What do you know about the ACA?

[DBP]

>>I consult my conscience first. And while I respect yours… don’t count on it being the same, and don’t count on me to accept yours either.

—Understood, and agreed. Thank you.

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[JV]

Let’s step back and ask ourselves a few important questions:

1.) Will the ACA make healthcare costs increase or decrease?

2.) Will the ACA result in better patient care or worse patient care?

3.) Will the ACA help our country financially, or will it hurt.

4.) Will a great number of companies opt out of providing insurance for their employees because the fines are far cheaper than providing care?

5.) Then what? Where do the employees go, (medicare/medicade) and was this the objective all along? (to get everybody into a single payer system?)

6.) Can we afford the huge dump of people onto the public system? Revisit question #3.

(or maybe we don’t care about those obvious flaws, and as Jan suggested, we don’t like the “Obama” part)

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[DBP]

Hm. Are you asking these questions because you really want to know the answers? Or are you asking because you want us to concede in advance that Obamacare’s “flaws” are obvious?

If you’re asking because you really want to know, I think you’ve got the right questions, at least.

And what I will concede (in advance) is that both sides are making some big assumptions about Obamacare. I’m willing to revisit the whole thing if it fails on the merits. But if it fails merely because employers/providers/politicians are sabotaging it, that’s another story.

So I guess I would add another question to your list, JV. To wit:

7.) How do we differentiate between sabotage and honest failure of the program, and how do we address the problem in each case?

 

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[kootchman]

Oh, how about some truth?

we have the best doctors, technology, and are the source of the best iinnovation and pharmaceuticals in the world. Let that fact stand alone. Just acknowledge it.

Second, that superlative achievement came from medicine for profit. That was and is the incentive.

I recognize there is disparity in access.

This administration is not telling the truth. The costs are substantial. As are the levels of deception in order to “sell” it.

CBO is told how to mark up a bill, but only within the confines of the assumptions is is handed. It is not an “impartial” or “reputable” body. It’s an organ grinder monkey. It will crank out and dance to any tune you put on the rollers. Garbagege in, garbage out. They are told to “assume” 4 million companies will drop employee coverage. Mark it up accordingly.

Now, AEI, Chamber of Commerce, AMA, MassMA, say.. that’s not our data. That’s not what our memberships says. Some of us on this site are actually small business people, provide professional services, invest in them. We are not laborers or task workers. we are required, depend upon, long term knowledge about what those businesses intentions are. Yes some are anecdotal, but at least we talk to them. we aren;t “guessing” we are being told what the contingency plans are, what our customers, and peers intend to do. We know what we intend to do.

Your premise that these are acts of “sabotage” is largely a misnomer to begin a false argument. Return to the guiding light of businesses. Maximize profits. That alone will illuminate what path they will take. Posit the question another way, “how are businesses likely to respomd”?

Look at at statements like… “my friend in Mass loves their healthcare plan” or “Mass plan has lowered costs and increased access.. and then list the talking points. well, that is not true. There is hard data that the costs are higher than projected. The rate of increase is higher than budgeted for. Access is getting harder. Private companies dumped coverages, that if extrapolated, would make CBO projections look like pure fantasy. To add flavor to the discussion, Mass is a high income state relative to the rest of the country. It should be more capable of absorbing these costs. In fact, it is the highest income state in the union at 51K. Outpaced only by (no surprise) WA DC. at 71K. One should or could wonder… the insular effects of living in DC instead of out in the “real world” contributes to this perception of limitless resources to be taxed. WA state btw is at 45K.

We are at rough parity with CA, in income. And while deep in deficits ourselves.. we are listed at 25th place as “good place to do business” a substantial loss over the last decade. Reason? Taxes, ease of regulatory burden, government debt. Is it starting to show? Yes it is. We are taxing the hell out of everything,. Now take CA and Ill..they are in a truly humble state of fiscal solvency… hundreds of billions in deficit. In year three of Obamacare they have to come up with billions.. billions they don’t have, and billions they can’t borrow because neither one is an acceptable bond risk now. Thats over 45 million people who won’t be covered by the expanded program, revenue the CBO was told to assume would come from the states in their mark uo, would be available. CBO just released the start-up costs are already double the projected costs. The program isn’t even off the ground and it is 100 per cent over budget. Ya think a business wouldn’t put an immediate stop or hold for an exhaustive review before proceeding farther down the path? Not our current congress or president. It’s the Solyndra model all over again. Every red flag that could be waved is waving.. and we are going to ignore them to satisfy a political objective.

