Digby's Hullabaloo
2801 Ocean Park Blvd.
Box 157
Santa Monica, Ca 90405

Facebook: Digby Parton

@BloggersRUs (Tom Sullivan)

thedigbyblog at gmail
satniteflix at gmail
publius.gaius at gmail
tpostsully at gmail
Spockosbrain at gmail
Richardein at me.com


Mother Jones
Raw Story
Huffington Post
Crooks and Liars
American Prospect
New Republic

Denofcinema.com: Saturday Night at the Movies by Dennis Hartley review archive

January 2003 February 2003 March 2003 April 2003 May 2003 June 2003 July 2003 August 2003 September 2003 October 2003 November 2003 December 2003 January 2004 February 2004 March 2004 April 2004 May 2004 June 2004 July 2004 August 2004 September 2004 October 2004 November 2004 December 2004 January 2005 February 2005 March 2005 April 2005 May 2005 June 2005 July 2005 August 2005 September 2005 October 2005 November 2005 December 2005 January 2006 February 2006 March 2006 April 2006 May 2006 June 2006 July 2006 August 2006 September 2006 October 2006 November 2006 December 2006 January 2007 February 2007 March 2007 April 2007 May 2007 June 2007 July 2007 August 2007 September 2007 October 2007 November 2007 December 2007 January 2008 February 2008 March 2008 April 2008 May 2008 June 2008 July 2008 August 2008 September 2008 October 2008 November 2008 December 2008 January 2009 February 2009 March 2009 April 2009 May 2009 June 2009 July 2009 August 2009 September 2009 October 2009 November 2009 December 2009 January 2010 February 2010 March 2010 April 2010 May 2010 June 2010 July 2010 August 2010 September 2010 October 2010 November 2010 December 2010 January 2011 February 2011 March 2011 April 2011 May 2011 June 2011 July 2011 August 2011 September 2011 October 2011 November 2011 December 2011 January 2012 February 2012 March 2012 April 2012 May 2012 June 2012 July 2012 August 2012 September 2012 October 2012 November 2012 December 2012 January 2013 February 2013 March 2013 April 2013 May 2013 June 2013 July 2013 August 2013 September 2013 October 2013 November 2013 December 2013 January 2014 February 2014 March 2014 April 2014 May 2014 June 2014 July 2014 August 2014 September 2014 October 2014 November 2014 December 2014 January 2015 February 2015 March 2015 April 2015 May 2015 June 2015 July 2015 August 2015 September 2015 October 2015 November 2015 December 2015 January 2016 February 2016 March 2016 April 2016 May 2016 June 2016 July 2016 August 2016 September 2016 October 2016 November 2016 December 2016 January 2017 February 2017 March 2017 April 2017 May 2017 June 2017 July 2017 August 2017 September 2017 October 2017 November 2017 December 2017 January 2018 February 2018 March 2018 April 2018 May 2018 June 2018 July 2018


This page is powered by Blogger. Isn't yours?


Sunday, March 12, 2017

Who says you can't go backwards?

by digby

Those of us who are in the individual health insurance market know this. But perhaps those who get their insurance through their employer, Medicare or the VA don't. So it's worthwhile having some charts.Michael Hiltzik of the LA Times provides them:

Congressional Republicans, evidently hoping that by repeating an untruth they’ll convince American voters, and perhaps themselves, that it’s a truth, on Wednesday said the Affordable Care Act has “failed.”

The undistilled version of this view came from House Speaker Paul Ryan (R-Wis.), who emerged Wednesday from a meeting with Vice President-elect Mike Pence to assert: “This law has failed. Americans are struggling. The law is failing while we speak. … Things are only getting worse under Obamacare. … The healthcare system has been ruined — dismantled — under Obamacare.”

Every one of those statements is demonstrably untrue. How do we know this? We know because every measure of healthcare spending, access and cost has improved since the passage and implementation of the Affordable Care Act. Timothy McBride of Washington University in St. Louis has done the heavy lifting of pulling together the relevant charts and graphs, and posting them online in a series of 12 tweets compiled on Storify. We’ve culled some of the most important, and present them here.

We should add, first, that Ryan also pledged, once the GOP repeals the law, to “make sure that there is a stable transition to a truly patient-centered system. We want every American to have access to quality, affordable health coverage”

This is nothing but fatuous gobbledygook. The GOP has had six years to come up with an alternative plan, and never has done so. Its current strategy is to repeal the Affordable Care Act now, and then cook up a replacement sometime in the next two, three, even four years. (They can’t even agree on a time frame.) What exactly is a “patient-centered system,” anyway?

Here are the charts, courtesy of professor McBride.

