White House delays employer mandate requirement until 2015

[waitforufo]

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/02/white-house-delays-employer-mandate-requirement-until-2015/?print=1

 

Is this the beginning of the end for ACA (aka Obamacare)?

Why not go ahead and save all that money by implementing ACA on time? Why miss a year of savings?
You would think Obama and the Democrats would want to bask in the glory of ACA in the lead up to the next election.

Okay, enough of the sarcasm.

I doubt employers will rejoice in this delay. Perhaps they will postpone some layoffs and some hour cut back plans but I doubt it. Employers hate uncertainty. The uncertainty of the impact of ACA has been holding back the economy long enough. Roll it out already and let the chips fall where they may. At least then employers will know the situation they are in and act accordingly. Now they just have more wait. Implement it so we can know what is in it.

 

 

[overtone]

As an aspect of the US trend toward rightwing authoritarian government, so marked and disturbing over the past couple of decades, mandated purchase of medical insurance on the private market looks bad to me. There are all kinds of things wrong with it, in theory and in practice.

 

But I can't help but enjoy, in a way, the sight of the very political faction most strident in promoting "markets" and "competition" and employer based health insurance as the answer to the burgeoning cost and inadequate coverage and crippling effects of the current US medical care setup suddently confronted with the prospect of actually being forced to make good on their prescriptions.

 

After so many, many years of listening to people promote employer based private market medical insurance as the solution to all our woes (instead of the source), their floundering and backpedaling and panic at the prospect of such a setup being forced to provide what they have been promoting it to provide, is kind of humorous in one of those sad, ironic ways that actual misery can be.

 

They were obviously never serious about providing medical care to the young, old, lower class, sick, injured, unemployed, and otherwise non-prosperous people in the US. They were willing to pay double for medical care, risk bankruptcy and misery, not to show off their p[rosperity or other such understandable reason, but merely for the privilege of denying it to the undeserving. They earned this fate.

[iNow]

Is this the beginning of the end for ACA (aka Obamacare)?

If it is, then I hope it's because we're going to replace it with some sort of single-payer universal system.

[waitforufo]

If it is, then I hope it's because we're going to replace it with some sort of single-payer universal system.

That would be far better than the current ACA. But I don't see how that will ever pass either. The Democratic party passed this current mess without a single Republican vote. If the Democratic party wanted single payer, passing ACA without any Republican votes proves they could have passed single payer instead of ACA. Why didn't they? Will they get another bite at the apple with the failure of ACA? I doubt it, but who knows.

Edited July 7, 2013 by waitforufo

[iNow]

That would be far better than the current ACA. But I don't see how that will ever pass either.

Agreed. It's sad, really, that we as a populace seem to like remaining willfully ignorant and force ourselves so consistently into sub-optimal solutions instead of things that we know actually work and cost less and cover more.

 

The Democratic party passed this current mess without a single Republican vote. If the Democratic party wanted single payer, passing ACA without any Republican votes proves they could have passed single payer instead of ACA.

Not if they couldn't get every democrat on board for the bigger package. Your logic is flawed by assuming all democrats (and other key stakeholders and constituents that fund them) would have equally supported a single payer approach. Just because they were able to pass legislation A without a single republican vote doesn't mean they could equally pass legislation B without a single republican vote. Edited July 7, 2013 by iNow

[overtone]

 

 

If the Democratic party wanted single payer, passing ACA without any Republican votes proves they could have passed single payer instead of ACA. Why didn't they?

There aren't enough leftwing Democrats in Congress to pass single payer even just within the Democratic side of the aisle. The Clintons won that fight in 1991 - Obama didn't even put a public option for low income buyers on the table.

 

The most likely route to something that makes sense is probably a gradual and partial "stealth" expansion of Medicare (allowing it to negotiate drug prices, that kind of thing) perhaps as a response to the current boom in SS disability claims. The Republicans might back off their currently controlling media leverage against something like that, because the cost and stupidity of the current setup is beginning to bite their corporate support.

[waitforufo]

Not if they couldn't get every democrat on board for the bigger package. Your logic is flawed by assuming all democrats (and other key stakeholders and constituents that fund them) would have equally supported a single payer approach. Just because they were able to pass legislation A without a single republican vote doesn't mean they could equally pass legislation B without a single republican vote.

