Has U.S. Democracy Been Trumped?

[y66]

From The New Study That Shows Trumpcare’s Damage by David Leonhardt May 4, 2017:

 

When Massachusetts expanded health insurance a decade ago, state officials unknowingly created an experiment. It’s turned out to be an experiment that offers real-world evidence of what would happen if the House Republicans’ health bill were to become law.

 

The findings from Massachusetts come from an academic paper being released Thursday, and the timing is good. Until now, the main analysis of the Republican health bill has come from the Congressional Budget Office, and some Republicans have criticized that analysis as speculative. The Massachusetts data is more concrete.

 

Unfortunately for those Republicans, the new data makes their health care bill look even worse than the C.B.O. report did. The bill could cause more people to lose insurance than previously predicted and do more damage to insurance markets. The $8 billion sweetener that Republicans added to the bill on Wednesday would do nothing to change this reality. President Trump and Speaker Paul Ryan are continuing to push a policy that would harm millions of Americans.

 

Here are the basics of the new study, and why it matters:

 

The Massachusetts law subsidizes health insurance for lower-income households, and does so via four different income categories. Everyone in a category — for example, a family of four earning between $44,700 and $55,875 a year — would pay the same price for insurance. A family earning less would pay less, and a family earning more would pay more.

 

This system creates what economists call a “discontinuity.” People who have only slightly different incomes pay very different prices for an insurance plan. A family earning $44,701 could pay a couple of hundred dollars more per year than a family making $44,699.

 

Discontinuities are a social scientist’s friend, because they set up natural experiments. The price difference faced by the similar families I just described allows researchers to analyze how much the cost of insurance affects people’s willingness to sign up.

 

And price ends up mattering a lot. When plans become even slightly more expensive, far fewer lower-income families sign up. “Most low-income people aren’t willing or able to pay much for health insurance,” says Mark Shepard, a Harvard economist and an author of the new study.

 

Why? Partly because people know that they have an alternative. They can instead rely on last-minute emergency-room care, in which hospitals typically treat them even if they lack insurance. Such care is problematic: It tends to be expensive, raising costs for other patients, and it’s often not as good as preventive care. But many poorer families choose E.R. care over taking money from their stretched budgets for health insurance.

 

The Republican health bill wouldn’t raise people’s costs by only a small amount, either. It would force many low-income families to pay hundreds or thousands of dollars more for insurance — and most of them would likely respond by not buying insurance. The people who still buy plans would disproportionately be sick people, which would then cause costs to rise even higher. “When premiums go up, it’s the healthier enrollees who drop out,” said Amy Finkelstein of M.I.T., another author of the study.

 

The authors didn’t specifically compare their data to the estimates by the C.B.O. But the magnitude of the new results suggests the C.B.O. estimates of insurance losses were conservative. Nathaniel Hendren of Harvard, the paper’s third author, said that the Republican proposal would effectively end enrollment in the insurance markets for families that make less than $75,000 a year.

 

It’s important to note that the study’s three authors aren’t political animals. Finkelstein has won the John Bates Clark Medal, an award for the top academic economist under the age of 40, and her research on Medicare is frequently cited by conservatives.

 

The Republican health bill is simply a bad bill. It’s been blasted by conservative and liberal health experts, as well as groups representing patients, doctors, nurses and hospitals. Above all, the bill cuts health benefits for the poor, the middle class, the elderly and the sick, and it funnels the savings to tax cuts for the rich.

 

In the name of a political victory for themselves and Trump, House Republicans may now be on the verge of passing the bill anyway. The only things that can keep it from becoming law — and harming millions of Americans — is the United States Senate.

[jogs]

There is no homogeneous thinking in any of the Western countries. The elite think one way and the common folks think another. It's all about globalism versus populism. We populists think the purpose of government is to protect the interest of its own citizens.

[Winstonm]

Though Trump knows little, he does understand how shallow is the mind of a broad swath of Americans concerning social conservatism and how emotive is their reactivity so all he has to do to garner their support is produce the illusion, a la reality t.v., of taking actions on their behalf; the raft of executive orders in lieu of legislation shows how clearly he understands this power of perception compared to fact; it is in perception where both his greatest strength and his greatest weakness lies, as exposing his empty deceptions leaves him standing naked in front of a mirror, a king with no clothes.

