U.S. Politics, 7

[Ser Reptitious]

Commodore,

I'm all for spending cuts to offset any tax cuts.

That's all fine and well, but the point I'm making is that if the deficit is such a huge concern then eliminating it should take priority over everything else, including tax cuts.

Once the deficit monster has been slain then you can start arguing about whether to cut taxes or not.

Unless, you know, the Republicans aren't quite as concerned about the deficit as they pretend to be...

[Swordfish]

Exactly. Some people may have made the argument that Swordfish suggested, but many made qualifying statements such as "even if it did cost a bit more, wouldn't that be worth it to cover tens of millions of people?"

That isn't the position that started this discussion. Feel free to go back and look if you don't believe me.

And there are plenty of people who are still adamant that it will be deficit reducing.

You are moving the goalpost.

An article from The Economist on the new study from CMS on the health care law that we've been discussing.

Thank you for illustrating my earlier point that some supporters of the bill are still trotting out the nonsensical 'preventative care will save money' argument.

[Ser Scot A Ellison]

Triskele,

I'm still not convinced it's going to cover the 30 Million. As the costs of Health Care coverage rise to deal with the influx of people who will actually use the insurance costs are going to go up. If the fine people pay is lower than the cost of the health insurance and people are able to jump into the pool regardless of their pre-existing conditions what is to stop them from paying the fine until they get sick and then getting coverage only when they need coverage? In effect only having people who will drain the pool jump into the pool and thereby further pushing up costs for everyone else already in the pool encouraging them to simply pay the fine and creating a dangerous feedback loop in this new system?

(This is regarless of whether I believe the fine itself is a Constitutional exercise of Congressional power)

[The Marquis de Leech]

Balanced budget baby. If I had my way, the next amendment to the constitution would read something like:

"The budget for the Federal Government in any given year can not exceed the revenue of the prior year. This can only be overridden during a time of war, as declared by the congress. In the event of a year-over-year decline in revenue resulting in a budgetary deficit, Congress is directed to reduce spending as it sees fit until all expenditures are covered by existing revenue. All expenditures of the Federal Government are required to be present on the budget."

Tax increases would reduce the deficit too. Except that that (shock horror) would see the rich paying more.

[Tormund Ukrainesbane]

Tax increases would reduce the deficit too. Except that that (shock horror) would see the rich paying more.

So they would. But I am of the opinion that the government is about a quadrillion times bigger than it needs to be already. Also, a balanced budget amendment allows for tax increases. Congress merely has to reduce spending if they are running a deficit this year. They can then pass tax increases to ensure that next year said deficit is eliminated and they can bring spending back up to prior levels.

[Former Lord of Winterfell]

Exactly. Some people may have made the argument that Swordfish suggested, but many made qualifying statements such as "even if it did cost a bit more, wouldn't that be worth it to cover tens of millions of people?"

The people who made that argument include the President, who used that repeatedly as a selling point. And it also includes a great many people here, who ridiculed opposition to the bill on precisely the basis Swordfish articulated "it's going to cover more people and reduce costs -- how could any sane person oppose it?"

And Swordfish, as you say, we don't know for sure that this new number from the Medicare actuary will be accurately just like we didn't know if the CBO scores would be accurate. And I don't begrudge you your feeling that the federal government will find a way to make sure it costs too much, but the bottom line right now is that an aggregation of all the estimates shows it having a minimal impact on overall health spending versus if the bill had not been passed.

There are two points here, and the first goes to the lying sacks of shit who sold us this plan. The plan has not yet been implemented. Nothing has changed. Yet, the estimates are going up. How is that possible? I can understand costs going up when implementation doesn't go as predicted, but when the estimates themselves are being revised upwards before anything has happened, it looks very much like the earlier estimates were intentionally low.

The second point is what is going to happen when implementation actually occurs. Remember, the alleged deficit-reduction and even this overall increase are dependent upon Congress making future, undefined cuts in Medicare spending. If those cuts don't happen or are smaller than expected due to political pressures (and gee, you think that might happen?), all these estimates are going to be even more wrong than they are now.