You say my logic is flawed, but I agree with everything you say above with the exception to your opinion about my logic. This is a Democratic Party law. The Democrats passed it in the House, Senate, and had a Democrat President sign it. ACA was the best they could come up with. Now Obama can't enact it. It's sad really. While I never agreed with the legislation, I hate to see my country fail so publically and spectacularly. What an embarrassment caused by simple hubris.

 

On a personal note, I had a great ride over the holiday weekend. One of the highlights was Highway 21 from Boise to Stanley Idaho. Spectacular.

[iNow]

This is a Democratic Party law. The Democrats passed it in the House, Senate, and had a Democrat President sign it. ACA was the best they could come up with.

See, here's where I think you're entirely mistaken. I personally think it's pretty obvious that the ACA was not "the best they could come up with." Based on all objective accounts I've read and my own read of the news stories, the ACA is probably better described as the best they could pass given the political climate. Pretty major difference if you ask me. One is a much better and smarter approach that other nations have demonstrated time and again works successfully and costs less and covers more people, the other is a compromise to appease people who are opposed for ideological reasons instead of factual ones.

 

On a personal note, I had a great ride over the holiday weekend. One of the highlights was Highway 21 from Boise to Stanley Idaho. Spectacular.

Ugh! So totally jealous. I spent my entire week doing little more than plumbing, drywall, and tile work, and then a day or two doing a bit of word work building a cradle. How I WISH I was out riding and through such an intensely beautiful landscape. Cheers, man.

[overtone]

 

 

While I never agreed with the legislation, I hate to see my country fail so publically and spectacularly. What an embarrassment caused by simple hubris

It sounds like you are blaming "the Democrats" for it, though, rather than hubris by those afflicted with hubris.

 

The main reason the ACA is so difficult to enact and so badly constrtucted, such an embarrassment, is the rightwing and especially Republican opposition to reasonable health care legislation in this country - and the hubris with which that Party has set out to prevent the US from being governed well has been the dominant feature of the American public political discourse since Reagan.

 

As far as "the Democrats", the central one has been Obama - the most striking feature of his Presidency so far has been its compromising, wheedling, can't we all just get together and do the right thing behavior.

[waitforufo]

The main reason the ACA is so difficult to enact and so badly constrtucted, such an embarrassment, is the rightwing and especially Republican opposition to reasonable health care legislation in this country - and the hubris with which that Party has set out to prevent the US from being governed well has been the dominant feature of the American public political discourse since Reagan.

I'm sorry but I think you are wrong here. The Democrats passed ACA. Not one Republican voted for it. The Republican Party telegraphed this zero vote for months. Everyone knew it was going to happen. I remember plenty of liberals pushing for single payer knowing that Republicans wouldn't vote for any health care bill. The Democrats still passed ACA into law. They could have passed anything they wanted. The best they could come up with was ACS. You shouldn't be pointing your finger at Republicans or conservatives. You should be trying to figure out what is wrong on your side of the isle.

[iNow]

I remember plenty of liberals pushing for single payer knowing that Republicans wouldn't vote for any health care bill. The Democrats still passed ACA into law. They could have passed anything they wanted. The best they could come up with was ACS.

You keep saying this, but it seems very much untrue, as already noted above. Is this your sincere belief... that the ACA was "the best they could come up with," and not "the best they felt was politically feasible?"

[waitforufo]

You keep saying this, but it seems very much untrue, as already noted above. Is this your sincere belief... that the ACA was "the best they could come up with," and not "the best they felt was politically feasible?"

I think our opinions only differ in semantics.

 

The Democrats knew for some time before passing ACA that they would get zero support from Republicans. Conservatives just don't think the government solves problems as well as the private sector. Democrats knew they alone would be held responsible if it turned into an unworkable mess. Sure the Democrats will try to point fingers and whine about partisanship but only silly people will buy it.

 

Given the above, Democrats cobbled together ACA on their own. You say what they came up with was “the best they felt was politically feasible.” The way I read that is that the Democrats knew their own constituents didn’t want single payer and would vote them out if that is what they passed. So it was “the best they could come up with” and still get reelected was ACA. That path always had a high potential to turn into a bad bet if ACA stumbles badly out of the gate. Max Baucus has already dropped out. Try as you might to blame the Republicans, but they can always point to the fact that zero Republicans voted for ACA.

