Going, Going, Gone

[Brittain33]

Yes about the fact that there is a gap period potentially when you get sick (so yes there is risk, but as Levin says, a lot less risk), but did you notice what I said about gap insurance? I suppose you could make gap insurance illegal, but that is not in the Obamacare law either, assuming it were constitutional to prevent consenting adults to enter into their own private contract using their own money.

I think "gap insurance" has a specific meaning.  I don't think it is insurance you sign up for in the hospital to cover your current hospitalization.  Does someone sell such a product?  That would have to be the worst insurance model.  Or am I not understanding your meaning?

Such "gap insurance" is a sure loser because it encapsulates adverse selection. This is why Yuval Levin has to imagine it... Maybe the Hobby Lobby CEO can take proceeds from the liquidation of his business over the contraception mandate and plow it into offering this profit-hemorrhaging product as a way to stick a final stake through the heart of Obamacare.

The universe owes no one a "just so" story.

[Torie]

Levin did not mention gap insurance (I guess you didn't read the article) - I did. I don't understand the balance of your post Brittain33. As to the point about rehashing old stuff, if you read the article, you might find that more is put on the table. It certainly summarizes well the conundrums. When one finds what one considers a good article on an important public policy issue, one puts it up, even if some of it involves what has been discussed before. Isn't that what you do? Heck it might change someone's mind, and continues the informative process. Folks serially quoting the word "yawn" may be a nice way to get a dig at me (and no, it won't deflect me), but I doubt anyone who drops by this thread will be particularly impressed by it.

I have to agree with you that the Pubs will probably not do anything constructive to fix Obamacare while Obama is POTUS, and I am not sure the Dems are prepared to fix it either, if they have your attitude that the gloom and doom predictions are just partisan hackery, and acting chicken little like on steroids. Of course, some Dems just view Obamacare as a gateway step to single payer universal health care, so they might not mind that the gears on the existing law are broken. But it will be fixed eventually. It just has to be given the fiscal implications.

[Brittain33]

Torie, I dipped into the article and to be blunt, it's based on a foundation of pure, unadulterated bull[inks]. The comparison to individual insurance plans now, on which he relies so heavily, is specious, as very few young people are able to purchase those cheap examples he cites as a baseline--either because it's not sold in their states or because insurance companies regularly deny those headline rates to applicants. I saw Avik Roy's comparison debunked many times when it came out two months ago--to rely on it uncritically is to be dishonest. Google Avik Roy and debunk, you'll see what I mean. I look forward to hearing your reaction to that.

This article argues against all evidence that Obamacare raised premiums for young people on that basis and then says people who disagree are dishonest--he does not address the reductions in NY or MD.

Torie, this is an opinion piece in a republican magazine that is not fact-checked and has no obligation to present facts fairly. It has been a waste of time to look into except in that I was able to spy the dishonesty, reliance on debunked sources, disingenuous repetition of dishonest editorializing as "facts", and outright propagandizing that prove it is an opinion piece with a goal in mind that is not reform of our healthcare system.

So, no, in the future, I'm not going to read these pieces from the Weekly Standard, National Review, or similar outlets presented as helpful advice for Democrats, because they do not meet basic standards of honesty or academic integrity, as evidenced by the cost basis they use in this article for showing the incredible mark-up on youngs. It's dishonest and a waste of time.

[Torie]

I don't think the article was packaged as helpful advice to Dems. Never heard of Avik Roy, but per your suggestion, I did google it.  What should I be reading that debunks Levin's points? Anyway, I do appreciate you actually coming up with specific refutation points. That is far more constructive than what came before IMO.

[Brittain33]

To be concise: his article is predicated on the idea that young people have ready access to inexpensive catastrophic health coverage that will be replaced with more expensive, less valuable coverage in the future. He and you make suggestions based on that.

His assumptions are broadly incorrect.
1. Cheap coverage for youngs is rare and often hard to get, even when advertised. In many states, it's not available at all.
2. Most youngs getting coverage under Obamacare will do so because of new mandates on employers to cover young people on parents' plans or via the (delayed) employer mandate.
3. Coverage now has minimum standards, which will drive out the very cheapest plans, but provide better coverage;
4. Obamacare subsidies, of which you've heard plenty that I need not repeat myself;
5. Obamacare introduces a viable individual market at affordable prices in states where it doesn't exist now--a true godsend.

