It Does But It Does Not

In the con­tin­u­ing saga of the GOP House efforts to undo the Afford­able Care Act, the House is cur­rent­ly work­ing on a repeal of the Inde­pen­dent Pay­ment Advi­so­ry Board (IPAB).

Speak­er of the House John Boehn­er’s office:

The House will act this week to repeal anoth­er part of Oba­maCare: IPAB, which empow­ers a board of unelect­ed bureau­crats to deny care and raise costs.

If the IPAB will raise costs then repeal­ing it will save mon­ey, right?


Tea Par­ty activists are upset about some­thing else entire­ly. GOP lead­er­ship has opt­ed to fund the $3.1 bil­lion cost of repeal­ing IPAB with leg­is­la­tion writ­ten by Rep. Phil Gin­grey (R‑GA) that would reform med­ical mal­prac­tice laws.

So repeal­ing the IPAB will cost 3.1 billion.

The bill has to have a “pay for” ele­ment to off­set the costs of repeal­ing IPAB. Boehn­er’s office sim­ply makes ref­er­ence to the IPAB rais­ing costs. Which to believe.…

Those Damn Socialists!

I am cur­rent­ly hav­ing to spend a few min­utes each day dri­ving my van which lacks an FM radio. The pick­ings on AM radio are rather slim, so I some­times end up lis­ten­ing to con­ser­v­a­tive talk radio (or “con­ver­sa­tion radio” as the host called it today). I have no idea whose pro­gram I was lis­ten­ing to today (but not Rush or Beck…does Beck still have a show?).

Any­ways, the guy was going on at great length about how the Oba­ma social­ists were set­ting things up in the Afford­able Care Act. He was key­ing in on the busi­ness man­date. Any busi­ness that has more than 50 employ­ees is going to have to include health insur­ance in the employ­ee ben­e­fit pack­age. If the busi­ness fails to do this, the fine will be $2,000 per employee.

The host makes the point that any busi­ness (includ­ing ones that already offer health insur­ance) would look at the choice and choose to pay the fine. After all, it is much cheap­er! This will force all the employ­ees into the Social­ist Health Care that Oba­ma set up…and then “they” (the Social­ists) will have “them” and come elec­tion time the Democ­rats will say of the Repub­li­cans “They want to take away your health care!”

Where to begin. Well, in the first place, if a busi­ness is today offer­ing health care to its employ­ees, why would it sud­den­ly stop when there is a fine added to the costs of stop­ping? Why not just stop now? There is no fine today! Hmm­mm, could it be that there are rea­sons beyond gov­ern­ment man­dates why busi­ness­es sup­ply health insurance?

But some busi­ness­es will not offer insur­ance. Most of these are prob­a­bly not offer­ing insur­ance today. So none of the employ­ees will be forced into the Social­ist Health Care that is Oba­maCare. No, they will be buy­ing insur­ance from a pri­vate com­pa­ny just as they are doing today! Only they will get a sub­sidy if they do not make enough money.

And if the indi­vid­u­als do not buy a pol­i­cy? They will be fined:

Impose an annu­al penal­ty of $95, or up to 1% of income, whichev­er is greater, on indi­vid­u­als who do not secure insur­ance; this will rise to $695, or 2.5% of income, by 2016. This is an indi­vid­ual lim­it; fam­i­lies have a lim­it of $2,085.[44][45] Exemp­tions to the fine in cas­es of finan­cial hard­ship or reli­gious beliefs are permitted

and they will not have insur­ance. They will have to rely on char­i­ty and emer­gency rooms just like today! (at least, I think that’s what happens.)

But wait! What about the Social­ist Health Care that is Oba­maCare? Peo­ple have to buy pri­vate insur­ance with a sub­sidy if they qual­i­fy. Jeep­ers, how much more social­is­tic can you get?

Final­ly, there is the host’s point about how the Democ­rats will use the Health Care to retain/​gain pow­er. How DARE they try and use the poli­cies they favor to cur­ry favor with the vot­ers! This would be like a Repub­li­can say­ing he or she will cut your tax­es to retain/​gain power!

Remem­ber, “the Repub­li­cans want to take away your Health Care!”

This is an admis­sion that peo­ple will like the Afford­able Care Act once it is ful­ly imple­ment­ed in the same way Tea Partiers protest­ed with signs that read “Keep your gov­ern­ment hands off my Medicare!” Damn those Social­ists cre­at­ing Medicare! Oh wait! The Tea Partiers are vot­ing for Republicans!

