home

The Case Against The Voucher/Exchange Model For Health Insurance Reform

Paul Krugman:

On health care costs, [Paul Ryan] declared that ďOur plan is to give seniors the power to deny business to inefficient providers.Ē Remember, what the plan actually does is hand out vouchers whose value will fall well short of the cost of coverage. So how much power do those Americans who canít afford decent health insurance have right now in their dealings with providers? If you think people who donít get coverage through their employers have the upper hand, you believe that the Ryan plan is empowering.

(Emphasis supplied.) In what way is Krugman's criticism of RyanCare not applicable to the exchanges in ObamaCare?

Speaking for me only

< Pelosi: "We Have A Plan: It's Called Medicare" | Liu Nomination Fails Cloture Vote >
  • The Online Magazine with Liberal coverage of crime-related political and injustice news

  • Contribute To TalkLeft


  • Display: Sort:
    Ryancare is a conservative Republican plan (5.00 / 2) (#1)
    by MO Blue on Thu May 19, 2011 at 01:07:52 PM EST
    that provides some money for private insurance not health care. Obamacare is a conservative Republican plan that provides some money for private insurance not health care. The only real difference is that one conservative Republican plan was promoted and passed by a Democratic president and a Democratic congress.

    the difference is (none / 0) (#2)
    by CST on Thu May 19, 2011 at 01:10:22 PM EST
    one eliminates medicare and one supplements it.

    Ignoring that is essentially like saying medicare is irrelevant.

    Parent

    "supplementing" can be equivalent to (5.00 / 1) (#4)
    by observed on Thu May 19, 2011 at 01:19:18 PM EST
    taking away. Would you say that school vouchers supplement public schools? I wouldn't.

    Parent
    how is obamacare competing with medicare? (none / 0) (#7)
    by CST on Thu May 19, 2011 at 01:23:10 PM EST
    In your scenario the school vouchers are taking students and funding away from public schools.

    How is that happening in Obamacare?

    Parent

    What is relevant to (none / 0) (#16)
    by Big Tent Democrat on Thu May 19, 2011 at 01:50:23 PM EST
    evaluating the exchanges?

    If Medicare is superior to RyanCare isn't a public option superior to the exchanges?

    Parent

    of course a public option (none / 0) (#17)
    by CST on Thu May 19, 2011 at 01:54:04 PM EST
    or medicare for all is superior to the exchanges.  

    What I would say is different is that seniors would be facing the exchanges with a much worse hand/stacked deck for "negotiation" than the general public.

    So it's not that medicare/public option is not better than Obamacare (it is) for the reasons stated.  It's that the Ryan plan is worse for seniors than the exchange would be for the general public because of the basic costs involved with providing healthcare for seniors.

    Parent

    I can just imagine what (none / 0) (#22)
    by nycstray on Thu May 19, 2011 at 01:58:51 PM EST
    would be offered on the exchanges for seniors within their voucher range . . .

    Parent
    Now imagine it (none / 0) (#24)
    by Big Tent Democrat on Thu May 19, 2011 at 01:59:48 PM EST
    for Americans in the exchanges with subsidies.

    Parent
    Already did that back in the day (none / 0) (#25)
    by nycstray on Thu May 19, 2011 at 02:01:31 PM EST
    just call me 'ye of lil' faith'.

    Parent
    Why? (none / 0) (#23)
    by Big Tent Democrat on Thu May 19, 2011 at 01:59:12 PM EST
    I think seniors are actually in a much better position to "negotiate" (of course their position is worse but they are much better informed than younger Americans.)

    I actually think there is a better argument for seniors shopping than younger Americans.

    Of course seniors will pay more, they use health care more.

    Parent

    not about informed (none / 0) (#28)
    by CST on Thu May 19, 2011 at 02:03:30 PM EST
    so much as need.

    If I don't need something, I can buy whatever version of it I want.  If I need something for basic survival, and the person I am trying to get it from knows that, then you are automatically negotiating from a weaker position.

    Parent

    Informed because of that (none / 0) (#35)
    by Big Tent Democrat on Thu May 19, 2011 at 02:14:53 PM EST
    Informed about what though (none / 0) (#44)
    by CST on Thu May 19, 2011 at 02:25:48 PM EST
    What difference does it make that you know more about what you need if you can't get it.

    Parent
    About what? Indeed (none / 0) (#50)
    by Big Tent Democrat on Thu May 19, 2011 at 02:31:02 PM EST
    And when that "can't get it" is the result under exchanges, for SENIORS or for working poor, how is it different?

    Parent
    I think it is more likely (none / 0) (#52)
    by CST on Thu May 19, 2011 at 02:34:30 PM EST
    that seniors "can't get it" than the younger working poor based on the fact that their healthcare needs and costs are higher.

    The definition of "it" is vastly different for these two groups.

    Parent

    And I think you are wrong (none / 0) (#56)
    by Big Tent Democrat on Thu May 19, 2011 at 02:36:28 PM EST
    The reason is the voucher for seniors will be MUCH bigger than the voucher under ObamaCare.

    you have it entirely backward imo.

    Parent

    It seems Ryan's plan (2.00 / 1) (#10)
    by Abdul Abulbul Amir on Thu May 19, 2011 at 01:32:41 PM EST

    is not much different than what the federal workforce has in place.  If Medicare were so hot, then AARP would not be raking in a ton of cash selling medi-gap insurance.  

