Friday, August 2, 2013

Read Stuff, You Should

Happy Birthday to Peter O'Toole, 81.

Good stuff, good stuff:

1. Sarah Kliff does some great reporting of conservative efforts to get young people to not sign up for health insurance. Terrific piece. As I said on twitter, however, I wish she had asked officials at FreedomWorks about whether they were also going to boycott their own ACA-regulated, government-subsidized health insurance.

2. Meanwhile, Jonathan Cohn thinks that young healthies -- or enough of them, at any rate -- will buy insurance. Sounds right to me.

3. Brendan Nyhan on scandal coverage of the IRS story.

4. Jed Lewison on Ted Cruz's campaign to use the CR to defund Obamacare.

5.  And Norm Ornstein on John Boehner and the upcoming budget showdown.


  1. There's no link for Lewison.

  2. Re: #5

    Greg Sargent and company last night in the Happy Hour Roundup seemed pretty convinced that all the sturm and drag was simply about rhetorical positioning for 2016 and a conservative grift operation for campaign and non-profit co. donations. That is, shutdown and/or debt default are not a real danger because the GOP lawmakers' private intentions are to avoid them in the end.

    This also seems to be the tacit assumption of a lot of mainstream media editors and reporters (given that there hasn't been much day to day prominent coverage of the legislative climate as deeply dangerous). Is media coverage appropriately canny about this or behind the curve (i.e. we should all listen to Ornstein more)?

  3. I asked this in a thread the other day but I think the thread had petered out...

    Regarding the Cohn piece, he says the same thing a lot of people say about young people signing up: They want to be covered so they don't get crushed by big medical bills if they aren't insured.

    But that gets to one of the biggest weaknesses of Obamacare: If you violate the mandate by not getting health insurance, you just pay a small fine (to grow larger later, but this is the first year we're discussing). But the other regulations of insurance: no pre-existing conditions, no recission, consistent pricing, all mean you could pay small fines every year and then go buy insurance when you get sick. Literally just sign up in the hospital. So I would think that a lot of healthy people could make that calculation and hold off initially.


    1. Yes, that's precisely what the fine was supposed to prevent, but it could be a problem if the fine is too small.

    2. Just to nitpick, "sign at the hospital" might be unrealistic in a lot of cases (presuming you can't get it retroactive). Insurance applications take time to process, and emergency medicine is pretty damn expensive. Sure, it'll be easy to wait to sign up if you develop cancer or such, and major accidents often have persistent effects. However, I'd presume that getting a broken arm treated is probably front-loaded in terms of costs. At least, that's part of my thinking about why I'm signing up through an exchange whenever they open up.

    3. I believe there's a yearly open season; if you miss it, you're out of luck until the next year.

      Not 100% that's correct, or correct for all states.

    4. Still, the concern is that people will delay until they need it. (And they may not know about the technicalities that could make it difficult if they wait too long.)

      As a former young adult myself, I'd also like to remind them that they won't be young forever and they might not want to undermine the system before they do need it.

    5. I'd like to point out that the Millennials I work with are not big on uncertainty or insecurity. They wear seat belts, they wear helmets, they use GPS to find new restaurants, and they're pretty risk averse. (Of course, most of my students are from middle class upbringing.) These kids don't think of insurance premiums as money wasted - they would rather have confidence that they will be okay if something happens.

      I think it's also key that the cost approaches the cost of a high-end phone plan.

  4. Anyone read the comments in Nyhan's article? Nyhan does a nice job of demonstrating how media loses interest in stories over time. It convinced me at least as I've long felt this was how it worked.

    But look at the comments - every commenter believes that this is evidence that the media is liberal or in collusion with the Obama Administration. And many of the criticisms, to me at least, sound like incipient birtherism - we need more evidence. The evidence is out there but it is being suppressed.

    I see the same thing when I read rw sites about Benghazi. There is never enough proof.

    The great Republican echo chamber.

    I can't wait for the start of the 2016 campaign so I can explain to people that Whitewater was bogus the first time around and it is still bogus.

