Dept. of Humanitarianism

[tim]

I am *so* *fucking* *tired* of what passes for health care debate that assumes the problem is any or all of:
1. rich people (i.e. people like you, the person reading this, and me, the person posting this on a taxpayer-sponsored computer) have to pay too much for health care
2. rich people spend too much on health care
3. other organizations spend too much on health care on behalf of rich people
4. rich people sometimes spend 3 months not having health care when they change jobs

The problem actually is:
5. poor people die of asthma attacks because they can't afford preventive care,

you idiots.

And no, (5) is not a direct consequence of (1) through (4), because the problem isn't that the pie isn't big enough for everybody, or that some people are bigger eaters than others; the problem is that most people find it convenient to throw extra pie in the trash rather than giving it to people who don't have any.

Comments

[asrabkin]

The president has 60%+ approval ratings when this debate started, has a vast donor base and the support of large, well-heeled unions and advocacy groups. If he can't make this case in the face of opposition, that's a bad sign.

But in fact, one of the things that hurt him a lot is that the nonpartisan Congressional Budget Office reported that several of his claims just weren't true. Is the CBO part of the health insurance disinformation machine?

[etb]

one of the things that hurt him a lot is that the nonpartisan Congressional Budget Office reported that several of his claims just weren't true.

Which report(s) are you referring to?

[asrabkin]

http://cboblog.cbo.gov/?p=345 and http://cboblog.cbo.gov/?p=332 Both contradict claims made by the Administration.

[etb]

If you're talking about this report, I don't see how it supports your claims. That report says the net impact on the deficit over 10 years (i.e. added debt load) would be $239B. I'm very skeptical that some CBO report I haven't yet heard of has been a major part of the debate, but since only I know how much or how little I've been paying attention, there's no point in arguing about that. I'll just ask, again, for a direct citation of the CBO report(s) that support your claim.

[asrabkin]

See above for citations.

I think this does support my claims. I said "it'll cost a trillion dollars" -- which is what the CBO says. The $200B is what's paid for with borrowing; the rest is covered by a half-trillion dollars in increased taxes, plus price controls in Medicare spending.

[etb]

I said "it'll cost a trillion dollars"

Nope. You said "Let me see if I follow. 'It'll cost a trillion dollars more than we claimed' is merely 'predictable exaggeration'..." You were thus claiming that the proponents were saying that it would cost nothing (i.e. $0B instead of the CBO's $1,042B). Who has said that?

[asrabkin]

The president has said that "health care reform is not going to add to that deficit; it's designed to lower it" (http://www.boston.com/news/politics/politicalintelligence/2009/07/obama_on_health.html)

[etb]

That doesn't back up your claim, which was, again, that the proponents claimed it would cost $0 instead of $1T.

[asrabkin]

You got me there -- I believe I've heard administration surrogates saying "this will save money, net". But I can't dig up a good reference in a few minutes of googling, so I'm falling back to "administration claimed this will reduce deficit, when it will actually increase it by 0.2T". Which is still an instance of disinformation by advocates of the plan.

The promotional material on whitehouse.gov is full of ambiguous references to "reducing costs", where it isn't quite clear if they mean "net costs to individuals", or "to society" or "to the government" or what. Which, again, isn't quite on point.

[etb]

The promotional material on whitehouse.gov is full of ambiguous references to "reducing costs"

You're accusing a politician of ambiguity? You'll have to step outside.

[asrabkin]

Bah. I'm not phrasing myself clearly. That wasn't meant as a criticism of the white house. I was explaining why that's a non-example of "the president claiming the cost is $0".

[etb]

For people who don't want to read the CBO report, I want to make several things clear:

1) the CBO numbers are over the 10 year period 2010-2019;
2) the CBO is not saying that the proposal would increase the deficit by $1,042B, but that the insurance coverage provisions alone will cost $1,042B over 10 years;
3) the cumulative increase in the deficit would be $239B, again, over 10 years, for an average of $23.9B.

I don't see fudging $80 per capita per year as remotely comparable to pull-the-plug-on-grandma shit-flinging. But you're free to explain how it is.

[asrabkin]

The president has said, many times, that his plan will not increase the deficit at all. $200B is rather significantly greater than zero.

Note that averaging the expense per year is misleading -- If I understand correctly, the plan has negligible expenses in the first few years, before the public option comes online. The average yearly cost, starting from year 11 and going forwards, will be much more than $20B per year.

[etb]

The average yearly cost, starting from year 11 and going forwards, will be much more than $20B per year.

"Estimating the effects of major changes to the health care and health insurance systems over the next 10 years is very difficult and involves substantial uncertainty; generating longer-term estimates is even more challenging and is fraught with even greater uncertainty." —CBO

[asrabkin]

I don't dispute that -- there's a reason I'm not being quantitative. But it's still misleading to treat this program as having constant per-year costs, given that the most expensive parts only kick in late in the 10-year period.

[etb]

it's still misleading to treat this program as having constant per-year costs, given that the most expensive parts only kick in late in the 10-year period.

It also doesn't have constant per-year savings. In the CBO's projections, the program increases expenses by $187B for 2018, and by $202B for 2019—up $15B in one year! oh noes! But it reduces other outlays in 2019 by $50B, vs. $42B in 2019, and increases revenue by $86B in 2019 vs. $82B in 2018. So the yearly deficit only increases* by (202 - 50 - 86) - (187 - 42 - 82) = $3B. If we look at 2015 through 2019, it's not quite as low; the average deficit increase is $8.3B a year. [ETA: *I mean the deficit would be $62B higher in 2018 and $65B higher in 2019.]

I really don't understand how you can both accept that

"Estimating the effects of major changes to the health care and health insurance systems over the next 10 years is very difficult and involves substantial uncertainty..."

and also act like anyone with a deficit estimate that's more optimistic than the CBO's is peddling disinformation.

[asrabkin]

I don't believe the white house has released estimates; they've just released assertions, without any sign of a serious and dispassionate analysis.