I/III. http://krugman.blogs.nytimes.com/2009/12/26/numerical-notes-on-health-care-reform/
<http://krugman.blogs.nytimes.com/2009/12/26/numerical-notes-on-health-care-reform/>DECEMBER 26, 2009, 7:44 AM Numerical notes on health care reform A couple of notes to address complaints about the Senate bill from the left and the center. (There’s no use addressing complaints from the right; in general, the safest thing when dealing with crazy people is to avoid eye contact.) For people on the left who think this is all a big nothing, consider the subsidies. From the Kaiser Health Reform Subsidy Calculator<http://healthreform.kff.org/SubsidyCalculator.aspx#tableLinkDiv>, here’s the percentage of insurance premiums on the individual market that would be covered by subsidies at different levels of income measured as a percentage of the poverty line (all calculations are for a family of 4 headed by a 40-year-old): [image: DESCRIPTION] Kaiser Family Foundation Guys, this is a major program to aid lower- and lower-middle-income families. How is that not a big progressive victory? For people in the center who worry, as my colleague David Brooks puts it<http://www.nytimes.com/2009/12/18/opinion/18brooks.html?_r=1&ref=opinion>, that there may be unintended consequences if you “centrally regulate 17 percent of the economy”: um, it’s a little late for that. First of all, government insurance programs — Medicare, Medicaid, and smaller programs like the VHA, already pay more bills than private insurance companies: Centers for Medicare and Medicaid Services And even the private insurance is overwhelmingly provided through employers — and employment-based insurance is only tax-free unless IF it obeys extensive regulations. Not coincidentally, those regulations resemble, in a qualitative sense, the goals of the new health reform: [image: DESCRIPTION] employers have to offer the same policy to all their employees, which in effect rules out discrimination based on medical history and subsidizes lower-paid workers. The point is that we don’t have anything resembling a free market in health insurance — nor should we. Reform is filling in the gaps in the subsidized, regulated system we already have — which should calm centrists — in a way that offers big benefits to those most in need — which should please progressives. Do the math. II. http://krugman.blogs.nytimes.com/2009/12/23/simulating-single-payer/ <http://krugman.blogs.nytimes.com/2009/12/23/simulating-single-payer/> [image: Paul Krugman - New York Times Blog]<http://krugman.blogs.nytimes.com/> DECEMBER 23, 2009, 10:29 AM Simulating single-payer When I first began writing a lot about health care, I often found myself taking the pro-single-payer position against people who argued that it was better to work through private insurance companies. I took to arguing that Massachusetts-type plans were, in fact, just imperfect, somewhat inefficient ways of simulating the results of a single-payer system. And if I thought there was any chance of creating Medicare for All any time in the next decade, I’d be pushing for single payer now. But what actually seems possible — not in the distant future, but *tomorrow morning* — is the passage of a Massachusetts-type plan for the United States. And now my argument cuts the other way: what we’re getting will, in its overall results, work a lot like a single-payer system. It will be an imperfect, inefficient simulation; but those on the left who decry it as terrible, evil, nothing but a giveaway to the insurance companies are missing the very real good it will do. Let me show you two schematic charts I’ve used over the past couple of years to describe two different approaches to near-universal coverage. First, single-payer. This relies on taxes, collected from everyone — but with the well-off paying more — to provide a basic health benefit to everyone. Schematically, it looks like this: [image: DESCRIPTION] Now consider the type of plan we’re actually about to get. (It’s labeled “Hackerish” on the slide because the genesis of the plans offered during the Democratic primary was a proposal by Yale’s Jacob Hacker.). This plan combines three main elements: community rating, so that premiums can’t be based on medical history (which means that coverage becomes available to people with preexisting conditions); an individual mandate, so that healthy people are in the pool, keeping premiums down; and subsidies, to help lower-income families afford the premiums. The subsidies are ultimately paid for with taxes on the relatively affluent. So the picture looks like this: [image: DESCRIPTION] At this level of abstraction, it’s basically the same as single-payer. Let me say that I get especially, um, annoyed at people who say that the plan isn’t really covering the uninsured, it’s just forcing them to buy insurance. That’s missing not just the community rating aspect, but even more important, it’s missing the subsidies. And we’re talking about big stuff: between Medicaid expansion and