So here's another anti-Obamacare ad aimed at Kay Hagan, running now across the state with the frequency that big out-of-state money can buy.

Like the spot discussed here, this commercial is carefully constructed in terms of tone and feeling. It's not a red-meat call for repeal, but a pitch to moderate voters by a soft-spoken woman who seems disappointed that she has to deliver this critique of the Affordable Care Act: "It just doesn't work." 

It's another effective ad, but also one that shows how the conversation about healthcare reform is changing -- and how Hagan can fight back (as noted in the previous post, Hagan is going to own Obamacare in this race whether she wants to or not, so she'd better make the best of it). For starters, the ad reflects the reality acknowledged by the Burr/Coburn/Hatch proposal -- our healthcare system really was broken and something has to be done to fix it (another inadvertent lesson of the GOP plan: coming up with a workable strategy is not easy). 

The pushback should begin by pointing to ways that the ACA is working. That means addressing claims about the damage done by Obamacare, correcting any misstatements or overstatements, and promising to fix what's not right. And it means telling the stories of real people who have benefited from the changes to date. It means saying, "It does work."

Of course, Obamacare will need to maintain the momentum it's gained for this campaign to work, so pushback ads probably can't run until April. It would be very helpful if North Carolina's surprisingly strong enrollment numbers continue to trend upward. And Hagan is going to need a whole lot of money to move the needle after the long barrage of ads against her.

But pushing back against this campaign is possible, and, again, the only choice Hagan really has. 

Comments

[Greensboroobserver.wordpress.com]

Ed-

What are your thoughts on the impact of ACA on cost of goods sold/inflation and nominal interest rates? Also the impact on the number of full time versus part time jobs offered by companies?

MK

[Polifrog]

For starters, the ad reflects the reality acknowledged by the Burr/Coburn/Hatch proposal -- our healthcare system really was broken and something has to be done to fix it ...

I missed the assumed argument that before, during and after the passage of the ACA that nothing was broken in our healthcare.

As I recall the two arguments were, one, "we need more government to fix healthcare" and, two, "we need lees government to fix healthcare."

The former argument won out in the form of the ACA.

Now we find that things are worse.

== Insurance rates are higher. (we were promised an average $2500 savings)
== Deductibles are higher.
== More people have been forced off insurance than those who were once uninsured have gained insurance.

== More people are out of work due to the ACA. (As the CBO notes ... free stuff is as much a disincentive to work as a tax.)

== Once full time individuals have been forced into part time work due to the expense of the ACA.

== Many of us have not been allowed to keep their doctor ot their insurance plans as promised.

Ed, many of these are structural issues.
...I suppose your free advice for Kay is free for a reason.

[Ed Cone]

Hi Marty, good to see you blogging.

I would need some more guidance to address your question about cost of goods sold/inflation and nominal interest rates. I am concerned about corporations minimizing hours to avoid insurance obligations, and also concerned for small businesses trying to provide benefits, the latter being an issue I hear about from business owners.

But my approach to the overall issue is from the ground up. If the foundational arguments are sound, as I think they are, then all else is in the details.

The first point: If we have some form of universal access to healthcare, as we do, and if there is no serious movement toward denying this universal access (that is, denying any care to those who can't pay), then there should be some form of universal insurance coverage.

The second point: If our current form of universal access is broken, which it is, then we should find ways to improve it, such as making non-emergency care more widely available.

I take those points as axiomatic. The ACA attempts to address both of them. The law also tries to deal with costs, by changing the way healthcare providers get paid (this is a big problem with NC's refusal to expand Medicaid -- beyond denying insurance to many people, it makes providers take all the economic pain without allowing them one of the principle offsets to that pain designed into the law.)

The law is far from perfect, and I'm interested in hearing about improvements or even replacements. Repeal alone would take us back to the untenable preexisting condition, so that's a non-starter, and anyway people already expect things like coverage for pre-existing conditions (which I think will unleash considerable economic value as workers are no longer chained to jobs to keep insurance for themselves or family members). The GOP establishment clearly understands this reality, even as their own suggested plan falls short in key areas.

What's your take?

[Fred Gregory]

Poli on your point about the CBO report, I am amazed at the defenders of the ACA and their mangling ( insanely spining ) of a 2 1/2 million job loss into a blessing in disquise. Pure fantasy.

Check this out

The Economist Who Exposed ObamaCare

" In September, two weeks before the Affordable Care Act was due to launch, President Obama declared that "there's no serious evidence that the law . . . is holding back economic growth." As for repealing ObamaCare, he added, "That's not an agenda for economic growth. You're not going to meet an economist who says that that's a number-one priority in terms of boosting growth and jobs in this country—at least not a serious economist."

