Just an annual reminder on where political power lies in any health finance debate.
- Groups with lots of money have more power than groups with no money.
- Groups that routinely vote have more power than groups that don’t vote.
- Groups that are trusted have more power than groups that are not trusted.
- Groups that are liked have more power than groups that are not liked.
What does that mean?
At the major lobbying group level, we always have to remember that doctors and nurses are some of the most trusted professions in America. We also have to remember that hospitals, especially rural hospitals, are frequently the largest employer in the town or the county. We also have to remember that the sympathetic blonde seven year old with a bowl cut whose parents are doing reasonably well for themselves will be able to get on TV and cry.
Insurers are usually slightly more popular than stink bugs and we don’t look good on TV. Any story that involves an insurance company is usually a bad thing as we are in a position where insurers say no to the crying doctors and nurses and we fill the role of EVIL BASTARD quite well.
Just keep these basic assumptions in mind when do a power analysis of interest group lobbying over the next year’s wild ride of health care and health finance legislation.
Brachiator
This week, I was one of the instructor/hosts for a group of tax professionals. There were some who were adamantly against the Affordable Care Act, mainly because of the individual mandate and rising costs.
During a break, there was a debate concerning a hypothetical: what if a taxpayer who did not have health insurance did not put his dependents on his tax return? The taxpayer might pay higher income taxes, but would avoid paying the Individual Shared Responsibility Payment for his or her dependents. The idea is that he would leave off the dependents until Trump and Congress repealed the tax plan.
BTW, during this seminar, no one explicitly talked about who they voted for, but some danced around it. And it was not the case at all that the majority of participants appeared to be, or gave off hints of being Trump supporters.
artem1s
are their any insurance companies out there that understand the long term implications of killing off their client base? or are they all just looking at the short term grift and grab? I would like to know what those in the industry who help craft Romneycare, think about killing this policy initiative that was developed by a right wing think tank. Not the usual idiot players who scream ‘government overreach’ every chance they get. There were some pretty serious minds who put this idea together in the first place. Do they have nothing to say in this debate? Or are they to busy pleasuring themselves over the prospect of forcing everyone to buy in and not having to pay out on any claims ever?
catclub
To all the GOP senators who NOW say that repealing the ACA is complicated and will take a while. I want every reporter to ask them, every time, why they can’t just bring back the ACA repeal bills that were passed 47 times in the House over the last three+ years. What was wrong with those bills?
Major Major Major Major
@catclub: that would indeed be a good question to ask them.
Brachiator
@catclub:
You might ask this of “single payer or nothing” activists as well.
piratedan
@artem1s: excuse me… I couldn’t quite understand what you were posting in the middle of all of the hookers and blow.
piratedan
@Brachiator: these guys had SIX years to come up with a plan to “fix” this. Ever since it was passed by the slimmest of majorities, anyone with a firing synapse knew that this would need to be tweaked and modified in order to make it more functional. After all, hadn’t we watched said same happen with Medicare? This was on the assumption that we had two political parties that served the people of the nation. Instead… well, you lived thru it just like me and the change that people voted for was to not replace the windows and foundation that have been vandalized but to instead relocate the vandals inside the building.
Botsplainer
@artem1s:
Grift and grab. It’s what American companies do best anymore – sell vapor at rentier rates while telling you it is gold.
OceanBeach
I can tell you that the ACA was not popular with many of my middle class friends. Specifically non involved political friends and of course the righties. These are all friends who do ok. They saw it as an extra tax on them. My rightwing friends saw it as another handout off of their dime. I tried to explain that Medicare costs and the like were coming down by the billions and that eventually they would see real savings. Medicare added 11 years of solvency under the ACA. People don’t have time to delve into all the numbers. Forget it if you are receiving your news from the right. Here’s how I see it. They just voted for a guy because they resented having to pay for the ACA. The extra money they said they paid out every month. Now their parents medicare is going to be privatised, wth. Everyone will get vouchers under Paul Ryans plan. This is mind boggling. This is to help ppl spend their vouchers wisely. Do I have that right? They think ppl will be rational consumers when it comes to their health? I don’t know even where to start with that. God help those with diabetes are some other chronic condition. “Pain in an HSA world is concentrated most among the least lucky. Pain in the ACA world hits the lucky as they throw in more to cover the unlucky and unwell”- Thanks for the summary Richard.
