Obama’s Awkward ‘Between Two Ferns’ Interview

The online comedy talk show Between Two Ferns today became a commercial for the Affordable Care Act. Zach Galifianakis, with his signature awkwardness, interviewed none other than President Barack Obama. It had its moments, but when the host and guest transitioned to a plug for the health insurance marketplace, the show lost all semblance of being an episode of Between Two Ferns. It had become rather a promotional piece set to look and sound like the popular show on FunnyorDie.com.

I don’t fault the president for doing the interview.  He needs to sell the Affordable Care Act, to the younger uninsured crowd especially, and appearing online with Galifianakis has netted him and the marketplace website more attention. It was probably a smart move, despite the totally predictable backlash.

I do fault Funny or Die.  Not because Galifianakis helped promote the Affordable Care Act, but because he wrecked his art and comedy doing so. Bringing the President on to promote his program turned Between Two Ferns into a vehicle for driving home a political message.

This might have worked if the show wasn’t already defined by its history of criticizing “obsequious celebrity interviews,” to use the words of Sunny Bunch.  It’s out of form, to say the least, for the Galifianakis of Between Two Ferns to give such deference to a powerful guest. His barbs fell flat because they were obviously intended to cover the political purpose of the interview.

Political comedy is at its best when it critically resists the prevailing social order, but that doesn’t mean that comedians cannot ever legitimately put their art to political uses that help sustain that order. However, Between Two Ferns wasn’t the place for such an effort. Galifianakis and Obama would have done better to create a standalone skit for Funny or Die that didn’t have any established expectations.

Kyle Cupp is an author and freelance writer. Follow him on Twitter, Facebook,and his personal website.

Photo: Funny or Die

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218 thoughts on “Obama’s Awkward ‘Between Two Ferns’ Interview

  1. The most fascinating part of all of this to me is that I guess Between Two Ferns has become the biggest referrer of young people to the ACA site. Which kind of says something about the world today, and I’m not sure it’s good.

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    • I was completely unaware of Between Two Ferns before this. After seeing the Obama skit, I watched the skit in which Galifinakis asks Natalie Portman for her phone number and things get awkward. This looks to me like “situational comedy,” in which the description of the comedy is funnier than the comedy itself. …not really my thing.

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  2. “he wrecked his art and comedy doing so.”

    Well, you could say this is less funny than the usual episode, I suppose. (I might disagree.)

    But he wrecked his art and comedy? Seriously? What?

    A.) This is the guy that made three Hangover movies. Selling out to Obama. I guess?

    B.) He even referenced that Obama was making a plug about “the thing that doesn’t work.” I thought that was the funniest part, the irony of how shameless the plug was and how openly disinterested Galifiniakis was.

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    • He wrecked the specific art and comedy of ‘Between Two Ferns,’ making it into a commercial for the Affordable Care Act, rather than what it has been up to this point: a satire of celebrity talk shows. Instead of the jokes serving an artistic purpose, they served a political one. This might have worked in a medium without an established form, say a standalone skit, but using ‘Between Two Ferns’ broke the rules of its game.

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      • You weren’t saying that Galifianakis wrecked his comedy and art comprehensively beyond the context of this episode of this series – just that he wrecked it for this episode. Right? However funny the next episode is, it’s actually that funny. Or no?

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      • No it really didn’t break any rules of its own game. The rules of the humor are that Galfiniakis plays dumb and angry and his guests are angry and the conversation is awkward. This can be done to tease celebrities or politicians or to not tease at all.

        You’re reading more into Galfianakis’ humor than is there, which is sort of what makes his humor work.

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  3. A counterview:

    http://nymag.com/daily/intelligencer/2014/03/obama-galifianakis-and-the-dignity-fetish.html

    One of my least favorite faux-outrages from the right wing during the Obama administration has been
    about how he disgraces the dignity of the office of Presidency. Obama gets photographer with his feet up on the Oval Office desk. Outrage. Can you find pictures of white Presidents doing it? Absolutely.

    I also dissent that anti-ACA people are really voices for the people. There is also the story going around about how the Woman with Cancer in the Koch Brothers ad is saving at least 1000 dollars a year because of ACA. The more conservative Detroit News ran the numbers but she didn’t believe it when confronted with the facts and figures.

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    • You have to admit that GW Bush looked very dignified with his feet on the desk. Some… errr…. types of people just can’t pull it off the way he did.

      And did you see him pardon that turkey? Ridiculous.

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    • My trouble with Chait’s piece is that I think there is something important about the dignity of the office. And if it’s too tough to cut through all of the rest of the RW clutter with Obama, google “GEORGE.BUSH.ANGELA.MERKEL.BACKRUB.VIDEO”

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      • Did O invade Galafinakas’s personal space and get all touchy/feely when he didn’t dig it? Hell R’s thought Clinton playing sax on tv was beneath the dignity of the office.

        Really both these things are small potato’s that don’t really mean anything. I agree about the dignity of the office thing, but i can’t see this as a massive affront. Not that you are saying this, but if people want to have some dignity for the holder of the office, then stop smearing every bit of stupid sleazy poop at him.

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      • Tod,

        I think the personal space and frequency issues are good points. Also the coming up with ground rules. People thought William Jennings Bryan was violating the dignity of the office by campaigning. FDR with fireside chats. Coolidge with his cowboy outfit. And I am not Mr. Light exactly.

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      • I’m not particularly concerned about the dignity of the office. If ratcheting the dignity down a few pegs makes it less likely along some margin that presidents will abuse their power, then maybe it might be a good thing. I could, on the other hand, imagine a counterargument in which it’s the very loss of dignity that frees the president to do dastardly things. I don’t think extra-judicial assassinations really dignify anybody.

        As for this interview….I didn’t watch the whole thing, just some snippets on a news show (I think the NewsHour, but I forget). It seemed kind of entertaining but stilted. I’m not a big “funny or die” person and I’m even less of a big Galafinakas person. I imagine that Kyle’s point is largely correct. I think that people with power usually make poor comedians because so much of comedy is wrapped up in criticizing those with power or privilege.

        And with that, I’m off to work.

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      • @newdealer

        There is a difference between saying “doing X doesn’t diminish the dignity of the office” (which I wholly agree with in all of your examples ND, as well as the BTFs appearance) and arguing that there is no dignity to that office, and taking that into consideration when deciding how a president should behave is therefore a ridiculous exercise.

        IMHO, Chait seems to have taken a silly position be the right and some members of the press, and tried to deflect that position by tacking to an even more ridiculous extreme.

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    • Yeah, Chait is one of my favorite writers. The right is kind of reprehensible on this subject, understandably calculatingly desperately reprehensible but reprehensible nonetheless.

      But on the upside, if the ACA can chug along despite their throwing the kitchen sink and Grandma at it then it’s probably going to be a usefully functional program.

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  4. I expected this post to be an analysis of whether Obama was excessively undignified, but it’s actually about whether a web comedy show “sold out”. I’m sorry, but that’s a lot funnier than the skit was.

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  5. Sunny Bunch levels this charge:

    None of this, of course, is surprising. Funny Or Die’s cocreators, Adam McKay and Will Ferrell, are committed liberals who think that their second job is to make you laugh. Their first, naturally, is to sell you on the wonders of the Democratic Party.

    Should we believe this?

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    • DNC sock-puppeting or not, there is something to be noted here about how the selling and dissemination of ideas happens and is received these days. Funny or Die and Will Ferrell have shilled Democratic politics before. Perhaps more interesting, though, is all the marketing and cross-promoting that Ferrell did as Ron Burgandy for the Anchorman sequel and various corporate sponsors. If I remember correctly, Anchorman was a bit of a sleeper hit, so it was a bit odd to see that character turned into a pitchman on steroids. And yet, people loved it, ate it up, and shared it all over social media.

      It’s all very odd for a committed, self-serious Gen Xer like myself to look around and find himself in a moment when people are dying to be sold stuff, sold products, sold ideas, sold whole identities. The vexing thing about the millennial generation is just how much they seem to want their artistic/entertainment spaces to be invaded by politics and commerce. I remember that brief shining moment (OK, it wasn’t exactly shining, more earth-toney) after the over-the top glam 80s when cool was defined subtly and as an opposition to overt authority and outright commercialism. Maybe that moment never really existed, but it was certainly an aspiration.

      As I said on the Facebook yesterday, the greatest trick the Man ever pulled was convincing millennial that he no longer exists.

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      • As i say in the comment below, I’d be interested in your examples of the previous shilling, especially by Will Ferrell in particular. (I’m honestly interested in them, not challenging you that they exist.)

        I think it’s a little weird to express surprise that a movie star would stump for the sequel to a movie that was a surprise hit. I was pretty amazed as well at the sheer scale of the campaign he mounted, but that’s the business. I can’t really see being surprised that he’d be heavily engaged in selling his movie.

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      • For one there is this from 2009: http://www.funnyordie.com/videos/041b5acaf5/protect-insurance-companies-psa

        I’m not surprised that Obama would want to be on Between Two Ferns. And I’m not surprised that Ferrel and Anchorman’s producers would want to get him as much publicity as possibly. And I’m not surprised that Chrysler would want to use the Burgundy character to sell cars.

        All of that makes perfect sense. Politicians and corporations have for a long time been trying to co-opt aspects of popular culture to sell their products. What doesn’t make sense to me is how much pop culture seems to want to be co-opted by politicians and corporations. To put another way, I understand why the media spins. I just don’t understand why so many people are willing to be spun.

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      • – how was I not aware of that? That is ridiculous.

