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... a funny thing has happened: Health spending has slowed sharply, and it’s already well below projections made just a few years ago. The falloff has been especially pronounced in Medicare, which is spending $1,000 less per beneficiary than the Congressional Budget Office projected just four years ago.
That is one key paragraph from this Paul Krugman column in Monday's New York Times.  As is often the case, his column is chock full of facts, most of which demonstrate how wrong the naysayers have been.

Continue with me as I explore a few parts of this important column.

Krugman says there are three key things to note.

First, the supposed fiscal crisis due to the explosion of Medicare costs

has been postponed, perhaps indefinitely. . . .We’ll probably have to raise more revenue eventually, but the long-term fiscal gap now looks much more manageable than the deficit scolds would have you believe.
Second, because Medicare is a government program, the savings are NOT due to a slowdown in the economy, but in fact are real.

And finally,

The third big implication of the Medicare cost miracle is that everything the usual suspects have been saying about fiscal responsibility is wrong.
Krugman parses the arguments made by those who have criticized Medicare as unsustainable, or argued for private insurance, for example, claiming that Medicare Part D's costs are less than projected because of the private sector involvement, whereas Krugman points at the real reasons:
Medicare Part D is costing less than expected partly because enrollment has been low and partly because an absence of new blockbuster drugs has led to an overall slowdown in pharmaceutical spending.
He also dispense with the suppose sticker shock, pointing out that increases in premiums for "Obamacare" are now project to be minimal in most costs, and in a few states (CT and AR) are actually projected to fall.

All this leads to his conclusion:  

What’s the moral here? For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all.

When it comes to ensuring that Americans have access to health care, the message of the data is simple: Yes, we can.

Beyond the Obama tag-line at the end, the data points at one key point he does not directly address -  how much could the savings have been had we truly pursued single-payer, whether in the form of Medicare for all or some other version thereof?

I now teach AP Economics.  One key lesson of economics is that it involves choices.  Another is that the models we use need to be adjusted to match the real-world data, a point that is very much in play for example in the recent work of Thomas Piketty on capitalism, where he examines and analyzes massive amounts of data.

Krugman has looked at the data on health care.

The sky is not falling.

Except upon the chicken littles of the Right who hoped to use the failure of "Obamacare" to take full control of the reins of government.

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Comment Preferences

  •  The Reason Medicare Could Pass At All Was It Cover (52+ / 0-)

    ed the old, statistically our sickest and most expensive.

    It seems to me that any way we'd have expanded it, as either full-stop Medicare for All, or in small increments like dropping the age to 55 or my own suggestion of Medicare For Microbusiness, we would have been adding cheaper participants than the initial population were.

    How could the program not become more sustainable by expanding it?

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Sun Aug 31, 2014 at 06:06:41 PM PDT

    •  Because... (18+ / 0-)

      President Obama is a Democrat, he's not part of the white establishment and... and...



      ...Benghazi!!!

      •  If Republicans stopped saying dumb stuff, (2+ / 0-)
        Recommended by:
        leonard145b, eyesoars

        people might mistake them for Democrats.

        Warren/Grayson 2016! Yes We Can!

        by BenFranklin99 on Mon Sep 01, 2014 at 12:27:32 AM PDT

        [ Parent ]

      •   your comment is not reality based (5+ / 0-)

        Both parties have blocked Medicare expansion and reform (eg drug reimportation had bipartisan support). at the state level both parties have acted to privatize Medicaid.

        I think its sad that so many here can't handle that fundamental dynamic in DC and at the state level.

        Medicare for all was blocked by both the President ("not in the American tradition") and Democrats in Congress even when the party held large majorities.  If the President had wanted it, he would have offered it given the popularity of Medicare.

        How is the lack of willingness to pass the legislation when we had the majority the fault of the GOP?  It just comes across has claiming the Democratic Party is  victim of circumstances even when its leadership has the power to vote its preferred outcome.  You may or may not see the party as a victim that's coerced, but the evidence doesn't back it up ( eg books written about how ACA happened by Democrats certainly don't indicate the leadership was full of a bunch of victims)

        The truth is that the only acceptable policies are conservative solutions that somehow involve the public supporting private companies. We see this again and again even when costs to citizens would reduced and choices increased.

        Ultimately what is done is done. However if you want better outcomes in the future, it is a bad idea to deny reality. When it comes time to push for Medicare for all , I think its better to start with assuming both parties will resist it bc it lets one know the real challenges. Not just challenges that fit one's partisan POV

        •  This comment is just (2+ / 0-)
          Recommended by:
          orlbucfan, Jasonhouse

          wrong.  It wasn't "blocked".  It was never on the table.  Obama did not support it in the primaries.  None of the major candidates in 2008 said they were for Medicare for all.

