. But as Mitsu can’t read – he’ll poo poo that poll and not “listen” to it and have his own view until the cows come home. Listening is not Mitsu’s strong point.

    You can’t write about Hayek.

    You can’t write logically about HCR.

    You can’t listen to logic in so many areas .

    The only thing you CAN listen to is Obama. You even trotted out Obama’s talking points on Dole and Baker as if this 2733 page monstrosity is actually good because of that talking point.

    This 156 NEW department, 1,000’s of tax increases bill (on a bunch of women’s products like breast pumps and tampons), with huge impositions on state budgets that are already in over their head, treating people who pay HIGH premiums for health care as needing to pay some sort of ‘luxury’ tax monstrosity of a bill is nowhere near positive.

    Not positive.

    Not at all.

    And you can’t get it right to save your life on this simple cut and dry issue. And you can’t get Hayek’s views right either. You lied about Hayek and then didn’t apologize about it or address it later. That is cowardly. I’ll admit if I got something wrong. Mitsu can’t.

  77. Baklava Says:

    http://www.washingtonpost.com/wp-dyn/content/article/2010/03/14/AR2010031401388.html

    A man much smarter than Mitsu speaks.

    His name is Paul Ryan. He speaks common sense.

  78. Baklava Says:

    And Thomas Sowell writes:

    http://www.humanevents.com/article.php?id=36155

  79. SteveH Says:

    Mitsu says…”I certainly can’t be sure this law is going to work.”

    Would you imagine a used car salesman with a shady reputation trying to shove a used car down your throat that you don’t want, might just have ulterior motives other than you getting a good car like you wanted?

    I’d say theres not a snowballs chance in hell i’d trust such a dubious reputation to sell me ANY CAR. This objection by a majority of Americans is not about the intellectual intricacies in a 2400 page healthcare manifesto. It’s intuitive common frickin sense that most people learn by the age of 12 that protects them in life from charlatans and con men.

  80. Wolla Dalbo Says:

    I point to two very significant op/ed pieces that have appeared today.

    One, in the Washington Times, is an op/ed titled, ”Will America Break Up?” which–in a very straightforward and lucid way–lays out the argument for Obama & Co.’s policies setting the stage and provoking such a break up (http://www.washingtontimes.com/news/2010/mar/25/will-america-break-up/).

    The other op/ed titled, ”Pelosi Sends Chill,” which accuses Speaker Pelosi of tyranny and the abuse of her power, is even more surprising, since it was published in “The Hill,” a tabloid that circulates on Capitol Hill, which could probably best be described as the trade paper for members and employees of Congress. As such, “The Hill” (so as not to alienate potential readers and advertisers) usually prints material that is pretty un-inflammatory, and not very hard hitting at all.

    This op/ed is the antithesis of the material they usually print, and the fact that they printed it tells me that the people at The Hill—knowledgeable and close observers of the goings on on Capitol Hill– are very worried, indeed (http://thehill.com/opinion/columnists/cheri-jacobus/89241-pelosi-sends-chill).

  81. Baklava Says:

    Off topic: but WOW !

    http://dailycaller.com/2010/03/25/obama-inspires-black-politicians-to-seek-office-%E2%80%94-as-republican-candidates/

    36 Black republicans inspired to run for Congress

    GO STAR PARKER and ANGELA MCGLOWAN !

  82. Baklava Says:

    Off topic again:

    http://gatewaypundit.firstthings.com/2010/03/obama-refuses-to-dine-with-jewish-leader/

    omg.

  83. Baklava Says:

    Corruption:

    Average Democrat brings in twice as much as Republican districts.

    Rewards? Kickbacks? Discrimination?

    Need more reason to reign in this fascist big government?

    http://biggovernment.com/vderugy/2010/03/26/politics-democratic-stimulus-haul-is-almost-double-republicans/

  84. ethos Says:

    Entitlement Apocalypse

    http://tinyurl.com/yb5swth

  85. Mitsu Says:

    Baklava: Can you provide more details on the change in compensation for specialists? I assume you’re talking about Medicare, since the bill doesn’t mandate any particular compensation for doctors who are being paid by private insurers.

