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October 30, 2013

The Reality of ObamaCare Offers a Teachable Moment

"Someone please tell me why my premium in January will be $356 more than in December?”, asks Sue Klinkhamer, a former Democratic staffer and ACA supporter who is shocked to learn that the insurance policy available under the Affordable Care Act isn't actually affordable.... for her.

In the video below, she makes the following points:

1. Some of the mandatory "essential" services required by the ACA were already included in her old policy. So she's not getting better care or a lot more services under ObamaCare.

2. She's not buying the administration's line that only "junk" policies are being cancelled. She liked her old policy and it was affordable for her.

3. [Shocker alert] Though her premium is going up, she isn't eligible for a subsidy.

4. She thought she'd be placed into a pool with other "healthy" people (which is why her old policy cost less), but instead she's being placed into a pool with unhealthy people whose "affordable" health care policies (and lifestyle choices) she's going to have to subsidize.

It must really bite, finding out that *you're* one of the folks being asked to pay for other people's medical care. It's even worse when you consider that many of them suffer from entirely preventable "lifestyle" diseases.

Klinkhamer's disappointment highlights the huge gap between what voters support in the abstract - fluffy, feel-good notions like income equality and affordable health care for all - and what they support in the real world (giving up part of their hard earned salary to pay for those fluffy, feel good ideas). Most people, regardless of political affiliation, think they've earned their salaries and their success. Few of us think it's "unfair" when we succeed and others don't. And the idea of equality is far more attractive in campaign speeches than it is when it hits us right square in the pocketbook.

In the real world, providing "affordable health care for everyone" means that for the rest of her life, even if she is responsible and takes care of herself, Ms. Klinkhamer will be paying for other people's decisions not to. Because she is subsidizing other people's insurance, Klinkhamer no longer has the freedom to earn lower premiums by taking good care of herself and minimizing her chances of contracting one of the many preventable (and costly) medical conditions Americans are particularly susceptible to.

This strikes the Editorial Staff as one of those "teachable moments" the education lobby are always yammering on about - the perfect moment to point out that all those unpleasant tradeoffs conservatives were mocked for worrying about turned out to be depressingly real. We can't help wondering if ObamaCare will turn out to be the Prohibition of the 21st century - one of those teachable moments that future generations will use to demonstrate that even the best intentions often produce painful unintended consequences?


Posted by Cassandra at October 30, 2013 06:30 AM

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Lessons to be learned:

1) Subsidies need to be higher and extend to 900% of the poverty line ('the near poor,' to borrow a page from the NYT).

2) Unhealthy people should be in their own category so they don't raise costs on everyone else. Of course they will then need 100% subsidies because their 'insurance' for illnesses they already have will be very expensive. This should be paid for by a new tax on Wall Street and Fortune 500 companies.

3) Also, ban smoking and drinking and sugary drinks and eating too much. Mandate participation in Mrs. Obama's exercise program -- maybe we could revitalize the 'militia clause' to force organization of communities into exercise battalions with mandatory daily participation.

Posted by: Grim at October 30, 2013 12:25 PM

Lather, Rinse, Repeat.

Posted by: Yu-Ain Gonnano at October 30, 2013 01:24 PM

On a somewhat tangentally related topic: We have another woman falling on her sword to protect the bossman. Apparently, the buck stops way over there in the War on Women.

Posted by: Yu-Ain Gonnano at October 30, 2013 02:00 PM

I'm not really sure what to say here.

If you guys really believe that NOTHING - even having ObamaCare blow up in their own faces, cost them more money, not deliver the promised features, etc. - will change ANYONE's mind, then we might as well give up on any form of government short of despotism.

If you really believe that, then what we need is some sort of benevolent dictator, or no government at all. I realize that's exactly what a lot of folks seem to think is the answer, but doing away with government isn't going to stop people from wanting what they didn't earn or being stupid.

You're exchanging one set of problems for another. That may or may not be a good idea (I tend to think it's a very bad idea because historically, no government has never been a very good idea and unless something comes along and decimates the population, things are a lot more complex than they were in 1776).

People and societies do learn from mistakes, even if not as quickly or as easily as we might wish they did. We learned not to allow slavery. We gave women and blacks the vote because we became convinced as a society that this was the right thing to do, and I don't see too many serious arguments these days for going back to the way things were. We learned that Prohibition backfired and we had only substituted one set of problems for a worse set.

Maybe you believe that every single Democrat out there is a mindless automaton incapable of logical thought or learning, but I don't.

Maybe you believe that every single Democrat out there will just knuckle under if/when the govt. tries to completely take over their lives AND charge them for services rendered, but I don't. The Democrats I know supported ACA because they focused on the benefits and ignored the costs. Having those cost graphically demonstrated to them is about as persuasive a mechanism as I can think of.

