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15 November 2013

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JohnH

How does the government know if you're insured? Interesting question. I assume there will be people who eligible for tax credits who will apply for the credits but not the insurance. Under the current system, my family's biggest deductible expense for several years was medical, since we were laying out 30% of our income for it (25% for insurance alone.) I thought that such enormous deductions would surely trigger an IRS audit, but it never did. I assume that was because it fell within IRS expectations and that our expenses were not atypical.

Those getting the Obamacare tax credit without bothering to get insurance would presumably be overlooked because they fell within IRS expectations. Of course, the NSA could just check the bank statements and tell the IRS...

turcopolier

JohnH

Aside from the issue of NSA type snooping, I remain puzzled as to how they will manage to know so much. Break. Will the exchange generated subsidies always be delivered as tax credits? In the case of people who do not pay income tax I suppose that they will be on Medicaid. pl

Matthew

Col: The demand for healthcare greatly exceeds the public's ability or desire to pay for it.

Simply put, our expectations are unrealistic.

toto

"Will the IRS demand this information?"

Under Romneycare, the Government of Massachusetts does.

GulfCoastPirate

I thought we were going to be asked a question on our tax forms as to whether or not we had insurance. At that point I assume a number of returns will be checked for accuracy just as they are now.

Aren't the subsidies generated through the exchanges going to show up as lower premiums? For instance if you have a policy that costs $500 a month and are eligible for an 80% subsidy then you would pay $100 a month as your premium.

I find all this angst about the ACA bemusing. People seem to forget that in 2008 the health care system was breaking down and Obama received a lot of corporate donations specifically because they expected something to be done with healthcare. Those corporations who provide insurance (and particularly those who operate worldwide) were fed up with the yearly increases associated with the cost shifting and were threatening to cancel their employees policies if something wasn't done. I think sometime people fail to notice the business community (big and medium size specifically) did not fight this health care overhaul. It's actually produced a marked slowdown in the size of the yearly increases they were experiencing. I'm fairly certain many of the multinational corporations that have dealt with single payer overseas would welcome a similar system here (as would I but for different reasons) as it would allow them to plan for yearly expenses more accurately than they can do today (not knowing what type of price increases they would experience for healthcare).

The biggest problem we had is not all employers provided healthcare so those costs got shifted onto those employers who do through premium increases. We also had the problem that Reagan passed the laws that forced providers to provide services in emergency situations without regard to ability to pay. Those costs also were shifted through premium increases. Last, by 2008, it was clear that 'real' wages were in no way keeping up with the yearly inflation costs in healthcare so we were rapidly reaching a point at which the vast majority of Americans would soon be priced out of the health care market.

It would have been nice if the Republicans had chosen to cooperate in trying to solve these problems as opposed to trying to gain a political advantage. We probably would have ended up with a more workable system but I doubt it would have looked much different than the ACA as long as they insisted on keep private insurance companies involved. Hopefully, at some point, we can move to single payer (we already have the infrastructure through Medicare)and simply charge people a percentage of their income for their health insurance as we do now for SS/Medicare. I personally don't see what services the private insurers provide. All they do is drive up the costs (witness the US paying almost twice the percentage of GDP for healthcare as the next country on the list).

One thing you don't see in the current debate is the Republicans providing any type of alternative to the ACA. Why will they not tell us what they would replace the ACA with if they had the chance? My guess is they don't say because they know as well as the Democrats that healthcare is eventually going to have to be a government service for the vast, vast majority of people just as it is in other western societies. Wages simply aren't keeping up for most people and each year more and more people will be priced out of the market absent some type of government subsidy.

Unless they just plan on letting people die in the streets ...

JohnH

I wondered, too. It appears that the tax credits will be issued as refunds if you don't pay taxes. The Earned Income Credit works that way, too. This is contrary to most tax credits, which zero out at the point when you no longer pay taxes.

This whole fiasco is worse than I thought. It turns out that CoverOregon site lets you browse plans. Questions include zip code, income, county of residence and age. Then there is an unidentified yes/no question. If you answer yes, your premiums are 50% higher. Unbeknownst to the browser, the site is asking about smoking, yes or no!

This site has been up for months, and there's still a major bug on a key page! I mean, how hard could this be to fix? Imagine what the rest looks like!


Medicine Man

Speaking as a sometimes priggish Canadian, I don't feel an iota of discomfort about Rob Ford. I grew up learning jokes about the self-centeredness of Toronto (and Ontario) politics. He is their front-man, not the representative for the entire country (though Harper is a whole different subject...).

You're right about the whole episode being a disgrace though. That Ford can live out his grand denial while drawing pay from the public with no recourse is silly.