 

The difficulty for the reality-based community is figuring out a way to expose the deceptions so that those deceived feel betrayed rather than protected.

[PassedOut]

There is no homogeneous thinking in any of the Western countries. The elite think one way and the common folks think another. It's all about globalism versus populism. We populists think the purpose of government is to protect the interest of its own citizens.

Those labels are false flags. The real disagreement is about what will actually protect the interests of the citizens and what will not:

 

Walls won't help. Tariffs won't help. Tax breaks for the rich won't help. Small insurance risk pools for the sick won't help.

 

Rebuilding the infrastructure will help. Expanding public education and vocational training will help. Universal healthcare will help.

[barmar]

Though Trump knows little, he does understand how shallow is the mind of a broad swath of Americans concerning social conservatism and how emotive is their reactivity so all he has to do to garner their support is produce the illusion, a la reality t.v., of taking actions on their behalf; the raft of executive orders in lieu of legislation shows how clearly he understands this power of perception compared to fact; it is in perception where both his greatest strength and his greatest weakness lies, as exposing his empty deceptions leaves him standing naked in front of a mirror, a king with no clothes.

Indeed. When he touts all his accomplishments in his first 100 days, most of them have little substantive impact. His only real accomplishment was getting Neil Gorsuch onto the Supreme Court. The rest give the illusion of acting on his promises, but don't really change much. I guess in the case of the travel ban he can claim that he tried -- but should we really credit him for making promises that any knowledgeable person would know he couldn't really keep?

 

For instance, relaxing regulations on coal companies is not going to bring back coal jobs. Coal has been in decline because other energy sources (e.g. natural gas) are cheaper and preferable, not because of burdensome regulations. And the majority of coal jobs were lost to automation, not because of the reduced number of coal mines. Trump can put on a show of signing EOs intended to restore coal jobs, but few coal miners will get help from them.

[ldrews]

Expanding public education and vocational training will help.

 

The education system in the US has been deteriorating for decades under the current policies. As Einstein is quoted to have said: "Doing more of the same thing and expecting a different result is a definition of insanity." The US education systems needs significant reform, not expansion.

[PassedOut]

The US education systems needs significant reform, not expansion.

The US education system varies wildly in quality, with many citizens getting little of value from it. Looking out for those citizens means expanding it to those citizens to ensure that they too get an education that prepares them for modern life.

 

The US education system has been discussed a fair amount in the Water Cooler. One obvious reform would be to eliminate the censoring by Texas politicians of widely-used textbooks.

[kenberg]

The House passage on Health care is, I think, a very big deal. Democrats will oppose it. that's a given. Probably they will defeat it, we shall see. I have no real feel for how this will play out with the voters. Just about everyone has some interest in health care.This is no longer an abstract repeal and replace, and I imagine there will be a large number of people asking how this will affect them . Possibly they will even demand clear and honest answers. Something along the lines of "I have, or my aging parent has or my young child has, medical problem X. Under this plan, the treatment for X will be covered how and at what cost?" Something like that.

 

We shall see how this goes. I don't thin that the argument "We have to replace the ACA because the Ds did it and Ds are bad' is going to fly. I also don't think that the argument "We have to oppose this replacement (ok, modification) because the Rs are doing it and the Rs are bad" is going to fly. In each case the argument will fly with some, but there are a lot of voters out there and some, maybe quite a few, will want to hear a little more substance to the argument.

[Winstonm]

The House passage on Health care is, I think, a very big deal. Democrats will oppose it. that's a given. Probably they will defeat it, we shall see. I have no real feel for how this will play out with the voters. Just about everyone has some interest in health care.This is no longer an abstract repeal and replace, and I imagine there will be a large number of people asking how this will affect them . Possibly they will even demand clear and honest answers. Something along the lines of "I have, or my aging parent has or my young child has, medical problem X. Under this plan, the treatment for X will be covered how and at what cost?" Something like that.

