Whither Obamacare?

[Monoriu]

Kind of hoping the tax cut goes through.  So I can dedicate a piece of it to the next Democrat that runs in NJ-3.

Should be stock index fund or treasury bonds 

[viper37]

Kind of hoping the tax cut goes through.  So I can dedicate a piece of it to the next Democrat that runs in NJ-3.

Should be stock index fund or treasury bonds 

too conservative.  Rf is usually below inflation rate, so you lose money in real rate.  Political investment is risky, but the payoff can be huge, and on average, it will beat inflation.
So JR's investment strategy is sound.

[Eddie Teach]

Hell no that's Eagles country.

This response doesn't reassure me that you are a Manhattanite.

[The Minsky Moment]

Hell no that's Eagles country.

This response doesn't reassure me that you are a Manhattanite.

I'm a lawyer not a Russian oligarch.  I can't afford Manhattan.

[CountDeMoney]

Not even with your Global Cabal membership card?

[The Minsky Moment]

Not even with your Global Cabal membership card?

HQ moved to Brooklyn.

[garbon]

Not even with your Global Cabal membership card?

Recall that he's just saying he can maintain his opulent lifestyle in Manhattan.

[OttoVonBismarck]

Thing is, I actually think a plan kind of like the GOP one is probably the path forward. One of the reasons PPACA was so unpopular with people, at least the people I know who had exchange plans, and the rhetoric I've heard from the broad populace, is the high premiums. Premiums on the exchanges were just undeniably higher, particularly for young working people and even middle aged people with no pre-existing conditions. For people with pre-existing conditions, for many of them they could finally get insurance that didn't cost $15,000/yr in premiums for an individual plan. The subsidized and Medicaid expansion folks were generally pretty happy too. But a big problem is working age middle class people have a lot of political clout, and even probably some degree of political power. For a host of reasons some of the biggest beneficiaries of PPACA were those less likely to vote at all--like all the people covered by the Medicaid expansion (the lowest income brackets have generally always had the lowest political participation.) Those who were negatively impacted by being on a PPACA exchange were thus also the ones more likely to vote in the first place.

I think there's basically just a core problem when you say we want to create an market for people who don't have employer sponsored plans, and to make it work all the non-sick are going to subsidize the sick. The problem is you're basically taking a ton of money out of regular working people's pockets to pay for a sick person's health insurance. It's hard to really defend as positive the high premiums for exchange plans held by people who didn't get full subsidies (and even some of those on partial subsidies) when those people didn't have pre-existing conditions. This isn't a case of taxing the rich to help the poor, but rather taxing the healthy middle class to pay for the sickly middle class. The wealthy do get taxed to pay for PPACA but their increased taxes are what fund the subsidy payments for people under poverty-limit multiplier limits, the people on unsubsidized plans are basically just in a real shitty risk pool.

So I do think there's a validity to just saying people with chronic conditions who aren't lucky enough (or healthy enough) to have a good employer plan from some Fortune 500 that can just easily eat the cost, really don't belong on the exchanges. The government just needs to put them into high risk pools and be done with it. Where I differ substantially from Republican leadership is I think those risk pools should be funded so that premium payments are capped at some reasonable number, maybe 10% of take home pay or something like that, similar to how the subsidies work for those who qualify to cap their premium payment to a percentage of income. The current proposal for high risk pools is problematic because it's technically only proposing a temporary pool, with no guarantee they will be extended, and it's also only funded for $8bn over the duration of the pool's lifetime--I've seen some estimates that $8bn isn't even enough to properly fund these high risk pools for a single year. To me if we need to pay $15bn/yr to pay for these high risk pools (and again, I'm fine with people on them, many of whom are employed or otherwise they'd qualify for Medicaid sharing some of the costs) then so be it, in the grand scheme of our government $15bn/yr to get all these sick people off the exchanges, which is a social good in covering their health expenses, and also lowers premiums of exchange plans drastically, that's a reasonable annual bill. We upped the DoD budget by $12.5bn with the most recent budget CR and hardly anyone batted an eye. I worked at DoD for years, the vast majority of that $12.5bn will be entirely wasted, DoD is by far the least efficient and most corrupt government entity I've worked at.

[CountDeMoney]

Go fuck yourself, Otto.  Stop reading the wife's trade magazines on the shitter.

[OttoVonBismarck]

It's weird but my wife and most of her colleagues that I know personally are bleeding hearts when it comes to the medical system. I've basically told them--specialist pay, surgeon pay particularly are like 200% of what's seen in many OECD countries. A true socialized system some of these people are going to have to trade down from Bentley's to BMWs and drop down to a country club with a $50,000 initiation fee instead of $100,000.

[Zanza]

It's weird but my wife and most of her colleagues that I know personally are bleeding hearts when it comes to the medical system. I've basically told them--specialist pay, surgeon pay particularly are like 200% of what's seen in many OECD countries. A true socialized system some of these people are going to have to trade down from Bentley's to BMWs and drop down to a country club with a $50,000 initiation fee instead of $100,000.

I always wondered about the cost side of the American health care debate. A lot of the providers, be it doctors or pharma  companies (and probably insurance and hospitals too?) seem to earn very well. If America wants a market to regulate this, is there enough competition on the supply side?

Poor cost control seems one of the deficiencies of most health care systems.

[11B4V]

Go fuck yourself, Otto.  Stop reading the wife's trade magazines on the shitter.

Where the ACA was Budweiser beer, The AHCA is Pabst in quality.

[derspiess]

Yeah, both suck.

[Eddie Teach]

Yeah, both suck.

Perhaps we should import a system from Europe.

[Valmy]

Indeed. What would private industry do? Find the most cost efficient and effective system and implement it. The Republicans always talk about running government like a business so I am sure they would be excited to do this Eddie.