If deficits and debt were supposed to be an actual issue in 2009/2010 instead of a bludgeon against liberal change during the course of a recession that is still competing with the Great Depression, one would think that a program and policy that implements actual structural reforms to the labor market by beginning the slow process of disentangling health insurance and more importantly insurability from employment and reducing the long run costs of a major social welfare program without harming the recipients and beneficiaries of that program, but actually expanding coverage of benefits would be a major policy win that would lead to its sponsors bragging.
The Affordable Care Act is a massive structural reform that is expanding social insurance coverage while reducing long run costs while also engaging in labor market structural reforms. Below is a table of the CBO’s mandatory Medicare expenditure projections that shows how the cost curve is continually bending.
Some of the cost curve is technical changes to economic projections. A decent chunk of the difference is the rapid drop in projected costs of Medicare Part D as the drug pipeline for expensive on-patent new drugs is thinner than many thought it would have been. Another and more important chunk is due to a combination of new programs in the ACA that is slowly shifting the United States away from a per widget fee for service model towards a population health model where the incentives to save money are lining up to actually save money. To do this, Medicare Advantage is no longer a massive transfer to insurance companies buying better hookers and more blow but reducing the pricing differential to where the value proposition between Medicare Advantage and traditional Medicare are approaching parity. It means penalizing providers who readmit too many patients within a month of a hospital discharge. It means trying to get hospitals and providers to focus on chronic condition management to save money over the long term. Those things seem to be working to some degree. This is structrural reform without inflicting pain on the bottom 90% of the population.
At the same time, the ACA is a labor market reform which should, over the long term, produce a more flexible and risk taking labor force. The CBO has projected that 2.5 million full time equivilent workers will voluntarily remove themselves from the labor force because they were tied to the labor force for health insurance reasons only. They wanted to be doing something else, but they were prevented due to market failures in the individual health insurance market. People who had a good idea but a good reason to worry that they were uninsurable if they went on the individual market can now take a risk to run with their own idea, or leave Giant Evil Corporation to work at a little 7 person boutique firm.
If you think that the biggest problems with the American economy are supply side instead of demand side, the ACA is a significant supply side structural reform. It is also a massive demand side reform as the ability of more Americans to engage in the health insurance market place should reduce the aggregate level of optimal savings which should make it slightly easier to get out of a demand trap.
Or shorter Richard Mayhew: Shut the fuck up Chuck
JGabriel
What’s making Schumer so pissy about the ACA, anyway. Did the president accidentally get between Schumer and a camera, or something?
KG
@JGabriel: the Dems lost an election, putting them in the minority in the Senate, which allows Schumer to go back to representing his true constituents: the haves.
Richard Mayhew
@KG: Not even that, I think anything healthcare related beyond passing CHIP expansions (as saying no to sick kids is politically tough for any Dem and some Republicans) falls under Schumer’s definition of “nice to have” and not “really want to have”. So PPACA in Schumer’s mind displaced several “really want to have” priorities that retrospectively speaking, he thinks could have saved the Democrats several dozen seats in the House and half a dozen seats in the Senate which makes his life a whole lot easier.
I don’t see how that process would work as Schumer never pushed for Stimulus Part 2 with 1.5 trillion dollars aimed at high marginal propensity to spend individuals but that is what I think he argues.
Another Holocene Human
The damage this Congress is on track to do is depressing. The same “fun” from statehouses across the country.
I got hide rated on GOS the other day for casually tangling with a more popular poster who was on a rage tear about real trauma she’d experienced but expressing it by trolling the fuck out of people (one charming aspect was that she’d confused an anti, ie troll diary with a totally unrelated diary and was too ragey to actually read the diary she was trolling in). So I told her to stop apologizing for enablers. That’s literally what I said, and I’m assuming she got her friends to help HR me because it takes more than one vote.
I shouldn’t have engaged at all … and maybe this is part of why GOS comments are such an abusive cesspit. Kos wanted to hide UID but it isn’t UID, it’s the karma system and mass mob modding that is the problem, people set up diaries just to get other people hidden or banned. Abusive posters sit on their perch for years and years tormenting people before they’re finally kicked off (real notorious case a couple of months ago). So many people of color have quit and some were banned unfairly and I’m starting to see why.
I’ve had comments on other blogs deleted but they really were over the line kind of stuff, and since I didn’t persist (instead I took it as a lesson that my idea of “funny” or in-bounds wasn’t) I didn’t get banhammered.
