Obamacare cost...

[VirginiaCougar]

With apologies for all the links, below are just a few of the critiques of this nonsense (even a few from Republicans):

http://www.politico.com/story/2013/0...548.html?hp=r6

http://www.politico.com/story/2013/0...537.html?ml=co

http://www.ksl.com/index.php?nid=960...m=most_popular

http://online.wsj.com/article/SB1000...j_nview_latest

Indirectly related - more big picture: http://opinionator.blogs.nytimes.com...lton-friedman/

http://www.nytimes.com/2013/09/25/op...rssnyt&emc=rss

Brooks clip on NewsHour: http://landing.newsinc.com/shared/vi...r&VID=25167097

[VirginiaCougar]

VC - good to see you back. I was hoping to get your feedback from this exchange last week:

I do need to reply, they are fair questions worth discussion and I hope to get to them today.

[VirginiaCougar]

VC - good to see you back. I was hoping to get your feedback from this exchange last week:

I will deal specifically with ACA here and not the budget/spending cuts, which follow a similar path. If I were to try and summarize what I argue below, it is that I agree with you, but you are wrong on the timing. In other words, later on Obama on ACA did push out the GOP (somewhat similar path occurs on the budget stuff), but only after early attempts to find the bipartisan big deal failed due to the right wing of the GOP rejecting any effort in the House/Senate. Once the GOP decided to obstruct and not legislate, then yes - you are right.

The first part is anecdotal and I understand if you don't want to accept it. It is based however on numerous conversations with dozens of former students and friends who work in various capacities in the House/Senate.

When Obama was elected, he REALLY want to cement his legacy as a new type of President. His first attempt was ACA. He ran on Health Care and compromise. The whole reason ACA has key elements of the Heritage plan is because he wanted to find common ground. However, key Republicans decided that they wouldn't work on health care with Obama regardless of where he started. This was during the efforts on the right to delegitimize his whole presidency with the birther nonsense. A number of close friends, one a state director of a Senator and a couple of others in DC working with GOP members all told me exactly the same thing. Their members of Congress/Senate wanted to work with Obama and Democrats to have a big bipartisan deal on Health Care. After meetings, the right-wing got their way and these guys were explicitly told they couldn't work with Obama on it. GOP participation would be simply obstructionist, regardless of content. To kill it with destructive amendments, etc - again regardless of content. ANYTHING was going to be called socialist/Marxist/etc. Even their own ideas. The Senator that one good friend worked for actually was knocked off from the right (in a Convention some might remember) partly because he pushed hard to engage the President on Health Care, the debt, etc. Suddenly he had some very well-funded astroturf orgs opposing him and keeping him out of a broader primary where his views would have likely won the day quite easily. The right wing wanted nothing of negotiation on this or anything. They wanted Obama brought down.

At this point, yes Obama and the Democrats locked out the GOP, primarily because all they were trying to do was kill the bill, not participate, improve, or find any common ground. So at that point, you are pretty much correct - however, even then Obama continued to reach out to some Republicans because he really wanted positive participation. He desperately wanted a bipartisan outcome. For an objective and length summary of this history, read pp. 137-169 (yes, it is really long).

http://www.aallnet.org/main-menu/Pub...o-2/2013-7.pdf

Just a few excerpts of that length academic article and of what I am describing, just to summarize my points (emphases are mine, references removed here, but found in original journal article and well worth reviewing, even though I know that is tedious process):

1) Health care reform was one of newly elected President Barack Obama’s top domestic priorities, and he was determined to press forward with the effort early in his first term. Rather than having the executive craft the bill that would ultimately be introduced in Congress, as had been done in President Clinton’s failed effort more than fifteen years earlier, President Obama laid out the broad principles and goals that he wanted in a health care bill and left it to the House and Senate to provide the legislative details. Both chambers began working on health care in the early months of 2009,with the House taking the lead.

