ObamaCare aka "Patient Protection & Affordable Care Act" (1 Viewer)

[tommyGunZ]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

 

[Sand]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

May like this one - "The bill spends more than the president promised, it covers fewer people -- probably 2 million fewer people -- and it taxes more than was expected,"

The bill was built on the artificial facade of the CBO only predicting 10 years out (so the long term health care portion includes all the payments in, but since outflows start at 10 years out it artificially shows much better numbers), among many other sleight of hand tricks. The numbers are now showing it since the new CBO cost runs are now going past the original 10 years. And the future is damn expensive.

 

[tommyGunZ]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

May like this one - "The bill spends more than the president promised, it covers fewer people -- probably 2 million fewer people -- and it taxes more than was expected,"

The bill was built on the artificial facade of the CBO only predicting 10 years out (so the long term health care portion includes all the payments in, but since outflows start at 10 years out it artificially shows much better numbers), among many other sleight of hand tricks. The numbers are now showing it since the new CBO cost runs are now going past the original 10 years. And the future is damn expensive.

The CBO always predicts 10 years out. It's not a facade, it's exactly how they score every bill, since it becomes very difficult to predict the economic effects of legislation further out due to the changing political and economic winds.

The fact that this fox piece accuses the CBO of a "slight of hand" when the CBO was using it's SOP tells you all you need to know.

 

[Sand]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

May like this one - "The bill spends more than the president promised, it covers fewer people -- probably 2 million fewer people -- and it taxes more than was expected,"

The bill was built on the artificial facade of the CBO only predicting 10 years out (so the long term health care portion includes all the payments in, but since outflows start at 10 years out it artificially shows much better numbers), among many other sleight of hand tricks. The numbers are now showing it since the new CBO cost runs are now going past the original 10 years. And the future is damn expensive.

The CBO always predicts 10 years out. It's not a facade, it's exactly how they score every bill, since it becomes very difficult to predict the economic effects of legislation further out due to the changing political and economic winds.

The fact that this fox piece accuses the CBO of a "slight of hand" when the CBO was using it's SOP tells you all you need to know.

Not accusing the CBO of sleight of hand. The construction of the ACA deliberately included provisions (see: long term care provision) of gathering money early in the 10 years and then starting to expend that money after the 10 years. Thus the sleight of hand.

The public accounting of this was a blatant lie. No way around it. Not any different than a many other things that the govt. provides costs for that are terribly underfunded despite claims of much lower costs, but nevertheless a big 'ol lie on this one.

The real cost of this won't be anywhere near revenue neutral, as claimed. In fact, it never was revenue neutral. This will cost trillions more than originally predicted.

 

[Politician Spock]

This will cost trillions more than originally predicted.

That money ends up somewhere.

Some people are going to be huge financial beneficiaries of this historic change.

 

[matttyl]

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

That's the thing. All you need are a few easy calculations on the back of napkin and some common sense to see how this will turn out. It's a train wreck.

 

[DrJ]

Whole lot of heartless people in this thread. You can't put a price on human life. It's worth infinity billion dollars.

 

[BigSteelThrill]

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

That's the thing. All you need are a few easy calculations on the back of napkin and some common sense to see how this will turn out. It's a train wreck.

Tea party types. The gift that keep on giving.

 

[humpback]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

Can't wait to hear your spin on these two "wackos".

 

[drummer]

If an industry standard practice that is predicated on the use of say, an MRI scan machine that has fluctuations in pricing due to the marketplace, then the machines value also fluctuates due to the arbitrary pricing. When you have to price a procedure due to the marketplace, you ultimately are not practicing medicine, instead placing value of your practice with outlying values. Modern medicine is a competitive field in today's world, and there is a premium in the value chain. The reason why a desire for Government to get involved is because the Health Care industry is another bubble model. To me it ultimately comes down to pricing, and the Health Care industry has huge lobby to protect it's economic ecosystem, thus legislation that ultimately protects said ecosystem.

If you need a procedure that costs as much as your personal assets that ultimately has the Banks involved that could own what you have earned due to medical bills, then that alone is a systemic failure outside of any Government legislation. That means that the only way the Health Care industry can survive is through Government intervention.

Personally, I love the power of the Free Market, because we determine the value chain. But if the value chain is rigged to where we don't have that power anymore due to permeation of special interest, then those like me who even have less options with something less imperative - like media delivery choices that causes a horrid market due to the bought and sold FCC - only shows what we already know; that the Government can't fix an inflated Health Care industry that's all corporate, which also has a ton of Law firms involved.

We lose the free market value chain, and we lose, plain and simple. But there is no way that we can think it can sustain itself without the Government involved, simply because both the Corporate world and the Government are in bed with each other. They are the ones dictating the markets. All this political noise is just added value to the media markets they also control.

 

[Rich Conway]

Isn't Obamacare hitting us all in the pocketbook?

I am sorry, but health insurance has been hitting the pocketbooks for years! Even before Obamacare came to life. I will give you this Obamacare does not address the main need and that is to look at the costs. But when did health insurance become an entitlement?

