The Economic Damage of Obamacare

[code1211]

Gruber is a private citizen. His opinion (and he apparently only suggested this once and later retracted it) is irrelevant. His claim to fame is that he says thoughtless, dumb things.

I'm asking what communications or policy guidance from HHS (or Congress, I suppose) to states tried to "force" them to set up exchanges by suggesting tax credits were contingent on them doing so? Answer: none. Because no such coercion ever existed.

Gruber may have been completely un-associated from the ACA. I was too. He received $400,000 to be associated. I recieived $0.00 to be un-associated.

We may draw 1 of 2 conclusions from this: 1. i was severely underpaid. At some point Gruber was NOT UN-associated.

To disown him now is a little disingenuous. Disingenuous in this case is as gentle a word as is available.

Did Jonathan Gruber earn ‘almost $400,000′ from the Obama administration? - The Washington Post

 

[Fearandloathing]

Gruber is a private citizen. His opinion (and he apparently only suggested this once and later retracted it) is irrelevant. His claim to fame is that he says thoughtless, dumb things.

I'm asking what communications or policy guidance from HHS (or Congress, I suppose) to states tried to "force" them to set up exchanges by suggesting tax credits were contingent on them doing so? Answer: none. Because no such coercion ever existed.

Who was paid nearly a half million dollars to help design the law AND the political strategy. To say he was uninvolved as the the liar in chief has claimed is like saying the pig is not involved in breakfast bacon.

I strongly suggest he has a better working knowledge of Obamacare than 99% of Americans including the dolts who passed, and certainly a lot more than the lemmings who troll to support it.

 

[Greenbeard]

Gruber may have been completely un-associated from the ACA. I was too. He received $400,000 to be associated. I recieived $0.00 to be un-associated.

Can you point to a single policy communication from HHS to states supporting the argument that someone was trying to coerce the states into establishing exchanges by threatening to withhold tax credits?

If a single off-the-cuff remark from a private citizen is the best you've got, I'm going to assume that's a no. And you'd be correct: no such coercion ever occurred.

 

[code1211]

Like the ones proliferating right now under reform? Ask the conservative Manhattan Institute:

The problem is that the HSA approach is not universal.

The folks who have Obamacare are expanding as I understand it. The insurance folks I talk to say they have hired extra folks to administer these. In one case, a company has brought the work "in-house" and stopped contracting it now that they have a better image of what is happening with it.

That said, though, most of the non-critical care could be shopped as the blood is not actually bleeding at the moment. If a check up was advertised like a car with a defined price, lower prices and similar outcome would drive the costs down.

Eyeglasses, breast implants, and lasik come to mind.

I see no real reason why Wal Mart couldn't do the physicals for the school soccer team or why Target couldn't diagnose or refer in a triage kind of a way. Or CVS or Walgreens.

Hundreds of millions of people all shopping for a bargain would do a better job than the incompetents in the government.

The government could step in, as it should, to help those who cannot help themselves.

 

[Greenbeard]

Who was paid nearly a half million dollars to help design the law AND the political strategy. To say he was uninvolved as the the liar in chief has claimed is like saying the pig is not involved in breakfast bacon.

He made that remark more than six months after the IRS had released its draft ruled affirming that tax credits are available in all states.

Yeah, he sounds real plugged in.

Just to be clear: the claim being made here is that states were "coerced" into setting up exchanges because of a single remark a private citizen made, six months after the Obama administration made it clear tax credits would be there for all independent of states' exchange establishment decisions?

 

[code1211]

Can you point to a single policy communication from HHS to states supporting the argument that someone was trying to coerce the states into establishing exchanges by threatening to withhold tax credits?

If a single off-the-cuff remark from a private citizen is the best you've got, I'm going to assume that's a no. And you'd be correct: no such coercion ever occurred.

The hasty establishment of federal exchanges within the states that chose to not have them may have been an indication that the Feds wanted them set up in spite of objections from the states.

Does this qualify as a "communication from HHS"?

 

[Greenbeard]

I see no real reason why Wal Mart couldn't do the physicals for the school soccer team or why Target couldn't diagnose or refer in a triage kind of a way. Or CVS or Walgreens.

...that's what happening.

Shock treatment: A wasteful and inefficient industry is in the throes of great disruption

Millions of people are now looking for health insurance on the new public exchanges set up under the reforms. And Obamacare has come into effect at a time when American employers, who often provide health cover for their workers, are seeking to cut its cost by encouraging them to shop around on private exchanges, and by offering less generous plans.