        I am human and I need a reasonably-priced, reliable, mid-size sedan. Just like everybody else does.

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      • …And I guess I don’t really understand why it would be surprising that the group of people who made a semi-throwaway movie a huge surprise (“cult”) hit would be highly receptive to the marketing campaign for its follow-up.

        On young people being receptive to power’s efforts to spin for itself, you have a fair point there. Notice that what seems to work, though, is avoiding trying to sell them new wars and affirmatively trying to sell them programs ostensibly designed to help them. That’s consistent from the Johnson-Nixon days through to today. We’re taling broad levels of large-scale messaging here, not the specifics, where of course there’s plenty of inconsistency to be found, from the question of whether ACA really helps young people to whether Obama is really not selling them new wars. at the level of broad presentation, he self-presents as trying to end wars and establish helpful economic programs. Johnson definitely established those programs, but ultimately become completely associated with Vietnam.

        I’m not sure what you’re describing is new, I guess is what I’m saying. Young people just are generally open to liberalism through recent history (except the ones who aren’t). Did young people not respond to Clinton’s salesmanship? Young people went gaga for Kennedy. I think what you’re seeing is just that young people go for a certain vision of government more than another, not that they’re consistently anti-authority or uninterested in sales pitches directed at them across generations. Your corner of Gen X could just be a particular perspective.

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      • I think one of Corproate America’s greatest achievements is the commodification of cool and dissent and almost everything. I admire it in a very strange way.

        Industry events have become cool with bands ranging from Metallica to X to hip-hop artists performing. This goes not only for tech but also for lawyer conventions. A few years ago, rock and hip-hop artists probably would not have performed at these because it would be seen as selling out and a career killer. Now it is just another gig.

        I am not sure if this is good or not. There is still part of me that wants to believe in rock and hip-hop as a subversive and truth telling genre with selling out being a bad thing. People lap it up though and think it shows that Corporate America is letting its tie get loose.

        The other great viral video that happened yesterday was a video of “strangers” kissing. Turns out they were strangers in a strict sense but still mainly actors, musicians, and models who presumably can perform in a love scene/first make-out session. It was also an add for a clothing company and looked highly produced but people took to it: hook, line, and sinker.

        Many SF actors like Patrick Stewart, Ian McKellen, George Takei seem to be very canny users of social media and there fan bases take it up hook, line, and sinker.

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      • “What doesn’t make sense to me is how much pop culture seems to want to be co-opted by politicians and corporations.”

        seeing as corporations create the vast majority of pop culture, this seems like a weird thing to be confused about.

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      • You mean, millennials were the first generation that would pay good money to be walking billboards?

        The Nike swoosh T-shirt came out in ’71 and was an immediate success.

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      • , you have this uncanny ability to take my comments and condense them down to one snappy line of text. It is a neat trick. It would be even neater if you were actually accurate about what I was saying.

        , are you really confused about my confusion? Sure, corporations are a big part of creating art and entertainment. However, under the auspices of the corporation, there is a split between the creatives and the bean counters and the former tend to like to think of themselves as being independent of the latter.

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      • The fact you get upset about Schilling doing that just shows you’re still new around here. Even the grumpy libertarians like Hanley basically ignore it at this point.

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      • You’re saying that millenials are somehow awful in a way that previous generations were not. It’s exactly what Boomers said about you, and what the Greatest Generation said about Boomers, and it’s nonsense.

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      • “are you really confused about my confusion? Sure, corporations are a big part of creating art and entertainment. However, under the auspices of the corporation, there is a split between the creatives and the bean counters and the former tend to like to think of themselves as being independent of the latter.”

        they like to think it, sure. lots of people like to think lots of stuff. and of course there’s ongoing tensions and etc etc and so forth. but at the end o’ the day it’s popular because a lot of people see it and know about it and that only happens in a nation of hella millions with hella distribution channels.

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      • – Who said that I’m upset?

        – Awful is your word, not mine. Yes, there are some notable differences between Millennials and Gen Xers and between Gen Xers and Baby Boomers. There are also lots of things that we all have in common, but what fun is it to get all Kumbaya on the internet?

        I have some objective normative judgments about Millennials, but not many. I do have lots and lots of subjective judgments, though. And most of that just comes down to preference.

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      • jr,
        and yet the statistics say that the Boomers are the most propagandized generation…

        the millenials may like folks making fun of hypocrisy (why else watch The Daily Show?)… but a bit like Russians, they don’t believe the hype.

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      • I think one of Corproate America’s greatest achievements is the commodification of cool and dissent and almost everything. I admire it in a very strange way.

        Ditto that. The capacity to commodify almost everything up, to and including anti-commodification, is awesome (emphasizing the more archaic meaning of that word).

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    • I don’t. Not as a rule, anyway.

      Bunch is also wrong here:

      “The Obama interview, however, was just dreadful. After a few semi-unbearable moments during which the president shows he doesn’t at all understand the point of the show—the guest is not supposed to get in good zingers…”

      He must have missed, for example, the Oscar-themed show when Jennifer Lawrence repeatedly insulted Galifianakis.

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    • I think part of my issue is that I completely lack the context on this series to be able to feel where you’re coming from on feeling it has disappointed in meeting legitimately-set expectations. I’ve seen a couple of episodes; from that I can’t judge how out of character the treatment of this plug is or how relatively unfunny this episode is.

      That’s why I think the issues with Bunch’s column are problematic for using his words to establish this. (Another issue , for me at least, is where he approvingly quotes an assessment of Harold ramis’ vision (or, more slipperily, “the Ramis vision”) that becomes a full-bells-and-whistles restatement of Tea Party or at least anti-statist/anti-institutional political thematics. Ramis often poked fun at and skewered official ineptitude and malfeasance, but it doesn’t follow that his political vision is one of “a bottom-up, leaderless society with central power structures crushed and humiliated […] Pure Tea-Party.”)

      Clearly there is an agenda there, which makes it hard for me to take on Bunch’s description of the show’s usual method as a baseline. How does the show usually treat its guests’ attempts to plug their work? Does it not even operate on that formula at all, or is the claim that the treatment here is much softer. I didn’t actually think the treatment of the plug itself was very welcoming here, but perhaps it’s usually much more confrontaional.

      Then there’s ‘s point about the show’s and the site’s usual posture with regard to politics. Is this an exception in terms of just dealing with politics on B2f or funny or Die at all? seems to think not – I’d be interested in seeing his examples of previous shilling for Dems. One man’s shilling could be another’s incisive comedy, after all. It has to be judged in the particular I think.

      I tend to agree with you that the episode doesn’t seem to hold up as a legit episode of Between two Ferns, but, again, I haven’t seen nearly enough to judge that. I think a lot depends on a close reading of what the show has done in the past. i don’t think it suffices to make a thumbnail statement of what the show is (“a satire of celebrity talk shows”; “one of the few places where the idea of the obsequious celebrity interview is turned on its head”) and then rely on that statement to judge whether it is living up to its identity. You have to be more precise about exactly how it’s a satire of celebrity talk shows, if that is what it basically is, because i actually don’t think this episode ceases to be satire of a celebrity interview and lapses all the way into just being one based on a direct reaction to it. It’s only in the context of some baseline expectation for the humor that the art either does or doesn’t meet its own standard.

      Even then, I don’t think it’s unprecedented for comedians who can be cutting with political figures when working at a distance to be more solicitous when they offer to participate in the comedy. Nor do comedians make any pact with their audience to be politically neutral.

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      • Trolling Hillary Clinton was fucking awesome.
        But I don’t expect Every Single Show to troll their guests.
        Particularly not when it’s POTUS.
        (I mean, really, would you troll the President?
        Would you troll the president on National TV?)

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      • In regards to Between Two Ferns, the difference is that guests on the show are almost never there to promote something specific. If an actor goes on Late Night, you expect him or her to have a clip of their latest movie. When I see politicians on those kinds of talk shows it doesn’t strike me as odd. We all know that it’s about selling something.

        The aesthetic of Between Two Ferns is amateurish precisely because it’s a send up of other talk shows. That’s the appeal of viral video. Once it becomes obvious that it’s just another talk show, it becomes much less effective.

        The best description I can think of for the Obama episode is sponsored content.

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      • In regards to Between Two Ferns, the difference is that guests on the show are almost never there to promote something specific.

        That’s what I was wondering about, and it’s a significant point in favor of the thesis if true – and I accept without any personal knowledge at all that it is. (My personal suspicion, not having seen many episodes, was that, when it started, there was basically no correlation between who appeared when and what products were out there being promoted in other media, but that as it progressed, if you looked you could probably detect an increasing correlation. But as I say, I accept your assessment.)

        That being said, I would pretty much expect any comedy show of any kind, especially one based on an interview format, if contacted by the sitting president wanting to be on, to say yes in full understanding that he’s doing it for his own purposes. That would just be my baseline expectation. I would also expect the resulting comedy product to be somewhat less sharp. But I wouldn’t really expect anything other than that process to play out.

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  6. And here, we have a conundrum. The dignity of the office vs. the need to get a message out to people who need the message. Hmmm. Be above the common man or get down with the common man? Decisions, decisions, decisions.

    I’ve begun volunteering at the local food pantry. We know we only reach a small number of the people we should be helping (as little as 1/10 the people eligible by income.) The $100 to 150 worth of food we give out for a family of four would, for those families, be better spent on other important things like heat and car repairs so that they can get to work without risking a $300 ticket for moving violations and the accompanying increased insurance costs. We talked about how to reach more people last week; as a reformed newspaper person, my first instinct was the paper. But here’s the rub — the people who donate to our pantry read the paper. The people who we help? Not so much. If we had a local version of Between Two Ferns I’d be all over it in a minute. Because my dignity doesn’t matter here, while actually helping families living at the margins matters a whole lot.