2) Once the committee draft is agreed upon,the primary goal of the majority during the markup is not to shape it,but to retain the agreed-upon form, or at least a form that can pass on the chamber floor, and to keep any amendments to a minimum. The minority party, left out of the extra-committee consultations and usually unwilling to provide any positive input, is relegated to advancing futile amendments to embarrass the majority. Thus,the intensive committee discussion of the form legislation should take no longer occurs

(On this point, my argument from everything I've seen is that the reason they were left out is because they refused "positive input" as the article notes. Many efforts were made bring positive participation.)

3) The Senate Finance Committee’s work was distinguished by two conversations that took place as it tried to complete the bill, as well as by its long delay in finally reporting one. The first conversation was between a group of three Democratic senators—Finance Committee chairman Max Baucus, Jeff Bingaman, and Kent Conrad—and three Republican senators—Mike Enzi, Chuck Grassley, and Olympia Snowe. This “group of six”met throughout the late spring,summer, and early fall of 2009 but could not reach an agreement. Despite the group’s failure, some of the ideas it generated were incorporated into the Finance Committee bill. There is no official record of their discussions, which were
apparently conversational in nature,though they were covered in the press.... Baucus was not only talking with senators across the aisle, he was also negotiating with the pharmaceutical industry with the blessing of the White House.

(To add to this, there were other Senators approached, who wanted to participate but were told not to - as I referenced above. The addition of GOP ideas made in private but not publicly were included anyway, trying to bring the GOP into the discussion. Blue Dog Democrats in the House did similar things. In the end, they could not "reach an agreement" even when they included those points because in the end - the push from leadership was to not have any agreement, regardless. This was because they feared the right wing ideologues just as Boehner does now, he has tried to avoid this shutdown/default vote numerous times. )

4) Given the united Republican opposition to [any] Democratic health care legislation, Reid would have to make sure his proposal could count on the votes of all fifty-eight Democrats and the two independent senators who caucused with
them—no easy task considering there were disagreements on such complicated matters as the public option, employer mandates,taxing high-priced plans, and the need to keep the legislation’s price tag below the President’s $900 billion limit.
This reality narrowed what form the final proposal could take, since one unhappy senator could derail the entire bill. It also shaped the debate that would take place and the information that would be generated from it.

I often wonder how much better a bill we would have gotten if the many GOP members of the Congress/Senate that wanted constructive dialogue on the issue would have been allowed to openly participate by leadership in the process.

5) The fragile truce on side-by-side amendments began to unravel over difficulties in reaching a UCA for a motion by Senator Mike Crapo of Idaho to commit the bill to the Senate Finance Committee.198 The agreement completely fell apart on December 16, 2009,when Republican Senator Tom Coburn insisted, as a delaying tactic, that a lengthy amendment by Independent Senator Bernie Sanders for a public option be read on the floor. The process of amending the bill on the floor of the Senate had come to an end.

[byu71]

That is both a doozy of a conspiracy theory and an extreme view shared by Cruz/Lee. So, if I don't agree with the Cruz/Lee view, I will blow up buildings? I think it equally absurd when Pelosi says that there "is nothing left to cut." That doesn't fit your black and white narrative. I'd never vote for her nor a number of extreme liberals.

I would say to you, "remember" that not all liberals blow up buildings (Most don't and shockingly Conservative ideology also leads to the blowing up of buildings), nor is that argument particularly relevant to our times. As as blowing up institutions, I would point to Lee/Cruz and Constitutional governance as a much more relevant example from our times. I would also say "remember" that the so-called "media bias" is an overblown argument intended to keep the ideologues "pure" in their belief and not having to deal with any complexity. Perfect case in point would be your example from last weekend's Sunday talk shows.

So if Obamacare becomes devastating, you believe the dems will go along with just dismantling it? I know you are not that naive. Whoever is in power will get to decide if it is dismantled or we move on to Universal Health Care. There are too many quotes from leading democrats about the desire to have universal health care for you just to kiss it off as "conspiracy theory". Pretty cool, use that word and then put me in with the Cruz/Lee clown act and you successfully set me up as a nut job arguing with you the superior intellect. Kiss my ass.

