Ezra Klein's Claim about the Shutdown

There will not likely be any change.

The Zebra changes its stripes only by polling in mud.

Your characterization of the part regarding congressional staffers getting health insurance through the exchanges is very inaccurate. It is based on an amendment proposed by Chuck Grassley (R-Iowa), not Obama. Klein discussed the proposal at length yesterday.

The most realistic and best GOP goal I’ve seen is that (among other things) they’re pushing for an end to the medical devices excise tax, which is by definition quite regressive.

@David,
I think Ezra Klein was making a general description of Obamacare not trying to describe the Republican approach to dismantling it since that is changing all the time.

Ezra Klein, whom….
Shouldn’t it be who?

This is all about stopping a law that increases taxes on rich people and reduces subsidies to private insurers in Medicare in order to help low-income Americans buy health insurance. That’s it. That’s why the Republican Party might shut down the government and default on the debt.

Actually, by mandating that the young and healthy buy far more health insurance than they need, Obamacare effectively taxes the poorest age cohort of Americans to subsidize those wealthier than they are — the exact opposite of Klein’s complaint.

The young uninsured are quite literally the sheep whose shearing pays for this monstrosity.

Delaying the individual mandate can only be viewed as continuing to allow the irresponsible to rely on EMTALA to provide themselves with free healthcare.

EMTALA is a pittance — 3% of total health care spending in the US. That the disaster of Obamacare was at all rationalized by it is almost as funny as it is tragic.

@Michael,
It’s possible I didn’t understand your position and if so I apologize.
No need to apologize although I do appreciate your civility.
Some republicans have asserted that the OPM’s decision was illegal but I don’t know how they support that view. Do you know what the legal argument is against the OPM’s decision?
I’m pretty sure their argument is that there is nothing in the ACA that gives OPM the authority to do this. If you’re taking OPM as the arbiter of the law, as Klein seems to, that’s problematic. You’ve probably followed the Obama administration enough to know that it sometimes breaks the law, as with the early July decision, based on no legal authority, to delay by a year the employer mandate. That’s just one instance.
@MikeP,
Thanks for replying on grammar to John Hall.

@MikeP

On EMTALA, wouldn’t you say the availability of EMTALA is what allows young people to avoid buying insurance? It may only be 3% but that 3% is critical for the people who take advantage of it. Those people should be buying health insurance but instead are not.

Again your stance that young people do not need health insurance is completely based on EMTALA which you dismiss as only 3% of costs. Young people DO need health insurance. Low probability events happen all the time when you are talking about millions of people. This is exactly why insurance was invented. And of course the costs are still high when you are young – you have to amortize the costs of when you are older. How could the old possibly afford health insurance? Come on this is pretty basic math here…

Young people DO need health insurance.

Young people need catastrophic health insurance.

And the ACA has essentially made catastrophic insurance illegal.

And of course the costs are still high when you are young – you have to amortize the costs of when you are older. How could the old possibly afford health insurance?

The old could afford health insurance because they weren’t overpaying for comprehensive health insurance for 30 years that they didn’t need it.

Come on this is pretty basic math here…

Indeed. Stealing from the poorest age cohort to subsidize the richest reduces the gains of compound interest from the former’s wealth. Social Security, Medicare, and now Obamacare: the sheep will be sheared.

I don’t read Klein if I can help it (or maybe I’m thinking of Iglesias?), but based solely on your post I’d suggest that when he attributes the opposition to ACA solely to Republicans wishing to advantage the “rich” at the expense of the “poor,” he’s deliberately pandering to emotions at the expense of understanding the basis for valid ideological opposition.

He might acknowledge that those who cherish their personal independence oppose ACA because it makes every American a supplicant of the federal government for his routine health care, and will finally accomplish the progressive goal of making every last American a dependent (in some regard) of the federal government.

If ONLY it were a “rich” v. “poor” competition, it would not be as damaging to the character of our country.

PS to Hazel: I completely agree re: rich v. high income. If I were Queen, I’d have a rule that any pundit, talking head, columnist or blogger who used the terms “rich,” “poor” or “middle class,” would be required to define the parameters of the group.

