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trancelikestate

why disapprove of a us health care system

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danielost

Every state is built on the same system: a private insurance market (segmented into large and small group markets, as well as an individual market), a Medicaid population, and a Medicare population. There are variations between states as to the exact rules (some states have guaranteed issue or community rating laws in the individual market, some states subsidize low-income people to buy private insurance--as in Dirigo Health in Maine or the Connector in Massachusetts--some states have expanded their Medicaid programs to deal with that population, as with BadgerCarePlus in Wisconsin, etc) but the systems are the same. We don't have one state doing a single-payer system, one state relying entirely on HSAs or out-pocket spending, and then one with true socialized medicine with only state-owned hospitals and state-employed doctors, etc. Instead, every state does the same thing in slightly different ways.

So what uniformity is being imposed across states?

  • A simplification and expansion of Medicaid eligibility standards. Federal minimum standards for Medicaid are nothing new, as Medicaid is a joint state-federal program.
  • Non-discrimination rules (covering rating rules, issue rules, and benefit standards) in insurance markets. States will still administer their insurance markets, i.e. they will be running their own health insurance exchanges. Group health insurance plans are already subject to certain federal regulations through HIPAA so even this isn't some unprecedented concept. These will be strengthened and applied for the first time to the individual market.

And what happens if a state thinks it has a better way to achieve the same coverage goals? It applies for and receives a state innovation waiver and implements its own system.

Spare me the conspiracy theories. The CBO's impartiality and expertise are respected across the policy sphere. Are its projections perfect? Of course not, there's always substantial uncertainty in predicting the future. But their numbers are the best ones we have about the future of this program. And, as such, it's worth being familiar with them.

so your saying the states are or have taken steps to fix the health care problem. so now tell us why the federal government needs to be involved.

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J.B.

Spare me the conspiracy theories. The CBO's impartiality and expertise are respected across the policy sphere. Are its projections perfect? Of course not, there's always substantial uncertainty in predicting the future. But their numbers are the best ones we have about the future of this program. And, as such, it's worth being familiar with them.

Then take the report from outside the Policy Sphere. Anything "Congressional" is suspect. It's not a conspiracy theory, just common sense. Congress is under fire, so find someone in the middle to back them up. Else, they'll just be put through the ringer worse.

so your saying the states are or have taken steps to fix the health care problem. so now tell us why the federal government needs to be involved.

I've never even heard of the waiver he's talking about, which just reflects how little I know. Was that part of the bill now or were too few states using it to begin with?

Edited by J.B.

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Caesar

Then it's a good thing we're not making radical changes.

What will we be spending as a result of this new law compared to overall health care spending? Not all that much:

billsvstrills.jpg

Does it provide revenues and savings as it goes to pay for that extra spending? Indeed it does:

health-care_reform%27s_balance_sheet_2010-2019.png

Why is it that these projections are always way off yet people love to use them?

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J.B.

Why is it that these projections are always way off yet people love to use them?

Because they back up their claims?

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Startraveler

Why is it that these projections are always way off yet people love to use them?

Yeah. Always way off.

Why use them? As I just said, they're the best numbers we have from the authoritative groups on doing this sort of work (CBO and JCT).

Edited by Startraveler

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SpitHotFire

I read your post. I didn't comment on it because there's nothing in it worth commenting on. The country is big, its characteristics differ from those of Europe, we can't afford this, this won't work, etc. A mixture of irrelevancy and claims that, as I said, you have yet to justify. When distrust of the CBO is the linchpin of your argument, there likely isn't much there there.

No, you're just pulling a cop-out. I've debated way too many people who pull similar stunts.

As you've probably figured out, I take a strict economic perspective. I don't bother myself with saying "is it right or wrong?" in terms of UHC simply because it's a pointless argument which starts at a basic ideological division. Economics are, at least to me, the most unbiased.

I'll attack both of your links now. I'll start with the second one since it's the simplest. Now, I'm going to take a Keynesian perspective on this, so if you disagree with me there then we have an ideological difference that will make it impossible to see each others' terms. As you probably very well know, economies run in cycles. You have periods of increased economic growth called an expansion and periods of decreased economic growth known as a recession. It is perfectly natural and they occur all the time throughout the economic growth of a society. What we are in right now is, obviously, a recession. However, we are pulling out of it. Why? Is it because of the stimulus? I will argue: no. It's because of the natural cycle of the economy.

