If only we didn't call it "Obama-Care" . . . .

[drogulus]

     ACA is a start. There will be more reforms. Here's my conspiracy theory: Obama and his fellow conspirators crafted an obviously flawed plan which would either fail leading to increased support for a single payer system, or we would be able to slowly expand the scope of the plan by grandfathering in essentially everyone into a public plan with the private insurers allowed to "administer" their cut (not being cut out entirely). Eventually they would face being squeezed out unless they accepted their diminished role, which they would, having no choice.

     Now, what's the difference between what's really happening and my conspiracy theory? I'm not really sure.

[Todd]

This country leads the world in health care administration.

Huh?  What does this mean?  Do you mean with respect to insurance, or with respect to delivery?  Well, you must mean insurance since only the VA is in the delivery business, and it is not considered a model for either insurance or delivery by anyone.  Medicare and Medicaid are public insurance programs and they use their quasi-monopsony power to force health care delivery companies (profit and non-profit alike) to accept defined monthly payments for each member.  It's easy to keep overhead low when you can force health care delivery companies to accept defined payments, and leave them to absorb any losses.

[eyeresist]

It's easy to keep overhead low when you can force health care delivery companies to accept defined payments, and leave them to absorb any losses.

Losses?

[Todd]

Losses?

Yes, of course.  When expenses exceed revenue.  Even non-profits cannot go on forever under such circumstances.  Even in an ideal world shorn of all profit seeking in health care delivery (and presumably everything else), I would guess that most health care consumers would prefer to rely on institutions that can deliver quality care today and tomorrow, and also deploy new technologies when available.  Last I checked, such things require money.

[snyprrr]

It wasn't meant to be a tax, wasn't supposed to be a tax, so, what, did Roberts just change... what?? He just changes the definition of a word?

[Todd]

It wasn't meant to be a tax, wasn't supposed to be a tax, so, what, did Roberts just change... what?? He just changes the definition of a word?

Please explain how a government imposed penalty/fine/user fee/license/permit fee, etc, is not a tax. 

[Gurn Blanston]

It wasn't meant to be a tax, wasn't supposed to be a tax, so, what, did Roberts just change... what?? He just changes the definition of a word?

Of all people whom I thought had a grip on semantics...    Surely I wasn't wrong and you are just being stubborn.

[Leon]

It wasn't meant to be a tax, wasn't supposed to be a tax, so, what, did Roberts just change... what?? He just changes the definition of a word?

I seem to remember when the subject of whether this law was unconstitutional, the argument was made that the mandate was crafted by Congress as a tax, and as such would pass constitutional muster.  However, President Obama is on record during an interview in 2010 saying that it was NOT a tax.  Probably because he does not wish to be perceived as raising taxes during a difficult economy.

Now that the Supreme Court has ruled that it is only constitutional as a tax, saying that the individual mandate as a mandate fails a constitutional test, there is no getting around the fact (at least legally) that the law is a fairly large tax increase.

Raising taxes during a bad economy is not a good idea.  Nor is giving employers less of a reason to hire people with unemployment rates hovering around 9%. 

If the Republicans play their cards right, John Roberts may have handed them a solid campaign issue.

But I never underestimate the Republican's ability to completely screw up an opportunity.

[kishnevi]

Please explain how a government imposed penalty/fine/user fee/license/permit fee, etc, is not a tax.

They aren't taxes because they're handy ways of increasing government revenue that don't require politicians to admit that they are proposing or voting for "tax increases".

In this case, it was the Obama Administration and the Democrats who strenously argued that it wasn't a tax, for procedural reasons.  Roberts performed a version of legal ju-jitsu on them.

Of course now we are are stuck with the proposition that while the Commerce Clause does have limits on Congressional power, there's no limits on Congress's power to tax. 

[Todd]

Raising taxes during a bad economy is not a good idea.

The mandate does not go into effect until 2014.  The tax hike during a bad economy argument doesn't hold water in this instance. 

They aren't taxes because they're handy ways of increasing government revenue that don't require politicians to admit that they are proposing or voting for "tax increases".

True, but if it looks like a duck, and quacks like a duck . . .

Of course now we are are stuck with the proposition that while the Commerce Clause does have limits on Congressional power, there's no limits on Congress's power to tax.

That has been the case, practically, since the 16th Amendment was ratified.

[Leon]

The mandate does not go into effect until 2014.  The tax hike during a bad economy argument doesn't hold water in this instance. 

