Divvying Up the Catfood

By Big Tent Democrat, Section Other Politics
Posted on Mon Nov 15, 2010 at 12:05:47 PM EST
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In a purely Ivory Tower sense, I thought this was an interesting exchange between Yglesias and Atrios. Yglesias initially posited:

Traditionally raising the Medicare eligibility age more than a teensy bit would be unthinkable, since absent Medicare an elderly person would be totally uninsurable. But under ACA that’s not the case. Of course subsidies will be needed for most retirees, but a workable highly progressive system would be in place to ensure that nobody has to go without access to health coverage.

The "workable highly progressive system" Yglesias is talking about are the vaunted exchanges. Representing those of us who disagree with the idea that the exchanges are a "workable highly progressive system" was Atrios:

Saying that "the Affordable Care Act haven’t really sunk in yet" is another way of saying that the assumptions used to calculate cost savings to the government of increasing the Medicare eligibility age are quite wrong. Shifting old people out of an efficient insurance provider into an inefficient one that they pay for with government subsidies isn't sound policy.

Synthesizing these two strands, Yglesias has an update (I do not know if it came after Atrios' post):

Thinking harder about this, the real cost-saver is a twofer. You add a public option with Medicare payment to the ACA exchanges and you raise the Medicare eligibility threshold. Basically we'd transition over time from a single-payer system for seniors and a crap for non-seniors, to a means-tested single-payer system for everyone.

(Emphasis supplied.) Now this is not an original idea. In fact, it was in essence, THE original Hacker idea as I understood it, but expressly using Medicare as opposed to a new public insurance program. And I still like it.

Of course no one in the Beltway will ever agree to this, but it was an interesting exchange nonetheless.

Speaking for me only

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Divvying Up the Catfood | 64 comments (64 topical)

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Oh yeah (5.00 / 5) (#3)
by lilburro on Mon Nov 15, 2010 at 12:34:50 PM EST

I am sure seniors are going to be thrilled with their subsidies which may vary from year to year and all the time they get to spend shopping on exchanges and trying to ensure they don't get screwed. That sounds a lot better than automatically being enrolled in Medicare.

Means tested (5.00 / 1) (#9)
by cawaltz on Mon Nov 15, 2010 at 12:56:11 PM EST

almost guarantees that something will be a political football in my opinion. The GOP and their "pull yourselves up by the bootstraps and you should have planned better"mentality will have no problem reframing the vulnerable who would depend on such a program as selfish, lazy n'er do wells who are sucking the lifeblood from the business community and responsible for higher taxes for hard working Americans. I can almost hear the rhethoric now.


Well (none / 0) (#11)
by Big Tent Democrat on Mon Nov 15, 2010 at 01:04:33 PM EST

When you say Seniors, you mean folks already eligible for Medicare right?


: I do (none / 0) (#19)
by lilburro on Mon Nov 15, 2010 at 01:17:57 PM EST

I am addressing the idea in MY's original post.
I wish Yglesias would provide an Ivory Tower POV that didn't play into all the preexisting right wing framing all the time. Discuss strengthening the social contract, and gasp! possibly even raising taxes. Instead of the deficit and very technocratic solutions. I feel like there are some on the left who think we can win by using microscopes. Yglesias is what he is...I would like it better if he worked at WaPo instead of Think Progress though.

No one is automatically enrolled (none / 0) (#37)
by jimakaPPJ on Mon Nov 15, 2010 at 07:25:33 PM EST

in Medicare. You must sign up.

Also, Medicare does not cover all health care costs.

ASSUMING the treatment is approved, Medicare covers 80% of the doctor bill and the hospital cost in excess of the first $800.

Plus, the monthly premium is around $110.

I'll skip the drug coverage.


You mean (none / 0) (#38)
by the capstan on Mon Nov 15, 2010 at 07:46:25 PM EST

Medicare covers 80% of the approved cost from the doctor. And that approved cost may be most of the amount charged or very little of the amount charged. I pay for Medicare plus a bit over $350 a month for the state Medicare Supplemental. The supplemental insurance covers anything Medicare does not pay of the approved amount plus covering deductibles and prescriptions (minus co-pays) each year. The catch: if Medicare does not cover a procedure or such, you collect zero.