 

We shall see how this goes. I don't thin that the argument "We have to replace the ACA because the Ds did it and Ds are bad' is going to fly. I also don't think that the argument "We have to oppose this replacement (ok, modification) because the Rs are doing it and the Rs are bad" is going to fly. In each case the argument will fly with some, but there are a lot of voters out there and some, maybe quite a few, will want to hear a little more substance to the argument.

 

Politically, I think the biggest mistake made was in rushing through this bill without an CBO report on its impact; you can fool some of the people some of the time, but keep it up, sucker, and we'll kick you stinkin' ass.

[Winstonm]

There is no homogeneous thinking in any of the Western countries. The elite think one way and the common folks think another. It's all about globalism versus populism. We populists think the purpose of government is to protect the interest of its own citizens.

 

Here is your "populist" president in action and what his repeal of the ACA will do: (emphasis added)

 

The Affordable Care Act ushered in a historic reduction in the national uninsured rate. By targeting assistance to low- and middle-income families that need health coverage and forbidding health insurance companies from rejecting people with pre-existing conditions, it expanded coverage to about 20 million people.

The American Health Care Act, which is the House Republican bill, would undo both of those things.

The legislation would end the Affordable Care Act’s expansion of Medicaid to poor adults and drastically cut federal funding for Medicaid overall, jeopardizing coverage for children, people with disabilities and elderly people in nursing homes. The bill also would allow states to permit health insurers to go back to turning away customers because of their health status and medical histories, or charging them higher rates.

 

The American Health Care Act is also a vehicle for almost $600 billion in tax cuts for wealthy people and health care corporations.

 

Those making $250K a year or more get tax cuts on the backs of poor and middle class who lose their health coverage - great populism there.

[kenberg]

WaPo of course reported on the new health care bill.

 

https://www.washingtonpost.com/powerpost/republicans-plan-health-care-vote-on-thursday-capping-weeks-of-fits-and-starts/2017/05/03/e7dd7c28-306d-11e7-9dec-764dc781686f_story.html?hpid=hp_rhp-top-table-main_healthvote-705a%3Ahomepage%2Fstory&utm_term=.f88ca9005270

 

I said there will be questions.

For instance, the measure does not eliminate the ACA’s requirement that most Americans carry health insurance, although the penalty for not having coverage would be erased. In its place, insurers would be allowed to charge 30 percent higher premiums for one year to customers who have had a gap in coverage of roughly two months or more.

 

Is this accurate? I imagine myself as 30 years old and in good health, holding a job that does not help pay health insurance. So I have to pay for my own. It costs X dollars a year. But I am healthy. So I don't bother yo get it. In the first four months I save X/3 dollars by not having this insurance. The plan is that I will get the insurance if my health changes. Should that misfortune occur, I will then start paying the X dollars a year for my insurance, and the X/3 that I saved during the first four months will cover the penalty.

 

If the description is accurate, then surely this would be a sensible approach for 30 year old healthy me.This seems so obvious that I find it hard to believe that the reporting is accurate. But if it is accurate, it seems that the effect is this: There will be no substantive penalty for waiting until you are ill to buy insurance.

 

Tihs would be nuts. Of course I am 78, not 30. When I got Medicare years ago, the deal was this (I don't promise absolute accuracy, but basically this was the deal): Everyone gets one part, called, I think, part A. A person can opt ot have part B, which covers much more. But you must choose as soon as you are eligible. Maybe one vould still get part B later, but the penalty was very substantial. I, and everyone I know, got part B. We paid during the years we didn't need it, we use it when we do need it. This is sane. Allowing people to avoid insurance when they are healthy and then requiring insurers to insure them when they are sick, with a minor penalty, is insane.

 

Surely I misunderstand the provision.

 

Now that's on policy. I have to add another note. I see the Ds were chanting "hey, hey, hey, goodbye".

 

My conclusion? We have elected total morons to handle the country's business. These people have to go home and have dinner with their kids, do they not? I just don't get it.