These are facts.

Is the objective better health? Or is the objective political satisfaction?

Small ball first. If one thing works, lowers costs, expand it, A complete takeover of the healthcare system as a start up project? Pure self destructive fiscal behavior. And what is the rallying cry of supporters? Trust us, it will get better.

Mediciad and Medicare are not sustainable now. Every actuarial table shows it, Congress knows it. SS is not sustainable, not under the assumptions made 80 years ago. That’s the trifecta of budget deficits. See any acts of political courage there?

Yea it’s a big problem… let’s not put the entire economy under the stress to fix it all in one fell swoop. we won’t recover from another entitlement catastrophe .. no matter how “fair” it is. Our greatest national asset is at risk.. capitalism. The engine that pulls the cars.

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[dobro]

Here’s a nice long post with some facts and citations.

Already in effect:

It allows the Food and Drug Administration to approve more generic drugs (making for more competition in the market to drive down prices)

(Citation: An entire section of the bill, called Title VII, is devoted to this, starting on page 747)

It increases the rebates on drugs people get through Medicare (so drugs cost less)

(Citation: Page 216, sec. 2501 )

It establishes a non-profit group, that the government doesn’t directly control, PCORI, to study different kinds of treatments to see what works better and is the best use of money. (Citation: Page 665, sec. 1181)

It makes chain restaurants like McDonalds display how many calories are in all of their foods, so people can have an easier time making choices to eat healthy. (Citation: Page 499, sec. 4205)

It makes a “high-risk pool” for people with pre-existing conditions. Basically, this is a way to slowly ease into getting rid of “pre-existing conditions” altogether. For now, people who already have health issues that would be considered “pre-existing conditions” can still get insurance, but at different rates than people without them. (Citation: Page 30, sec. 1101, Page 45, sec. 2704, and Page 46, sec. 2702)

It forbids insurance companies from discriminating based on a disability, or because they were the victim of domestic abuse in the past (yes, insurers really did deny coverage for that) (Citation: Page 47, sec. 2705)

It renews some old policies, and calls for the appointment of various positions.

It creates a new 10% tax on indoor tanning booths. (Citation: Page 923, sec. 5000B)

It says that health insurance companies can no longer tell customers that they won’t get any more coverage because they have hit a “lifetime limit”. Basically, if someone has paid for health insurance, that company can’t tell that person that he’s used that insurance too much throughout his life so they won’t cover him any more. They can’t do this for lifetime spending, and they’re limited in how much they can do this for yearly spending. (Citation: Page 14, sec. 2711)

Kids can continue to be covered by their parents’ health insurance until they’re 26. ( Citation: Page 15, sec. 2714 )

No more “pre-existing conditions” for kids under the age of 19. (Citation: Page 45, sec. 2704 and Page 57, sec. 1255)

Insurers have less ability to change the amount customers have to pay for their plans. (Citation: Page 47, sec. 2794 )

People in a “Medicare Gap” get a rebate to make up for the extra money they would otherwise have to spend. (Citation: Page 379, sec. 3301)

Insurers can’t just drop customers once they get sick. (Citation: Page 14, sec. 2712)

Insurers have to tell customers what they’re spending money on. (Instead of just “administrative fee”, they have to be more specific).

Insurers need to have an appeals process for when they turn down a claim, so customers have some manner of recourse other than a lawsuit when they’re turned down. (Citation: Page 23, sec. 2719)

Anti-fraud funding is increased and new ways to stop fraud are created. (Citation: Page 699, sec. 6402)

Medicare extends to smaller hospitals. (Citation: Starting on page 344, the entire section “Part II” seems to deal with this )

Medicare patients with chronic illnesses must be monitored more thoroughly.