further support for families above the poverty line, we’re looking at around $200 billion a year a decade from now. Yes, a fraction of that will go to insurance industry profits. But the great bulk will go to making health care affordable. So how anyone can call a plan to spend $200 billion a year on Americans in need a defeat for progressives is a mystery. I wish there were a public option in there; I wish there were broader access to the exchanges; I wish the subsidies were even bigger. There’s lots of work to be done, work that may eventually culminate in a true, not simulated, single payer system. But even in this form, we’re looking at something that will make America a more just, more secure nation. III. http://www.fivethirtyeight.com/2009/12/postscript.html Politics Done Right 12.24.2009 Postscript <http://www.fivethirtyeight.com/2009/12/postscript.html> by Nate Silver @ 1:36 PM<http://www.fivethirtyeight.com/2009/12/postscript.html> [image: Bookmark and Share] Share This Content I'm a little bit reluctant to write about this for a variety of reasons ranging from holiday cheer to the fact that it will feel like kicking salt in the wounds after the Senate's passage of its health care bill this morning<http://www.fivethirtyeight.com/2009/12/senate-passes-historic-health-care.html> . I do want to make clear, though, that I should probably have made some finer points of distinction among those who I have lumped under the broad heading of "kill-billers". There is a healthy debate to be had over the merits of the health care policy, and there's much to be said from an Overton window<http://en.wikipedia.org/wiki/Overton_window> perspective about a world in which you're having two liberals (me and Darcy Burner) square off against one another for nearly 15 minutes on Hardball, or David Sirota writing the opposing viewpoint<http://blogs.usatoday.com/oped/2009/12/opposing-view-go-back-to-drawing-board.html> to USA Today's editorial position that the health care bill should be passed. Moreover, pressure from the left has been more successful than the pressure-ers might allow. The concessions that liberals won in exchange for giving up the public option are not trivial<http://www.fivethirtyeight.com/2009/12/extremely-premature-retrospective-on.html>, and some further improvements will probably be made to the bill in conference. There have also, however, been people who have been arguing the bill in what I believe to be bad faith -- recycling or inventing a grab-bag of misleading and often self-contradictory<http://www.fivethirtyeight.com/2009/12/another-left-right-convergence.html> talking points against the bill's passage. The progress of the debate over the past week has perhaps been revealing; whereas some advocates, like Markos Moulitsas and Howard Dean, have tended to ratchet down their rhetoric, in some cases even explicitly calling for the bill's passage, others have tended to become more entrenched. By "others", I mean in particular two or three of the writers at the blogFireDogLake<http://fdlaction.firedoglake.com/>. I don't exactly know what's going on over there; as a group, they're whip-smart, and they also reflect a diversity of voices, some of which I have had a problem with and others of which I haven't. But some of the initiatives they've launched over the past week, particularly teaming with Grover Norquist<http://action.firedoglake.com/page/s/investigaterahm?source=web&subsource=side> to pursue a conspiracy theory about Rahm Emanuel, threatening to primary Bernie Sanders<http://fdlaction.firedoglake.com/2009/12/23/vt-voters-to-bernie-sanders-stand-up-for-whats-right-or-risk-losing-your-seat/>, and attacking Joe Lieberman's wife<http://action.firedoglake.com/page/s/hadassah>, are a little bizarre and not reflective, in my view, of a website that is in the frame of mind right now to have a fact-based debate about the merits of the health care bill. I don't have a lot of patience for people who are arguing in bad faith. I have spent many thousands of words explaining why the bill is a good one for progressives and why most of the criticisms do not hold up (see in particular here<http://www.fivethirtyeight.com/2009/12/health-care-elevator-pitch.html> , here<http://www.fivethirtyeight.com/2009/12/20-questions-20-responses.html> and here<http://www.fivethirtyeight.com/2009/12/insidious-myth-of-reconciliation.html>). When the people to whom I address those arguments -- and again, I'm referring principally to two or three*particular* people at one particular blog -- are unwilling or unable to engage with them, I don't know how I'm supposed to take their position seriously. Let me, however, recapitulate three particular sets of arguments that I believe have not been adequately rebutted. *Firstly, I don't think you can make a credible argument that the bill will leave poor people worse off.