    Regarding the “tampon tax”: there is no tax on tampons in this legislation. I have seen a few scattered references to that on some conservative blogs, but in fact they seem to be referring to a section of the bill which is a 2.3% excise tax on medical devices: but it specifically excludes over the counter devices, which obviously includes tampons.

    As for Paul Ryan’s article: there are some interesting ideas in there, in particular his support for Wyden’s alternative health care proposal which tries to address some of the issues by introducing a tax exemption for personal purchase of health insurance. There’s some merit to that approach but it would also be expensive: none of these approaches are free. Ryan’s insistence that the law will raise the deficit, however, seems to be just an assertion not backed up by any specific analysis. The law is intended to be deficit-neutral or actually good for the deficit, because the subsidies and other costs are offset by the taxes and Medicare spending cuts I noted above.

  86. Baklava Says:

    Will you read it Mitsu?

    http://online.wsj.com/article/SB10001424052748704471504574443472658898710.html

    Are poo poo it? Just like the poll concerning 1/3rd of doctors will quit their practice with this monstrosity… you can’t ignore this stuff. You have to give it it’s due diligence.

    Excerpt from the bottom of the article:
    Markets are supposed to determine the composition of the workforce, not a command medical economy run out of Washington. It is perfectly insane to support one type of doctor by punishing others on a flawed theory about cost-control.

  87. Mitsu Says:

    Fair enough, Baklava. When I have more time I’ll look more into this. However, keep in mind that that article was written about the Baucus bill which came out of the Finance Committee; the same bill which Olympia Snowe voted for. The bill has changed considerably since then. Are the same Medicare payment rules in place now?

  88. Baklava Says:

    More time?

    How about stepping away from the keyboard until you actually understand Hayek and the HCR?

    And during this cram down… with emphasis on cost reductions by you and Obama … with 2733 pages… you bet I believe it is in there in some form. The war on specialists was a part of the Hillary plan also.

    And let me say this. You are dealing with somebody very well read who reads both sides of the argument. I was a liberal pre-1991. It was that year I visited the library 3 times a week for a full year trying to determine what was true.

    More or less – this is a matter of common sense – this bill with 156 new departments / agencies and 1,000’s of tax increases, no tort reform, etc is the WORST possible plan.

    We can learn from India’s health system.

    We would actually be better off with a nationalized system rather than this Obama care plan which you tend to like.

  89. Mitsu Says:

    I think it’s amusing that you think a nationalized system would be better! Well, we shall see. Again: I haven’t been able to find any references to the specialist cuts in Medicare in the final version of the bill — articles referencing this seem to be about much older versions of the bill. This is not to say it isn’t in there, just that I haven’t found references to it yet.

    I am sure you are well-read, Baklava. Nevertheless I think you might find it interesting to read about economic psychology and other more recent developments in economics. I find the whole subject quite interesting.

    Consider this simple case: you have several fisheries fishing in the same lake. If you overfish the lake eventually there will be no fish left. So, three of the fisheries voluntarily reduce their take, but one does not. The one that does not gets more fish and makes more profit and eventually outcompetes the other fisheries. But then they have overfished the lake and it goes out of business.

    The basic problem with markets is that they work well for reaching local optima, but they aren’t as good at coordinating activity to prevent long-term problems such as overfishing, because one “defector” from a scheme to avoid the problem can temporarily outcompete the others. To me, the role of government isn’t to micromanage markets, but it is to look for these sorts of larger scale problems and issue regulations which sensibly limit private behavior in a way that takes into account these larger scale issues. Government shouldn’t fix prices or allocate resources directly, but it can set the rules so that the system is more stable in the long run.

  90. Artfldgr Says:

    Baklava! How dare you give away one of our most treasured secrets on the right? To think that Mitsu might learn of the Economic calculation problem is beyond the pale…

  91. Baklava Says:

    -10 vs. -9.

    Yes. A nationalized system would be better than this worse approach.

    This approach is nowhere near positive.