    I’d say the same of Obama and this appearance; and I’ll leave the art and comedy to the artist and comedian. We’ve screwed my children’s generations out of jobs, loaded them up with college debt, and created a health-care system that was, pre-ACA, out of reach for most of them. I’d say any way we can reach young adults matters right now.

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    • I agree. This is expressedly the president’s job.

      Tips for reaching folks: Barbershops, McDonalds, maybe even the dump (do folks sit out in front of yours? — I’m grabbing that one from SW VA), county fairs (heh. gonna need good PR for that one)

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    • This implies that selling the ACA is more humanitarian intervention than politics. In point of fact, the ACA needs the young and the healthy more than the young and the healthy need the ACA.

      More generally though, this is how politics works, by convincing people that it is vital, so vital that there can be no spaces free from the intrusion of politics and politicians. We are not better off for this.

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      • This implies that selling the ACA is more humanitarian intervention than politics. In point of fact, the ACA needs the young and the healthy more than the young and the healthy need the ACA.

        Such binary thinking. Yes, to work ACA needs those young people to enroll. But those young people, without ACA also face potential economic crisis if they have a health-care emergency without insurance or shift the costs of their care to others, driving prices up for those of us who are insured. So it seems to me that encouraging them to enroll is both political (making a program work for everybody) and humanitarian (providing access to the health care system without creating economic burden and cost shifting).

        On my food pantry example: the #1 source of referrals to the food pantry comes from the town offices of the communities we serve; not from schools, from word of mouth, from churches, or from the newspaper. People in need ask what kind of help they can get from their local government.

        You may have a problem with that; but I don’t. Government isn’t some other, to foreign invader in our lives, it’s of the people, and it should be there to help people work together to be as successful as possible. Certainly the business owners in my community know how to go to government to make their needs known; why shouldn’t the citizens?

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      • But those young people, without ACA also face potential economic crisis if they have a health-care emergency

        And it’s our job to make sure that they don’t choose to take such risks.

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      • And it’s our job to make sure that they don’t choose to take such risks.

        Yeah. Right. WTF does that mean?

        Choose not to get sick? Not to have a car accident? A bike accident when they’re hit by a car while biking to their work? Not to slip on the ice? Should they stay home, playing video games by themselves until they’re magically employed by some generous company that offers health insurance?

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      • James,
        Because it’s our job to pay for health 20 year olds collapsing on Cardiac Hill.
        We can either pay in the ER, or we can pay their PCP to tell them not to exercise when they’re allergic to the air (that it is not our job to regulate!)

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      • ,

        I think “choose to take the risk” is pretty explanatory–they choose to take the risk of not having insurance, even though something might happen to them.

        But who could possibly argue against the idea that it’s society’s job to make sure people don’t take risks that might blow up in their faces? Only a monster could think that risk-taking is an allowable behavior.

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      • So it seems to me that encouraging them to enroll is both political (making a program work for everybody)

        It doesn’t work for everyone. It’s very deliberately designed to make some people worse off by forcing them to subsidize others.

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      • “In point of fact, the ACA needs the young and the healthy more than the young and the healthy need the ACA.”

        This is both true and meaningless. The ACA will *always* need the young and healthy more than the young and healthy need the ACA, in the same way that property insurers homeowners need those whose houses don’t burn down more than vice versa.

        @jm3z-aitch “But those young people, without ACA also face potential economic crisis if they have a health-care emergency”
        “And it’s our job to make sure that they don’t choose to take such risks.”

        Not quite it, either of you. Young people need to be part of the health insurance system because they will not always be young people, and a system that caters to mostly those both older and less healthy will collapse — just as our pre-ACA system was collapsing.

        They don’t need to join because they might get injured tomorrow; they need to join because they will eventually need a healthcare system at some point in their lives.

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      • James,
        yeah, um, i’m okay with anyone not having insurance so long as we make those “do not treat” orders fucking mandatory, and applicable for people whose side of their face is rotting off, or feet falling off.

        When you tell me I have to pay for the person whose tooth got infected, with my public dollars, I say — can we get some insurance on that?

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      • As long as we can define other people’s needs for them, I can’t think of any justification for not requiring them to fulfill those needs.

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      • That’s just silly.

        Potable water, police and fire protection, a standing army to defend borders, there are all kinds of things that we supply for everyone for the good of the whole without making sure that every single person wants it at every given moment.

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      • When you tell me I have to pay for the person whose tooth got infected, with my public dollars, I say — can we get some insurance on that?

        Would you agree that the fact that you’re spending on them creates a compelling interest for their behavior?

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      • BB,

        It does subsidize teh poors.

        However, insurance benefits those who are unhealthy but could become sick, pretty mich by definition. So you can’t say, “this Obamacare hurts the healthy who could be paying less, if we got rid of the ACA and community rating.” Because it is true that the healthy are now better off because they could become part of the sick group. That is, they are gifted a protection against risk by the ACA.

        One can say the same about the old and the young, too. The ACA forces the young to pay more than they otherwise would, but the young benefit from this because they will eventually become old.

        I suppose you could say in this society we need to subsidize the young poor more and the middle class elderly a little less. I’d agree with the first part and not the second.

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      • statistically there are very few of us who will not access the health care system. We’ll get pregnant. We’ll get sick. If it’s a communicable disease, we’ll risk infecting others. Very few of us will opt to not get a broken bone set, to not treat cancer. And I think very few of us would suggest it’s okay to turn someone in need of care away; though the fringes of that get to be very confusing (it’s wonderfully fractal).

        So the need here is, at some point in your life, medical care. And a way to pay for it when you need it. Or you need to accept a medical crisis screwing someone’s odds of succeeding. Or you need to say suck it up because we’re not going to help you.

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      • Let me be clearer. Community rating benefits everyone: rich, poor, old, young. (Is that an oversimplification? Eh, a bit.)

        The premium subsidies benefit the working poor (paid for by taxes from the wealthier, ultimately). Medicaid (paid for by taxes from the wealthier) benefits the cery poor.

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      • Fuck no. You don’t seem to understand. If the person isn’t flat out dying, the emergency room can refuse care. That means that the person WILL need hospitalization, and will NEARLY DIE. And very well MIGHT DIE if they get something that is even a little antibiotic resistant.

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      • Potable water, police and fire protection, a standing army to defend borders

        We don’t require people to buy potable water policies or police protection policies, do we? We handle those differently. If you want to argue that health care is like those, then handle health care like we handle those. It doesn’t work as a defense of ACA, it only highlights how stupid ACA’s design is.

        ,
        Or you need to accept a medical crisis screwing someone’s odds of succeeding.

        If they made the choice to take the risk, why shouldn’t I accept it? To do otherwise would be to substitute my judgement for theirs. In the normal course of life we call such people busybodies and control freaks; let them speak on Really Important IssuesTM and we call them caring citizens; put them in public office and we call them statesmen.

        Or you need to say suck it up because we’re not going to help you.

        Do you even imagine that I have a problem with this? Look, I have sympathy with poor people who can’t afford health care. Let’s be clear on that, but that’s not who we’re discussing here. We’re discussing those who can pay for it but opt not to. Their business, their risk, their cost if the risk goes sour. Don’t socialize the losses (just as we ought not do with failed businesses). Middle Class Joe wants to be uninsured, have a few drinks, then race his motorcycle without a helmet. His choice; let him pay the price.

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      • “It’s very deliberately designed to make some people worse off by forcing them to subsidize others.”

        Aaaaarrrrrggggghhhhh….

        Look, premiums paid to an insurance scheme is a transaction that transfers risk; that risk in transferred whether you have a loss or not. Transfer of risk is not worthless, and I’m not even talking “what’s important to me” fuzzy stuff — it actually has a set monetary value.

        Look, EVERYONE — I get that the word “subsidize” works really well for you in political arguments, but you need to stop using it as a critique when discussing insurance. It makes you look like you don’t know what you’re talking about. Pooling of risk is a different thing than subsidization.

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      • James,
        naturally you realize that single payer is something the libs want, right?

        I’m not for allowing stupid risks to our population. Let people wander around with limbs rotting off, let people crawl around because they can’t walk anymore? Have people with severe systemic infections that they don’t fix?

        Recipe for Pandemic, no? Part of the documented reason for the black plague, yes.

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      • insurance benefits those who are unhealthy but could become sick, pretty mich by definition.

        Do you actually think anybody has argued against this claim? Whether insurance is beneficial is not even close to the question here.

        they are gifted a protection against risk by the ACA.

        That’s an empirically false statement. They are not “gifted” anything when they are required to pay for it, and especially not when they are required to pay for it against their will. What an egregious abuse of language–pure political spin of the most cynical kind.

        If I went to Wal Mart and they required me to buy something that was beneficial but that I would not have chosen to buy for myself, then they said they had “gifted” it to me, would you nod your head in agreement, or would you criticize their dishonesty?

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      • I am not only talking about poor people who cannot afford health care. I am talking about working people — people who work 40 or more hours a week — who cannot afford health care. I cannot afford health care insurance; we are self employed, and old enough that we pay the highest premiums. I don’t have $14,400 a year, our cost for a plan on the individual market; but I can manage $6,000 a year; and ACA put us there.

