Sunday, October 6, 2013

Sunday Question for Liberals

It's Day 6 of the exchanges: how are you feeling about the future of the ACA?
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Posted by Jonathan Bernstein at 4:39 PM
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24 comments:

  1. massappealOctober 6, 2013 at 5:01 PM

    Assuming no changes in law between now and Jan. 1, pretty good. I expect the next few months to be filled with challenges in getting the exchanges up and running. By this time next year, I expect they'll be running relatively smoothly. And I expect it will take about a decade for the Medicaid expansion to take root in all 50 states.

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    1. PatOctober 6, 2013 at 7:14 PM

      I don't think the hospitals in the red states can wait that long. I give it 3 years, tops, before everyone takes some form of Medicaid expansion.

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    2. Chris GOctober 6, 2013 at 9:12 PM

      And remember that at least some of the holdouts are likely to have new governors by 2015.

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  2. TIBOctober 6, 2013 at 5:02 PM

    Fantastic. I worried that there would not be enough competition for low premiums without a public option, but so far things look good. From anecdotal reports I see the joy and relief of people who were shut out of the insurance system and can finally purchase coverage, this hints at the vast numbers of people Obamacare helps.

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  3. JeffOctober 6, 2013 at 5:03 PM

    The ACA will survive all this and ultimately thrive, I think. That's not the problem. What I'm wondering about is the future of any other reform, or even the possibility of passing major legislation of any kind ever again. You just can't have a system where 30 Congressmen from gerrymandered districts have the power to shut everything down against the wishes of the whole rest of the government. It really is Weimar-like. Any thoughts about how a "Madisonian" system survives long-term under these conditions?

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    1. AnonymousOctober 6, 2013 at 5:56 PM

      30 don't have that power. The speaker of the House, along with many other MoC under him decided to give in. So it's still a broken system, but only because a majority of the House wants it that way.

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  4. Scott MonjeOctober 6, 2013 at 5:46 PM

    There's a sobering article in the New York Times online today about the coalition of millionaires, activists, and organizations that have been strategizing and contributing hundreds of millions of dollars to defund Obamacare, repeal it, and/or "educate" people into not participating in it. Yet for all the money, time, and effort, they don't seem to have much to show for it so far.

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    1. nanuteOctober 7, 2013 at 4:09 AM

      Scott,
      It's amazing how the millionaires stay that way. Just like the sugar daddies that latched on to a losing Republican candidate during the R's presidential primary.

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  5. SNFOctober 6, 2013 at 6:21 PM

    I think the ACA will be fine, so long as the site is usable within the next few weeks and the economy doesn't collapse via a debt ceiling breach.

    Of course, the healthcare situation will be much worse in red states, but hopefully people will push for that to be fixed once they see the massive disparity.

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  6. Captain FutureOctober 6, 2013 at 6:54 PM

    I feel a whole lot better about the future of ACA than I do about the future of the country beyond next week, after the speaker's statements today. Talk about ten days that shook the world--they seem to be coming up.

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    1. SNFOctober 6, 2013 at 9:34 PM

      Yeah...this is my reaction.

      I'm actually very concerned about the country and our entire system of governance. If the country ends up okay, then I think the ACA will do fine. If the country goes past the debt ceiling and explodes I think we'll have bigger things to worry about.

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    2. JeffOctober 7, 2013 at 2:38 AM

      To be fair, the Soviets once had tens of thousands of nuclear warheads pointed at us. So that probably qualifies as one of the top two threats. And there are the banksters who blew up the economy once already (more than once, if you consider them part of the same group, over time, as the Wall Street brokers who helped bring on the Great Depression). But I agree that the current nutballs are making a bid to move up in the threats-to-America league tables. If we consider this essentially the same crowd (again, over time) that compelled previous presidents to send federal troops into the South in the 1950s and '60s -- and arguably, also in the 1860s -- then yeah, we're talking about a persistent, Southern-based faction that has no use for American democracy and periodically tries to destroy it, to the point of treason if necessary. It's no joke.

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    3. AnonymousOctober 7, 2013 at 5:23 AM

      Once again we see the way the commenters here even-handedly police bad language and insults towards ones opponents.

      Calling Republicans neo-Nazis and traitors without a shred of evidence? A-OK. Pointing out that shiftless welfare-recipients are a reliable Democrat voting bank? How uncouth!

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    4. AnonymousOctober 7, 2013 at 5:35 AM

      shiftless welfare-recipients are a reliable Democrat voting bank .....

      shiftless welfare-recipients don't vote you TWIT

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    5. Matt JarvisOctober 7, 2013 at 12:35 PM

      Appropos to this sub-thread....

      http://www.washingtonpost.com/blogs/monkey-cage/wp/2013/10/07/liberal-comment-trolling-polarizes-conservatives-but-not-vice-versa-study-says/

      Delete
    6. JeffOctober 7, 2013 at 2:07 PM

      Very interesting study, thanks. My guess, it's a function of liberals being more procedure-conscious, which includes the procedures governing the conversation itself. And/or it has to do with the kind of local ecology that develops on liberal as opposed to conservative sites. That may have to do with who uses the internet and in what ways.