In a way, Mr. Obama had a point: "Never met him," says economist Casey Mulligan. If the unfamiliarity is mutual, the confusion is all presidential. Mr. Mulligan studies how government choices influence the incentives and rewards for work—and many more people may recognize the University of Chicago professor as a serious economist after this week. That's because, more than anyone, Mr. Mulligan is responsible for the still-raging furor over the Congressional Budget Office's conclusion that ObamaCare will, in fact, harm growth and jobs "

RTWT

[Polifrog]

Fred,

It is interesting how quickly the CBO retreated from their analysis upon the executive's revisionism of the ACA. Either they don't even bother with pretense, that the executive acts without planing or, most likely, the CBO has been forced to work on the fly due to law that has become less and less a law in the American tradition and more and more something so foreign to Americans that they have difficulty recognizing it for what it is.

Regardless, it is clear that a delay in even parts of the ACA results in improved job expectations...

But perhaps Ed's right...Democrats should embrace the suck.

[Polifrog]

I heard a good phrase today, "Running around the block to get next door."

And I believe it aptly describes why prices for not only healthcare, but education as well rises faster than inflation despite the anti inflationary nature of technology on each.

In both instances government has, with the intention of curbing costs, interfered with the market and has in each case driven costs higher. The solution? More government interference with the ACA in one hand and college loan expansions in the other. The result? Higher costs for each.... running around the block to get next door.

I suppose I take it as axiomatic that the American virtue of trusting citizen solutions over government solutions begets actual solutions.

[Greensboroobserver.wordpress.com]

Ed-

Thanks, I'd welcome any feedback on the blog or blogging protocol.

On ACA -- I'm concerned that it will result in higher cost of goods sold and inflation. I've heard business owners talking about the additional costs they will incur by having to provide health insurance. I've also seen estimates and had discussions about premiums going up (which would likely have to in order to cover those with preexisting conditions). I believe those costs will be passed on to consumers in the form of higher prices. A jump in prices means inflation.

With inflation comes higher nominal interest rates as they are the sum of the real interest rate and inflation. I'm concerned that interest rates will rise over the next few years. As interest rates rise, the cost of products and services will rise as well. That leads to even higher inflation.

A high interest rate environment would have devastating effects on the economy and stock market.

Another impact I fear is a move to part time workers. As companies try to avoid coverage, they will reduce hours for workers because of the incremental cost of a worker over 30 hours. Those 10 extra hours will have a significant cost, in the same way overtime does. Darden Restaurants tried a pilot program of reducing all staff hours to less than 30, but shut it down due to negative media attention. I would expect them to roll out that program along with many other national chains when the employer mandate kicks in. This will likely lead to staff having two jobs.

In summary, I'm concerned that ACA will increase the cost of goods, drive up inflation, increase interest rates and decrease the number of full time positions available.

[Fred Gregory]

Poli,

Allow me to add this to your bill of particulars.

CBO Says Obamacare’s Bailouts Might Make Money for the Government. Here’s Why CBO Might Be Wrong.

" Several weeks ago, Sen. Marco Rubio (R-Fl.) and Washington Post columnist Charles Krauthammer took aim at a little known provision within Obamacare known as risk corridors, dubbing the mechanism a bailout of insurers and calling for repeal.

The risk corridors are a temporary program designed to share the financial risk of health plans offered through Obamacare’s exchanges between insurers and the federal government. In theory, the sharing is symmetrical: If insurer expenses within those plans are lower than expected, then insurers pay the federal government a percentage of the difference between their expected target and actual spending. If insurer costs turn out to be higher than expected, because members are sicker and use more expensive medical care than predicted, the federal government picks up a chunk of the tab.

The bigger the difference between insurer costs and expectations, the more that the federal government pays out. When the law was written, the goal of the provision was to entice insurers to offer plans in the exchanges by limiting their risk exposure."

Please RTWT

[Polifrog]

Thanks, Fred. I have not read that. However, as is the norm, I'd like to turn more philosophical...

======

Setting aside that the ACA not only resulted from but is operating as a pretense of democracy, I wonder how one can support the ACA as Ed does.

Ed said,

The first point: If we have some form of universal access to healthcare, as we do, and if there is no serious movement toward denying this universal access (that is, denying any care to those who can't pay), then there should be some form of universal insurance coverage.

The second point: If our current form of universal access is broken, which it is, then we should find ways to improve it, such as making non-emergency care more widely available.

While his points were admittedly difficult to argue with prior to the ACA we are no longer living at a point prior to the ACA; we are living under it. We now know its reality.