Posted by: Cass at October 30, 2013 02:05 PM

One more point: the minority of committed partisans aren't going to change their minds on either side, but their votes aren't the only ones that get counted in elections.

Posted by: Cass at October 30, 2013 02:06 PM

I'm one of those lucky folks whose insurance policy is cancelled come January 1st. It appears that the policy we've had for years and years doesn't measure up to the requirements of the Affordable Care Act. (It did not include, for example, prenatal care for my wife, just in case the Baby Jesus decides to make His return.) So far, it looks like we'll be able to score some really killer coverage for only about 35-40% more than we pay currently, provided that we don't mind incurring an annual deductible only slightly higher than a couple of mortgage payments.

Fortunately, we aren't poor, so I don't have to worry about having my ego bruised by accepting a government subsidy. But, like most people, much of my vast fortune is tied up in speculative investments, so in order to make this new affordable health plan work for my family, I'm going to have to trim some things from the family budget-like Daughters No.3 & No.4.

But seriously, the money to pay for increased premiums is going to have to come out of the economy somewhere, and my guess is that the first group that'll feel the pain is the automobile industry. We had planned to replace my wife's 12 year-old SUV before the end of the year. But that car payment just got earmarked for health insurance. So I guess Ol' Betsy'll have to run a while longer - at least until all this shakes out sometime next year, maybe longer. And how many people out there do you suppose have come to the same conclusion? Hmmmm?

But, hey, once they get the website fixed...

Posted by: spd rdr at October 30, 2013 02:56 PM

Cass, I don't share your hope in folks seeing thru lies. Only 50 plus percent need to buy the lies one reads on any comment string re the ACA. Said strings demonstrating that plus percent do buy the lies. Further demonstration in that those strings typically argue from anecdote rather than wrestle with principle. (Of course ACA is failing to do what promised; no way barring repeal of the First Law of Thermodynamics it would not fail.)

In addition to my being bugged by my being required to support life style diseases, I'm even more bugged by not having that support money to use on, well, because that's what it is, voluntary charity.

Posted by: Roy at October 30, 2013 03:27 PM

"...the senator did not know that he had invested in either company until fall 2005,..."

He didn't know about Fast and Furious, the IRS targeting, Benghazi, the Healthcare.gov website problems, Solyndra, the NSA....has anybody told him he's the fucking President!

Posted by: DL Sly at October 30, 2013 03:43 PM

Roy, you don't have to agree with me.

But I would be careful about assuming that what goes on in comments sections is in any way representative of the real world.

A fraction of voters spend any amount of time on the Internet. A fraction of those read comments.

An even smaller fraction of those go on to post comments.

So you're dealing with a fraction of a fraction of a fraction of people who vote - a self-selecting sample.

I'm not happy about the ACA, but from what I hear many Democrats aren't happy either. Extrapolating from comments in a comments section (and not all comments sections - only certain ones) to the voting populace just doesn't strike me as a good way to estimate popular support or opinion regarding ObamaCare.

Posted by: Cass at October 30, 2013 03:55 PM

"Maybe you believe that every single Democrat out there is a mindless automaton incapable of logical thought or learning, but I don't."

I think they'll draw a lesson. I'm just afraid that the lesson will "I should be subsidized more." This woman thought a wagon ride sounded like great fun until she realized she'd be expected to help pull. What makes you think her solution will be to ask more people in the wagon to get out and help? She's more likely to vote for the next guy who promises her she can get in the wagon and ride. She's been told all her life that there's an inexhaustible supply of cart horses from among people she's never met and never has to care about.

Sure, eventually, the wagon stops. Have we reached that point yet? That's when there will be a teachable lesson that breaks through.

Posted by: Texan99 at October 30, 2013 04:33 PM

PS, and one way to make the wagon stop moving faster is to stop pulling. It's time to renegotiate.

Posted by: Texan99 at October 30, 2013 04:34 PM

I think the screaming will really start once people discover some of those "technical changes" actually affect them. Different recommended medications. Different doctors and clinics. Different therapies to be tried first. ... Many of these things happen every year as policies change, with minor grumbles, but this year (and next) there is a big, obvious place to put the blame, not on the nearly anonymous insurance company, but the "You can keep your plan" planners.

Posted by: htom at October 30, 2013 04:35 PM

IF I may add that what we are now seeing is only the tip (the self insured only) of the ice burg of everyone. Those that are still covered by employer plans will not get their letters raising rates untill this time next year. Stats say that is 70% of people currently insured. Then we should hear the people howl, when it is to late to stop it.

