Browsing the blog archivesfor the day Monday, January 17th, 2011.


Show Me the Numbers; or, My Response to “Tim”

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Health Care, Wingnuts Being Wingnuts

Introduction: I started to write an answer to a comment, then when it got a bit long I decided to turn it into a post. I am responding to a comment from Tim, which turns out to have been copied and pasted wholesale from Vox Populi. But here’s my response, addressing Tim:

Tim, there’s much here you don’t seem to understand. Let me see if I can explain it to you in plain English.

First, some background: Congressional Budget Office analysis of the badly named “Patient Protection and Affordable Care Act of 2010″ (PPACA), probably known to you as “Obamacare,” said it would REDUCE the federal deficit by $143 billion over ten years. I am providing a link to the CBO analysis so you can read this for yourself: I don’t have time to write a Cliff’s Notes summary or you to show you where the savings come from, but I will give you the benefit of the doubt and assume that you are as capable of reading and understanding it as I am.

Just don’t try to argue with me about this until you have read the analysis. I will know.

Also note that “That’s stupid; everybody knows it’s going to raise the deficit” is not an argument. You have to provide reasons and data to show that the points made in the analysis are wrong. And I require links to show where you are getting your data. Otherwise, you don’t have an argument. On this blog, you don’t get away with pulling some data out of your ass and make me do the work of figuring out where you got it so I can refute it. (See “debating rules for rightwingers,” item #8.)

You write, “The CBO’s revised estimate for health care reform, which does NOT include the Medicare fix, is $1,055 billion.” Obviously, there is a discrepancy between what you say and what the actual report, to which I linked, actually says. I couldn’t find the figure “$1,055 billion” in the actual CBO report anywhere.

And the Medicare fix is not included in the CBO analysis because the Medicare fix is an entirely separate issue from the PPACA. The Medicare fix issue has been with us for several years and is the result of legislation passed back in 1997, and it will not go away if “Obamacare” is repealed. I’ll come back to this point later in this post.

Now, the House Republicans have written a stupidly named bill called the “Repealing the Job Killing Health Care Law Act” — notice the link; you can see for yurself the title is about as long as the bill.

The CBO figures that repealing health care reform would ADD $230 billion to the deficit over ten years and result in 32 million fewer people having health insurance by 2021. Such a deal. You can read that report for yourself also, if you like.

House Speaker John Beohner dismissed the CBO analysis as “their opinion.” But in order to get you tools budget-conscious conservatives to support repeal, Republicans had to concoct their own analysis to show the opposite of what the CBO analyses show.

So, somehow, Republicans calculated that the CBO got it backward, and that PPACA would add to the deficit and repealing it would reduce the deficit. Several people, not just Krugman, have written that Republicans do this in part by claiming costs for the PPACA that are not in the PPACA.

And frankly, I have to take their word on this, because I’ve been all over the web looking for a Republican analysis that spells out costs and savings in the same way the CBO analysis does, and I can’t find it. So I can’t say for sure how they crunched their numbers. If you know where it is, send me a link.

Please note that a list of unsupported claims is not the same thing as an analysis. As my math teachers used to say, you gotta show the work.

But note also that House Republicans have decided to exempt the repeal bill from their own rule that any increase in spending be offset by cuts in other programs. This suggests to me they know good and well they are lying.

What Krugman is saying here is that the Republican analysis is a crock that adds items as “cost” that don’t have anything to do with PPACA and which are going to happen whether PPACA is repealed or not. For example, he says, Republicans have added the cost of the annual Medicare “doc fix” to the cost of PPACA, which is an issue entirely outside of PPACA.

Then, you write, “Krugman is assuming that the Medicare fix is as inevitable as a mortgage payment. . . . the possibility that doctors might elect not to see Medicare patients hardly makes increasing Medicare payments a necessity.”

First, you should be aware that in dismissing the Medicare fix issue, you are arguing AGAINST the Republican analysis. Krugman is saying that REPUBLICANS claim the Medicare fix as an inevitable cost of the PPACA, and they’re putting that into the secret analysis I can’t find to argue that “Obamacare” is too expensive.

But here’s what you’re not getting — the bleeping Medicare reimbursement rate shortfall was NOT CAUSED BY THE PPACA AND WILL STILL BE DRAINING MONEY OUT OF THE BUDGET IF PPACA IS REPEALED. That was Krugman’s point.