The reality of the ACA is in line with the predictions made by its detractors. It is undeniable that there are now more people without insurance coverage than before the ACA. Furthermore, of those who have signed up only 10% had no insurance prior to the availability of the ACA. That means 90% of the ACA's new customers were kicked out of the insurance plan the they were promised they could keep. The ACA has done nothing for the 30 to 40 million uninsured who were dwelled upon prior to the ACA's passage and Americans as a whole are now worse off due to the ACA.

Remainder of comment edited by ec. Post is about ACA and the Hagan race, comments should be, too. Save the fanfic about about my imagined political philosophy for other venues.Thanks!

[Fred Gregory]

Ed wrote " anti-Obamacare ad aimed at Kay Hagan, running now across the state with the frequency that big out-of-state money can buy."

Kay's opponents can't match this kind of raw, corrupt, out of state power.

Somebody needs to tell Kay Hagan, who is going after the evil Koch brothers as if they are trying to destroy American democracy with their evil spending, that she needs to adjust her aim:

" This week Senate Democrats once again asked the IRS to crack down on conservative groups including Americans for Prosperity, funded by the billionaire industrialists Charles and David Koch.

Democrats want to silence the opposition.

So how big of a threat are the Koch Brothers?

Over the past twenty five years, from 1989 to 2014, Koch Industries has donated $18,083,948 in political contributions to Republicans. While that seems like a large sum, it only ranks them as number 59 on the list of top all-time political donors – behind 18 different unions."

[Jim Buie]

Glad you're blogging again, Ed.

Poli wrote: "More people have been forced off insurance than those who were once uninsured have gained insurance." Actually, Gallup has determined that the number of uninsured has already declined from 17.1% in the last quarter of 2013 to 16% in the first quarter of 2014. http://www.gallup.com/poll/167393/uninsured-rate-drops-far-first-quarter-2014.aspx

Poli also wrote: "Insurance rates are higher. (we were promised an average $2500 savings). == Deductibles are higher." Other than anecdotal evidence, what economic analysis can you point to that has already, hastily, come to this conclusion, a month and a half after Obamacare went into full effect?

Premiums are not higher for the 14 million people who are likely to be better off, according to the Congressional Budget Office, if you add the seven million projected Obamacare sign-ups this year to seven million new Medicaid enrollees. About five to seven million people will qualify for subsidies that will pay most of the cost of comprehensive plans. http://www.nytimes.com/2013/11/11/opinion/high-and-low-premiums-in-health-care.html?hp&rref=opinion

Somewhat fewer than four million people, if they don't currently have insurance, could feel worse off this year, if they make too much money to qualify for a subsidy ($46,000 for individuals; $95,000 for families) and don't find satisfactory health plans in their marketplace. But if they can't find a policy for eight percent of their income or less, they are exempt from the mandate.

Obama's temporary fixes -- allowing insurance companies to keep consumers on substandard plans until the end of 2014, and waiving the individual mandate for the first year for consumers' whose plans were cancelled -- are likely to reduce the four million even further.

So, it looks like 14 million will be better off and significantly fewer than 4 million might be worse off.

[Fred Gregory]

Jim,

The rosy 3.3 million enrolee figures are inflated AND according to the industry 30% of them have not even paid their premiuns.

Should have read it before they passed it. More trublesome , not insignificant , details

Obamacare 'Bailout' For One Insurer Will Cost Up To $450 Million In 2014

"There’s been a lot of discussion about whether the risk adjustment tools embedded in ObamaCare amount to a bailout for the insurance companies, or are a reasonable feature of the law. There’s been far less information about how much money the insurers stand to gain from these measures, to offset their expected losses.

Now we have some hard numbers. Humana announced that it expects to tap the three risk adjustment mechanisms in ObamaCare for between $250 and $450 million in 2014. This amounts to about 25 percent of the insurer’s expected exchange revenue. This money is needed to offset losses that the insurer will take as a result of slower enrollment in its ObamaCare plans, and a skewed risk pool that weighs more heavily toward older and less healthy members than it originally budgeted.

More than half of the money will come from the $25 billion reinsurance pool that ObamaCare provides (collected through a tax on employer-sponsored health plans). The other half will come mostly from the risk corridors. Humana is expected to book the money as revenue to offset shortfalls between what it collects in exchange premiums and pays out in medical claims.

The company blamed the Obama Administration’s decision late last year to extend grandfathering of individual market plans for the overall deterioration in the risk pool. That means that Humana (like other insurers) was counting on people from the individual market being forced to transition into ObamaCare plans. It’s widely perceived that the Obama Administration counted on that migration as well. But Humana’s statement was a very clear expression of this expectation."