Reduces the costs for some companies that handle benefits for the elderly. (Citation: Page 492, sec. 4202)

A new website is made to give people insurance and health information. (I think this is it: http://www.healthcare.gov/ ). (Citation: Page 36, sec. 1103)

A credit program is made that will make it easier for business to invest in new ways to treat illness by paying half the cost of the investment. (Note – this program was temporary. It already ended) (Citation: Page 830, sec. 9023 )

A limit is placed on just how much of a percentage of the money an insurer makes can be profit, to make sure they’re not price-gouging customers. (Citation: Page 22, sec. 1101)

A limit is placed on what type of insurance accounts can be used to pay for over-the-counter drugs without a prescription. Basically, your insurer isn’t paying for the Aspirin you bought for that hangover. (Citation: Page 800, sec. 9003)

Employers need to list the benefits they provided to employees on their tax forms. (Citation: Page 800, sec. 9002)

Any new health plans must provide preventive care (mammograms, colonoscopies, etc.) without requiring any sort of co-pay or charge. (Citation: Page 14, sec. 2713 )

1/1/2013

If you make over $200,000 a year, your taxes go up a tiny bit (0.9%). Edit: To address those who take issue with the word “tiny”, a change of 0.9% is relatively tiny. Any look at how taxes have fluctuated over the years will reveal that a change of less than one percent is miniscule, especially when we’re talking about people in the top 5% of earners. (Citation: Page 818, sec. 9015)

1/1/2014

This is when a lot of the really big changes happen.

No more “pre-existing conditions”. At all. People will be charged the same regardless of their medical history. (Citation: Page 45, sec. 2704, Page 46, sec. 2701, and Page 57, sec. 1255)

If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it. (Citation: Page 145, sec. 5000A)

Question: What determines whether or not I can afford the mandate? Will I be forced to pay for insurance I can’t afford?

Answer: There are all kinds of checks in place to keep you from getting screwed. Kaiser actually has a webpage with a pretty good rundown on it,

Medicaid can now be used by everyone up to 133% of the poverty line (basically, a lot more poor people can get insurance) (Citation: Page 179, sec. 2001)

Small businesses get some tax credits for two years. (It looks like this is specifically for businesses with 25 or fewer employees) (Citation: Page 138, sec. 1421 )

Businesses with over 50 employees must offer health insurance to full-time employees, or pay a penalty.

Insurers now can’t do annual spending caps. Their customers can get as much health care in a given year as they need. (Citation: Page 14, sec. 2711)

Limits how high of an annual deductible insurers can charge customers. (Citation: Page 62, sec. 1302 )

Place a $2500 limit on tax-free spending on FSAs (accounts for medical spending). Basically, people using these accounts now have to pay taxes on any money over $2500 they put into them. (Citation: Page 801, sec. 9005 )

Establish health insurance exchanges and rebates for the lower and middle-class, basically making it so they have an easier time getting affordable medical coverage. (Citation: Page 88, sec. 1311)

Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won’t be footing their health care bills any more than any other American citizen. (Citation: Page 81, sec. 1312)

A new tax on pharmaceutical companies.

A new tax on the purchase of medical devices.

A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.

The amount you can deduct from your taxes for medical expenses increases.

1/1/2015

Doctors’ pay will be determined by the quality of their care, not how many people they treat.

1/1/2017

If any state can come up with their own plan, one which gives citizens the same level of care at the same price as the PPACA, they can ask the Secretary of Health and Human Resources for permission to do their plan instead of the PPACA. So if they can get the same results without, say, the mandate, they can be allowed to do so. Vermont, for example, has expressed a desire to just go straight to single-payer (in simple terms, everyone is covered, and medical expenses are paid by taxpayers). (Citation: Page 98, sec. 1332)

2018

All health care plans must now cover preventive care (not just the new ones).

A new tax on “Cadillac” health care plans (more expensive plans for rich people who want fancier coverage).

2020

The elimination of the “Medicare gap”

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[kootchman]

Point by point.. too long but I’ll select a few

It allows the Food and Drug Administration to approve more generic drugs

we are in critical shortage of off patent drug right now. It’s a national health crisis. I will assume you are current on the issue. It costs over 700 million to bring ONE new drug classification to market. Vital cancer treatments are being denied for substitutive therapies of less effectiveness. No one is making them!!!!!