ETA: All of that said, one of my current worries about PPACA is that the coverage expansion will be a double-edged sword on access. There are incentives in the bill to increase primary care (which we already have a shortage of), but there's no way those will be enough to keep up with the expansion of coverage which is likely to happen quickly once 2014 comes.

This, however, could be a boon for hospitals who will now see a greater number of their ER patients covered than they do now.

Ack! Remember when opponents of this bill asked how it was possible to increase access and reduce expenditures at the same time? That increased access would require more health care personnel and more facilities, yet the bill contained absolutely nothing in the way of reducing health care wages? You just made that point in spades, and the kicker is that is exactly what happened in Massachusetts. We had an example of what happens when this type of "reform" is implemented, and ignored it.

[Former Lord of Winterfell]

So they would. But I am of the opinion that the government is about a quadrillion times bigger than it needs to be already. Also, a balanced budget amendment allows for tax increases. Congress merely has to reduce spending if they are running a deficit this year. They can then pass tax increases to ensure that next year said deficit is eliminated and they can bring spending back up to prior levels.

I'd prefer a constitutional cap on the amount of total debt. It would ignore all the difficulties in making precise estimates and cuts from year to year, but Congress couldn't simply raise the debt ceiling of its own accord and therefore would be compelled to have a balanced budget over the long term.

The problem with tax increases as a way of closing deficits is that they just give politicians more money to spend. Yes, an increase can close the deficit for awhile. But then they'll just start spending again, and need another increase down the road to close that gap. Pass a constitutional amendment capping the debt at maybe $2T more than it is right now, and then in two years, set that figure to start declining by $100B/year until the debt ceiling gets down to a few trillion or so, then freeze the debt ceiling at that point.

The fact that Congress can raise the debt ceiling any time it wants is just obscene.

[Tormund Ukrainesbane]

The problem with tax increases as a way of closing deficits is that they just give politicians more money to spend. Yes, an increase can close the deficit for awhile. But then they'll just start spending again, and need another increase down the road to close that gap.

That is true, but if you look at my amendment you'll see that loophole is much smaller. The budget for next year can't be more than this year's revenue. So if you pass a tax increase this year, next year's revenue will go up. That means that the additional money won't be available to spend until the year after, and of course, there will be a surplus at the end of next year. They won't even be able to spend that surplus, because it didn't show up on this years budget. I can't imagine that constant year-in-year-out tax increases would be tolerated for long. (we have them now in the form of inflation and debt, but since you don't have to write one big check for that no one pays attention).

[Former Lord of Winterfell]

That is true, but if you look at my amendment you'll see that loophole is much smaller. The budget for next year can't be more than this year's revenue. So if you pass a tax increase this year, next year's revenue will go up. That means that the additional money won't be available to spend until the year after, and of course, there will be a surplus at the end of next year. They won't even be able to spend that surplus, because it didn't show up on this years budget. I can't imagine that constant year-in-year-out tax increases would be tolerated for long. (we have them now in the form of inflation and debt, but since you don't have to write one big check for that no one pays attention).

Conceptually, we're in complete agreement. We'd just prefer different mechanisms to get us there, but I'd certainly prefer your alternative to what we have now, which is no restraint other than complete economic collapse.

I guess what's kind of interesting is to wonder why the Founders didn't put something about that in the Constitution. They weren't stupid, and the concept of deficit spending by a government was hardly new -- it had been around for thousands of years. I'm guessing that either they never expected a government of such limited powers to have the ability to do that, and then I suppose they didn't even permit income taxes anyway. Maybe part of it was the experience of the Continental Congress needing to borrow money to keep Washington's army in the field. Makes me wonder if anyone has ever researched that issue.

[Former Lord of Winterfell]

Also a fair point. I spoke about the Independent Medicare Commission (I forget what named they settled on...) in the past and I know that there's a common "commissions like this never work." But it was written in that Congress has to go out of its way to keep the commissions recommendations from becoming law. McCain used this very commission to scare seniors with the argument that it would cut the Hell out of Medicare.