Well, it was on the radio. It must be true.

Maybe It Is Infectious

Sen­a­tor Ron John­son has an op-ed in the Wall Street Jour­nal and tells the touch­ing sto­ry of the med­ical care that saved his daugh­ter’s life and goes on to claim that under the Afford­able Care Act this med­ical care might not have been there for his daugh­ter. He offers no evi­dence of this, but what need is there of evi­dence when one has a touch­ing anec­dote regard­less of how rel­e­vant it is. He also man­ages to cher­ry pick a bunch of sta­tis­tics to show the US is good and Europe is bad

So, of course, lib­er­al blog­gers are jump­ing all over his absurd claims.

One such blog­ger is Igor Vlosky writ­ing in the Wonkroom blog at Think Progress. Mr. Vlosky makes the case for why Sen­a­tor John­son’s op ed most­ly dis­plays Sen­a­tor John­son’s lack of under­stand­ing of heath care and the Afford­able Care Act. He fin­ish­es up with some com­par­isons of the US to Europe, end­ing with

The Unit­ed States is also “ranked 29th in the world in infant mor­tal­i­ty, tied with Poland and Slo­va­kia.” And so, John­son gets it wrong. The ACA wouldn’t have killed Johnson’s daugh­ter, but thou­sands of oth­er unin­sured babies would have died with­out it.

I did a quick Google and I am pret­ty sure the infant mor­tal­i­ty stats for 2010 are not yet avail­able, though the rate did go down in Milwaukee.

Giv­en that the US has been expe­ri­enc­ing over four mil­lion births a year and that the mor­tal­i­ty rate has been over six per 1000, there are cer­tain­ly thou­sands of babies to be saved. But I do not believe there is as yet any evi­dence that the Afford­able Care Act has in fact done so.

Sen­a­tor John­son makes claims based on no evi­dence and Mr. Vlosky does the same after read­ing John­son’s claims.* Is it infectious?

I can tell you that the Afford­able Care Act has not just saved tens of thou­sands of lives already, but is large­ly respon­si­ble for the eco­nom­ic recov­ery as well as the free­dom move­ments in north­ern Africa and the mid-east.

*and Steve Benen at the Wash­ing­ton Mon­thy blithe­ly quotes Mr. Vlosky’s absurd claim.

Spare the Cheaters, Screw the Lower Income Earners

One of the pro­vi­sions of the Afford­able Care Act is a require­ment that busi­ness­es more com­plete­ly report pay­ments made to oth­ers. This is done with form 1099. I believe cur­rent­ly the law requires a 1099 any­time pay­ments exceed­ing $600 with­in a year are made to an indi­vid­ual or a com­pa­ny that is not incor­po­rat­ed. I’m not sure how the ACA changed this, but I assume that the $600 thresh­old is low­er, maybe all the way to zero.

The inter­est­ing thing here is, this change rais­es rev­enue (and it is dou­bly inter­est­ing that nobody argues with that). The only way this could raise rev­enue is if it puts income on the radar of the IRS that would not oth­er­wise have been report­ed. In oth­er words, it catch­es tax cheats.

Of course, the busi­ness com­mu­ni­ty and Repub­li­cans do not talk about the tax cheats. They talk about the extra bur­den of the addi­tion­al 1099’s on business.

Extra bur­den? If your busi­ness is so small that the books are not on com­put­er, then you like­ly will not be mak­ing out very many 1099s, and doing so will not be that dif­fi­cult since you can prob­a­bly scan a years worth of checks for relevent pay­outs in a few min­utes. And if your books are on com­put­er, then the next soft­ware upgrade will accom­mo­date the new requirement.

I’m sor­ry, but the extra bur­den argu­ment is bogus. This is in defense of tax cheats. Remem­ber, every time you hear calls for the elim­i­na­tion of the IRS there is a good chance you are hear­ing “Tax cheats should be able to get away with it.”

So, to make sure that tax cheats can con­tin­ue with impuni­ty, Con­gress wants to remove the height­ened 1099 require­ment. Since it rais­es rev­enue, its removal must be bal­anced with oth­er rev­enue or costs must be cut. It seems the choice is to low­er the sub­sidy to low income people.

