it already happened.

Your neo-liberalism is showing, Mr. Krugman!

He was all for single payer and is just in the mode of not letting the perfect be the enemy of the somewhat good.

Who is also a New York Times columnist

of Mr. Krugman's stances on trade:

http://online.wsj.com/article/SB122394373157731081.html

repeat this part:

Keeping single payer out of the room was a lousy negotiating strategy. It's like telling the opponent where you WON'T attack.

And there were many things that would have been "better" than a GOP plan from 10 years ago. Your false dichotomy not withstanding.

HCR managed to "help" about 7-12% of the population get health INSURANCE with little guarantee that they would get health CARE. That's what constitutes "not falling through the cracks". Roughly half of those people already were eligible for federal assistance to begin with. Another chunk are 26 year olds who can continue to be covered by their parents policies. A final chunk are people being forced to purchase health insurance, regardless of their ability to actually afford the underlying health care. This is how we are "closing cracks". Something Obama described during the campaign as "the equivalent of solving homelessness by forcing people to buy homes".

"It's called negotiation"

...yes. That's what happened.

"And there were many things that would have been 'better' than a GOP plan from 10 years ago. Your false dichotomy not withstanding."

There is only one thing better: single payer. A public option added to the current bill would improve it, but it still relies on reform.

Still, the bill can be improved.

You keep pushing the 7% claim, which is misleading. It's 12 percent: http://www.democraticunderground.com/?com=view_post&forum=1002&pid=404486

There are many MANY things better than federalizing health insurance regulation, which is basically what this did.

For example, we could have implimented health CARE reform. We could have ATTEMPTED to control health CARE costs. We could have allowed companies to purchase health insurance through the medicare program. We could have allowed drug price negotiations by medicare part D. We could have established the simple fact that health CARE was a right INSTEAD of establishing that health INSURANCE was an obligation.


Oh, and announcing that single payer is a nonstarter before negotiations start in Congress isn't "negotiating", is surrendering before the battle has been engaged.

It was the general assumption that the PO was the replacement for single payer. Single payer advocates were told that the PO was the back door to ultimate single payer. But by giving up on it before it was ever started, the adversaries could make it a negotiation between PO and none, instead of between PO and single payer. They won, Obama (and the rest of us) lost, and single payer didn't even get to play.

But the GOP did get their plan passed without having to vote for it.

Their negotiating strategy was absurd.

It left regulation to the states, which means that in many states regulation will be completely non-existant.

Not necessarily completely, but much of what this did was to establish federal standards for health insurance, including what services must be paid at 100%, no pre-existing conditions, coverage of 26 year olds, and much of the rest of what was passed. There are still state level regulations, mostly having to do with the business side and the exchanges. But that's true of almost all federally regulated industries.

And those states that don't impliment the exchanges, the feds will do it for them.

is Single Payer.

How are you substantiating that? There are models used that are not Single Payer that might be better as well. There is a NHS, there can be strictly regulated non-profits, maybe the Taiwanese solution would work better, I think a similar design to what we have now with a national exchange available and an end to the anti-trust exemption to one and all would be a step in the right direction.

This has never been approached honestly and has always been an effort to change the underlying system as little as possible. Never have we bothered to even publically examine the other systems around the world with a willingness to make systemic changes.

Single payer is the most attractive to me but there are other approaches that may easily be better than than our current clusterfuck or that same clusterfuck with a few pay for play features and an insane interpretation of the Commerce Clause that would set a precedent that literally ANY activity or non-activity can not only be dictated from the government, even with post-tax dollars but further the government can dictate you must make these purchases from the company store.

Recent polls show that most Americans have little or NO idea WHAT will happen in 2014.
That is when the Mandate takes effect,
and 40 - 70 MILLION (projected uninsured by 2014) already struggling Working Class Americans will be forced to BUY a near worthless "Bronze" Insurance policy on the "Big Government" Insurance Exchange.
Even with a partial subsidy (Corporate Welfare which goes directly to the Insurance Corporation), these TENS of MILLIONS of Americans will be digging deep into near empty pockets to come up with their part of the premium.
Most will not be able to use their "Bronze" Insurance due to high Co-Pays/Deductibles.