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    7. AnonymousOctober 8, 2013 at 5:03 AM

      Makes sense to me. Conservatives care about form and decorum, so the kind of evil language used in this thread naturally annoys. "Liberals" live in the gutter anyway, so they probably barely notice they're being insulted.

      Delete
  7. DianeOctober 6, 2013 at 7:04 PM

    I'm worried about the technical problems with the sites. The administration is trying to pass them off as just scaling or capacity problems, but those would be easily fixed. What techies are reporting is more like major issues several screens deep into a session, and applications not being completed and hanging in limbo. If you haven't seen this link, it's an example. This kind of problem may not be fixed easily, and people may think they have signed up when in fact their application was not processed.

    http://www.slate.com/articles/news_and_politics/politics/2013/10/obamacare_one_woman_s_unsucessful_quest_to_sign_up_for_obamacare.html

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  8. PatOctober 6, 2013 at 7:17 PM

    The subsidies are key, at least for my kin. Some of the areas where my family live had unreal insurance prices, over $1100 a month. But the federal subsidies will bring that down to 3% of their household income, which makes all the difference.

    The ones who don't make enough to qualify for the subsidies are pretty well screwed this year, though.

    This will actually be a little stimulus in a lot of rural areas, because getting decent health insurance will put money in a lot of peoples' pockets.

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  9. AnonymousOctober 6, 2013 at 10:18 PM

    A few years from now Obama care will be as locked in as Social Security and woe unto any idiot politician that tries to screw the American people from their affordable coverage. The liar Right Wing Congressional servants of the Billionair Health Care CEO's know this is true. This is the reason these rabid dog corrupt scum bag anarchists are fighting so hard to keep Americans blinded from the truth. On Faux's , Sean Insannity show there is a huge poster behind the bought and paid for corporate shill Hannity , that says. "The Obama government shutdown." That would be hilarious if the village idiots did not actually believe this wacko propaganda.

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  10. nanuteOctober 7, 2013 at 4:15 AM

    I'm hopeful that the system will get sorted out, and the program will be a long term success. The question will be, going forward, will competition be real enough, to hold down costs in a modest range relative to annual inflation. Jonathan, can you explain how the subsidies work? We keep hearing the government subsidies. Aren't the subsidies paid for by the health care industry? There was a recent attempt in the CR debate to eliminate the tax on medical device makers, right?

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  11. Matt JarvisOctober 7, 2013 at 11:22 AM

    Unsure. The question is about the future of the ACA, not health care. The ACA seems to be doing OK; not stellar, standard rollout problems, but good enough.

    I actually regard this as a bad thing.

    Why? I want ACA to fail, because I think the only way we'll get single-payer is if the system is falling apart. Since I believe single-payer to be a MUCH better world than the one we live in (either before or after ACA), my preference is to get to that world sooner rather than later. Now, a person could (fairly) claim that I'm being absolutist here, behavior which would be somewhat ironic given the absolutist demands of the GOP. I think that the ACA is a band-aid and we've got an infected wound, so the sooner we deal with the problem, the better.

    Is ACA-world going to be better than non-ACA world? Yes. For a large number of people, life will be better. But, I think those same people plus many, many more would be still better off under single-payer.

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    1. JeffOctober 7, 2013 at 2:04 PM

      Matt, I sympathize, but the failure of ACA would be a disaster. Yes, eventually we'd get single-payer -- I think we will anyway -- but it would take several election cycles, I'm guessing 15 years minimum, probably more like 20 - 25. Just imagine the unbelievable tide of misinformation we'd be hearing from the time it became a serious proposal through all the legislating and litigating and on through the rollout. Fox and company would be assuring us that while ACA was merely about death panels, single-payer is a plot to steal your children and sell them to cannnibal slavers. And meanwhile another generation is lost to American non-health-care.

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  12. AnonymousOctober 7, 2013 at 9:00 PM

    The way to get single payer is in expansions at the margins of medicaid and medicare. The medicaid expansion is a solid step towards single payer. I'd two step back and forth between the two, and legislatively slow boil the process over many years. Next step, open enrollment for medicare from age 60-65. Pay for it by assessing a medicare tax on all capital gains. That takes the oldest/sickest off the rolls which drives down insurance premiums for the rest of us. Step two, single payer for kids by expanding medicaid/medicare to all children 18 and under with really robust benefits so nobody loses a doctor. That kicks a ton of dependents off the rolls which drives down insurance premiums for the rest of us. Pay for it by assessing a medicaid tax on all capital gains and with a transaction tax on all trades (a penny per trade). Step three. Establish a 'transition phase' rule for kids between the ages of 18 and 26, they can opt to join their parents plan, enroll in medicare/aid or buy their own insurance through the exchanges. Most opt for the former two options because they're cheaper or better. Step four, expand medicare to open enrollment for anyone 50 or older. This should kick most of the oldest and sickest off the rolls. Pay for it with a hefty tax on all income and capital gains income above 500,000, 10% sounds low, but I'm feeling generous rather than asking for a more reasonable and higher tax.

    Step five, sit back and watch while everyone between the ages of 26 and 50 wonders why they have to be forced to buy this fucking insurance scam and rapidly agitate and organize in favor of single payer.

    Single payer by 2030, it's possible, it just has to happen in phases.

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