Obamacare? what are your thoughts

Episteme · Jun 7, 2014

This is an abstract taken from a round-up of abstracts published by Science magazine. I tried to get it directly from Science but they have a paywall. But it was published intact on Powerlineblog.com

If you give poor people middle class stuff... can you make them into middle-class people? Does giving access to health care for free contribute to unemployment. Here is a case study from the State of Tennessee

Gilbert Chin

What is the relationship between employment rates and access to public health insurance? Garthwaite et al. analyzed what happened in 2005, when the state of Tennessee discontinued Medicare health insurance coverage for about 4% of its non-elderly adult population, many of them nondisabled low-income adults without children at home. With a new need for private health insurance, which is often provided by employers, many of these people found new jobs. State employment rose by 6 percentage points from 2004 to 2006. This change mirrors the Congressional Budget Office projections of the decline in employment due to the expansion of public health insurance mandated in the U.S. Affordable Care Act.

Q. J. Econ. 129, 653 (2014).

There are many causes for our sluggish economy. I would suggest the ability to get free health care and free food and 99 months of unemployment are a disincentive to work. Hence a jobless "recovery".

MunoRN, RN · Jun 7, 2014

This is an abstract taken from a round-up of abstracts published by Science magazine. I tried to get it directly from Science but they have a paywall. But it was published intact on Powerlineblog.com
If you give poor people middle class stuff... can you make them into middle-class people? Does giving access to health care for free contribute to unemployment. Here is a case study from the State of Tennessee
Gilbert Chin
What is the relationship between employment rates and access to public health insurance? Garthwaite et al. analyzed what happened in 2005, when the state of Tennessee discontinued Medicare health insurance coverage for about 4% of its non-elderly adult population, many of them nondisabled low-income adults without children at home. With a new need for private health insurance, which is often provided by employers, many of these people found new jobs. State employment rose by 6 percentage points from 2004 to 2006. This change mirrors the Congressional Budget Office projections of the decline in employment due to the expansion of public health insurance mandated in the U.S. Affordable Care Act.
Q. J. Econ. 129, 653 (2014).

There are many causes for our sluggish economy. I would suggest the ability to get free health care and free food and 99 months of unemployment are a disincentive to work. Hence a jobless "recovery".

Their evidence that greater access to health insurance increases unemployment, the CBO report, doesn't actually say what they are inferring. From the report:

"The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in business’ demand for labor, so it will appear almost entirely as a reduction in labor force participation and in hours worked relative to what have occurred otherwise rather than as an increase in unemployment (that is, more workers seeking, but not finding jobs) or underemployment (such as part-time workers who would prefer to work more hours per week)."

In other words, prior to Obamacare the only way to access quality insurance was through an employer, so people got jobs and worked full time hours in large part just to get access to better healthcare, not because they needed the earnings from wages. Now that individual plans are required to be comparable to employer provided plans, those who don't actually need to work won't be taking up valuable jobs, making them more available to people who actually need the hours.