Medicine Man

I've heard Mark Warner's name bandied about as a possible presidential candidate. Any thoughts on him, Col?

Townie 76

Pat, I believe that part of the problem with the ACA is the shear immensity of the legislation. It is my understanding it was almost 2000 pages in length, and rather than being written by members of the legislative branch the process devolved to members of their Staff and members of the Committees involved staff. These earnest young men and women, educated in the finest of America's schools in the arcane application of policy, but without real life experience, put together a law that was overly complex and woefully lacking in common sense. We the good citizen must now live with their handiwork. There was a time when legislation was written by the Members of Congress, and that legislation was generally short, sweet, and simple. Unfortunately that is no longer the case.

kao_hsien_chih

Without any regard for partisanship and/or "politics," ACA has been too much of a mess: too complicated and too underplanned, with a good measure of dishonesty on top. For all the political inconvenience, a working Single Payer Plan (say, expand Medicare to provide catastrophic coverage for all, with options for buying extra coverage from private insurers) would have been a good idea and relatively easily implementable--while the politics of it would have been an altogether different matter, I actually doubt getting that through would have been necessarily much harder than it actually was with respect to ACA.

The mess that ACA finds itself in, I think, makes this an increasingly more attractive option.

turcopolier

townie 76

That's part of the problem, but IMO the true cause is the underlying desire of the left to provide free health care for their constituencies among the poor and the willingness of the left to screw lower middle class people who may or may not qualify for substantial subsidies. Why would they do that? Just listen to them prattle on about how much better off the masses will be even though there will be pain along the way. It all sounds remarkably Bolshie. pl

turcopolier

MM

Warner? Mebbe so. I would have to think about it. I would never even contemplate Kaine. pl

Fred

"Aren't the subsidies generated through the exchanges going to show up as lower premiums?" That was the sales pitch. It won't be the reality.

"... healthcare is eventually going to have to be a government service for the vast, vast majority of people just as it is in other western societies." Why? The USSR provided health care for its citizens, Cuba still does. I don't see us adopting either model.

"Wages simply aren't keeping up ...." Yes, and we have record highs on WallStreet and still zero jailed after the financial collapse.

Fred

Excellent question about the Governor General of Canada. I would think there would be a dozen laws they could indict him under, from protecting the drug trafficker he bought the stuff from to keeping it on government property. Seems like a complete lack of ingenuity up North.

Farmer Don

Since this is a varied forum let me include a link to this HOUR long interview of:

Paul Craig Roberts; Police Have Been Militarized Sees Public as Enemy, Dollar Implosion

https://www.youtube.com/watch?v=N9DBhAkY5lE

This interview is a couple of years old, but rings the more true because of it.

Craig Roberts (I think), has the same judgment of Lincoln, FDR, the Neocons, Canada, and as well the Afghan War as Col. Lang.

PS I'm glad I'm thousands of Miles away from the Toronto Gong Show.

Richard

If they can't get the portals working to get this started, do they have the software up and running to support their program?

Tyler

You can have a welfare state or you can have open borders, but you can't have both.

Norbert M Salamon

Within the single player system as evidenced in Alberta, there is both an overt and a covert limitation on the services provided [e.g. total no of heart transplants is limited by #, time delay on non emergency surgery -perhaps the patient will die ere surgery] beauty treatments, chiropractors etc. are unfunded, there is means testing for glasses,and dentures, further drug copayment's will be means tested from January 1st - for those of us over 65, where we now pay 30% to a max of $25 per prescription -- be it noted that Government limit is prescription to cover 3 months I pay $25 for three moth's supply of Advair [6 inhalers] wherein the retail price of each is $105, at present.] Next year I will pay retail until an unknown by me maximum.

Paul Escobar

Mr. Lang,

Re: Toronto Canada

I live right on the border of the city & the burbs, and have a slightly closer view of the situation.

We are not living this as broad & clear-cut as you think.

It is not "class struggle" that sustains Rob Ford's (declining) popularity. It is the abstention of his most credible rivals.

The competetive former mayor - David Miller - retired, out of sheer exhaustion from dealing with a protracted garbage strike. His telegenic & popular "heir" - Adam Giambrone - was then hounded by our Liberal media for having consentual relations with an "undergrad" (of legal age)...and he chose to retire as well.

This left Ford with no credible challengers, and he glided into office.

In the first few years of his term, he commanded the obedience of many elected councillors. But as Ford's desires clashed more & more with common sense & popular senitment, these councilors simply stopped listening.

