Morning Reads for Tuesday, June 27

Good morning! It’s kind of a slow week. So far…

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xdog
xdog

The Georgia Supreme Court Monday rejected a religious challenge to a tax credit program for students to attend private schools.

Andrew C. Pope
Andrew C. Pope

Morning y’all. CBO scored the Senate Wealthcare bill last night. It’s not pretty. Rather than waste more digital ink re-litigating Republican healthcare policy, I want to share a personal story. I hope y’all will oblige me. When I was in 6th grade, my mom was diagnosed with breast cancer. The thing about being in 6th grade is that you’re old enough to know that cancer is bad, but young enough to be unaware at just how horrible the disease is. I could appreciate the fact that my mom was sick, but I didn’t know enough to consider the prospect she… Read more »

Noway2016
Noway2016

Informative story, Drew. I know you and Eiger are seemingly the two more informed folks on here on this subject. I’m almost to the point of supporting single payer. Don’t gasp too hard. I don’t know what to do, either. Can the two of you inform us on how a single payer system would be rotten — or a Godsend? They have a gov’t sponsored health system in my second country, Colombia. Your financial ruin scenario just hit someone close to our family. Their ten year old son was diagnosed with leukemia, father unemployed, just a devastating financial haymaker. Just… Read more »

The Eiger
The Eiger

Single payer would work great if you are okay with how the VA treats veterans and are okay with going from $20 trillion in debt to $40 trillion in debt almost overnight.

bethebalance
bethebalance

There are certainly ways to improve on any existing single payer system. What’s lacking is the vision, innovation, and courage. As an aside, health care costs will always increase steeply in the short term when you provide new care to previously uninsured or underinsured ppl. But imagine you could build a system from the ground up. It wouldn’t be the VA- but perhaps the VA equivalent would be a minimum safety net. And the safety net could include ways to address physician supply, etc. But in this country, we also have opportunity to be better than other countries’ systems in… Read more »

xdog
xdog

Every other western democracy manages their national healthcare demands less expensively and with better results than the USA. They have done so without doubling their national debt while treating their patients including veterans efficiently and with dignity.

We haven’t done that. A large part of the ruling class don’t even want to try. With ACA nearing extinction many sick Americans will have to decide between dying and becoming a pauper. Hell of a choice there. Thanks America.

The Eiger
The Eiger

“Their ten year old son was diagnosed with leukemia, father unemployed, just a devastating financial haymaker. Just damn….” This is the perfect role for Medicaid. A safety net for the truly needy. That is what it was intended for. Now Medicaid dollars are being stretched because of the expansion of Medicaid. Instead of only taking care of kids with Leukemia who’s parents are unemployment it now has been expanded to the 28 year old millennial living in his parents basement holding out on that $100,ooo a year job instead of working his way up to it. He should not be… Read more »

bethebalance
bethebalance

The problem is that it’s not a safety net- Medicaid eligibility already depends on poverty. With the exception of a few legal mechanisms as exemptions, Medicaid requires ppl to be too poor or to bankrupt themselves in order to be eligible. Avoiding bankruptcy to pay medical bills is something that Drew’s story alluded to. No insurance, even public insurance, should require that. Single payer could eliminate the requirement to go bankrupt, and have some graduated premiums.
And for the record, healthy ppl are not the ones using up Medicaid- or other health care- dollars.

The Eiger
The Eiger

The original intent of Medicaid was to be a safety net for the poor and disabled. Politicians since 1965 have layered more and more into Medicaid. You may think that is a good thing we have expanded Medicaid to people who aren’t poor or disabled. I do not think it is a good idea.

Andrew C. Pope
Andrew C. Pope

ACA expanded Medicaid eligibility to persons making up to 133% of the poverty line. For a household of 2, that’s $21,307 per year. For a household of 3, that’s $26,813. The median household income in the US was $56,516 in 2015. Medicaid is still serving the poor, we’ve simply updated our understanding of “poor” to recognize that, despite having a full-time job, some people still struggle to make ends meet.

bethebalance
bethebalance

And I’ve been trying to digest the whole reference to the 28-yr. old Millenial in the basement. Not that I know all Millenials, but the only way one qualfies for Medicaid is if you are poor AND disabled. That 28-yr.old may have stayed covered under the portability of their parent’s plan through age 26, but the idea that an able-bodied/non-mentally-ill indivdual (who is not a child or pregnant) will get Medicaid is simply incorrect.

bethebalance
bethebalance

And the idea of pregnancy just brings up another major flaw in the system. What is it, like over half of all births are covered by Medicaid? That’s in no small part because of the pre-existing condition limitation. Where folks want to let insureres offer pared-down plans bc it will allow cheaper options, without some sort of mandate, insurers will, wherever possible, simply not offer coverage for certain conditions (see also autism). That is an epic market failure. So maybe Medicaid is perfect for maternity coverage. And maybe it can be expanded to cover other non-profitable conditions and people, with… Read more »

The Eiger
The Eiger

“That 28-yr.old may have stayed covered under the portability of their parent’s plan through age 26, but the idea that an able-bodied/non-mentally-ill indivdual (who is not a child or pregnant) will get Medicaid is simply incorrect.”