It's not really much different from the "automatic" Medicare cuts that require congressional action to stop that have been in place for years. And Congress goes out of its way to stop those cuts. But more importantly, the report of the actuary even addressed the $500B in Medicare savings used to provide half the financing for this bill:

Actually, said the actuary (paid to analyze data, scenarios and risk), a rosy forecast for Medicare based on health care reforms doesn't add up. "The financial projections shown in this report for Medicare do not represent a reasonable expectation for actual program operations in either the short range... or the long range," Foster wrote.

Near term, Obamacare relies on "unsustainable" reductions in reimbursements to health care providers, he wrote. Long-term, basic assumptions collapse because reductions in price rates for most service categories probably won't be "viable."

Read more: http://newsok.com/report-from-medicare-actuary-has-troubling-figures-on-obamacare/article/3484029#ixzz0z9cOOLxV

First of all, it's totally possible in theory to increase access and reduce spending at the same time if a number of other variables are tweaked. That may not happen with this bill, but it's not a law of physics that this cannot be done.

Well, the biggest thing is controlling provider costs, and neither this bill nor the Massachusetts bill really touched that.

As has been pointed out (By The Economist), ObamaCare was always more about expanding access. Massachusetts was the same way. Yes, many during the health debate tried to also argue that it would reduce the deficit over the first ten years (because CBO said so). And in fact, CBO said it would further reduce it in the 2nd decade. The new CMS actuary report is a minor change in the prediction. As that Economist article pointed out, claims from the right that this is some concrete sign that the bill will explode health spending are overblown. It may, but this new report doesn't really make it any more likely than it was before this report came out.

Actually, the Economist just said the higher costs shouldn't surprise anyone because that's what the Economist had been saying all along. And I understand your point about access. And it's completely fair to argue that the greater access is worth higher cost. But I hope you understand why opponents of the bill are jumping all over this, because the higher cost argument is the exact argument proponents, including the President, were denying during that debate. It went to the core of the appeal: "Covers more people and costs less too!" Now that the bill has passed, the truth leaks out. Wouldn't you think this analysis should have been completed before the bill was voted on? This isn't a new estimate by the actuaries. It's the first one.

[Swordfish]

I guess my point was (and the way I read that Economist column, I thought its point was too) is that while this new report does conclude "health law now expected to cost more than previously estimated," it doesn't say "health law now expected to cost light years more than previously estimated, resulting in financial disaster."

So while some in favor of the bill have pointed to the earlier CBO reports on cost savings, some opponents of the bill have gone very far in the other direction and argued something along the lines of "no matter what any estimates say, it's going to cost tons more and be a total disaster." The new report does not validate that second statement. Of course it may ultimately turn out to be true, but that is an unknown and the report from CMS doesn't do much to validate that line of thought in my opinion.

Well, to be fair, those of us concerned about cost predicted that this is EXACTLY what would happen. The incremental increases in cost estimates. So... We were right.

And it hasn't even been implemented yet!

All you have to do in order to accept your 'wait and see how much it cost before deciding' argument is ignore the history of entitlements in this country, the fact that the estimates are already rising, and the fact that there will undoubtedly be additional spending measures in the future.

With all due respect, that's just a pretty pollyannaish way to look at this.......

Cost estimates are rising. Cost estimates are going to continue to rise. Honestly, I don't think that's even a controversial conclusion unless you have other strong reasons to want to believe otherwise that aren't related to the fiscal aspects of UHC at all.

[Former Lord of Winterfell]

I guess my point was (and the way I read that Economist column, I thought its point was too) is that while this new report does conclude "health law now expected to cost more than previously estimated," it doesn't say "health law now expected to cost light years more than previously estimated, resulting in financial disaster."

Ah, it may be two different estimates, then. There's the cost of the plan itself, and then the overall estimate of health care costs in the economy as a whole. The Actuary's report said that the latter actually would be going up, which is a bit different.