Posted by: bus28stuff at October 30, 2013 04:50 PM

FWIW, although my insurance is through my employer, I fully expect to "lose" it (in the sense that my costs will go up, my policy will be cancelled and a lesser one will take it's place, and/or I'll be taxed for having a "Cadillac" plan) sooner rather than later.

What really isn't making a whole lot of sense to me right now is the argument (on the one hand) that this law is so fatally flawed that it *can't* work - this happens to be my belief, by the way - and on the other hand, that it will *not* fail spectacularly and painfully (or won't do so "soon enough" to shift public support, which was already low before the rollout and is even lower now. Seems to me that public opinion IS shifting and has been for quite some time.

I have no claim to know the future, but some of the arguments I'm seeing aren't hanging together.

Which is it?

If it's only slightly flawed then the Dems are correct about it working eventually and fiscal Armageddon isn't lurking just around the corner. I don't believe that, but let's face it - that's the logical conclusion IF we're saying it can be fixed or made to limp along. Of course even if it does this, the money to fund all these entitlements just isn't there (which has been another argument - even if we taxed the rich 100% to pay for it, there STILL wouldn't be enough money). Which means eventually, we'll have to raise taxes on the poor, the near-poor, and all those huddled massing living at 400% of the federal poverty line... and they will *not* be happy when that happens.

So again, which is the case?

Is there secretly enough money (but we just don't want to pay it)? If so, we should say so. Is it fatally flawed, or are these only minor "glitches" we're seeing? I don't think so, but I haven't worked out how an underfunded, fatally flawed law ridden with internal contradictions is going to keep going?

Posted by: Cass at October 30, 2013 05:05 PM

I was half-joking, but there is a serious point to be made. Yes, this is a 'teachable moment.' But what is going to be learned from it?

The easiest way to teach a lesson is to argue from principles already accepted by your audience. Supporters hold these principles already:

1) The sick should be able to get health care. Insofar as insurance is how we pay for care, then, they must be insured.

2) Someone else besides the sick should pay for it, because a decent society doesn't bankrupt you just because you happened to get sick.

When it comes time to learn from this collapse, are they going to unlearn those principles? Or are they just going to learn that this system didn't work? If it's the latter, what they'll want is another system -- one that will work.

Even the most explosive failure here won't do anything to undermine those principles as ideas. Yes, there's a teachable moment. Who is the teacher who can explain why the principles themselves are wrong? Convincing them to abandon those principles is a harder job than convincing them to reason from their existing principles to another, farther-reaching system.

Posted by: Grim at October 30, 2013 05:58 PM

I'm not sure why it's hard to believe that something can be fatally flawed and yet not be discontinued. Social Security? Medicare? Our fiscal and monetary policy? The Great Society? Public education?

Things can get propped up in such a way that the moment of truth is delayed, even though the ultimate reckoning will be much, much harsher than it need have been--like a meth addict skipping meals and sleep. Our Founding Fathers did a fine job with the Constitution considering what they knew at the time, but they failed to prevent a state of affairs in which a little over half the population could vote itself benefits from a little under half. There's no sudden collapse, no political reform that stops this system. There's just a slow but steady deterioration of the productiveness of the economy, until there are too few resources to fix the problem.

History shows us that these things do eventually collapse, but it's horribly disruptive, and a lot of people tend to die from violence or want before something new gets built up from the wreckage. New things do get built up; there are bright spots in the former Soviet bloc.

That doesn't mean I've given up. I spend all day, every day, trying to wake up that fraction of the voters who still are capable of seeing what's wrong and changing their behavior and their votes. It does mean that I'd be awfully surprised to win over any Democrats, though I know that it happens from time to time as they get older. Luckily, committed Democrats are a minority. Mostly I concentrate on those "Independents" who don't quite know what they think, except that it should involve "common sense." If they can be persuaded that a real-live candidate is worth supporting over the alternative, they can make a difference. If they think all politicians are hopeless and it doesn't matter who they vote for, they can't. (Although some few in that latter category do go into politics and run for office, which is a good thing.)

I'm encouraged by the fact that quite a lot of independents are mad about this latest business. I'm not so convinced that they'll elect anyone to improve it. Many of them will elect someone to give them better subsidies.

Posted by: Texan99 at October 30, 2013 06:10 PM

What core principles were behind amending the Constitution of the United States to enact Prohibition, Grim?

Were they, or were they not, "unlearned" when it failed?

I think you're operating under the false premise that most ACA supporters are operating from deeply held principles. Some are. But a lot aren't. And they don't all think with the same hive mind.

Posted by: Cass at October 30, 2013 06:11 PM

I never said they had a hive mind, just core principles. That's not an insult.