        I’m really sick of every discussion of government devolving to ‘poor.’ Try ‘people’ for a change. Most of the ‘people’ I know who will benefit from having access to health care don’t choose to take a risk on not having health insurance, they cannot afford to have health insurance. Many people I know in other states, couldn’t get health insurance before ACA because they were already proud owners of a pre-existing condition.

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      • zic,
        Yeah, That.
        And we haven’t even mentioned the friend who died because her insurance sucked that bad.
        Or the multiple shmucks who were thinking of emmigrating to well, anywhere, because American insurance sucks that badly.

        I could cite names. Some of these dudes are pretty famous (at least one of them has been cited on this site).

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      • your sounds of frustration aren’t justified — you’re missing something important here.

        If I buy insurance, I’m paying the insurance company to take on my personal risk. That risk has a cost, and if we’re talking about life insurance or car insurance, I’m paying the full cost of my own risk — if I’m a teen or I’ve had a lot of accidents, I’ll pay more for car insurance than 40-year-old with a perfect driving record.

        Per the PPACA, younger, healthier people are paying more than the actuarial cost of their personal risk so that older, sicker people can pay less. This is not inherent in the concept of insurance.

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      • ,
        I’m not arguing about people who can’t afford health care.

        You’re not addressing my points; you’re trying to shift the argument away from my issue to the issue you want to argue about. I’m not going to play that game.

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      • Since we’re talking about subsidies, lets not forget that employer-provided insurance is a subsidy; their share is income that you do not pay taxes on. This a huge subsidy; and the people who didn’t get it were the ones working part time, self-employed, or who’s employers were, for whatever reason, unable or willing to offer health insurance.

        I don’t know if is tenured, but I bet he does get a health-insurance subsidy through his insurance from his employer. I know we did, last year, when my husband worked for a private school as full-time faculty; it was over $700/month.

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      • And it’s our job to make sure that they don’t choose to take such risks.

        We don’t require people to buy potable water policies or police protection policies, do we? We handle those differently. If you want to argue that health care is like those, then handle health care like we handle those. It doesn’t work as a defense of ACA, it only highlights how stupid ACA’s design is.

        Let’s see: police, defense, water safety — they’re all government functions. This sounds like a classic argument for a Canadian-style single-payer system. I agree. But I had to settle for a market-based system. And for a market-based system to work, everyone’s got to engage the payment end of the market because everyone will engage the services end of the market.

        And no, I’m not changing the subject. I just don’t live in an elitist tower were, for a few $100 a month, I think I’m pulling my share of the load because I’m unaware of the actual burden of cost to my employer.

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      • Tod:
        I know how insurance works. Really. Not as well as you, because it wasn’t my full-time job for decades, but enough not to say really stupid things about it. And I’m pretty sure we’ve had this conversation before.

        There’s a sense in which all insurance is a subsidy. You pay your premium based on the expected costs of your coverage, and then some people have bad stuff happen to them and get big checks from the insurance company, and some people don’t, and get nothing. Let’s call this an ex post subsidy, because it comes after the insurable event. That’s what you’re talking about. That’s not what I’m talking about.

        The subsidy I’m talking about—let’s call it an ex ante subsidy because it comes before the insurable event—is the one where the government arranges for you to get your insurance for free, or at some price less than the expected cost of your coverage, and forces someone else to make up the difference.

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      • Brandon,
        so long as the care isn’t coming in the form of ER visits, we’re still making out.

        Seriously, unless you want people with their feet falling off (NOT a hypothetical in a Pittsburgh winter) not getting that shit fixed — and we’re talking gangrene here…
        They’re going to get help at some point. And it’s going to COST YOU MONEY.

        Note: leaving the government out of it Also Costs You Money (the hospital picks up the care’s tab, and passes it on to you).

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      • Let’s see: police, defense, water safety — they’re all government functions. This sounds like a classic argument for a Canadian-style single-payer system.

        Exactly. What’s going on here is not a good argument for ACA, but for a true national health care program.

        But I had to settle for a market-based system.
        Yes, so can we stop a) making arguments that only work for a true national health care program, and b) condescedingly tell young people what’s really truly their best interests.

        And for a market-based system to work, everyone’s got to engage the payment end of the market because everyone will engage the services end of the market.

        No, that statement is incorrect. Everyone has to engage the payment end regardless of whether they engage the services end, to cover the cost of those who do engage the service end. And those who engage the service end least need to pay more to cover the costs of those who engage it the most.

        And no, I’m not changing the subject.

        Yes, you bloody well are. This thread began with j r saying “, the ACA needs the young and the healthy more than the young and the healthy need the ACA,” and that’s the population I was talking about when you engaged me and tried to shift the discussion to a different population, those who can’t afford health insurance. Those two populations are not identical, even if there’s overlap; I was talking about one; you talked to me about the other–that is how changing the subject works.

        I just don’t live in an elitist tower were, for a few $100 a month, I think I’m pulling my share of the load because I’m unaware of the actual burden of cost to my employer.

        Wow, nice personal attack, zic. It impugns me as an ivory tower academic totally divorced from reality and doesn’t bear on the topic at all. Of course you don’t actually know me or my life at all, but go ahead and make all kinds of assumptions. I’m sure I grew up in an upper middle class family in a nice suburb, with both of my parents being high level execs who paid for all my education. I probably even had my own television and game system in the private bathroom of my unshared bedroom. Bonus points if we ate caviar every Sunday.

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      • This fervent defense of ACA from people to the left of me is really perverse, because it’s not about the well off taking care of the less well of, as a national health care system based on progressive taxation would be. It’s about young people who could afford health care, perhaps with a bit of stretch, taking care of older people who are in many cases better off, but less healthy.

        Any young person who’s making real dough will most likely (not all, but the great majority) be getting health insurance through their employer. Any young person not making any substantial dough, of course cannot afford health insurance. The sticking point is those who could afford it, but choose not to because they’re making some dough, but not enough that they want to spend it on health insurance.

        That’s so progressive. I’d be a lot more impressed if you all quit trying to make up justifications that don’t fly, and just said,

        “Yeah, ACA’s a piece of crap, but if that’s what it takes to provide health insurance for those who can’t afford it, then by god my liberal principles say that’s so important that if I can’t manage to squeeze the rich, then it’s regrettably necessary to squeeze those middle class young kids until their pimples pop, and by god we hope enough people find the benefits so desirable, but the structure so bad, that down the road the public will demand movement to single payer.

        Because I think that’s your real argument.

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      • you’re a statistically predictable person — a 40+ professor who a wife and kids, and (through either you or your spouse) an employer-provided health insurance plan that your employer likely pays between $6,000 and $12,000/annum for; income on which that you don’t have to pay taxes.

        While those details may not fit you in specific, they fit the statistical model.

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      • @j r“In point of fact, the ACA needs the young and the healthy more than the young and the healthy need the ACA.”

        This is both true and meaningless.

        This is somewhat, though not totally, meaningless in a discussion about whether the ACA is good policy, but that’s not the discussion that I was having. I was responding to zic’s claim that Obama’s outreach to young people was humanitarian in nature as opposed to being more of a political appeal. In that context, I hope you see why the disposition of the young and healthy is far from meaningless.

        And , I can assure you that I am far from binary in my thinking. I am an economist by trade, so I tend not think in binaries much. Rather, I think in terms of sustainable equilibria. It would also be quite weird of me to see the government as a “foreign invader” as I am a government employee. It seems that you are the one with the binary mode of thinking: the ACA is unequivocally good and anyone offering a critique of it must be one them.

        It’s fine if you think of the ACA as an exercise in humanitarianism, but understand that this is an assertion based on your opinion. Some people have a legitimate disagreement as to whether this is the case. There are lots of different ways that the government could work together with the people to improve the health care market and the ACA is only one choice out of many.

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      • And no, I’m not changing the subject. I just don’t live in an elitist tower were, for a few $100 a month, I think I’m pulling my share of the load because I’m unaware of the actual burden of cost to my employer.

        Insurance is not a gift or subsidy from your employer. It comes out of your wages. Not explicitly, but employers generally don’t hire people whom they don’t think will be a net benefit to the company, net of the total cost of employment. If you get insurance through your job, you’re pulling your weight, at least in that respect.

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      • James,
        Jesus fucking christ. Writers guild insurance sucked before ACA. Now it will suck less, and fewer people who can afford Insurance will die (and, yes, I can cite sob story after sob story — because they’re freaking WRITERS and they fundraise for each other).

        So, see, there’s actually another group of people: “Those who are old(ish) and couldn’t afford insurance because they weren’t part of a group”

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      • “Yeah, ACA’s a piece of crap, but if that’s what it takes to provide health insurance for those who can’t afford it, then by god my liberal principles say that’s so important that if I can’t manage to squeeze the rich, then it’s regrettably necessary to squeeze those middle class young kids until their pimples pop, and by god we hope enough people find the benefits so desirable, but the structure so bad, that down the road the public will demand movement to single payer.”

        As a Canadian who grew up under a then-functioning single payer system, this sounds about right to me.

        Particularly since every time someone tried to engage me on the topic (in person) before it passed, I said something like, “I hate ACA, it’s NOTHING like a reasonable healthcare system, it’s still based on bullshit assumptions, it’s just better for most people than the BS you have now, a LOT more likely to get past the lobbyists than anything actually good would be, and I think the people it’s bad for are more able to handle it than the people it’s bad for now. Honestly, it stresses me out because I’m pretty sure it’s going to spread insidiously to Canada just like the rest of the crap that Harper has copied from your political system.” almost EVERYONE got mad at me (even when I didn’t add that last sentence).