 

Succeed or fail, Democrats own ACA. Its success or failure will be Obama’s primary legacy.

 

By the way, I don't think my comment above about getting reelected is only a Democrat thing. Ask any politician what is best for the country and they all will tell you that winning their next election is most important future event for the country. How could the country possibly improve without their personal participation? Better yet would be their party being in the majority. Such opinions are an essential part of being in the political class. Those of us outside of the political class should never forget that.

 

 

 

[iNow]

Conservatives just don't think the government solves problems as well as the private sector.

That's fine as a simplistic ideology, but the harsh reality is that it's plainly untrue in context of our consumption of healthcare.

 

 

Here's perhaps one of the more decisive papers on this, but there are countless others supporting my point that markets fail miserably in this domain:

 

http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

 

Uncertainty and the Welfare Economics of Medical Care

 

This paper is an exploratory and tentative study of the specific differentia of medical care as the object of normative economics. It is contended here, on the basis of comparison of obvious characteristics of of the medical-care industry with the norms of welfare economics, that the specific economic problems of medical care can be explained as adaptations to the existence of uncertainty in the incidence of disease and in the efficacy of treatment.

 

Another summary of similar issues:

 

http://krugman.blogs.nytimes.com/2009/07/25/why-markets-cant-cure-healthcare/

 

There are two strongly distinctive aspects of health care. One is that you dont know when or whether youll need care but if you do, the care can be extremely expensive. The big bucks are in triple coronary bypass surgery, not routine visits to the doctors office; and very, very few people can afford to pay major medical costs out of pocket.

 

This tells you right away that health care cant be sold like bread. It must be largely paid for by some kind of insurance. And this in turn means that someone other than the patient ends up making decisions about what to buy. Consumer choice is nonsense when it comes to health care. And you cant just trust insurance companies either theyre not in business for their health, or yours.

 

This problem is made worse by the fact that actually paying for your health care is a loss from an insurers point of view they actually refer to it as medical costs. This means both that insurers try to deny as many claims as possible, and that they try to avoid covering people who are actually likely to need care. Both of these strategies use a lot of resources, which is why private insurance has much higher administrative costs than single-payer systems. And since theres a widespread sense that our fellow citizens should get the care we need not everyone agrees, but most do this means that private insurance basically spends a lot of money on socially destructive activities.

 

The second thing about health care is that its complicated, and you cant rely on experience or comparison shopping. (I hear theyve got a real deal on stents over at St. Marys!) Thats why doctors are supposed to follow an ethical code, why we expect more from them than from bakers or grocery store owners.

 

You could rely on a health maintenance organization to make the hard choices and do the cost management, and to some extent we do. But HMOs have been highly limited in their ability to achieve cost-effectiveness because people dont trust them theyre profit-making institutions, and your treatment is their cost.

 

Between those two factors, health care just doesnt work as a standard market story.

And another describing the market failures evident in healthcare...

 

http://www.thefiscaltimes.com/Columns/2013/06/18/7-Important-Examples-of-How-Markets-Can-Fail.aspx#page1

 

There are two important market failures in the health care market. The first is moral hazard, and it is much like the moral hazard problem in retirement insurance markets. If people know that society will care for them if they break a limb, have a life-threatening disease, and so on if they can always go to the emergency room at someone elses expense many will choose to go without insurance. A solution to this problem, one that is part of Obamacare, is to force everyone to buy insurance and contribute to the care they get.

 

There are many other market failures in health care markets, e.g. patients not knowing enough about treatments to be informed consumers, and all of them can be mostly resolved through government managed health care systems such as those adopted in other developed countries.

And here are two more full expositions of the market failures evident in healthcare:

http://theincidentaleconomist.com/wordpress/health-insurance-market-failures-and-what-can-be-done-about-them/

http://theincidentaleconomist.com/wordpress/health-care-market-failures-and-what-can-be-done-about-them/

 

 

Seriously... This is about ideology, not facts. The facts clearly indicate that healthcare should not be left to the market, no matter how strongly conservatives may believe it does a better job than the government at solving such problems. That belief is unequivocally contradicted by reality.