The upshot is that there are growing numbers of consumers seeking better treatment for less money. Existing health-care providers will have to adapt, or lose business. All sorts of other businesses, old and new, are seeking either to take market share from the conventional providers, or to provide the software and other tools that help hospitals, doctors, insurers and patients make the most of this new world.

Patients are increasingly having to pay higher “deductibles” out of their own pockets, before the insurance kicks in, to keep the cost of the cover down. So for minor ailments and simple tests, it makes sense for such patients to go to one of the increasing numbers of walk-in clinics, staffed by well-qualified nurses, on the premises of retail pharmacies such as CVS and Walgreens (see chart). The prices are clear, the care is cheap and the service is quick. Walgreens has a partnership with Theranos, a diagnostics firm, which offers customers a range of tests from a tiny drop of blood. Walmart, a giant supermarket chain with many in-store pharmacies, also intends to become one of the leading sellers of affordable health services, says Alex Hurd, its product-development chief.

For injuries and illnesses that are more serious but not immediately life-threatening, lots of “urgent-care centres” are being opened as an alternative to going to a hospital emergency unit. Private-equity firms are pouring money into independent chains of centres. Merchant Medicine, a consulting firm, reckons that between them, these chains now have just over 1,500 urgent-care centres, up from about 1,300 at the start of 2013. The market is still fragmented but a national brand could emerge from one of the largest chains, such as Concentra or MedExpress.

Some hospital operators, seeking to cut their costs of care, and choosing to be among the disrupters rather than the disrupted, are also opening urgent-care centres. Aurora Health Care, a Wisconsin-based chain of hospitals and clinics, now has more than 30 of them.

 

[Fearandloathing]

He made that remark more than six months after the IRS had released its draft ruled affirming that tax credits are available in all states.

Yeah, he sounds real plugged in.

Just to be clear: the claim being made here is that states were "coerced" into setting up exchanges because of a single remark a private citizen made, six months after the Obama administration made it clear tax credits would be there for all independent of states' exchange establishment decisions?

No.

You claimed Gruber had no "involvement" meaning at all...when he practically wrote it. The meme he was a minor character is bull**** on top of lies from the White House.

The fact he made the statement six months later changes ****.

NO one with a brain is going to believe an administration that has lied as much as this one, 400 "you can keep your plan" lies and then a lie of "I never said that"

The only thing true out of Obama's mouth was his comment that he considers Republicans his "enemies"....as he has sure waged a better war against them than ISIS.

In short, when it comes to Obamacare, I believe nothing, nil, nada, goose egg.....

 

[code1211]

He made that remark more than six months after the IRS had released its draft ruled affirming that tax credits are available in all states.

Yeah, he sounds real plugged in.

Just to be clear: the claim being made here is that states were "coerced" into setting up exchanges because of a single remark a private citizen made, six months after the Obama administration made it clear tax credits would be there for all independent of states' exchange establishment decisions?

I believe the post was made in response to your request for evidence of "policy guidance".

Are "coercion" and "policy guidance" synonyms?

 

[Greenbeard]

The hasty establishment of federal exchanges within the states that chose to not have them may have been an indication that the Feds wanted them set up in spite of objections from the states.

Does this qualify as a "communication from HHS"?

Of course HHS wanted the states to do it. That's not the same as saying they tried to coerce states by threatening them with the loss of the ACA's tax credits if they didn't. That, of course, never happened. Those tax credits were always understood by the states and by the federal government to be available in all states regardless.

 

[Greenbeard]

No.

You claimed Gruber had no "involvement" meaning at all...

Huh? You're using quotes but you're not actually quoting me. That's a bit of a no-no as I understand the rules.

 

[code1211]

...that's what happening.

Shock treatment: A wasteful and inefficient industry is in the throes of great disruption

Well, not exactly...

The provision of HSA's and the education of the patients by public advertising and word of mouth is a little hampered by the existing local laws.

For instance, medical procedures are not the topic in local advertising for bargain basements. I've heard that it's illegal here to do this kind of advertising. Because I have insurance and no dog in the fight, I don't care.

It's absolutely obvious to me, though, that the more the individual makes the decision on what constitutes value, the better the value becomes.

In a free society, you get a Honda Accord and in a closed society you get a Volga GAZ 21. The best value almost always is defined by infinitely higher quality, wider availability and a lower price.

Obamacare is a closed society solution that rose from a different closed society option.

 

[code1211]

Of course HHS wanted the states to do it. That's not the same as saying they tried to coerce states by threatening them with the loss of the ACA's tax credits if they didn't. That, of course, never happened. Those tax credits were always understood by the states and by the federal government to be available in all states regardless.

Out of curiosity, why was there a separate exchange created in each state?

If the Federal Exchange was a Federal Exchange, why have 30 or 35 different Federal Exchanges? Seems a bit redundant.