          Want Medicare for All? Start by supporting a presidential candidate in the primaries who supports it.

          Politicians - "You can't be a pimp and a prostitute too"

          by fladem on Mon Sep 01, 2014 at 06:17:11 AM PDT

          [ Parent ]

          •  How does your comment differ from what I said ? (2+ / 0-)
            Recommended by:
            Chi, TracieLynn

            In fact, I said almost exactly the same thing , which is that the Democratic leadership aren't victims, a lack of Medicare for all isn't reducible to partisan positioning and that if one wants to change things they must be real  about the lack of Democratic leadership support for Medicare for all.  The only thing you added was in agreement with what I wrote and the only thing I would add  is that the President broke promises on health care reform that he did make and twisted arms to make it seem like he had no choice so my view of him on health care reform is dimmer bc the default public money to prop up private industry was pushed by him even when it was not necessary (eg drug reimportation ) I would add to your comment  that its more than finding Democrats to mouth the words of support for Medicare for all. There were a plenty of Dems who supported the public option until its passage looked likely.  What has to happen, but won't, is the Democratic incumbent or candidate must believe the voters will primary them out of office. That's unlikely to happen but it would make Medicare for all more likely

          •  Link regarding presidents support of PO (2+ / 0-)
            Recommended by:
            Chi, TracieLynn
        •  This is exactly what you said back then (0+ / 0-)

          It's interesting that, despite Paul Krugman's positive take, that you remain steadfast in your conviction to the exact same things you were saying way back when this wasn't even law.  

          Streichholzschächtelchen

          by otto on Mon Sep 01, 2014 at 08:42:33 AM PDT

          [ Parent ]

          •  Straw man (0+ / 0-)

            I respond to a comment about what's blocking Medicare for all by saying that neither party supports it despite the attempt to blame just the GOP and that people need to be realistic about the lack of support if they want change the party's position

            You respond with a straw man asking me to comment on something not at issue about the support for Medicare for all

            Unless you believe the democratic leadership did and will support Medicare for all and Krugman is arguing this?

            •  I'm not having a formal debate (0+ / 0-)

              I'm just remarking on something.

              I pointed out that you are very consistent, and that you have maintained the same position the whole time.

              What's the point of arguing with that?  

              You got me on that one.

              Streichholzschächtelchen

              by otto on Mon Sep 01, 2014 at 09:54:05 AM PDT

              [ Parent ]

              •  Are you arguing Democratic leadership supports (0+ / 0-)

                Medicare for all?

                If they don't ,why would I change. my position to claim that they do support it when they don't ?

                •  I am commenting on your statements (0+ / 0-)

                  I am saying that you have said the exact same things from the beginning.

                  It's not very likely that you'll have many good interactions when you are as inflexible as that.

                  I would expect that you will maintain the same position you currently hold no matter what anyone says.

                  So, why would it matter what I answered?

                  Streichholzschächtelchen

                  by otto on Mon Sep 01, 2014 at 10:43:59 AM PDT

                  [ Parent ]

                  •  So to be clear, you want me to state (0+ / 0-)

                    that the Democratic leadership supports Medicare for all in response ti a comment about Medicare for all support although the Democratic leadership does not in fact support Medicare for all?

                    That would be your definition of flexible.

                    •  He's saying in a roundabout way that you're... (0+ / 0-)


                      ...an ideologue on this issue. (or maybe I'm mistaken)


                      As for me personally, I think you must be one hell of an expert on healthcare to know with certainty that 'medicare for all' is without a doubt the absolute best way to go, no other way could possibly be better.

                      And for the record, I also don't support Medicare for all.

                      I do support the idea of a singular program that all federal public healthcare would be administered by. I think that having Medicare, Medicaid, VA, etc is needlessly redundant.

                      But I also think that for the general population, there should be plenty of private options too, but they should strictly be non-profit organizations.

                      In short, I prefer something akin to what Germany and France have, but a little different to better suit our society's differences from theirs. (such as, I personally don't think we should directly tie our healthcare to employers at all. Their contribution should come through benefit improvements in terms of sick leave, disability and so on. But I could be convinced otherwise, as I'm no expert like you.)

    •  The idea of gradually dropping the age (1+ / 0-)
      Recommended by:
      otto

      for Medicare seemed very appealing to me - Gov. Richardson favored that approach.  60 one year, then 55, then 50...