[Jim Buie]

Fred, it's interesting that you guys quote the CBO when it suits your purposes, that Obamacare will somehow doom the nation, but discount any good news, such as the CBO's projection that Obamacare is on target to sign up seven million uninsured for each of the next three years, and 28 million by 2017, down from 58 million uninsured in 2013. You might take a look at this Forbes.com column by Obamacare critic Avid Roy of Forbes.com headlined, "Sorry, Conservatives, But Based On the Latest Sign-Up Figures, There Won't Be an Obamacare Death Spiral."

http://www.forbes.com/sites/theapothecary/2014/02/12/sorry-conservatives-based-on-the-latest-sign-up-figures-there-wont-be-an-obamacare-death-spiral/

A CBO study estimates that federal health care spending for 2012 is coming in at 15% below initial estimates, and that hundreds of billions of dollars are being saved in Medicare and Medicaid. For the fourth straight year, the rate of growth in health care spending has declined, and the CBO attributes "a significant part" of the savings to health care restructuring resulting from Obamacare, according to Forbes.com. http://www.forbes.com/sites/rickungar/2013/02/12/new-data-suggests-obamacare-is-actually-bending-the-healthcare-cost-curve/

The Humana "bailout" story, which is hardly certain since Obamacare only took effect January 1 and Humana doesn't yet know for certain how many people will sign up, starts from the assumption that there should be no built-in shock absorbers to stabilize the insurance market "while carriers adjust to new regulations that prohibit them from denying coverage, withholding benefits,or charging higher premiums to people with pre-existing medical conditions." http://www.newrepublic.com/article/116353/republicans-say-obamacare-insurer-bailout-tying-debt-ceiling

Unless you're an ideological zealot who only wants "facts" that reinforce preconceived dogma, it's really premature to come to any final conclusions about a program that just began January 1. This debate on Obamacare's impact will go on until at least 2017. Obama is president until then and can veto any attempt by Congress to scrap it.

[Ed Cone]

"It's really premature to come to any final conclusions about a program that just began January 1."

Yes. A lot of the arguments, including the commercial's "it just doesn't work," are designed to cut off the discussion before the evidence is in.

The evidence will be mixed in either direction, given the size and complexity of the issues, but the naysayers are understandably nervous about any positive trends.

Those trends, should they solidify, may emerge too late to save Hagan's seat, but already (as seen in Burr/Coburn/Hatch and even comments here) the essential argument has shifted to fixing the fixes, not going back to the status quo ante.

[Jim Buie]

Given that Obama can veto any "harm" Congress might pass to his signature legislation, I think we're realistically looking to 2017 before new or corrective legislation will be seriously considered. And wisely so, since it will probably take that long to judge the legislation's full impact. Until then, there will be a public relations war between supporters and opponents, pouring millions into swaying and manipulating the public. Click

[Ed Cone]

Marty, thanks for the response -- sorry for the delay, it got hung up in my spam filter for some reason (as did one of my own comments; computers is dumb.)

Anyway: Given the fundamental issues at stake, and our ongoing low-inflation/low-interest-rate era, and the possibility that reform will slow healthcare cost inflation, I don't see the "what if" arguments you advance as compelling reasons to reconsider reform.

As I said, I share your concern about the move to part-time workers.

[Fred Gregory]

This thread began as a discussion of how evil out of state money was being used to bring down our junior senator.

She is now in engaged in a series of Dorian Gray ( Oscar Wilde ) transformaions

The Many Faces of Kay Hagan

"The Tar Heel Democrat, eager to retain her Senate seat, tries a series of political makeovers.

Feb. 13, 2014 6:12 p.m. ET

Defying physics, ObamaCare has managed to create energies where none existed before: confusion over policies, anger over lost doctors, panic over costs. Most amazing has been the law's ability to produce entirely new Washington life forces. The scientific formula goes like this: Another day + Another ObamaCare disaster = A New Kay Hagan...."

[Jim Buie]

Yep. If she doesn't come out swinging in the spring after the Obamacare numbers for the March 31 deadline come in, she could be in trouble. However, her most likely opponent, Thom Tillis, is getting some negative, unwelcome attention on his health care positions that might offset some of the attention on Hagan.

http://www.youtube.com/watch?v=Vxi-CIzU4nA

[Ed Cone]

Fred, out-of-state money is one topic in the post, and surely it's a part of this campaign story, but my main focus is meant to be on shifting views of healthcare reform and the opportunities and liabilities thus presented to Hagan (and, as JB points out, Tillis).