I don't think I have ever put you in the camp with the clowns on the left, Pelosi, Reid, Shumer and B for Boxer. Go ahead and do the dumbell by association thing, dems are great at doing that. Rush Limbaugh and Sean Hannity the leaders of the Republican party my butt.

Lastly, what is your definition of overblown? Why on earth when you are trying to reach a compromise right now would you bring someone in who isn't even interested in a compromise and who does not represent the majority of republicans. You tell me why you bring that clown in to be the face of the republicans right now.

Why didn't they bring in Pelosi and Reid and drill them with questions?

[Pelado]

I will deal specifically with ACA here and not the budget/spending cuts, which follow a similar path. If I were to try and summarize what I argue below, it is that I agree with you, but you are wrong on the timing. In other words, later on Obama on ACA did push out the GOP (somewhat similar path occurs on the budget stuff), but only after early attempts to find the bipartisan big deal failed due to the right wing of the GOP rejecting any effort in the House/Senate. Once the GOP decided to obstruct and not legislate, then yes - you are right.

The first part is anecdotal and I understand if you don't want to accept it. It is based however on numerous conversations with dozens of former students and friends who work in various capacities in the House/Senate.

When Obama was elected, he REALLY want to cement his legacy as a new type of President. His first attempt was ACA. He ran on Health Care and compromise. The whole reason ACA has key elements of the Heritage plan is because he wanted to find common ground. However, key Republicans decided that they wouldn't work on health care with Obama regardless of where he started. This was during the efforts on the right to delegitimize his whole presidency with the birther nonsense. A number of close friends, one a state director of a Senator and a couple of others in DC working with GOP members all told me exactly the same thing. Their members of Congress/Senate wanted to work with Obama and Democrats to have a big bipartisan deal on Health Care. After meetings, the right-wing got their way and these guys were explicitly told they couldn't work with Obama on it. GOP participation would be simply obstructionist, regardless of content. To kill it with destructive amendments, etc - again regardless of content. ANYTHING was going to be called socialist/Marxist/etc. Even their own ideas. The Senator that one good friend worked for actually was knocked off from the right (in a Convention some might remember) partly because he pushed hard to engage the President on Health Care, the debt, etc. Suddenly he had some very well-funded astroturf orgs opposing him and keeping him out of a broader primary where his views would have likely won the day quite easily. The right wing wanted nothing of negotiation on this or anything. They wanted Obama brought down.

At this point, yes Obama and the Democrats locked out the GOP, primarily because all they were trying to do was kill the bill, not participate, improve, or find any common ground. So at that point, you are pretty much correct - however, even then Obama continued to reach out to some Republicans because he really wanted positive participation. He desperately wanted a bipartisan outcome. For an objective and length summary of this history, read pp. 137-169 (yes, it is really long).

http://www.aallnet.org/main-menu/Pub...o-2/2013-7.pdf

Just a few excerpts of that length academic article and of what I am describing, just to summarize my points (emphases are mine, references removed here, but found in original journal article and well worth reviewing, even though I know that is tedious process):

1) Health care reform was one of newly elected President Barack Obama’s top domestic priorities, and he was determined to press forward with the effort early in his first term. Rather than having the executive craft the bill that would ultimately be introduced in Congress, as had been done in President Clinton’s failed effort more than fifteen years earlier, President Obama laid out the broad principles and goals that he wanted in a health care bill and left it to the House and Senate to provide the legislative details. Both chambers began working on health care in the early months of 2009,with the House taking the lead.

2) Once the committee draft is agreed upon,the primary goal of the majority during the markup is not to shape it,but to retain the agreed-upon form, or at least a form that can pass on the chamber floor, and to keep any amendments to a minimum. The minority party, left out of the extra-committee consultations and usually unwilling to provide any positive input, is relegated to advancing futile amendments to embarrass the majority. Thus,the intensive committee discussion of the form legislation should take no longer occurs

(On this point, my argument from everything I've seen is that the reason they were left out is because they refused "positive input" as the article notes. Many efforts were made bring positive participation.)