That statement is correct for non expansion states like Georgia, but completely false for the states that expanded Medicaid.

The Eiger
The Eiger

Here is the list. Key word being “individuals” not families or children. So…I’m not incorrect. Thanks for playing.

“Individuals at or below 133% FPL Age 19 through 64”

https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Downloads/List-of-Eligibility-Groups.pdf

bethebalance
bethebalance

Yes, I was focused on GA. Typical. But then the concern is that Medicaid is a disincentive for someone to get a job? So, just a brief look into the stats show that around half of adults receiving Medicaid (nationally) are in fact disabled. Of the remaining, over half have jobs (albeit low-paying ones) or are in school. The rate of unemployment is either similar or lower among Medicaid recipients as compared to the rest of the public. So, the incentive argument fails. But I get the concern nonetheless. So, then the policy problem goes to smaller and more specific… Read more »

The Eiger
The Eiger

I don’t believe I said that being on Medicaid was a disincentive to getting a job. A better option would be to allow insurance plans to be sold that may not meet all of the essential health benefits in the ACA, but still covers catastrophic events and would be much more affordable. Pairing this with needs based tax credits and refundable tax credits. This is an idea that Claire McCaskill recently talked about on Morning Joe about how it would help stabilize the market and keep people insured. But I’m cruel and a terrible person when I mention it.

bethebalance
bethebalance

I wouldn’t say cruel, not on this particular issue, anyways 😉 But the degree of passion is understandable. But your position doesn’t seem to be the one that’s on the proposed Congressional bill(s) either. As for the bare bones plans, OK, but then how best to manage the risk and costs when those plans fail? Tax credits would mean the doc bills could still be astronomical, and you can’t refund so much. There needs to be a better back-up for the un/underinsured (and poor). Medicaid-negotiated pricing makes sense. Evan absent all-out expansion. Or Medicaid could be a re-insurer for private… Read more »

Andrew C. Pope
Andrew C. Pope

But doesn’t offering a 28-year old affordable healthcare through Medicaid when he’s making $18k a year while “working his way up to” a 100k job help him if he tears an ACL playing ultimate frisbee or gets seriously ill? 28-year olds get cancer, too. Having very recently been a 28-year old with a $100k job, I can tell you that, even on that salary, it’s hard to save once you’ve paid for student loans, car loans, rent, food, gas, credit card bills (credit cards you opened and maxed out while making $20k and holding out for that $100k job). To… Read more »

The Eiger
The Eiger

I’d rather offer him insurance he can afford (which is possible) and take care of the people that Medicaid was designed for.

Andrew C. Pope
Andrew C. Pope

Even if it’s “affordable” by some Congressionally cooked-up metric, it doesn’t mean a 27 year-old working a low-paying policy job in DC and a side job as a bartender will find it “affordable.” I agree you can make insurance affordable for young people, but I don’t think the House and Senate approach to creating affordable premiums for young people (the old “make insurance cheaper for 28-year olds by jacking up premiums on 50 and 60-year olds” strategy) is the best way to go about it. Let’s also not pretend like 20 somethings like me present a significant burden on Medicaid.… Read more »

The Eiger
The Eiger

Again, if young healthy folks aren’t using a lot of health care we should be able to offer them a product that they can afford without having to put them on Medicaid. The whole idea of the ACA was to get young healthy people in the market to drive down costs for older sicker people. The ACA failed at this. Also, you don’t help drive down costs by adding healthy young people to a “free” government program. We would all be better off if healthy young people were offered a product in the private market that they can afford. Adding… Read more »

Andrew C. Pope
Andrew C. Pope

If I believed Republicans truly cared about the solvency of Medicaid, I’d lend more credence to your argument. But when the “savings” from kicking 725,800 enrollees (the entirety of expansion-eligible enrollees in AK, AR, NV, WV) off of Medicaid are being used to fund a $33 billion tax cut for the 400 wealthiest households in America, I fail to see how this has anything to do with the solvency of Medicaid. The vast majority of people y’all want to kick off of Medicaid aren’t “holding out for a 100k job,” because there is no 100k job magically coming to West… Read more »

The Eiger
The Eiger

“This isn’t about saving Medicaid. This isn’t about providing more affordable healthcare. This isn’t about providing better healthcare. This is about giving a tax break to the wealthiest Americans at the expense of poorer ones.”