        Which is to say, I think the leftists who hate ACA mostly don’t bother to talk about it because there’s no purchase in everyone yelling at them.

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      • jr,
        I’d be interested in hearing what you’d recommend, for a health care/gov’t scheme.

        If you’re an economist by trade,a nd you work for the government, I’m suddenly quite interested in both where you work, and what division you work for. not that you have to tell.

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      • Maribou,
        you’ll probably get the EHR regardless. Hope you guys don’t have to deal with the manifest uncertainty present in “meaningful use” regs. (I sympathize with the regulators, too! Nothing like trying to figure out what will Help People when you don’t have science to back up anything)

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      • …But on the substance, clearly most liberal-progressives would like to raise taxes some to help fill in some of the gaps in coverage for people with expensive illnesses. In particular, i think a lot of liberals would like to expand various single-payer programs to include more such cases. but I think a lot of liberlas do buy into the idea that people of all ages should pay into the health risk pools in order not to pose a risk to the health-cost system that they very possibly couldn’t ever really be responsible for. (Ultimately, i think if you pressed them, this would shake out to support for a mandate for catastrophic insurance but not comprehensive isurance.) others would rather not have any mandate, but accept it as preferable to not having the reforms in place that the ACA provides.

        So how is that not more or less what they’re saying? People can think that a certain prong of a policy is not what they’d ideally like, but still accept it as playing a necessary role in a policy that has benefits that are more important. People can think that the mechanism chosen to play that role (the mandate here) is not the one they’d prefer, but is still on balance justified given the trade-offs. they can think that, on balance, they’d like to find a different mechanism but believe the justification for this one is sufficient. Those wo beliefs are not in tension. So they defend the overall policy and even give the justification for the prong they don’t find maximally preferable. Where is it they haven’t told you their real argument? Have you asked them whether the prong in question is their preferred mechanism for fulfilling its function? or have you just challenged whether it can be justified?

        Just because someone doesn’t think a certain prong of a policy is the best one available doesn’t mean they don’t think that the one chosen can be justified, especially given the tradeoffs (but even on its own terms), and it certainly doesn’t mean they support it only as a means to squeeze the population with painful policy in order to spur them to change it (though if it has that effect, that would be okay too).

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      • This thread is complelty boggling. Some things people apparetnly forget:

        Lefties complained intensely about the ACA and loud group suggested ditching alltogether.

        Of course there are many ways to fix our health care problems. How many actual choices were we presented with: ACA vs Nothing. Did anybody actually want fewer options????? It wasn’t jsut until this year some R pols actually presented plans that still don’t even have full support on their own side.

        Really, how many people actually love the ACA? Very few that i can think of. How many people think its better that nothing a lot? How many people think its at least heading in a better direction.

        To often criticism of the ACA is a stalking horse for the R desire to do nothing much. Not everybody who criticizes the ACA is an R or wants to do nothing but it awfully hard to tell the difference at times. But for all the problems of the ACA where is there a desire and energy and votes to try to fix our HC problems? Well i can show you one coalition that just held their 50th vote to repeal the ACA.

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      • It’s fine if you think of the ACA as an exercise in humanitarianism, but understand that this is an assertion based on your opinion. Some people have a legitimate disagreement as to whether this is the case. There are lots of different ways that the government could work together with the people to improve the health care market and the ACA is only one choice out of many.

        On the first part — humanitarianism — we are not going to turn people away from some basic level of care. We just won’t do it. So humanitarianism is built in, no matter how we approach the problem.

        I completely agree with ACA being one of many choices. But it is the choice that became law. And the law was structured as it is because that’s what economists like you recognized was required to make these particular set of choices work. James is right, I’d prefer a single payer plan; it was never an option. I’d also like a government-option; a way to by-pass the for-profit insurance industry altogether; but that got taken off the table early on in the debate. So this is what we have.

        As a liberal, I consider it a starting point; that over time, we’ll refine it to work better, and much of that refinement will go toward getting the insurance industry out of the business of insuring, and have them serve more as a record-processing and boutique provider industry.

        But it is the system we have. Right now. I’m tired of the debates about what it should or shouldn’t be, they are a distraction from actually doing what we can to make work, including finding and fixing the flaws that keep it from working as well as it should. And for it to work, economists like you say: get the young folk engaged. If they don’t engage, we’ll have to work that out.

        Part of the big communication problem here is that so much of ACA is not just about insurance; it’s about the business of how we deliver health care. Those changes are already built in. They’re what happened in the years after the ACA passed and before the exchanges opened and the mandate kicked in. ACA is not going away; and it wasn’t ever going away since about two years ago, no matter how many votes they took in the house. Having the prez out there, encouraging people to sign up is good business; it gives us the best chance of uncovering the flaws and moving toward functionality.

        And since you’re economist, you completely understand that we, here in the US, pay the highest prices in the world for mediocre medical outcomes; functionality matters.

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      • James,

        Yes, “gifted” is the wrong word. But I was addressing BB’s point.

        BB claims that the ACA and community rating is harming the healthy and the young at the expense of the sick and old. I was arguing that the healthy and young get an actuarial, risk-reduction benefit under community rating that is worth the (in some cases) slightly higher rates they pay under community rating. I should’ve said “benefit” and not “gift,” yes.

        We all grant that medicaid and the ACA subsidies for the poor are redistributive measures that cost (harm, if you will) the wealthy. That is so obvious, that can’t be what BB meant. He meant to smear the community rating and mandate as harming (intentionally, hahahaha) the young and the healthy, which it does not. Or do you disagree?

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      • Right now. I’m tired of the debates about what it should or shouldn’t be, they are a distraction from actually doing what we can to make work,

        No. They are legitimate disagreements over how a huge sector of the economy ought to work and the proper and most effective use of government power. That’s not a distraction. That is called good governance. That is called citizenship.

        If the president wants to go out and communicate his vision, that’s fine. That’s his job. No objection from me. Let’s remember that this is not a post about critiquing the president. It’s a post about the aesthetic decision that an artist made to open his medium up to what is effectively sponsored content.

        As for the claim that the United States spends more for worse health outcomes is accurate but needs a whole lot of unpacking before it becomes meaningful. For one thing country-to-country comparisons involving the US are tricky. The US is more like the EU than it is like any European nation. And many of the things that influence health outcomes (eg violence, lifestyle, diet) don’t have all that much to do with health care. Also, the US leads the world in medical innovation and that serves as a form of subsidy to all those other countries with nationalized health care systems.

        My view on healthcare is this: our pre-ACA system was terrible in a lot of ways. We had a roughly market-bases system with no functioning price system. And we had a system with lots of government involvement, but without universal coverage. To put another, we had the worst of both worlds. The ACA addresses the latter issue, but doesn’t do much for the former and that is its weakness. The ACA promised to do two things at once extend coverage, which it will, and rein in prices, which it won’t. Some people will consider that a success and some won’t.

        It would have been much better to simply expand medicare and start tearing down the barriers that keep a functioning health care market from developing. Singapore is a great example where everyone is entitled to a minimum level of care, but those with money can pay to upgrade. Of course, it is hard to have something like that here, because people get very turned off to no-frills health care services.

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      • jr,
        we currently spend 15% of our healthcare spending on waste (lotta billing, but there’s other stuff there). if we can improve the quality of care (and we’re working on that), then maybe we can get the pricing fixed.

        What’s your thoughts on fee for service versus ACA?

        also: jr and James, I love you guys, but I’m totally bored with this conversation. When ACA is DOA, and Medicare/singlepayer, etc get back on the table, we can discuss then. Because then we’ll have actual ideas that are relevant.

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      • It’s a post about the aesthetic decision that an artist made to open his medium up to what is effectively sponsored content.

        Seriously, when you’re POTUS, everything you say is ‘sponsored content.’ That’s part of the bubble of being POTUS. Getting an interview with POTUS and the sponsored content they spout about the issue du jour, would, in a normal world, be considered a feather in the cap.

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      • “The critique is about forced pooling of risk. That’s where the word subsidize becomes relevant.”

        Then it is a difference without distinction, because — unless you are quite wealthy — almost every single insurance policy you have right now is one where you are being forced to join a pool.

        Your home insurance? Forced. Auto? Forced. Workers comp, unemployment, disability, life (assuming you get it from your place of work)? All forced.

        Are you a doctor, attorney, architect, builder, or just about any kind of profession that is often sided for professional neglect/error? You’re forced to buy insurance for it. Do you own a building where you rent space to others? You’re forced to buy certain kinds of liability.

        Are you an American that has either home or commercial Earthquake insurance? If so, the odds are overwhelmingly good that you are being forced to purchase it. Same thing with flood insurance.

        “Forced to buy insurance” is not something that the ACA invented; it’s the way the vast preponderance of insurance is sold.

        : “Per the PPACA, younger, healthier people are paying more than the actuarial cost of their personal risk so that older, sicker people can pay less. This is not inherent in the concept of insurance.”

        No, that is the very basis of insurance. The health insurance you had before ACA operated exactly the same way. So too does every policy you own. It’s why you might have paid $15,000 over the past decade in car insurance, and if you get in a $2,000 fender bender your rates are probably going up anyway. Insurance does not work to an absolute scale of risk — it can’t. Otherwise the cost of insuring a 40 year old driver with a clear record would be $5 a year and the cost for a 17 year old boy $35,000 a year. That we push the the ends of potential cost close together to form a more uniform expense IS pooling risk.