    1. One of the great success stories in opinion formation is the efforts by elite Republicans to convince rank-and-file Republicans, and even some others, that the press has massive liberal biases.

      It's pretty easy, because the press does in fact have lots of biases. They aren't liberal (or conservative) biases('s a bit more complicated, but essentially). But given that there's plenty of bias, some of it will manifest as good for one side or the other, so it's always easy to find confirming evidence.

  5. "Young healthies" sound like something hunters would want to bag.

  6. I had the same thought as ResumeMan, and I did a little research, and it looks like there isn't an open window for signing up. You have to sign up by March 1, 2014 to avoid the penalty, but the exchange is always there, always open, unlike your current large group plan with the one-month signup window, usually in the fall.

    Cohn framed his defense of young people signing up in the context of those who don't make much and receive subsidies. Yes, for them, the costs of the exchange aren't so onerous that signing up is a problem. Unfortunately, the young poor are not the ones who will subsidize the ACA, as they (being subsidy recipients) are definitionally not paying much in. The critical ones who will make the law work are the young rich - and for them the math really doesn't argue for signing up early. Here's why -

    Its 2015, and the full "teeth" (!) of the ACA are in effect. You're a young hipster, living large, healthy, making 60 K in IT at BigCo, who just dumped you on the exchange. You can wait to sign up until (if) you need the coverage, and pay a penalty that - on a going basis - will be 2.5% of your income, or about $1500.

    Or you can sign up. If memory serves, because your $60 K salary doesn't qualify for a subsidy, you're gonna pay full boat for your demographic, which varies by state, but (roughly) is somewhere in the ballpark of $1000-$1500/month.

    So here's your choice: take a chance on paying something out of pocket to set a broken arm (following Bitter Fig's example) plus a $1500 penalty, or cough up $18,000 to be certain your broken arm is fully covered.

    That ain't a choice at all. The hipsters will tell the pollsters that they will sign up, because they support Obama, and they support universal health care, and Jonathan Cohn told them they should. But when they look at the math, they won't. Why would they?

    Assuming there aren't restricted windows for the exchanges (brief internet research turned up no evidence of it), why would anyone making more than the subsidy ceiling ($46 K) preemptively pay 10X more for the insurance than the penalty, especially since pre-existing conditions aren't excluded and you can sign up anytime?

    They'll say they will cause they're ideological fellow travellers with the President.

    But they won't, cause it's not in their interest.

    I really hope I'm wrong on this, but I can't imagine how a penalty that is 1/10th the cost of insurance will get the (essential) young, healthy, reasonably well-off to take on their critical role of subsidizing the ACA.

    1. But is it really the case that it is the young rich, paying full share who are important? Is not the issue keeping premiums low? In order to do that, it is important that the insurance providers have an adequate percentage of healthy people to facilitate cost sharing in the insurance pools. For those purposes, which are critical for the law's function, all that is important is that the insurance providers have enough healthy people and that they are getting money, whether through subsidies or direct payment.

      Now, it is somewhat cheaper for the government in terms of short term subsidy costs if a lot of the young are paying for themselves. But once again, that is dwarfed by long and medium term interest in keeping rates low. So I am not sure it is even that important to the government as to whether they are getting the healthy poor or the healthy rich.

      In other words, CSH, I think you are too easily conflating separate issues - who is paying for the young, which is a short term issue, and how many young sign up, which is the important thing. I am sure that all of that has been taken into account in back rooms somewhere. Now, it may well be that they have not adequately considered all these nuances, but I do not think your argument is especially convincing either, especially since you assume a fact (large company dumping) which I know you fear but which is not yet in evidence.

    2. Anastasios, I agree that keeping premia low provides some benefit. At a 30,000 foot level, an insurance program is only the net of inflows and outflows, and the concern with the ACA is that bringing insurance to folks with pre-existing conditions and other issues will necessarily increase the outflows. Where will the inflows come from?