MunoRN, RN · Jun 7, 2014

No... single payer doesn't work flawlessly. Consequently, some of the "big boy" nations are allowing people with resources to operate in a better, parallel system much like we can still remember. So single payer appears to become a dual system, one for the haves and one for the little people. There's a lot about progressives I don't understand but I know the current buzz words are "equity" and "equality" and I don't believe the rich having excellent care and the less rich getting to wait 18 months for a knee replacement is what they are after.
If I'm wrong, I'm sure you'll tell me. Broad introductory comments are very easy to twist.
Here is what I find indefensible. WE DON'T HAVE THE ACA. We have whatever the h*ll HHS wants the law to be this week. It had an incredibly incompetent roll out, we have had arbitrary delays on uncomfortable provisions that could swing elections. As we speak, the computer program is being reworked to something else for the November open enrollment deadline.
There are over 2 million applicants whose data don't fit (remember, PAPER applications are still being processed) and it cannot be determined whether many have paid their first premium. Which is just A-OK with the politicians whose careers are riding on this because if the real data were available, it would look lame. It's data no one can get. Just trust us. 8 million people are enrolled. The cost curve is being bent downward and if you like your doctor you can keep your doctor.
Most egregiously, it is now being admitted that almost no one is going to pay the penalty for not signing up for insurance because (again, totally apart from the law itself) if you've had a "life-changing event" in the last year, you're excused.
WITHOUT THE MANDATE YOU DO NOT HAVE THE ACA. The care for the uninsured was supposed to be born by the young and healthy who would perforce buy expensive policies OR, having failed to do so would face a penalty to be assessed by the IRS. NOW we are told that anyone can avoid the penalty. You just sign an attestation to the fact that your life has changed... and you skate. THIS IS NOT IN THE ACA.
The interest group with the most pull in DC are labor unions whose members will pay a 45% tax on their "Cadillac plans" and the betting is on as to how the law will be twisted again to keep that constituency happy.
We don't have a health care law. We have a slow-rolling train wreck.
And it is at this point that those who celebrated the ACA (per the quote noted above)... tell us "well, we wanted a single payer system... we could only get a half measure because the T-party, foul Republicans, Chamber of Commerce, rich 1 percenters wouldn't let us have what we really wanted. So, you see... it's their fault.
No one on the right supported this. It is your baby. Live it. Love it.
I am also told that the "party of no" has nothing positive to offer. The President laments that all he hears is criticism and if just one person would come to him with suggestions... (meanwhile if you like your doctor you can keep your doctor and Oh baby, of COURSE I'll love you in the morning). While I don't think it's my job to dig up information readily available to those who have complete field-cut/neglect on their right... I offer just one of many that are being proposed and have been proposed by evil conservatives. There have been all along. This is only ONE offering available from the Manhattan Institute.
Covering Pre-Existing Conditions in a Market-Driven Health System | e21 - Economic Policies for the 21st Century

If you read back through the thread you'll find responses to most of your issues, but to review:

"We have whatever the h*ll HHS wants the law to be this week." - Like every law before it, the implementation of laws is managed by the executive branch along with regulatory and administrative agencies such as the HHS. To facilitate implementation the timeline has been adjusted, just as the Bush administration changed the timeline of the rollout of part D, and just like every other law has been managed.

"There are over 2 million applicants whose data don't fit "- The figure doesn't actually include those who applications have not been at least initially processed. The process for making the first payment is no different than it was prior to Obamacare; you pay your insurer for your plan.

"The cost curve is being bent downward and if you like your doctor you can keep your doctor."- The cost curve is being bent downard, you disagree?

I fully agree it was ignorant to give people the idea that we were regulating insurers to require them to include all doctors in their plans. Insurers have always used preferred providers, do you think we should take this competitive aspect away from insurers?

"Most egregiously, it is now being admitted that almost no one is going to pay the penalty for not signing up for insurance.." The first conservative complaint was that we had a mandate, in response it was pointed out that it's not really a mandate as the law provides for exemptions, now the complaint is that it's not really a mandate?

"THIS IS NOT IN THE ACA." - It is actually, the ACA leaves it up to the IRS and other agencies to determine the exemptions.

"The interest group with the most pull in DC are labor unions whose members will pay a 45% tax on their "Cadillac plans" - The cadillac plan tax isn't 45% on the plan. It's 40% on the amount over the limit. So a family plan with $28,000 will have a "cadillac tax" of .7%. The purpose of the cadillac tax is to discourage plans that have no or near no out of pocket costs for the customer, something that nearly all conservative 'alternatives' to Obamacare agree with.

"No one on the right supported this. It is your baby. Live it. Love it."- Obamacare looks an awful lot like the various conservative positions on health reform: the Heritage plan, Gingrich's think tank plan, all the way up to the current alternatives which seem awfully similar, with the only potential differences being left up to the imagination.

"There have been all along. This is only ONE offering available from the Manhattan Institute." - This is about as much of an "alternative plan" as any of the others, which isn't much. It's framed as an alternative, although it's hard to tell how it's different than the government sponsored high risk pools already established by Obamacare, or those that existed prior to Obacmare, which is called Medicaid. All this "plan" consists of is to say that those with pre-existing conditions should be covered by the government (apparently missing the fact that they are still then paid for by our tax dollars). They vastly underestimate the number of people effected by pre-existing conditions, putting it at less then 1%. A congressional investigations found that 1 in 7 claims in the individual market were denied due to claims of pre-existing conditions, 14%, a rate which was progressively increasing. Without the restrictions included in Obamacare, insurers are free to just dump patients into the high risk pool whenever they incur costs, which would greatly increase everyone's contribution to government paid healthcare. In other words, all that plan does is increase total costs which just shifts more costs to the rest of us to support these high risk pools.