Still, having this combination saved my neck when my husband had a stroke. I am not comfortable going with private insurance instead of the state's health plan.


Yes (none / 0) (#45)
by jimakaPPJ on Mon Nov 15, 2010 at 09:28:56 PM EST

We also do the supplemental...

I'm looking at an Advantage Plan... United Health is getting too high...


: Advantage Plans or Supplementary Medicare (none / 0) (#64)
by norris morris on Wed Nov 17, 2010 at 08:01:16 PM EST

AARP is too high as is Medicare Plan D Rx which are getting over $300 per month. Advantage Plans get paid by the government [Medicare] and therefore are middlemen who've taken over your Medicare, Drug Ins, etc. But it's the landmine of details that are daunting regarding using one's own doctors, and what's in and out of various Advantage Plans.
Again some of the Advantage Insurers are ok and many are not. Finding out who fulfills senior's needs without unseen hurdles and denials is not easy.
As it stands now Medicare A & B costs have been correctly itemized in posts on this page. There are also many Doctors who must be paid upfront before they file for your Medicare reimbursement
for office visits.
And without Supplementary Insurance or Advantage plans which pick up the unpaid 20%,seniors would not make it. Drugs remain very high as the Donut Hole leaves seniors uncovered by Medicare PlanD RX as soon as you reach the Cap.
Easy to do if you need expensive drugs on 24/7 basis.
Seniors are up for grabs as the only talk about Medicare is how to cut it, and the additional premiums charged for Supplemental Insurance are climbing UP.
Our president doesn't seem at all interested and in fact is responsible for making a backroom deal with BigPHarma about Medicare Rx. Obama's plan?
In TEN years little by little we may see some costs go down. And promises from BigPHarma to not oppose him on the stump.
No importation from Canada is allowed. Obama is the Drug Industry's darling.
Generics have been slow coming to market, and who knows what kind of deal Obama made about allowing generics to reach the market sooner?
Seniors haven't been levelled with and the entire HCR is mostly vague and hadn't been clarified or explained in detail. No messaging of value has come from the WHouse and it's no accident.
We're being hoodwinked and seniors are getting the shaft along with millions with no insurance at all.

If Medicare eligibility was raised to 68 (none / 0) (#39)
by MO Blue on Mon Nov 15, 2010 at 07:48:41 PM EST

and you were 65 - 67 and were required to purchase health insurance in the exchange even on a modest income you would pay considerably more for a policy that only covers 70% of the costs. If your income was 46,700 or higher, your premium based on someone 64 your premium would be at least 12,206 for a plan that would only cover 60% of your care. Health subsidy calculator

What a deal they have for you.


I figured it was a good deal! (none / 0) (#42)
by the capstan on Mon Nov 15, 2010 at 08:35:38 PM EST

I am 78 and agi was a little under $50000 last year. Other factors: must have a doctor who accepts assignment (all do for now). And if I am out of the state, I may have to mail in the claim for the supplemental program. Finally, since Medicare pays zero for care outside the US, so does the supplemental plan. (You can purchase travel insurance on your own.)


: typo: (none / 0) (#43)
by the capstan on Mon Nov 15, 2010 at 08:50:09 PM EST

I figured MINE was a good deal! (Not the exchange bumf--)

"Means Tested Single Payer System" Heh. (5.00 / 4) (#4)
by Dan the Man on Mon Nov 15, 2010 at 12:35:58 PM EST

I love how Yglesias appropriates a word (i.e. "Single Payer") used by the people to the left of him and re-defines the word so that it means the exact opposite of what it originally means.

Dude, the term "Means Tested Single Payer" is an oxymoron. "Single Payer" obviously means only "one payer" - i.e. the government. "Means Tested Single Payer" means only the means tested will get the single payer while others other will get other payers. So "Means Tested Single Payer" cannot actually exist because means testing implies there will be multiple payers. The Left of Yglesias's have already dropped using the term "public option" because of how Yglesias and his fellow progressives have re-defined the term. Now Yglesias is trying to re-define the term "Single Payer" also so that it doesn't mean what it plainly means. Does he have no conscience?