There are several cost control measures in the ACA. They rarely get talked about, and are totally ignored by folks wanting to bash GOVT CONTROLLED OBAMACARE!!!, but they are there.

For maybe the fourth time in the thread, what are those cost control measures again?

 

[Sand]

Isn't Obamacare hitting us all in the pocketbook?

I am sorry, but health insurance has been hitting the pocketbooks for years! Even before Obamacare came to life. I will give you this Obamacare does not address the main need and that is to look at the costs. But when did health insurance become an entitlement?

There are several cost control measures in the ACA. They rarely get talked about, and are totally ignored by folks wanting to bash GOVT CONTROLLED OBAMACARE!!!, but they are there.

For maybe the fourth time in the thread, what are those cost control measures again?

Maybe the promised "if we pass the ACA then we can tackle fraud" statement talked about by Obama over and over then promptly forgotten as soon as it was passed? Because tackling fraud was impossible without the ACA.

But, just like SNAP, I'm sure there is vanishingly little fraud now in the system since we don't hear anything about it.

 

[matttyl]

So far, no one really has come up with any good alternatives to the ACA plan the way it's currently set up. It's not an easy thing to do, either, and I'm not saying it is. This is an extremely complicated issue that brings with it morals, economics, accounting, (unfortunately) politics, and most important of off the overall improvement and affordability of healthcare (in case you missed it, it's right there in the title of the darn law). It seems to be that since it's the only alternative, it must be the best option (though I honestly don't think it's any better than what we have now that I understand isn't working either).

I'd like to take a shot, if I may.

Background - The entire idea here needs to be having more people have coverage. Some simple numbers are that we've got roughly 50M uninsured Americans. Roughly 10M of those live in households that can afford coverage (but choose not to), and over a third of the 50M live in households with incomes over $50k, and a quarter of the 50M is already eligible for current public assistance plans. Only 10% of the uninsured market is considered "uninsurable" because of a pre-ex. So only about half of the uninsured market can not afford coverage after receiving any government assistance that they may be eligible for - and 90% of the uninsured market are healthy enough to obtain coverage (taking out the affordability aspect). All those numbers come from wiki, take them for what they are worth, but they do give you an idea of the current marketplace.

As you can see, the current marketplace is set up in such a way that we can easily get more people to have coverage. That's why in the big scheme of things, I actually think the mandates are a good thing. What I don't agree with is government only allowing these new plans (typically much higher than current plans) to be eligible to be exempt from the mandate. Therefor, we should suspend the exchanges, keep the current market place in tact for the time being, and implement a mandate that can actually be a viable threat to the uninsured.

I know what will come next - "well what if they can't obtain coverage and/or afford it - you're going to tax/penalize them for it you heartless *******?!" No, I would not. If you can show that you've been turned down by 2 or more individual insurance carriers in your state because of your health - or that the coverage that you would qualify for would be over 9.5% of your income - then you would be exempt from any penalty.

I believe this will get a very, very large number of currently uninsured back into "the pool", and since something like 38% of the uninsured market is under 34, getting all those young people into the pool will greatly help future rates.

That still doesn't solve the problem for all. We should have some "guaranteed issue" type plan for the remaining that can't obtain coverage - and it doesn't need to be nearly as strong or have nearly as many built in bells and whistles which are what have made these ACA plans so expensive. This will also act as an "incentiveizer" in a way for these people who would want to be eligible for better or more comprehensive coverage. I know it won't be able to work for all as that are many things that you can never get over and be healthy enough to obtain underwritten coverage - I get that and I'm not saying my plan is perfect by any means.

As for the people who could obtain it, but can't afford it - those are the people that need some sort of subsidy. These healthy people are the ones who NEED to be in the pool so the entire house of cards doesn't fall down (see New York, for instance).

I have other thoughts, and this is just a start to possibly get some discussion going about ideas rather than just bickering back and forth at each other. If nothing else, maybe it will educate people who come here looking for what this plan is really all about and what the issues are around it.

Thank you for all who read my above rambling.

 

[timschochet]

It's not a bad idea, mattyl. But while it might be fun to discuss the details of such a plan on paper, in the real world it's largely irrelevant.

A lot of people both on the left and right seem to refuse to accept the reality that Obamacare is here to stay. Conservatives think we can still get rid of it. Progressives believe that eventually we'll have single payer. Neither is going to happen. Not for years, probably not for decades. Obamacare is going to be with us for a while, no matter how much it ends up costing. We're all going to be able to find out if Tommy is right about the CBO or not.

 

[matttyl]

It's not a bad idea, mattyl. But while it might be fun to discuss the details of such a plan on paper, in the real world it's largely irrelevant.

A lot of people both on the left and right seem to refuse to accept the reality that Obamacare is here to stay. Conservatives think we can still get rid of it. Progressives believe that eventually we'll have single payer. Neither is going to happen. Not for years, probably not for decades. Obamacare is going to be with us for a while, no matter how much it ends up costing. We're all going to be able to find out if Tommy is right about the CBO or not.

I know, I know.....

Just wanted to vent.....

 

[tommyGunZ]

Isn't Obamacare hitting us all in the pocketbook?