Episteme · Jun 7, 2014

Their evidence that greater access to health insurance increases unemployment, the CBO report, doesn't actually say what they are inferring. From the report:
"The estimated reduction stems almost entirely from a net decline in the amount of labor that workers choose to supply, rather than from a net drop in business’ demand for labor, so it will appear almost entirely as a reduction in labor force participation and in hours worked relative to what have occurred otherwise rather than as an increase in unemployment (that is, more workers seeking, but not finding jobs) or underemployment (such as part-time workers who would prefer to work more hours per week)."
In other words, prior to Obamacare the only way to access quality insurance was through an employer, so people got jobs and worked full time hours in large part just to get access to better healthcare, not because they needed the earnings from wages. Now that individual plans are required to be comparable to employer provided plans, those who don't actually need to work won't be taking up valuable jobs, making them more available to people who actually need the hours.

So I quoted from the Quarterly Journal of Economics, on hard data, from events that happened on a state level, can be examined retrospectively with statistical accuracy in a study given the thumbs up in Science magazine. (The only journal with the prestige of the Journal Nature.)

You reply with a non-sequitor from a CBO report that attempts to explain the jobless recovery.

Well, Oh-kee-dokey then.

MunoRN, RN · Jun 8, 2014

So I quoted from the Quarterly Journal of Economics, on hard data, from events that happened on a state level, can be examined retrospectively with statistical accuracy in a study given the thumbs up in Science magazine. (The only journal with the prestige of the Journal Nature.)
You reply with a non-sequitor from a CBO report that attempts to explain the jobless recovery.
Well, Oh-kee-dokey then.

I think you maybe missed that the CBO report I was referring to was the same CBO report your article from science magazine was based on. And the section of that report I quoted was actually referring to the effect of Obamacare on the job market, not on the 'jobless recovery'.

You posed the question earlier "does giving access to healthcare for free contribute to unemployment?" and then seemed to think the CBO report suggested the answer is "yes", even though the CBO was pretty clear in stating that's not the case. What's happening is that people don't have as much incentive to take hours away from people who actually need them just so they can get in on employer provider plans. To give a real world example, Trader Joe's explained why their employees were actually better off now that they were dropping employer provided insurance for part timers, and gave the example of one of their few employees who could maybe complain; an employee who's spouse worked as a independent contractor and made over $200,000/year. The employee was only working so that they could purchase a group plan through their employer. Now that they can purchase a group plan outside of an employer they don't need to work, since they never really needed the extra income which now makes hours and work available to those who actually need to work. Since "unemployment" is defined as people who need to work but are unable to find work, Obamacare doesn't increase unemployment and actually has the potential to decrease unemployment, at least according to the CBO report referred to in the article you posted.

RNsRWe, ASN, RN · Jun 8, 2014

If you want a glimpse of how well "single payer" works, just take a look at your local VA Medical Center. You'll likely get pretty decent care once you're in there, but before that happens your request for an appointment may outlive you, buried in a stack of stuff in somebody's desk drawer. They were just "too busy" to deal with it before going on a smoke break/lunch/vacation/retirement. And besides, the union says they're entitled to that vacation time along with the bonuses they receive for delivering such high quality service.

Wow, SO.MUCH.WRONG. with this assertion not sure where to start. Unions for upper-level administration officials? Interesting.

Might just have to step away from statements that are more inflammatory than accurate....

toomuchbaloney · Jun 8, 2014

No... single payer doesn't work flawlessly.

It was interesting to me that you decided to generate a very long argument with this opening notion...a flawless single payer system. Of course, no one here has said that any system, including single payer would be or is flawless.

