Divvying Up the Catfood

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 thatís 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 havenít 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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    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


    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.


    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.



    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
    1.  Merriam Webster: an examination into the financial state of a person to determine eligibility for public assistance

    2.  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.


    Yes (5.00 / 0) (#34)
    by TeresaInSnow2 on Mon Nov 15, 2010 at 03:46:21 PM EST
    I'm sure Jerry's rates would be affordable!  After all it's called the insurance "Affordability" Act, isn't it?

    Clear skies, healthy forests, insurance affordability....LOL, all bills with names opposite the truth.


    Moving people from a government run (5.00 / 3) (#7)
    by MO Blue on Mon Nov 15, 2010 at 12:44:08 PM EST
    system and forcing them into a much more expensive private insurance system is a conservative wet dream.

    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.

    I am confused as to how the government subsidizing private insurance premiums at a higher cost does anything to cut the deficit. The cost differential between the government higher cost of private insurance if they adopted a highly progressive system and what they would save because a small percent of seniors would be required to pick up the entire tab would be negative IMO unless the range of subsidies were very small. This IMO is correct:

    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.

    This the equivalent of a pony for everyone:

    You add a public option with Medicare payment to the ACA exchanges

    Using Medicare rates is strictly "pie in the sky" before they go to moving to just the exchanges as being good or at least better than nothing. Congress was not willing to adopt any system based on Medicare rates. They would not even go with Medicare rates + 5%. Their donors would not allow it then and they will not allow it now.

    Seniors have prepaid for their benefits. I don't think that the government defaulting on their obligations is either good policy or good politics.  


    It is a shell game. (5.00 / 1) (#13)
    by inclusiveheart on Mon Nov 15, 2010 at 01:05:02 PM EST
    Give them your gold coin and they swap it out for one made of fool's gold.

    You paid for benefits (5.00 / 5) (#22)
    by MO Blue on Mon Nov 15, 2010 at 01:28:27 PM EST
    but now we want to take that away and make you go on welfare. Just an old "welfare queen" that didn't pull themselves up by their boot straps.

    And not only are these cretins talking about reducing my benefits, in the same f@cking report they want to reduce taxes for corporations and the extremely wealthy. I paid for those benefits for 49 years (starting at 16) and no way am I willing to have them reduced so that politicians get more campaign contributions and they and their savvy friends can add more millions to their net worth.


    I really can't believe I'm sitting here (5.00 / 3) (#25)
    by nycstray on Mon Nov 15, 2010 at 01:44:46 PM EST
    thinking "keep your f*cking hands off my SS/MC!"

    I don't know why anyone would (5.00 / 5) (#32)
    by Anne on Mon Nov 15, 2010 at 03:11:08 PM EST
    suggest something on the basis of an entity or entities that don't even exist - and may never exist: the so-called exchanges.  Well, other than the fact that it isn't enough that everyone under 65 will be required to buy insurance, now the insurance companies - and those who invest in them - want to feast on the wallets of those over age 65.

    The same people who saw a way to make a killing in the mortgage market no doubt have plans for the Social Security and Medicare dollars; why any sane person would entertain the idea at all is a mystery to me, but you can be sure it's being bandied about even as we speak.

    No one who is suggesting benefit cuts or forms of privatization has learned anything from what's been happening, but we knew that when they took single-payer off the table, Obama convened the commission that has functioned in relative secrecy and has conned the Congress into accepting dictatorial terms for completing the process, and the media started filling up with Pete Petersen acolytes in an attempt to control an extremely one-sided message that these were not people who wanted to learn anything other than, "how much money did I make today?"  

    The answer to solvency of either program is not to start cutting benefits, but to start raising revenue; raise the cap on wages subject to the SS tax.  Raise the Medicare tax by some small percentage on income over some relatively high amount.

    And then stop trying to figure out ways to steal it back so they can give it to their good friends on Wall Street or in the insurance industry.

    Enough already.


