Archive for the ‘ACA’ Category

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Since Obamacare causes such controversy, and for good cause, it’s worth trying to untangle some of the issues presented by what I’m generically going to call government-managed health care. I’m using this umbrella term to cover anything that remotely resembles Medicare, the Veterans Health Administration, and the myriad of similarly large health care systems managed by governments across the world. Given the amount of debate on the issue, some other clarifications seem necessary. This article isn’t looking at the quality of the care, or whether it has any private components to it. These are certainly very important issues, but I’m only human, okay? One thing at a time.

Unless there are gross inefficiencies, which government is often unjustifiably famous for, the government’s overhead for administering health care is dramatically lower than private entities’ because profit and marketing are less important factors. This is even true for Medicare, despite the ridiculously high cost of health care in the US. But this only gets us a half way to the answer. The question is perhaps better measured by how much we currently spend on health care, and how much of that is paid for by the taxpayer.

First, although some struggle with costs, governments across the world already shoulder this burden. So it’s definitely possible. And before someone compares the cost of care in the US to the cost of care elsewhere, many, if not most, of the medication used elsewhere is also used here. Since private companies do not sell medication at a loss, it follows that the sales in other countries also operate profitably, and therefore, those costs are necessarily similar. The truth may be that US patients may be the victims of broadly-orchestrated price-gouging, but that’s beyond the scope of this article. In the US, taxpayers already fund over 60% of all health spending. And that number doesn’t account for the discounts on taxes that we give to companies operating emergency rooms, which is one of the main ways health care is provided to Americans. The US tax code grants non-profit status to hospitals that have emergency rooms. So, in effect, we’re saying, you don’t have to pay the government money you’d normally owe it if you’re spending it to run emergency care. This kind of quid pro quo is about the same as if the government taxed the entities and then spent money to provide similar health care. The amount of money spent on emergency care may not be much, but that’s, in part, because the uninsured, which are most of the emergency care patients, simply don’t seek medical care that much. I can’t really blame them, given the prices they have to pay, and the fact that the median household wealth for those without insurance is less than $20,000 (as opposed to over three times that if you’re insured).

So, it’s likely that US taxpayers already cover about 70 or 80% of US health care costs. Given the difference in overhead mentioned above, it’s easy to imagine that a government-managed health care system would incur lower costs, and therefore the percentage of actual health care costs covered would rise very close to 100%.

Another point that nudges the equation towards “why aren’t we already doing this?” is the fact that health problems are a significant drag on the economy. This works out in several ways. It might be the fact that the guy making your lunch can’t afford to get treatment for whatever contagious disease he might be tossing into your salad. Or the notion that employers have to, whether required by law or as a draw for employees, frequently offer health care coverage, which is a cost they incur. Or the number of medical bankruptcies. Or the vast number of other costs associated with preventable or treatable disease.

Given the above, recognizing that taxpayers already foot most of the health care bill and changing things simply so that the money is spent more efficiently would not only alleviate one of the biggest concerns for Americans, it would also probably galvanize the economy and productivity in a big way. Fiscally speaking, it seems like a no-brainer, and it appears that Congress is only against it because there are very wealthy donors that profit under the current scheme. Sorry, I’m contractually required by Brett to go there.

More info, if desired, at the Physicians for a National Health Program.

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Affordable Care Act Checkup

Posted: September 12, 2016 by Nazim in ACA

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We’ve covered the cases that went to the Supreme Court, and it’s been a couple of years since it’s been implemented, so it’s time for a checkup on Obamacare. How is it doing?

Despite the initial hiccups with the website, the coverage marketplace or exchange seems to be working: we’ve seen large drops in both the number of uninsured and the uninsured as a proportion of population.  However, a lot of insurance rates have certainly gone up. The notion that “if you like your current plan, you can keep it” has proven to be false for a large number of people.  Health care insurance premium rates, have recently gone up dramatically, even though the average did not change much when the reform was initially implemented. It’s hard to compare this rate to that in a parallel universe in which Obamacare was not implemented. Historically, rates have gone up pretty steadily and at a rate higher than inflation, so, these rate increases might also happen in that parallel universe.