I started doing colonoscipies every two years since age 55 (govt guidelines are every 5) So far, bout’ 8 little bumps have been removed. No co-pay? How they going to do that? Cutting the fee to the hospital or the doc? Rationing the care? SOMEONE will be paying.. and I doubt my very busy doc will accept lower fees. Gonna get yours at Oil Can Henry’s? You bet Kaiser loves the plan.. they are the ones along with AARP that are making up the standard of care… less care per patient, more money for them.

All those taxes.. ha ha ha.. those are freebies? Rebates means a transfer of someone elses money to you. Someone had to be taxed for it. why tanning booths? Let’s slap a tax on dobro players?

That’s the assignment pool. It is a perversion. what that means is your doc will get “x amount per year to treat you… whatever he doesn’t spend he pockets. That’s the Kaiser plan. The less treatment you get.. the healthier you are…

Perfect, the more effective an insurance company is, the more consumers choose their better systems .. the more their provider gets taxed???. Thats as smart as having Ford pay more because they have larger market share and giving Saab a pass on taxes cause they have little market share. Let the market reward successful execution.. by more customers. Don’t penalize them.

Make top of the line medical devices, better than your competitors and you get taxed MORE? Medtronicis is sure to stay in country for that. Don’t grow or move offshore.

It’s classic liberalism…. tell em there are cookies in the jar.. someone else is paying for them.

My favorite….

Congress and Congressional staff will only be offered the same insurance offered to people in the insurance exchanges, rather than Federal Insurance. Basically, we won’t be footing their health care bills any more than any other American citizen. (Citation: Page 81, sec. 1312

They all knock down (staffers) big bucks.. here.. take a look..

Legislative Assistant for Congressman Connoly of VA… 13,444 per month… yea.. right they are going to have the peon plan .the rest of us have. a 160K staffer is going to have the same coverage as a 7-11 clerk? you are dreaming

http://www.legistorm.com/person/Hera_A_Abbasi/32657.html

If you can afford insurance but do not get it, you will be charged a fee. This is the “mandate” that people are talking about. Basically, it’s a trade-off for the “pre-existing conditions” bit, saying that since insurers now have to cover you regardless of what you have, you can’t just wait to buy insurance until you get sick. Otherwise no one would buy insurance until they needed it. You can opt not to get insurance, but you’ll have to pay the fee instead, unless of course you’re not buying insurance because you just can’t afford it

This is precisely what is happening in Mass…. paying the fine.. until they are sick.. then joining the plan.. often DURING admission… not bad deal… 95 month fine… then stiff the program for your car wreck and reconstructive surgery.

No more “pre-existing conditions” for kids under the age of 19. (Citation: Page 45, sec. 2704 and Page 57, sec. 1255)

that’s a keeper.. I’d go for that.

smoke and mirrors… Don’t forget the lynchpin of ALL this… 100 per cent of the states enroll… and they had the club taken away by the Supreme Court.. they cannot penalize states that don’t join by withholding basic Medicare. Now that it is a tax.. hold tight to your knickers…

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[redblack]

we have the best doctors, technology, and are the source of the best iinnovation and pharmaceuticals in the world. Let that fact stand alone. Just acknowledge it.

sure. but you need to acknowledge this fact:

we have the most bureaucratic, ass-backwards, expensive way of delivering that technology to consumers of any country in the industrialized world.

17% of GDP. how do you justify that?

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[JanS]

tanning booths = skiin cancer…’nuff said..

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[JanS]

and that’s $95 the first year…it goes up the second year, and even more the third year…

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[kootchman]

Ya want the best.. you pay for the bes… if you wanted a CAT scan in Congo… it would be 900% of the annual earnings of the average Congolese. we do a hell of a lot of elective surgery!

http://misunderstoodfinance.blogspot.com/2011/03/new-healthcare-law-will-not-reduce.html

“Even without considering the fiscal caveats already mentioned, the health care reform law has only a negligible net impact on the size of the health care sector and its growth over time (Chart 5). This is not necessarily “bad,” as one might reasonably expect a high-income country with high-quality upper-end care to spend a great deal on health care. But it does reinforce the point that cost control is unlikely to be the lasting legacy of the law.”

But you sadly make my point … because… 65% of all medical care is provided by? Federal Programs!!! And you want to givve them 100%? I don’t understand that logic. ? The more they take over, the more expensive it gets.