* The bill provides very impressive subsidies<http://www.fivethirtyeight.com/2009/12/why-progressives-are-batshit-crazy-to.html> to working-class people, in some cases providing them with in excess of $10,000 worth of assistance per year. Perhaps more importantly, as Jonathan Cohn and Jonathan Gruber have outlined, itradically reduces the downside risk<http://www.kaiserhealthnews.org/Columns/2009/December/122109Cohn.aspx> to lower-income families because of annual caps on out-of-pocket expenses. And -- something that hasn't gotten enough attention -- the bill increases the Medicaid threshold from 100 percent to 133 percent of poverty; about half of the assistance in the program is devoted to that Medicaid expansion. Now, you can certainly argue that the bill is not quite generous enough -- I wholeheartedly agree with that position, and hope that the subsidy levels can be improved, particularly in the 133-250 percent of poverty range. There have been some efforts<http://www.dailykos.com/storyonly/2009/12/23/818372/-UPDATE:-This-Senate-Health-Bill-Does-Not-Provide-Affordable-Insurance>, however, to conflate the maximum amount that people might have to pay under the bill with the amount they will *usually *pay. In a typical year, a family of four making $50,000 will have to pay about $300 per month in premiums to cover the entire family. That compares with a retail cost, before subsidies, of about $1,000 per month. They'll probably also bear some out-of-pocket expenses. *But no matter how bad things get*, a family's exposure is limited to about 20 percent of its annual income. That compares with the status quo, in which even an *insured* family can bear downside risk of as much as 68 percent of its income, and in which an uninsured family has essentially unlimited downside risk. I don't mean to suggest that 20 percent of one's income is pocket change -- especially given how little savings the typical American family has -- but it's potentially the difference between having to cut back on vacations, entertainment and meals out versus filing for bankruptcy or losing one's home. *Secondly, I don't think you can make a credible argument that reconciliation is a smart strategy.* You can certainly argue that reconciliation is possible -- meaning, that you mightbe able to pass something that you call a health care bill via reconciliation. But I've not seen a persuasive case -- or even really an unpersuasive case -- to rebut the argument<http://www.fivethirtyeight.com/2009/12/insidious-myth-of-reconciliation.html>that what reconciliation would take out of the bill (most notably the exchanges and the protection for people with pre-existing conditions) is better than what it might be able to put back in (a middling public option or Medicare buy-in). Nor have any of the structural problems I've pointed out with the more "creative" versions of reconciliation really been addressed; people have just dropped the argument when I've pointed out these problems. Although, with the Senate's passage of the bill this morning, this has probably become a moot point. *Thirdly, I don't think you can credibly argue that the bill would be improved -- policywise -- by dropping the individual mandate.* You can argue that dropping the mandate makes *political *sense. You can argue that we can add the mandate later. You can argue that the mandate should be restructured. You can even argue that it's morally unacceptable. I'd disagree with most of those arguments, but you can make them in good faith. But fundamentally, you can only get (at most) two out of the following three things: a bill *without* an individual mandate; affordable health insurance; coverage for people with pre-existing conditions. This is Health Care Economics 101<http://voices.washingtonpost.com/ezra-klein/2009/12/draft_1.html>. (In the status quo, we sacrifice coverage for people with pre-existing conditions and arguably affordability, especially for those on the individual market.) If you want to argue that the Senate's bill is worse than the status quo, or otherwise an unwise choice, without resorting to any of these three arguments, then more power to you; we're in disagreement, but we're having a logically coherent discussion based on different preferences and priors. And if you want to argue that the appropriate progressive reaction to the bill is a lukewarm one, and that it would be premature to celebrate while the bill can and should still be improved, I certainly don't have a problem with that. Implicitly, in fact, that's what a lot of people -- particularly Markos, Howard Dean, the unions, and Darcy Burner but also many others -- have been saying all along. The differences I have with those folks are more semantic than substantive, and I apologize to anyone to whom I've conveyed the wrong impression. -- Peace Is Doable -- You received this message because you are subscribed to the Google Groups "Green Youth Movement" group. To post to this group, send an email to [email protected]. To unsubscribe from this group, send email to [email protected]. For more options, visit this group at http://groups.google.com/group/greenyouth?hl=en-GB.