  92. Baklava Says:

    Mitsu wrote, “Government shouldn’t fix prices or allocate resources directly, but it can set the rules so that the system is more stable in the long run.

    Yes. But what we have is a fascist system where the government isn’t setting fair rules. It’s picking winners and losers in the marketplace. Granting more for people who are irresponsible and/or democrats or donating more and basically making the worst case systems to cause misery and then saying, “See?! We need to step in and fix this”. All the while LYING about the fix and having YOU believe the lie.

  93. Artfldgr Says:

    Perhaps Alex Nove could talk to Mitsu?

  94. Baklava Says:

    http://en.wikipedia.org/wiki/Economic_calculation_problem

    excerpt: Friedrich von Hayek responded that the system of equations required too much information that would not be easily available and the ensuing calculations would be too difficult.[3] This is partly due to the fact that individuals possess useful knowledge but do not realise its importance, or may have no incentive to transmit the information.[4] He contended that the only rational solution is to utilize all the dispersed knowledge in the market place through the use of price signals.[5] The early debates were made before the much greater calculating powers of modern computers became available but also before research on chaos theory. In the 1980s, Alex Nove argued that even with the best computers, the calculations would take millions of years[6]

    It may be impossible to make long-term predictions for a highly complex system such as an economy

    Mitsu misunderstand the basic concepts. Mitsu translated the inability to “predict” into something else. Mitsu’s basic misunderstanding is BORN of the fact that he thinks that he can centrally plan or that the government with enough information can centrally plan.

    But it’s basically chaos. Capitalism = people choosing who gets what resources. Yes we should be a nation of laws. Yes we need a Patent and Trademark office and anti-trust and courts and even food inspectors.

    What we have now is WORSE than chaos. What we have now is government picking the winners in picking people and companies who make poor decisions and punishing people and companies who make good decisions.

    Additionally, it is necessary that specialists are rewarded with higher compensation until such day that there is a glut and compensation will reward people choosing another field. It is the most efficient means of distributing resources and services.

    Yes, there are inefficiencies in capitalism as well. And yes, companies may fail during the down business cycle. But it is good policy to have people suffer the consequences of not saving for the rainy day.

    As this nation implodes under an avalanche of debt created by Obama and Mitsu – we can tell our children (my daughters) that we tried to convince people that these policies were horrendous – but they failed to ‘listen’.

    Mitsu – will you continue to fail to ‘listen’ – thinking that you are smarter and a better planner – throwing our next generations money down the sewer?

  95. Mitsu Says:

    No, you misunderstand me, Baklava. I completely agree that central planning is never going to work, for precisely the reasons Hayek points out. In fact, I came up with the same argument myself, on my own, when I was in college, debating the issue with the few Communists who still existed back then on campus. Hayek is absolutely right that central planners cannot possibly process enough information to optimally allocate resources.

    However, there are other issues, as I mentioned before. If you have a shared resource that is not going to be depleted in the short term, then pure market dynamics will favor the entity that maximally utilizes the shared resource in the short term, even if it means in the long term everyone will run out of that resource (overfishing example, above). Purely private choices with market signals can’t solve the problem because even if some fisheries voluntarily restrain themselves, the defector will “win” in the short term.

    This is basically a problem of local vs. global optimization. Central planning cannot work well because they are trying to do both local and global optimization centrally. But purely local optimization has its flaws as well, because you can get stuck moving along a locally optimal path (path of least resistance) which leads to a dead end. The only way, it seems to me, to resolve this problem is to have another feedback mechanism in the form of a democratic government which can set rules to avoid the dead ends, to set larger scale rules. If those rules also attempt to do local optimization then they run into the problem Hayek rightly points out.

  96. Baklava Says:

    Your argument with natural resources do not apply.

    We have well-regulated natural resources (lakes). It’s a poor argument on your behalf.

  97. Mitsu Says:

    I’m not sure what you mean My argument is simply a proof of concept that government regulation can solve certain larger-scale problems which pure market dynamics can’t. The libertarian view, as I understand it, is that the only role of government is to enforce contracts and eliminate fraud; I’m simply saying the example of regulation of, say, overfishing, is an example where there’s a clear problem of resource overutilization where local (market) mechanisms alone will lead to a highly non-optimal outcome (complete depletion of the resource).