      The theory is from young healthies who will pay full boat and consume very little. Similar to the vast majority of us who pay auto or homeowners insurance and yet almost never make a claim. While the subsidized poor provide a critical mass, a significant percentage of their inflows will be coming from the tax base - which feeds right into criticism that the ACA will be an unwieldy tax monster. Especially if the unsubsidized semi-wealthy don't throw in their chips like the ACA needs them to.

      Funny you mentioned dumping; my hypothetical guy was dumped, but I wasn't making a dumping argument here per se. It is interesting though that the issue with the individual mandate penalty is the same as the employer mandate penalty: both are much too toothless to encourage compliance.

      There's always crossing our fingers, though.

    3. For my area in NY state, a plan paying 70% of costs, with a cap of $6K out of pocket costs, will run $350 a month. And there are cheaper plans, too, that pay 60% up to the same cap. They run around $250.

      The $1500/month is so last year, guy.

      Next, let's figure out what fraction of young, uninsured people actually make $60K a year - I'm guessing 20%? And such a nice young man is a good catch. He and his spouse will qualify for subsidies once they marry.

    4. Right. The young healthies who are single and making good money are the ones least likely to sign up - no question. Even more so -- especially the men. Even then, I'd bet that quite a few will sign up, since the costs aren't that high, and the risks are; Jon Cohn (I think; I've read it somewhere recently) makes the point that most people in that category do take health insurance when offered through employee plans, even when they have to pay significant amounts.

      Also, I agree with Anastasios. If people who qualify for subsidies are the bulk of sign-ups, that's bad for the federal budget, but just fine with the insurance companies. Which, in the long run, also works out OK for the federal budget (not as good, obviously, as if only unsubsidized people sign up, but better than if no one does).

    5. A really important aspect of this is that hospitals charge different rates for the same procedure depending on who is paying for it.

      Right now, uninsured people might be charged up to twice what insurance companies are charged, because insurance companies negotiate a lower price with their affiliated hospitals. Medicare/Medicaid pays even less.

      Remember, the federal government eventually covers all the costs incurred by the uninsured.

      By moving the poor from uninsured to Medicaid, the government will actually pay less for them to have the same care.

      And by having the middle class pay something, even a hundred bucks a month, towards their costs will reduce what the government would have to pay.

      Medicare for all would have been the cheapest solution for the government. Nonetheless, like all industries, medicine has grown fat during this unregulated phase. It has taken time for hospitals to cut out a lot of unnecessary management costs. I think a major concern was that reducing payments to hospitals too quickly would cause some of them to fail.

    6. Nonetheless, like all industries, medicine has grown fat during this unregulated phase.

      Approx half of medicine was paid for by taxes before Obamacare. Do you think that there were no regulations on this gov spending?

      Have you never heard of state health insurance boards?

      Do you know what the word "unregulated" means?

    7. Must force Young Healthies into the pool!! Get in the pool, Young Healthies!!

    8. Well, the concept of insurance is that each of a large number of members contributes a small amount of money. That way, as a few individuals incur large expenses, they can be covered from the pooled money.

      Once upon a time, conservatives called this "personal responsibility." Now they call it "giving young healthies the shaft." Whatever the day requires, I guess.

      Since Pres. Reagan required all hospitals to provide care for those at risk of death, people who are uninsured receive care anyway.

      However, those costs are not regulated by state boards, as they are not covered by insurance. Hence, your reference to state health insurance boards is off-topic.

      Obamacare is the attempt to put regulations on this government spending, byf.

  7. Actually, at the risk of being unnecessarily provocative, Cohn's column is the quintessential illustration of why conservatives, even when they share many goals with liberals, are strongly in disagreement about process. Against the charge that young people won't sign up for the exchanges, Cohn says 'don't worry, what with all the subsidies and stuff the young poor will be able to afford their way into insurance!'

    Amazing, really, that nearly a century into the Great Society era in America, y'all still haven't figured out that no one is concerned about finding enough recipients of federal largesse. Its true - conservatives have never worried about that, really, not ever.

    Its the lack of subsidizers we fear.

  8. On enrollment windows:


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