    I would like insurance companies competing for my $15K business.  AARP will probably hate it because it means the medi-gap business is kaput.

    shorter version (none / 0) (#11)
    by CST on Thu May 19, 2011 at 01:36:47 PM EST
    we should get rid of sidewalks because people still buy cars.

    Parent
    you want to give the insurance (none / 0) (#12)
    by nycstray on Thu May 19, 2011 at 01:43:45 PM EST
    companies 15k a yr when you're retired?

    Parent
    thats the medicare average payment (none / 0) (#37)
    by Abdul Abulbul Amir on Thu May 19, 2011 at 02:16:01 PM EST

    I'd be happy with that kind that kind of purchasing power.  It works for the federal workers, and you don't get stupid turning 65.

    Parent
    Yeah (none / 0) (#40)
    by Ga6thDem on Thu May 19, 2011 at 02:19:07 PM EST
    but Ryan's not going to give you 15K.

    Parent
    Do you know what the (none / 0) (#81)
    by jimakaPPJ on Thu May 19, 2011 at 03:14:35 PM EST
    proposed voucher is??

    Parent
    He doesn't (none / 0) (#88)
    by Ga6thDem on Thu May 19, 2011 at 03:39:35 PM EST
    say in his proposal ( yes I read it) so you should assume that it is not going to be very much. Probably less that 10K I would imagine.

    Parent
    Hmm . . . (none / 0) (#47)
    by nycstray on Thu May 19, 2011 at 02:28:50 PM EST
    I don't think my mom is paying 1k+ a month. Heck, when Dad was still alive I don't think they paid that combined . . .

    Parent
    Medicare is about...per month... (none / 0) (#105)
    by jimakaPPJ on Thu May 19, 2011 at 08:33:34 PM EST
    $110/person. Medicare Supplement, which pays what Medicare does not is about $175. Rx Insurance is about $50 for a decent plan. So with the Rx doughnut hole of around $2500 that would be a annual hit of around $5000 to $7000, $10,000 to $14,000 for a couple.

    The question is... how big is the voucher and price does the insurance corps want to charge.

    Parent

    I have no idea what the voucher would be (none / 0) (#106)
    by nycstray on Thu May 19, 2011 at 09:00:19 PM EST
    and would be afraid to look at what the ins co's would charge :/ I'll admit to being a total pessimist on the issue though.

    Isn't the doughnut hole closing? So medicare cost for the user would actually be going down? Your rates look closer to what I remember my mom telling me. IOW, it sounded much more affordable to me, who has to shop the individual market . . . Dad was on expensive drugs (Parkinson's, dementia, etc), Mom, not so much, so they did hit the DH when he was alive.

    Parent

    Those are 2011 numbers (none / 0) (#113)
    by jimakaPPJ on Fri May 20, 2011 at 08:54:37 AM EST
    and yes the doughnut is supposed to go away in 2014 (I think 2014, maybe sooner).  

    What they don't tell you is that the RX Insurance rates will just go up to cover the additional cost to the insurance corps and the $4500 cap will disappear so your actual drug costs will go up. Way up if you are on some drugs.

    Plan costs have been going up around 8% a year.

    I don't know what the answer is. But I do know that Obamacare, Ryancare and the rest of the existing plans cannot work long term.

    Parent

    A Kaiser (none / 0) (#111)
    by Ga6thDem on Fri May 20, 2011 at 06:17:55 AM EST
    plan here in GA with a 5K deductible would cost you about 1K per month. Obama said that it would cost retirees about 6K more a year. So if he's right, the voucher would probably be 6K per person.

    I guess you also could get a plan with something like a 25K deductible for 6K per year.

    Anyway you look at it, the Ryan plan would cost the retirees in this country a ton of money. Maybe Ryan thinks retirees take too many cruises???

    Parent

    Like I said, I'm no fan (none / 0) (#112)
    by jimakaPPJ on Fri May 20, 2011 at 08:45:15 AM EST
    of RyanCare or Obamacare.

    But I don't follow your logic on what a voucher would be.

    Parent

    You (none / 0) (#114)
    by Ga6thDem on Fri May 20, 2011 at 02:38:38 PM EST
    said you didn't know what a voucher would be for. I'm telling you the costs of a plan and how much the voucher would probably be for.

    Parent
    Neither you or me have the (none / 0) (#115)
    by jimakaPPJ on Sun May 22, 2011 at 01:06:22 PM EST
    slightest idea of what a voucher would be.

    Parent
    But we do have a CBO estimate (none / 0) (#116)
    by Raymond Bell on Mon May 23, 2011 at 08:00:53 AM EST

    And because Ryan eliminates the government's ability to lower administrative costs and use its buying power to lower prices, his plan is guaranteed to have the most expensive outcome. As Dean Baker often reminds us, the CBO estimated that the higher cost for Medicare-equivalent insurance would be more than $30 Trillion over coming decades under Ryan's plan. In other words, if Medicare's rising costs (from rising provider costs) are a serious threat to US debt and the main reason for deficit hysteria, then Ryan's plan is trillions of dollars worse for the rest of the economy.