[Greensboroobserver.wordpress.com]

Ed-

I put together a detailed post on inflation/interest rates on my blog. Kind of hard to post everything here - plus half your post is about the politics and ad, the other half about ACA working. Here's a link to it - http://greensboroobserver.wordpress.com/2014/02/15/will-inflation-and-interest-rates-rise-aca-impact/.

I've linked to this thread of comments in the post. Let me know if I'm following proper blog etiquette - I'm new to this.

MK

[Ed Cone]

Marty, interest rates are bound to increase from their historically low levels -- and they should. Current rates are a backdoor bailout for banks and a major disincentive to saving. So just saying rates will go up at some point is a no-brainer. You also say higher rates could hurt stock prices. Again, yes -- super-low rates feed bubbles. As with the Fed taper, the idea is to take our economy off life support.

Your case that maybe healthcare reform might increase interest rates and inflation in some parts of the economy is 1) speculative 2) incomplete with considering possible reductions to healthcare inflation and 3) ignores other benefits to people and the economy from a broader insurance pool. That makes assessing its impact on a net basis impossible.

[Andrew Brod]

The ACA isn't going to spawn inflation. Even if Marty's scenario plays out, and employers pass on an increased cost of offering insurance to their customers, it'll essentially be a one-time phenomenon. Yes, a one-time price increase would be recorded as inflation... but only one time. It could not generate a sustained inflation, i.e. an ongoing series of price increases.

Beyond that, what we know is that some employers' benefits costs will rise and some won't change. But thereafter, the projected reduction in the increase of healthcare costs (per the CBO) will mitigate that.

Moreover, as Ed noted, we're in a very low-inflation environment, which means, among other things, that sellers have little market power to raise prices. They have more power to push back on wage and salary increases than to raise prices. To the degree that the ACA raises benefits costs, it's more likely to affect workers' wages than consumer prices.

[Greensboroobserver.wordpress.com]

I think the price increases will be a little more spread out, as all businesses won't alter prices all at once. But if we see a significant short term pop in inflation, the associated interest rate movement may be enough to increase prices again. That could compound. Think of it as a balloon that's been popped. What are your projections for inflation and interest rates in the next 5 years?

I also agree that ACA will cause some employers to re-trade wages or shift from full-time to part-time staff. Any projections on that impact?

I've read much of the White House's argument that health care costs are under control - http://www.whitehouse.gov/sites/default/files/docs/healthcostreport_final_noembargo_v2.pdf

But most business people I know are seeing health insurance premiums increase substantially. So I'm just not seeing the reductions in healthcare inflation on a local level. On the ground in Greensboro, are you seeing health care costs go down?

As far as the broader health care pool, it really depends on who's in that pool. What's the data showing? Some surveys show that only 11% of those who signed up were uninsured before. So what are the numbers for the broader health care pool?

Andrew and Ed - I'm asking these questions and commenting because I really am interested in your opinions on the topic.

[Ed Cone]

Marty, not sure what you're asking new here. My thinking still starts with the need to get pretty much everyone into the risk pool for services they will almost certainly use, and I still don't think your hypotheticals about the impact and questions about the results to date of a brand-new law amount to a compelling argument against the ACA.

As I asked you before, what's your take?

Do you think we should deny all care to people without the means to pay for it?

If so, fine. We disagree.

If you don't think that, then do you prefer the system the ACA is trying to fix (uninsured people get access in an inefficient, unhealthy, and expensive way, with the costs dumped on private insurance plans, the government, and charity)?

If you want to return to the pre-ACA system, then we disagree.

If you don't want the status quo ante, what would you like to see? Do you agree that universal access demands some sort of universal coverage? If so, what would it look like?

[Greensboroobserver.wordpress.com]

I'l post a more detailed response later. I'm headed out the door now.

But in short, I'd like to see:
Greater efficiencies in health care
Tort reform
Better use of technology in health care, i.e., not having to fill out several pages every time you go to the doctor
Reasonable limits on the extent of health care provided, a ROI type approach.

[Ed Cone]

Looking forward to your detailed response.

A few points:
*Tort reform may be a good idea in and of itself, but it hasn't done much to lower costs where applied, and it doesn't address access and coverage.
*Electronic medical records/paper reduction are happening now. It's an efficiency and quality move, but it doesn't address access and coverage.
*"Greater efficiencies" rank up there with mom and apple pie on the list of things we all love. Certainly universal insurance and earlier access to the system qualify as powerful tools for efficiency -- are those what you have in mind?

I do hope you'll answer my questions directly, as listed in my comment of 6:24 PM.