In fact, the two principles I offered are pretty creditable things to believe. You could be a very decent person and deeply believe those things.

There aren't that many ACA supporters, but the ones that there are are men and women of the Left. These seem to be principles they really hold. Both of them conflict sharply with the market principles of the right and the libertarians (right or left); but just why they conflict has to do with what it means to run a market, and a belief that markets -- even though they don't guarantee good outcomes like the sick always getting health care -- entail better results for everyone in the long run.

So it doesn't make sense to have a 'market' in things no one in their right mind would sell ("insurance" for someone already suffering from the disorder being "insured against" being a good example of that -- any such "insurance" ought to cost the expected cost of the disorder, not ACA rates). And it doesn't make sense to remove payment responsibilities from the person receiving the good ('price signals,' as Tex was just talking about the other day).

There's a pretty hard conversation that has to be had about what works and why it works, and it doesn't answer to these principles of the Left at all. You've got your moment, but how do you begin to teach the lesson?

Posted by: Grim at October 30, 2013 06:57 PM

Hi Guys,
With respect, I'm guessing that some of us are becoming needlessly pessimistic . . .

History has repeatedly demonstrated that (American) voters can and do 'turn out the rascals' after obvious policy failures; just ask Jimmy Carter!

Best Regards,

Posted by: CAPT Mike at October 30, 2013 07:02 PM

I'm sure you're right. There are even signs that people don't blame this fiasco entirely on insurance companies! That's major. Also that a lot of people are getting their first glimpse of what medical care actually costs--how big a fraction of everyone's lifetime expenses it is, even if they have an ordinary run of medical luck.

Under Carter, things seemed pretty darn hopeless, but they got better quick when people voted in an alternative approach. It didn't stick, but nothing works forever, and it did make things better for a while. It could happen again. It may even be that this fiasco is extreme enough to spur a change, though I'm afraid to get my hopes up too much.

But really, you know, I see people trot out the usual nonsense this week ("It's really a Republican plan from the Heritage Foundation"; "it wasn't really a lie") and get shouted down almost with a unified voice. They're left standing there like someone clicking a remote control with dead batteries: why isn't it working the way it usually does? Maybe it's a sign of life.

Posted by: Texan99 at October 30, 2013 07:20 PM

The Internet is like a big funnel.

On the plus side, it allows us to connect with like-minded people. On the minus side, it exposes us to a veritable Vortex of Crap (CWCID: the highly esteemed Spousal Unit) that really isn't representative of real life.

I remember the night before the 2004 election - based on exit polls (really????) and the Internet feedback loop, conservatives were publicly slitting their wrists and whining about how incompetent Bush was.

And then he won. I went to bed about 1030 totally disgusted with the lot of them. I didn't really know if my gut was right, but I just had more faith in the common sense of the American people than these "experts".

Yes, voters can be misled. And all too often we vote with our hearts rather than our heads. But there's a gut instinct there - a grounding and goodness - that I think we need to have more faith in. We're not perfect, we humans. But we can and do learn.

Posted by: Cass at October 30, 2013 08:03 PM

Maybe it's a sign of life.

Yes, yes, yes :)

Don't lose faith. People aren't perfectly rational, but they're not complete idiots either. We learn best by experience, and we're getting a heaping helping of experience now.

I think that's normal and healthy even if it's not pretty to watch.

Posted by: Cass at October 30, 2013 08:06 PM

I'm not comfortable conflating "people with pre-existing conditions, chronic health problems, whatever we want to call them" with "people who have made lousy lifestyle choices and should have to pay for those lousy choices themselves". It is possible to be chronically ill without having made bad lifestyle choices.

If this is going to be a teachable moment, conservatives will have to be clear on what needs to be taught. I don't think the lesson should be that chronically ill people brought it on themselves and non-chronically ill people shouldn't have to subsidize their bad decisions. I think the lesson should be that if someone who isn't getting something now starts getting it then someone, somewhere is going to have to pay for it. If the person doing the getting isn't going to be the one paying then some innocent bystander will be.

As for whether this will be a wake-up call, part of the problem is that the story isn't finished. To steal a thought from Ross Douthat (who I believe was quoting someone else), all we're hearing about now are the people who are losing under ObamaCare. These are the people who have been buying their own health care, have gotten cancellation letters, and are savvy enough to figure out they aren't going to qualify for subsidies even without being able to use HealthCare.gov.

If and when HealthCare.gov starts working, we'll start hearing about the winners. For every person who is paying more now because he doesn't qualify for a subsidy, there will be someone who is paying less because she does. For everyone whose benefits are now worse, there will be someone who didn't have health insurance and now does. The question is whether the great mass of voters, who are personally untouched by all this, decide helping the winners outweighs hurting the losers. I suspect that those who hold the views Grim talks about probably will. So, I think, will those without such principles but with an attachment to the Democratic Party or to Obama; and so will those with a deep antipathy to Republicans.