    So, sure, all these plans include some form of "mandate," and in a true universal system, some form of mandate is needed to increase the risk pool, as Volsky says. But not all mandates are the same. Paul Ryan's mandate plan is by far the dumbest, most "careless," and most expensive way to include a mandate anyone has proposed. His mandate strips individuals of economic power and forces them to transfer tens of trillions in their wealth to insurers and health corporations.

    Paul Ryan Misrepresents the \"Mandate\" in his Medicare Voucher Plan Again

    Parent

    The question is (none / 0) (#3)
    by Buckeye on Thu May 19, 2011 at 01:17:46 PM EST
    whether Romneycare working at extending coverage while bringing costs down?  

    I am not sure, but from what I have read, costs are not being contained but coverage is up to 98% of the state and virually all children have health coverage in MA.  This does not mean Ryancare will work with seniors but it does show that regulated exchanges with subsidies and a mandate can provide coverage to those without employer provided healthcare.

    we also have medicare (none / 0) (#6)
    by CST on Thu May 19, 2011 at 01:22:05 PM EST
    and schip, and various other government run programs that help with that burden.

    putting seniors into the private insurance market and expecting subsidies to keep up with that is not tested.

    Parent

    Stipulated that Ryancare may not work (none / 0) (#8)
    by Buckeye on Thu May 19, 2011 at 01:26:27 PM EST
    with seniors.  In fact, I am almost certain it won't.  After Truman failed to deliver universal healthcare, private insurance companies tried for the next two decades to cover the elderly and could not.  By the end of the 50s, 75% of seniors still did not have coverage.  That is why we got Medicare.  However, when predicting the success/failure of Obamacare, we need to look at Romneycare.

    Parent
    RomneyCare (none / 0) (#15)
    by Big Tent Democrat on Thu May 19, 2011 at 01:48:59 PM EST
    So RyanCare is RomneyCare without the mandate?

    Parent
    I think comparing Ryancare to Romneycare (none / 0) (#18)
    by Buckeye on Thu May 19, 2011 at 01:55:04 PM EST
    is apples and oranges.  I am not sold on Romneycare...but one could criticise Ryancare while believing Romneycare is good and not be contradicting themselves IMO.

    Parent
    Not my point (none / 0) (#21)
    by Big Tent Democrat on Thu May 19, 2011 at 01:57:13 PM EST
    Defend the efficacy of exchanges as reform is my point.

    I think it is indefensible personally.

    Parent

    My point is that Ryancare does not equal (5.00 / 1) (#26)
    by Buckeye on Thu May 19, 2011 at 02:02:21 PM EST
    Obamacare...but Romneycare does = Obamacare.  We can judge whether the exchanges through Romneycare.  Since Romneycare's exchanges, subsidies, and mandates seem to be improving coverage considerably (at least from what I have read), then one could conclude (as Krugman did during the ACA debate) that the exchanges will be a success.

    Ryancare OTOH has no mandate, the subsidies are insufficient, and he is dealing with the elderly who have substantially different health care needs that Medicare handles very well (which Obamacare/Romneycare did not modify).

    Do I think there is a better system than exchanges?  Yes.  But seeing Romneycare in action, the exchanges do not seem to be a failure either.

    Parent

    Is the mandated coverage improving care? (none / 0) (#29)
    by nycstray on Thu May 19, 2011 at 02:04:55 PM EST
    and access to care?

    Parent
    Romneycare/ACA was not designed (none / 0) (#30)
    by Buckeye on Thu May 19, 2011 at 02:06:55 PM EST
    to improve care, just improve coverage.  From what I have read, it has.

    Parent
    Actually Ryancare has its own version of the manda (none / 0) (#27)
    by Dan the Man on Thu May 19, 2011 at 02:02:48 PM EST
    also.  Slate

    "Under both provisions, the result is the same: People who choose to carry health insurance have a lower tax bill than they would if they chose not to. In terms of their respective potential impact on individuals' bank accounts and tax liability, the manner in which they affect individuals' financial incentives, and hence the constraining effect on individuals' financial choices to either buy or forgo health insurance, the two "mandate" provisions are identical."

    "In addition to cloning the ACA's framework for coverage of adults under 65, the Ryan plan would also apply a similar approach to Americans currently covered by Medicare."

    "Of course, Americans would be required to continue to pay their annual Medicare tax throughout their working lives. Hence, the Republicans' proposal to replace Medicare with partially subsidized private insurance also operates to "compel" people to pay for private health insurance policies."

    Parent

    It's completely applicable to Obamacare (none / 0) (#5)
    by CST on Thu May 19, 2011 at 01:19:34 PM EST
    Obamacare did not provide medicare for all.

    The big problem for me is saying that the two programs are the same.  They are not the same.  One of them eliminates an existing program.

    I would love medicare for all, it's a great program.  But absent that I'd say medicare for seniors is the least we can do.  But we are operating under the assumption here that seniors typically have higher medical costs and need a greater amount of help with it than the average citizen.  Which is something I think we can all generally agree with.

    That doesn't mean everyone else should get left in the lurch, but I would say seniors are at a particular disadvantage when it comes to "negotiating" with these people precisely because of their higher cost.

    My post is about the efficacy of the exchanges (none / 0) (#14)
    by Big Tent Democrat on Thu May 19, 2011 at 01:48:17 PM EST
    Ryan's vouchers mean: here's some money, (none / 0) (#9)
    by steviez314 on Thu May 19, 2011 at 01:29:52 PM EST
    so call around and see what you can do with it.

