Raidne, on 06 March 2012 - 10:44 AM, said:
But I also think having employers bear the burden of healthcare chokes economic growth in the US compared to other countries so it's worth it to me. Additionally, health care has gotten so out of control that some amount of brakes from the top down has unfortunately become necessary. I want single payer government insurance + private supplemental insurance and I'll keep pushing for more government funding of health care until that happens.
Raidne, on 06 March 2012 - 10:44 AM, said:
FLOW, I do think, FTR, that the ACA increases government spending. Not sure when you throw projected Medicare costs into the equation, but I think we'd be seeing cuts to Medicare without the ACA, so that's moot for me.
Well, about 1/3 of the funding for the ACA comes from future, unspecified cuts in Medicare. That's why it is a bit of an accounting trick, because you can't count those Medicare cuts as helping the bottom line of Medicare, while also counting on those same funds to pay for the ACA. The reality is that if those cuts occur, and you say they improve Medicare's outlook, then you're really saying that the ACA is adding hundreds of billions to the deficit.
I don't think those cuts will happen anyway, because (as the CBO itself noted) the political reality of finding completely new cuts in Medicare every year that Congress won't stop is unlikely. It's the same reason for the doc fix. Reimbursement rates are supposed to be much lower than they are now due to supposed automatic cuts, but each year, Congress passes legislation to stop them. Cost savings that require members of Congress to touch that third rail every year won't happen, which is why real savings must be in the form of a major piece of structural reform that is effective when passed, and doesn't need to be revisited every year.
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But I also think having employers bear the burden of healthcare chokes economic growth in the US compared to other countries so it's worth it to me. Additionally, health care has gotten so out of control that some amount of brakes from the top down has unfortunately become necessary. I want single payer government insurance + private supplemental insurance and I'll keep pushing for more government funding of health care until that happens.
Assuming this is true, then the ACA is the worst possible solution. At least, if you believe the Administration's projections. Because according to the Administration, only 7% of employers will drop coverage. The rest will all maintain coverage, and will pay significantly
more for that coverage than they did before because of the cost of the additional mandates -- no lifetime caps, no preexisting conditions, etc. etc. etc. That makes for an
increased burden on American businesses, and more choking of economic growth than under the current system.
And then you have the ACA's effect on all those employers who do not currently offer insurance. They'll all be slapped with a brand new, $2000/employee fine. Wouldn't that also have a negative effect on economic growth by making them less competitive?
So the only way you get what you desire -- moving insurance away from the employment relationship -- is if the Administration's projections are
wrong, and large numbers of employers ditch coverage and pay the $2000 fine instead. And you're right -- that would lower employment costs, and arguably would make those businesses more competitive. But, that would blow the alleged fiscal integrity of the ACA all to hell, because the budgeting of subsidy dollars is based on subsidizing a much smaller number of employees. Having to pay out subsidies as high as $7500 per employee, and having that paid for by fines of only $2000/employee, simply does not work.
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Regarding a conversation, I don't expect Republicans to come around on health care. You're still trying to privatize social security half a century later - some things are core values.
Well, that's sort of my point, and even more so with respect to Medicare. The passage of the ACA and creation of a brand new health care entitlement program means that there cannot be agreement on a structural reform of Medicare that reduces the level of entitlement
under that program. As you say, it is a collision of core values, where one side is willing to pay
whatever is required to guarantee health care for all, and the other side isn't.