This is true, but the argument is still valid; with the slow pace of the "recovery" there is no guarantee the economy will be much better off in 2014.  Insurance premiums have already risen in many cases, and employers plan for the future and this law will not help unemployment whether it goes into effect this year or 2014.  If anything, this law will insure that any recovery will be weak and unemployment rates will remain disturbingly high.

[kishnevi]

This is true, but the argument is still valid; with the slow pace of the "recovery" there is no guarantee the economy will be much better off in 2014.  Insurance premiums have already risen in many cases, and employers plan for the future and this law will not help unemployment whether it goes into effect this year or 2014.  If anything, this law will insure that any recovery will be weak and unemployment rates will remain disturbingly high.

I rather think that, on the macro scale, the Europeans running around like chickens with their heads cut off (the politicians and the bankers, that is) and the politicians in Washington more interested in winning elections than in actually doing anything substantive (this applies to both sides of the aisle) is far more important.  And far more important is the fact that in large parts of the country (for instance, where I live) consumers are not, for one reason or another,  consuming/buying as much.  Compared to that, nothing else matters: it would be a very bad business man who hires in the expectation of increased sales when in fact there's every expectation that sales and revenues will at best stay flat for the foreseeable future, no matter how favorable the tax codes, regulations, etc. are towards business and investment.

[Todd]

the argument is still valid

Not really.  Tax changes two and more years out have a negligible impact, at most, on economic conditions today.  While it is true that the recovery to date has been weak, this has nothing, or at least vanishingly little, to do with health care and health care premiums.  Businesses large and small hire based on exisiting and projected business; more business means more hiring.  Health care expenses are something to be worked with/around.  I work for a small company (<40 employees), and our staffing planning is not based in any way on health insurance costs.  Of course, other companies may be forced to make tough choices, but I see arguments that the new health care law will negatively impact employment as basically without merit, rather like the arguments against minimum wage increases, where actual evidence shows no negative impact.  It will be the same here. 

One consequence of the law will be that some mid-sized firms will opt to not offer coverage and pay the penalty and will force workers to buy insurance or face their own penalties, but it's hard to see how that will have a significant impact on employment.  Even here, I think the dire warnings are overblown; health insurance is still a perk used by more than a few companies to attract talent.  Granted, not every firm can or will do that, especially those that require less skilled workers, but it will be a few years before it will be known whether or not firms stop providing insurance in droves.

[Leon]

I rather think that, on the macro scale, the Europeans running around like chickens with their heads cut off (the politicians and the bankers, that is) and the politicians in Washington more interested in winning elections than in actually doing anything substantive (this applies to both sides of the aisle) is far more important.  And far more important is the fact that in large parts of the country (for instance, where I live) consumers are not, for one reason or another,  consuming/buying as much.  Compared to that, nothing else matters: it would be a very bad business man who hires in the expectation of increased sales when in fact there's every expectation that sales and revenues will at best stay flat for the foreseeable future, no matter how favorable the tax codes, regulations, etc. are towards business and investment.

Sure, but my point is simply that this law only adds to the troubles (like the ones you mentioned) facing this economy. 

When spending is suppressed, and recovery stalled and unemployment high and pressures from many sides driving the economic indicators in the wrong direction, it is not a good idea to enact legislation which will cause health insurance premiums to go up and penalize businesses for both not offering health benefits or offering health benefits that are too rich.

[Todd]

it is not a good idea to enact legislation which will cause health insurance premiums to go up

Health care premiums have risen steadily for years without Obamacare.

[Leon]

Not really.  Tax changes two and more years out have a negligible impact, at most, on economic conditions today.  While it is true that the recovery to date has been weak, this has nothing, or at least vanishingly little, to do with health care and health care premiums.  Businesses large and small hire based on exisiting and projected business; more business means more hiring.  Health care expenses are something to be worked with/around.  I work for a small company (<40 employees), and our staffing planning is not based in any way on health insurance costs.  Of course, other companies may be forced to make tough choices, but I see arguments that the new health care law will negatively impact employment as basically without merit, rather like the arguments against minimum wage increases, where actual evidence shows no negative impact.  It will be the same here. 

One consequence of the law will be that some mid-sized firms will opt to not offer coverage and pay the penalty and will force workers to buy insurance or face their own penalties, but it's hard to see how that will have a significant impact on employment.  Even here, I think the dire warnings are overblown; health insurance is still a perk used by more than a few companies to attract talent.  Granted, not every firm can or will do that, especially those that require less skilled workers, but it will be a few years before it will be known whether or not firms stop providing insurance in droves.