    The exchanges already will have a range of plans to choose from.

    I think it will be easier for a 30 year old to make an informed choice from an exchange menu than a 70 year old with a voucher in one hand and a telephone to all the insurance companies in the other.

    Since Obamacare doesn't change Medicare, you're asking an apples and oranges question.

    So if the Ryan Plan adds exchanges? (none / 0) (#13)
    by Big Tent Democrat on Thu May 19, 2011 at 01:47:19 PM EST
    As long as it eliminates Medicare, it is not (none / 0) (#33)
    by steviez314 on Thu May 19, 2011 at 02:08:56 PM EST
    in any way comparable to Obamacare.

    Parent
    Hmmm (none / 0) (#34)
    by Big Tent Democrat on Thu May 19, 2011 at 02:14:14 PM EST
    that is good rhetoric, but not really true.

    If it creates an exchange, then it is like Obama Care with regard to an exchange.

    Parent

    Yes (none / 0) (#39)
    by Ga6thDem on Thu May 19, 2011 at 02:18:29 PM EST
    and the people that though Obamacare was so wonderful should think that Ryancare is too.

    Parent
    Obamacare creates an exchange for people who have (none / 0) (#42)
    by steviez314 on Thu May 19, 2011 at 02:25:09 PM EST
    nothing right now.  While a public option would have been better, an exchange is an upgrade from uninsured.

    Ryan has nothing to do with the uninsured.  It only downgrades people who would get Medicare in 10 years and wishes them good hunting.  

    Even if Ryan gave those people an exchange, it would still be a downgrade from Medicare, which they would still get in Obamacare.

    Thus, apples and oranges.

    Parent

    It would change the status quo (none / 0) (#48)
    by Big Tent Democrat on Thu May 19, 2011 at 02:29:41 PM EST
    and offer the same type of insurance coverage for both classes of people.

    But the reforms themselves are certainly comparable.

    Parent

    Obamacare (none / 0) (#49)
    by Ga6thDem on Thu May 19, 2011 at 02:30:26 PM EST
    basically creates nothing. The people who don't have insurance now are still not going to have insurance even after the exchanges are set up. Well, maybe they will have junk insurance but that kind of insurance is pretty much like not having insurance at all.

    And I've had 10K deductible insurance so I know of what I speak.

    You keep making the point that Ryancare is bad but that Obamacare is good. It's pretty much the same plan. If there were no Medicare would you think Ryancare was a good thing? I think you would.

    Parent

    If there were no such thing as medicare (none / 0) (#51)
    by CST on Thu May 19, 2011 at 02:32:26 PM EST
    than yes, providing vouchers for seniors for private health insurance would be a good thing, certainly better than not providing vouchers.

    Parent
    Begs the question (none / 0) (#53)
    by Big Tent Democrat on Thu May 19, 2011 at 02:35:31 PM EST
    If Medicare is good for Seniors, why isn't it good for everyone else?

    And how do "exchanges" leads towards Medicare for all.

    Better to scrap the exchanges and just understand that there is no reform down that road.

    Parent

    Well, now at least you're making an argument (none / 0) (#59)
    by steviez314 on Thu May 19, 2011 at 02:38:27 PM EST
    that the exchanges are not better than nothing for the uninsured.  That's a different argument than providing exchanges=privatizing Medicare.

    Parent
    They are not reform (none / 0) (#63)
    by Big Tent Democrat on Thu May 19, 2011 at 02:42:57 PM EST
    and pretending it is reform is impeding reform and effective health coverage.

    the exchanges are a problem we need to solve.

    Parent

    it is, they don't (none / 0) (#64)
    by CST on Thu May 19, 2011 at 02:43:39 PM EST
    I'm not Joe Lieberman.

    It's the subsidies and regulatory reform (yes I know your opinion on that - and strongly disagree) and the money for medicaid and health centers that make me support the package.  I do not personally find any of that insignificant.

    But as for whether exchanges will work or not, probably not - but I don't find them harmfull. While I do see eliminating medicare as harmfull.

    Scrap exchanges if you want but not on behalf of everything else.

    Parent

    Actually (none / 0) (#67)
    by Ga6thDem on Thu May 19, 2011 at 02:46:50 PM EST
    the exchanges are harmful because apparently an executive order is enough to allow what can be offered in them.

    Parent
    But (none / 0) (#55)
    by Ga6thDem on Thu May 19, 2011 at 02:36:26 PM EST
    not really effective though? Right? The seniors would probably be able to get some high deductible insurance for their vouchers but still not be able to afford medications or much of the care that they might need.

    Parent
    Ryan's plan eliminates Medicare and replaces (none / 0) (#54)
    by steviez314 on Thu May 19, 2011 at 02:35:57 PM EST
    it with vouchers.

    You ask "if there were no Medicare"...then there is no Ryan plan to replace Medicare with vouchers and I don't understand your question.

    Parent

    No (none / 0) (#58)
    by Ga6thDem on Thu May 19, 2011 at 02:37:40 PM EST
    if there were no Medicare it would be comparable to Obamacare. Right?

    Parent
    Why, did Obamacare eliminate Medicare? (none / 0) (#61)
    by steviez314 on Thu May 19, 2011 at 02:39:15 PM EST
    Can I not get Medicare in 11 years?