      But after going through all the actuarial stories on the ACA, it now seems exactly wrong.  It brings in the most expensive cohort to care for, making the younger workers - who would get no current benefit - pay higher rates.

      Maybe there's some way that it could be made to work.  But it no longer seems like an easy no-brainer to me.

      •  That's true ,but (1+ / 0-)
        Recommended by:
        Chi

        The cost compared to the private would likely still be much cheaper.  It would also be a step in convincing seniors that adding younger people would not harm them.

      •  one basic argument - (3+ / 0-)
        Recommended by:
        Chi, indres, greengemini

        to encourage people to retire to open up employment opportunities that pay more for younger people

        I know people who are burnt out but hang on until they can get Medicare because otherwise they would lack medical insurance.

        and while for someone who works with the brain working into your 70s at a job you enjoy might not be stressful, think of those folks who either do very high stress work (air traffic controller for example) or whose jobs involve heavy physical labor.

        We allow military and FBI to retire at younger ages and get a pension.  In the case of the military they still if retired have access to health care.  We acknowledge that beyond a certain point they probably would have difficulty continuing to function -  I do not think you are going to see too many 55 year old Navy Seals for example.  Should not the same reasoning apply to coal miners, lumberjacks, etc?

        "My religion is kindness." - His Holiness the 14th Dalai Lama

        by teacherken on Mon Sep 01, 2014 at 07:51:06 AM PDT

        [ Parent ]

  •  drug companies (26+ / 0-)

    Drug companies are the Devil.  Recently there was an article showing that as a drug is about to lose patent protection, the price is upped tremendously.  On top of that, no Big Pharma strives for cures, they want treatments that need constant rx renewals.  The government should have a seat on the boards of all drug companies that desire approval by the FDA.  We need transparency when it comes to the health of our citizens.

    Actions speak louder than petitions.

    by melvynny on Sun Aug 31, 2014 at 06:15:40 PM PDT

    •  They also stop making it and "force" transfer (7+ / 0-)

      to their newer patented drugs so that by the time the patent runs out and a generic is available, the patient has now been on the newer, probably not any better but still under patent drug, and that makes it much tougher to transition back to the generic.

    •  your right - what have drug companies ever done? (1+ / 0-)
      Recommended by:
      Heart of the Rockies

      i mean, those drugs that are beneficial just coalesce out of nothing.  i am a nurse, i see drugs save life and limb and improve peoples lives everyday.  drug companies are not perfect, but they are not even remotely as evil as you suggest.

      •  Drug companies are rather beyond greedy (5+ / 0-)
        Recommended by:
        orlbucfan, eyo, psnyder, otto, greengemini

        and could be called evil. They have been dumping most all vaccine and antibiotic research  work because it's not too profitable choosing instead to push for medications for chronic illnesses that can be blockbusters.

        We desperately need new antibiotics yet the lab division working on antibiotics of a major Pharma was just shut down and disbanded. Not enough profit.

        The drug industry spends more on PR and advertising than the do on R & D.

        i mean, those drugs that are beneficial just coalesce out of nothing.
        Most of the new drugs come out of US government grant supported research in universities and small start ups — after basic research in the universities.

        Drugs are for sale for much lower prices elsewhere but here there is no control and the sky is the limit. Extravagant prices are set on how much can we get away with. We have no bargaining power when many people demand that the most absurd prices be paid for often minimal or no benefit.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Sep 01, 2014 at 05:20:43 AM PDT

        [ Parent ]

      •  Slippery slope (2+ / 0-)
        Recommended by:
        eyo, psnyder

        Its possible to believe companies should make reasonable profits from their patents without buying into your slippery slope fallacy that reasonableness equals letting them capture the government politically to use their monopoly power ( that's what the government grants them) to harm consumers.  It is not reasonable, as is now the case, for the patent system and artificial market barriers (prevention of drug importation that would be cheaper) to enforce price gauging of the American public, as compared to other countries where costs are much less.

        •  Are you responding to the right person? (0+ / 0-)

          Nathanfl didn't say anything suggesting he/she bought into any "slippery slope fallacy."  The comment was made that the drug companies have problems (yes, they do, plenty of them) but they also produce products that save lives or improve quality of life (who can deny that?).  Most of us know people who have benefited from the drugs produced by those evil companies.  And don't forget Congress's role in supporting the drug companies.

          •  Since no one is disputing that medication has (0+ / 0-)

            Some value   I'm responding to the notion that its value is an excuse to ignore reasonableness of the prices

            At best one can say its a straw man rather a slippery slope to argument about value in the face of the actual criticism since I don't believe anyone is arguing there is no value

    •  No, more correctly minions of Hell (0+ / 0-)

      Insurance companies?  SATAN.