[Al_U_Card]

The plan is that I will get the insurance if my health changes.

 

We are talking insurance. You pay when you don't need it so that it is in force (and obstensibly) paid for when you do.

 

I paid into our governmental healthcare plan all of my working life. Apart from a couple of visits to the outpatient emergency room for an elbow fracture and physical exams by a doctor every 10 years or so, I have never made use of the system. Since I retired and left my company's group insurance plan, I now pay about $600 a year to the governmental plan for prescription drugs. So far my need has also been 0.

 

Should you also only start paying your house insurance once the smoke starts?

 

Government healthcare insurance is a business and an inefficient one at that. Costly but necessary according to the social will. At least here it is.

[Winstonm]

WaPo of course reported on the new health care bill.

 

https://www.washingtonpost.com/powerpost/republicans-plan-health-care-vote-on-thursday-capping-weeks-of-fits-and-starts/2017/05/03/e7dd7c28-306d-11e7-9dec-764dc781686f_story.html?hpid=hp_rhp-top-table-main_healthvote-705a%3Ahomepage%2Fstory&utm_term=.f88ca9005270

 

I said there will be questions.

 

 

Is this accurate? I imagine myself as 30 years old and in good health, holding a job that does not help pay health insurance. So I have to pay for my own. It costs X dollars a year. But I am healthy. So I don't bother yo get it. In the first four months I save X/3 dollars by not having this insurance. The plan is that I will get the insurance if my health changes. Should that misfortune occur, I will then start paying the X dollars a year for my insurance, and the X/3 that I saved during the first four months will cover the penalty.

 

If the description is accurate, then surely this would be a sensible approach for 30 year old healthy me.This seems so obvious that I find it hard to believe that the reporting is accurate. But if it is accurate, it seems that the effect is this: There will be no substantive penalty for waiting until you are ill to buy insurance.

 

Tihs would be nuts. Of course I am 78, not 30. When I got Medicare years ago, the deal was this (I don't promise absolute accuracy, but basically this was the deal): Everyone gets one part, called, I think, part A. A person can opt ot have part B, which covers much more. But you must choose as soon as you are eligible. Maybe one vould still get part B later, but the penalty was very substantial. I, and everyone I know, got part B. We paid during the years we didn't need it, we use it when we do need it. This is sane. Allowing people to avoid insurance when they are healthy and then requiring insurers to insure them when they are sick, with a minor penalty, is insane.

 

Surely I misunderstand the provision.

 

Now that's on policy. I have to add another note. I see the Ds were chanting "hey, hey, hey, goodbye".

 

My conclusion? We have elected total morons to handle the country's business. These people have to go home and have dinner with their kids, do they not? I just don't get it.

 

You don't get it because you are looking at this as a healthcare bill when in fact it is an administrative move to remove taxes from the wealthy in order to prepare the way for even more tax cuts for the wealthy. My understanding is that the Republicans have been done in by their own rules so they have to offset any tax reduction plan with spending cuts - this bill cuts spending, which was primarily paid for by taxes on wealthier Americans. Once the books are juggled, another round of tax cuts for the wealthy can be passed.

 

This is where populism collides with oligarchy.

[kenberg]

You don't get it because you are looking at this as a healthcare bill when in fact it is an administrative move to remove taxes from the wealthy in order to prepare the way for even more tax cuts for the wealthy. My understanding is that the Republicans have been done in by their own rules so they have to offset any tax reduction plan with spending cuts - this bill cuts spending, which was primarily paid for by taxes on wealthier Americans. Once the books are juggled, another round of tax cuts for the wealthy can be passed.

 

This is where populism collides with oligarchy.

 

Ok, but I still have my question: Am I correct in understanding that a young person can decide to save 20X dollars by skipping insurance for 20 years, and then sign up as he gets older and/or sick, by paying a penalty of 30% of X dollars? If that is the plan, surely many will opt for it.

 

This bill could bring about much needed clarification on basic philosophy. What do we expect from our medical system and how do we intend to pay for it? I don't think that we, as a country, have answered this question. The ACA is one answer, but I am not so sure it will survive. This ill is another answer, I gather few think it will become law. This is what happens when we have not worked through our basic goals.