So with respect to emergency care, health insurance is financial insurance. Your health will be taken care of: your finances may not

But isn’t this the whole problem? The young don’t get insurance because we have guaranteed them we will keep them alive. But then we ruin them financially. And even taking everything they have still will not recoup the healthcare costs. There are problems with ACA (and actually I think they should scrap the employer mandate) but the individual mandate makes sense to me. We have already mandated the “we will keep you alive” half of the equation. The other side is the individual mandate that says “in exchange for keeping me alive I will buy insurance”.

And which party do you think made sure that restriction was in there?

Presumably the one party that voted for ACA.

Presumably the one party that voted for ACA

Ha! That is great. Bend over backwards to make them happy then “we didn’t vote for it”.

It’s time to put to rest the rationalization that the individual mandate is there to avoid free-rider use of emergency rooms. If that were the case, then Obamacare wouldn’t have made it illegal for insurance companies to offer insurance policies to young people that are too cheap relative to older people’s policies

Am I missing something? Don’t young people eventually become old people? I mean I understand for car insurance you can group people by how they drive. A good driver may remain a good driver for quite a while. In fact I wouldn’t be surprised if driving risk decreases with age (to a point). But that is not true with health insurance. We will all eventually be in a very high risk group.

Steve J:

It seems like it is easier to require insurance than to figure out some method to distinguish the responsible from the irresponsible at the emergency room entrance.

I’m baffled why you think we need to do this at the emergency room entrance.

Analogy: Restaurants do not run credit checks on customers as they come in through the door. You get seated, order your meal, eat, and then pay. If you don’t pay, you get thrown out, possibly arrested, and the restaurant may or may not come after you for the debt while refusing to serve you in the future.

Obviously the situation with emergency healthcare is somewhat different: ER patients are unlikely to be deliberately stealing from the healthcare provider, so there probably isn’t cause to arrest them. That said, what’s the problem with sending them a bill for services rendered, trying to collect on the debt normally, and refusing to treat them in the future if they can’t pay?

To Steve J.:

You made the statement, “If the other side had any sort of alternative there might be a debate here.”

I don’t claim to be “the other side”, but I’ll provide an alternative for you to ponder.

1.) Change tax law to allow 100% tax deductibility for ALL actual healthcare outlays – to individuals only. (I agree the direct insurance tax deductibility should be repealed for businesses.)
This individual tax deductibility should be applicable to either realized actual out-of-pocket health care expenses, OR health insurance premiums – paid by individuals only.
(Special note here: Current tax law allows deduction for health care expenses only in excess of 7.5% of AGI. ACA increases that threshold to 10% of AGI.)

2.) Change tax law to allow the tax deductibility to be transferable to any other tax-paying entity. Tax deductions aren’t of significant value to low/no income folks, but they are of high value to high income folks especially with an increasingly progressive tax system. The transferability feature incentivizes (and allows) others to offset costs of delivered healthcare through the tax code, whether those “others” are “rich folks”, charitable organizations or even family members.

The focus of this alternative is to get the “third party” payers out of the U.S. health care system decision making process and out of the cost structure.

To give you an idea of how costly the third-party-payer system is, consider that one of the “provisions” of ACA is that insurance companies are “limited” to 20% of their revenue being diverted to “administration” – 80% of their premium revenues must be to pay for actual “health care”.

Just now, the U.S. GDP is about $17,000B, and by all estimates, 18% (just over $3,000B) is health care related. Assuming (conservatively) that private insurance covers 50% ($1,500B) of actual health care costs, and the insurance companies adhere to ACA limits, the U.S. costs of private insurance “administration” alone – limited to 20% – translates to about $300B per year.

That’s $300B per year for ONLY the private insurance company “administration” costs – as mandated by the ACA 20% limit. It does not include hospital/doctor office/clinic “administration” costs – that is paid out of the 80% private insurance outlay for “actual” health care. Nor does it include the Fed Gov “administration” costs incurred simply monitoring private insurance to make certain they limit their “administration” costs to only 20%. And it certainly doesn’t include the “administration” costs of Medicare/Medicaid/Indian Health Services (IHS)/ VA or any of the other government “health care” programs.

I have no problem helping pay for actual health care costs of folks who actually have extreme health issues, or who don’t have incomes/financial means of paying for their health care costs. But I’d rather be incentivized to help, rather than coerced to help. I have an EXTREME problem with being forced to pay upwards of $1,000B per year for multiple layers of “administration” costs that have nothing at all to do with health care delivery to these folks, or myself. That is the major problem with ACA, or anything resembling ACA.