tag:blogger.com,1999:blog-8512362.post2875329796871109438..comments2024-03-10T13:59:19.230-04:00Comments on xpostfactoid: A major divide in the ACA individual market for health insuranceAndrew Sprunghttp://www.blogger.com/profile/17601269968798865106noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-8512362.post-70621566941928115202016-04-05T05:48:36.945-04:002016-04-05T05:48:36.945-04:00The Sanders group has the vision, but the Clinton ...The Sanders group has the vision, but the Clinton group has practical politics to consider.<br /><br />All of us would like a health care system with no insurance premiums, co payments, or deductibles. In fact many elderly persons on Medicare with a Plan F Medigap policy see virtually no bills during the year.<br /><br />The trouble is that this little slice of health care heaven costs:<br /><br />$200 billion in payroll taxes for Part A<br />$400 billion in income taxes for the bulk of Part B<br />Senior's premiums of $120 a month for Part B<br />Senior's premiums of $200 a month for Medigap policy<br />$50 billion roughly in income taxes to subsidize Part D<br /><br />The Clinton group recognizes that extracting this much and more for a single payor plan is not possible today.<br /><br />The ACA with all its limits is funding with a 3% extra tax on capital gains and very large incomes, plus cats and dogs of other revenue extracts. This was hard enough to pass with Democrats controlling both Houses and the Presidency.<br /><br />But a $1 trillion annual tax package for single payer is not going to happen. Not even if the slippery Sanders projections of mysterious 'savings' commes to pass.bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-21181877736935053082016-04-03T20:15:48.068-04:002016-04-03T20:15:48.068-04:00Hi Bob,
Thanks for the reply! Yes, I agree, the su...Hi Bob,<br />Thanks for the reply! Yes, I agree, the subsidy cliffs are a big problem and incoherent from a means-testing standpoint.<br /><br />I pre-emptively apologize for speaking generally about my sense of a "Sanders" left-liberal/democratic-socialist/social-democratic vision for health insurance (and health care provision). But if you'll indulge my good faith effort to describe matters, I'd be interested in yours and Andrew's reaction/corrections/etc.<br /><br />The nugget of an emerging left-of-center debate that I'm intrigued by is the following: Given the evidence of Sanders' single-payer plan outline and of many Sanders' supporters' expressed dissatisfactions about the US health-care system, the left wing of the Democratic Party wants to make a greater priority of improving the insurance for lower-middle and middle income Americans, both in terms of lower cost and greater coverage of actuarial value (comprehensiveness). In a certain way, I think the ambition of the vision is to do away with what we'd meaningfully describe as "insurance" all together: that is, the goal should be to socialize (NB: not a dirty word for me with any bad connotation) all costs and provide nearly or completely full coverage (0-minimal premiums, co-insurance, deductible), not gear health "insurance" to managing the risk of large costs due to extraordinary health risks. On this accounting, even "Medicare for All" is found wanting. Sanders pointedly does not like the idea of gradually expanding Medicare downward to 55+, then 45+, etc. His plan calls for universal comprehensive coverage with little to no premiums or co-insurance, something Medicare has never had.<br /><br />On the other hand, the current mainstream of the Democratic Party, extending to past neoliberals like Hillary Clinton who evolved left to fit with mainstream liberalism since ~2006/2008, has maintained as a priority -- and agrees with Sanders liberals -- that universal coverage is morally paramount, and so is also seeking to close the gap on that last 8-12% of the population. It would also ideally like to keep improving subsidy levels (directly or indirectly, straightforwardly or piece-meal) across the board from 0-400% FPL, mainly by relying on taxes on very high income Americans or on the changed revenue picture that would come from jumpstarting the economy. This mainstream of the Democratic Party, building on the PPACA, also has diffuse plans about trying to continue to "bend the cost curve" ideally on the provider side, and less so on the consumer dissuasion of needed care (a love of the GOP). BUT it doesn't really have that Sanders' vision that foresees turning the everyday employer-sponsored insurance of lower/middle/upper-middle-income Americans into something with an across the board actuarial value of ~90-100% -- something which I think that really captures the imagination of the Sanders liberal supporters I know who have very good middle-class and upward jobs in things like higher education / media and the arts / etc.<br /><br />So I feel like this is the emerging intra-liberal debate, and it does to a substantial extent turn on priorities and what we mean by "insurance," and thus by what is "under-insurance" and what could conceivably be "over-insurance."PFhttps://www.blogger.com/profile/00263515090451316188noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-12437296750771920432016-04-03T17:43:30.634-04:002016-04-03T17:43:30.634-04:00Sanders' supporters are tired of the endless m...Sanders' supporters are tired of the endless means testing and subsidy cliff. It makes no sense that a single 55 year old has a $350 monthly subsidy if he/she earns $44,000, but sometimes no subsidy if they earn $45,500. (numbers approximate but not far off)<br /><br />This happens in Medicaid all the time too. It is repulsive how many people go ond off Medicaid in the course of just a year or two, due to varying incomes.<br /><br />Sanders' supporters want universal programs, paid for with broad based universal taxes.<br /><br />bob.hertzhttps://www.blogger.com/profile/09686373408419885558noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-30227336642553589092016-04-02T13:49:33.183-04:002016-04-02T13:49:33.183-04:00Thanks for these past two posts. I'd love to s...Thanks for these past two posts. I'd love to see a rough statistical analysis (or set of informed guesstimates) about where lower and middle income people with ESI stand in relation to the marketplace population, in terms of average AV. It would expand the picture and help me get a better handle on just where the growing under-insurance crisis lies in the US population. For example, a lot of the energy among Bernie Sanders supporters emphasizing his single-payer plan seemed to come from people who had ESI but clearly felt underinsured and dissatisfied with the AV they could get for a given price-point. And Sanders' plan really seemed to focus on moving toward a plan in which a very high AV would be offered to everyone. Would this be "over-insurance"? Either way, supporters of Sanders seemed to have a different set of guiding priorities in their vision of improving US health insurance in the existing population.PFhttps://www.blogger.com/profile/00263515090451316188noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-923420551085415222016-04-02T09:32:11.573-04:002016-04-02T09:32:11.573-04:00Thanks - fixed. That's what comes of copying a...Thanks - fixed. That's what comes of copying a chart and filling in new numbers.Andrew Sprunghttps://www.blogger.com/profile/17601269968798865106noreply@blogger.comtag:blogger.com,1999:blog-8512362.post-81233010464884559742016-04-01T20:44:05.643-04:002016-04-01T20:44:05.643-04:00Another error:
--Your second to last table reads: ...Another error:<br />--Your second to last table reads: % of unsubsidized<br />enrollees<br /><br />--Should read: % of subsidized<br />enrolleesBrad Fhttps://www.blogger.com/profile/10366408815395434941noreply@blogger.com