“Health care in the United States is provided by many separate legal entities. Health care facilities are largely owned and operated by the private sector. Health insurance is now primarily provided by the government in the public sector, with 60-65%[citation needed] of healthcare provision and spending coming from programs such as Medicare, Medicaid, TRICARE, the Children’s Health Insurance Program, and the Veterans Health Administration. “

Let’s do it this way… in 1964, the year before Medicare and Medicaid, healthcare was 1.35 % of GDP… now it is 17.4. Hardly cost controlled is it? Defense spending as a per cent of GDP has varied less than 2% in the same period of time. Government rarely makes things, better, cheaper, more efficient… for sure never more efficient.

Does this sound familiar” It should. The reason Fannie and Freddie sucked up all those loans? Thee government wanted their GSE to be a monopoly. Now they are moving to take effective control over the healthcare system.

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[DBP]

Geez, these posts are just getting longer and longer. I can’t keep up.

kootchman, you said this:

This administration is not telling the truth. The costs are substantial. As are the levels of deception in order to “sell” it.

Maybe you’re right, maybe you’re wrong. But it’s too early to say that, and I’m not willing to kill this thing before it gets off the ground just because some people don’t trust anything the government does.

In the spirit of 365 Stairs, let’s try to iron out a compromise on this. I think a good compromise would be to let the ACA go forward and set up some kind of review commission. If it turns out to be too costly, or if it just doesn’t deliver the goods, then we can revisit it and maybe even shut it down.

Shutting it down at this point is obviously not a compromise position. That’s an extremist position.

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[JV]

dobro do those goodies just appear out of thin air? And in return for those goodies, insurance premiums increased 8-10% per year so far since Obama waved his magic pen.

As for taxes, it’s Economics 101; TAXES ON COMAPNIES ARE PASSED DOWN TO ALL OF US, SO EVERYTHING IS MORE EXPENSIVE!!

A new tax on pharmaceutical companies.

A new tax on the purchase of medical devices.

A new tax on insurance companies based on their market share. Basically, the more of the market they control, the more they’ll get taxed.

I have a feeling that if the gubmn’t passed another huge tax on oil companies today, dobro would celebrate, then wonder why gas jumped $8 per gallon.

They SAY it’s a tax on XYZ so the sheep won’t get all upset, but XYZ passes it down to you.

It’s not a “mandate” it’s a tax.

It’s not a “penalty” it’s a tax.

It’s not a “fee” it’s a tax.

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[kootchman]

DPB… we know the federal government. Remember we had the national helium reserve in existence for over 90 years.to inflate barrage ballons.. to snag the wings of bi-planes on strafing runs over trench lines. It employed 160 people in some congresspersons district. Give this thing roots and it will become porkulus extremis.

Giving Obamacare full free range is not compromise either. But DPB… we will see. The compromise is going to be 1. How many states adopt it. 2. What the voters say in November. Funny thing about compromise… it means BOTH sides.. going forth full blast with this much risk and the reputation of this government? Remember, this is the same IRS that gave out a few billion in child tax credits for dependent chilldren of illeglas who lived in Mexico!!!! Sorry DPB 2.7 trillion to get this thing “started” is a bit too lavish in these times.

want proof? watch our own congressional delegation… when they try and cut defense spending… Fairchild, Everett, Bangor, Ft. Lewsis, McChord., Keystone, Roosevelt Island, Yakima, .. see if smelly sneakers goes for that! See what happens to Everett if that carrier battle group is reassigned to the new Guam station when the cut the carrier fleet by 4 and have to forward deploy the carrier groups.

Let’s try, interstate sales so insurance companies can get BIGGER and spread their costs over a bigger base. See COSTCO? Exactly why they wil tax big companies.. they will deliver more efficiently . Not something you want to happen when you are seeking government monopoly. Tort reform? Stop subsidizing trial lawyers at the public expense. Let’s try a couple of those first.. if the don’t work … then let’s talk about a gradual increase in the government roll. It’s hard to tell a whale to be a minnow.

Once the feds give birth… it liveth forever.

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[JV]

DBP, I hope you’ll seek out information on both sides of this issue.

I disagree with your last statement. Passing a HUGE piece of legislation, on Christmas Eve, by a single party, using back room deals and kickbacks…that was extreme. Repeal and Replace is common sense.