The Affordable Care Act (which is the official name for Obamacare) also smoothed a lot of regulatory wrinkles and closed a lot of coverage loopholes, such as exclusion of coverage for pre-existing  conditions or the Medicaid part D prescription drug “donut hole” coverage gap. However, annual wellness checkups are free, even though they don’t always end up that way.

Perhaps the biggest question is whether Obamacare has reduced the number of bankruptcies due to medical debt. Well, this is a complicated question to ask. Money is a fungible form of payment, which is to say that if I owe you and two other people $30 each, and I only have $50 to pay all my debts, none of the debts are individually unaffordable, but the combination of my debt is unaffordable in the aggregate. So, if one of those debts is to a medical provider, it’s disputable whether I can say that my ensuing bankruptcy was due to the medical debt. And this is the most common scenario. However, medical-related bankruptcies continue to be a problem, even though they have gone down significantly in Massachusetts, which implemented Romneycare in 2006, after which Obamacare was modeled. On the other hand, Massachusetts has a pretty comprehensive array healthcare safety nets, which the nation as a whole lacks, and the rate of underinsured (folks with lower overall coverage or higher deductibles) has been going up, probably due to increased premiums, which may explain why the rate of medical bankruptcies of insured has is far from dropping.

I’ve been trying to end this on a bright note, and I’m not sure I have a relevant one, so here’s a somewhat relevant one: overall, bankruptcy rates are decreasing in the US, but this trend is not imputable to Obamacare. On the other hand, Canadian bankruptcy rates have been steadily trending up, although they remain lower than ours. That makes me happy in a nya-na-nya-na-nyaaa-naa kind of way. Just kidding. I love our hat. And, regarding Obamacare, it’s a mixed bag, and it’s not going anywhere, so we’ll just have to wait and see.

WHAT HAPPENED:  Two years ago, the Supreme Court ruled in Hobby Lobby v. Burwell that the contraceptive mandate could not compel religious institutions to provide birth control to their employees.  “Fine” said the government, “You don’t have to provide birth control, and instead you just have to fill out these two forms and we’ll take care of it for you”.

WHY IS THIS BEFORE THE SUPREME COURT:  “NO!” replied the host of religious institutions who were not satiated by the Supreme Court’s favorable ruling in Hobby Lobby.  “Two forms, as nominal as it may seem, constitutes an affirmative act in favor of providing birth control and that is a sin.”  And that is where we stand now, in that the Court must determine whether two forms is an acceptable burden to place on a company that is denying medical care to their employees, or if two forms is a condemnation to hell-fire and brimstone.

WHAT IS THE RULING:  Thankfully, this case is not yet decided.

RAMIFICATIONS:  Everything and nothing.  Everything if the idea that a hypothetical employee of the Catholic Church cannot get birth control serves as the opening of Pandora’s Box toward overruling Roe v. Wade and diminishing Women’s Rights.  Nothing if you are neither person described in the above referenced sentence.

ROOT FOR ZUBIK IF:  To you, the idea of hell isn’t ridiculous.

ROOT FOR BURWELL IF:  You would like to end more sequels to this never-ending horror movie of a Supreme Court case, which by the way, was what I was going for with the picture above of Dennis Hopper fighting Leatherface in Texas Chainsaw Massacre 2.

This week’s episode covers King v Burwell, a case that saved Obamacare in America despite being almost completely incorrect from a strict statutory construction standpoint.  King is also compared to the Texas Disparate Housing case and how both cases illustrate the difference between being persuasive and being correct.   Brett and Nazim also share their thoughts on the outcome of the same sex marriage case, despite recording the day before it was decided.

This is not a test.

This is not a test.

Hobby Lobby

Posted: January 3, 2015 by Nazim in ACA, Dissent, Equal Protection, Religious Freedom

Brett and Nazim break down one of the more controversial decisions of 2014, by discussing their initial thoughts on the case and then expanding on those thoughts after actually reading the decision for the first time. Libsyn link

Image source: the progressive pulse.