[Greensboroobserver.wordpress.com]

Ok - so focussing on access, coverage and priorities - per Ed's request:

EC"My thinking still starts with the need to get pretty much everyone into the risk pool for services they will almost certainly use"
-If that is your objective, then I think you're talking about national socialized medicine. My concern about ACA is that people who need it will sign up and people who don't won't. With the preexisting conditions component of ACA, why would anyone sign up until they actually think they need it. I also get confused by the ACA proponents thinking on geographic scope - why national and not international or local or state level?

EC"Do you think we should deny all care to people without the means to pay for it?"
I believe people should have significant freedom to prioritize their own needs. In a perfect world, everyone would have food, shelter, safety, education and be healthy. But that "ranks up there with mom and apple pie on the list of things we all love." I also believe that others should have the freedom to give to those in need - wherever they may be in the world and for whatever that person feels is a priority. That's where the charity concept comes in.

"All care" is also an extreme. I believe that we already provide a fair amount of care through local, state, and federal programs. Perhaps you could clarify what you mean by "all care".

EC"If you don't think that, then do you prefer the system the ACA is trying to fix (uninsured people get access in an inefficient, unhealthy, and expensive way, with the costs dumped on private insurance plans, the government, and charity)?"
-A federal government solution isn't the only solution. A greater coordinated effort between charities, govt agencies and health care providers would go a long way. I don't think the current system is efficient, but I feel that way about most bureaucracies. I'd like to see an overhaul of of all government as well as zero-based budgeting and a discussion of ROI. In general, I believe in smaller government.

EC"If you don't want the status quo ante, what would you like to see? Do you agree that universal access demands some sort of universal coverage? If so, what would it look like?"
-A multi-prong approach. 1) a primary charity that can decide how best to use its funds to impact the most people (the big question become scope and geography), 2) sub chapters of the charity that are focussed on certain health care issues or specific regions/priorities, and 3) a private system that allows those that want high quality health care to get it. And more thinking in terms of global solutions, not just national.

EC"As I asked you before, what's your take?"
-I'd like to see an end to suffering in the world, but wouldn't we all. So then you get to the idea of who do you help, what help you provide and how to pay for it. If I choose to help a starving child in South Africa versus a smoking induced lung cancer patient in Minnesota, that should be my choice. If some choose to spend their money on a performing arts center in Greensboro, well that's their choice. What I don't like the idea of is someone else deciding which causes/charities I should support.

[Ed Cone]

Thanks, Marty. Maybe it's me, but I don't see a lot of specifics, or direct answers in your response.

You don't like the ACA. Fine, I think everyone agrees it's far from perfect. But what about the problems it's meant to address?

When I say "all care" I mean care at any point of need or access.

As in, would you favor turning away someone who can't pay at the emergency room?

If yes, we disagree.

If no, then who should pay for their service, and why shouldn't they be required to take some responsibility for it?

I have no clue what you mean by a "primary charity." What is it? Who runs it? How is it funded? How does it fit into existing payment structures? What "global solutions" are you talking about?

I don't see any movement toward ending high-quality private care. Even truly socialized systems like the UK allow it. My guess is we're moving more toward a system like Germany's, based on private insurance.

[Greensboroobserver.wordpress.com]

EC"As in, would you favor turning away someone who can't pay at the emergency room? If no, then who should pay for their service, and why shouldn't they be required to take some responsibility for it?"
- No, I think that those who would like to provide certain free health care should band together to pay for that service for the people they think deserve it most.

The same could be said about food, shelter, education, etc.

Let's discuss personal responsibility - should people be allowed to purchase a Big Gulp, or smoke cigarettes, eat fatty foods, ride a motorcycle, or skydive? When you start looking at government controls to curb health care costs there are some personal freedom versus personal responsibility issues at play as well. I believe in personal freedom, but that comes with personal responsibility as well.

[Ed Cone]

Yes, let's discuss personal responsibility.

You seem to be saying people should be able to make the choice not to carry any health insurance, with the expectation that they can just show up and get emergency medical care when they need it.

I don't think that's very responsible, personally.

You and I, as people with private insurance, already are paying for the uninsured. But those costs are hidden, and the system they support is inefficient in terms of both cost and outcomes.

Please tell me more about the "primary charity" mentioned in your previous comment, and the coalition of the willing that would serve uninsured patients in your latest comment. Who organizes and funds these organizations? What happens to people who don't live near one these generous hospitals? How long does it take to implement this plan?

ACA has moved the debate to the particulars. Again, maybe I'm missing something, but what I'm getting from your comments is very vague and not really relevant to the situation on the ground -- the complexities of our healthcare system, and the real lives of millions of people, today and tomorrow.