People can learn but if you show people a set of examples that contradict what they think is true or right and then a set of examples that confirm what they think is true or right, most people will focus on the latter set.

Posted by: Elise at October 30, 2013 09:28 PM

" For every person who is paying more now because he doesn't qualify for a subsidy, there will be someone who is paying less because she does."

The problem with that *win*, though, is everybody else is paying for it.

" For everyone whose benefits are now worse, there will be someone who didn't have health insurance and now does."

This I have never understood. Medicaid has always been available to those below the poverty line all they had to do was apply. Now, for some reason, a great many people think it's something new they can get....just for applying.

Posted by: DL Sly at October 30, 2013 10:53 PM

I doubt it will ever be as simple as to say that there will be a winner for every loser. Because of the subsidies and the unequal application of the rate hikes, the losses will be heavily stacked onto whatever class is most politically disfavored: too rich, not closely enough connected to a union (or at least a large corporation with an approved donor profile that can secure a waiver), not a federal or state employee, and especially way too much like a self-employed person or entrepreneur. Each unlucky member of that class will be carrying many people who are too poor or too sick to take care of their own medical needs. That already was true, of course, because of the progressive income tax, but this will make the problem sharply worse. Politically, the problem will not be addressed, because if you hit 10-15% of the population with $5K annual increases in cost, you can buy the happy votes of the 50% of the population to whom all that largesse will be spread, at perhaps $1K a head. Why should they care that the unlucky 10-15% will vote against them? They're just the milk-cows. It's all too easy to get the 50% to a place where they feel entirely comfortable relying on the police power to keep this transfer of funds going. After all, they need it.

But will the milk-cows produce indefinitely on those terms? Experience tells us that people do not work at peak capacity when they are being drained against their wills to support complete strangers who hold them in utter contempt. No matter how needy the strangers are, and no matter how guilty the state or the culture tries to make them feel about it.

I don't see how the system is ever supposed to work if it's the people taking the money who decide the mandatory level of generosity of the people donating it. I mean, I see how it can be imposed by brute force for a while, but I don't see how the culture survives for long. That's why it's so important that the segment of the population identified for charity should be a fairly small percentage: so that it's possible to build a consensus, not only among the recipients, but among the donors, that commands a majority vote in elections.

Posted by: Texan99 at October 31, 2013 12:16 AM

Elise, I don't think I conflated lifestyle diseases with medical conditions that have nothing to do with lifestyle - the qualifier "lifestyle" was used precisely to distinguish preventable conditions from non-preventable ones.

And I said nothing about pre-existing conditions at all. They're completely separate issues, or at least they were when there was still some relationship between premiums and risk.

Regardless of political affiliation, most people believe in some kind of safety net for those who are suffering through no fault of their own. As someone with a hereditary condition (severe migraines), I am painfully - literally - aware that not every medical condition can be cured through diet, exercise, or taking better care of yourself.

I don't see how the system is ever supposed to work if it's the people taking the money who decide the mandatory level of generosity of the people donating it. I mean, I see how it can be imposed by brute force for a while, but I don't see how the culture survives for long. That's why it's so important that the segment of the population identified for charity should be a fairly small percentage: so that it's possible to build a consensus, not only among the recipients, but among the donors, that commands a majority vote in elections.

This is exactly what I was implying when I mentioned the lifestyle diseases. Most people - even supposedly heartless conservatives - can be persuaded to support some sort of safety net for a small number of people whose problems are not of their own making.

But when you swell the ranks of those covered by the safety net exponentially (to include everyone with any sort of problem), you begin to run into two problems:

1. The cost of the safety net goes through the roof, at least for the lucky few paying the bills, and

2. The cash cows begin to feel taken advantage of.

Posted by: Cass at October 31, 2013 07:54 AM

There aren't that many ACA supporters, but the ones that there are are men and women of the Left.

So if there aren't that many ACA supporters, what's the problem? We outnumber them, but we can't get a majority to repeal the ACA?

This is another argument that doesn't make sense to me. I don't actually know how many people support the ACA. Opinion polls aren't terribly reliable because they are worded so many ways and people's transitory feelings don't always correspond to the way they vote.

It's how they vote that matters.

These seem to be principles they really hold. Both of them conflict sharply with the market principles of the right and the libertarians (right or left); but just why they conflict has to do with what it means to run a market, and a belief that markets -- even though they don't guarantee good outcomes like the sick always getting health care -- entail better results for everyone in the long run.