      To be on the wrong side of Dick Cheney is to be on the right side of history.

      by mbayrob on Mon Sep 01, 2014 at 01:27:15 AM PDT

      [ Parent ]

    •  The Problem Is The Profit Motive. Drug Companies (5+ / 0-)

      try to maximize their profits by cornering markets and getting as close to monopoly power as they can.

      They have no incentive to invest in innovation or the research that will help the most people when they can make billions very cheaply by modifying a molecule here or there and re-naming wrinkle creams and diet pills.

      •  Example: Ebola (4+ / 0-)
        Recommended by:
        orlbucfan, eyo, majcmb1, Leap Year

        And frankly a plethora of "Tropical diseases." Big Pharma is "best" at producing "enabling potions" to allow (usually) people with some level of disposable income to  some nagging but usually not life threatening condition. The intent is not to "cure" these conditions, but to encourage in effect addiction of a sort.

        Ebola, like Cholera and the other "tropicals", simply doesn't have the characteristics that draw Big Pharma to crafting and distributing some "enabling potion", in part because the potential customers don't have deep enough pockets to be worth the "investment." All of this conveniently ignores that most Big Pharma "research" is cherry picking of breakthroughs discovered at overwhelmingly Public Research Universities and the extension of existing patents by manipulation of a (probably medically inert) molecule. There's no reason for tropical diseases to not be a standing, properly funded division of the WHO...other than greed.

        Change does not roll in on the wheels of inevitability, but comes through continuous struggle. --Martin Luther King Jr.

        by Egalitare on Mon Sep 01, 2014 at 04:59:25 AM PDT

        [ Parent ]

        •  actually perhaps a different problem (1+ / 0-)
          Recommended by:
          otto

          which is why the whole notion of "orphan drugs" - too few people will need the treatment to warrant the pharmaceutical companies making the investment and spending the time to develop and get approval of a product for which the return will be so low.

          The daughter of a neighbor had a rare disease, and he fought like hell to get a situation where in such cases drugs that had not been through the full approval process could be used as a life-saving measure.  Unfortunately it came too late for Abby.  But you can see the results of that struggle here

          I watched her grow up - her parents were divorced but she was with her father on weekends, half a block a way.

          She was brilliant - an Echols Scholar at UVa.

          And she died very young.

          "My religion is kindness." - His Holiness the 14th Dalai Lama

          by teacherken on Mon Sep 01, 2014 at 07:55:10 AM PDT

          [ Parent ]

          •  I recall reading that diary (0+ / 0-)

            But the orphan drug paradox is merely an explanation of why FOR PROFIT Pharma washes its hands of involvement.

            Fortunately, I suspect that "gut therapy" is going to eventually be the "answer" for pretty much every "tropical disease"...unless of course Big Pharma finds a legal path to patenting intestinal bacteria.

            Change does not roll in on the wheels of inevitability, but comes through continuous struggle. --Martin Luther King Jr.

            by Egalitare on Mon Sep 01, 2014 at 10:53:57 AM PDT

            [ Parent ]

    •  Yes, and people should still use medicine (0+ / 0-)

      I understand that the companies have serious conflicts of interest, but they do in fact produce medications which are life saving, or significantly beneficial.  

      It's a sharp moral edge to consider whether to use an RX or to eschew it for sociopolitical reasons, even if it offers you great benefit.  

      Streichholzschächtelchen

      by otto on Mon Sep 01, 2014 at 08:49:08 AM PDT

      [ Parent ]

  •  Once again I want to stress that (47+ / 0-)

    President Obama deserves much of the credit for this.  He put task forces to work looking for waste, fraud and mismanagement, then built measures into the ACA that addressed key issues.  This wasn't a lucky break or an incidental side-effect it was deliberate, thoughtful, and data-driven.

    Thanks, Obama!!

    I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

    by I love OCD on Sun Aug 31, 2014 at 06:21:36 PM PDT

    •  Sadly, he did a terrible job of selling it (12+ / 0-)

      He seems to assume that because smart people like him get it, everyone else will too. But the US is a country of mostly ignorant and simpleminded people who need things explained to them. Nothing is self-evident to them.

      "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

      by kovie on Sun Aug 31, 2014 at 07:48:08 PM PDT

      [ Parent ]

      •  He also had to sell it (16+ / 0-)

        against a well-funded misinformation campaign.