I am sorry, but health insurance has been hitting the pocketbooks for years! Even before Obamacare came to life. I will give you this Obamacare does not address the main need and that is to look at the costs. But when did health insurance become an entitlement?

There are several cost control measures in the ACA. They rarely get talked about, and are totally ignored by folks wanting to bash GOVT CONTROLLED OBAMACARE!!!, but they are there.

For maybe the fourth time in the thread, what are those cost control measures again?

Too lazy to google it yourself?

PPACA reduced payments both Medicare and Medicaid
make to hospitals that serve a disproportionate share of low-income
patients. This change reflects the expectation that PPACA’s major
coverage expansions will result in significantly fewer uninsured hospital
patients. Also, PPACA reduced estimated Medicare spending through
changes to rates paid to Medicare Advantage organizations—Medicare’s
private plan alternative to the original Medicare fee-for-service—to align
Medicare Advantage payment rates more closely with spending on
Medicare’s fee-for-service program.12
In addition, PPACA created a number of cost containment mechanisms
designed to slow future growth of health care spending, such as:

• Productivity adjustments. PPACA seeks to restrain health spending
growth by reducing the payment updates for many Medicare services
for productivity gains. This is intended to provide a strong financial
incentive for health providers to enhance productivity, improve
efficiency, or otherwise reduce their costs per service.

• Independent Payment Advisory Board (IPAB). PPACA called for the
creation of a 15-member board to make recommendations, with
certain restrictions, for reducing the costs of Medicare when per capita
Medicare growth exceeds specified targets beginning in 2015. These
recommendations are automatically implemented unless overridden
by lawmakers.

PPACA also incorporated certain tax provisions designed to generate
revenue. Beginning in January 2013, PPACA imposed an additional
Medicare Hospital Insurance tax on wages, compensation, and self
employment income in excess of threshold amounts, defined as $200,000
for individuals, $250,000 for spouses filing jointly, and $125,000 for
spouses filing separate returns. PPACA also imposes an excise tax on
high cost employer-sponsored health plans beginning in 2018. Employer
sponsored plans with a benefit value exceeding specified thresholds will
generally be subject to a 40 percent excise tax.15 The excise tax will be
levied on insurers but is expected eventually to be passed on to their
customers. CBO, OACT, and other observers expect that the excise tax
will create an incentive for employers to reduce the scope of their health
benefits and, therefore, the demand for health care services.

 

[Rich Conway]

None of those things change the cost of providing care.

 

[matttyl]

And I love that we're calling a tax a "cost control measure".

 

[humpback]

None of those things change the cost of providing care.

And I love that we're calling a tax a "cost control measure".

Or, setting up an advisory board to make recommendations, with certain restrictions, to reduce Medicare costs if they exceed specific targets in the future. They'll be "automatic", unless of course lawmakers "override" them, which we know never happens.

More importantly, he still hasn't acknowledged that there's a lot more to "costs of healthcare" than just what the government decides to pay. I guess as long as the government isn't on the hook for it, it doesn't matter what it costs the people.

The sad thing is, in his fairytale land, he's just destroying everyone with his "facts".

 

[matttyl]

How about something to offset the $12B increased cost from delaying the large employer mandate a year (so far)?

 

[matttyl]

On Obamacare, Tea Party is on Right TrackVitriol has gone beyond partisan give-and-take in the nation's politics. It is now seeping into and poisoning the ranks of the Republican Party.

Mainstream Republican politicians are cringing at the proposal by senators in the Tea Party movement -- Ted Cruz of Texas, Mike Lee of Utah and Marco Rubio of Florida -- that upcoming legislation to appropriate funds to operate the federal government be held hostage on condition that Obamcare funding is withheld.

Republicans opposing this strategy see it as lose-lose. They don't believe this tactic can defund or deliver a deathblow to Obamacare. At the same time, they see it producing more antipathy toward Republicans and branding them as zealots and obstructionists.

I think the Tea Partiers are on the right track, and I think the "mainstream" opposition is missing key, important points.

Republicans should be thinking about two objectives.

First, fight public resignation that Obamacare will become an inevitable part of our national landscape and continue building public understanding of how bad and dangerous this law is for our health care and our economy.

Second, continue the ongoing work to build public awareness that Republicans are not the party of "no" but the party of "yes" to a conservative agenda, which is really the only viable path to national recovery.

On the first point, the Tea Party strategy is already working.

If Republicans sit politely on the sidelines and allow business as usual to continue in Washington, the American public can only conclude that everything is basically OK.

But everything is not basically OK.

We don't even have to look to Republicans to show what a disaster Obamacare is.

The Obama administration itself initiated a one-year delay in implementing one of the most central features of the law -- the mandate on employers to provide government-defined health insurance. No clearer statement could be made of the unworkability of this bureaucratic nightmare.

Now Howard Dean -- former Democratic presidential candidate, Democratic National Committee chairman, Vermont governor and still a physician -- calls for scrapping another central feature of Obamacare: the Independent Payment Advisory Board.

This is the unelected committee of 15 Washington bureaucrats who will play the central role of pricing medical services under Medicare.

Pricing of medical services by bureaucrats is the pure socialism of Obamacare that those opposed to the law said from Day One would not work. Now Dean confirms this.