The arguments I hear from Democrats I talk to are things like, "It's 2013 - we're a rich nation. We should be able to/can afford to take care of the poor and suffering."

Note the qualifiers: we should be able to and we can afford to. They both strongly suggest that taking care of others is something one does if/because one can afford to, not an absolute duty. And I can pretty much guarantee you that if tomorrow, Congress levied a flat tax on all households (or even a painfully high progressive tax) to pay for the safety net, you'd suddenly see a LOT of Democrats revisiting their feelings about what we "should" and "ought to" be doing to help others.

What we support in the abstract when the benefits are magnified and the personal cost minimized is much different than what people are willing to support when the costs are taken into account.

Posted by: Cass at October 31, 2013 08:14 AM

Interesting post, and even more interesting comments. My take is that the ACA is purposefully designed as a camel's nose into the tent of socialized medicine.My logic is that the people who did the "Ramming and Jamming" back when are not stupid. They knew that the ACA would drive health costs sharply up, they knew that health insurance companies could not bear those costs on their own, they knew that the premium required to do so would become outrageous, they knew that the most likely outcome was then government subsidies to those insurance companies; they knew this meant that government would then be able to dictate all the rules for healthcare for everyone; resulting in a health care system completely controlled by the central government covered by a fig leaf of fictitious private ownership. They planned it, They're getting it.The sheep aren't looking up.

Posted by: CAPT Mongo at October 31, 2013 09:01 AM

"We should be able to/can afford to take care of the poor and suffering."

It's a mixed-up "we." They mean "you."

Posted by: Texan99 at October 31, 2013 11:23 AM

o if there aren't that many ACA supporters, what's the problem? We outnumber them, but we can't get a majority to repeal the ACA? This is another argument that doesn't make sense to me.

You're talking about teaching lessons. Who are the teachers? Well, they are people like John Stewart; and for that matter, the majority of teachers-union public school teachers; and college professors.

The ACA has few supporters, but they're significantly placed. These are the lessons I think they will learn, and these are the lessons they will proceed to teach.

It won't do to expect people to learn the right lessons on their own. Some may, but most people have to be taught if you want them to understand an abstract concept like our economic theories. So who will teach them? The ones already in place are the ones most likely to draw the opposite conclusions, because they already hold principles directly opposed.

Posted by: Grim at October 31, 2013 11:47 AM

I don't think they are mindless. I think they are simply minding their own bottom line. We've seen several stories of ACA supporters bemoaning the sticker shock and website issues. But we haven't heard anyone say they changed their mind about the ACA being a good idea.

They've all complained, "why are *my* premiums going up?". If the subsidies were extended to themselves and their premiums had gone down would they be looking at the difference between the unsubsidized price and the subsidized price and think that that expense puts to much pressure on an already overburdened budget? No. They wouldn't. They'd be out there claiming "I told you it would work".

They don't object to the idea of one group paying the cost for another. It just shouldn't be *them*. Between two politicians, one who vows to repeal the ACA and one who vows to reduce their personal costs of the ACA by making "The 1%"™ pay, ACA supporters will vote for the latter in droves.

Sure that new group will be even more mad, but 1) they likely weren't supporters to start with, and 2) push it up high enough there won't be enough votes to change an election. They can be as mad as they like. It won't matter.

No one who supports the ACA is going to see the guy driving a Mercedes as an oppressed victim. Oh boo hoo, poor baby has to schlep it in a BMW now.

Posted by: Yu-Ain Gonnano at October 31, 2013 11:50 AM

The ACA has few supporters

But only a portion of the detractors want it repealed, the other portion wants it expanded.

Posted by: Yu-Ain Gonnano at October 31, 2013 11:53 AM

Elise, I don't think I conflated lifestyle diseases with medical conditions that have nothing to do with lifestyle - the qualifier "lifestyle" was used precisely to distinguish preventable conditions from non-preventable ones.

And I said nothing about pre-existing conditions at all. They're completely separate issues, or at least they were when there was still some relationship between premiums and risk.

My apologies then - I misread what you wrote.

What we support in the abstract when the benefits are magnified and the personal cost minimized is much different than what people are willing to support when the costs are taken into account.

Agreed but the personal cost of this go-round isn't hitting very many people. Those people are very vocal and the media are picking up on their complaints and the problem is particularly egregious since Obama and others lied about what would happen but there just aren't that many of them (us, actually, since I'm one of "those people").

Posted by: Elise at October 31, 2013 11:59 AM

"The ACA has few supporters . . . . But only a portion of the detractors want it repealed, the other portion wants it expanded."

This is exactly right, and has always been a problem with the polling on the ACA.