    Everybody forgets this part (5.00 / 7) (#15)
    by gyrfalcon on Mon Nov 15, 2010 at 01:11:08 PM EST
    "Seniors have prepaid for their benefits."

    yup. (5.00 / 2) (#16)
    by nycstray on Mon Nov 15, 2010 at 01:15:05 PM EST
    But the same logic is not being applied to SS (none / 0) (#33)
    by BTAL on Mon Nov 15, 2010 at 03:20:17 PM EST
    payments.  It seems to be okee-dokee to just take more but not offer the same return on all that pre-payment.

    That's because SS (none / 0) (#46)
    by Harry Saxon on Mon Nov 15, 2010 at 09:42:20 PM EST
    is a social insurance plan.

    Where is Spike Lee when we really need him? (5.00 / 3) (#12)
    by oldpro on Mon Nov 15, 2010 at 01:04:43 PM EST
    Just "Do the right thing!"

    Medicare for all...too simple, too obvious.

    Not gonna happen with this gang of wimps and thieves.

    Raising Hand (none / 0) (#56)
    by AngryBlackGuy on Tue Nov 16, 2010 at 11:40:04 AM EST
    If some here argue that HCR as it stands will never make it because a GOP congress will eventually defund it, do we think that they would not attempt even more strongly to defund a public option type plan.

    My point: incremental change at times can be good. Many valid points made on this chain about the various paths we can go, but while we're in the hurdle figuring out various game plans, I am looking at the defense lining up.

    It's like we're looking for the 30 yard TD play when they've got all of their corner backs and safeties in the game and the running play is there for the taking.

    Move the ball. This is a long game and people here sometimes talk as if everything has to be done on one play.


    There are two questions that (5.00 / 1) (#59)
    by Anne on Tue Nov 16, 2010 at 02:14:16 PM EST
    no one who supports this abominable plan seems to be able to answer: (1) if the plan was so good, why make people wait so long to benefit from it? And (2) if the system is in such a crisis, how does long-delayed implantation help end it?

    There are other questions, of course:

    1.    Why take the chance on a shift in the balance of power by delaying implementation of the most important parts of the plan so long?

    2.    Why not use the power of the majority to set out the most ambitious and truly historic plan, sell the public on the advantages, and get concessions from the other side - the one that isn't holding most of the cards?

    3.    Why take the best solution off the table and out of the discussion if you are really interested in actual reform?  

    4.    Who asks the industry largely responsible for this mess what it recommends, what it would be on board with, what wouldn't upset its golden apple cart too much, before handing them the potential to collect insurance premiums from 50 million more people?  And puts no controls on the ability of these companies to hose their existing customers in the meantime?

    There have been many studies and plans that show single-payer would not have the devastating effect on jobs at all, that it would take the pressure off the business community, that care would increase without also increasing the cost.  Physicians For a National Health Plan have a wealth of information, a daily discussion on health care-related issues and would have, I believe, added a dimension to the discussion on how to solve the crisis - but they weren't permitted to have any input.  

    The defense of which you speak was and always will be there, but nothing takes the wind out of the naysayers' sails like a happy public, state and federal budgets less-burdened by the cost of care, employers with healthier employees - and the political benefit: voters who will go to their graves voting for you because you helped save their physical and financial lives.

    There were other ways to go on this; even an enhanced Medicare for those 55-64 would have been worth doing - I'd pay a higher Medicare tax for that option, and imagine what I could do with the over $8,000 I spend in premiums every year.  Think of how I could be better-prepared for my retirement, how I could put more into the local economy.

    Think about the exponential benefit if I'm one of several million people in that age group.

    Seems like "But, We Can't" has replaced "Yes We Can" as the message of this president; it certainly seems to have become a constant refrain from you.


    I think you miss the point . . . (none / 0) (#57)
    by nycstray on Tue Nov 16, 2010 at 11:50:11 AM EST
    in your constant defense of Teh One . . . .

    I think (none / 0) (#58)
    by CST on Tue Nov 16, 2010 at 12:52:53 PM EST
    one of the big differences is the assumption that a public option would ultimately pay for itself with premiums, and even passing a small public option would put a foot in the door for going to a more comprehensive government plan at a later date.  Another assumption being that a public option would ultimately become like medicare/medicaid/social security - so popular and important it becomes politically difficult to eliminate.  

