US-Politics The Resistible Rise of Donald J. Trump

[BloodRider]

This is what the evidence suggests. That article links to and discusses a study in which a firm switched many of their workers into high-deductible insurance plans and gave them new tools to incentivize price comparisons (access to online tools to price check + a $3,750 subsidy to a health savings account to offset their new $3,750 deductible). The result was that the patients didn't shop for a better deal. They just used a lot less health care. (Now, some bean-counters might consider this a win - after all, less health care was used. But presumably we want a health care system which actually, you know, provides health care to people, rather than one where all the incentives line up against using it at all.) 

Here's another article speculating about part of why this might be the reason - which is that your average consumer of health care has zero basis to evaluate variations in quality of health care service prior to using it. Which is all pretty common sense stuff that liberals have been saying forever anyway. 

Yup - Its a huge problem.  And it highlights a major failing of Libertarian philosophy.  When the product is as complicated as health care, it is impossible to become an expert in what it all means.  Hell, even Dr. specialize - and most of them have NO skills navigating the Insurance side of things.  Asking a patient to get up to speed on both their condition and how insurance handles it at the fucking point of sale is risible - near tantamount to negligence, if not pure exploitation.

[Mr. Chatywin et al.]

I submit another entry in the "JEB! is just bad at this" file:

 

http://www.cnn.com/2015/12/30/politics/jeb-bush-hurricane-katrina/

This man  is making Romney look good. And that's the guy who apparently had to be talked out of telling Hurricane victims it was their own damn fault.

Hey now, he's the "smart" one. Is our JEB! learning? No, no he is not. 

W might have been a moron that sounded like a Texas hillbilly, but he was at least a decent campaigner.

[Ser Scot A Ellison]

Tywin,

I don't support anyone at this point but being a "good campaigner" is a pretty shitty reason to select a candidate for President of the US.

[Mr. Chatywin et al.]

Tywin,

I don't support anyone at this point but being a "good campaigner" is a pretty shitty reason to select a candidate for President of the US.

It's one of many reason to select a candidate. You could have the most qualified person in the country at handling the day to day aspects of being the president, but if they can't give a speech, set up an effective campaign organization and handle retail politics then what's the point? They won't win the presidency.

The three most qualified people running are Clinton, Bush and Kaisch. And they're all terrible campaigners. Bush and Kaisch have no chance of winning their primary (and this is so dumb because Kaisch/Rubio is a dream ticket) and Clinton is only doing well because she has weak opposition (that's not a shot at Sanders, but it's unrealistic to say he ever had a chance to with a majority of the party's support).

[Ser Scot A Ellison]

Why does running a campaign have any bearing on actually being President?

Perhaps this is jusf an aspect of one of the worst features of representative democracy, in my opinion.  We give power to people who want power.

[Mr. Chatywin et al.]

Why does running a campaign have any bearing on actually being President?

Perhaps this is jusf an aspect of one of the worst features of representative democracy, in my opinion.  We give power to people who want power.

There are some parallels between running for office and performing your job once in office. For example, IMO  the second most important job of an executive is to be able to put the best staff possible around you. And you need to put a great staff in place to have a successful campaign.

As to your second thought, how would you replace it? Would you go the route of the Chinese? I personally like their system, but it will never happen here.

[Ser Scot A Ellison]

Tywin,

Churchill said it first, "Democracy is the worst form of government... except for all the others."  

I do wonder if making offices like the Presidency a duty for 2 year terms rather than elected might be a better method, probably not but it's interesting to speculate about.

[Mr. Chatywin et al.]

I do wonder if making offices like the Presidency a duty for 2 year terms rather than elected might be a better method, probably not but it's interesting to speculate about.

How would that ever work?

[Ser Scot A Ellison]

Tywin,

Like Jury Duty but with the presidency.

[Mr. Chatywin et al.]

Tywin,

Like Jury Duty but with the presidency.

I think that might be the single worst idea I've ever heard of. It might work out for the the House, but having some random idiot in charge of the military is so foolish.

[Mudguard]

Whoops - I thought I had included those in my post.  Sorry.

http://healthaffairs.org/blog/2015/03/23/what-is-behind-the-post-recession-bend-in-the-health-care-cost-curve/

http://www.forbes.com/sites/rickungar/2013/02/12/new-data-suggests-obamacare-is-actually-bending-the-healthcare-cost-curve/

 

The first link is the more interesting of the two.  It's much more recent and has a lot more data to do the analysis.  The second link doesn't provide any analysis and just quotes the CBO and Whitehouse.  I would like to see what the CBO is saying now when health care expenditure growth is approaching prerecession levels again.

The conclusion of the first link is that the slowdown is mostly attributed to the overall reduction of inflation (60% of slowdown), and then the rest mostly to the recession.  Then there's a very small portion that can be accounted by structural changes made in the health care system.  Based on this analysis, it doesn't appear that the ACA did much to bend the cost curve.

This all suggests that the vast majority of the post-recession slowdown is attributable to lower economy-wide price inflation along with some temporary noncyclical factors. Of the surprisingly small amount left to be explained by the recession and structural changes, I would attribute the greatest share to the recession.

[Mudguard]

The experts aren't 100% certain, as I understand it, but I've read that the bend of the curve was sharp enough that there is good reason to think the ACA had a positive impact.