[waitforufo]

I see no need to turn this into a debate about public versus private sector solutions. The debate here is about ACA, and if it will work. It seems like the white house is saying no it will not. As public sector solutions go, I think single payer is far better than ACA, in part because I too don't think ACA will work.

Conservatives have their beliefs. They voted that way. Had they voted the other way, their constituents would have thrown them out. That too would have gone against the two primary beliefs of the political class. Get reelected, and get your party in the majority position. Do both of those things and never mind how it impacts the country.

Another personal note. My recent ride also included WA Highway 129 and Oregon Highway 3 between Clarkston WA and Enterprise OR. Check it out right around the border. You also said you were building a cradle. Are congratulations in order?

[iNow]

[iNow]

Is this the beginning of the end for ACA (aka Obamacare)?

 

The experts appear to think the exact opposite.

 

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/07/08/obamacare-just-got-easier-to-implement-not-harder/

 

This hasn’t been a banner news week for Obamacare. But can it really be true, as my colleague Jennifer Rubin writes, that “Everyone now agrees: Obamacare can’t be implemented”?

 

Er, no.

 

<snip>

 

[The] head of the Office of Management and Budget, disagreed with Rubin. “Delaying the employer mandate makes successful implementation more likely, not less likely,” he told me.

 

Larry Levitt, vice president of the nonpartisan Kaiser Family Foundation, agreed. “There’s nothing about the delay in the employer requirement that suggests Obamacare can’t still be implemented,” he said. “If anything the delay removes some potential administrative complexities from the plates of the implementers, and avoids the problem of some employers reducing the hours of part-time workers to get around the requirement.”

 

Timothy Jost, a health law expert at Washington and Lee University’s School of Law, was even blunter. “Implementation just got easier rather than harder,” he said.

 

Well, so much for “everyone.”

 

As those interviews indicate, the thinking among health-care experts is closer to the precise opposite of Rubin’s bombastic headline: The Obama administration has decided to accept some bad media coverage now, and some higher costs later, in order to make Obamacare much, much simpler to implement next year.

 

<snip>

 

Obamacare’s critics appear to be enjoying something of a Pyrrhic victory right now: They get to (rightly) criticize the administration for unilaterally delaying unpopular and ill-drafted elements of the law. But they seem to be assuming that the bad media coverage now can be extrapolated into bad implementation next year.

 

That misses the choice the White House actually made: Bad press now, and higher costs in 2014, in return for an easier roll out. Whether you think the White House is making the right policy call will depend on whether you prefer slightly lower costs to a smoother rollout. But so far as Obamacare’s implementation goes, it just got easier, not harder.

[overtone]

The Democrats knew for some time before passing ACA that they would get zero support from Republicans.

Your presumption that there is a faction you can label as "the Democrats"and

 

Conservatives just don't think the government solves problems as well as the private sector.

treat as if they were not "conservative" is a fantasy. The Demcoratic Congress is majority rightwing conservative now, and has been for decades.

 

 

 

Democrats knew they alone would be held responsible if it turned into an unworkable mess. - - - -

 

Given the above, Democrats cobbled together ACA on their own.

The ACA was written almost in its entirety by the Republican (Romney) administration of the State of Massachusetts, adopted by the US Congressional Democratic Party's rightwing majority in preference to the various far superior but unfortunately partially socialist plans still being pushed by the minority leftwing faction of the Democratic Party.

 

 

 

Sure the Democrats will try to point fingers and whine about partisanship but only silly people will buy it.

Why would only silly people be capable of recognizing political fact? As you yourself pointed out - not a single Republican vote, and widespread sabotage efforts among Republicans nationwide, for something that started out as a Republican plan designed to meet all Republican objections and prevent liberal or leftwing setups from being established. What is that if not blind and destructive partisanship?

 

Just to point to the most obvious factor, any health care legislation needed not a majority but a filibuster proof supermajority in the Senate - or a plan that would not be filibustered by the Republicans.

Edited July 9, 2013 by overtone

[iNow]

The ACA was written almost in its entirety by the Republican (Romney) administration of the State of Massachusetts, adopted by the US Congressional Democratic Party's rightwing majority in preference to the various far superior but unfortunately partially socialist plans still being pushed by the minority leftwing faction of the Democratic Party. <snip> for something that started out as a Republican plan designed to meet all Republican objections and prevent liberal or leftwing setups from being established.