    Parent
    Imagine (none / 0) (#62)
    by Ga6thDem on Thu May 19, 2011 at 02:40:53 PM EST
    there is no Medicare. You are saying that Obamacare is superior because it adds coverage. Right? If there were no coverage for seniors i.e. no Medicare then Ryancare would be superior under your beliefs.

    Parent
    That has no meaning. If there is no Medicare then (none / 0) (#66)
    by steviez314 on Thu May 19, 2011 at 02:45:46 PM EST
    the government is not spending $20K per year on seniors (or whatever the amount is).  So why would Ryan be giving seniors $15K a year to buy insurance?

    If we lived in some alternate universe without Medicare and all seniors were just paying for insurance on their own, we wouldn't even be having a discussion about what Ryan wants to do to Medicare.

    There is no "Ryancare"--it's purely a cruel way to offload costs from government to individuals.

    Parent

    Ryan (none / 0) (#70)
    by Ga6thDem on Thu May 19, 2011 at 02:50:28 PM EST
    would basically be offering Obamacare to seniors. If there was no Medicare they would be under Obamacare which is essentially what the Ryan Plan is.

    Do you think Obamacare would be good for seniors?

    If we lived in some alternate universe without Medicare and all seniors were just paying for insurance on their own, we wouldn't even be having a discussion about what Ryan wants to do to Medicare.

    This is what all of us under 65 were doing before Obamacare (paying insurance on our own)so why do we even need Obamacare then?

    Parent

    I would think insuring the uninsured would count (none / 0) (#72)
    by steviez314 on Thu May 19, 2011 at 02:52:11 PM EST
    for something.

    Parent
    Is the goal to have insurance or is the (5.00 / 1) (#79)
    by Anne on Thu May 19, 2011 at 03:04:19 PM EST
    goal to increase access to and affordability of care?

    For many people who do have insurance, after they pay premiums and factor in deductibles, they still cannot afford actual care.

    The problem with the effort to "reform" the system is that it was built on making sure everyone had insurance, not that everyone could get care.

    Parent

    Yes (none / 0) (#74)
    by Ga6thDem on Thu May 19, 2011 at 02:54:56 PM EST
    but the crux of the matter is that people who are currently uninsured are probably not going to be insured. They are probably not going to be able to pay the premiums and will probably opt to pay the tax if anything at all.

    Parent
    that's not what happened (none / 0) (#76)
    by CST on Thu May 19, 2011 at 02:58:09 PM EST
    In MA.

    Parent
    Yes (none / 0) (#84)
    by Ga6thDem on Thu May 19, 2011 at 03:28:43 PM EST
    but the MA plan is superior to what we got. They at least have a public option. Right?

    Parent
    No public "option" (none / 0) (#91)
    by CST on Thu May 19, 2011 at 03:54:06 PM EST
    at least not for anyone who doesn't qualify for free care.

    If you are in the exchange (we call it "connector") there is no public option there.

    Parent

    But there IS Medicare. Why do I have to pretend (none / 0) (#75)
    by steviez314 on Thu May 19, 2011 at 02:57:53 PM EST
    there isn't just to denigrate Obamacare and create some kind of false equivalency with Ryan?  

     

    Parent

    I'm saying (none / 0) (#85)
    by Ga6thDem on Thu May 19, 2011 at 03:29:45 PM EST
    it because it just shows the inanity of calling the ACA the "most progressive piece of legislation" evah.

    Parent
    steve I'm 73 (none / 0) (#19)
    by jimakaPPJ on Thu May 19, 2011 at 01:55:33 PM EST
    And am perfectly capable of taking care of my affairs... Why, I even use the internet, have a cellphone, balance my checkbook, coach little league... even walk and chew bubble gum at the same time.

    I actually do spreadsheets and cost analysis.

    And I have a lifetime of experience in making "informed choices."

    Now, if you get the idea that I find your comment insulting then you have made an informed thought.

    Parent

    Right. The fact is that NOBODY (5.00 / 2) (#31)
    by observed on Thu May 19, 2011 at 02:07:27 PM EST
    is capable of making informed decisions about their own medical care, regardless of age, especially if they are under time pressure and sick.
    You may find that insulting, but it's the truth.


    Parent
    Thank you (5.00 / 1) (#46)
    by Big Tent Democrat on Thu May 19, 2011 at 02:28:40 PM EST
    The reason why the exchange "reform" is a cruel joke.

    Parent
    Those who think that they can make (none / 0) (#57)
    by KeysDan on Thu May 19, 2011 at 02:36:51 PM EST
    an informed decision on their own medical care are those who do not understand sicknesses, let alone treatment decisions.  And, health insurance, as with most insurance, you really don't know what you really have until you need it and use it.  

    Parent
    Let me remind you all (none / 0) (#78)
    by jimakaPPJ on Thu May 19, 2011 at 03:02:41 PM EST
    that my preference is for a single payer system modeled on Medicare paid for by a national sales tax.

    And me, or whoever, would not be making a decision when I/they were sick. It would be done annually, just as Medicare Part D is done now.

    Now, if you want to say that the decision might be too complex for "some people" based on lack of education and/or intelligence, but age by and of itself is not one of them and this is one Grandpa that knows age discrimination when he sees it and is not shy about pointing it out.