All false as usual. Please keep defending the failures of the ACA. I’ll keep trying to fix the problem. The fix isn’t adding healthy abled bodied people to Medicaid. I’ve seen first hand the good that Medicaid has done for families that truly need it. Yes, I want to save Medicaid. Expanding Medicaid is not how you safe it.

Andrew C. Pope
Andrew C. Pope

Nor are block grants without spending restrictions that fail to adequately grow relative to healthcare costs.

Andrew C. Pope
Andrew C. Pope

How much time do you have? The greatest challenge with single payer is cost. Providing health insurance is an expensive endeavor and its even more expensive in rural areas without easy access to medical services. In Alaska, for example, getting to the ER may involve a couple plane or helicopter rides to get you from a remote village to a city like Anchorage. If you glance at a map, you’ll notice that we live in a pretty big country and we’ve got plenty of people that live in rural areas that lack a nearby hospital or even a town doctor.… Read more »

alpha male
alpha male

I am neither an attorney nor health care wonk. However, it seems to me that single payer will never be the answer here for a number of reasons including possible constitutional issues.

However, many folks conflate single payer with public option. They are not necessarily the same. I could see us eventually devolving into a 2 track health care system. A private pay/ private insurance driven system for the healthy, relatively well off and a public option for those with pre-existing conditions and the less well off. I believe this is the system some Euro countries employ.

Andrew C. Pope
Andrew C. Pope

If we’re talking about working within the existing confines of the healthcare system, the public option is the most straightforward solution. I also think that early buy-in to Medicare would also go a long way toward re-shaping risk pools, but that’s a topic for another day. If we’re building a healthcare system from the ground up, I would think single-payer is the way to go. As others have mentioned, there are significant hurdles to getting there. Doesn’t mean we shouldn’t try, but recognize it’s a major burden legislatively. I don’t know that there are constitutional questions around it, alpha. I’m… Read more »

alpha male
alpha male

If structured as Medicare for all you are probably correct. I was thinking more on the Canadian type lines. As stated, I am definitely not a con lawyer. But as you and others have stated there are other hurdles as well. I just don’t see it here. It will be difficult enough getting the right to go along with public option.

But I believe public option is inevitable. As it seems to me as an acknowledged non wonk, that: guaranteed issue, community rating, no mandate ( or an ineffective mandate in ACA’s case), and low premiums, are mutually exclusive.

Andrew C. Pope
Andrew C. Pope

Are you calling me a con? You’re on the right track, generally Congress will have a wide berth when it comes to legislating on an issue like healthcare, which is undoubtedly within the realm of interstate commerce. Most of the hurdles I’m talking about are practical hurdles based in political reality. The GOP is never going to go along with single payer healthcare and the insurance industry, pharma, etc. will never support it. Our best shot at single payer was the 1947, around the same time Labour was pushing for the NHS in the UK. The interests are simply too… Read more »

Noway2016
Noway2016

Never saw what people saw in her from the outset. Karma, people, Karma!! She is the new Deborah Norville! Maybe The Squatty Potty needs a new pitch-person?
http://variety.com/2017/tv/news/tv-ratings-sunday-night-with-megyn-kelly-1202478257/

Dave Bearse
Dave Bearse

It seems something could soon break with respect to the Trump campaign colluding with the Russians, based on the new GOP talking point making the rounds: Collusion, while it would be obviously alarming and highly inappropriate for the Trump campaign, of which there is no evidence by the way, of colluding with the Russians. It’s not a crime. — Brit Hume What was the collusion? That maybe somebody in the Trump campaign talked to somebody in Russia … Is that a crime? — Sean Hannity I’ve said it before and I’ll say it again: collusion is not a crime. …… Read more »

Saltycracker
Saltycracker

Here you go, fake news, CNN regrets being caught and blames employees.

AJC headline:
“Trump sounds off after 3 CNN employees resign over retracted Russia story”

Dave Bearse
Dave Bearse

Read the story. It wasn’t that it was fake news, but that it didn’t meet CNN journalist standards and probably wasn’t true. I know the concept of standards with respect to truth and facts is tough to comprehend, what with a sociopath leading the country, and the GOP enthralled.

Ellynn
Ellynn

Conservative income redistribution… What a concept.

https://www.nytimes.com/2017/06/27/opinion/the-gop-rejects-conservatism.html

Ellynn
Ellynn

President Trumps has stated many times we are more respected in the world then before (or something along those line).

Survey say…

https://www.reuters.com/article/us-usa-trump-image-survey-idUSKBN19I00F

chefdavid
chefdavid