I also love how Yglesias is now arguing the elderly don't need Medicare anymore because they can just use the exchanges. I've been arguing for MONTHS that was "the implications of" the progressive arguments progressives have been making in support of the new health care plan. Somebody should pay me for spreading progressive talking points.

He means means tested (none / 0) (#6)
by Big Tent Democrat on Mon Nov 15, 2010 at 12:42:48 PM EST

in the sense that you have to pay if you can afford it.

Suppose, for example, you are a millionaire, should you pay for Medicare?


Higher income people pay (5.00 / 5) (#8)
by MO Blue on Mon Nov 15, 2010 at 12:54:47 PM EST

higher premiums for Medicare Part B right now. Also, I seriously doubt that the legislation would be so progressive that only those with incomes of a million dollars or more would have to pay full price for their insurance premiums.

Really a bad idea to implement any scenario that can be used to portray Social Security or Medicare as a welfare programs. The reasons they are popular now is that they work and they are viewed as rights - something that everyone pays for and not just given away.


Well (none / 0) (#10)
by Big Tent Democrat on Mon Nov 15, 2010 at 01:03:30 PM EST

No one under 65 has a chance to get Medicare now so the ability to pay for it is a bonus.

If in exchange, people who can pay continue to pay to age 68 is the trade off for a real chance at single payer, sorry, I am thrpowing you overboard on this one if I can.

But I can't politically. As I said, Ivory Tower stuff.

It's why I have not written a word on the Social Security stuff from the Catfood Commission.

This interested me a little because of how the public option worked into it.


So rather than work to implete a (5.00 / 3) (#18)
by MO Blue on Mon Nov 15, 2010 at 01:17:43 PM EST

real single payer system or move people onto Medicare at an earlier age, you would be willing to move more people from a effective system that they paid for into an ineffectual cost prohibited system where they might not actually be able to pay for health care on the off chance that someday more people might be moved into a better system.

Sorry, don't think agree that taking known benefits away from people now on the slim chance that somewhere in the distant future it will provide other people benefits is a very good idea.


I truly do not get (5.00 / 6) (#23)
by cawaltz on Mon Nov 15, 2010 at 01:37:34 PM EST

why the one program we know that actually controls costs and is politically popular wasn't expanded. I mean how difficult would it have been to allow anyone 55 or older to buy in? It would have expanded the pool and been a means to solidify the support for a social program that actually works. I think the argument even could have been made to increase the percent of withholding for the rest of us upward could have been made if we knew that when we reached 55 that we'd be eligible for the program.


Come again? (none / 0) (#21)
by Big Tent Democrat on Mon Nov 15, 2010 at 01:19:48 PM EST

Who exactly under 65 is on Medicare?


Here is some info (5.00 / 3) (#26)
by MO Blue on Mon Nov 15, 2010 at 01:57:48 PM EST

To be eligible for Medicare, an individual must either be at least 65 years old, under 65 and disabled, or any age with End-Stage Renal Disease (permanent kidney failure that requires dialysis or a transplant.) link

Working towards moving people into Medicare (buy in at 55) at an earlier age is far superior than compromising on a "public option" that will in the current atmosphere never materialize in a workable form.


: I would have been okay with (none / 0) (#31)
by cawaltz on Mon Nov 15, 2010 at 02:49:57 PM EST

a public option if the stipulation would have been that it be modeled after the only program that we know that controls costs- Medicare. It would have meant creating from piecemeal a FEDERAL program that encompassed at least 10% of the market share and would have had to had the same stipulations that Medicare has in regards to hospitals and doctors and required an additional pay in of a certain percentile to cover anyone choosing to buy in but it could have been done . Nobody within the party had the leadership skills or the nads' to actual define the public option in such a way( with the exception maybe of Weiner) though. Instead we got some vague pie in the sky plane that was poorly defined and doomed to fail because it was never clearly defined in a way that people could see the material benefits of implementing it.

