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About two thirds, or one trillion dollars over the next decade, is money out of the government treasury. The rest is from major sources of revenue and program cuts. From TNR:

Cuts to Medicare providers, much of it in the form of a “productivity adjustment” that will result in hospitals receiving lower reimbursements … $415 billion

Higher taxes on the wealthy, via a higher Medicare payroll tax on individuals with incomes above $200,000 and families with incomes above $250,000 … $318 billion

Fees on the health care industry, including fees on drug and device makers … $165 billion

Penalties, from individuals who could get affordable insurance but don’t, and from medium- and large- employers who don’t fulfill the requirement to offer coverage … $161 billion

Reduced payments to private health insurers offering coverage to seniors through the Medicare Advantage program … $156 billion

The “Cadillac tax,” which starting in 2016 will reduce the existing tax break for the most expensive health plans … $111 billion

And one obvious takeaway is that the majority of funding in the law is money paid by—or given up by—either the wealthy or parts of the health care industry. It’s higher taxes on families making more than $250,000 a year, or new fees for the device industry, or cuts for health insurers serving Medicare patients. The exceptions are two of the smaller categories of spending, the penalties and the Cadillac tax. Some of that burden will fall on middle class people. But only some.

The health care industry in general, and hospitals in particular, are re-engineering themselves so that they can do more with less—although experts disagree about how real or long-lasting the effect will be.

As for the cuts to Medicare Advantage insurers, those have been long overdue for their own sake. A series of private and public assessments, including studies by the Congressional Budget Office and General Accounting Office, suggested the government had been overpaying insurers by large margins. In other words, it had become a form of corporate welfare.

The article summarizes the redistribution neatly:
The simplest way to describe Obamacare is as a transfer from the lucky to the unlucky. And when it comes to health, you don't have to be poor to be unlucky.
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Comment Preferences

  •  Already I see a problem with the math: (1+ / 0-)
    Recommended by:
    Heavy Mettle
    Penalties, from individuals who could get affordable insurance but don’t, and from medium- and large- employers who don’t fulfill the requirement to offer coverage … $161 billion
    ...which would be nice...IF the employer mandate had been left in place.

    Plus, the penalty for individuals won't be collected until they file their year 2014 2015...and the "Cadillac Tax", as you pointed out, doesn't even kick in until 2016.

    Where is the money for those revenue streams going to come from in 2014 when insurance companies will expect subsidy payments? That's a 17% slice of the pie you presented.

    Adequate health care should be a LEGAL RIGHT in the U.S without begging or bankruptcy. Until it is, we should not dare call our society civilized.

    by Love Me Slender on Tue Dec 10, 2013 at 10:51:09 AM PST

    •  Good point, LMS. And, at one time, there was a (2+ / 0-)
      Recommended by:
      Love Me Slender, Heavy Mettle

      move to repeal the "device makers" tax.  Senators Franken and Warren were on-board with this tax repeal effort.  (Will have to follow-up to see where they went on that.)

      Also, have a slightly different take (than HM) on a category or two regarding who is paying for ObamaCare.  But will have to swing back by this evening to complete that thought.


      Otherwise, nice diary Heavy Mettle.  "Pie charts" are really effective--love 'em!



      "Only he who can see the invisible, can do the impossible."-- Frank L. Gaines


      by musiccitymollie on Tue Dec 10, 2013 at 11:35:51 AM PST

      [ Parent ]

  •  And unluck for us all. We are born into medical (1+ / 0-)
    Recommended by:
    Heavy Mettle

    unluck (participating in the previous 9 months of unluck in our host uterus), and die into unluck.

    This is one of the reasons I find it so amusing that certain people (primarily of the Republican persuasion) object to covering pregnant females...after all, each of us has a pregant female to thank at least once (except the goddess Athena, of course).

  •  All dollars are belong to us and are issued by (2+ / 0-)
    Recommended by:
    Heavy Mettle, Glen The Plumber

    the Treasury. The question is how many hands that dollar passes through on its way to the medical/health care providers. When it comes out of the Medicare fund, the route is quite direct. If subsidies go to the insurance companies, that's a layer of middlemen for services whose benefit is questionable.

    What fries our friends in Congress is that the dollars from the Trust Funds are mandated to be spent on particular goods and services or distributed (as pensions) to individuals directly. Which means that Congress critters have no say in to whom those dollars are sent and cannot claim the recipients' fealty in exchange--unlike when they approve grants to munitions makers and can expect their employees to appreciate that they are still at work.

    Congress critters are about incumbency, which they insure by targeting dollars to affect the vote. If they can't do that, they might as well get ready to go home. Since 2008 about 212 House members have been replaced. That's a phenomenal turn-over rate that nobody wants to talk about. Apparently, it hasn't made the rest more sensitive to voter intent. So, more will have to be replaced.

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Tue Dec 10, 2013 at 10:59:22 AM PST

  •  Also, given that the annual expenditures by (3+ / 0-)
    Recommended by:
    Heavy Mettle, whenwego, petesmom

    the medical industrial complex account for $2.7 trillion, one trillion over ten years is not signficant.
    What we need to remember is that each dollar can be and is spent over and over again, just like the vowels and consonants in this comment. No matter how often they are used, their worth is not increased, nor their value diminished.

    Obamacare at your fingertips: 1-800-318-2596; TTY: 1-855-889-4325

    by hannah on Tue Dec 10, 2013 at 11:25:55 AM PST

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