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View Diary: Maneuvering in the middle on fiscal cliff is still veering too far right (189 comments)

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  •  Not only that (29+ / 0-)

    but it has to be the most fucking stupid idea out there for saving money.  It doesn't.  

    All you're doing is removing the healthiest people off Medicare which means the costs of Medicare will skyrocket.  A majority of those people 65-67 won't be able to afford private insurance because frankly NO insurance company in it's right mind will want to ensure a 65-67 year old unless it's at a ridiculously high premium with some equally ridiculously high deductible.  That means, those 65-67 year olds will very likely end up in Medicaid which of course will drive up the costs of Medicaid as well.



    This is your world These are your people You can live for yourself today Or help build tomorrow for everyone -8.75, -8.00

    by DisNoir36 on Mon Dec 10, 2012 at 03:45:51 PM PST

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    •  it's not stupid if your goal (17+ / 0-)

      is to destroy Medicare and open it up to total privatization. In fact, it's exactly what you would do, as the opening salvo.

      The Ryan plan is not intended to begin the battle. You reserve that all-out assault for when you've already opened up a breach.

      If this deal goes through, I give Medicare ten years, tops before it's privatized into nothing.

      Cuts to the social safety net will cause a recession because those programs have a huge economic impact. That recession will be used as an excuse for more austerity, to cut further.

      Then we will see the reemergence of the Ryan plan, except this time it'll be passed into law.

      "In America, the law is king." --Thomas Paine

      by limpidglass on Mon Dec 10, 2012 at 03:54:11 PM PST

      [ Parent ]

    •  Are they going to (4+ / 0-)
      Recommended by:
      janinsanfran, barbwires, jm214, whaddaya

      have an age donut hole in health care coverage from say 65 to 67?

      People at that age would simply would live in Hungary or Poland between 65 and 67 where health coverage would be a fraction of the price and where full USA-level Social Security payouts are required by treaty.

    •  Medicare is financially 100% funded until (10+ / 0-)

      about 2019 and Social Security is 100% funded to about 2037.

      The current financial problems lie outside of Social Security and Medicare.

    •  Cost of Medicare will not skyrocket, but the (1+ / 0-)
      Recommended by:

      per-capita cost will go up.

      The real problem is ACA. Those people who get kicked off of Medicare would be eligible to buy insurance through exchanges and, for most of them, receive huge tax credits (not deductions) to mitigate their costs.

      So -- this is a saving that might actually cost money.

      BTW -- it would be ok if they went on Medicaid instead, as the CBO estimates that Medicaid costs will be substantially less than exchange costs.

      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

      by dinotrac on Tue Dec 11, 2012 at 07:52:47 AM PST

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      •  Yeah, except the (4+ / 0-)

        Reublican governors are refusing Medicaid money, and refusing to set up exchanges.  So Seniors will have nowhere to go for help from states either.  Does no one remember the very reason WHY we set up Medicare in the first place?!  Retirees losing their employer paid health insurance, and unable to get affordable health insurance on the private market, because they were OLD and expensive.  Can't make a profit off old folks who are guaranteed to get older and sicker.

        •  Governors cannot keep exchanges from being (1+ / 0-)
          Recommended by:

          set up.  If the states don't run them, the feds will.

          The exchanges will be an option for those kicked off Medicare, but there is a first year problem as the subsidies come in the form of tax credits.

          There could be some cost savings, depending on the number of seniors who purchase coverage from the exchanges.

          Part of the CBO calculation of ACA savings is an estimate that 3,000,000 Medicaid recipients kicked off of Medicaid will opt to go without insurance instead of purchasing insurance through the exchanges.  The CBO estimates that exchange insurance will cost the federal government $9,000 a head by 2020, as opposed to $6,000 for Medicaid, meaning no money is saved if too many of those abandoned recipients sign up for low-cost insurance on the exchanges.

          I imagine that a similar dynamic would apply to Medicare -- enough people go without insurance, money is saved. Otherwise, more money is spent.

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Tue Dec 11, 2012 at 08:26:11 AM PST

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          •  Bigger problem w/Federal exchange (0+ / 0-)
            but there is a first year problem as the subsidies come in the form of tax credits.
            As was pointed out to me, the PPACA includes a feature to "Provide refundable and advanceable premium credits". I've don't know what form that these will take or how much paperwork this will require but this may not be a big problem.

            A bigger problem with the Federal exchanges is that the PPACA does not actually provide subsidies for those utilizing the Federal exchange, only for those utilizing state exchanges.