Disabled (none / 0) (#28)
by Amiss on Mon Nov 15, 2010 at 02:23:22 PM EST

are on Medicare that have made it through the SS maze.


Cuts to Social Security Ivory Tower Stuff? (none / 0) (#53)
by MO Blue on Tue Nov 16, 2010 at 08:08:45 AM EST

No politician willing to vote for the cuts?

Sen. Mark Warner CNN's State of the Union

Listen, some of this stuff is not Democrat or Republican. Some of it's just math. For example, 50 years ago, eight retirees for every worker, now only two. Look, folks at 25 or 30 years old today aren't going to get Social Security at 65 or 67. We're going to have to raise the retirement age slowly, in a slow way that doesn't affect folks 50, 55. But this is just math. We've got to do some of these things. link

Democratic Senators demand creation of the the Bipartisan Task Force for Responsible Fiscal Action the precursor of the Cat Food Commission.

A group of 15 Democratic senators say they will not vote for deficit-boosting legislation unless the commission is created.

Senator Claire McCaskill was kind enough to actually publish some of the names involved. Here are 11 of the 15 Bayh is claiming:
1. Evan Bayh, Indiana
2. Mark Begich, Alaska
3. Michael Bennet, Colorado
4. Kent Conrad, North Dakota (not named in the link, but one of the ringerleaders)
5. Diane Feinstein, California
6. Amy Klobuchar, Minnesota
7. Joe Lieberman, Connecticut
8. Claire McCaskill, Missouri
9. Bill Nelson, Florida
10. Mark Udall, Colorado
11. Mark Warner, Virginia
link

I feel the need to cough up a hairball (none / 0) (#54)
by Anne on Tue Nov 16, 2010 at 10:23:55 AM EST

reading that list.

Jesus.

Yeah, Obama could have kept the door closed on all of this; instead he wedged his foot in it, and now we've got the likes of the people on that list weaseling their way in.

Some days I wonder why we allow people who don't understand the economy and monetary theory and economics vis-a-vis the government to make decisions that have such huge effects on the lives of everyday people. I know the American people, in general, don't understand it, either, but they can't look to their members of Congress to educate them, and they certainly can't become informed citizens via the media, so it's not entirely their fault.

I'm still waiting for some very serious media-type to ask one of these people, "Why are you even discussing Social Security? It's not a budget issue, or a deficit issue, so why so much interest in cutting benefits? Isn't the answer to raise the ceiling on income subject to the SS tax so there's never again a concern about being able to pay people the full benefits most of them need in their retirement?" Hell, I'd prefer to see a tidal wave of Democrats swamping the disingenuous, factually wrong and dangerous talk being spouted by Republicans and some of their own, and demanding an answer to that - and other - questions.

But I'm not holding my breath, so no danger I'm going to pass out waiting.

I guess the simple answer is that these people don't care if they know anything about anything, as long as they get to keep their jobs.

Gak.


The "very serious media-types" (none / 0) (#55)
by MO Blue on Tue Nov 16, 2010 at 10:47:24 AM EST

are from what I can determine on board with cutting Social Security and Medicare. Was over at my daughters a few months back and the commentators on CNN's regular program on monetary issues were in full throttle on the necessity of "fixing" Social Security through raising the retirement age and cutting benefits. There was not one person on the show who presented an opposing view.

Even with the current Democratic majority in the Senate there are enough people on that list to pass any and all bipartisan cuts to the "entitlement programs" that the actual powers that govern our country want. In the next Congress, with Republican control of the House and most of the Dems on that list still in the Senate, the chances increase dramatically that regular people will lose even more ground to rich individuals and corporations.