On the second point, Republicans must wake up to the public relations battle they have lost over recent years. Radical left-wing Democrats have been accepted in the public eye as moderate and reasonable, and conservative Republicans are portrayed as the nutty extremists.

When President Barack Obama took office, the nation was headed toward the bottom of a terrible recession.

His priority then should have been economic recovery.

It was not. He used the honeymoon of his first year in office to enact his socialist dream of government-funded health care.

Obamacare -- The Affordable Care Act -- was passed in March 2010 through legislative sleight of hand and without a single Republican vote. It brings socialism to almost one-fifth of the American economy. Its core features are regulation and the government printing press.

Where is the money going to come from to pay for all the subsidized purchases of government insurance? Where is the money going to come from to pay for the 20 million or so dumped into Medicaid on top of the 60 million already there?

And somehow those who brought us this nightmare are the moderates?

No, the Tea Partiers are right. The future of our country is at stake.

The Republican Party's priority must be to wake America to what faces us, to show who the real radicals are, and to demonstrate that the only way out of this mess is by restoring personal and fiscal responsibility and a functioning free market.

 

[Slapdash]

None of those things change the cost of providing care.

They don't need to do that to have an impact on overall health care spending.

 

[Slapdash]

On Obamacare, Tea Party is on Right Track Vitriol has gone beyond partisan give-and-take in the nation's politics. It is now seeping into and poisoning the ranks of the Republican Party.Mainstream Republican politicians are cringing at the proposal by senators in the Tea Party movement -- Ted Cruz of Texas, Mike Lee of Utah and Marco Rubio of Florida -- that upcoming legislation to appropriate funds to operate the federal government be held hostage on condition that Obamcare funding is withheld.

Republicans opposing this strategy see it as lose-lose. They don't believe this tactic can defund or deliver a deathblow to Obamacare. At the same time, they see it producing more antipathy toward Republicans and branding them as zealots and obstructionists.

I think the Tea Partiers are on the right track, and I think the "mainstream" opposition is missing key, important points.

Republicans should be thinking about two objectives.

First, fight public resignation that Obamacare will become an inevitable part of our national landscape and continue building public understanding of how bad and dangerous this law is for our health care and our economy.

Second, continue the ongoing work to build public awareness that Republicans are not the party of "no" but the party of "yes" to a conservative agenda, which is really the only viable path to national recovery.

On the first point, the Tea Party strategy is already working.

If Republicans sit politely on the sidelines and allow business as usual to continue in Washington, the American public can only conclude that everything is basically OK.

But everything is not basically OK.

We don't even have to look to Republicans to show what a disaster Obamacare is.

The Obama administration itself initiated a one-year delay in implementing one of the most central features of the law -- the mandate on employers to provide government-defined health insurance. No clearer statement could be made of the unworkability of this bureaucratic nightmare.

Now Howard Dean -- former Democratic presidential candidate, Democratic National Committee chairman, Vermont governor and still a physician -- calls for scrapping another central feature of Obamacare: the Independent Payment Advisory Board.

This is the unelected committee of 15 Washington bureaucrats who will play the central role of pricing medical services under Medicare.

Pricing of medical services by bureaucrats is the pure socialism of Obamacare that those opposed to the law said from Day One would not work. Now Dean confirms this.

On the second point, Republicans must wake up to the public relations battle they have lost over recent years. Radical left-wing Democrats have been accepted in the public eye as moderate and reasonable, and conservative Republicans are portrayed as the nutty extremists.

When President Barack Obama took office, the nation was headed toward the bottom of a terrible recession.

His priority then should have been economic recovery.

It was not. He used the honeymoon of his first year in office to enact his socialist dream of government-funded health care.

Obamacare -- The Affordable Care Act -- was passed in March 2010 through legislative sleight of hand and without a single Republican vote. It brings socialism to almost one-fifth of the American economy. Its core features are regulation and the government printing press.

Where is the money going to come from to pay for all the subsidized purchases of government insurance? Where is the money going to come from to pay for the 20 million or so dumped into Medicaid on top of the 60 million already there?

And somehow those who brought us this nightmare are the moderates?

No, the Tea Partiers are right. The future of our country is at stake.

The Republican Party's priority must be to wake America to what faces us, to show who the real radicals are, and to demonstrate that the only way out of this mess is by restoring personal and fiscal responsibility and a functioning free market.

I hope this is a copy and paste job.

 

[matttyl]

I hope this is a copy and paste job.

Yup, I don't write that well. Was hoping that the title and author would come through, I can post link if you like.

 

[Slapdash]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

ETA: Referring to this section:

PPACA also imposes an excise tax on

high cost employer-sponsored health plans beginning in 2018. Employer
sponsored plans with a benefit value exceeding specified thresholds will
generally be subject to a 40 percent excise tax.15 The excise tax will be
levied on insurers but is expected eventually to be passed on to their
customers. CBO, OACT, and other observers expect that the excise tax
will create an incentive for employers to reduce the scope of their health
benefits and, therefore, the demand for health care services.

 

[Slapdash]

I hope this is a copy and paste job.