The trick is, and always has been, to hide the cost. For most people who get employer-based insurance, the cost has been so hidden for decades that they have ABSOLUTELY NO IDEA that healthcase insurance often costs something like $15K a year for first-dollar coverage. They almost never find that out unless they have to apply for COBRA (and then they're outraged at either the insurer or Congress or both). The only people with any notion what it costs are management and union negotiators, or people who buy individual policies. If insurance were separated from employment, many more people would get sticker shock, unless the collectivized-medicine crowd found a way to hide the premiums under subsidies and lull everyone back to sleep.

That's why the website has been such a disaster. Information about the real cost of insurance is seeping out fast than people have been able to get their mitts on some sweet, sweet subsidies.

"You're the richest country in the world. You should be able to pay for my healthcare."

Posted by: Texan99 at October 31, 2013 12:12 PM

Thing is, the ACA does nothing to control the actuals *COSTS* of healthcare. If anything, it makes the cost of the provision of healthcare (separate from the cost of *INSURANCE* to pay for said provision of healthcare) go up. Medical device tax, anyone?

Posted by: Miss Ladybug at October 31, 2013 12:21 PM

My apologies then - I misread what you wrote.

No apology needed! I just didn't want you to think that's what I was arguing.

I often think I'm being crystal clear when I'm not. After all, *I* know exactly what I meant :p

Posted by: Cass at October 31, 2013 12:27 PM

No one who supports the ACA is going to see the guy driving a Mercedes as an oppressed victim.

Agreed, but they do see people who it was supposed to help (who have instead been hurt) as victims. The hard core leftists don't, but they're also in the minority.

I agree with Tex that hiding (or refusing to confront) the cost is the real problem. And this is forcing cost out into the open.

I have absolutely NO idea what my HC policy costs. I know it's a Cadillac plan b/c I can compare my benefits to other people's and they're just more generous. But I suspect it costs a ton of money.

Posted by: Cass at October 31, 2013 12:31 PM

I actually do have an idea of how much my employer-sponsored health insurance costs. It's not "first dollar" coverage, but it's decent (and it is ACA-compliant). For the current year, my medical insurance (doesn't include vision or dental) is just shy of $4600, for which my employer covers about 85%. Since regaining coverage (I was uninsured for a while, between earning my M.Ed and requiring a full-time with benefits job), I have yet to use anywhere near $4600 worth of medical care, but it's nice to know I have the coverage, should something happen again (I did end up in the hospital while uninsured and most of that was paid by the Catholic hospital's charitable foundation). I don't go running to the hospital every time I get a sniffle.

Posted by: Miss Ladybug at October 31, 2013 12:35 PM

Oh, I meant to mention that I don't know how much this same ACA-compliance policy will cost for 2014, as we have not had open enrollment yet. This policy is just for me (husband is still using his VA benefits for his medical needs, which have been extensive since we met just over 2 years ago).

Posted by: Miss Ladybug at October 31, 2013 12:38 PM

Agreed, but they do see people who it was supposed to help (who have instead been hurt) as victims. The hard core leftists don't, but they're also in the minority.

But that can easily be solved by expanding the subsidies and pawning off the cost onto those *other* people.

No learning is required, just apply some more of the same solution.

Posted by: Yu-Ain Gonnano at October 31, 2013 12:58 PM

I don't agree, Yu-Ain. As has been pointed out many, many times, even taxing the rich 100% won't yield enough money to pay for all these entitlements.

At some point, the shortfall will force an expansion of the pool of cash cows. That has, in fact, already started to happen. It was promised that the ACA would result in lower premiums, but it's not doing that and that's being covered in the news.

Increasing both the amount of subsidies AND the pool of people who qualify for them to more than 400% of poverty level is subject to exactly the same math problem. The money just isn't there.

Posted by: Cass at October 31, 2013 01:18 PM

I think there's probably a lot of truth in the idea that we're a rich country and could afford to make sure that no one lacks for food, shelter, clothing, and medical care. The problem is that the flipside of that would be that almost no one you'll ever meet will be wealthy enough to take a vacation, have a home that's more than 1,000 sq. ft., or own a second car--or perhaps a first one.

People think they can get around that by imaging that there's a pool of Americans who are richer than themselves who can foot the entire bill for all this help. If most voters really thought they could afford more charity, they'd be writing more checks to charity. If they really thought charity was that important, no one would have to force them to pay for it.

As things stand, we don't even want to pay for expenditures at their current level; we borrow instead. Where is this "wealth" that will pay for vastly increased help for the unfortunate? It can only come from tens of millions of American households giving up their TVs, their phones, their beer, their vacations, and -- and this is where I draw the line! -- their internet connection. But frankly, all I run into are people who think others should do the giving up while they go on as usual.