Oba­ma has said that he is will­ing to take the 1099 require­ment out of the Afford­able Care Act. We will see if he is hap­py with how it is paid for.

The class war continues.

Delegating Powers to the Vice President in the Mubarek Administration

OK, that does not roll off the tongue as nice­ly as rear­rang­ing deck chairs on the Titan­ic. But either metaphor serves in the case of our elect­ed fed­er­al offi­cials and the deficit.

Let us begin with an old chart from the Con­gres­sion­al Bud­get Office via our, ahem, good friend Ross Perot:

This chart is a bit dat­ed, but the curves have not changed much. Future deficits are the result of medicare/​medicaid and inter­est. The last being the same as say­ing future deficits are the result of future deficits. If future deficits can be brought under con­trol, then the inter­est pay­ments will take care of themselves.

Want some­thing more recent?

This is from Feb­ru­ary 25th, 2011. It assumes that the Bush tax cuts will expire and that the Oba­ma stim­u­lus tax cuts also expire. Note that the growth of health spend­ing goes from over eight per­cent of GDP to 12% of GDP while the total deficit at that point is 3.2 per­cent of GDP. So the entire pro­ject­ed deficit in 2021 could be attrib­uted to the growth of med­ical spending.

The Afford­able Care Act (Oba­macare) actu­al­ly includes sev­er­al mea­sures intend­ed to bring down med­ical costs. The CBO grades the Act as low­er­ing the deficit even though they did not take many of the cost sav­ing mea­sures into con­sid­er­a­tion on the grounds that the mea­sures had not yet shown they would work (they were not even law at the time…).

So the only seri­ous deficit reduc­tion effort in Wash­ing­ton today is the Democ­rats defense of health reform. Oba­ma freez­ing spend­ing and the Repub­li­cans talk of cut­ting spend­ing amounts to noth­ing more that del­e­gat­ing pow­ers to the vice pres­i­dent in the Mubarek administration.

Oh yes. If you want to clear up the short term deficits, this chart might prove useful:

For good or for ill, the spend­ing that the Repub­li­cans want to cut is there for a rea­son. Peo­ple like it. That spend­ing is pop­u­lar. War, the Bush tax cuts, and the reces­sion dri­ve the short term deficit.

Even if the wars end tomor­row, the sav­ings there will be min­i­mal. Some­thing else will come along. It always does.

Many of the cuts the Repub­li­cans pro­pose would actu­al­ly weak­en the eco­nom­ic recov­ery and so increase the deficit.

The Bush tax cuts should be allowed to expire. All of them.

Who Puts a Value on a Life?

I am not sure (but I think so) if it made it into Health Care Reform, but there is no deny­ing that many lib­er­als want what the right referred to as “death pan­els”. Of course, not death pan­els, but a method of deter­mi­nat­ing what treat­ments are not effec­tive, includ­ing treat­ments that give lit­tle val­ue for a high price.

Con­ser­v­a­tives con­tin­ue to insist that the first Health Care Reform that should be passed is mal­prac­tice reform includ­ing lim­its on jury awards. Pre­sum­ably, such lim­its would include cas­es where death was the result.

Who wants to put a dol­lar val­ue on a life?

Health Care Reform!

Con­gress has passed it. The Pres­i­dent signed it. It is law. We still need the rec­on­cil­i­a­tion to be passed, but I am con­fi­dent that it will get done (may take more effort than one would think, but it will get done).

Seems like a com­mon theme I was hear­ing in recent weeks was how Oba­ma’s pres­i­den­cy was a fail­ure (from con­ser­v­a­tives). Now I hear that the Oba­ma pres­i­den­cy is an his­toric suc­cess (from lib­er­als). In both cas­es it is a bit soon to judge. It is still too soon to judge George W. Bush’s presidency.

This was not rammed through against the wish­es of the Amer­i­can peo­ple. It was passed by nor­mal leg­isla­tive pro­ce­dures against the wish­es of a minor­i­ty of the Amer­i­can peo­ple. 53% of vot­ers vot­ed for Oba­ma. Any­one who vot­ed for Oba­ma and did not know he or she was vot­ing for health care reform was not pay­ing atten­tion. Although there were recent polls show­ing that a major­i­ty were against the health care reform bill, those polls actu­al­ly showed that a lot of peo­ple were against what they believed the health care bill to be, not what it was. And a few were against it because it was not lib­er­al enough.