        •  And with a media determined to bring it down (7+ / 0-)

          Have you ever seen a positive national media story on the ACA?

          And you never will.

        •  And against the very loud (1+ / 0-)
          Recommended by:
          I love OCD

          "progressives" who insisted that without a small not very important program, the public option, the bill was NO DAMN Good.

          Kill the Bill echoed through the halls of DKos College campus.

          There is still a faction demanding a PO or constantly bemoaning its absence without realizing the real public option they have (though the Repubs are doing a good job of ruining it in some states).

          You do realize if the was Medicare for all no abortion coverage would exist and many of the best, but most expensive contraceptives would not be covered.

          I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

          by samddobermann on Mon Sep 01, 2014 at 05:29:31 AM PDT

          [ Parent ]

        •  He seemed to do ok against it (1+ / 0-)
          Recommended by:
          Heart of the Rockies

          when he ran for president. Try again, you're just giving excuses.

          "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

          by kovie on Mon Sep 01, 2014 at 05:53:10 AM PDT

          [ Parent ]

          •  Honestly, I can't understand (2+ / 0-)
            Recommended by:
            greengemini, joe from Lowell

            why you refuse to accept that "death panels" will get the media slavering and a 15 minute explanation of how '6 changes in compensation for hospitals and doctors, covering certain mismanagement issues, will begin to bring medical costs down over time' will be totally blown off.  We claim to understand how wretched our media is but keep missing the obvious: few liberal values/planks/proposals fit on bumper stickers.  You can't explain women's right to bodily autonamy in a tweet.  You can't explain why militarizing the police is bad in simplistic language.  You can't sell the ACA in sound bites.  Without a media that covers actual issues there's no point in crafting a message.  I see them trying on Facebook.  Unless you already get it, positive ACA stories take paragraphs, not characters.  

            I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

            by I love OCD on Mon Sep 01, 2014 at 08:07:57 AM PDT

            [ Parent ]

            •  What I refuse to accept (0+ / 0-)

              is the idea that Obama had no control over that situation and did the best that he could, which is total nonsense. He barely fought back, and that with one hand tied behind his back, afraid to appear to be too partisan or upset his corporate buddies. It is possible, you know, to acknowledge and even praise his accomplishments while honestly claiming that he could and should have done better. What I don't understand is when people are ok with leaving something on the table. Why must it be that we have to either hate or love him, unconditionally? Why can't we like parts and not like others?

              I will never be convinced that Obama handled the ACA well, from its design to its implementation to its selling, even if we're all better off for it nonetheless. It's a big improvement, but it should and COULD have been even better, I believe. I see these two views as completely reconcilable and consistent.

              "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

              by kovie on Mon Sep 01, 2014 at 09:04:46 AM PDT

              [ Parent ]

              •  He pushed it, against all advice from (0+ / 0-)

                all sides, when the entire Democratic Majority was asking him to drop it.  It wasn't about his corporate pals, it was about arm-twisting the guys who were supposed to be on his side for fuck's sake.  Good luck selling something every Senator and Representative was running from so fast the roads were smoking.  Maybe you have some magic power he lacks, maybe you could have single-handedly taken on the Republican lies and the Democratic cowardice and somehow gotten a hostile media to listen to Professor Obama explaining the ACA, and to write thoughtful articles about it.  

                Just a note, those insurance company executives he was supposedly pandering to paid an extra $72,000,000 in income taxes this year.  Plus they've got a fixed profit margin.  Plus they're getting slapped around every time they think they've found a new workaround.  

                It really is time for the realities of that battle to be shared.  I like you, Kovie.  I get really impatient when you trot out stuff that's common knowledge here and completely wrong.  It's a stressful thing to confront you.

                I'm not looking for a love that will lift me up and carry me away. A love that will stroll alongside and make a few amusing comments will suffice.

                by I love OCD on Mon Sep 01, 2014 at 06:03:50 PM PDT

                [ Parent ]

        •  True, but both Obama and Democrats (2+ / 0-)
          Recommended by:
          eyo, greengemini

          in Congress dropped the ball in the summer before the mid-terms when all the talk was of death panels, etc.  There should have been a far more aggressive pr campaign promoting it.

        •  ....during the worst economy since the Depression. (2+ / 0-)
          Recommended by:
          Ozy, I love OCD

          This Bully Pulpit! model of politics, where how well the President "selling" his policies is the main determinant of public opinion, is not taken seriously by anyone who actually researches politics and public opinion.