Yup, I don't write that well. Was hoping that the title and author would come through, I can post link if you like.

That article wasn't anything to aspire to.

 

[matttyl]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

 

[Arsenal of Doom]

And I love that we're calling a tax a "cost control measure".

A tax can very clearly be a cost control measure, in fact I've seen some early research that suggests this is already happening as employers are shying away from those higher end packages even before the official tax policy is in place. The point of that provision isn't to generate revenue per se, but to address the issue of moral hazard associated with the extreme high end coverage plans where the true cost is hidden from the consumer.

We know as a matter of fact that health care spending has been growing at a much slower pace than it did prior to ACA. Much of that is the state of economy, but a recent Kaiser Foundation study found that around 25% of the slowdown is attributable to other external factors, e.g., ACA. That's probably not enough to be sustainable yet, but it's also encouraging.

 

[Slapdash]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

 

[Arsenal of Doom]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

 

[matttyl]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

I said that a few pages back about federal employees (specifically Congress and their staffs) and that didn't go over too well. I only said that with the assumption that the ACA was going into place as we know it.

 

[Rich Conway]

None of those things change the cost of providing care.

They don't need to do that to have an impact on overall health care spending.

Well, no, not exactly. I mean, something as simple as denying care wouldn't change the cost of providing care, yet it would change the total amount spent on care.

I specifically asked, a number of times, how Obamacare lowers the cost of providing care. I've yet to see an answer.

 

[Rich Conway]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Yes, I wholeheartedly agree with this. In fact, it's one of the big reasons I don't like Obamacare. By not taking the opportunity to divorce health-insurance from employment, it has significantly postponed something that desperately needs to happen.

 

[matttyl]

None of those things change the cost of providing care.

They don't need to do that to have an impact on overall health care spending.

Well, no, not exactly. I mean, something as simple as denying care wouldn't change the cost of providing care, yet it would change the total amount spent on care.

I specifically asked, a number of times, how Obamacare lowers the cost of providing care. I've yet to see an answer.

Just some things to consider...

(in 2009)

Merck & Co. reported a net income of $13Billion

Johnson & Johnson reported a net income of $12.3Billion

Pfizer reported a net income of $8.6Billion

These were the three larges health care companies by net income in he US, all 3 in the world's top 6. Bristol-Myers Squibb, Abbott Labs, Wyeth, and Eli Lilly were all in the top 12, all US based.

Blue Cross Blue Shield, which provides coverage to about 100 million Americans, in 2008 had a net income of $320Million (less than 2.5% of what Merck made)

 

[tommyGunZ]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Exactly.

 

[tommyGunZ]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Yes, I wholeheartedly agree with this. In fact, it's one of the big reasons I don't like Obamacare. By not taking the opportunity to divorce health-insurance from employment, it has significantly postponed something that desperately needs to happen.

This seems like a silly reason to oppose the ACA.

 

[Rich Conway]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Yes, I wholeheartedly agree with this. In fact, it's one of the big reasons I don't like Obamacare. By not taking the opportunity to divorce health-insurance from employment, it has significantly postponed something that desperately needs to happen.

This seems like a silly reason to oppose the ACA.

I oppose legislation that accomplishes little, when the opportunity was there to accomplish a lot, especially when the existence of the legislation pretty much precludes any other meaningful changes for a decade or more (due to politicians believing they've already dealt with "the healthcare issue"). That is, from a political standpoint, Congress has pretty much shot its load with respect to healthcare, yet we don't have much meaningful reform to show for it.

 

[tommyGunZ]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Yes, I wholeheartedly agree with this. In fact, it's one of the big reasons I don't like Obamacare. By not taking the opportunity to divorce health-insurance from employment, it has significantly postponed something that desperately needs to happen.

This seems like a silly reason to oppose the ACA.

I oppose legislation that accomplishes little, when the opportunity was there to accomplish a lot, especially when the existence of the legislation pretty much precludes any other meaningful changes for a decade or more (due to politicians believing they've already dealt with "the healthcare issue"). That is, from a political standpoint, Congress has pretty much shot its load with respect to healthcare, yet we don't have much meaningful reform to show for it.

Ah, the Nirvana fallacy.

 

[Rich Conway]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Yes, I wholeheartedly agree with this. In fact, it's one of the big reasons I don't like Obamacare. By not taking the opportunity to divorce health-insurance from employment, it has significantly postponed something that desperately needs to happen.

This seems like a silly reason to oppose the ACA.

I oppose legislation that accomplishes little, when the opportunity was there to accomplish a lot, especially when the existence of the legislation pretty much precludes any other meaningful changes for a decade or more (due to politicians believing they've already dealt with "the healthcare issue"). That is, from a political standpoint, Congress has pretty much shot its load with respect to healthcare, yet we don't have much meaningful reform to show for it.

Ah, the Nirvana fallacy.

Call it whatever you want, but the fact is that Obamacare does virtually nothing to address cost of care and quality/efficiency of care. Those are the real issues we're going to face in the long term.



I'm not a fan of passing a decidely-mediocre-at-best bill just to be able to say "look, we passed a bill" (also see, Patriot Act).