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      • There is forced insurance, and there is unforced insurance. And there is insurance that is required to do various things, which isn’t quite the same as insurance that is required by virtue of being a citizen.

        It’s true that actuarial risk assessment is incomplete, both due to incomplete information and legal restrictions on what can and can’t be assessed. I’d argue that there is a distinction and a difference where actuarial assessment is attempted and where it is not. Or where it is attempted more and where it is attempted less.

        That the ACA greatly reduces the scope of the actuarial assessment is relevant, regardless of whether this is a good thing or a bad thing. Even if they exist along a spectrum, the degree of actuarial assessment (of the individual) from the standpoint of car insurance and post-ACA individual health insurance is extremely relevant.

        Further, the less actuarial assessment we allow, the more we are moving away from one concept of insurance and towards another and the word “subsidy” becomes an increasingly accurate characterization of what is taking place. The “forced” is important because we are not allowing people to determine for themselves whether they want to enter the pool. The lack of actuarial assessment (on an individual level) seems like an admission that we simply want some people to pay for the health care of other people.

        Which we do! It is what it is.

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      • Drew
        Ah, it’s ok for zic to do that, and for you to do that, but not for me to do that. I’ve never respected people who try to apply rules to others that they don’t follow themselves, so I think you and I are done.

        ,
        You’ve followed up an argumentum ad hominem fallacy with the ecological fallacy. Please stop trying to define me by the few facts you know about me. Are you defined entirely by your current position in life? Does your past have no relevance? If yours does, perhaps you might agree that mine has relevance, too, and you don’t know my past.

        And those criticisms, if true, have no bearing on the question of who’s paying to support whom, or on whether it’s appropriate or not to deny people the choice to take the risk of being uninsured. Whether it is, or whether it is not, my position in life has absolutely no relevance. Your reference to my current position in life is an attempt to rebut by attacking the source, not a rebuttal of the actual argument. It’s beneath your usual standards.

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      • My rebuttal is that people who receive tax-free subsidies from their employers (who might find themselves on the receiving end of a tax increase, if they’re at the very top of earnings) already receive a subsidy.

        But those same people often seem to want others to have to go without.

        I didn’t even get into the argument that decoupling health care from employment might be a net economic boon, because it would leave people more employment options; insurance has, until this very year, trapped a lot of people in jobs and been a disincentive to launching your own business; particularly soul-prop businesses. Writers, programmers, accountants, plumbers, graphic artists — whole lot of potential opens up for these folk as freelancers and consultants if they don’t have to work for a corporation to get tax-subsidized health insurance from an employer that they couldn’t get on their own. Not to mention temp workers, a whole other underclass of people out there.

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      • Whaaaaa???

        It *is* okay for you to do that, and for me to do that. I did it the other day; today you did it. So we’re clear: it’s okay. It just didn’t seem okay to you the other day. But you’ve come around, apparently.

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      • Let’s look at four people, Trumwill at 20, Clancy at 20, Trumwill at 33, and Clancy at 33.

        In a non-forced, actuarial market, T-20 and C-20 are both reasonably healthy non-smokers. T-33 is a smoker and C-33 had something pop up on a blood test that suggests that she is at risk of serious illness. The actuarial risk profile ot T-20 and C-20 is significantly smaller than that of T-33 and C-33 individually or collectively.

        Since this is unforced, the pricing for T-20 and C-20 has to be low enough to make it worth their while to purchase it. This risk assessment would be incomplete for T-20 and C-20, as one of them is going to become a smoker and another is going to get a blood test with some problematic results. But T-20, C-20, and the insurance companies don’t know this. The possibility is going to be baked in to their rates.

        Once the smoking starts and the blood test comes back, though, T-33 and C-33 are in different risk categories. So in an unforced, actuarialized market, they’re paying more. The risk of future health problems is greater.

        If we have a system that allows insurance companies to charge these four people different rates to try to get them to sign up, it’s difficult to argue that it’s a subsidy. Or more precisely, if it’s a subsidy, it’s not a forced subsidy. If T-20 gets the insurance, even though he isn’t likely to need it as far as he knows, he is still presumably getting his money’s worth because he decided to buy it. If not paid back in dollars, then paid back in peace of mind.

        On the other hand, if the only way to get T-20 to buy the insurance is to force him to, I think he has a much stronger claim that he is being forced to subsidize others. Especially when his relative lack of risk isn’t sufficiently taken into account. Because he does not believe what he is getting back is actually worth it. Which he might be wrong about, but I don’t think it’s quite right so suggest that he doesn’t understand how insurance works. Or that the nature of the subsidy between the forced and unforced insurance plans and more actuarialized and less actuarialized rate structures isn’t actually different.

        (Unless anyone is worried, Clancy is perfectly fine. The problem – which was latent even then – was flushed out of her system a long time ago. That doesn’t necessarily matter, though. What matters is that she tested positive for it once, in 2008. That alone makes PPACA a good deal for us.)

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      • zic,
        there’s no “might” in that statement. I’m certain someone (if not James or Jr, Krugman or Stiglitz or half a dozen other folks) has run the numbers on decoupling health care from employment.
        There may be other costs (particularly if the new health care costs more, which I am not as certain of as JR).

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      • Some things people apparetnly forget:
        Lefties complained intensely about the ACA and loud group suggested ditching alltogether.

        Exactly! I remember, and Irespect that position. which is why I said that, instead of this weak defense of ACA, is their true position. As I agreed with zic above, a fully socialized system is much more defensible than ACA. I, me, that libertarian whacko agree.

        ,
        I bet he does get a health-insurance subsidy through his insurance from his employer.

        Compensation != subsidy. My neighbor works at a Ford plant, blue collar work. I’m sure he’ll be thrilled to hear that Ford’s giving him, not compensation for the long hours and hard work he puts in, but a “subsidy.”

        What do you think the UAW would do if Ford decided they didn’t want to pay the “subsidy”? Do you think they’d sigh and say, “well, it was nice while it lasted?” Or do you think they’d howl, “That’s compensation! And if you aren’t going to give us the insurance you’re damn well going to pay us more to make up for it!”

        I know what response I’d wager on.

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      • Something I never even thought to ask: does ACA make insurance premiums paid in the individual (or now exchange) markets (or was it already the case that they were?) deductible at the federal level, and if not why the hell not? Are the affordability subsidies thought to be the equivalent? I suppose in fact turning them into sliding-scale subsidies in that way makes the program a lot more progressive as an overall implied tax than it would be if it just made insurance deductible for individuals like it essentially is for people in the employer market.

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      • Really? OK, pardon my ignorance then — I always assumed that for non-health insurance I was paying just the expected actuarial cost for a person in my age/gender/risk factors group. I do think that, as Will says, the degree of pooling is still relevant to the discussion — it’s not fair to say that there’s always pooling so it doesn’t matter how much we flatten the rates. But I didn’t realize that it was already happening to some degree.

        As a safe driver in his forties, that kinda sucks — I’d much rather pay $5/month than what I’m paying now.

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      • Michael Drew,

        You were the one bitching about it recently, unless I once again misunderstand some of the incomprehensible stream-of-consciousness hash that you pretend is writing.

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      • See, James? Like I said, it’s perfectly okay to say what *you think* other people really think.

        I mean, I’m bitching that you turn around and do it after bitching about it. I want to clarify that you think it’s okay now.

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      • It has occurred to me, but I’ve not found anything on it. Given that it’s harder to find a negative than a positive, I assume that PPACA does not do that.

        As for the “why” I think it’s because it’s a general belief that it was a dumb move to do it for employers and doing it for everyone else would be compounding that error. Liberals and libertarians both object to the status quo (as do a large number of conservatives) but nobody can agree on how to best address it. People are very protective when it comes to what they have (hence “If you like your current plan, you can keep your current plan.”)

        I am guessing that the subsidies were an easier sell, or otherwise that they were considered to be more politically beneficial. It’s easier to notice direct subsidies than indirect subsidies. It also might have complicated the tax filing process? That’s a guess.

        In hindsight, they might have been better served by doing it in the form of tax breaks. I would guess (and again, totally guessing here) that the subsidies were supposed to be more appreciated than they are. That through the subsidies they’d better be able to avoid the sticker shock people got when the rollout didn’t work as gracefully as intended and many people saw the un-subsidized prices.

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      • As for the “why” I think it’s because it’s a general belief that it was a dumb move to do it for employers and doing it for everyone else would be compounding that error.

        Good point.

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      • when we first moved to Maine, we still had my husband’s insurance from his job in the MA health-care r&d industry; the academic side of it. That was some sweet insurance early on, paid everything, no questions, small premium taken out of the paycheck for the family, the worker got 100% coverage paid. Then, it switched to an HMO in the late ’80’s, early ’90’s; and it wasn’t as generous, but still generous.

        When we both became self employed in the early 2000’s, we had to buy in the individual market. Luckily, living here, we couldn’t be denied, because we would have been in many places due to pre-existing conditions (my neck damage & migraine, he has stenosis). Even here, we had to maintain our insurance, or we would have been denied; we could not let it lapse. Ever.

        Our early days in this scenario, all we got for ‘subsidy’ was an HSA account that we had to pay 1) know to set up (I say this, because I found a lot of people didn’t know about them, mostly likely person to benefit from one was the least likely to know they existed) which was limited to $6,000 of out-of-pocket direct medical expense, and which was on top of the premium. You could use it for the deductible; but our deductible changed, $5,000 at first, then $10,000, then $15,000 as the premiums went up. During these years, the only benefit we got beyond not having to make a choice between losing our home or our health, was the lower price on services the insurers negotiated on our behalf; they never paid a penny for any direct care. Even at the $5,000 level.