 

Dems plan to block this bill in the Senate. I imagine they will succeed, and I imagine some Reps are not all that fond of it anyway. But "Hey, hey, goodbye" does not help the cause of clarification. To slightly alter the advice Thumper received from his father, I would say to these Dems "If you can't say something without embarrassing yourself, don't say anything at all".

 

We can at least hope for better from those we have elected. I grant that we probably will be disappointed.

[Zelandakh]

I think the part you might be missing is that of pre-existing conditions, Ken. If the additional charge for this is high enough then waiting until care is needed ceases to be a realistic strategy. The 30% premium just looks to be a charge against being too poor to keep healthcare running continuously all of the time. On the surface, Winston appears to be correct that the nett effect of these changes is going to be positive for the rich and bad for the poor. No doubt Trump's supporters will hold it up as proof of his "draining the swamp" regardless though.

[jogs]

You don't represent the views of the majority of any people. The common people don't jog.

 

I really don't know what the two have to do with each other. The fact that the majority of a people did one thing does not mean that Zel doesn't represent their opinion on an entirely different thing.

 

You are saying that since Zel (supposedly, I didn't check) was a Bremainer, he is not allowed to state anything anymore, e.g. that the British like fish and chips.

 

If you sincerely think that makes sense, I would suggest that you don't represent the views of the majority of the US people.

 

Rik

Zel doesn't represent the opinion of all the British people. I doubt if any of the country folk would elect mayor Khan of London for dog catcher.

[barmar]

Is this accurate? I imagine myself as 30 years old and in good health, holding a job that does not help pay health insurance. So I have to pay for my own. It costs X dollars a year. But I am healthy. So I don't bother yo get it. In the first four months I save X/3 dollars by not having this insurance. The plan is that I will get the insurance if my health changes. Should that misfortune occur, I will then start paying the X dollars a year for my insurance, and the X/3 that I saved during the first four months will cover the penalty.

You could also do this under the ACA. The tax penalty ("individual mandate") for not having coverage is the price of the cheapest plan or 2.5% of your income, whichever is lower; if you have coverage for part of the year, the penalty is pro-rated. So what you can do is drop coverage and pay the bronze rate while you're healthy, then when you get sick you buy a silver or gold plan, and you've saved the difference in prices.

 

However, one of the provisions of the AHCA is that states are allowed to drop the preexisting condition requirement. If you're in one of those states and you wait until you're sick to buy health insurance, they can jack up the rates, which could wipe out whatever you saved by not buying insurance for the first 4 months.

 

And for those of you Trump supporters, remember that he repeatedly said that his replacement for Obamacare would definitely keep the preexisting condition rule.

[jogs]

WaPo of course reported on the new health care bill.

 

https://www.washingtonpost.com/powerpost/republicans-plan-health-care-vote-on-thursday-capping-weeks-of-fits-and-starts/2017/05/03/e7dd7c28-306d-11e7-9dec-764dc781686f_story.html?hpid=hp_rhp-top-table-main_healthvote-705a%3Ahomepage%2Fstory&utm_term=.f88ca9005270

 

I said there will be questions.

 

 

Is this accurate? I imagine myself as 30 years old and in good health, holding a job that does not help pay health insurance. So I have to pay for my own. It costs X dollars a year. But I am healthy. So I don't bother yo get it. In the first four months I save X/3 dollars by not having this insurance. The plan is that I will get the insurance if my health changes. Should that misfortune occur, I will then start paying the X dollars a year for my insurance, and the X/3 that I saved during the first four months will cover the penalty.

 

 

The individual insurance market is a ripoff. They should be allowed to be uninsured. Also medicaid should allow these people to join. Only they are required to pay for the services they use.

[barmar]

The individual insurance market is a ripoff. They should be allowed to be uninsured. Also medicaid should allow these people to join. Only they are required to pay for the services they use.

Are you EVER going to answer my question about that that means? The point of Medicaid is that you DON'T pay. What does it mean to join and also pay?