3) The Senate Finance Committee’s work was distinguished by two conversations that took place as it tried to complete the bill, as well as by its long delay in finally reporting one. The first conversation was between a group of three Democratic senators—Finance Committee chairman Max Baucus, Jeff Bingaman, and Kent Conrad—and three Republican senators—Mike Enzi, Chuck Grassley, and Olympia Snowe. This “group of six”met throughout the late spring,summer, and early fall of 2009 but could not reach an agreement. Despite the group’s failure, some of the ideas it generated were incorporated into the Finance Committee bill. There is no official record of their discussions, which were
apparently conversational in nature,though they were covered in the press.... Baucus was not only talking with senators across the aisle, he was also negotiating with the pharmaceutical industry with the blessing of the White House.

(To add to this, there were other Senators approached, who wanted to participate but were told not to - as I referenced above. The addition of GOP ideas made in private but not publicly were included anyway, trying to bring the GOP into the discussion. Blue Dog Democrats in the House did similar things. In the end, they could not "reach an agreement" even when they included those points because in the end - the push from leadership was to not have any agreement, regardless. This was because they feared the right wing ideologues just as Boehner does now, he has tried to avoid this shutdown/default vote numerous times. )

4) Given the united Republican opposition to [any] Democratic health care legislation, Reid would have to make sure his proposal could count on the votes of all fifty-eight Democrats and the two independent senators who caucused with
them—no easy task considering there were disagreements on such complicated matters as the public option, employer mandates,taxing high-priced plans, and the need to keep the legislation’s price tag below the President’s $900 billion limit.
This reality narrowed what form the final proposal could take, since one unhappy senator could derail the entire bill. It also shaped the debate that would take place and the information that would be generated from it.

I often wonder how much better a bill we would have gotten if the many GOP members of the Congress/Senate that wanted constructive dialogue on the issue would have been allowed to openly participate by leadership in the process.

5) The fragile truce on side-by-side amendments began to unravel over difficulties in reaching a UCA for a motion by Senator Mike Crapo of Idaho to commit the bill to the Senate Finance Committee.198 The agreement completely fell apart on December 16, 2009,when Republican Senator Tom Coburn insisted, as a delaying tactic, that a lengthy amendment by Independent Senator Bernie Sanders for a public option be read on the floor. The process of amending the bill on the floor of the Senate had come to an end.

Your argument on point 2 - that the Republicans were left out because they refused "positive input" is not supported by the article. The quoted paragraph gives only a generalization of the markup process as used today. In the paragraph previous to the one you cited, the author explains how useful the markup process used to be before it was so well documented:

Congressional committees evaluate and shape legislation through the markup process, in which committee members debate, amend, and then vote on whether to report out legislation. Under the traditional model, the markup ranks highly as an expression of what Congress wanted to do and why because it contains one of the first intensive discussions of the legislation by members. In the past, markups were not often used when compiling legislative histories because it was difficult to obtain proceeding transcripts. Now, proceedings are recorded and displayed on committee web sites, C-SPAN’s web site, and even YouTube. Unfortunately, the accessibility to markup proceedings has coincided with a decrease in the substance of the deliberations that made them so valuable. Instead, committee leadership now usually drafts a bill outside the markup process, behind closed doors, and this is what happened with House bill 3200.

The paragraph you quoted concedes that "the minority party" is "left out of the extra-committee consultations" which were held behind closed doors. The "unwilling to provide any positive input" clearly relates to the markup process, and is not justification for excluding the minority from the closed-door bill-drafting sessions. Not that the majority needed any justification for excluding the minority.

[VirginiaCougar]

Your argument on point 2 - that the Republicans were left out because they refused "positive input" is not supported by the article. The quoted paragraph gives only a generalization of the markup process as used today. In the paragraph previous to the one you cited, the author explains how useful the markup process used to be before it was so well documented:

The paragraph you quoted concedes that "the minority party" is "left out of the extra-committee consultations" which were held behind closed doors. The "unwilling to provide any positive input" clearly relates to the markup process, and is not justification for excluding the minority from the closed-door bill-drafting sessions. Not that the majority needed any justification for excluding the minority.