Not to mention that the idea of an individual mandate came from a brief put out in 1989 from the one of the most powerful and influential right-wing conservative think tank groups in the entire US... A group whose stated mission is to "formulate and promote conservative public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense."

 

This group was the Heritage Foundation and the mandate was their idea.

 

http://www.policyarchive.org/handle/10207/bitstreams/13354.pdf

[zapatos]

[Phi for All]

 

Congratulations, Papa!

[waitforufo]

Congratulations to you and your growing family. I wish you and yours the best.

 

Your presumption that there is a faction you can label as "the Democrats"and

 

treat as if they were not "conservative" is a fantasy. The Demcoratic Congress is majority rightwing conservative now, and has been for decades.

 

 

 

The ACA was written almost in its entirety by the Republican (Romney) administration of the State of Massachusetts, adopted by the US Congressional Democratic Party's rightwing majority in preference to the various far superior but unfortunately partially socialist plans still being pushed by the minority leftwing faction of the Democratic Party.

 

 

 

Why would only silly people be capable of recognizing political fact? As you yourself pointed out - not a single Republican vote, and widespread sabotage efforts among Republicans nationwide, for something that started out as a Republican plan designed to meet all Republican objections and prevent liberal or leftwing setups from being established. What is that if not blind and destructive partisanship?

 

Just to point to the most obvious factor, any health care legislation needed not a majority but a filibuster proof supermajority in the Senate - or a plan that would not be filibustered by the Republicans.

Zero Republicans voted for ACA. Democrats selected the Massachusetts (Romney) plan. It was the best they thought they could do. They chose it and they own it. If it works out I doubt they will be giving Romney credit.

[overtone]

Zero Republicans voted for ACA. Democrats selected the Massachusetts (Romney) plan. It was the best they thought they could do.

It was the best some of them thought they could do in the face of vicious and unprincipled partisanship by the irresponsible and frankly idiotic Republicans, yes.

 

Are we supposed to give the Republicans a pass on the consequences of their vicious and unprincipled partisanship? Are you attempting to absolve the Republicans of responsibility for the contents of their legislation and the consequences of their actions?

 

 

They chose it and they own it.

I still think the fact that it was a Conservative Republican plan in the first place, and only existed in that first place as a Republican ploy to prevent a State from adopting an economically centrist or even leftwing approach to providing health care, is worth considering when establishing "ownership".

 

You are still talking as if "the Democrats" were some kind of unified body that as one entity chose the ACA from among alternatives, btw. You are also talking as if this unified Party you dreamed up was in control of both housed of Congress and voting as a bloc (the way the Republicans did, even against their own legislation that they wrote). You use "they" as if referring to some coherent group. That is talk radio Fox level delusion.

 

You are also talking as if the united Republican opposition vote to a plan some of them wrote in the first place and had long supported in the past was not merely a case of obviously destructive and corrupt and dishonest partisanship, but instead reflected some kind of principled or ideologically reasoned stance. If they (and the pronoun makes sense when referring to Reps in Congress) had any principled objections to the ACA, why did they write it and promote it in the first place?

Edited July 9, 2013 by overtone

[waitforufo]

It was the best some of them thought they could do in the face of vicious and unprincipled partisanship by the irresponsible and frankly idiotic Republicans, yes.

 

Are we supposed to give the Republicans a pass on the consequences of their vicious and unprincipled partisanship? Are you attempting to absolve the Republicans of responsibility for the contents of their legislation and the consequences of their actions?

 

 

I still think the fact that it was a Conservative Republican plan in the first place, and only existed in that first place as a Republican ploy to prevent a State from adopting an economically centrist or even leftwing approach to providing health care, is worth considering when establishing "ownership".

 

You are still talking as if "the Democrats" were some kind of unified body that as one entity chose the ACA from among alternatives, btw. You are also talking as if this unified Party you dreamed up was in control of both housed of Congress and voting as a bloc (the way the Republicans did, even against their own legislation that they wrote). You use "they" as if referring to some coherent group. That is talk radio Fox level delusion.