To expound on my point, I will explain a factor called "correlation does not imply causation." CDNIC states that simply because two factors are correlated does not necessarily mean that they cause each other. You can see this in violence in the media vs. violence in teenagers: does violence on TV make kids violent, or do violent kids just watch more violent TV? The answer is, according to behavioral psychologists, the latter (my source: social psychologist David Buck and psychologist David G. Myers). I will argue that CDNIC is the prime cause for yours and the CBO's misinterpretation of the rise in the economic standings. And, let's face it, the reason why I attack your CBO source is because it's Congressional research rather than basic third-party analysis. It's incredibly biased. It doesn't take a sociologist or economist to know that. You try bringing that up in an academic setting and your report will literally be laughed out of the room. I know, I've actually seen it in my Social Problems course. Exhibit A: "Big fat government spending can sometimes trigger a significant shift in resources and distort the economy, but this economy is so weak that we haven't seen much of a crowding-out effect." Well, no, not really. Our economy isn't that weak, and it has distorted the economy by providing stimulus to dying companies that should be left to die. That's how new entrepreneurs take up the reins and we see an evolution in the economic sectors (again, I'm assuming that you know this). That is distorting the economy by disgusting proportions. Auto industries are desperate. Prices have actually decreased in cars because the stimulus given to them is furthering production, but nobody wants to buy it. Obama's stimulus package is running on the outdated trickle-down theory which just plain doesn't work, because his stimulus is not putting money into the hands of the consumer, only that of the producer. Simply supply and demand can show you the causal relations between that. Now that's the causation, whereas that report in the Atlantic only explains the correlation. We are not in a depression. This recession isn't nearly as bad as the reports say it is, and Obama's attempts at instigating almost a New Deal-esque stimulus is running on an outdated dogma that doesn't work.

[We really need an economist running the country, not a politician.]

Alright, time to attack your initial graphs again. Economies are very difficult to hold onto and attack for face value. Now, I take it that you're an objectivist, or otherwise you wouldn't rely on only graphs and spreadsheets to support your argument. I take a functionalist sociological perspective, so again let's hope we can rationalize our views toward each other. You can't really judge whether or not you're in a recession until the recession has already passed or you're several months into it - that economic data takes time to collect. Economies are so volatile, especially ours with the Iraq War and such, that it's extremely difficult to accurately portray the changes in the economy with any good degree of certainty (source: sociologist Annette Schwabe, statistician Michael Crane). That's one of my issues with your graphs: you don't state anything about why the increases would occur or what degrees of certainty are there. In fact, you're entire argument is baseless because of that. You provide a graph, but there is no explanation as to why the changes will occur, how this data was measured, etc. You've fallen prey to the phenomenon described by Joel Best as "Missing Numbers." You've provided a graph that shows trends, but you don't explain 1) how those numbers were correlated, 2) what research methods were used to gather the data, 3) under what economic principle this is, and 4) compared to what other plans. That's why you have failed to provide anything adequate. And you call my data irrelevant? At least I can provide primary sources who do this sort of stuff for a living (like my friend in the initial insurance company quote) who know what they're talking about. Let's talk about another feature of the first of those graphs. Why don't the two points start off at the same level in 2009, or why is only the projection shown? Why is there a 2.5 billion dollar difference in where those graphs start? Surely they must; we don't live alternate realities here. Another flaw in your source.

My final claim (because my pizza just got here and I'm sooooo hungry) about the lack of efficacy in your graphs is how they seem to ride off of the current positive economic tide. If we find ourselves in an expansion again within the next few years (which we will!), then of course you'll savings/spendings change. Another failure of them to take into account CDNIC. But of course, this is just conjecture anyway because there's such a lack of information to accompany your graphs to begin with that there's nothing for me to even base this claim off of! And I almost find that ironic.

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Startraveler

Let's talk about another feature of the first of those graphs. Why don't the two points start off at the same level in 2009, or why is only the projection shown? Why is there a 2.5 billion dollar difference in where those graphs start? Surely they must; we don't live alternate realities here. Another flaw in your source.

What are you talking about? The graph comparing projected exchange subsidies by year to total projected health care spending? Unless I'm reading you incorrectly, it sounds like you're asking why the 20-odd million people who'll be entering the exchanges won't be getting subsidies totaling $2.5 trillion. I suppose the simplest answer is that we won't be giving them, on average, $100,000 to pay for their premiums.

The reality is that federal spending on exchange subsidies will be around 4% of total (federal and non-federal) health care spending, not 100% as you seem to be assuming.

Edited by Startraveler

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SpitHotFire

What are you talking about? The graph comparing projected exchange subsidies by year to total projected health care spending? Unless I'm reading you incorrectly, it sounds like you're asking why the 20-odd million people who'll be entering the exchanges won't be getting subsidies totaling $2.5 trillion. I suppose the simplest answer is that we won't be giving them, on average, $100,000 to pay for their premiums.

The reality is that federal spending on exchange subsidies will be around 4% of total (federal and non-federal) health care spending, not 100% as you seem to be assuming.

Wait, then what is the graph comparing if that's not it? I feel like this is just a very poorly made graph because the more I look at it the more I question what it's trying to say.