Their objective is to “give” us all of these nice things then say, “good luck trying to walk that back” because they know that once people get an entitlement, it can never be taken back. See any gov’t program as an example.

7.) How do we differentiate between sabotage and honest failure of the program, and how do we address the problem in each case?

I’m curious how you define sabotage. I think this was designed to “fail” which ultimately means a single payer system. Self sabotage is written into this thing.

I fully believe that Obama wants companies to stop insuring their people, and put the insurance companies out of business. Then they will have to go into the government “single payer” system. That was the objective all along, and it’s a mathematical certainty.

He set it up so business drop their insurance coverage, because it’s cheaper to drop your health coverage and pay the fine than to pay the ever-increasing insurance premiums. Then businesses are the bad guys for dropping their employees’ coverage, and the big nanny government will take care of us all!

They created a problem so you’d seek them for the solution.

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[JV]

I forgot to mention something that dobro said:

1/1/2014

This is when a lot of the really big changes happen.

I think he means January 21st, 2013, which is Presidential Inauguration day…THAT is when the big changes will happen.

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[kootchman]

Oh JV… on that day.. may we quote Gerald R Ford…. ? Our long national nightmare is over. DPB.. you are as “independent” as Bagdad Jim…. I don’t care what your voter registration is. You be liberal, you trend liberal, … come out of the closet.

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[kootchman]

Jobs reports are coming out this Friday… new unemployment claims…. just what Obama doesn’t want to talk about… back on message this week. Four more years of this? … and now that have the Obamacare Tax Increase to sorta bookend it all this… not only is our economy STILL in the tank…. now we have a 2.7 trillion dollar tax increase staring at us. Yipeeee.. tax and spend is back! wouldn’t it be interesting of the 29 republican states didn’t sign on to Obamacare? We have so many weapons to kill this thing… budget reconciliation if we get the Senate, outright repeal and replace if we get the WH and Senate, Republican Governors Association, threaten to raise state taxes in all the red states to cover the costs of Obamacare?…. this is no done deal.

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[dobro]

The ACA is actually a huge tax CUT for small bizness and the middle class. Currently, the cost for ER care to the insurance holders is pegged at 1000 dollars per. That will go away. Small biznesses get subsidies and credits. According to the CBO scoring, the ACA will reduce the deficit and lower costs.

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[DBP]

So that’s your compromise, kootchman? Repeal and replace?

Replace with what? Where’s your better alternative? I don’t think I ever saw a package on the table from your side, and you’ve had since at least the Carter era to work on this.

What it sounds like to me is: Replace with nothing. Back to the status quo ante.

If you disagree with that assessment, I’ll give you another chance to outline your own alternative health care reform package.

[Using a #2 pencil, please write in the space provided below.]

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[dobro]

The package from the Repubs was this same plan, Bob Dole era. They don’t like it now. I wonder why?

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[JanS]

DBP. That what I want Romney, Boehner, Ryan, McConnell to do. Specifics are important. What will you replace this plan for? Listening to Chris WAllace ask specifics of McConnell, and listening to McConnell ignore, welch, dismiss was pretty eye opening.

http://www.youtube.com/watch?v=UTyANr6zhdo&feature=player_embedded

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[kootchman]