[Hartzman]

Many doctors need to make less money for the health system to work.

Medicare needs to be able to negotiate prescription prices like the Veteran's Administration.

To say there has been little inflation in healthcare and education costs makes no sense to me.

The more government is involved, the higher the prices.

Beef prices are at all time highs.

Processed food containers keep getting smaller.

The US has exported a great deal of our inflation to other countries and financial markets.

[Ed Cone]

Hartzman: "The more government is involved, the higher the prices."

Germany and other countries with high-quality healthcare at much lower prices than our own: "Really?"

[Hartzman]

We don't live in Germany and other countries.

My understanding is that Germany has single payer, as most likely the other countries to which you refer.

Our health care system is the most expensive and corrupt on the planet.

The ACA didn't fix what was wrong with our system, it preserved the worst of it, as both parties and the press ignore the accounting fraud of the doc fix.

Too many contributors and advertisers to profit from.

The largest, most powerful union in America isn't called a union.

It's called the American Medical Association.

[Ed Cone]

So you don't mean "government," you mean "our government." Which means the problem is not "government," but the US system. You know, the one we're trying to fix.

Your understanding of the German system is incorrect -- it's a multi-payer system, as also exist in many other countries with high-end healthcare and much lower costs than our own. Plenty of good resources out there on models around the world -- here's one.

Doctors are part of the cost story in the US, but it's a gross oversimplification to put too much blame on them alone.

[Polifrog]

Germany and other countries with high-quality healthcare at much lower prices than our own: "Really?"

As we are seeing, the price of healthcare can be reflected in more than just the cost of, say, a broken arm.

The cost of healthcare can also be spread around the economy in the form of lowered job prospects, lower take home pay, less patient choice, lower quality healthcare and higher costs for insurance coverage. Make no mistake, the ACA saves no money, it simply redistributes the costs of healthcare to those who have no influence in regard to bending the cost curve down.

==When one pays for healthcare via lower take home pay, by what method may they affect the cost of healthcare?

==When one is demoted to part time work due to the cost of healthcare, how may they lower the cost of healthcare so that they may return to full time work?

==When one finds themselves with fewer doctor choices as a result of the cost of healthcare, how may they affect change on the market so that they may once again have choice?

The dawning reality for Americans is that it is a gross oversimplification to measure the cost of healthcare by the cost of the service alone whether that service be the cost of a broken arm or the cost of insurance.

So, yes.... really, government intervention has raised the cost of healthcare in the US as well as other countries. One might say it is axiomatic.

[Hartzman]

"Doctors are part of the cost story in the US, but it's a gross oversimplification to put too much blame on them alone."

Ed Cone
.
.
I didn't.

"Medicare needs to be able to negotiate prescription prices like the Veteran's Administration."

Then there is the medical device industry.

Lack of price transparency.

I could go on, but as a board member of Cone Health, you know all this stuff already Ed.

http://www.conehealth.com/about-us/board-of-trustees/

[Ed Cone]

I know some of it, George, but I'm eager to keep learning. I do think, per my comments in response to Marty, that we're well past the time to focus on specifics and not generalities.

In that vein, I hope the details I've provided about government involvement and multi-payer systems in other countries were helpful and will be integrated into your future remarks.

[Fred Gregory]

Democrats in Denial Over Obamacare...Sen. Kay Hagan benefited from President Obama's coattails in 2008 in North Carolina. Now she's distancing herself from him

"For nearly three years, the Democratic approach to the political unpopularity of President Obama's health care law was denial. Deny it played a significant role in the party's historic midterm losses in 2010. Insist, in the face of contradictory evidence, that as more voters experienced the benefits of the law, the more popular it would become. Deny it would be a major issue at all in the 2014 midterms.

The latest version of the argument points to polling showing that voters don't want to repeal the law but prefer to see it fixed—perfectly in line with the newly adopted positions of vulnerable Democratic officeholders..."

[Greensboroobserver.wordpress.com]

EC- "what I'm getting from your comments is very vague and not really relevant to the situation on the ground"

Obamacare (ACA) will cost the UNC system $47 million in 2015. This is a recurring annual amount. http://greensboroobserver.wordpress.com/2014/02/21/obamacare-aca-to-cost-unc-47-million-per-year/

[Ed Cone]

Marty, next blogging tutorial is embedding links in comments.

It's a little hard to show because if you do it live then you see the link, not the code.

So, say you want to make the word "cost" in your comment link to your blog post. On the left side of the word you type <

Then, with no space after that less-than sign, you type a href="your url for the post">cost

Then with no space after "cost" you type another less-than sign and then no space /a and then no space greater-than sign.