 

[Greenbeard]

Well, not exactly...

The provision of HSA's and the education of the patients by public advertising and word of mouth is a little hampered by the existing local laws.

First of all, my point was that your notion that low-cost care should increasingly move into the retail space is happening. The number of retail and urgent care clinics has been exploding as consumers have become increasingly price sensitive. Market dynamics are starting to show up (which is the point of that article from The Economist).

Second, if you have a problem with your local laws, change them. In my state, payers and providers are required to disclose comparative price information so consumers can easily shop around for procedures. Surely with so many states having GOP leaders at present, local laws inhibiting the market dynamics that ACA is trying to achieve can easily be removed?

 

[Greenbeard]

Out of curiosity, why was there a separate exchange created in each state?

If the Federal Exchange was a Federal Exchange, why have 30 or 35 different Federal Exchanges? Seems a bit redundant.

Because HHS is only empowered by the law to create a state's state-based exchange for it ("the Secretary shall...establish and operate such Exchange within the State"). That's the whole point--an exchange facilitated by HHS isn't some separate concept, it is that state's state-based exchange.

If it were otherwise, as you've been suggesting for pages now, then yeah you wouldn't need a separate one for each state. But you do.

 

[iguanaman]

In most cases it was for purely financial reasons.

Florida lost $5.9 billion in federal funds because of not expanding medicaid. So I assume you mean they didn't know what to do with the money.

 

[iguanaman]

No. Just the opposite.

OK But why is it that the Red States refused the responsibility of making exchanges instead of the Federal Govt doing it for them?

 

[iguanaman]

I wonder why the folks who have used money to make money throughout the history of the USA have suddenly become fearful of taking risks with their money.

Perhaps they don't see the need or demand for expansion considering the wage stagnation of the middle class?

 

[code1211]

First of all, my point was that your notion that low-cost care should increasingly move into the retail space is happening. The number of retail and urgent care clinics has been exploding as consumers have become increasingly price sensitive. Market dynamics are starting to show up (which is the point of that article from The Economist).

Second, if you have a problem with your local laws, change them. In my state, payers and providers are required to disclose comparative price information so consumers can easily shop around for procedures. Surely with so many states having GOP leaders at present, local laws inhibiting the market dynamics that ACA is trying to achieve can easily be removed?

Both of these things, sahopping around for better deals and the examination of the antiquated health insurance and regulations, are good things.

Neither of these things were prescribed by the ACA.

 

[code1211]

Because HHS is only empowered by the law to create a state's state-based exchange for it ("the Secretary shall...establish and operate such Exchange within the State"). That's the whole point--an exchange facilitated by HHS isn't some separate concept, it is that state's state-based exchange.

If it were otherwise, as you've been suggesting for pages now, then yeah you wouldn't need a separate one for each state. But you do.

I haven't been suggesting that. I am only questioning the appropriateness of the court making the decision that it made for the reason that the decision was made.

 

[code1211]

Florida lost $5.9 billion in federal funds because of not expanding medicaid. So I assume you mean they didn't know what to do with the money.

That is one side of the coin.

How much was avoided in extra costs by making that move?

 

[code1211]

OK But why is it that the Red States refused the responsibility of making exchanges instead of the Federal Govt doing it for them?

I was not involved in any of those decisions or the original passage of the law and did not receive any of the bribes that made the whole thing possible.

My comment was on the statement that Conservatives don't want power reserved to the states.

Of course, conservatives do. Republicans and Democrats prefer centralized power.

 

[code1211]

Perhaps they don't see the need or demand for expansion considering the wage stagnation of the middle class?

Do you think the wage stagnation might be a result of the economy not expanding quickly as opposed to the cause of the economy not expanding quickly?

You may have the egg laying a chicken in your analogy.

There really was absolutely no need for a personal computer in 1965. In 1995, the presence of the PC in any private home was unusual.

Now the presence of a device to access the internet is so universal, if you find a gathering of more than 5 working adults, the odds that NOBODY in the group can access the internet is almost non-existent.

Did the investment create the need or did the need create the investment?

By the by, I just switched from and Android to an I-phone and it's much more user friendly to an old codger like me. I poo-poo-ed the differences and I can't really define why, but the I-phone just "feels" better.

 

[Renae]

ACA was certain to slow the economy. But we were lucky that the recovery was strong. That way the US has been able to grow better than most oecd countries'.

Strong compared to France isn't really something to brag about.

 

[iguanaman]

Strong compared to France isn't really something to brag about.

Then compare us to Germany, Great Britain, or any other major economy in the free world. We have the fastest GDP growth and lowest unemployment.