 

You are also talking as if the united Republican opposition vote to a plan some of them wrote in the first place and had long supported in the past was not merely a case of obviously destructive and corrupt and dishonest partisanship, but instead reflected some kind of principled or ideologically reasoned stance. If they (and the pronoun makes sense when referring to Reps in Congress) had any principled objections to the ACA, why did they write it and promote it in the first place?

The above is the silliness I was speaking of earlier. Zero Republicans voted for ACA. That means Republican opinions could have, and should have, been completely ignored. Democrats only needed to put together a bill that they could vote for. In my opinion, that is what they did. Even within their own coalition they could not find support for a single payer system. Democrats have no one to blame but themselves for ACA. If it works out they can also take all the credit. That seems fair to me.

 

What is being implemented now isn't even ACA. It's whatever the white house thinks ACA should be. I thought we were a nation of laws.

Edited July 9, 2013 by waitforufo

[overtone]

Zero Republicans voted for ACA. That means Republican opinions could have, and should have, been completely ignored.

1) No, it doesn't. For one thing, several Republican votes in the Senate were necessary to beat the filibuster. For another, a show of attempting to compromise with the Republican coalition was necessary for favorable media attention anywhere, a key to gaining vulnerable Democratic support. There are many others, which even the most casual perusal of events or randomly vague memory of the past ten years in this country would have brought to mind.

 

2) "The Democcrats" do not exist - the opinions of the far right wingnut faction of Democrats had to be considered.

 

 

 

Even within their own coalition they could not find support for a single payer system. Democrats have no one to blame but themselves for ACA.

There is no such Democratic coalition. You are mistaking the current Republican fascistic ideology of Party loyalty for a political universal.

 

Considering the coalitions found in reality, there is no reason for the people who fought for single payer health care for decades to take blame for the ACA. These people were almost entirely Democrats and never Republicans only because there are no competently legislating Republicans left in Congress, meanwhile Congressional Democrats were not mostly those people.

 

There is reason for the people who wrote the ACA in the first place, and established it in political reality, and eliminated any of the better alternatives to it, to take some blame for its existence. That would mean blaming the Republican coalition (which does in fact exist) for the stuff they did and the consequences of their actions, which seems reasonable to me.

 

 

 

What is being implemented now isn't even ACA. It's whatever the white house thinks ACA should be.

If true, "the Democrats" get even less blame.

 

It's not true.

Edited July 10, 2013 by overtone

[waitforufo]

1) No, it doesn't. For one thing, several Republican votes in the Senate were necessary to beat the filibuster. For another, a show of attempting to compromise with the Republican coalition was necessary for favorable media attention anywhere, a key to gaining vulnerable Democratic support. There are many others, which even the most casual perusal of events or randomly vague memory of the past ten years in this country would have brought to mind.

 

2) "The Democcrats" do not exist - the opinions of the far right wingnut faction of Democrats had to be considered.

 

 

 

There is no such Democratic coalition. You are mistaking the current Republican fascistic ideology of Party loyalty for a political universal.

 

Considering the coalitions found in reality, there is no reason for the people who fought for single payer health care for decades to take blame for the ACA. These people were almost entirely Democrats and never Republicans only because there are no competently legislating Republicans left in Congress, meanwhile Congressional Democrats were not mostly those people.

 

There is reason for the people who wrote the ACA in the first place, and established it in political reality, and eliminated any of the better alternatives to it, to take some blame for its existence. That would mean blaming the Republican coalition (which does in fact exist) for the stuff they did and the consequences of their actions, which seems reasonable to me.

 

 

 

If true, "the Democrats" get even less blame.

 

It's not true.

Again more silliness. You seem to think there are good liberal Democrats and bad conservative Democrats. That may be, but it doesn't matter. Every politician is judged by how they vote and with whom they vote. Zero Republicans voted for ACA. I'm not sure but I think all Democrats voted for ACA. Together collectively the Democrats own ACA for good or for bad. It is there bill signed by their President. Now their President can't make it work so he is rewriting the ACA on the fly with wavers and postponements in order to avoid the economic impact of this law especially before the next election. I believe the constitution requires the president to implement enacted laws as written. Not doing so was one of our complaints about the British monarchy. The President should be implementing the law that he signed. He should do that so we know what is in it and hold those accountable for approving it.