    Parent

    It's not just intelligence/education (none / 0) (#82)
    by nycstray on Thu May 19, 2011 at 03:26:17 PM EST
    there's also age related health issues that effect decision making. Most people that they want to dump Ryan care on are currently dealing with their aging parents and are vary aware of the problems that could crop up . . .  

    Parent
    Give Me a Break (none / 0) (#83)
    by ScottW714 on Thu May 19, 2011 at 03:26:38 PM EST
    If declaring that old people aren't as sharp as young people is age discrimination, then you got me.  But you may want to check that dictionary for the word discrimination, pretty sure I can't do it via the net.

    Parent
    Then yes, I've got you (2.00 / 1) (#96)
    by jimakaPPJ on Thu May 19, 2011 at 04:38:15 PM EST
    You condemn a whole group of people based on their age.

    treatment or consideration of, or making a distinction in favor of or against, a person or thing based on the group, class, or category to which that person or thing belongs rather than on individual merit:

    Now I realize you probably, like too many people who discriminate, don't think of it that way. Why you know someone who's 73 and they are in assisted living drooling on themselves so everyone must be like that, right???

    The problem is that person has probably suffered a stroke and has brain damage, just like brain damage suffered by the oh so smart 30ish who didn't wear a helmet while riding their bicycle and bounced their noggin off the concrete road bed.

    Parent

    I am not a fan of Ryan care. (none / 0) (#97)
    by jimakaPPJ on Thu May 19, 2011 at 04:40:19 PM EST
    I am also not a fan of Obamacare. Especially since it will suck $500 billion from Medicare.

    Parent
    Let's play make-believe. Pretend you're 63 with (none / 0) (#32)
    by steviez314 on Thu May 19, 2011 at 02:07:48 PM EST
    every pre-existing condition you might have, every ache and pain you might currently experience, every underlying condition you are taking medication for, and start calling around to get some medical insurance.

    Let's see what you can get.

    Parent

    That's Good to Here... (none / 0) (#68)
    by ScottW714 on Thu May 19, 2011 at 02:48:16 PM EST
    ... but that's not the norm by any means.

    My grandma, who died at 78, wasn't capable of operating her remote for about the last 10 years of her life.  She had a solid mind and took care of herself up until the end, but the learning curve went flat after about 60-65.  Previous knowledge was in there for good, but anything new, it just didn't stick.

    I don't know what the original posters comment meant exactly, but to have private insurers in there, is pretty much guaranteeing predatory behavior.  Your lucky, but many aren't, and none of us know who will be fortunate, and who is going to have child like processing skills.  I for one do not want for profit companies selling their goods to people who or who may not have the reasoning skills as fine tuned as yours (which I have argued in other posts aren't that fine tuned).

    IMO this is an area that the private sectors flaws will flourish and an area that history has proven the government is more than capable of administering.

    Parent

    As I noted (none / 0) (#80)
    by jimakaPPJ on Thu May 19, 2011 at 03:09:18 PM EST
    my choice is a single payer system modeled on Medicare paid for by a national sales tax.

    Parent
    Good (none / 0) (#36)
    by Ga6thDem on Thu May 19, 2011 at 02:15:05 PM EST
    grief. The exchanges are a joke. Apparently the majority of people on this blog have never been in the individual insurance market.

    What's the difference between having an exchange and a person shopping for insurance going to their local independent insurance agent? None that I can see other than your choices are going to be more limited due to the fact that Obama signed an executive order limiting coverage in the exchanges.

    I'm sure the elderly are quite capable of figuring out insurance for themselves and they do not need to be on the phone with a bunch of insurance companies. You can do it online, you can do it with an agent

    Parent

    Insurance on the exchanges will be (none / 0) (#41)
    by steviez314 on Thu May 19, 2011 at 02:20:42 PM EST
    guaranteed issue and community rated, and have group premiums.  These are not features of the individual insurance market.

    Parent
    And (none / 0) (#43)
    by Ga6thDem on Thu May 19, 2011 at 02:25:43 PM EST
    what I am paying right now in group rates is the same premium amount that I paid for an individual policy so apparently the insurance companies are finding a way around that one. As a matter of fact my deductible is 1K higher now than it was in the individual market.

    Parent
    Do the same for RyanCare (none / 0) (#45)
    by Big Tent Democrat on Thu May 19, 2011 at 02:28:12 PM EST
    Insurance premiums are based on zip code (none / 0) (#98)
    by jimakaPPJ on Thu May 19, 2011 at 04:41:06 PM EST
    and gender . . . (none / 0) (#101)
    by nycstray on Thu May 19, 2011 at 05:11:13 PM EST
    Indeed (none / 0) (#20)
    by andgarden on Thu May 19, 2011 at 01:56:43 PM EST
    Honest people will recognize this immediately.

    Assuming for the moment that (none / 0) (#38)
    by Anne on Thu May 19, 2011 at 02:18:23 PM EST
    the exchanges ever actually come into being, what are the chances that people who qualify for subsidies are not going to find that all they will be able to afford are high-deductible plans that still will not increase their access to actual care?

    And for those who keep wanting to make the distinction between a Ryan plan that eliminates/completely privatizes Medicare and an Obama plan that doesn't, let's not forget that plans are perking along for - and both sides support - "changes" to Medicare that include higher cost-sharing, among other things, and what will the result of that be?  Less affordability of care, and possibly reduced access.