    In other words, markets work well for short-term concerns, regulation is appropriate for long-term concerns. But regulation should be limited, for the reasons Hayek rightly pointed out, to introducing incentives and other rules into the system which deal with the larger scale issue while leaving short-term resource allocation decisions to the market.

    Essentially what I am saying is there are more options than just total laissez-faire and total central control; the option I argue for is laisse-faire for local allocation decisions, and *limited* regulation which sets larger-scale rules or biases in the market while attempting, as much as possible, to avoid micromanaging the market. This is more or less, of course, the way nearly every capitalist democracy currently functions, and I think it works well. I believe the libertarian argument that capitalist countries ought to do away with nearly all regulation is, in essence, wrong, and an overreaction to the problem Hayek points out.

  98. Mitsu Says:

    Sorry, left out a period between “you mean” and “My”, above.

  99. csimon Says:

    SteveH– You’re right. That is just the point. But given the opportunities and privileges available here, it is more a question of who can……and who WON’T. The problem is not the “who cannot achieve.” It is those who “WILL NOT.”

    My mother had a favorite saying and she repeated it ad nauseum to me and my brothers much to our dispair:

    “LIFE ISN’T FAIR.”

    There is a segment of leadership that preaches that America is terrible because we don’t take care of every last soul living within our borders. Now, I have plenty of sympathy and empathy — in other words, I’m a “mush” and thus contribute all the time (to the extent I am able) to those truly in need. Americans have one of, if not the most generous spirit in the world, so I am not alone. But history proves over and over that continuing to give something for nothing, creates first a person who comes to expect that, and eventually, someone who demands it! That was the great lesson we were supposed to have learned when we created the Welfare to Work programs, phasing out those laws that created a permanent welfare class, and, instead, offering a helping hand with the explicit understanding that it was for a specified amount of time during which those who needed it, received help to become a responsible member of society. Too many people, I’m afraid have this dreamlike vision of a a giant pot of gold that is endlessly replenished. It’s not their money, not my money, nor yours — it the governments (!) which means it belongs to all of us. Unfortunately, people are all too eager to get something for nothing, and all too many who preach victimization and thus people are owed that which others have learned.

    The fact is, America grew to be the most successful nation on this earth because of our unique spirit of appreciating the opportunities available to all those who have come and were willing to work. And so they did, as they taught their children, and their grandchildren — that success has only boundaries that that one puts there. Success also is not always measured by dollars, but also by happiness, and quality of life.

    The Magnanimous One who believes he is the Messiah come to rescue us fools from ourselves and our accomplishments in order to “spread the wealth around” is bent on recreating this nation into one whose people do the least to get the most. History as proved this over and over and over — it never works. It saps the strength of the country’s primary resource: namely, the people, creating a dependent class whose needs ever grow, while earnings deplete, and then the govt. begins borrowing….and borrowing….and, well, you know the rest.

  100. IgotBupkis Says:

    > I think analysts are predicting this bill will either be neutral

    I think analysts are irrelevant,as I think ever single person with a rational thought in their heads is expecting it to be repealed in a complete and total repudiation of this Congress and a rebuke of the PotUS heretofore unknown in US politics.

    I predict Obama is going to be the first incumbent president to run for re-election and lose his own party’s nomination. Others may have been able to do that, but Obama’s ego is going to be too big to admit that everyone hates his guts, even by that time.

    After all, this is Amerikkkkkkka, home of the racist whopper.

  101. GINA COBB Says:

    Quote of the Day: “Big” Is Not the Same as “Good”…

    “We keep hearing that the passage of HCR was historical—or, in the immortal words of the great Joe Biden, “A big F-ing deal.” But “historical”—or even “big F-ing deal”—has no moral valence. It doesn’t mean “good” or “bad.” …

  102. Bob From Virginia Says:

    IgotBupkis
    What do you think of the possibility of Obama being impeached and throw out of office? His treatment of Bibi is clearly indicative of mental instability.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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