            The IRS regulations don't make this distinction (their regulations provide subsidies for clients of the Federal exchange as well) so the IRS is not implementing the letter of the PPACA. This will end up in court unless it is rendered moot by intervening legislation. I think it's likely that the courts will hold that the IRS must implement what the PPACA stated, not what they have specified in the regulations they drafted. However, the legislative history of the PPACA may reveal something that I'm unaware of. Earlier drafts of the PPACA did provide subsidies for clients of both types of exchanges so the omission seems to be intentional rather than just an oversight (IIRC, text was explicitly removed in later versions to limit subsidies to just clients of the state exchanges).

            An employer is only subject to a penalty for not offering health coverage if one of their employees receives a subsidy as a result. Therefore, the party with the best standing to challenge the discrepancy between the IRS regulations and the PPACA is an employer who is assessed a penalty for not offering insurance and whose employee(s) received a subsidy on the Federal exchange.

            Since employers won't be penalized until well after the subsidies have already been paid, if the government successfully fights this based on standing, that would delay the courts' involvement for a while. Hopefully that won't result in the subsidies being "clawed back" if the courts rule against the IRS position.

            Perhaps the IRS can skirt this issue by just not implementing fines on employers whose employees are all in states w/o state exchanges in order to deny these employers standing.

            •  You're making my head hurt. (0+ / 0-)

              Just when I thought I was starting to understand this mess.

              It's worse than I thought.

              Back to reading...reading..reading.

              Thanks, though, for the clarification.

              I think.

              LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

              by dinotrac on Tue Dec 11, 2012 at 10:41:35 AM PST

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      •  Yeah, because Medicaid is a death sentence for man (6+ / 0-)

        y. Good luck finding, e.g., a urologist or cardiologist that will even see Medicaid patients.

        And for all the Punditpeople who are so happy about shoving the old and weak worker or fellow American of any sort or personal history into Medicaid "nursing homes," I hope and pray that each and every one of them encounters a life change that puts THEM "on Medicaid," so they can enjoy the kindly attentions that for-profit-drive Sad Sack nurses and aides and CNAs in those hellholes will "afford" them. And of course the "drive-by doctors that specialize in Medicaid "patient care." I'm a nurse, and would be happy to hear other nurses' horror stories of what goes on in the way of "care" in UNsurance-land and state-experiment Medicare.

        And why are so many so happy to be excusing Obama and his hit men in advance for "getting the best deal that was available?" It sure looks like a sellout and a good start on the demolition of the New Deal, which is what the shitheads on the Rich Right have been wanting since they failed to kick FDR out with a coup back in 1933.

        He just signed off on $651 billion for "defense," that enormous fraud, and another half a trillion is out there on off-books fun money for the war-gamers to play with. Focus, please?

        "Is that all there is?" Peggy Lee.

        by jm214 on Tue Dec 11, 2012 at 08:33:49 AM PST

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        •  Couldn't have said it better myself, and I'm real (1+ / 0-)
          Recommended by:

          sure we come from very different angles politically.

          We've been so busy congratulating the administration for getting ACA pass, we've ignored that the real problem is that American health care is rotten (and expensive) to the core.

          That problem wasn't addressed, which is too bad, because there really is no need for Medicare and Medicaid as special programs if health care is made rational.  

          LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

          by dinotrac on Tue Dec 11, 2012 at 09:01:37 AM PST

          [ Parent ]

          •  Gee, and what do you mean by "rational?" Privat- (2+ / 0-)
            Recommended by:
            tsk, whaddaya

            ize everything?

            Maybe I should run my tape about how much of my time I spend, every day, trying to get the people I try to provide actual CARE for past the default "deny coverage" phalanx of gate-keepers in the Private Unsurance business? Formulary games, "stepped therapy," a whole range of "prior authorization" tricks and scams? How about the "donut hole?"

            There's no getting any kind of "rational" actual health care, as opposed to just another money-grubbing, regulatory-capturing, fuck-over-the-weak-and-poor business model, if you "trust the dead hand of the market" to "fix things." It's the core sickness of our culture, especially the "business" culture.

            And yes, Medicare is a leaking tanker, with lots of "business" types unlimbering their power drills to make more holes to siphon the General Welfare out of. But as a caregiver and a participant, I KNOW IT WORKS. And you can never kill off all the corruption in our species, but there are lots of relatively straightforward fixes for the bad incentives and loopholes and scam-perations that are currently part of it. Medicare IS NOT THE PROBLEM. Stealing the last bit of security and comfort and mutual care from most people's lives, to fatten the lives of a very tiny few even further than they already are, is not any kind of an answer. It's a "I got mine and most or nearly all of yours too, so FUUUUCCKKKK-YOU!" to the rest of us.