Yes and no. It is a general statement of which the specific case is representative. Its placement in the long narrative of the legislative history of the ACA is evidence. Nor is that statement inconsistent with what I argued. So yes, it is a general point to which the ACA is a representative case consistent with what I argued. As I said before, I didn't say there wasn't later efforts at avoiding GOP participation (in fact I said the opposite and explained why - which this quote does as well.)

I completely agree on the second quote about the decrease in the substance of deliberations in the public sphere (have to present for the talk radio/blogosphere crowd - substance rarely helps in that environment). Nor is that statement in any way inconsistent with what I argued here.

Since both references you make are not inconsistent with my arguments, I am not sure what point you are trying to make.

[LA Ute]

Most Popular Question at Healthcare.gov: How to Get Exemption From Lack-of-Coverage Penalty Fee?

[imanihonjin]

Yes and no. It is a general statement of which the specific case is representative. Its placement in the long narrative of the legislative history of the ACA is evidence. Nor is that statement inconsistent with what I argued. So yes, it is a general point to which the ACA is a representative case consistent with what I argued. As I said before, I didn't say there wasn't later efforts at avoiding GOP participation (in fact I said the opposite and explained why - which this quote does as well.)

I completely agree on the second quote about the decrease in the substance of deliberations in the public sphere (have to present for the talk radio/blogosphere crowd - substance rarely helps in that environment). Nor is that statement in any way inconsistent with what I argued here.

Since both references you make are not inconsistent with my arguments, I am not sure what point you are trying to make.

Now you are back tracking....you specifically stated after you cited the article in your 2) argument that:

(On this point, my argument from everything I've seen is that the reason they were left out is because they refused "positive input" as the article notes. Many efforts were made bring positive participation.)

So either you didn't know what "positive input" meant in respect to the way the article characterized it or you were blatantly hiding the meaning to make it look like Republicans were not providing something that is customarily provided, that is "positive input". However, as Pelado pointed out, minority input in general is not a part of the mark up process any longer.

Your argument made it seem as though because the Republicans didn't provide "positive input" in the mark up process they were some how being hostile to the president, when in fact, as pointed out by Pelado, the article suggests that the minority doesn't often provide input at all in connection with mark ups any longer.

[Pelado]

Yes and no. It is a general statement of which the specific case is representative. Its placement in the long narrative of the legislative history of the ACA is evidence. Nor is that statement inconsistent with what I argued. So yes, it is a general point to which the ACA is a representative case consistent with what I argued. As I said before, I didn't say there wasn't later efforts at avoiding GOP participation (in fact I said the opposite and explained why - which this quote does as well.)

I completely agree on the second quote about the decrease in the substance of deliberations in the public sphere (have to present for the talk radio/blogosphere crowd - substance rarely helps in that environment). Nor is that statement in any way inconsistent with what I argued here.

Since both references you make are not inconsistent with my arguments, I am not sure what point you are trying to make.

Not a big deal, but on the House side at least, my reading of the article makes the argument that the Republicans were excluded even from the beginning:

The paragraph you quoted concedes that "the minority party" is "left out of the extra-committee consultations" which were held behind closed doors.

On the Senate side, the article indicates that the bill came from the discussions between the 6 senators you named, but it doesn't really dive into how much of the Republican ideas/arguments were included/addressed in the bill.

Your earlier argument seemed to be that Obama and the Democrats really wanted Republican input and buy-in. I will concede that there may have been some of that behind closed doors, but there was certainly no public attempt from Obama or the Democrats to court Republicans or to make the bill bipartisan.

The public backlash against the Democrats at the time was such that a Republican vowing to stop the ACA was elected in a special election in MA, after which the House under Pelosi acquiesced and accepted the bill previously approved by the Senate knowing that it could no longer count on a supermajority in the Senate.