 

[humpback]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

Can't wait to hear your spin on these two "wackos".

More importantly, he still hasn't acknowledged that there's a lot more to "costs of healthcare" than just what the government decides to pay. I guess as long as the government isn't on the hook for it, it doesn't matter what it costs the people.

Just going to continue to ignore anything that doesn't fit your narrative?

 

[tommyGunZ]

And I love that we're calling a tax a "cost control measure".

It is more a removal of current tax breaks in place for the high-end of the employer market. I would prefer to eliminate the entire employer tax break for providing medical coverage, but I don't see how you can't call that a step in the right direction for limiting cost growth.

Eliminating the employer tax break would cause a great number of employers from dropping coverage for their employees. The tax break is likely a much lower "cost" to the American people than having all of those people now enrolling through an individual exchange.

I'm just saying I think it's a bit disingenuous calling an additional tax a "cost control measure". It's a revenue source, plain and simple. It may have another effect which is a cost control measure, but seeing any of that will likely take years to account for much of anything on the scale we are talking here.

Divorcing from the employer provided health-insurance model needs to happen in the long run. It is one of the key reasons it is hard for anything resembling a free-market to develop in health-care; end consumers are too removed from the decision making process.

Yes, I wholeheartedly agree with this. In fact, it's one of the big reasons I don't like Obamacare. By not taking the opportunity to divorce health-insurance from employment, it has significantly postponed something that desperately needs to happen.

This seems like a silly reason to oppose the ACA.

I oppose legislation that accomplishes little, when the opportunity was there to accomplish a lot, especially when the existence of the legislation pretty much precludes any other meaningful changes for a decade or more (due to politicians believing they've already dealt with "the healthcare issue"). That is, from a political standpoint, Congress has pretty much shot its load with respect to healthcare, yet we don't have much meaningful reform to show for it.

Ah, the Nirvana fallacy.

Call it whatever you want, but the fact is that Obamacare does virtually nothing to address cost of care and quality/efficiency of care. Those are the real issues we're going to face in the long term.



I'm not a fan of passing a decidely-mediocre-at-best bill just to be able to say "look, we passed a bill" (also see, Patriot Act).

Under your standard, no legislation would ever get passed. That is no way to govern.

 

[Rich Conway]

Under your standard, no legislation would ever get passed. That is no way to govern.

Meh, I'd argue that at least 50% of all legislation is unnecessary and/or damaging anyway.

 

[tommyGunZ]

Well, he's ignoring analysis that has been done by non partisan experts who are considered the gold standard at this stuff in favor of his back of the envelope guesstimates. Resident FFA tea party clowns eat it up, but those of us who actually value data and expertise generally tend to find the CBO a bit more credible.

You generally tend to find anything that fits your narrative a bit more credible and ignore anything that questions it. A hack of the highest order.

You're officially a wacko when you're dismissing the CBO's analysis, and instead buying into matttyl from the internet's back of the napkin analysis.

Can't wait to hear your spin on these two "wackos".

More importantly, he still hasn't acknowledged that there's a lot more to "costs of healthcare" than just what the government decides to pay. I guess as long as the government isn't on the hook for it, it doesn't matter what it costs the people.

Just going to continue to ignore anything that doesn't fit your narrative?

I'm working, and I can only argue with one of you wackos at a time.

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

 

[matttyl]

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

and that's not saying much.

 

[humpback]

Just going to continue to ignore anything that doesn't fit your narrative?

I'm working, and I can only argue with one of you wackos at a time.

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

So are they wackos too? Must be quite the dilemma for you.

I guess the private component of health care costs isn't important since you ignored that one yet again.

 

[tommyGunZ]

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

and that's not saying much.

So you agree that they are the best source we have for evaluating and estimating the costs of legislation?

 

[Arsenal of Doom]

And I love that we're calling a tax a "cost control measure".

A tax can very clearly be a cost control measure, in fact I've seen some early research that suggests this is already happening as employers are shying away from those higher end packages even before the official tax policy is in place. The point of that provision isn't to generate revenue per se, but to address the issue of moral hazard associated with the extreme high end coverage plans where the true cost is hidden from the consumer.

We know as a matter of fact that health care spending has been growing at a much slower pace than it did prior to ACA. Much of that is the state of economy, but a recent Kaiser Foundation study found that around 25% of the slowdown is attributable to other external factors, e.g., ACA. That's probably not enough to be sustainable yet, but it's also encouraging.

Since I have a second, here were the two reports I mentioned in this post.

High-End Health Plans Scale Back to Avoid ‘Cadillac Tax’ By REED ABELSONSay goodbye to that $500 deductible insurance plan and the $20 co-payment for a doctor’s office visit. They are likely to become luxuries of the past.

Get ready to enroll in a program to manage your diabetes. Or prepare for a health screening to determine your odds of developing a costly health condition.

Expect to have your blood pressure checked or a prescription filled at a clinic at your office, rather than by your private doctor.

Then blame — or credit — the so-called Cadillac tax, which penalizes companies that offer high-end health care plans to their employees.