Adding insult to injury, the IRS will be acting as the Insurance Industry "Collection Agency",
so all those rebellious Americans that say "Hell NO I ain't gonna pay" WILL be talking to the IRS.
They aren't going to be happy when they find out WHAT is in store for them in 2014.
These Tens of Millions WILL blame the Democratic Party,
and rightly so.
The "Democrats" passed a Republican Insurance SCAM
without forcing The Republicans to take ANY responsibility!!!!
ALL the Republicans have to do is sit back and say, "Yep. We voted against it"
and Democrats will be unelectable for a generation.

The people who designed this "reform" really have no clue about Americans who Work for a Living.
It is MUCH easier to collect the money BEFORE an American gets to SEE it, and put it in his pocket.
Forcing Americans to come out of their pocket to pay their part of the Premium is NOT going to be easy.
Threatening them with The IRS HAMMER will only make things worse.

The BEST thing that could happen for the future of the Democratic party would be for the Supreme Court to Strike Down The Mandate.
Then the Democratic Party could walk quickly away,
and mumble "Well, at least we tried."

The term "Medical Bankruptcy" is unknown in civilized countries,
but will STILL be Big Business here even after all the provisions of the ACA are in effect.
Perhaps even BIGGER Business as Working Class Americans actually TRY to access health CARE with their "Bronze" policies.


Mr Krugman is Looking Out from inside his cozy, Upper Class, Rose Colored Bubble.
He will never have to buy a "Bronze" policy on the Insurance Exchange.
He will never have to worry about getting Health Care.
But Good Luck to the rest of us.


This guy does a good job explaining WHY an Insurance Mandate is BAD for America:

I don't think the impact will be as vast as you suggest. Possibly the GOP will attempt to make it so, but I'm dubious. The number of individuals that will be directly affected will be in the single digit percentages. Many of them will be the "transient" uninsured which means they are between employers providing coverage. No small number of them won't particularly be aware of the affect on them until they get their tax returns and realize they owe money, or have a smaller return than they are used to.

Many of them of course will already be republicans and so they'll just be finding ANOTHER excuse for their anger. In the end, in terms of moving votes one way or another, I don't think it will have a big effect. In essence it is the same reason that alot of people who ARE aided by HCR won't particularly notice, and the democrats won't be able to particularly campaign on the legislation. Most aren't affected (be design) by HCR. Of those that are, they won't necessarily notice (it will come with their new job and they won't realize it). Then of course there are those folks that SHOULD notice, but still will watch Fox News and vote GOP.

But I'm a bit with you in this sense. It won't be hard to find pissed off people to put on Fox News, and any other media outlet looking for a desire to do so. 2015, around tax time, is when alot of people might notice, and guess what's happening about then.

but I don't think so.

The projected number of uninsured by 2014 is between 40 MILLION and 70 MILLION Americans, and recent polls have shown most of these MILLIONS are going to be very surprised at what they will be required to buy.
Every one of these 40 - 70 MILLION WILL be directly affected.
Some, on the very bottom end, will be eligible for Medicaid (GOOD!).
The next lowest rung will get a "subsidy",
but most will be required to BUY "Bronze" (junk) Insurance on "The Exchange".
They won't all be Republicans, and I don't believe that very many of these MILLIONS are going to be delighted
at being forced to buy something they can't afford to use.

Last week, I had a conversation with an educated couple in my area who are active in the local Democratic Party,
and consider themselves well informed. We were in a group of 8 others who were active in our local Farmer's Market.
Two couples (4) in that group were on Medicare. The rest of us were uninsured, self-(un)employed, and praying to make it to Medicare before we got sick. I casually mentioned the Mandate in 2014, and the couple (the Party Activists) insisted that the ACA still contained a Public Option!!!
They refused to believe me on the spot when I informed them that it did not,
and accused me in public of "making stuff up to make Obama look bad!"
I received a phone call apology from them that night.

Nobody in that group of eight had a workable understanding of ACA, The Exchange, or The Mandate,
and these were educated, intelligent people.

Do yourself a favor, and ask a few of your friends of neighbors who aren't addicted to DU
how much they understand about the ACA, The Exchange, and the Mandate.