        Then my husband returned to teaching, and we had insurance under a group policy, and they funded the HSA with the amount of the deductible on the group policy ($2,000). We began purchasing that insurance through COBRA last year; so I know that they were paying more then $700 for the policy on top of our premium.

        With ACA (and this is a huge change,) we could pay our COBRA premium out of our HSA account; I’m not certain yet, but I think we’ll be able to pay for our marketplace insurance with the HSA. That puts getting individual insurance, tax-wise, more on a par with employer-provided group insurance.

        But the marketplace premiums I saw offered less coverage for the same price as the group plan, or the same coverage for a much higher price. The tax credits through the exchange made up that difference and a little bit more, putting us, financially, slightly better off then we were before, when we had the group plan.

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      • Sorry, edit this:

        Our early days in this scenario, all we got for ‘subsidy’ was an HSA account that we had to pay 1) know to set up (I say this, because I found a lot of people didn’t know about them, mostly likely person to benefit from one was the least likely to know they existed) which was limited to $6,000 of out-of-pocket direct medical expense, and which was on top of the premium.

        1) We had to know to set up an HSA account; they were not opaque or easy to understand without an employer to set one up for you, and
        2) Contribute to the plan and remember to use it to pay for medical expenses; in the early days, if you didn’t use it, you lost it, too.

        Many people who purchased their own insurance did not take advantage of this meager help; $3,000 year per person to offset the cost of direct care after you purchased your own insurance, because it wasn’t easy to do.

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      • ,

        Right, so the subsidies work through the tax code, which basically just makes them a progreissive-ized version of a partial (or in some cases >100%) tax deduction for private purchase of insurance, I think. I think that’s right; I’m not sure.

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      • I think there’s also a credit for any portion of the premium that might force your family below the poverty level.

        I’m not sure how the curve there works there, premium vs. distance from poverty, but it goes up above families at median income. There is a COBRA cliff there, Andrew Sprung has been doing some research and collecting numbers; I hope he keeps on going, he’s laid some great groundwork for understanding how it’s working.

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      • Drew,

        I’m sure you think you’ve got some there there. I think you’ve got no there there. What I do think is that you’ve put your head in an un-recommended orifice.

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      • on the last tax-credits that keep families above poverty, that might be considered comparable to an unearned income credit; a direct subsidy that goes directly into paying the premium.

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      • I’m pretty sure the subsidyis referring to is the tax break employers get which is in turn passed on to employees.

        A) Maybe, but that is in no way a subsidy from my employer. Like Shazbot talking about gifting, if the people I’m arguing with want to be taken seriously on the ACA issue, they’d get a lot further if they make an effort to avoid such egregiously inaccurate statements.

        B) I’m on record on this here very blog as opposing that tax treatment for health care, and arguing that it was a mistake from the beginning because it created a perverse market. So I don’t take kindly to moralistic preaching from certain quarters about how I’m just speaking from my elite status.

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      • I do think the “elitist tower” comment was out of line and it does help me understand why you read her comment the way that you did.

        I also agree that if that’s what she was saying – that employer-based health care counts as a subsidy that it’s wrong. I read it the other way due to her explicit mention of the tax incentives. I have seen people make the other argument – here, in fact – with regard to congressmen. As though the health insurance they get as a part of their compensation package is comparable to government-supplied health care in the more socialistic sense.

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      • I did some research, and yes, it is on a par. I wasn’t sure about the employee share of group insurance, it is deducted pre-taxes.

        For individual insurance purchases, since the time the law was passed, it’s been ramping up to parity, kicking in full-force with the exchanges, and subsidizing costs for people when the premium pulls them below poverty.

        What I’m unsure of is how the upper ranges of subsidy work; they taper off, and are pretty small, but go up to incomes close to $90,000, which can be, depending on where you live, either a little or a lot. This may be one benefit of having the exchanges work at a state level; the amount of that subsidy can get built in to the local cost of living.

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      • Drew,

        I disagree. But do congratulate yourself on your superiority. Be sure to do so very smugly, with a fine wine in your hand. Be careful not to spill it as you pat yourself on the back.

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      • I also agree that if that’s what she was saying – that employer-based health care counts as a subsidy that it’s wrong. I read it the other way due to her explicit mention of the tax incentives. I have seen people make the other argument – here, in fact – with regard to congressmen. As though the health insurance they get as a part of their compensation package is comparable to government-supplied health care in the more socialistic sense.

        I lived through this socialism; on both sides of it, too. I had, as part of our household wages, health insurance that was paid for by an employer with untaxed dollars; and when we left that employment, we had to pay for our insurance with after-tax dollars.

        That is reality.

        It’s also reality that many people could not purchase insurance at all. It’s reality that people who had insurance were getting thrown off once they got sick.

        But if you had employer-provided group insurance, you were insulated form this, to some extent. Smaller companies occasionally did drop insurance when someone in their group got sick; many companies went out of business (combined with cheaper imports; those two worked together, particularly for small manufacturers). Bigger companies offered less and less. But it still all functioned on pre-tax dollars, while individual purchases happened on after-tax dollars and were only cheap in places that excluded those already ill.

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      • Whether I agree with you or disagree with you depends entirely on which aspect you’re talking about. If you’re talking about the government incentives, I agree that it’s problematic. Though the government incentives are only a part of the picture. The other part of the picture is the employer contribution, which as others have pointed out is a form of compensation and doesn’t really qualify as a subsidy just as paychecks aren’t a subsidy.

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      • On re-reading, she might have meant it as you say.

        But the “elitist tower” comment really really pissed me off. The presumption that she knows about my life…I have no polite words for that.

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      • ‘Yeah, ACA’s a piece of crap, but if that’s what it takes to provide health insurance for those who can’t afford it, then by god my liberal principles say that’s so important that if I can’t manage to squeeze the rich, then it’s regrettably necessary to squeeze those middle class young kids until their pimples pop, and by god we hope enough people find the benefits so desirable, but the structure so bad, that down the road the public will demand movement to single payer.’

        Because I think that’s your real argument.

        For the record, that’s pretty much been my argument from the start, except that I’m not particularly hopeful that there will be enough demand for a single payer system to actually create one. I also have a different definition of middle class from the one you’re using here, but I do agree that the ACA is regressive in the demands it makes on the young and middle- to lower-income people.

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      • Exactly. I’m not trying to make up some smear about what I think liberals believe. I think that’s an honest representation of what they believe, and you and greginak and zic have essentially all agreed.

        I’m not criticizing or mocking that position. I’m saying that it’s more reflective of that true position to just say ACA sucks, but we hope it leads to something better, than to make defense of ACA that don’t really hold up, such as the defense that “it’s really better for those young healthy people who could afford health insurance but just wouldn’t pay it.” If we need them, let’s just say we need them and damn their preferences; let’s not pretend that we can really substitute our judgement for them.

        That was pretty much the entirety of my argument–don’t pretend we can substitute our judgement for other people–and it all got turned into something about how I’m complaining about subsidizing people through tax dollars because I’m an ivory tower elite with good health insurance.

        Which, to me, all sounded like a good way to avoid dealing with my point.

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      • If we need them, let’s just say we need them and damn their preferences; let’s not pretend that we can really substitute our judgement for them.

        I think this is quite right. And it well explains why (a) I don’t have a particular problem with the mandate and yet still (b) get grumpy about how it’s totally for their own good regardless of their own thoughts on the subject.

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      • and it all got turned into something about how I’m complaining about subsidizing people through tax dollars because I’m an ivory tower elite with good health insurance.

        That’s true, and I do think the ad hominems are off-base. Not only do I not believe them to be accurate, I don’t believe them to be relevant, either.

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      • I think guaranteed issue and community rating (except for more variance according to age and certain lifestyle choices like smoking) are a worthy goal. And with that, you have to account for adverse selection. The Mandate isn’t how I would have done it, but it was apparently the most politically palatable way to do it.

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      • Opposed to all of them. Each of them is an attempt to solve a social problem by making a requirement on businesses that is harmful to their bottom line, but which is not market justified, as a regulation preventing fraud or externalities is. Because a rule like that causes severe problems, it becomes necessary to pass another rule as well, one that is not justified on its own, but only because of the other rule’s problems, and so it often causes further problems. The structure you build up normally doesn’t become really well-functioning, but just creaks along threatening to fall apart

        I think that’s what we have with ACA. It seems evident that the mandate is really problematic. Defenders can ask everyone to stop talking about it and focus on making it work, as happened on this page, but the on-going opposition, the sluggish rates of sign up, and even the fact that we still need to focus on “making it work (rather than the program just actually working well), are all indicators of the rule’s problematic nature.

        I suppose that gets interpreted in some quarters as me not wanting lesser people to have access to health care.

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      • James,
        yeah, this is what you get when you design a political bill first, and a corporatist bill second, and a helpful bill third.

        Still, I think you would have gotten TONS less pushback from the lefties, if you had said “This mandate thing is horrible. Why couldn’t we have gotten Medicare for all?” [which I believe is an accurate statement of your views].

        Liberals are understandably sensitive to the “do nothing” caucus, and not proposing an alternative is likely to slide you into it by default.

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  7. This is also an issue for the Colbert Report, which falls flat every time a guest of a certain level of prominence or high office comes on, and Colbert pulls all of his punches, cause hey, we’re all on the same team here, right?