So while some in favor of the bill have pointed to the earlier CBO reports on cost savings, some opponents of the bill have gone very far in the other direction and argued something along the lines of "no matter what any estimates say, it's going to cost tons more and be a total disaster." The new report does not validate that second statement. Of course it may ultimately turn out to be true, but that is an unknown and the report from CMS doesn't do much to validate that line of thought in my opinion.

Although again, the Actuary has now come out and said that the Medicare cuts that are a core part of the plan's financing are neither reasonable nor sustainable. So on top of these higher numbers due to basic number-crunching, if the Actuary is correct, those cuts on which the calculations are based won't happen, and that'd make it a huge budget-buster.

[The Progressive]

And it hasn't even been implemented yet!

Errr, no. Some provisions have already been implemented, which probably account for the cost.

[Swordfish]

Yes, costs are rising. And they were estimated to rise with or without the act.

Seriously? What the fuck are you talking about?

I'm referring to the costs of the bill.

I'm going to walk away from this discussion at this point, because I know you're not a moron, and therefor the only possible other factor at play here is that you are being deliberately obtuse.

For someone who is constantly claiming that the 'it will cost less' argument doesn't matter, you sure to spend a lot of energy trying to defend it.

I believe that the actuary's report also said that most of the cost increases are between now and 2014 or 2015 with it tapering off in the 2nd five years once everything is in place. You could argue that this is bad on the Dems for the way they designed the timeline, but that portends well for the 2nd decade. And to be fair about people's cost savings arguments, many people pointed out "it reduces the deficit in the first decade and is estimated to reduce it even more in the second decade."

No. It wasn't.

And even if that WAS their argument, what is the relevance of this statement, since we know now that it doesn't reduce the deficit in the first decade?

I have no idea why you would be pointing out old, wrong arguments at this point, but it certainly doesn't support your claim that any of this portends well for the second decade.

Quite the opposite.

Yes, I understand the history of entitlements, but this bill also attempts to cut entitlements on one side and expand them on another. It's largely a shifting from Medicare to Medicaid (and Medicaid is cheaper per person by far). It may end up being true that it fails to do so, but I think it's highly likely that something else will be done to cut Medicare in that event.

Then you are even more of a pollyanna than I thought.

[Former Lord of Winterfell]

A couple of vile and degenerate liberals have explanations along with a graph from Health Affairs on what the spending differences actually look like. It backs up what I just said about how there's a spike in the early part of implementation but then a major leveling off after that. Sure doesn't look like a financial disaster compared to the status quo (to which we must always compare it).

Here.

Also here.

The report says on page 10, that total national healthcare expenditures in 2019 will be 21.3% of GDP under Obamacare versus 20.8% under current law. That's a cost increase equal to 0.5% of GDP, hardly an insignificant number. Klein, in particular, is being a disingenuous little twit. He points to the one-time spike in growth rates due to adding people as if a one-year spike only affects that year. "See? It drops back down!" But obviously, that spike increases the baseline costs for each succeeding year. So even if the rate of growth drops back down, the growth rate is being applied to a higher cost.

Most importantly, and not surprisingly, both of those guys completely ignored the other part of the Actuary's report, which states that the Medicare cuts upon which the Obamacare cost estimates depend are unsustainable. That's a critical point since the only reason net costs aren't estimated to go up even more than that 21.3% is due to these purported Medicare savings.

The most troubling thing about the report to me is that the Actuary basically says "nobody's done anything this big before, there are a great many moving parts, nobody really knows what is going to happen, so all these estimates contain a great deal more uncertainty than estimates they normally do on healht care bills.

[Shryke]

Actually it was the argument all along. Whenever cost was brought up, people (including me) continually pointed out that the CBO report showed savings in the first decade and EVEN MORE in the second decade. Although the second decade estimates are much looser (as said by the CBO itself), which was also mentioned frequently.

But really Swordfish, you seem incapable of grasping the idea of 2 different but not contradictory arguments. Most people said "It'll save money in the long run" and then "Even if it doesn't, it'll still cover more people".