I don't dispute how many will be affected, merely how many will be "aware". Heck, look at the people that lined up to say "We don't want government run health care, and keep your hands of my medicare". When you break down the people that will have to buy insurance directly, who don't already, it becomes an increasingly smaller group of people. 30% of them already don't like the democrats. Another sector is going to be the young, mostly in their 20s, and they tend towards a poor voting block as it is. The lowest economic classes will be large among this group, and they again make a lousy voting block as it is. There is a real possibility that a few of the affected will actually be folks that already buy their own insurance, but will now get it cheaper due to an exchange or the loss of a pre-existing based premium.

It's not that they won't be affected, I'm just dubious on how much of a POLITICAL effect it will be. We're talking single digit percentages here and those are just really soft voting blocks.

That's the same group from which many have been retired unwillingly and are just scraping along. For those like me who live in or near major cities, because that's where the work is, those premiums will cause many to forget insurance and pray that they make it to medicare age.

and not gouge the ignorant and trusting (or anybody else, for that matter) is irrational.

Actors are intelligent if they recognize that other actors are rational.

Intelligent actors can put themselves in the other actor’s position and rationalize from their point of view.

A central concept of noncooperative game theory is that the “equilibrium” is driven by an actor’s intelligence.

A condition of equilibrium will be achieved if each actor follows certain rules of behavior.

In market relationships the buyer and sell may have diametrically opposed interests, the seller seeking the highest possible price and the buyer the lowest, but unless they can reach a compromise that is acceptable to both sides, neither can do business.

The rationality assumption has prompted debates over its validity.

A large portion of human behavior is not purposive calculation, but rather of social roles that define appropriate behavior.

Many challenge the notion of consistent preferences and utility maximization.

People rarely possess consistent preferences.

People engage in “satisficing” behavior rather than maximization.

People routinely make cognitive errors in calculation.

A game of incomplete information is one in which the rules of the game are not common knowledge among the actors.

There is some asymmetry in the information possessed by the actors even at the start of the game.

Most real world games are games of incomplete information.

Actors do not know the motivation of their competitors.

They do not know their costs and hence their profits from certain actions, nor even if they are guided by profits or some other objective.

Actors do not know the feasible sets of actions by their competitors.

Actors differ in their knowledge of the world.

Max Weber: (Action that is motivated by self-interest can still be) substantially heteronomously determined... (in) a market economy, though in a formally voluntary way. This is true whenever the unequal distribution of wealth, and particularly of capital goods, forces the non-owning group to comply with the authority of others in order to obtain any offer on the market... in a purely capitalist organization of production this is the fate of the entire working class.

Once implemented, they'll be happy to have coverage. That's the relevant kind of working knowledge.

"Coverage" does NOT equal Health Care.

Do you have any concept of what $200/month means to someone who is barely scraping by?
The shit is really going to hit the fan when these already struggling Working Class Americans actually try to USE their "Bronze" Policies, and discover that the Money Pump has barely started.

AND if they try to say "No Thanks, I'd rather die", THEN they get hit by none other than the IRS.

Listen to this guy explain WHY the Mandate is BAD for America.

Having coverage that you can't use isn't going to make anyone happy, especially when they drop $2500/ year for a worthless policy that leaves them bankrupt anyway if they have a bad accident/illness.

The Kaiser Family Foundation has a calculator for what it expects premiums to be.

I'm single and almost 57. Two years ago, the calculator showed that I would pay $950 a month for a gold policy. Now it is showing $1100 for a bronze. If I make over $46,000, I will get no subsidy. If I stay under $46,000, I will pay $550 a month for a lousy policy under the subsidy.

I pay full freight on income taxes because I have no dependents and have never been able to get the money together to buy a home due to uncovered medical expenses.

I may be able to make over $46,000, but until I make $20,000 more, roughly, I will come out behind because my total insurance payments plus the tax on the income that I will need to pay the premiums comes out to that amount.

I have almost zero chance of getting a job that will either pay the higher income or have a group policy in which I will pay less.

I'm really going to be careful between 59 and whenever I will be allowed to get Medicare. Even though Medicare is a lousy policy, it isn't as expensive as my ACA policy will be.

I realize that some people will be helped, but I realize that, as ususal, I will receive little or no help from these "helping" programs.

I'd be better off if Obama had put in the catrastrophic policy, which is $619 for lousy coverage, and focused on getting the economy going again instead of leaving the economy to rot while he got wrestled to the ground by himself and the republicans on health care.