Matt McIrvin
@artem1s: The healthier their client base is, the more money they make. So killing off the sick ones probably helps them.
greengoblin
Does the private insurance industry actually want Medicare gone? I can’t see them as excited to cover an expensive and very sympathetic group like the Olds. Serious question
Brachiator
@piratedan:
No reason to belabor the obvious. The GOP never had any plan or notion to fix it. They simply wanted to abolish it, which also morphed into the general principle of opposing anything that Obama favored. It was also, of course, an easy way to keep the conservative base riled up.
Now they are faced with the reality that most sane people do not want to go back to nothing, or being fucked over by the insurance companies, and that a simple repeal is a conservative fantasy.
I do note, however, that I have recently had conversations with people who think that you don’t need no insurance, just a kind doctor who might help you out now and then when you get sick, take almost anything, including poultry and livestock as payment.
If I were a Democrat in Congress, I would insist that a rider be attached to any repeal legislation that would also repeal all government health plans for members of Congress and their staff.
Botsplainer
@greengoblin:
Olds have a lot of tappable home equity and 401Ks.
Roger Moore
@artem1s:
Given the combination of market churn and Medicare to take the oldest and sickest off their hands, insurance companies have a strong incentive to look at the short term. Richard has a number of blog posts about how to get the insurance companies to think further than a 6-12 month time horizon on things like vaccinations; he wouldn’t need those if they tended to think in the long term.
schrodinger's cat
Before Medicare was enacted the poverty rate among seniors approached 25%, that’s going to happen again. Its not profitable to insure old people because their probability of getting sick is high.
Roger Moore
@Brachiator:
GOP policy in a nutshell.
catclub
@Brachiator:
Let me know which ones are sitting Senators.
This equating things the powerless left says with what the powerful right says is not helping.
SenyorDave
@schrodinger’s cat: Its not profitable to insure old people because their probability of getting sick is high.
My mom is 87 and fairly healthy compared to her friends of the same age. In the last seven years she has broken her wrist, had cellulitis in her toe and almost lost it, broke her kneecap (that was in the grocery store and she got a settlement that included paying the $45k Medicare bill), and at this point goes to the doctor what seems like once a week for some checkup. If I were an insurer writing an individual health care policy for her, I would think it would have to be upwards of $50k. She has friends that are in and out of the hospital constantly. I’m sure insurers would be very anxious to cover people like that, especially since the year they actually die will mostly likely end up being major bucks.
Kelly
@Botsplainer: That’s us. I’m a retired IT guy and we’ve the assets to get through this. What I’ll never understand is my brother in law that drives dump truck see’s in Trump. He didn’t finish high school, worked logging and construction all his life. Needs knee surgery, has a disabled adult child on social security, no savings, trivial home equity. His family needs all the stuff the Republicans want to kill. Not looking forward Thanksgiving.
greengoblin
@Botsplainer: But that would put pressure on their families as they burn through their assets.
I think it was Krugman who pointed out that Medicare and Social Security aided younger generations by keeping elders from becoming a financial burden. More than the Olds will be adversely impacted.
Brachiator
@catclub: RE: You might ask this of “single payer or nothing” activists as well.
Your assertion of a powerless left is false. The morons, including Uncle Bernie, who kept mindlessly pining for single payer, as though universal health care was a single thing, could have used their talents to make ACA better from the start. And the worst of them live in a bubble in which they believe that a conservative assault on ACA will lead to revolution and the eventual rise of their health care nirvana.