While most of the attention on the Obama administration’s health care law has been on providing coverage to tens of millions of uninsured Americans by 2014, workers with employer-paid health insurance are also beginning to feel the effects. Companies hoping to avoid the tax are beginning to scale back the more generous health benefits they have traditionally offered and to look harder for ways to bring down the overall cost of care.

In a way, the changes are right in line with the administration’s plan: To encourage employers to move away from plans that insulate workers from the cost of care and often lead to excessive procedures and tests, and galvanize employers to try to control ever-increasing medical costs. But the tax remains one of the law’s most controversial provisions.

Bradley Herring, a health economist at Johns Hopkins Bloomberg School of Public Health, suggested the result would be more widely felt than many people realize. “The reality is it is going to hit more and more people over time, at least as currently written in law, ” he said. Mr. Herring estimated that as many as 75 percent of plans could be affected by the tax over the next decade — unless employers manage to significantly rein in their costs.

The changes can be significant for employees. The hospital where Abbey Bruce, a nursing assistant in Olympia, Wash., worked, for example, stopped offering the traditional plan that she and her husband, Casey, who has cystic fibrosis, had chosen.

Starting this year, they have a combined deductible of $2,300, compared with just $500 before. And while she was eligible for a $1,400 hospital contribution to a savings account linked to the plan, the couple is now responsible for $6,600 a year in medical expenses, in contrast to a $3,000 limit on medical bills and $2,000 limit on pharmacy costs last year. She has had to drop out of school and take on additional jobs to pay for her husband’s medicine.

“My husband didn’t choose to be born this way,” Ms. Bruce said. The union representing her, a chapter of the Service Employees International Union, has objected to the changes. Her employer, Providence Health & Services, says it designed the plans to avoid having employees shoulder too much in medical bills and has reduced how much workers pay in premiums.

Proponents of the law say the Cadillac tax is helping bring down costs by making employers pay attention to what their health care costs are likely to be in the long run. “It’s really one of the most significant provisions” in the Affordable Care Act, said Jonathan Gruber, the M.I.T. economist who played an influential role in shaping the law. “It’s focusing employers on cost control, not slashing,” he said.

Cynthia Weidner, an executive at the benefits consultant HighRoads, agreed that the tax appeared to be having the intended effect. “The premise it’s built upon is happening,” she said, adding, “the consumer should continue to expect that their plan is going to be more expensive, and they will have less benefits. ”

The trend is accelerating. The percentage of employers revising their plans as a result of the tax has increased to 17 percent this year from 11 percent in 2011, according to a survey of United States companies released this month by the International Foundation of Employee Benefit Plans.

Although the tax does not start until 2018, employers say they have to start now to meet the deadline and they are doing whatever they can to bring down the cost of their plans. Under the law, an employer or health insurer offering a plan that costs more than $10,200 for an individual and $27,500 for a family would typically pay a 40 percent excise tax on the amount exceeding the threshold.

“I’m actually much more focused on the Cadillac tax in 2018 than on 2014,” Steve First, a benefits executive at Pfizer, said at a recent meeting of employers. “For us, 2018 is a challenge.”

Raising deductibles is one way to lower the cost.

Since 2009, the percentage of workers in plans with a deductible of at least $2,000 has doubled, to 14 percent, by 2012, according to the Kaiser Family Foundation. A little over a third of workers are in plans with a deductible of at least $1,000 a year.

Larger companies are also trying a variety of initiatives to improve the health of their workers — experimenting with an array of disease management and wellness programs, for instance, or even setting up their own work-site clinics as a way to sidestep the tax.

“These changes will take time, and employers seem to recognize that,” said Barry Schilmeister, a consultant for Mercer.

Cummins, the Columbus, Ind., engine manufacturer is one example of a company experimenting with both approaches. The tax “is in our line of sight,” acknowledged Dr. Dexter Shurney, the company’s chief medical director.

Cummins has switched employees to plans with deductibles as high as $6,000 for a family and is working with health coaches to educate employees on the dangers of high sodium present in processed food, for example, as a way to start reducing the cost of treating chronic diseases like high blood pressure. “There’s a lot of savings there,” said Dr. Shurney. “It’s not only good for us, but good for employees.”

Even employers who won’t talk about details acknowledge the tax is bringing about change. “You’re getting taxed at 40 percent,” explained Larry Boress, the chief executive of the Midwest Business Group on Health. “That kind of hit is something that is viewed as untenable by employers in general.”

But one critic pointed out that employers have been raising deductibles and asking employees to contribute more for many years. Tom Leibfried, a legislative director for the A.F.L.-C.I.O., one of the unions whose plans are vulnerable to the tax, says the demands that workers pay more for their care is a perennial aspect of labor negotiations. “We’re very concerned about the hollowing out of benefits in general,” he said. “What the excise tax will do is just fuel that.”

Others say some of the plans at risk of being taxed as overly generous simply reflect of the high costs of care in certain regions. “These plans are costly, just by the nature of where they are,” said Kinsey M. Robinson, the president of the Roofers’ union, which has recently called for significant changes to the law or its repeal. “The cost of good health care is expensive.” The law does make adjustments, including for older workers or those in certain high-cost professions.