    If the results are the same in the end, it just seems foolish to me to labor - and it really is a labor - to make a distinction between what Ryan proposes and what Democrats, including Obama, are working toward on the side.

    As they have all along, the benefits of any health system that is built and relies on an insurance industry model are always going to accrue to the industry, and those who invest in it.  This has been glaringly obvious right from the beginning; the exchanges are not designed to make it easier for people to get quality care, they are designed to make it easier to sign people up to start paying premiums or directing subsidies into the pockets of these companies.

    Exchanges are the EZPass that makes it easier for the companies to take our money and keep the pipeline flowing.  

    Krugman Isn't Being Logical (none / 0) (#60)
    by Dan the Man on Thu May 19, 2011 at 02:38:28 PM EST
    If, as Krugman believes, the Obamacare exchanges are awesome while the Ryancare exchanges are awful, one possible solution would be to put everyone - including all seniors - into the Obamacare exchanges.  This way everyone would have health insurance (with the help of the Obamacare exchanges) and Medicare would no longer being necessary.  For some reason, Krugman doesn't even consider such a plan.

    Or...we could also have begun to (none / 0) (#73)
    by Anne on Thu May 19, 2011 at 02:53:58 PM EST
    take the more obvious approach: transition everyone over to an existing single-payer structure - Medicare - instead of designing something "new," but that was not only not allowed "on the table," but couldn't even be discussed.

    The best ideas, the ones that could actually solve the crisis, were too threatening to the industry, so the man-who-ran--for-president-as-an-agent-of-change - just ran.

    It was a loss of opportunity that will not be coming this way anytime soon, much to the relief of the health insurance industry, I'm sure.


    Parent

    I have (none / 0) (#65)
    by Ga6thDem on Thu May 19, 2011 at 02:44:19 PM EST
    never in my life seen so many people turn logic on it's head when it comes to Obamacare/Ryancare. They are essentially the same plan.

    Seems to me, we've had this (none / 0) (#69)
    by nycstray on Thu May 19, 2011 at 02:49:39 PM EST
    "voucher" discussion before . . .

    Parent
    first (none / 0) (#71)
    by CST on Thu May 19, 2011 at 02:51:09 PM EST
    do no harm

    Parent
    Too late for that, I'm afraid. (5.00 / 1) (#77)
    by Anne on Thu May 19, 2011 at 02:59:35 PM EST
    Now, it's just a question of how bad it's going to get, not which party will be responsible, because I think they're both headed to the same place.

    Don't make the mistake of seeing ObamaCare as a finite structure that can't be undermined from the perimeter; that's already happening.  And it's not just Republicans that are behind it.

    Parent

    I think conservatives (none / 0) (#86)
    by lilburro on Thu May 19, 2011 at 03:31:32 PM EST
    think one of the greatest pleasures in life is to "deny business."  Whereas I sort of find it a pain in the @ss.

    My understanding is that the exchanges in the ACA are in place mostly for individuals on the individual market.  When you compare the exchanges to Medicare, Medicaid or insurance from your employer the individual market still seems sh*tty.  IMO the battle will be about the exact subsidy levels provided when the exchanges role out.  If the subsidies don't cut it I think the ACA is in trouble.  God knows the GOP will run against the system as a whole (expansion of Medicaid v. crappy subsidies for "the middle class") and their success will be dependent upon the subsidies actually working.  

    The argument against is flawed from the get go (none / 0) (#87)
    by vicndabx on Thu May 19, 2011 at 03:33:13 PM EST
    it assumes, under the plan that was passed, insurers won't provide fairly priced insurance for those in the target group. This statement used in support:

    vouchers whose value will fall well short of the cost of coverage

    is made absent any evidence that it is true.

    Beneficiaries also are reaping these savings.  In 2008, the average monthly premium for available standard coverage is $25.1 While this is an increase over 2007 levels, when the average premium was $22, it is still about 40 percent lower than was originally estimated for 2008.

    In fact, evidence shows seniors were quite happy with coverage obtained via drug coverage exchanges. Stands to reason younger, presumably more saavy people who do well also.


    Correction (none / 0) (#89)
    by vicndabx on Thu May 19, 2011 at 03:42:13 PM EST
    presumably more saavy people would do well also.

    Parent
    So you're pro Ryancare? (none / 0) (#90)
    by lilburro on Thu May 19, 2011 at 03:45:00 PM EST
    We don't really know what the subsidies will necessarily be for the ACA.  And the exchanges are going to be a lot bigger than Medicare Part D.

    Parent
    Not at all (none / 0) (#92)
    by vicndabx on Thu May 19, 2011 at 04:20:30 PM EST
    We need to take care of our elderly. No need to screw w/Medicare.

    I am however, against any argument that exchanges do not work.  There is no evidence to support it.  Further, it assumes insurers are all out to scam people - which is simply not true.  The same issues that plague private insurance (payments, coverage, etc.) affect Medicare/Medicaid also.

    The other thing is w/r/t the ACA and exchanges, they shouldn't be viewed as permanent.  Ideally, use of the exchange is a stop gap to ensure people aren't stuck w/a huge bill or forced to go the ER for basic needs (yearly check ups, sick kid, etc.)  What should happen is, like most gov't provided care for working aged adults, people would use it temporarily and move off the exchange to to an employer that offers group health coverage w/o need of the exchange.