: Yes, and the newest assault (none / 0) (#60)
by KeysDan on Tue Nov 16, 2010 at 03:16:50 PM EST

on social security often goes unchallenged. For example, during a debate between senate candidates Marco Rubio, Charlie Crist and Kendrick Meek, Crist and Meek defended social security, with Meek pointing out that the program was in good shape until at least 2037 and could be "fixed" easily. Crist agreed.
Rubio demurred, stating that for the first time since 1983, expenditures exceed tax receipts, so we must raise the eligibility age and increase taxes, on employees. Neither of the other candidates, countered with the fact that while Rubio was correct as far as he went, he did not go far enough to provide an honest answer. True there is estimated to be a $41 Billion deficit this year, EXCLUDING interest income. Moreover, the deficit is attributable to (a) the recession and (b) a $25 Billion downward adjustment to 2010 income that corrects for excess payroll tax revenues credited to the trust funds in earlier years.
The deficit is expected to shrink substantially in 2011 and return to small surpluses in 2012 to 2014, as the economy improves. After 2014 the deficits will grow as baby boomers retire and the number of beneficiaries increases faster than covered workers. However, in accord with the budgetary plan, annual deficits will be made up by redeeming trust fund assets in amounts less than interest earnings through 2024 and then by redeeming trust fund assets until reserves are exhausted in 2037, at which point tax income would be able to pay about 75 percent of scheduled benefits through 2084.
Of course, it is a curious emergency that suggests an immediate cut in benefits of about 25 percent to avoid, possibly, a 25 percent cut in benefits in 27 years.

Ideally, no, you shouldn't (5.00 / 1) (#14)
by gyrfalcon on Mon Nov 15, 2010 at 01:07:46 PM EST

Do we charge millionaires for using the public streets? Ideally, health care should be simply something that's paid for for the entire population through (universally higher, of course) general tax revenues. Millionaires would already be paying more for their health care because they pay more in taxes.


Indirectly through higher income taxes (5.00 / 3) (#24)
by andgarden on Mon Nov 15, 2010 at 01:41:27 PM EST

which is exactly how this should be.


Ideally (none / 0) (#20)
by Big Tent Democrat on Mon Nov 15, 2010 at 01:19:09 PM EST

Everyone would have a job, a chicken in every pot, a pony in every pasture, etc.


: Not comparable ideals (5.00 / 1) (#36)
by gyrfalcon on Mon Nov 15, 2010 at 06:04:41 PM EST

But we're not getting single-payer anytime soon, means-tested or not, so the whole thing is moot anyway.

Dictionary definition of "means test" (none / 0) (#17)
by Dan the Man on Mon Nov 15, 2010 at 01:17:36 PM EST

Merriam Webster: an examination into the financial state of a person to determine eligibility for public assistance
Cambridge dictionary: the official process of measuring how much income a person has in order to decide whether they should receive money from the government

The income level at which a person (none / 0) (#40)
by MO Blue on Mon Nov 15, 2010 at 07:55:43 PM EST

pays the full premium in the exchange is $46,500 for a 60% actuarial policy. That level of income falls a wee bit short of being a millionaire. And paying at least 12,206 for insurance that only picks up 60% of the tab falls way below Medicare coverage and fails IMO of providing affordable health care.


How does it work if you make less (none / 0) (#41)
by nycstray on Mon Nov 15, 2010 at 08:04:41 PM EST

say 40K a year? I did it at that and it said that part of it would be picked up with a tax credit. does that mean a person would pay up front and then get a portion back after they do their taxes? or is it an 'instant' credit so a person doesn't have to go out of pocket the full amount every month and wait for a "credit" months down the road?


At one time it was going to be a subsidy (none / 0) (#44)
by MO Blue on Mon Nov 15, 2010 at 09:10:36 PM EST

and then it changed to a tax credit. I never read how the tax credit would work. I did try initially to find out using google but never could get an answer. Considering my skills are primitive at best, I might have just used the wrong search criteria. Since I am currently on Medicare, I didn't take the time to do any further research to find out exactly how the tax credits were going to work for subsidies. Hopefully, I will remain on Medicare in the existing form and not have to deal with it. Sorry, I couldn't be more helpful.


I admit that I may have missed this (none / 0) (#47)
by andgarden on Mon Nov 15, 2010 at 09:49:41 PM EST

but I had understood that the final version was a subsidy.

If it really is a tax credit, the Republicans are going to find it basically impossible to defund IMO.