No it isn’t dobro. It’s pegged at 900 according to Obama, watch the Stpehopoulous interview. what don;t you understand about subsidies” If you subsidize corn prices… who do you think pays that subsidy? The taxpayer. The CBO scoring assumes 100 per cent participation of all states… and that ain’t going to happen. The CBO is given a set of data… by congress. Then they are told to score it as if that set of data is correct. They are not allowed to say or comment on the assumptions. Now if you were to ask the CBO to score it if 50 per cent of the states don;t participate,.. and if the AEI projections hold true that by the second year over 20 million small businesses drop their coverage. THEN look at the score… it’s a multi-trillion dollar shortfall. Even the current CBO says it’s at least 2.7 trillion to get the program initiated. Ummm tell, just where is that cash laying around? well we know they took 500 billion our of Medicaid… it is going to be borrowed money if it happens. Your CBO scoring talking point is properly phrased this way… ” if eveyhing the Democrats said comes to pass… then this is the likely outcome. we already know that is not going to happen.. the Supreme Court gutted the state mandate to kick in 10 per cent in year three… and more thereafter. 12 states have already no they are not going to participate.. more will follow. It’s cheaper to pay the 900 than implement Obamacare. And the quality of care will fall…. as it has in Mass. You are ignoring the very words of the people who intend to drop the coverage… the SBI has surveyed their members.. at least 40% say they are dropping health coverage. The don’t see it as a cut. This is an old congressional “ploy” telling CBO “use these assumptions” and give us an answer. Of course the assumptions have already been number crunched to insure the outcome congress wants. Like ethanol subsidies…which were blown all to hell… the production costs did not fall as predicted in the use and volumes models presented to the CBO… and lo and behold… ethanol is not profitable and to stay alive as an octane booster will live on perpetual subsidy… even though the CBO “scored” the assumptions under the data given.. ie.. at a certain level of production, and at a certain market price for corn… the break even point was “x”… corn FYI has risen over 30% in the last two months given the drought condiitions. It also doesn’t mark up the cost of diverting corn from a food and feed commodity, to a fuel supplement, and you also pay in the increased price of your cornflakes by expanding demand.

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[Bostonman]

Sorry I have been so swamped, I apologize if it seems I am dropping comments and then never reposting.

DP, in some ways I suspect my boss/owner is doing it for bother the reasons you mentioned. He really isn’t unlike most other small business owners though so calling him ruthless is perhaps a bit of a stretch but it does come down to the all mighty dollar.

Redblack, your right and I am not disagreeing with you that you will either pay your premium or you will pay the tax. No disputing that and I don’t think I have ever represented otherwise. The unforseen is going to be what employers do. I have done the math for my 54 person company and I can tell you it is far cheaper for the company to just drop the health insurance benefit and pay employees a little more money even with the company having to pay a tax for not offering insurance. Employees will then be left to fend for their own insurance.

There is no doubt that health care needs to be reformed. Even the fiscal conservative in me can see that the current system is broken. If anything the law didn’t touch on the more important areas that would have greater impact to the average american. Only time will tell if rates will go down but that usually doesn’t happen with increased demand as Dobro mentioned in an earlier post. increased supply drops prices, increased demand raises prices if there is no additional supply.

Just looking at basic economic theory I can’t see how adding millions of people to insurance rolls will reduce insurance costs for everyone else unless we get more supply on the doctor and hosipital end. I think the average person will see premiums go up, demand go up and quality of care go down. Doctors are not going to be able to keep up with all the new people with insurance and if it takes a week to get in to see your doctor then I think that time will double.

Now, this is just what I see what will happen with my measly college education and understanding of economics and that I have run some of the numbers from a small company perspective. I hope I am wrong, I hope it works out to be a great thing socially for everyone. Its to far reaching and impacts to many people for it to be taken lightly. I hope I am wrong and you guys are right.

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[kootchman]

B’man … the scary part is we HAVE a micro version to compare it to. Mass. Costs are going up. Employers have dropped coverage, Access times have been protracted. and practictioners are leaving. It’s not quality healthcare for anyone if your wait time to see your primary care doc is 2 months. The Mass Medical Association has shown the data… the average wait time is now 46 days to see an internal medicine doc… the gatekeeper docs who make the speciality referrals as needed. This is way too much risk, at too fragile a time, to be blowing smoke to achieve election or re-election. I say lets let one or two more states live under the Obamacare mandates for 4 years… those that want to participate. See if the promises deliver before we are all in. A few prototypes that can be measured and observed first.

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[kootchman]

Expand the insurance markets to allow interstate comparative shopping. More access always means lower prices.

Cap and limit tort actions. Bring down the cost of defensive medicine and malpractice insurance.

Get the USDA off their asses and their cozy relationship to the food industry and start teaching nutrition, and spending more to serve balanced foods. USDA administers school lunches…start education there! Make food stamp recipients attend nutrition classes as part of enrolling in food subsidy programs.

Obesity has to be part of risk assessment. If your BMI is over 22, I don’t care what your economic status is… you have to pay more. we do it now… smokers get killed in health and life insurance premiums for those things they can control and exert influence over. It’s the number one health threat to this country… nothing in Obamacare addresses personal responsibility.

Those are some starters.

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