This GOS thing is bizarre. It feels abusive. I love Kos elections but I’m questioning whether I should post there at all. It’s much too easy for me to engage in the comments with a log in and there are all these traps and snares waiting.
(And let’s face it, dkos comments have always been more heat than light … I started to follow a couple of posters though and that reeled me in.)
beltane
@Another Holocene Human: I rarely post there anymore and from the looks of things, site traffic has gone down significantly over the past few years. It’s a shame, because it would be nice to have some kind of platform from which to rekindle enthusiasm, but the community has gotten out of control. They are very strict about enforcing certain specific rules (I got a HR and warning for uprating a “Fuck You” comment addressed to a particularly vicious troll), but insidious trolls are allowed to do their dirty work without consequence.
CarolDuhart2 (Aquariusmoon)
You haven’t even mentioned the job openings from early retirement or folks going to part-time because they can afford coverage more readily now.
And the real savings will be from folks not having to let things go until they qualify for Medicare. These people will have better health outcomes when they do, and fewer major problems because they could afford to take care of themselves better.
CarolDuhart2 (Aquariusmoon)
@beltane: I went back to Kos recently, and I find it much harder to navigate than before. To me, there’s no longer really a front page where I could scan for the most important topics of the day, but several different things not related.
Perhaps the days of kos’s being the big thing are now over. Smaller blogs are getting the traffic now because they are easier to navigate and relate to.
beltane
@CarolDuhart2 (Aquariusmoon): When they went to the new format a couple of years back the site lost all focus and with the loss of focus went power. It’s a lot easier to divide and conquer when everyone is split into little groups and subgroups, etc. Solidarity, not becoming the Facebook of the progressive movement, should have been the goal.
Mike E
@Another Holocene Human: Welp. Some bounce over to here, too, because they are bipartisan-curious or sumptin. Fuck ’em…I continue to lurk over at Chez Atrios even when the same sorta thing occurs there as well, because I can still find gems on a consistent basis, like:
Word.
Mike E
@CarolDuhart2 (Aquariusmoon): Or, even better, this.
Tree With Water
Schumer democrats believe that Wall Street’s best interests equals the best interests of the country. Republicans believe the best interests of Wall street trumps the best interests of the nation. Republicans are more clear, honest, and open about their point of view, is all.
mai naem mobile
@Another Holocene Human: i was on DK so early that i had a 3 digit uid(was also on DK when Howard Dean had a realtime Q and A) and i would have had a 2 digit if i hadn’t taken a couple of days deciding ifni wanted to do the registering thing. Anyhow,same thing happened to me. I got hidden for using the term Republic××t. I thought it was in questionable taste but funny. I frankly don’t remember but I think i was referring to Ann Coulter. For that i lost my trusted user status. I had a bunch of positive ratings, very few negatives and for a single bad post you’re done. I’ve been back less than five times following a link but thats about it. Its a pity because there are some very talented writers there. The good regular front pagers are all on twitter and i follow them all.
WereBear
I bailed when I posted an animal rights related diary and someone came on and started bashing Anna Sewell (author of Black Beauty) with some awful idiocy calculated to make me upset. And nothing more.
EthylEster
Shorter Richard Mayhew: Shut the fuck up Chuck
Amen, brother.
JoyfulA
@Another Holocene Human: I was active on GOS long ago and have been inactive since long ago (maybe 2002 or 2003? I have a 3-letter name there; don’t know my number). It seemed like the commentariat was sort of glibertarian in that it was primarily male, quick to pick a fight, and aggressively atheist.
So I stopped reading comments, which seldom had any content worth reading and often offended me, and just read posts. Then I found other blogs and didn’t bother with GOS.
I was reading the state politics section more recently, now that I think about it. It was worthwhile because the PA state posters were knowledgeable and there wasn’t any testosterone-based arguing. I’ll check it out again someday if I can find it.
Elie
Amen, Brother Mayhew– Amen…Preach….
karen
Even shorter: Upchuck.
Another Holocene Human
@WereBear: Just you relating this is making me feel nauseated. Not because of Sewell or anything but the behavior displayed. Hugs.
rikyrah
I am late, but thank you for telling Chuck to STFU.
Alan in SF
The Senator from Wall Street seems intent on fattening the middle class up for the next slaughter.