I think that they went with credits in (none / 0) (#48)
by MO Blue on Mon Nov 15, 2010 at 10:37:15 PM EST

the final version. Finally found something that might be a worthwhile summary. IMO Kaiser has been pretty good at documenting the legislation as it has progressed through the sausage machine. Here is their PDF file Titled Summary of New Health Reform Law. Based on a quick look, here are some excerpts:

Limit availability of premium credits and cost-sharing subsidies through the Exchanges to U.S. citizens and legal immigrants who meet income limits...
....
Provide refundable and advanceable premium credits to eligible individuals and families with incomes
between 133-400% FPL to purchase insurance through the Exchanges

I'm much to low on energy and brain power to go through the whole thing tonight but the wording seems to emphasize premium credits.

Why would it be basically impossible for the Republicans to defund program? It is my understanding that their initial goal is to starve the implementation of start up operation of funds.

It does seem like a tax credit (none / 0) (#49)
by andgarden on Mon Nov 15, 2010 at 11:20:06 PM EST

It will be harder to change largely because changing the tax code in that way is probably harder than attaching a "may not spend" rider to an appropriations bill.

In my view, Obama will veto any spending bill that attempts to gut implementation. And in a stalemate, the state-based exchanges probably open for business, with the tax credits intact.


Do you really think that Obama will (none / 0) (#50)
by MO Blue on Mon Nov 15, 2010 at 11:37:33 PM EST

keep vetoing necessary spending bills if the Republicans persist in generating them without funds to implement the health insurance program? If he wants a spending bill seems he will decide give in much like on the tax cuts for the wealthy.

My guess (hope, prayer. . .) (none / 0) (#51)
by andgarden on Mon Nov 15, 2010 at 11:47:26 PM EST

is that he will draw a line in the sand at some point.


: From various things I've read in the last (none / 0) (#52)
by MO Blue on Tue Nov 16, 2010 at 12:13:45 AM EST

week or so there are quite a few Democratic Senators more than willing to help the Republicans "fix" the legislation to meet more of their requirements. IIRC even Obama has said he is also willing to do this. From the sounds of it even if it is not defunded, more "compromises" are in store and they will not IMO be improvements.

Well (5.00 / 2) (#5)
by TeresaInSnow2 on Mon Nov 15, 2010 at 12:37:34 PM EST

Because of insurance companies and their gaming of the "ACA" policies they're having to implement now, insurance is becoming increasingly unaffordable. I predict that by 2014, people on the individual insurance market that MY is proposing as an insurance avenue for some Medicare recipients are going to be dropping off insurance rolls like flies and thanking heaven that the mandate tax is ony $1000, or whatever it is.

The wonderful exchanges will be based on what insurance costs in 2014, by then a price that will most likely be totally and completely an unjustifiable expense by anyone with half a brain. Affordability act? Such a name is nothing but hype, along the lines of Bush's Clear Skies and Healthy Forests acts. Subsidies? Over Republicans and many Democrats dead bodies. This is the group that thinks we gotta raise taxes on the middle class, lower taxes for the rich, and cut social security for "deficit reduction". Do you think they'll offer REAL subsidies?

Here's an article that does a nice job of depicting what Regence in our state is doing right now...raising premiums atrociously and cutting benefits just about anywhere not mandated by the "Affordability" act...that means cutting prescription drugs, scans, raising deductibles...etc. All of this, they say is to justify the added expense of changes they now have to make to comply with the law.

Affordability? Nothing but pie in the sky.

: This is a real "cutie" from Regence (5.00 / 0) (#29)
by MO Blue on Mon Nov 15, 2010 at 02:35:04 PM EST

One reason for Nilssen's potentially steeper-than-average rate hike is the way Regence wants to cover kids. Many families currently pay a flat rate for two or more kids. Regence has proposed that families now pay per kid.
Wonder if the Catholic bishops will waive in on that. Definitely penalizes people who abide by Catholic doctrine.

But smaller families are on notice too. Jerry Henderson, a 60-year-old computer programmer from Bellevue, said his premiums would jump by 70 percent in more than three months under the insurer's proposed rates.

Wonder what Jerry's premium would cost when he is 66 or 67 if he is no longer eligible for Medicare.