In short, Obamacare is handing legions of youngs a sturdy, low-cost horse to ride, and Yuval Levin complains that it is more expensive and less reliable than the free unicorns young people enjoy today.

[Brittain33]

I don't think the article was packaged as helpful advice to Dems. Never heard of Avik Roy, but per your suggestion, I did google it.  What should I be reading that debunks Levin's points? Anyway, I do appreciate you actually coming up with specific refutation points. That is far more constructive than what came before IMO.

Look up Ezra Klein and Jonathan Cohn's debunking his piece.

http://m.washingtonpost.com/blogs/wonkblog/wp/2013/06/01/the-shocking-truth-about-obamacares-rate-shock/

[Torie]

Yes, everybody agrees that the existing insurance system is not working. The scope of mandatory coverage to me is a moral hazard problem. You need enough coverage to insure against risks that will break one financially, and become a burden on the state, but too much, and you take away choices from folks that are in their best interests.

Anyway, I found this piece from WAPO (hopefully you will find that source not dismissible out of hand). And you know what first came to my mind? I thought, hey maybe this will be enough for krazen to now support Obamacare.

[Link]

I have to agree with you that the Pubs will probably not do anything constructive to fix Obamacare while Obama is POTUS, and I am not sure the Dems are prepared to fix it either, if they have your attitude that the gloom and doom predictions are just partisan hackery, and acting chicken little like on steroids.

I think what you are seeing is push back because Republicans have been so unreasonable.  Remember the way we got into the mess we are in today was Democrats bending over backwards to try and craft this thing so they could get Republican votes.  I don't think anyone in their right mind would say the finished product doesn't need changing.  But that doesn't mean every criticism is valid.  You aren't really going to get a meaningful dialog started when the other side votes every week to trash the thing.

[Torie]

I don't think the article was packaged as helpful advice to Dems. Never heard of Avik Roy, but per your suggestion, I did google it.  What should I be reading that debunks Levin's points? Anyway, I do appreciate you actually coming up with specific refutation points. That is far more constructive than what came before IMO.

Look up Ezra Klein and Jonathan Cohn's debunking his piece.

http://m.washingtonpost.com/blogs/wonkblog/wp/2013/06/01/the-shocking-truth-about-obamacares-rate-shock/

 

Will do, but they are liberals aren't they?  There is a certain lack of symmetry here. Right wing sources are dismissible out of hand, and left wing sources are not. Anyway, I don't approach matters that way. I can evaluate the merits on my own as to what folks claim.

[Brittain33]

Certainly, some employers, particularly ones aligned with the GOP, are going to go that route. We see elsewhere in this forum that Hobby Lobby is threatening to close down altogether rather than accept the contraception mandate! Time will tell if this persists or if they quietly reverse themselves in the future.

[Link]

Yes, everybody agrees that the existing insurance system is not working. The scope of mandatory coverage to me is a moral hazard problem. You need enough coverage to insure against risks that will break one financially, and become a burden on the state, but too much, and you take away choices from folks that are in their best interests.

Anyway, I found this piece[.url] from WAPO (hopefully you will find that source not dismissible out of hand). And you know what first came to my mind? I thought, hey maybe this will be enough for krazen to now support Obamacare.

There have been numerous things that resulted in local governments not just cutting hours but entire jobs.  Local governments are cash strapped entities.  Repealing Obamacare isn't going to address the underlying problem.

[Torie]

Local governments are Pub employers?

And yes, Link, localities have other financial problems, but the WAPO piece suggests that Obamacare is exacerbating those problems. But that is, in the end, just a who pays for it issue. If Obamacare were going to work like a Swiss watch, with the only problem being who pays for it, that would be fantastic. Would that that be true.

[Torie]

I did read the article, although I didn't see much in Levin's argument that was new; much of it is a re-hash of Roy's "rate shock" piece. I'll second Britain33's recommendation of these responses by Ezra Klein, Rick Ungar, and Jonathan Cohn.