And that's not even looking at all the other shit it does, like removing the ability to discriminate based on pre-existing conditions.

[alguien]

Yes, Swordfish, for all his talk of moving goal posts, seems to want to insist on ascribing a much more precise stance of every single person who ever gave the bill any kind of support than every actually existed.

But to his credit, at least there was no mention of the term "unique snowflake" or a ;) icon.

[Tormund Ukrainesbane]

Libertarians, which Tea-Party geniuses like to pretend that they are, explain to the Tea Party that they are morons for voting republican.

WASHINGTON - Looking toward the 9/12 Tea Party events in Washington, DC, Libertarian Party executive director Wes Benedict issued the following warning to Tea Partiers: "Republicans are trying to fool you again."

"There are two kinds of Tea Partiers," said Benedict. "One kind is so blinded by its hatred of Obama and Democrats that it cannot see fault with Republicans. It's the other kind the Libertarian Party is reaching out to

Benedict continued, "Libertarians have much in common with Tea Party goals of reducing government spending and taxes. While many Tea Party supporters will admit that George W. Bush's administration grew government, Libertarians want to remind Tea Partiers about previous Republican administrations that loved big government.

"Republican Newt Gingrich and the Contract with America promised to eliminate the Departments of Education and Energy. Yet once Republicans took control of Congress, they failed even to reduce the spending on those departments.

"Republican President George Bush, Sr. remains famous for coining the phrase 'Read my lips, no new taxes,' and then raising taxes.

"Republican President Ronald Reagan grew federal government spending to the highest level it had reached since World War II. He also 'saved Social Security' by raising payroll taxes.

"Republican presidential candidate Bob Dole was a huge supporter of taxpayer subsidies for corn and ethanol.

"In 1971, Republican President Richard Nixon instituted wage and price controls. That made a group of free-market supporters so angry that they decided to form the Libertarian Party.

[Swordfish]

Yes, Swordfish, for all his talk of moving goal posts, seems to want to insist on ascribing a much more precise stance of every single person who ever gave the bill any kind of support than every actually existed.

Bullshit.

I have never claimed that was the argument of every person who supports UHC. But it was, and still is, most certainly quite prevalent, and there is no disputing the fact that is is the argument that started THIS current discussion. To suggest otherwise is laughable.

Just like the 'Preventative care will save money' argument.

Again, for someone who claims that the 'it'll save money' argument doesn't matter, you sure do spend a lot of time trying to defend it, and the people who make it.

[Swordfish]

I'm not saying it doesn't matter. You're just trying to use semantics. And I'm only "defending" it to a certain degree in the context of this new discussion which is to say that the new report doesn't tell us anything all that revelatory or instructive. As has already been pointed out many times, the CBO scores showing that it reduced the deficit weren't what most proponents of the reform were basing their support on.

Which makes it odd that that argument was trotted out ad nauseum, yes?

That is precisely the point which started this discussion. Go back and read it.

There was a 'how could you be against the deficit reducing bill that gives UHC to everyone' statement, FLOW pointed out that most democrats didn't even believe that deficit reducing nonsense, I commented that even the CBO doesn't really think that anymore.

Go back and look at any previous UHC thread on this board and then come back and tell me with a straight face that that isn't the ARGUMENT that MANY supporters of UHC fling around first and most often.

What is the ultimate point that you're trying to get at? That there's a chance that this will be a financial disaster? If so, I concede. It's possible. But none of the reports we've been talking about including this new one suggest that.

Of course they do. Because they are following a familiar pattern that in the past has led to unsustainable entitlements. We've been over this. I get that you don't want to accept it, but......

That's why I'm holding out some hope that the Independent Medicare Advisory Panel whatever it's called will do something because it has to. But again, if it doesn't, it just proves that we were beyond fucked before this bill was passed.

So your argument is that we were fucked anyway, so might as well have an orgy with a bunch of diseased hookers and go out with a bang?

We were probably fucked before the bill was passed, true.

We are most assuredly fucked now.

IMO, naturally.