[calicoug]

I will explain my earlier comment with this totally made up example:

Say:
20-ers will face individual plan premiums that the CBO projected would go up 300%, but are only going up 250% (estimated)
30-ers will face individual plan premiums that the CBO projected would go up 200%, but are only going up 150%
40-ers will face individual plan premiums that the CBO projected would go up 100%, but are really going up 125%
50-ers will face individual plan premiums that the CBO projected would go up 50%, but will not go up at all
60-ers will face individual plan premiums that the CBO projected would go up 10%, but will actually go down 10%

Rather than publish the rate increases individually, the H&HS report lumps them all in together in their report findings, so that the decreases in projected costs from the 60 group will offset the precipitous increases for the healthier younger group. And they weight this lumped group so that the greater population of the older people will disguise the rate shock for the younger groups. I wasn't referred to the existence of an actual group plan that covers everyone from 18-65.

Now it's their (H&HS) findings, and they can publish their findings however they want, to get the statistics to back whatever they want. The question is why do they go to such great lengths to hide the results from their own data? Who in the heck reads the report and thinks: "I'm not in the least interested in how me and my family will personally be affected. We are just interested in some vague weighted average affect on the entire nation (or at least the nation of people between 20 and 65)"

Ah. Now I understand what you were saying. Thanks for the explanation.

You are correct HHS did not release data broken down by the age bands that will exist in the exchanges. Undoubtedly such a presentation obscures the fact that some (most likely the young and healthy) may see some rate increases over what they pay today without accounting for subsidies. That said, they weighted the average cost by state and gave all state level data for those averages and it simply is cheaper than what people claimed was possible. I don't know how that's anything but good news.

[calicoug]

That Freakonomics example is a good one that I hadn't remembered until you reminded me of it here.

The penalty is low in year one but it goes up quickly thereafter. And this isn't an instance akin to the Freakonomics example. People already go without insurance and feel free to use emergency rooms for care. They aren't constrained by guilt like the child care example. The fine will be a new cost that should impact decisionmaking. I'm surprised conservatives argue now the fine is too small. Just months ago when this was before the court the fine was too big and injurious to even be constitutional. Now it's too small to have an effect.

The penalty isnt the only cost either. Failure to keep healthcare will still expose people to the same issues they have now like possible bankruptcy.

[calicoug]

Right. No need to feel bad about freeloading off of society if you have to stop by the ER without insurance. You paid your tax, after all.

Good thing that isn't an issue without the tax. We dodged a bullet there. Why did anyone tinker with healthcare when it was working so flawlessly before?

[calicoug]

Thats what I am afraid of. I feel that paying my $96 penalty entitles me to the full services of any ER I happen to be near. And I am afraid that millions of others feel the same way, especially the young and healthy who would only have something catastrophic happen (which is geared to the ER).

Do you really feel that way? Will your subsequent bankruptcy cause you second thoughts? I'm guessing you don't really feel that way and are buying insurance. I love internet bravado.

[All-American]

Good thing that isn't an issue without the tax. We dodged a bullet there. Why did anyone tinker with healthcare when it was working so flawlessly before?

Just like parents picking up their kids late from daycare wasn't a problem. It's just that the solution, though perhaps well-intended, had unexpected consequences that failed to solve the problem, and in fact made the problem worse.

[imanihonjin]

The penalty is low in year one but it goes up quickly thereafter. And this isn't an instance akin to the Freakonomics example. People already go without insurance and feel free to use emergency rooms for care. They aren't constrained by guilt like the child care example. The fine will be a new cost that should impact decisionmaking. I'm surprised conservatives argue now the fine is too small. Just months ago when this was before the court the fine was too big and injurious to even be constitutional. Now it's too small to have an effect.

The penalty isnt the only cost either. Failure to keep healthcare will still expose people to the same issues they have now like possible bankruptcy.

Uh no it won't....you can't be denied for a preexisting condition, so this increases the likelihood that people will just wait until they are sick to purchase the insurance...which is stupid because at that point it ins't insurance it is a subsidy.