Thanks Nix.

[Brittain33]

Local governments are Pub employers?

Middletown, New Jersey is as much of a pub employer as Orange County, ca. 1970. That town is heavily settled by Wall Street workers who plumped for Romney in 2012 and would support this move.

Republican state governments have opposed Obamacare, even at the expense of their own constituents; why would Republican local governments behave any differently?

[Brittain33]

Torie, what's your proposition: is it that Obamacare doesn't "work like a Swiss watch", or that the whole rotten mess is "going, going, gone," destined for collapse?

The latter provokes a stronger reaction...

[Torie]

I didn't write the headline. Anyway, here is another article to throw on the pile (a bit dense, but whatever), discussing the Roy and his critics feud. (Hopefully this guy is not just another dismissible right winger.) The one thing that struck me (other than yes, the NY state insurance system is a mess, and so matters do vary by state as to what the impact will be - if you have a bad enough existing system, than it does not take much to improve it), is his comment at the end that "the debate is not going well."  It is not going well here, or out there on the Fruited Plain.

I might further add, that I never really pushed the sticker shock issue. I was, and am, more worried about the errant incentives issue. That is where the collapse will come, if my view of matters is correct. And I still don't like the way the cross subsidies are constructed, which divert from means testing to age cohorts far too much. But that is an equity issue, and not per se an issue that would necessarily lead to collapse.

[anvi]

I'll take a crack at some substantive comments.  Maybe some will think they're not substantive, but here they are anyway.

The essay linked in the OP compares the prices of the cheapest policies in some states now to the ACA's "bronze policy" in its critique of coming higher premium rates for youngs  But don't the "bronze policies" cover more than current bare-bones policies?  And if they do, isn't the price comparison, even without considering subsidies, a bit misleading? 

And, again, if the "bronze policies" do cover more than current and cheaper policies, why does that fact have nothing to do with the author's assessment of the value of the "bronze plans"?  His only concept of the value of insurance coverage for young healthy people seems to be wrapped up in the degree of risk they run without catastrophic coverage.  But what is so fundamentally irrational, I wonder, about having more coverage than less for a young, healthy person?  Is it so just because I look through actuarial tables and make the bet that I won't need something, so that having it isn't worth my money, and that's the only standard of incentive that should matter to any "rational" person?  It's like saying something is only valuable to the extent that I really should have it, but not valuable for what it might offer me if I do.  Isn't that kind of a shallow conception of the value of health insurance?

Cross-subsidization.  In a world with no ACA, the system we have now, if I'm a resourceful and sensible young person and I buy catastrophic coverage on the individual market, but, lucky for me, never have to use it, aren't my premium payments, in addition to managing my own risk, subsidizing the other people in the pool who do have to use that coverage?  Why shouldn't I in this circumstance feel just as cheated as the young person under ACA who, as the article says, can buy insurance for the same price as a sick person can, but may go without ever filing any claims while young?  Again, there is this very narrow argument offered in the piece that the only important thing about young people buying insurance is the incentives tied to managing very serious risks--and absent this concern, buying insurance is just the act of a sheer bonehead.  But isn't another important thing about buying health insurance the consequence that putting myself in the pool may help to add to the quality of insurance evadable for not just me but everyone else in the pool too?  The quality of the product and the social effect are just supposed to be a snazzy riff in a song that people like to hear but no one believes in?  Bad incentives indeed.

I think the issue that is most pertinent to most youngs not having health insurance is its relative un-affordability to them while young and earning low incomes.  There are certainly young people who have never been sick or injured and who don't feel they need health insurance because of the illusion of indestructibility.  But my own bet is that a lot more young people don't buy health insurance because they can't afford it, not because they think having more coverage than they might need is dumb. 

[Small Business Owner of Any Repute]

There's a lot of handwringing over the youngs, but we're the age group with which the ACA is the most popular. We don't have insurance. We want to be able to get insurance.

[pbrower2a]

Save "Going, going, gone!" for Detroit Tigers baseball games, especially when Miguel Cabrera is hitting.