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Startraveler

Wait, then what is the graph comparing if that's not it? I feel like this is just a very poorly made graph because the more I look at it the more I question what it's trying to say.

Then ask.

There are two graphs contained in what I posted above.

The first is meant to juxtapose the additional federal spending on health care called for by this law with projections of what total health care expenditures in the United States will be over the next decade. Right now we're spending around $2.5 trillion per year on health care as a nation. Some of that spending is federal spending (on Medicare, DSH payments to hospitals, FMAP funds to state Medicaid programs, VHA facilities, etc), some is state, and much is private. Right now the federal government subsidizes group insurance to the tune of about $250 billion per year through a tax exclusion. Under this new law, that tax exclusion is capped (i.e. the subsidy is no longer limitless) and buyers of insurance in the individual markets--primarily the new state-level health insurance exchanges--will be eligible for their own capped subsidies to buy insurance. Those subsidies, projected to go to a little less than 25 million people in 2019, will cost (yes, in CBO's estimate) $466 billion over the first decade. The rest of the spending falling under the bill's $940 price tag is due to the Medicaid expansion and the tax credits to small employers. Compare that to the $250 billion per year we're giving the 150 million people in employer-based group insurance right now (projected to rise to about 162 million people by 2019).

The point is that this new spending is a small fraction (not quite 4%) of the total amount of spending on health care that happens in our economy.

The second graph compares projections of those new outlays (by year) to projections of the impact on the revenue sources in the bill (i.e. the excise tax, the reductions in Medicare Advantage payments, the scaling back of DSH payments to hospitals, and the slowing of the growth of non-physician Medicare reimbursement rates). The takeaway point being that the law raises money in addition to spending it. This late in the game this fact should hardly need to be pointed out but c'est la vie.

To make a broader point: the danger here is when people start thinking that something radically new is happening. You quoted some guy on the dangers of medical loss ratios without noting that more than a dozen states already have medical loss ratio requirements on the books in their insurance markets, and have for some time. And even in states without such requirements, during times like these, when interest rates are low, revenue from invested float becomes virtually negligible and yet health insurance companies survive. They're not going to collapse (and even--I should say especially--they recognize this). The alarmism is tiring.

Edited by Startraveler

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acidhead

No, you're just pulling a cop-out. I've debated way too many people who pull similar stunts.

As you've probably figured out, I take a strict economic perspective. I don't bother myself with saying "is it right or wrong?" in terms of UHC simply because it's a pointless argument which starts at a basic ideological division. Economics are, at least to me, the most unbiased.

I'll attack both of your links now. I'll start with the second one since it's the simplest. Now, I'm going to take a Keynesian perspective on this, so if you disagree with me there then we have an ideological difference that will make it impossible to see each others' terms. As you probably very well know, economies run in cycles. You have periods of increased economic growth called an expansion and periods of decreased economic growth known as a recession. It is perfectly natural and they occur all the time throughout the economic growth of a society. What we are in right now is, obviously, a recession. However, we are pulling out of it. Why? Is it because of the stimulus? I will argue: no. It's because of the natural cycle of the economy.

To expound on my point, I will explain a factor called "correlation does not imply causation." CDNIC states that simply because two factors are correlated does not necessarily mean that they cause each other. You can see this in violence in the media vs. violence in teenagers: does violence on TV make kids violent, or do violent kids just watch more violent TV? The answer is, according to behavioral psychologists, the latter (my source: social psychologist David Buck and psychologist David G. Myers). I will argue that CDNIC is the prime cause for yours and the CBO's misinterpretation of the rise in the economic standings. And, let's face it, the reason why I attack your CBO source is because it's Congressional research rather than basic third-party analysis. It's incredibly biased. It doesn't take a sociologist or economist to know that. You try bringing that up in an academic setting and your report will literally be laughed out of the room. I know, I've actually seen it in my Social Problems course. Exhibit A: "Big fat government spending can sometimes trigger a significant shift in resources and distort the economy, but this economy is so weak that we haven't seen much of a crowding-out effect." Well, no, not really. Our economy isn't that weak, and it has distorted the economy by providing stimulus to dying companies that should be left to die. That's how new entrepreneurs take up the reins and we see an evolution in the economic sectors (again, I'm assuming that you know this). That is distorting the economy by disgusting proportions. Auto industries are desperate. Prices have actually decreased in cars because the stimulus given to them is furthering production, but nobody wants to buy it. Obama's stimulus package is running on the outdated trickle-down theory which just plain doesn't work, because his stimulus is not putting money into the hands of the consumer, only that of the producer. Simply supply and demand can show you the causal relations between that. Now that's the causation, whereas that report in the Atlantic only explains the correlation. We are not in a depression. This recession isn't nearly as bad as the reports say it is, and Obama's attempts at instigating almost a New Deal-esque stimulus is running on an outdated dogma that doesn't work.