          Art is the handmaid of human good.

          by joe from Lowell on Mon Sep 01, 2014 at 11:44:59 AM PDT

          [ Parent ]

    •  Yes, yes, yes! (13+ / 0-)

      Obama did a great job here!  He's so smart and has such a great command of the issues.   Beyond Medicare, ACA is also working, negotiated rates with hospitals and other providers are down or at least increasing at much lower rates than before.

      Since January 2009:

      Stock market is way up....

      Housing market is up......

      Unemployment is down.....

      The budget deficit is down.....

      All with great resistance from Congress.  It's really a miracle how much has been done with such little help.  Amazing.

      •  It's not a matter of "negotiated rates" (4+ / 0-)
        Recommended by:
        elfling, eyo, I love OCD, otto

        having been reduced. It is reducing the number of procedures performed and the mandatory quality control measures that reduce the medical care needed.

        In fact the fees for doctors etc on Medicaid were RAISED to the same level as Medicare.

        Not paying for the repair of mistakes made by providers tends to reduce the number of mistakes by the providers.

        Next year they are going to pay for keeping people with more than two chronic conditions well.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Sep 01, 2014 at 05:36:32 AM PDT

        [ Parent ]

  •  The Republicans will look at the same facts (25+ / 0-)

    and continue telling the same lies anyway.

    "We the People of the United States...." -U.S. Constitution

    by elwior on Sun Aug 31, 2014 at 06:38:06 PM PDT

    •  and be given a microphone (15+ / 0-)

      By scores of so-called journalists, and believed by millions of people.

    •  "Entitlement reform" is a "bipartisan" cause (18+ / 0-)

      The president advocated it before taking office.  In 2013, his budget proposal cut SS and Medicare by more than Paul Ryan's budget proposal did:

      On Medicare: Ryan's budget kept Obamacare's Medicare cuts and added another $127 billion. His budget projects $6.74 trillion in Medicare spending between 2014 and 2023. Obama cuts even deeper with $380 billion in cuts below his baseline, and his budget projects $6.67 trillion in Medicare spending over the same period. Upshot: Obama's ten-year Medicare budget is $70 billion below the GOP, and his announced cuts are about $250 billion deeper than the GOP. (See below for brief explainer on differences.*)

      In fact, as Michael Linden at the Center for American Progress (who helped me with many of these numbers), pointed out, Obama's new proposal would mean about $1 trillion in lower Medicare spending in this decade compared to projections from before he took office. That includes the effects of slowing health-care inflation after the Great Recession. That's a 13 percent reduction!

      I wish that GOP was only party we had to worry about here.  I wish even more that at least a few Dems would drop the word "entitlements" and use the accurate term of "earned benefits."

      Some men see things as they are and ask why. I dream of things that never were and ask why not?

      by RFK Lives on Sun Aug 31, 2014 at 07:27:07 PM PDT

      [ Parent ]

      •  Uhm, we should stop taking about (2+ / 0-)
        Recommended by:
        eyo, joe from Lowell

        "cuts" to Medicare … and talk about reductions in costs.

        Nobody is cutting anything.

        And Medicare is not really an "earned benefit."  The payroll tax for Medicare is just for the Hospital Trust Fund, which is Part A. Part B, regular Medicare, is paid by premiums from seniors for 25% of costs and from the general tax funds for 75%. I don't recall the split for part D but that is really used by fewer people.

        I'm asking you to believe. Not in my ability to bring about real change in Washington ... *I'm asking you to believe in yours.* Barack Obama

        by samddobermann on Mon Sep 01, 2014 at 05:44:32 AM PDT

        [ Parent ]

      •  Didn't you read the post? (0+ / 0-)

        Medicare costs are falling, without the slightest reduction in benefits to anyone.

        Spending as much money as possible isn't actually the point of Medicare, you know.

        Art is the handmaid of human good.

        by joe from Lowell on Mon Sep 01, 2014 at 11:40:52 AM PDT

        [ Parent ]

  •  We'll be paying for the Erie Canal (11+ / 0-)

    for the next 30 years, at the cost of my FreeDUMB! Just keep those grain prices low and don't ask me where it comes from.

    "Reagan's dead, and he was a lousy president" -- Keith Olbermann 4/22/09

    by kovie on Sun Aug 31, 2014 at 07:46:05 PM PDT

  •  A big reason for lower costs (17+ / 0-)

    is shifts over the last few years in Medicare's payment policies.  It used to be that if a hospital provided bad care to a patient, the hospital was actually rewarded by being paid for loads of follow-up services to fix the damage caused by the hospital's original mistake.  

