Map of life expectancy at birth from Global Education Project.

Friday, January 27, 2017

There's more to the ACA than health insurance

It's amusing to watch the Republicans continue to flail as they try to figure out how to screw millions of people out of health care without getting blamed for it. But they can do a lot to make health care in the U.S. worse without it being so obvious.

For example, the ACA includes funding for the Center for Medicare and Medicaid innovation, which supports demonstration projects to find way of delivering better care at lower cost. If you read this blog, you know that we pay a lot more for health care than other wealthy countries -- yeah, the ones who cover everybody because of socialism -- and we get worse results. Because freedom. CMMI is trying to bend the cost curve down while getting better results. But of course you have to spend money to do that, so socialism.

The ACA also established a fund for public health programs to prevent chronic diseases. Oh yeah -- it goes to the states. But that costs money too, so socialism.

Then there is the Patient Centered Outcomes Research Institute (which, full disclosure, has funded some of my research). PCORI compares treatments to learn which are better. Of course, that also costs money, which comes form a tax on insurance premiums, so socialism.

If they repeal all this, it will just make us less healthy in the first place, we'll pay more for health care, and we'll get worse results. But that's better than socialism. Oh wait, I mean it's better than making rich people pay taxes.


JenBob said...

Serious question:

Do you believe the ACA status quo is sustainable?

Anonymous said...

Modest proposal:

The folks who make these laws should have some skin in the game.

To show they aren't hypocrites they, and their staffs, should join the uninsured who will be affected by changes to the ACA and terminate their own health insurance policies.

Given the high percentage who are wealthy this should be far less of a burden on them than than those mothers working two jobs to support children whose fathers welshed out on their responsibility to support their children. (I prefer this phrase to the less descriptive "single mothers".)

PS: I toyed with "skedaddle dads" but that sounded too dated.

Anonymous said...


I forgot to put "government provided" in front of "health insurance policies".

Cervantes said...

The ACA needs some tweaks to be sustainable, yes. But it doesn't need to be repealed.

JenBob said...

The folks who make these laws should have some skin in the game.

Couldn't agree with you more!

Our professional political class should always be subject to the same laws as the rest of us.

That didn't happen when ACA was written. It specifically exempted not only the politicians, but their staff as well.

Cervantes said...

Well, that's kind of true and kind of not. They get employer provided insurance, as most people still do. There was talk of having them go on the exchanges, which might have been a fair idea, but they aren't "exempted," any more than employees of General Electric. And everybody is affected by the minimum requirements -- preventive care, no lifetime caps, etc., and benefits from other provisions of the act.

JenBob said...

Yeah...they get gold plans with a special 75% subsidy or they can opt out entirely.

I think you're arguing form over substance.

Bottom line is they carved out a special sweetheart deal for themselves and left the rest of us holding the bag.

Congressional leaders from both parties quietly and gratefully accepted the special deal from the administration’s Office of Personnel Management. It gives legislators and staff “Gold Level” ObamaCare coverage with a 75 percent subsidy paid by taxpayers or even the option of opting out and retaining their previous heavily subsidized plan. The income of members and staff is simply not counted.

This is in direct violation of the specific language of the law Congress enacted. The White House broke its own law to provide Congress ObamaCare gold and then fraudulently administered it through the District of Columbia’s Small Business Healthcare Exchange. In order to get their waiver, representatives of the House and Senate signed documents, under penalty of perjury, that each body employed no more than 50 people. To date more than 13,000 members and staff have signed up with the help of another gift--a dedicated team assigned only to Congress.

Cervantes said...

Well look, if you're lucky enough to have a management job at a big corporation, you'll get free health insurance. A single payer system would be more equitable, but members of congress and their staffs had government-funded health care before the ACA.

JenBob said...

...but members of congress and their staffs had government-funded health care before the ACA.

All you are saying is the pigs were at the trough before ACA so it's OK for them to (again)carve out *another* sweetheart deal for themselves.

Anonymous said...

Lawmakers are NOT corporate management, they are NOT civil servants. They represent the other 300 million of us and are tasked with creating / maintaining a set of 'rules' that hopefully optimize the lives, liberties, and pursuits of happiness for all of us.
It seems self-evident that those rules should apply especially to themselves. The only exceptions could be when one excessively interferes with their ability to perform their unique job as lawmakers. In the case of health care they as a group are far better positioned to provide for themselves than are a huge segment of those they represent. It is only fair then that they share in the consequences of their own decisions.
In this case I'd also say that the same should apply equally to their staffs. Then they just might be privileged to witness the consequences of their decisions first hand.

I for one, would be a guaranteed viewer of a reality TV show called "Undercover Congressman". ;^)