[We really need an economist running the country, not a politician.]

Alright, time to attack your initial graphs again. Economies are very difficult to hold onto and attack for face value. Now, I take it that you're an objectivist, or otherwise you wouldn't rely on only graphs and spreadsheets to support your argument. I take a functionalist sociological perspective, so again let's hope we can rationalize our views toward each other. You can't really judge whether or not you're in a recession until the recession has already passed or you're several months into it - that economic data takes time to collect. Economies are so volatile, especially ours with the Iraq War and such, that it's extremely difficult to accurately portray the changes in the economy with any good degree of certainty (source: sociologist Annette Schwabe, statistician Michael Crane). That's one of my issues with your graphs: you don't state anything about why the increases would occur or what degrees of certainty are there. In fact, you're entire argument is baseless because of that. You provide a graph, but there is no explanation as to why the changes will occur, how this data was measured, etc. You've fallen prey to the phenomenon described by Joel Best as "Missing Numbers." You've provided a graph that shows trends, but you don't explain 1) how those numbers were correlated, 2) what research methods were used to gather the data, 3) under what economic principle this is, and 4) compared to what other plans. That's why you have failed to provide anything adequate. And you call my data irrelevant? At least I can provide primary sources who do this sort of stuff for a living (like my friend in the initial insurance company quote) who know what they're talking about. Let's talk about another feature of the first of those graphs. Why don't the two points start off at the same level in 2009, or why is only the projection shown? Why is there a 2.5 billion dollar difference in where those graphs start? Surely they must; we don't live alternate realities here. Another flaw in your source.

My final claim (because my pizza just got here and I'm sooooo hungry) about the lack of efficacy in your graphs is how they seem to ride off of the current positive economic tide. If we find ourselves in an expansion again within the next few years (which we will!), then of course you'll savings/spendings change. Another failure of them to take into account CDNIC. But of course, this is just conjecture anyway because there's such a lack of information to accompany your graphs to begin with that there's nothing for me to even base this claim off of! And I almost find that ironic.

keynesian economics and the failure of the federal government™ to hold those accountable for their failures is what creates the 'engineered' boom and bust cycles

Yes... an economist running the country.....Ron Paul for president and Peter Schiff treasury sec.

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ninjadude
And, let's face it, the reason why I attack your CBO source is because it's Congressional research rather than basic third-party analysis. It's incredibly biased. It doesn't take a sociologist or economist to know that.

and yet not so much.

What are cost estimates and why does CBO prepare them?

By law, CBO is required to produce a cost estimate and mandate statement for every bill reported by a Congressional committee. Each cost estimate of pending legislation assesses (1) the potential impact on spending subject to appropriation (also known as discretionary spending), (2) any impact on mandatory spending (also known as direct spending), and (3) any impact on federal revenues (incorporating estimates by the Joint Committee on Taxation for legislation that would change the federal tax code). Used to determine whether the proposals are consistent with the budget resolution, CBO's cost estimates have become an integral part of the legislative process. See "CBO's Role in the Budget Process" and "What CBO Publishes." To find particular cost estimates, use the cost estimates search function, or browse through a listing of cost estimates for the current Congress.

How accurate are CBO's economic forecasts?

CBO regularly evaluates the accuracy of its economic forecasts and publishes the track record. Those evaluations help guide the agency's efforts to improve its forecasts and help Members of Congress and others in their use of CBO's estimates. Historically, the accuracy of CBO's two-year forecasts and five-year projections has been very similar to the accuracy of those by the Blue Chip consensus (an average of private-sector forecasters) and the Administration. For a related discussion, see What Is a Current-Law Economic Baseline and CBO's Economic Forecasting Record: 2007 Update.

How accurate are CBO's budget projections?

By statute, CBO's baseline projections must estimate the future paths of federal spending and revenues under current law and policies. The baseline is therefore not intended to be a prediction of future budgetary outcomes; instead, it is meant to serve as a neutral benchmark that lawmakers can use to measure the effects of proposed changes to spending and taxes. So for that reason and others, actual budgetary outcomes are almost certain to differ from CBO's baseline projections. For a related discussion, see Chapter 1 of CBO's Budget and Economic Outlook; see also The Uncertainty of Budget Projections: A Discussion of Data and Methods for supplemental information.

source

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Pseudo Intellectual

The CBO is nonpartisan, but the thing about it is that they don't predict; they estimate. They can't see the future.

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ninjadude

The CBO is nonpartisan, but the thing about it is that they don't predict; they estimate. They can't see the future.

a forecast is a prediction. We attempt to predict the future all the time. And then they adjust the prediction based on past performance of the prediction. Nearly every company of any size and the government do this.

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Pseudo Intellectual

Unfortunately, future adjustions mean nothing. People want to know the facts and what the results would be like now, not after the legislation has passed and been implemented.

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