In MA, medical bankruptcies are STILL 50% of the total years after "reform."

"People don't choose to be uninsured! They can't afford it, and they have preexisting conditions!!!"

But now that both of those issues have been addressed, they're even more pissed. I can only conclude that they're simply cheap bastards for whom the only fair price is "free".

...who can afford the rather steep Buy In for these expensive policies.
For those with under $300 - $500 per month disposable income,
this wonderful "reform" did exactly NOTHING beyond reminding them that they don't count as human beings entitled to health care.

The last figures I saw about 6 months ago disclosed that LESS than 16% of Americans with pre-existing conditions who were now eligible to BUY health Insurance were able to afford to do so.

And you want to proclaim that "those issues have been addressed".

You said:

Every family under $88,000 is eligible for a subsidy, everyone within 133% of FPL gets medicare, and insurance companies can't reject you, but don't let facts interrupt your "when the germans bombed pearl harbor" rant.

The only rational reason for hoping this law gets derailed is if one is a cheap bastard for whom the only fair price is free.

They are eligible for subsidies on the insurance, not the underlying health CARE. If you have a pre-eixsting condition, the care will be very expensive, the insurance won't be cheap either. There is a huge distance between what these people will be forced to pay and "free". In between those two will be alot of bankrupt people. This plan ensures that the insurance companies will get paid, even if the federal government has to kick in some money. Not so much on making sure that the health CARE gets delivered.

He isn't so much hoping the law gets "derailed" as he is concerned about the political backlash when people find out just how much health CARE will cost them, even with HCR. And for those that don't particularly need health care at the time, they'll be suprised to find out how much they've been forced to pay for insurance, that they couldn't afford to use anyway.

...the same nerve that "Blame the Poor" conservatives hit all the time.

There are PLENTY of rational reasons to object to the implementation of this bogus health "Reform".
It does MORE to protect the profits of the For profit Corporations
than it does bring American Health Care Policy up to 20th century Civilized World standards.

FDR & LBJ would NOT have supported this For Profit, repackaged Republican "reform".
To these "Democrats", universal access to quality Health Care WAS a RIGHT,
and a cornerstone of the modern Democratic Party .



You will know them by their WORKS,
not by their excuses.
[font size=5 color=green]Solidarity99![/font][font size=2 color=green]
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for folks in that income bracket (based on a family of four, it is lower for less people and of course singles.

For those 133% or lower of the absurdly low poverty line (well below full time minimum wage income) they will supposedly get Medicaid. I say supposedly because the program is an easy target that has and will continue to absorb cuts, the program in many, if not most states is a fucking mess to the point that some aren't accepting applicants and more aren't paying out to providers, and HHS and Obama are quick to hand out waivers.

Folks making as little as $8 and $9 an hour make too much for Medicaid.

Yup, you went straight to the Reich Wing welfare queens frame, insisting that someone that makes 15 or 16 grand are cheapskates because they will be challanged to pony up 10% of their pre-tax earnings to the insurance cartel before they get a lick of care.

The issues were addressed not resolved. This isn't about care, if it was there would be no provision that if the subsidies plus 10% of your gross don't cover the premiums, that waivers will be issued. Instead those poor souls would get coverage at least under the terms that everyone else gets.

People who make 140% of FPL will have their premiums subsidized to cap their costs at 3-4% of their income. Also, they will undoubtedly choose the "gold" insurance for that price, so their out of pocket expenses are limited.

If it remains intact, it will make medical bankruptcy comparatively rare, by virtue of the fact that a sick individual can opt in or upgrade their current coverage.

I wish the purists would stop spreading disinformation about this. ACA is a good thing for everyone who wants to have coverage. It's only bad for those who don't... and I'm unsympathetic to them.

And where I live, a single person earning $46,000 often cannot afford a small apartment in a marginal neighborhood. I can't even come close to a regular job anywhere else unless you're going to hire me. I guess that makes me a really cheap bastard.

If you think that the subsidies are adequate, particularly for older folks who are already having a tough time in the labor market, then you have an extremely hard heart.

When people realize that, thanks to the subsidy, they can for the first time actually afford insurance, even with their preexisting conditions, they'll wonder what all the bitching was about.

When the perfect isn't an option, good is the goal.