Don’t believe it when Repub­li­cans claim they had no choice but to oppose the bill at all costs since the Democ­rats refused to nego­ti­ate in good faith. It was the oth­er way around. In par­tic­u­lar, Sen­a­tor Bau­cus spent weeks try­ing to get a com­pro­mise that would gar­ner some Repub­li­can sup­port. Lat­er, the Democ­rats stug­gled to find the ground that would get both the con­ser­v­a­tive and the lib­er­al Democ­rats to vote for the bill. If there were some mod­er­ate Repub­li­cans there to stand in for the loss of the lib­er­al Democrats.….

This is not the sal­va­tion of the Demo­c­ra­t­ic Pary (though it does and will stand as an impor­tant achieve­ment). There are still seats to lose in November.

This is not the Water­loo of the Repub­li­can Par­ty. The Par­ty is not now exiled onto St. Hele­na to die six years hence. There are seats to win in November.

Now the law­suits begin. Under the head­ing of “be care­ful what you wish for”, if this bill gets thrown out as uncon­sti­tu­tion­al due to the indi­vid­ual man­date, then the next time around the bill that will be passed will be sin­gle pay­er. Yes, it might take a few years to get us back to such a point, but it will hap­pen if this gets tossed.

There are plen­ty of issues to occu­py Wash­ing­ton after health care, but my vote for most impor­tant issue is the deficit.

Make It Say Whatever You Need It To Say

As we, sup­pos­ed­ly, come down to the final hours before the House vote on Health Care Reform, the Repub­li­can Nation­al Com­mit­tee has come out with a poll on the sub­ject. The tim­ing of this poll is clear­ly intend­ed to intim­i­date Demo­c­ra­t­ic con­gress­man into vot­ing no.

From the link:

The RNC poll also holds oth­er good indi­ca­tions of a strong Repub­li­can show­ing in Novem­ber. Among unde­cid­ed vot­ers, 46% said that they would pre­fer a “Repub­li­can can­di­date who would be a check and bal­ance to Pres­i­dent Oba­ma and the Democ­rats in Con­gress,” com­pared to 19% who dis­agreed with the state­ment. 53% said that the would con­sid­er vot­ing for a Repub­li­can so as to “send a mes­sage to Pres­i­dent to Pres­i­dent Oba­ma and the Democ­rats and make them lis­ten to vot­ers like me.”

If the poll shows that 46% would pre­fer a “Repub­li­can can­di­date who would be a check and bal­ance to Pres­i­dent Oba­ma and the Democ­rats in Con­gress,” the poll had to have that lan­guage in the ques­tion. Dit­to with “send a mes­sage to Pres­i­dent to Pres­i­dent Oba­ma and the Democ­rats and make them lis­ten to vot­ers like me.”

The result is that the poll is, for all intents and pur­pos­es, mean­ing­less. But it was guar­an­teed to give the result the Repub­li­cans were look­ing for.

The Repub­li­cans are des­per­ate to pre­vent the bill from pass­ing because they fear the elec­torate will like the bill once it is seen for what it is and not through Repub­li­can distortions.

So Good At Communicating He Fails to Communicate

Or some­thing like that.

Oba­ma reminds me of Clin­ton. I remem­ber think­ing that Clin­ton would be a lib­er­al Rea­gan in that he, too, could be a “great com­mu­ni­ca­tor.” I thought that because he seemed to com­mu­ni­cate with the pub­lic so well as a can­di­date. But once he was in office, he stopped. And the Repub­li­cans con­trolled the mes­sage. Soon Clin­ton was declar­ing the era of big gov­ern­ment over.

Oba­ma seemed to be able to com­mu­ni­cate as a can­di­date and seems to not be able to do so as a Pres­i­dent. The Repub­li­cans con­trol the mes­sage and Oba­ma is try­ing hard to sound more cen­tric in the State of the Union address.

It is inter­est­ing that when polled about spe­cif­ic ele­ments that make up (one of?) the health care reform bill, the major­i­ty of Amer­i­cans are in favor of almost all of them.‑T.pdf

In oth­er words, if peo­ple under­stood what was in the leg­is­la­tion, there would be a lot more support.

I found the poll from a link on Jonathan Chait’s blog at The New Republic.

If only Oba­ma could communicate.