    Regulatory changes and subsidies require much more direct government funding, and are therefore subject to more shenanigans.  And there is no potential industry-altering foot in the door.

    I actually support the current HIR plan over what was in place before.  But I certainly don't think this was the best we could have done under the circumstances.


    Make up your mind! (none / 0) (#61)
    by observed on Tue Nov 16, 2010 at 04:07:16 PM EST
    Is Obama's HCR the best thing since sliced bread,or is it merely a small, almost symbolic step?

    Anbody (5.00 / 1) (#27)
    by Ga6thDem on Mon Nov 15, 2010 at 02:19:31 PM EST
    who thinks the "exchanges" are going to do anything other than offer one stop shopping either doesn't know what liberal ideas are or has never bought insurance on the individual market. They might be progressive ideas though.

    People on Medicare already have (5.00 / 5) (#30)
    by caseyOR on Mon Nov 15, 2010 at 02:36:03 PM EST
    to wade through a ton of cr@p every November during the annual  Part D and Medicare Advantage enrollment period. It is a terrible process with way too much info for anyone to wade through, much less someone who is sick or elderly.

    With Part D, it requires that you be able to see into the future to predict exactly what drugs you will need during the next year because the drugs covered by the various Part D plans (which are all private insurance plans) vary from plan to plan, and you are stuck with you plan for a year. Monthly premiums change every years, as do $$ amount of co-pays.

    Medicare Advantage plans, also private companies, come and go every year, so this years plan may b not be around for next year. Each plan offers different things for different amounts of money. Tons to wade through.

    The whole process is a time-wasting, stress-inducing annual mess, the exact kind of mess we can expect from the vaunted Exchanges. It will drive people crazy every year.

    Means tested? (5.00 / 2) (#35)
    by masslib on Mon Nov 15, 2010 at 04:57:34 PM EST
    Yuck.  This is ridiculous.  EVERYONE ultimately needs Medicare.  I can not even believe anyone thinks a good idea is means testing Medicare.  Utterly stupid, and not Hacker's plan, FYI.

    What did MY say about the public (none / 0) (#1)
    by observed on Mon Nov 15, 2010 at 12:10:25 PM EST
    option last year? I remember that EK was deadset against it.

    Just an Observation (none / 0) (#2)
    by ScottW714 on Mon Nov 15, 2010 at 12:33:29 PM EST
    You sure are spending a lot of time on something that you said was never ever going to happen, unserious, and unSerious.

    The Catfood Commission's proposals are filled with proposals that not only are bad, they are far outside the mainstream of what Americans want, and, more relevantly, what Congress will ever approve. I mean really - eliminate the mortgage interest deduction is going to happen? Cutting Social Security benefits is going to happen? Never. Ever. The Catfood Commission proposal is unserious and unSerious. BTD

    It's not just you, it's all the entire political/media establishment.  Similar to Death Panels, it was absurd, yet everyone had to pitch their two cents, and in this case, seems like your in for about a buck fifty for something that you claim is an improbability.

    Time to move on.

    Alan Simpson on Charlie Rose: (none / 0) (#62)
    by NYShooter on Tue Nov 16, 2010 at 11:21:42 PM EST
    Responding to a question from Rose regarding the perception that the Commission is skewed against poor people Simpson, with his patented humility, patted himself on the back and stated, "thank God somebody had the guts to make the hard choices; now, let the whining begin."

    And in  support, Erskine Bowles, typifying the kind of bi-partisan Democrat that gives President Obama nocturnal orgasms, piped in, "Yes, there will be pain, but we put everything on the table."

    Is there anything more pathetic than a bunch of millionaires making "hard choices" for our country's poor and congratulating themselves for having the guts to leave pain on the table?"

    That's some table, isn't it? (none / 0) (#63)
    by Anne on Wed Nov 17, 2010 at 02:41:24 PM EST
    Pain is allowed there, but not single-payer.  Or, post-2006 majority, impeachment.  Accountability is never on the table anymore, well, except for those deadbeats who don't pay their mortgages.  Huge profits and bonuses - I see Wall Street had a record year - those go under the table, I guess.  

    Time to turn the tables, I think...