Posted by: Texan99 at October 31, 2013 01:32 PM

The money just isn't there.

Of course the money isn't there. The money hasn't been there for the last 20 years of entitlement expansions. Yet it keeps happening.

A reckoning will be coming. And yes, what can't go on forever won't. But to my ears that sounds like a doctor telling a patient the "good news" is the cancer can't grow forever, it'll eventually kill itself off. While true, that's hardly comforting.

Posted by: Yu-Ain Gonnano at October 31, 2013 02:10 PM

I didn't really expect it to be comforting :p

I was just pointing out that there's a natural limiting mechanism. The debt is going exponential, so the rate of growth is not the same as it was 20 years ago, and it's also much harder to pretend nothing's wrong.

Even Dems are beginning to admit this is a problem.

Posted by: Cass at October 31, 2013 03:35 PM

Right, but while we need a limiting mechanism that's like a fuel gauge that tells the pilot when to look for an airport, what we're now relying on is the limiting mechanism that doesn't let the plane keep falling any more once it's crashed into the ground.

Posted by: Texan99 at October 31, 2013 06:09 PM

...what we're now relying on is the limiting mechanism that doesn't let the plane keep falling any more once it's crashed into the ground.

You're assuming that nothing will be done until it's too late. But that wasn't the case in Canada. You're assuming the self interest of all those folks who are dependent upon the govt. (and the politicians who are dependent on their votes) will somehow not kick in until it's too late.

Essentially, you're assuming that these folks wouldn't rather have half a loaf than no loaf at all.

It could well happen that way, but it could also happen the way it did in Canada, where they cut back their entitlement programs BEFORE the money had run out.

Posted by: Cass at October 31, 2013 06:48 PM

"You're assuming that nothing will be done until it's too late. But that wasn't the case in Canada."

Yes, but Canada has a Parliamentary system; which can change course at in a "No confidence" minute. We do not.

Posted by: CAPT Mongo at October 31, 2013 07:08 PM

That's true, but that doesn't mean we can't change our minds.

It is very difficult to pass an amendment to the Constitution, but we did that twice with Prohibition. And wrt to Canada, the ability to move swiftly cuts both ways: what was done could just as quickly have been undone.

That it has not (so far) suggests a shift in public support for lavish entitlement programs.

Posted by: Cass at October 31, 2013 08:18 PM

'For every loser, there will be a winner'
^emphatically *not* true!
- Gov't interference in the health care market will drive up overall costs, which will have to be paid . . . by someone. If evenly distributed, we would all pay xx% more per year.
> but because the new regs do not evenly spread costs, some (probably most of us)will see higher overall costs, as the regs mandate plans cover more 'stuff,' like pre-existing conditions.

>> more insidiously, while the regs mandate more issues be covered for more people(demand for health care), they not only do nothing to increase the supply of health care (people providing the service), they actually incentivize many in the field to either not accept new patients from the exchanges, there are credible reports that some will actually leave their practice early(ier) to avoid the hassle.

Best Regards,

Posted by: CAPT Mike at November 1, 2013 04:41 AM

I hope we won't have to suffer through what Canadians suffered through before they could fix their mess. A lot of people died or waited years for hip replacements before their benevolent Supreme Court ruled it wouldn't actually be illegal for them to contract privately for decent healthcare that was denied by the public system. Canadians had a semi-functioning system to the south that they could flee to if they were motivated enough. They had an economy to the South that could continue producing expensive drugs that they could pirate and sell cheap. We're not going to have that.

I agree things tend to get fixed in the end. Even when the plane crashes and all aboard die, someone else builds a better plane and live goes on. But it's not much comfort to the people in the plane.

Posted by: Texan99 at November 1, 2013 12:54 PM

"It is very difficult to pass an amendment to the Constitution, but we did that twice with Prohibition. And wrt to Canada, the ability to move swiftly cuts both ways: what was done could just as quickly have been undone."

Quite right.I served an exchange tour in Halifax (It was great--and I learned to appreciate single malt scotch). I do not think we would need a constitutional amendment. We would need both houses of Congress and the Presidency--or at least veto proof majority in the former. Glumly I do not see that happening between the entitlement voters and the playing of the abortion card by the Dems. That combination (which siphons off huge numbers of otherwise Republican voting women to the dark side) is---depressingly---seemingly unbeatable.

Posted by: CAPT Mongo at November 3, 2013 05:26 PM

"...the dark side..."

Hey, hey, hey! I'll not let you disparage my house so, as it would scare the living shit out of any looney liberal that dared cross the threshold.
0>;~}

Posted by: DL Sly at November 3, 2013 09:54 PM