Edited to add: Honestly, even if the ACA did nothing to affect costs it's still a way better system than the one we had, which was expensive and failed to protect lots of people.

After reading through Bloodrider's links, I'm even more convinced that the ACA hasn't really done anything to control health care expenditures.  On the bright side, it doesn't look like it's really done anything to increase the growth rate either.  I think this makes sense since there are parts that would tend to increase costs, like more people signed up under Medicaid and the conversion of a portion of the uninsured to insured, particularly those who were were sick.  This increase is balanced out by the few cost control measures implemented by the bill, and by the absurdly high deductibles in many of the ACA plans which tends to discourage consumption of health care services.  Also, the vast majority of people still receive health care through their employers or were already covered by Medicaid, so the changes that we are talking about account for just a small fraction of the overall costs.  It wasn't going to move the needle much one way or the other.

I think the ACA has been a mixed bag.  It's been great for the new people that have been able to qualify and sign up for Medicaid, and for the sick people that really needed insurance that either were denied insurance or were facing sky high insurance premiums.  But for others, it's made them worse off, mainly because the plans tend to really suck, especially if you don't qualify for subsidies.  The sky high deductibles reduce many of the plans into essentially catastrophic plans.  

If Congress was functional, these problems could probably be addressed, but that doesn't look like it's going to happen anytime soon.

[Shryke]

It's one of many reason to select a candidate. You could have the most qualified person in the country at handling the day to day aspects of being the president, but if they can't give a speech, set up an effective campaign organization and handle retail politics then what's the point? They won't win the presidency.

The three most qualified people running are Clinton, Bush and Kaisch. And they're all terrible campaigners. Bush and Kaisch have no chance of winning their primary (and this is so dumb because Kaisch/Rubio is a dream ticket) and Clinton is only doing well because she has weak opposition (that's not a shot at Sanders, but it's unrealistic to say he ever had a chance to with a majority of the party's support).

Uh, what? Clinton is doing well because she's campaigning well. She's securing endorsements, she's building her brand, she's doing well in debates and interviews and she's not speaking when her opponents are screwing the pooch all on their own.

[Mr. Chatywin et al.]

Uh, what? Clinton is doing well because she's campaigning well. She's securing endorsements, she's building her brand, she's doing well in debates and interviews and she's not speaking when her opponents are screwing the pooch all on their own.

She's doing well because she's the only viable choice. If there were other realistic options available when she was struggling to find a way to explain the email issue she would have been in serious trouble.

[Shryke]

She's doing well because she's the only viable choice. If there were other realistic options available when she was struggling to find a way to explain the email issue she would have been in serious trouble.

What are you basing this on?

[Manhole Eunuchsbane]

Why does running a campaign have any bearing on actually being President?

Perhaps this is jusf an aspect of one of the worst features of representative democracy, in my opinion.  We give power to people who want power.

At least it is some sort of indication as to whether or not they can do the job. If you can't get the job, you can't do the job.

[TrackerNeil]

I think the ACA has been a mixed bag.  It's been great for the new people that have been able to qualify and sign up for Medicaid, and for the sick people that really needed insurance that either were denied insurance or were facing sky high insurance premiums.  But for others, it's made them worse off, mainly because the plans tend to really suck, especially if you don't qualify for subsidies.  The sky high deductibles reduce many of the plans into essentially catastrophic plans.  

I don't see how people are worse off, unless you think that preventing them from buying shitty insurance plans is a bad thing. Generally speaking, it's better for everyone to be insured, and part of that by necessity is that some of are going to pay for the care of others. We were doing that before, truth be told, but now we're all aware that we're doing it. So I think that, like most progressive legislation, the ACA was a step forward even if two steps were what was really needed.

[Mudguard]

I don't see how people are worse off, unless you think that preventing them from buying shitty insurance plans is a bad thing. Generally speaking, it's better for everyone to be insured, and part of that by necessity is that some of are going to pay for the care of others. We were doing that before, truth be told, but now we're all aware that we're doing it. So I think that, like most progressive legislation, the ACA was a step forward even if two steps were what was really needed.

For one, the people that end up paying the penalty for not having insurance are worse off than before.  These people are still uninsured, and now also have to pay a penalty. 

[ThinkerX]

My monthly tab under the ACA is getting set to triple - and that's after the subsidies.  Plus, this last year, the insurance company flat out refused to pay for some tests.  So I had to pay those as well.  From what I read in the comments to various articles, I am not alone.  A great many people, left and right alike, have severe problems with the ACA.

[Mudguard]

My monthly tab under the ACA is getting set to triple - and that's after the subsidies.  Plus, this last year, the insurance company flat out refused to pay for some tests.  So I had to pay those as well.  From what I read in the comments to various articles, I am not alone.  A great many people, left and right alike, have severe problems with the ACA.

Yeah, lot's of people are seeing big increases in premiums.  The ACA was designed to have a very soft roll out.  Insurance companies were given big incentives through provisions like the risk corridors to initially underprice insurance premium to encourage people to buy into the system.  These incentives are now being phased out and the insurance companies also have a better idea about the composition of patient pools, so we are beginning to see the true costs of insurance on the market.

If it's not too personal, did you have health insurance before the ACA that you purchased independently?  If so, how does it compare with your current plan with respect to costs of premiums, deductibles, coverage of services, access?