Don't leave out the quotation marks or forget to close the string with the >

As to your link, I notice you aren't really responding directly to my queries as I had hoped. Instead, you're throwing up numbers without much context. What are the benefits of the expanded coverage you reference? Nice things cost money. What are we buying with that money? Is it worth it? The same questions apply to ACA as a whole. Of course there are costs. Are they worth it? And, again, if not, what is a better, practical solution?

[Andrew Brod]

Ed, there's a way to represent what you're trying to describe on an actual webpage. I did it near the bottom of the first page of this thread.

[Dave Dobson]

Here's an example:

<a href="http://mysite.com/mylink.php">Here's my link.</a>

produces this:

Here's my link.

[Ed Cone]

Huh. When I do it the link goes live and you can't see the code.

Marty, there's an old adage in blogging about the readers being smarter than the writers. Proved again.

Also, you might want to change your comment handle from your url to just the name of your site (if you don't want to use your own name). You'd still get the value of publicizing your blog, it would just look better.

[Dave Dobson]

I cheated to make it legible. I used escape codes to represent characters that would otherwise be interpreted as HTML.

[Marty Kotis]

Ed-

Thank you for the instruction. So a revised post would be:

EC- "what I'm getting from your comments is very vague and not really relevant to the situation on the ground"

Obamacare (ACA) will cost the UNC system $47 million in 2015. This is a recurring annual amount.

As for my log in - I clicked "Comment below or sign in with more..." which takes me to the Typepad SignIn page - where one option is using your WordPress account - I then key in my username and it apparently completes the rest for me. I'll test it now without signing in and just keying in information in the Your Information box below.

[Marty Kotis]

Now trying Dave's option

Obamacare to cost UNC $47 million.

As for your questions about my knowledge of detailed solutions for an alternative to ACA, I don't have a response. I'm not in healthcare, nor have I studied the issue in depth. I'm stating my observations about practical impacts and costs. I haven't seen those costs presented anywhere, so I'm questioning if they were factored in, or if the idea was to provide universal health care at any and all costs.

You seem to be more versed in the issue. What's the total cost to the taxpayers of the North Carolina? Or total costs on a national level?

[Ed Cone]

Marty, I'm not asking you to write policy. I'm asking you to respond to some fairly general questions and offer some fairly general, practical alternatives.

I think requiring some form of insurance for near-inevitable life-and-death needs makes economic and moral sense, and that the current system of access and payment is broken and inefficient. Perhaps you disagree. After all these comments, I still don't know.

The total cost of reform is a hard number to define. Does it include decreased income to hospitals and doctors, etc.? And more importantly, doesn't it have to be weighed against the total benefit? If healthcare costs continue to grow more slowly under ACA, as they have begun to do; if the general population is healthier; if people have more freedom to change jobs and start their careers -- then the cost is well worth bearing.

You can find a lot of estimates of budgetary costs. Some are referenced here. But again there are pesky details and hedges: "It could raise the national debt $6.2 trillion if its cost containment measures were phased out, or it could save the government $13.3 trillion if it works as intended."

[Andrew Brod]

I'd say that the cost doesn't have to be weighed against the benefits in every discussion. One reason in this case is that the ACA is projected to reduce costs slightly.

Beyond that, the total cost isn't the point; it's the change in the total cost relative to what it would have been without the ACA. I've seen experts and pundits compare the future cost under the ACA to the, say, 2012 cost without it. That's obviously the wrong comparison, because healthcare costs are rising with or without the ACA.

The recent CBO report on the ACA revised downward its estimate of the net budgetary cost of the law. According to CBO, it'll cost the federal government about $9 billion less than it previously thought, mostly because so many states have refused to expand Medicaid. Those states are effectively taking on more of the cost themselves, which of course is amusing (in a sad and/or maddening way) because many of them claimed to reject Medicaid expansion for cost reasons. So whatever North Carolina's total cost of the ACA will be, it could have been lower.

[Hartzman]

"the ACA is projected to reduce costs slightly."

Not true, as congress didn't do the doc fix.

Medicare payments to doctors were supposed to go down about 30%, and they didn't do it.

Crap in, crap out from the CBO, which did the math with the cost adjustment included.

[Andrew Brod]

Not "doing the doc fix" means not raising physician reimbursements. So strictly speaking, no doc fix implies lower costs in the short run.

More importantly, the doc fix has nothing to do with the ACA. It's an issue that existed before Obamacare and it needed to be resolved whether or not the ACA was passed, and therefore the cost of resolving it has nothing to do with the cost of the ACA.

And yet I'm not surprised that Hartzman would raise it as an issue here.