    Parent

    Fewer (5.00 / 1) (#93)
    by Ga6thDem on Thu May 19, 2011 at 04:31:02 PM EST
    employers are offering coverage.

    Parent
    fewer employers . . . (5.00 / 2) (#94)
    by nycstray on Thu May 19, 2011 at 04:35:14 PM EST
    are offering jobs to older workers . . .

    Parent
    Two points (5.00 / 1) (#95)
    by Big Tent Democrat on Thu May 19, 2011 at 04:38:13 PM EST
    You write:

    (1)I am however, against any argument that exchanges do not work.  There is no evidence to support it.

    There is evidence that public insurance programs are the most efficient in terms of cost and care. There is a reason you do not want to change Medicare. Public insurance is superior to exchanges. There is AMPLE evidence of this.

    (2) Further, it assumes insurers are all out to scam people - which is simply not true.  The same issues that plague private insurance (payments, coverage, etc.) affect Medicare/Medicaid also.

    Scam is a word I would not use. But it is undeniable that insurance companies seek to avoid paying out money. It is the nature of the beast. This tendency is less pronounced in public insurance programs because governments serve the people, not shareholders.

    Exchanges will fail as reform. Especially when compared to public insurance.


    Parent

    At best, the exchanges (none / 0) (#99)
    by andgarden on Thu May 19, 2011 at 04:51:22 PM EST
    will provide a more expensive, lower quality version of what Medicare would have.

    Parent
    I'm curious, how do you define quality? (none / 0) (#100)
    by vicndabx on Thu May 19, 2011 at 05:07:05 PM EST
    People go to the same provider of care regardless of what insurance they accept.

    Parent
    Wow (none / 0) (#102)
    by andgarden on Thu May 19, 2011 at 05:18:57 PM EST
    Is that intended to be a factual statement? Because it isn't.

    Do you have any understanding of why "HMO" is a punchline?

    Parent

    Do you have any understanding (none / 0) (#107)
    by vicndabx on Thu May 19, 2011 at 09:19:29 PM EST
    of what some doctors have to go thru to get paid by Medicare?  The only reason beneficiaries don't have to deal w/these same issues is it's cheaper/easier to deal w/the provider of care.  If by quality you are referring to the experience of simply getting a claim paid, I assure you, you do not have a full understanding of what Medicare contractors do.

    Parent
    He;s referring (5.00 / 2) (#109)
    by Big Tent Democrat on Thu May 19, 2011 at 09:59:02 PM EST
    to the "in the HMO system" restrictions, not to "how providers get paid" issue.

    Medicare is a lower reimburser than private insurance, because it can be, a lot of folks are on Medicare.

    One of the reasons for being for Medicare for All as the best "reform" for the health care industry.

    Parent

    The second part of your comment (5.00 / 1) (#103)
    by Anne on Thu May 19, 2011 at 06:02:09 PM EST
    assumes that (1) they can get a job, and assuming they do that, (2) their employer even offers a plan.

    And even if they can enroll in an employer-sponsored plan, that doesn't solve the problem of affording care, nor does it guarantee that the providers one would like to use accept the insurance offered.

    My firm has a CIGNA plan; I do not participate.  Premiums for a family run almost $1,000/month.  And aside from routine health screenings - pretty much the answer to everything is "no."  And trying to get to "yes" means spending hours and hours on the phone, never talking to the same person twice because they are in call centers all over the country.

    Telling you about a co-worker's efforts to get Cigna to approve pretty much anything their adopted-from-China daughter has needed would fill a small book.  Oh, yes, she's "covered," but that doesn't mean they will pay.  And even when you do everything they tell you to do, even with pre-certifications, and treatment plans, they manage to find ways to say "no" after the fact - after the care has been delivered.

    It's unconscionable that this is how people are treated in exchange for giving the insurance company upwards of $12,000/yr of hard-earned money.  She's been told by some providers that they have so much trouble getting paid by Cigna that they no longer participate in any Cigna plans.  It's gotten to the point where she just pays for things because it's so hard to get Cigna to approve anything.  Which no doubt cheers Cigna immensely - that is the whole point of "no:" some people will take that for an answer and just go away.

    It's as I have said for a long time: insurance is less and less a path to care and more and more a barrier.

    Exchanges work?  Suuuuure they do.  Because there's nothing the insurance companies want more than to find ways to help people get the care they need.

    Parent

    MLR (none / 0) (#108)
    by vicndabx on Thu May 19, 2011 at 09:20:41 PM EST
    Medical Loss Ratio requirements under ACA addresses these concerns.

    Parent
    No, they don't (5.00 / 1) (#110)
    by andgarden on Thu May 19, 2011 at 10:10:02 PM EST
    Unless you believe that the ACA will ultimately regulate the profits of the insurance companies.

    Parent
    That doesn't make sense to me (5.00 / 1) (#104)
    by lilburro on Thu May 19, 2011 at 06:29:05 PM EST
    in part because there's always going to be people who can't get insurance from their employers, and in part because the exchanges are designed to eventually accommodate small businesses.  The exchanges are supposed to get bigger, not smaller.  So I hope they don't exist just to provide sh*tty temporary care.

    Parent