First, the overall uninsured rate has come sharply down since the advent of Obamacare:

The decline in uninsured rates was especially pronounced among lower-income Americans, according to the Council of Economic Advisors and other sources:

Although Republicans claim that even if the Affordable Care Act brought down the uninsured rate, its enrollees had trouble seeing a doctor, that isn’t true. Numerous studies debunk claims that doctors shun Affordable Care Act enrollees. This sample by the Council of Economic Advisors shows that the decline in the uninsured rate is closely associated with a reduction in people who were prevented from seeking and finding medical care because of its cost:

Hospitals are major beneficiaries of the Affordable Care Act, as the Department of Health and Human Services and the Council of Economic Advisors report. Hospitals’ uncompensated care costs fell sharply in Medicaidexpansion states, as patients treated as indigent in the past are now covered by Medicaid. Their uncompensated care costs fell from an average 4% of operating costs before the Affordable Care Act to less than 2% afterward, a decline worth tens of billions of dollars nationwide.

Overall national health spending has come down even faster than was predicted, as a share of gross domestic product:

The average growth in per-enrollee spending by private health plans in key categories has slowed materially since the passage of the Affordable Care Act in 2010, from annual growth averaging 5% in 2000-2010, to 1.5% in 2010-2015. Spending growth on hospital services, physician services and prescription drugs all slowed. Medicare, which has instituted numerous cost-control initiatives under the Affordable Care Act, has seen an overall decline in spending per enrollee.

Finally, even though employer-based insurance hasn’t yet been directly affected by the Affordable Care Act, there seems to be a spillover effect from the overall reduction in healthcare spending growth. Premiums rose by an average 5.6% a year in the 10 years prior to passage of the Affordable Care Act, but only 3.1% since, according to Kaiser Family Foundation’s annual survey of employer health benefits.

Republicans have promised to give Americans a health insurance system better than the Affordable Care Act’s and at lower cost. This is almost surely a chimera; no plan that the GOP has considered would expand coverage beyond the Affordable Care Act. To the extent that the plans would reduce costs, they would do so by relieving the federal government of responsibility for paying for coverage and placing it even more heavily on the shoulders of individuals and families. That’s not lowering costs; it’s just shifting them to those least able to pay. The fact that the GOP will have to face is that bringing healthcare to more Americans costs money. Taking it away from millions of Americans will cost money, too.

No one claimed, either before the passage of the Affordable Care Act or afterward, that it was perfect or that it would solve America’s healthcare crisis in one swipe. What became evident in the three years since the individual insurance exchanges opened for business (on Jan. 1, 2014) is that the subsidies for premiums needed to be increased and improved. Because they’re inadequate, especially as households cross the threshold of 400% of the federal poverty line at which subsidies are eliminated — at about $97,200 for a family of four — middle-class families in the individual insurance market feel overburdened. They blame Obamacare for this injustice. The real culprits are Republicans who have refused to consider any approach to the Affordable Care Act except repeal. Now the GOP is “it” on healthcare, and it’s discovering that crafting a solution from scratch may be almost impossible.

What became evident during the most recent open-enrollment period for Obamacare exchanges is that “Obamacare is more popular than ever,” as Kevin Drum of Mother Jones observes. Enrollment grew to 12 million, up by about 1 million from 2015, even in the face of higher premiums. In any case, more than 85% of all enrollees are entitled to subsidies, which limits and in some cases cancels out the higher prices.

Yet the GOP pledges to overturn all that. The question the party never has found an answer to is: If this is what a failure looks like, how would it define a success?

As he says here are some real holes in the system that could be fixed if Republicans weren't malevolent destroyers of worlds. The subsidies don't go high enough and some middle class people are getting hit hard. That could be fixed. The medicaid expansion should be universal. We could add a public option. I'm sure there are million wonky details that could be fixed to make it better.

But there is simply no doubt that it is an improvement over what we had before. And there is also no doubt that repeal is going to take us right back there and their replacement is actually going to make it worse that it was before.

I know it's their holy grail and they want it gone because it's a government subsidized benefit and they are simply opposed to that no matter how many people suffer and die without it. But the reality is that we tried the "free market" approach to health insurance and it did not work. It was killing people and leaving families destitute. This is a hybrid system that incorporates as much "free market" as can be incorporated while making sure that people have affordable insurance and will not go bankrupt if they get sick.

I'd prefer something simpler, universal and comprehensive. Let's call it ... Medicare. It works fine. Expand the program to everyone and let's go home. But we weren't allowed to have that so this was the only option. And it's a hell of a lot better than nothing.

They may succeed in destroying this, they have all the power they need to get it done. And employed people, those on government health care like Medicare and the VA and well-off folks who can afford health insurance won't feel the pinch at first. But all you have to do is look at the overall cost lines in those charts above to see that it's not just us poor self-employers losers or Medicaid beneficiaries who will be impacted when these amateur wonks take a meat ax to the program without knowing what they're doing. The whole health care sector will be hit hard.

Remember, the ACA wasn't just about covering people in the individual market and expanding medicaid. It was an attempt to bring down spiraling costs through a complex set of regulations and requirements. The result of cluelessly reversing all that isn't going to be pretty for anyone.

The horror of the election results just never ends ...