In the last few years of Ford's term, he commanded very little. The mayor has limited oversight & appointment powers. Power has always rested in the collective action of our elected city council. Budgets were passed, programs were administered, and reports were filed...all while Rob Ford blustered & complained.

In the immediate aftermath of this scandal, the last of Ford's loyalist councilors were freed from his influence. He now sits completely impotent, merely attending events & delivering ignored sermons from the mount.

As of now, no charges have been filed against Rob Ford. But the province (our version of an American state) of Ontario has offered to intervene & concoct some legal maneuver to remove him - once Toronto council approves.

There are some in council who would like to wait until the police officially conclude their investigation & press charges against Ford. But I don't think this represents the majority sentiment.

IMO, the majority of council don't merely want to see Ford crash - they want to see him burn. Ford was a boor & a bully throughout his long career in Toronto. He attacked, scarred, ruined many good people. To simply remove him constitutes kindness - and few are willing to offer such a thing.

Our next mayoral elections are scheduled for 2014. Ford will not be mayor again. Polls have long indicated that the social-democratic widow - Olivia Chow - will be our next mayor. She is an experienced & widely respected institution here. IMO, this will all seem a bad dream in a years time.

In the meantime - Enjoy the show eh!,
Paul Escobar

twv

Romney was a really bad guy, as I recall many a poster here saying.
Now, we have the alternative.
People get the government they deserve.
As far as Obamacare is concerned:
Of course it was "designed" to fail, thereby forcing the country to rationed mediocre care - except for the political class.
Can anyone see Nancy Pelosi waiting in line?

Charles I

Ford is an exceptional circumstance reflecting a downtown/suburbs split that became active after amalgamation of a bunch of suburban cities with the downtown core, exacerbated by recent provincial tinkering extending terms from 3 to four years and, one must allow, resolute ignorance and surprising moral indifference from his supporters.

Today most all his powers and duties were un-delegated to him, one of 44 equal councilors; Monday they'll have his office budget and staff delegated to the deputy Mayor sidelining him to bottom.

There's no need for recall, and avoiding it saves much political bacon, leaves his dwindling but rabid tea partyish supporters to education by spectacle while all are united in just wishing he'd get help. The lacuna in law as you pose it in general is attributed to a deference to electoral will, and the City, a compleat statutory creature of the Province, has effectively dealt with any gap whilst avoiding a partisan clusterf**k certain to render his dwindling resolute base psychotic.

Mr. Ford's personal trajectory is beyond recall as well, and having refused to brace for bottoming, one can but await with hopeful compassion that he survives it, and sorta ignore him.

scott s.

From looking at the IRS regs, I don't see that they will ask you to self-report on your tax return, so I assume they will extract the data on who does or doesn't have "minimum essential coverage" from HHS databases. So they will know that eg you are on Tricare. Note that the requirement for maintaining minimum essential coverage is on a household basis, and a taxpayer is liable for all dependents. If a taxpayer is liable to make/file a return of income for his tax year, I guess IRS will determine any month or months in which minimum essential coverage was not maintained for any household member and assess the "shared responsibility payment" penalty. Though now with the waiver of minimum essential coverage for at least some individuals (who held such plans in 2013) I'm not sure how that will all work out.

As far as employer coverage, in my state it has been the law since 1973 that employers must provide insurance coverage to any employee working more than 20 hours a week. I don't see any evidence that this has reduced costs in any way. We are dominated by two insurers who provide for the individual, employer group, and medicare advantage markets.

The core problem though is insurance is based on the idea of forming a risk pool, and can only really operate efficiently if the risk of all parties is approximately equal. When it isn't, then you have the problem of low risk parties subsidizing high risk parties, and a lack of incentive to reduce risk. This is where the punitive power of government comes in, when there is no economic incentive to reduce risk the government will attempt to coerce you. We already see that in that government approved policies charge more for smokers.

AEL

In Canadian law, municipal governments are constructs of the provincial government. If the Ontario government really wants to get rid of Ford, they can craft a law to do it.
Of course, that would cause a ruckus because that is interfering city politics and would make every other mayor nervous because they no longer know where the line is.

The economics are clear that some form of single payer health care is the only reasonable way to structure a first world health care system. Other approaches simply squander several points of GDP in useless paperwork and confidence games.

turcopolier

AEL

"The economics are clear that some form of single payer health care is the only reasonable way to structure a first world health care system." I am coming around to this point of view. pl

Will Reks

If its not their staff its the lobbyists who end up writing these bills.

Length of the bill is a joke. If they had simply passed Medicare for All it would have been a 1 page bill. Still an immense piece of legislation but because they decided to keep the private system we have this 2000 page talking point.

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