Botsplainer
@greengoblin:
Most economists recognize that velocity is important to healthy economies. Even Wingnut cranks know this, which is why they go through rhetorical contortions to claim supply side works.
If olds and their offspring have to scramble and sell off assets in order to satisfy insurance costs and medical debt, it will:
1. Increase money velocity, causing short term bubbles and driving up interest rates;
2. Drives down real estate values (which also affects local property tax assessments in a downward fashion – yay conservatism);
3. As a further consequence it more difficult to get home equity loans by freeing up too much inventory.
Ultimately, it all becomes an epic disaster, especially as the money dries up and the olds become dependents of the youngs.
bemused
@Kelly:
He should thank you for voting for the stuff (aid, SS for daughter) he still has.
Botsplainer
@schrodinger’s cat:
I think I’m OK with this, since everybody is determined to screw me. Apparently, spite policy is the way to go – it works for the GOP.
Peale
@Brachiator: Since one of the problems is that the medical providers resist cost controls at all costs, I say we should add a rider making poultry and leftovers from charity spaghetti dinners legal tender for payment of medical bills.
Pogonip
I wonder if the $50-70K Trump voters are the ones bothered by the cost and high deductibles of Obamacare? Or I read that they’re high if you don’t have subsidies; don’t know anyone on it myself. (If you do have subsidies it seems fairly reasonable.)
Is Debit around? I’d like a Walter pupdate.
Arclite
And yet, instead of single payer or the public option, we got a handout to the insurance companies under Obama: the ACA. And insurance companies also torpedoed Clinton’s healthcare plan back in the 90s. So I’m not buying the “we’re not liked so we have no power” argument.
Richard Mayhew
@greengoblin: good question… private insurers will not touch old people without massive subsidies… what form those subsidies come in they are fairly agnostic.
The Moar You Know
@greengoblin: They refused and continue to refuse to cover them, which is why we have Medicare in the first place.
The insurance industry doesn’t give a shit if they are covered or not.
Applejinx
@greengoblin:
What, millenials? They can sell their diamonds.
Younger generations will have no choice but to let the olds die. As Gen X I openly question if I’m even going to outlive my elders, much less pay for their healthcare (ha!). This is gonna be great for social cohesion :P
Peale
@Arclite: Actually, when you look at it, Insurance Companies lost more than providers and manufacturers in ACA. I think that’s because between the payors, providers, and drug/device companies, payors were thought to be the least popular. People don’t want to hear about not being able to take whatever drugs their doctor prescribes because their insurance company said no. I think we thought “people hate their insurance company. Its always saying “no” to them.” But they love their doctors and nurses. Sadly, we found out the hard way that people actually liked their shitty insurance company a lot more. That’s what those teahadies are. All about the love.
Raven Onthill
I’m trying to imagine what kind of society the routine death of elders from treatable conditions would lead to.
schrodinger's cat
@Botsplainer: This will have macro repercussions. So we are all going to get screwed.
Shalimar
@Botsplainer: The next generation of olds won’t have nearly as high a percentage with home ownership and retirement accounts. Which is probably when we are forced to phase out vouchers because no one can get insurance with them anymore.
catclub
@Shalimar: Once you have vouchers, you no longer have a single payer who can exert downward pressure on prices. As the single payer has an ever smaller number of grandfathered Medicare holders over time, it gets less powerful as well, another downward pressure on prices goes away. Crappy days are here again.
The Truffle
I’m curious: where is the AARP in all this? They have to be hopping mad.
Botsplainer
@Raven Onthill:
If we’re only talking about a lot of miserable noncontributing free riders (like my hideously racist, nasty, greedy, lazy, grasping resource sucking maternal grandmother), then I’d say a better one overall. The nice ones would be happily helped by offspring, the assholes abandoned.
Unfortunately, some nice ones will get sucked in.
Ohio Mom
@The Truffle: This has come up on other threads. No one can answer with any authority, some as skeptical about where AARP’s interests lie. AARP sells a LOT of insurance to their members (Medigap, dental, life…)