            "Is that all there is?" Peggy Lee.

            by jm214 on Tue Dec 11, 2012 at 09:24:23 AM PST

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            •  By rational I mean a number of things: (1+ / 0-)
              Recommended by:

              1. Moved away from employer-based benefits

              2. Move to a more collaborative model similar to what you might see at the Mayo clinic or in the military care system.
              The current insurance-driven "handoff to a specialist" system is terrible medicine and terrible for cost control.

              3.  Probably a deep dive into something resembling socialized medicine or, at the very least, away from pay per procedure model.

              4. As to private/public, I am a great believer in free markets, so wherever that can work, I am happy. We have nothing like that in health care, and I'm not optimistic that we could -- certainly not with so much being driven by insurance companies.  Even little things get in the way of that, however.  How many of us are prepared to make good market decisions when told we have cancer?  Even Steve Jobs, a very smart man with all the money in the world, screwed up on that one.

              LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

              by dinotrac on Tue Dec 11, 2012 at 09:43:42 AM PST

              [ Parent ]

              •  I'm not sure that's a great example ;) (0+ / 0-)
                Even Steve Jobs, a very smart man with all the money in the world, screwed up on that one.
                The stupid decisions that Jobs made had nothing to do with cost, availability of care (except, perhaps, to use his vast resources to venue shop to increase availability of a last ditch liver transplant), or "markets" so his situation doesn't seem like a very good example.

                His personal, and probably fatal, decisions seem to have been driven by a lack of acceptance of standard medical and scientific methods (this failing was consistent with some of his behaviors well before he was diagnosed with cancer as far as anyone knows).

                I doubt he was reimbursed a penny for his "alternative" care/strategies or that we would implement a system in the US within our lifetimes that would force a mentally competent adult to receive conventional medical care if they refused it.

                •  Point taken, but not so bad if you think about it. (0+ / 0-)

                  Market theory presumes rational decision making, but we don't always react well to being told our life is in danger.

                  Jobs had the financial resources to do whatever he wanted to, but was unable to make a rational health care decision -- something he admitted near the end of his life.

                  How much worse it must be for somebody who's got to rob Peter to pay Paul, or just rob Peter and hope for the best.

                  LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                  by dinotrac on Tue Dec 11, 2012 at 10:45:21 AM PST

                  [ Parent ]

                  •  Cute Peter-Paulism there. "Market theory" is (0+ / 0-)

                    a lot of bullshit, from my perspective as a nurse and as a 66-year-old Vienam vet and father and grandfather who was an attorney for 28 years and has worked in and with a wide variety of businesses and for 14 years in state and federal government.

                    It's the narrowest kind of strait-jacketing of the nature of human interactions, removing all the normative and emotional richness of how we really "deal" with each other. But it's a waste of time to argue the point: You have your beliefs, which I think I can fairly infer from your comments, and I have mine. And the Rich Shits who are riding us working folks into the ground are much enamored of "Market Theory" (with the portentous apotheothetic Initial Caps) to justify their own soulless way of life.

                    I just got off the phone with a person with a slowly terminal disease, who has worked a long hard prudent life and now has to beg, for all kinds of stuff, while trying to dodge a "Market Theory" Juggernaut called the "donut hole." Cat food, or life-prolonging medicines: That's her "Market Theory" choice.

                    Your "Market Theory" ignores, or actually lauds and justifies,  the beatitudinal and horrific realities at the far ends of the power-and-wealth scale, including the continued stripping of the little bits of wealth and security of those in the middle of the scale for the .

                    I get VA health care and now qualify for Medicare, and have worked with all kinds of "health insurance" providers to try to obtain "care" for the patients I work with. Your set has nothing but sectarian contempt for "socialized medicine." I have nothing but contempt, and increasingly active hatred, for "libertarians," and Koch-suckers, and that whole bunch who are saddling us with the current load of long- slow- dying. Upward wealth transfer, a grand Henry Potter theft of all that's good, masquerading behind a film of pure fraud.

                    "Is that all there is?" Peggy Lee.

                    by jm214 on Tue Dec 11, 2012 at 12:28:20 PM PST

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                    •  "My set?" (0+ / 0-)

                      Goodness, you haven't been reading my posts very well at all, then, have you?

                      I have said, quite explicitly, that I prefer a kind of health care approach like the one I group up with, which was military medicine, a form of socialized medicine.

                      LG: You know what? You got spunk. MR: Well, Yes... LG: I hate spunk!

                      by dinotrac on Tue Dec 11, 2012 at 02:28:53 PM PST

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    •  Why doesn't anyone here (0+ / 0-)

      believe these people could use Obamacare?

      Is there some kind of exclusion for people over 65?

      Just trying to understand why the conversation here always seems to ignore Obamacare as the alternative if the age was raised.

      Don't get me wrong, I'm opposed to raising the medicare age - I think it should be lowered to 50, honestly - but I'm confused as to why this doesn't come up.

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