 

Does it just mean that the rate you pay for services is what the government would pay if they were covering you on Medicaid? So basically you're saying that hospitals and doctors should just drop all their fees for uninsured patients to the Medicaid rates, since everyone would just choose this option if it were available. Or in other words, the government gets to set health care prices.

[Winstonm]

Ok, but I still have my question: Am I correct in understanding that a young person can decide to save 20X dollars by skipping insurance for 20 years, and then sign up as he gets older and/or sick, by paying a penalty of 30% of X dollars? If that is the plan, surely many will opt for it.

 

This bill could bring about much needed clarification on basic philosophy. What do we expect from our medical system and how do we intend to pay for it? I don't think that we, as a country, have answered this question. The ACA is one answer, but I am not so sure it will survive. This ill is another answer, I gather few think it will become law. This is what happens when we have not worked through our basic goals.

 

Dems plan to block this bill in the Senate. I imagine they will succeed, and I imagine some Reps are not all that fond of it anyway. But "Hey, hey, goodbye" does not help the cause of clarification. To slightly alter the advice Thumper received from his father, I would say to these Dems "If you can't say something without embarrassing yourself, don't say anything at all".

 

We can at least hope for better from those we have elected. I grant that we probably will be disappointed.

 

Ken,

 

I believe that would depend on what state he lives in - this bill allows states to choose to opt out of the rule to cover pre-existing conditions, so your hypothetical youth may not be able to buy coverage once he is ill.

 

Also, the CBO found on the previous version of this bill that the small savings in premiums for the young was at the expense of older Americans who would not be able to afford the premiums and just drop coverage - letting older and sicker people die is surely less costly than treatment.

[Winstonm]

The individual insurance market is a ripoff. They should be allowed to be uninsured. Also medicaid should allow these people to join. Only they are required to pay for the services they use.

 

 

You do realize, don't you, that you are arguing for a tweak to the Affordable Care Act (Obamacare)?

 

The Affordable Care Act of 2010 created the opportunity for states to expand Medicaid to cover nearly all low-income Americans under age 65.

https://www.medicaid.gov/medicaid/eligibility/

[Zelandakh]

Zel doesn't represent the opinion of all the British people.

You wrote this already, almost word for word, so I will refer you to the answer I gave yesterday. Can we try to work on getting a comment that fits to the subject at hand on the next round please?

[StevenG]

Zel doesn't represent the opinion of all the British people. I doubt if any of the country folk would elect mayor Khan of London for dog catcher.

That is a repulsive post.

[rmnka447]

The plan is that I will get the insurance if my health changes.

 

We are talking insurance. You pay when you don't need it so that it is in force (and obstensibly) paid for when you do.

 

I paid into our governmental healthcare plan all of my working life. Apart from a couple of visits to the outpatient emergency room for an elbow fracture and physical exams by a doctor every 10 years or so, I have never made use of the system. Since I retired and left my company's group insurance plan, I now pay about $600 a year to the governmental plan for prescription drugs. So far my need has also been 0.

 

Should you also only start paying your house insurance once the smoke starts?

 

Government healthcare insurance is a business and an inefficient one at that. Costly but necessary according to the social will. At least here it is.

You might want to start having yearly physicals and establish a relationship with a primary care physician. The physicals will establish a baseline for your health. That can be very useful to your doctors if you do, in fact, get sick.

[Winstonm]

What is truly weird to me is that so many Trump supporters - and they have posted here in the WC - brag about being one of the "deplorables" Hillary Clinton defined.

 

Do they even understand what Clinton said?

"You know, to just be grossly generalistic, you could put half of Trump's supporters into what I call the basket of deplorables. Right?" Clinton said. "The racist, sexist, homophobic, xenophobic, Islamaphobic—you name it. And unfortunately there are people like that. And he has lifted them up."

 

So, those who brag about being "one of the deplorables" are bragging about being either: sexist, homophobic, xenophobic, or Islamaphobic. Perhaps the deplorable among us like being "lifted up" from the rubbish pile of their lives?