    Now Medicare is beginning not to pay people to fix the results of poor care.  Healthcare providers are recognizing the incentives and putting in more effort to treat patients effectively, not just to treat them a lot.  Still a ways to go though.

  •  Medicare for all! (13+ / 0-)

    i.e. Single Payer like in so many countries with lower costs, better results and truly universal healthcare.

    Daily Kos an oasis of truth. Truth that leads to action. UID: 9742

    by Shockwave on Sun Aug 31, 2014 at 08:19:16 PM PDT

  •  I believe the truly odious Movement Conservatives (9+ / 0-)

    at the top, the Koch Brothers, Steve Wynns and Sheldon Adelsons and the like, understand this.

    They know most of what they say about the social safety net is bullshit, and that they only have crisis-of-their-creation fiscal uncertainty windows to destroy Social Security and Medicare.

    So why isn't this a bigger part of our politics?

    We couldn't have Single Payer because it would have been a historic triumph and fundamentally transformational from what we would be leaving behind.

    What made it beyond the pale was it would have worked. America is broken where it is broken by design. As a feature and not a bug.

    There are huge tracts of policy real estate in our governance where mercenary bad faith in the service of somebody else's very massive bottom line is staring the pantheon of participants in these debates right in the face. The Democrats seem to expect to be rewarded simply by virtue of not being Republicans. They seem to expect the Democratic brand to be bolstered in a lasting and substantive way because the Republicans engineer crises they never have to answer for or take the blame for. I have never seen a paper tiger more willing to advertise that it is a paper tiger than the GOP. Because the GOP powers-that-be know that it is a bigger sin to point out they are serially wrong failures than for them to be serially wrong failures.

    This is another example of the Right being Wrong.

    If we could harness the power of conservatism being wrong, it would be like discovering how to build a fusion reactor.

    'Bad Cop' Betsy Mccaughey and 'Good Cop' Avik Roy during the HCR battle.

    We exist in a nation where they are both bad cops.

    Ultimately, Avik Roy and Betsy McCaughey serve the same masters and want the same outcome. But because Avik Roy says it politely, and smiles while he carries the same bucket of acid as McCaughey, he's serious.

    The most powerful conservatives operate under two schools of thought about dystopia fundamentally not being an issue for them but for others, God will save them, or their wealth will.

    My frustration as I read things like this is that we have reached a time in our history where we cannot do what will work because the idea that it will work makes it politically unfeasible.

    At a time when we need results. We need profound society-level changes in how we confront the future. As a species and as a nation, where the engineered disasters that can be directly traced back to the mindset of robber baron capitalists, and the modern Movement Conservative machine that serves as their minions, are rising to the level of being existential threats.

    The messes they are making are getting bigger in scale and scope, harder to fix in terms of money and time where you can do some triage, and will kill more and more people over time when the worst happens.

    Global Climate change will lead to devastating resources wars over food and water. The same people that did everything in their power to gum up HCR, that screwed up Kansas with mainlined RW thinktankery, who said cutting taxes raises revenue, that we would be greeted as liberators and that the war would pay for itself in Iraq, that sold massive aquifers to billionaires and corporations at the same time water is becoming more and more precious a commodity, will be telling us to use our massive military to steal food and water from other nations down the line.

    Even if the ACA keeps on keeping on, we should expand Medicare and push for adding the Public Option to the ACA.

    Sometimes the success of your opponents, in the face of being dead wrong and way off and completely discredited, tells you that something about yourself. About how you do things is fundamentally and fatally flawed in checking them or rolling back their excesses.

    "Heads I win, Tails you lose" is an indictment on the numbskull who stands there and keeps waiting for the game to be fair as it is the malignant wormskull flipping the two-headed quarter.

    There is no Bottom with Movement Conservatism, the GOP, or the Billionaires behind them. The Bottom is when things catastrophically come apart. When it breaks the country. The Environment. Civilization.

    "Real journalism is printing what someone else does not want printed. Everything else is public relations." -George Orwell

    by LeftHandedMan on Sun Aug 31, 2014 at 08:36:05 PM PDT

  •  The one problem for the left (0+ / 0-)

    is that if Obamacare works too well, then the argument for single payer will be no longer relevant.  Even if single payer is better in many ways, the argument for it won't have much currency with the public if Obamacare is seen as a success.  

    If you refuse to vote for the Democrat in a Presidential general election, then I hold you personally responsible for any right-wing Supreme Court decision.

    by USA629 on Sun Aug 31, 2014 at 08:38:36 PM PDT

  •  So health care that is decent and affordable is (4+ / 0-)
    Recommended by:
    elwior, BenFranklin99, eyo, jayden

    very good and the nay saying GOP, Tea-Kochers are wrong again as costs fall.