Righties have insinuated elsewhere that by repealing PPACA they’d be saving the “doc fix” costs, but they won’t, because the ‘doc fix” issue was caused by legislation passed back in 1997 and will not be affected if PPACA is repealed. I’ve written about this, um, prevarication in the past. See:

How the Game Is Played
Die Quickly for the GOP’ or, Righties Still Can’t Read

By the same token, if Congress wants to stop issuing the annual Medicare doc “fix” and allow physician reimbursement rates to drop by 23 percent, or more, they wouldn’t have to repeal “Obamacare” to do that, because it’s bleeping not in “Obamacare.”

So, essentially, your entire argument not only misses Krugman’s point, it also misses the point of GOP propaganda arguments. Hmm, maybe I shouldn’t assume you are as capable of reading CBO analyses as I am.

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HCR Repeal?

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Health Care

While the Right is in an uproar, screaming for news media to correct the “error” that the Right’s paranoid, eliminationist rhetoric might have been an influence in the Tucson shooting, as well as several others — this is what Orwell would call a “thought crime,” I believe — they are silent about some of the actual and verifiable lies reported in media everywhere.

For example, regarding the recent CBO report that said repealing health care reform would put a dent in the federal budget “in the vicinity of $230 billion” in the first decade — the GOP claimed that the HCR law will crank up federal spending to ruinous heights. And how did they figure that? By including spending that has nothing to do with the HCR law and which will happen anyway, even if it is repealed. For example, they are still trying to pin the cost of the “doc fix” on the HCR law, when it is really the fault of legislation passed back in 1997.

Anyway, House Republicans plan to put repeal of health care reform on the agenda for next week. It’s not going to happen, and not just because such a repeal (probably) would not pass in the Senate or survive a presidential veto. It’s not going to happen because the insurance industry doesn’t want it to happen. Industry bean counters have figured out that that 30 million new customers is nothing to sneeze at, which is what the individual mandate will give them.

So, the lobbyists have gone forth to tell their lapdogs Republican legislators that they had better back off the individual mandate.

For the insurers, the worst-case scenario would be if the “guaranteed issue” provision — that insurers can’t refuse to cover people with pre-existing conditions — remains in effect but the individual mandate is repealed. That really could be disastrous to the private insurance industry. So, that ain’t gonna happen.

Here’s the more interesting question, proposed by a diarist at Daily Kos (via Moonbat). They’ll keep the individual mandate, but eliminate …

… guarantee issue (cannot be denied insurance even at high cost due to pre-existing conditions) and community rating (price for insurance is not based on your individual risk, which is needed to make guarantee issue meaningful), the limits on medical expense ratio (insurance companies have to use the money to pay for health services, not overhead, marketing, profit and their own salary) and protection against rescission (dropping your coverage and refusing to pay once you get sick).

However, if the individual mandate remains but guaranteed issue and protection against rescission are dropped, it would leave millions of Americans with no way to purchase health insurance on the so-called “free market.” So either the individual mandate would have to be scrapped, or government would have to step in and provide a public “solution” — either make the “uninsurables” eligible for Medicaid or something similar, or set up a subsidized “public option” insurance program for people dumped by private industry. And that option (unlike the original one) would have to be subsidized by taxpayers up the wazoo because that risk pool would be filled almost entirely by higher-risk customers.

Bottom line — logically, the individual mandate and guaranteed issue cannot be separated; one can’t work without the other. That, of course, doesn’t mean the GOP won’t try to separate them, even if it means screwing the taxpayer. However, I agree the medical expense ratio limitation could be vulnerable.

Update: I forgot to mention — Republicans still have only the vaguest of notions of what they would provide in place of last year’s HCR law. Alex Seitz-Wald writes for ThinkProgress,

On Fox News Sunday today, conservative Weekly Standard Editor Bill Kristol could offer only the vaguest of promises about the replacement. When Fox News contributor Juan Williams challenged Kristol to explain “what are you going to replace it with?”, Kristol told Williams not to worry, because there would be hearings in a few months and Republicans would probably come up with something by then. …

… Just days away from the repeal vote, House leaders have no coherent plan to address health care if their repeal effort succeeds. The Washington Post’s Amy Goldstein reports that “according to GOP House leaders, senior aides and conservative health policy specialists, Republicans have not distilled their ideas into a coherent plan.

In other words, all those stacks of paper Republicans were waving around last spring and calling “their plan” were just props, as I said.

Update: See also “The Truth and Consequences of Repeal” and “‘Job-killing’ regulation? ‘Job-killing’ spending? Let’s kill this GOP canard.”

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