I've definitely seen how health insurance costs has effected my employer's behavior.  We have about 350 employees and each year the plan is renegotiated with different benefits, generally not as good, or a new carrier entirely.  Premiums for family members has gone up, and the co-pay and the deducible have gone way up.  These costs do effect staffing decisions, especially in bad economic times.  When the economy tanked in 2008, we let go 40 people, and the hiring since then has not been as robust as former years.  Hiring older employees is not attractive since health plans are negotiated based on collective claims figures and older employees generally file more claims.

My wife's independent policy went up immediately after the law was passed, and again in the last three months.   

I'm not saying this law is the main driving force,  but do see this law as the wrong medicine for an already unhealthy economy.

[Leon]

Health care premiums have risen steadily for years without Obamacare.

True, but the cost for almost everything has risen steadily over the years.   I've not seen our health care premiums rise as fast or as often as I have since the law was passed.   

You may love this law; I don't.

[Todd]

We have about 350 employees and each year the plan is renegotiated with different benefits, generally not as good, or a new carrier entirely.

This is common for many firms that do not self insure, and the reductions in coverage reflect a desire by employers to reduce costs, and on the flip side make more money.  This was happening before 2008, too.  It makes sense from a managerial perspective, though from the workers' perspective it is awful.

The real issue here is premiums rising faster than inflation, year after year, in good times and bad.  This has more to do with cost controls, something Obamacare is decidedly weak on. 

Clearly, there are firms that make staffing decisions partly on health care costs, but my experience at both giant firms (eg, 10,000+ employees) and small (<100; two of my last three employers) is that health care is not a significant determinant in hiring.  I've seen little evidence that health care has a material impact on employment economy wide, though clearly it does to those who are affected.

True, but the cost for almost everything has risen steadily over the years.   I've not seen our health care premiums rise as fast or as often as I have since the law was passed.   

You may love this law; I don't.

Yes, there has been inflation, but health insurance, like college education, has been rising at a rate far greater than inflation for decades.  This was an issue when Clinton tried to reform health care as well.

You may also want to rethink your assumptions.  I do not love Obamacare.  But I reject arguments against it that lack evidence.  That written, certain aspects of the law are quite good.  The prohibition against not insuring people with pre-existing conditions is long overdue.  Requiring electronic records is also long overdue. 

[kishnevi]

True, but the cost for almost everything has risen steadily over the years.   I've not seen our health care premiums rise as fast or as often as I have since the law was passed.   

Then you're lucky.  My employer--a large retail company with lots of stores and employees--has tried a number of things over the years to limit its health care exposure,  and now self insures.  My costs, including premiums and deductibles, are about three times what they were ten years ago, and almost all of that increase came before Barack Obama took the oath of office, and almost all of the rest came during his first year in office, before Obamacare was passed. 

About  twelve or fifteen years ago--I don't remember the exact year anymore--the company forced many of its employees onto part time status because it felt it needed to limit the number of employees on its health care plan.  That was during the Clinton years, so obviously Obamacare had nothing to do with it.  And even then it came around to offering a much more basic, less comprehensive plan to new part timers and full timers who had been forced into part time status.  I was lucky to be one of the people who were kept on full time.   I'm the sort of person who has enough health problems, including a chronic illness, that I have to have insurance, and one main reason I've stuck with the same employer for over twenty years is the fact that I've been able to keep decent insurance with them.  If that ever change....time for a new job.  But that's the opposite of the problem you're talking about.    For me, access to good insurance without it being linked to employment would be a very good thing, although I'm not sure if Obamacare can really deliver that for me.

[Todd]

For me, access to good insurance without it being linked to employment would be a very good thing, although I'm not sure if Obamacare can really deliver that for me.

This would be good for everyone, in my opinion.  Imagine the benefits that would accompany portability.  Labor force mobility would be greatly enhanced, which in my eyes is a very good thing.  I've long (secretly?) wished that business in general and any administration would come to some type of grand bargain on health care.  Trade some burdensome regulation (SOX, etc) for some type of (mostly) business tax funded health insurance that meets defined requirements and includes portability.  Call it "socialized" medicine, or whatever else you want, the end result would be a good thing, with one benefit being the reduction of some administrative staff in private companies.  And right wingers here in the US should realize that some of their now favored economists - of the Austrian persuasion mostly, it seems - were not opposed to universal health care.