Those of us who dislike our capitalism based health care system, who are not happy with the ACA, and who believe that expanding Medicare would have been a reasonable option; are realists in many ways. We are walking a line of what is broken while looking at what works in other parts of the world and ciphering an exceptionally American way to craft policy and practice here. Many of us believe that exceptional Americans, when allowed, can solve all sort of really complicated and difficult problems using tools and knowledge from across the globe. Many of us believe that what would result would not be a "Canadian" or "French" or other health system, it would be an American health system. We might get there if we ever stop legislating and politicking in fear.

Functioning in fear and anger is decidedly unChristian.

calivianya, BSN, RN · Jun 8, 2014

The have's will go to these Magnet hospitals with the most advanced tools and best doctors and will be reimbursed accordingly. ( remember if you can pay for insurance ( platinum) you're more likely to be healthier than those who can't work; hence the lower level bronze level patients will be relegated to urgi-centers and non profit hospitals). The capitalist view of medicine is how this is all headed.

I don't get how this is possible. I worked for a magnet hospital as a CNA before I graduated nursing school and did all of my clinicals there, and I absolutely took care of more indigent/medicaid patients than wealthy ones. I just had to talk to them to know. Hospitals are not allowed to discriminate and send someone away based on their financial status, or at least this one wasn't. People on medicaid got the exact same care as people with expensive private insurance. I helped transport plenty of homeless people to our brand new, fancy CT and MRI machines, and you bet they had the same amount of attendings/residents as anyone else, and absolutely stayed just as long.

Maybe we'll see less medicaid/bronze plan patients come in for elective procedures, if that... but as far as life-saving treatment goes, I can't see how anything is really going to change. A STEMI is a STEMI and if a magnet hospital would treat homeless with no insurance STEMI patients who will not be able to pay them a dime before the ACA rolled along, they would surely treat STEMI patients on the bronze plan where they will get some reimbursement now...

damrcngrl95 · Jun 8, 2014

I will correct you before our progressive friends. The VA is not a single payer system. It is overtly socialized medicine where the government owns the facilities and the people that work in them.
But your point is taken. VA, Post Office (an interesting "hybrid" that was supposed to work with government input) TSA, IRS, ATF, NSA, BLM... They're all doing great work for the American people. I am so glad the Feds are taking over to make sure I can get health care. They know what I need and how much I can pay much better than I do. Holy Smoke... how did I live as long as I have without their direct intervention?

Single payer is like medicaid/Medicare and Tricare. They are far from perfect, but as a Tricare recipient I love it. I have great doctors and a large pool to select from if I don't like my doctor or they move. The people posting that the VA is socialized medicine are so true. My husband is active duty and receives socialized medicine. The waits are long and good treatment is hard to come by. It will be a great day in 2 years when he retires. He will then join me in a single payer system. There is such a world of difference in single payer and socialized medicine. Single payer you have choices and socialized medicine you don't. You get what you get when they say you can get it.

MrChicagoRN, RN · Jun 8, 2014

FYI, according to the WHO, the US is rated 37th in healthcare...right behind Costa Rico. This was in 2000.

it will be interesting to see if our ranking changes after ACA implementation.

damrcngrl95 · Jun 8, 2014

Guy nurse, I can kind of see what you are saying about the haves and have nots. I do wonder about if we went to a single payer if certain things will be seen as elective and not covered. I had a friend that lived in Canada and had a great job with benefits. She of course had access to the regular Canadian insurance, but she also paid for a premium insurance through her job. She had fertility issues and her work insurance helped pay for that. At least that was my understanding of how things worked for her. So I learned that a basic health care is given for all and then a more premium insurance can be bought for people who can afford it. I don't know if she went to a different hospital, but she did have a better variety of care through her purchased insurance.

Do you think we may evolve toward something like that?

toomuchbaloney · Jun 9, 2014

FYI, according to the WHO, the US is rated 37th in healthcare...right behind Costa Rico. This was in 2000.
it will be interesting to see if our ranking changes after ACA implementation.

That is a good question. Personally, I doubt that it will change much. In my view the ACA regulates insurance more than it improves quality of care. The fact that access to care will have improved for millions should (hopefully) improve outcomes, but there are still way too many people who have been left behind because of the slow expansion of Medicaid by conservative governors.