  •  Bush give-away (8+ / 0-)

    I just read on of the excellent comments on the Times on this article that the cost of the Bush give-away of drugs to Big Pharma is more expensive than the entire ACA.  This will never be reported even in the NYT's.  Why are we so stupid?  We layer the criminal insurance industry between Doctors perhaps because Doctors seem to also be profit-based Republicans.  Time to join the rest of the world and give people a break from vulture capitalism.

  •  Krugman, Nobel in economics (8+ / 0-)

    tells it like it is. Love to quote him to people who argue that "entitlements" must end, that the deficit is the country's biggest threat, and that spending must be slashed to deal with it.

    "You know Paul Krugman said in the NYT?" I ask. They say "who's he some librul".

    Maybe. But he's talkng about economics and he won a Nobel prize for that. Surely he must be good at what he does. Surely he must know more than the average politician, Republican or Dem, no?

    They always fall silent. Always.

    So glad he's on the side of reason. So glad he wants to engage the public in this arena. So glad he can speak the truth plainly as he does. A treasure that brings hope.

  •  will the deficit scolds finally STFU (2+ / 0-)
    Recommended by:
    eyo, indres

    I won't count on it but their arguments are easily debunked now.

    "The real wealth of a nation consists of the contributions of its people and nature." -- Riane Eisler

    by noofsh on Mon Sep 01, 2014 at 04:36:53 AM PDT

    •  Never (3+ / 0-)
      Recommended by:
      orlbucfan, eyo, indres

      There is too much at stake in insisting that "Government does not work" even if the face of Government actually working.

      Cognitive dissonance is a revenue generator and very effective at concentrating profit.

      Change does not roll in on the wheels of inevitability, but comes through continuous struggle. --Martin Luther King Jr.

      by Egalitare on Mon Sep 01, 2014 at 05:07:03 AM PDT

      [ Parent ]

    •  No, this is their strategy (2+ / 0-)
      Recommended by:
      indres, LillithMc

      If you had those idiots continuing to vote for you, and you are a republican, then every time you can, you spend, spend, spend, and cut taxes.  

      You look great as you debt spend your way with more government jobs than Democratic admins.  

      And then they'll run against the debt that they created.  

      They'll blame Dems for being the spending party, even though it's all R spending.  

      They'll chide a Dem admin the entire time, even as it is reducing the wasteful spending policies of the previous R admin.

      Streichholzschächtelchen

      by otto on Mon Sep 01, 2014 at 08:57:23 AM PDT

      [ Parent ]

  •  "An absence of new blockbuster drugs" (0+ / 0-)

    The industry is shifting toward so-called "nichebuster" drugs. These are biologics which will be very expensive but targeted towards specific conditions. Approval processes for biologics are still being worked out.

    If you are in the upper few percent of income, the medical future is very bright for you -- although, you will probably give most of your income to Big Pharma.

    American Presidents: 43 men, 0 women. Ready for Hillary

    by atana on Mon Sep 01, 2014 at 10:35:56 AM PDT

  •  I assume AP Economics is a high school course? (2+ / 0-)
    Recommended by:
    jayden, Another Grizzle

    If so, I am heartened.  I went to a well-regarded high school a couple decades ago but there was not a single Economics class offered.  I know I would have benefitted from it.  I hope you have good enrollments and good feedback from students and parents about it.  Best, Gunnar

    •  college level taught in high school (2+ / 0-)
      Recommended by:
      Ozy, Another Grizzle

      offering both macro and micro and sitting for two different AP exams.

      I have three sections of student totalling around 60

      I have already talked with or left messages for all of my parents

      students had assignments over the summer - clip and summarize 5 articles dealing with economic issues; read and answer a series of 15 questions related to Freakonomics

      I was fairly impressed with the results.

      These are bright kids.

      They will keep me on my toes.

      "My religion is kindness." - His Holiness the 14th Dalai Lama

      by teacherken on Mon Sep 01, 2014 at 02:05:47 PM PDT

      [ Parent ]

  •  "Truly pursuing" single-payer health care... (0+ / 0-)

    would have done nothing to restrain costs, the way the ACA has done.

    Now, actually passing single payer health care would have restrained health care inflation quite a bit.

    But, of course, those are two very different things.

    Single-payer health care is superior to the ACA in every way but one: the ACA could pass Congress in this generation.

    Art is the handmaid of human good.

    by joe from Lowell on Mon Sep 01, 2014 at 11:34:51 AM PDT

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