Many employers say they were already taking steps to address rising costs, even as the increases have abated somewhat in recent years. “The 2018 date was looming out there,” said Mary Cranstoun, the senior director of medical benefits for Providence Health, where Ms. Bruce works. But Ms. Cranstoun said Providence had already decided to move more of its employees into high-deductible health plans.

The goal was to have employees pay more attention to costs, which have been rising some 5 to 8 percent a year. “As for any other company, when you take that out long term, those are big trend numbers,” she said.

The hospital system says the move is less about cost-shifting than engaging employees about their health, including offering financial incentives to undergo a health screening or using a high deductible to make them think twice about an expensive test.

The ultimate goal is to make sure the cost of coverage does not eventually exceed the system’s ability to pay for it, Ms. Cranstoun said. “We really are committed to offering our employees benefits in the long term, so we really want to make sure that we can do so,” she said.

Assessing the Effects of the Economy on the Recent Slowdown in Health SpendingApr 22, 2013
IntroductionHealth spending has been growing at historically low levels in recent years. The Office of the Actuary (OACT) in the Centers for Medicare and Medicaid Services reports that national health spending grew by 3.9% each year from 2009 to 2011, the lowest rate of growth since the federal government began keeping such statistics in 1960. Estimates from the Center for Sustainable Health Spending at the Altarum Institute suggest that the slowdown largely continued into 2012, with health spending growing by 4.3% last year. The Kaiser Family Foundation/Health Research & Educational Trust Employer Health Benefits Survey shows similar moderation, with premiums in employer-sponsored health plans increasing by 4% in 2012.

There has been a significant focus on whether this slowdown in health spending is a result of broader economic factors (such as the Great Recession of 2007-2009), structural changes in the health system that could lead to slower growth in the future as well, or some combination of the two. To the extent this is a temporary phenomenon driven by the economic downturn and abnormally low inflation, we can expect health spending growth to bounce back up in the future as the economy recovers. To the extent structural changes are at play – i.e., that health spending is growing more slowly than what would be expected given the state of the economy – we may see a continuation of historically low rates of growth even as the economy returns to full employment.

This has major implications for policy, since health spending growth is a major driver of federal and state budgets through the Medicare and Medicaid programs, as well as the tax exclusion for employer-sponsored insurance. Beginning in 2014, it will also affect the federal cost for subsidies provided to low- and middle-income people buying coverage through new health insurance exchanges. In particular, projected future increases in health spending are an important factor in estimates of the federal budget deficit, and the Congressional Budget Office (CBO) recently lowered its forecast of future Medicare and Medicaid spending based on the historically low rates of growth of health spending in recent years. A better understanding of what is driving changes in health spending will also be important context for interpreting what happens as the Affordable Care Act (ACA) goes into effect. Perhaps most importantly, if we believe health spending growth will remain low, we may be satisfied letting current cost containment strategies play out; if we do not, there may be greater impetus to consider new efforts to address health care costs.

This analysis uses a statistical model we developed to assess how much of the recent slowdown in spending is due to economic factors, and to identify sustained periods where health spending has grown faster or slower than would have been expected due to macroeconomic changes (i.e., growth in GDP and inflation). We also address what could happen to health spending in the coming years if the economy recovers as projected by CBO.

<clipped> Follow link for the full report

 

[tommyGunZ]

Just going to continue to ignore anything that doesn't fit your narrative?

I'm working, and I can only argue with one of you wackos at a time.

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

So are they wackos too? Must be quite the dilemma for you.

I guess the private component of health care costs isn't important since you ignored that one yet again.

Health care spending has slowed dramatically in recent years, currently at a 50 yr low. Thanks, in part, to the ACA.

 

[snogger]

Just going to continue to ignore anything that doesn't fit your narrative?

I'm working, and I can only argue with one of you wackos at a time.

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

So are they wackos too? Must be quite the dilemma for you.

I guess the private component of health care costs isn't important since you ignored that one yet again.

Health care spending has slowed dramatically in recent years, currently at a 50 yr low. Thanks, in part, to the ACA.

If you want to talk just about the amount withheld from my paycheck then yes.. The increases haven't been as much as in the past..

but that is only half the story..

My deductibles, co-pays and medication costs have gone up more then any other time I can remember..

Proclaiming that ACA is saving money is great if you only talk about half of the cost..

 

[tommyGunZ]

Just going to continue to ignore anything that doesn't fit your narrative?

I'm working, and I can only argue with one of you wackos at a time.

Both Vladeck and Tomasky are arguing strawmen - no one said CBO is infallible, only that they are the best we have.

So are they wackos too? Must be quite the dilemma for you.

I guess the private component of health care costs isn't important since you ignored that one yet again.

Health care spending has slowed dramatically in recent years, currently at a 50 yr low. Thanks, in part, to the ACA.

If you want to talk just about the amount withheld from my paycheck then yes.. The increases haven't been as much as in the past..

but that is only half the story..

My deductibles, co-pays and medication costs have gone up more then any other time I can remember..

Proclaiming that ACA is saving money is great if you only talk about half of the cost..

Huh?

The National Health Expenditure Accounts (NHEA) are the official estimates of total health care spending in the United States.