Exactly. I'd absolutely love a single payer system, but it was not going to happen. What we got was an imperfect bill that has flaws but plenty of great aspects, as well. And it can be improved upon. The idea of single payer health care in my lifetime is now as likely as ever thanks to Obamacare, and for that I'm grateful. (And I didn't even mention the many other things for which I'm thankful in the ACA)

We took a "right turn" when we passed this plan. It's pretty muc standing in the way of single payer since it places health insurance companies squarely between single payer and the public.

This plan is heavily modeled on one put together by the GOP in '95 with the expressed purpose of preventing anything like single payer. And the GOP got it passed without having to vote for it.

It established health insurance as an obligation, while very clearly establishing that health CARE was not a right.

He consistently advocates policies that would be good for the people, even though it makes him unpopular with the rich guys.

I sure the hell am not. BTW, that is what MA bankruptcies are like years after "reform." Before "reform" that percentage was 59%. An improvement, to be sure, but nothing that causes me to wet my pants in delight.

I wish someone would figure out why procedures are less expensive just about everywhere else in the developed world. Then maybe we'd have some idea as to how to get both costs and bankruptcies down.

Maybe that's another reason why the Mittster is trying to play down Romneycare. It's not getting the job done!

In countries with private insurance, the government not only dictates coverage, but also costs. In the Netherlands in 1996, my husband got an emergency root canal for $25 American (100 guilders). That's what the government said that root canals would cost. Of course they also acted to hold down the prices of all of the dentist's inputs, and paid for his education from kindergarten through dental school.

Malpractice insurance costs on average $100/month in the rest of the developed world. Why? Because people don't sue their doctors when they have unfavorable outcomes. And that is because the extra costs automatically get taken care of by universal coverage.

Maybe that's why we don't have Medicare for All.

Providers understandably resent cuts when they have huge med school loans to pay back, and there are no controls on the prices of the things they need to buy in order to practice, especially malpractice insurance. Improved Medicare for All could fix that.

Coverage isn't better. Systemic costs increase. Individual costs increase. Portability is not improved.

It is almost like some folks believe we have a unified pool or that this law creates one. The fragmentation is ongoing. We have maintained state regulation and enforcement (auto-fail), they still set the reimbursement rates, they still authorize and deny coverage, they maintain their anti-trust exemption (which clearly states no serious effort. Or even intent to regulate), you put an MLR on them but first set it at where they say they are to shareholders (making either pointless or a crime that needs to be prosecuted that isn't) then you allow the companies to collude, and make the only way to increase profits to be to increase the output on care while leaving them in control of setting allowable cost and collude.

Of all these and more serious problems in our system, why would increasing participation in a broken system (mostly those with no influence or money) be most critical? To save the insurance cartel from suicide as it would have dealt with serious threats to its model because of the boomers transitioning to Medicare with the current business model and the ability of the populace to drop coverage.
The cartel was on a collision course with pricing themselves out of existence without their "services" being mandated and frankly, without significant financial aid from the government.
It will still happen but the game can go on decades longer but eventually neither the people nor the government will be able to sustain the drain but in the meanwhile the profits will continue and keep increasing.

It seems apparent that the current system in which you can't get coverage if you're sick, and insurers can simply kick you out if you do get sick, will yield more bankruptcies than will be the case under aca.

The Mittster is trying to downplay romneycare because the current nationwide setup is more profitable for his class.

With "reform" people between 50 and 64 are entitled to empty their pockeds and have nothing left over to meet the outrageous deductibles.

When the American people have had a chance to feel the ravages of this mandated monopoly that we gave to the insurance industry. Wait until they realize that not only is there no public option to act as a price regulator, but there are virtually no price controls.

This Affordable Care Act is nothing more than a gift to the insurance industry, and another burden that will destroy the middle class.

The problem is that HCR will be a really major disaster for those aged 50-64. And now some "Democrats" want to impose it on those of us 65+, who have even higher on average health care expenses.

http://www.pressherald.com/news/GOP-Medicare-plan-borrows-from-and-repeals-Obamas.html

But if Obama is re-elected and his health care law is upheld by the Supreme Court, Wyden sees Medicare exchanges and a premium support system as the basis for a deal to reduce health care costs. He said Democrats would be hard pressed to argue against the idea if it is working for people under 65 as a result of the health care overhaul.