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  8. One of these days, we’ll get a president who’s a clown; who knows how to communicate through comedy and social media, and bypasses the traditional political and media structures; an era of indy politicians, brought to you via the Daily Show, youtube, reddit and twitter of the day. The Vine President, with a glitch; a rock star without a record-label recording on a radio-station play list.

    I can’t wait for the ensuing chaos, it will be a wonder to behold. My generation will be messing collective diapers in consternation.

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  9. I finally watched it (like most Americans my age, I’m guessing, I’d never heard of it before). I’m not sure how much of it is scripted, but I found Obama’s performance both intriguing and puzzling. At times he showed great comedic delivery and timing, but at other times–like when he was arguing that he wasn’t a nerd–he came off as suprisingly defensive. But the only time he stumbled on his delivery was during his pitch for ACA. The. only. time. he. stumbled.

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      • You don’t think it’s notable that the line he’s rehearsed the most, the line that is–by his own statement–the only reason he’s on the show, is the one he had the most trouble delivering?

        That all the jokey parts he either made up on the spot or had a short rehearsal for came out very smoothly, but his pitch for his own signature policy, caused him to stutter and say “ah, ah, ah, ah” is not worthy of focused attention?

        I think it’s remarkable (which is why I remarked on it; with periods). I’m just trying to figure out what the hell it means.

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      • Remarkable but not by much, I’d say. He stumbles really quite a lot when talking about policy, if you listen. I don’t think it’s surprising that he learned the jokes very specifically, as that’s what jokes depend on to work, and just decided to revert to his (stumbly) policy shtick on the pitch.

        I tend to reserve the periods for open-and-shut damning stuff, myself. (Actually, I try to avoid them because I don’t think they have a very clear meaning, but sometimes I succumb.) Maybe you meant it more to affirm that it was absolutely only there that he stumbled, not just mainly there. If so, fair enough. I read it as a statement of the observation’s significance, though.

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      • “That all the jokey parts he either made up on the spot or had a short rehearsal for came out very smoothly, ”

        I think decent timing on Obama’s part was helped by great editing on the producers part.

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      • Sounds like I’m totally wrong about the jokes being scripted to the word:

        http://www.slate.com/blogs/weigel/2014/03/12/the_director_of_president_obama_s_behind_two_ferns_interview_speaks.html

        So I guess his stumbling during the pitch means… whatever it means.

        …Also, the director is apparently utterly unconflicted about having the agenda of promoting the Affordable Care Act (as a secondary aim to making good comedy, though he goes on to say that he thinks the episode works as B2F episode, which kind of suggests that… he wasn’t making 100% sure that that was happening through the process. But then maybe he’s always not 100% sure any given material is working.)

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  10. , down here.

    Whether I agree with you or disagree with you depends entirely on which aspect you’re talking about. If you’re talking about the government incentives, I agree that it’s problematic. Though the government incentives are only a part of the picture. The other part of the picture is the employer contribution, which as others have pointed out is a form of compensation and doesn’t really qualify as a subsidy just as paychecks aren’t a subsidy.

    It’s untaxed wages, Will. In the individual market, where you shopped, you had to pay with taxed wages. This was a huge problem for people who worked as sole proprietors of businesses. It gave families who had one person working for a company a huge tax advantage — the untaxed employer contribution — over the self employed who purchased their own. Take two families, side by side, and have one have a group insurance, the other individual, and you’d see the difference between a family economically holding their own and one pushing poverty lines.

    Not to mention the other problems of excluding people from the system with pre-existing conditions, making a whole class of people unable to purchase any insurance, let alone at huge mark ups.

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    • It’s untaxed wages,

      So you’re talking about the government’s portion? The amount more in the compensation by virtue of the fact that it’s untaxed? Then we are in agreement (with each other and JH).

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    • No. I’m talking about the portion your employer pays. You are not taxed on those wages; they never even show up as part of your compensation in your pay stub. It’s on top of your wages.

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      • The portion that the employer pays is a part of your compensation package. It’s a form of payment for working there. It’s an incentive to try to get you to work there. It’s not a gift. If the money didn’t go there, it would go into increased wages most likely (the difference being that it would be taxed).

        Or to put another way, my last employer had a health care plan that cost roughly $350 a month. That’s the COBRA-revealed total cost. Let’s say that I didn’t pay anything for it. They’re effectively giving me $350 a month (to devote to a single purpose). Except that since it’s not taxable, if we assume a 20% tax rate, then actually the government should be getting $70 of that $350. But since they’re not, and since I am not working for them, I think it’s fair to call that a subsidy. The remaining $280, though, is a form of compensation for services rendered.

        In actuality, the company contributed almost nothing to my health care plan, but it’s the one that I am most familiar with. I could use my wife as another example. That plan, for the family, cost $1600 a month and the employer did pay full freight. If we assume a 30% tax rate, then it’s $480 coming from the government and $1120 from the employer as compensation for services rendered.

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      • That’s the group rate your employer had; the bigger (and younger/healthier) the group, the lower that rate will be.

        I said up thread, for us, that was in excess of $700/month, plus the $285/month we paid (also in pre-tax dollars).

        There was enormous geographical variation in that cost; there is enormous variation between cost due to the size of the group, enormous variation due to the community rating, and enormous variation due to what state’s mandated. States with laws restricting pre-existing conditions had much higher premium costs, as well. Those are the places where policies are now more expensive, I’d guess.

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      • Edit the last sentence there, state’s that allowed insurers to cherry pick the healthiest are now likely seeing premium increases, state’s the didn’t are likely seeing premiums hold flat or dip slightly.

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      • The total amounts were primarily meant to be illustrative rather than argumentative. I mostly brought them up as examples of how I think we should divide which parts of employer contributions should and shouldn’t count as subsidy.

        In the case of my wife’s last employer:
        Total cost: $1600
        Employee contribution out of taxed wages: $0
        Employer portion minus what should be taxed: $1120
        Government contribution: $480

        In the case of my last employer:
        Total cost: $350
        Employee contribution out of taxed wages: $330
        Employer contribution minus what should be taxed: $16
        Government contribution: $4

        Or if the company had picked up the entire tab:
        Total cost: $350
        Employer contribution minus what should be taxed: $280
        Government contribution: $70

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      • Actually, , it was listed on my W2 this year (for the first time ever). It appeared to be the total of employer plus employee contributions, but I’m not 100% sure on that score. I’m also not sure what the purpose was since my tax prep software never asked for that info.

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      • It seems pointless for the info to be on the W2, but I do think it should be on paychecks. Disclosure is a good thing.

        My last employer (the $350) lead me to believe that they were carrying almost all of the load and were quite defensive when I responded negatively to the fact that $330 was coming out of my paycheck. If they’d just said “Look, we give you a group rate” I wouldn’t have been thrilled (to be fair, I’d been unhappy with them for a number of reasons pre-dating this – and I was kind of angry at myself for not having asked beforehand) but I would have been less pissed than to find out that “We’re paying for as much of it as we can” consisted of $20.

        And then when we got the COBRA form for my wife’s job and found out it was so much, we might have reacted differently to the insurance situation there. We had been under the impression that the repeated claim denials were a product of them being cheapskates.

        So I think it would be better for all involved for this to be all out in the open earlier.

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      • Actually, having thought about it further (and I wouldn’t be going into this if I hadn’t earlier stated otherwise), in the case of my last job, the government portion would have actually been the full $70 because of the employer’s clever book-keeping. Instead of taking it out of my paycheck, they simply reduced my pay. Meaning that I wasn’t actually paying taxes on my own contribution. They saved money by paying me less, then saved more money by taking the deduction for the full amount of the insurance.

        Which actually brings me to another thing about the thing that rubbed me raw. The $330 assumed that I worked forty-hour weeks. If I worked enough overtime, my employer profited from the fact that I took advantage of their insurance.

        But these are the same people who put my “last day” a week after I left (the last day of the pay period, instead of the date my contract ended) so that they could appeal to the state unemployment commission on the basis that I had committed fraud by putting in my first claim a week early. So some apples are just bad.

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  11. But the “elitist tower” comment really really pissed me off. The presumption that she knows about my life…I have no polite words for that.

    I’m so sorry I hurt your feelings. Really, really sorry.

    I’ll remember this, because liberals get told their in self-interested towers all the time around here, and we’re just supposed to suck it up, usually with great irony about the foibles of hipsters and dirty hippies.

    Because all I really said was that there were already a class of people (those who do not have access to group insurance) who were at a tax disadvantage to those who have employer-sponsored insurance; the system was set up that way. And if you’re faculty at a university, unless you’re a lowly adjunct who doesn’t get any benefits, you are on the receiving end of this particular bit of socialism. I worked for the money that I paid the entire premium, too, and paid for it with after-tax dollars.

    Try making employees pay taxes on the employer share; report it in their wages, and tax it. Because that’s what was evened out with ACA. As a policy, not a theory that we all have fun arguing about. As the actual rules of the game.

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    • ,

      So, a fake apology and a continued insistence that the only part of my life that’s relevant is the present? I never thought I’d say this to you, but go fuck yourself. I don’t need your goddamned moralistic preening.

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      • Sweet, James.

        You’ve argued about how people argue instead of actually talking people’s arguments this whole thread. For instance your conversation with Michael Drew on the same thread.

        I’ve actually discussed how health-insurance markets worked, and how I’ve been observing them change since ACA passed, and doing so from the perspective of the people ACA was designed to assist — the uninsured and the self employed. ACA is the policy, now, and we should be examining how it functions and how it ought to be improved, not the ideals of some abstract system that will never be actual policy.

        As I said upthread, I’d 100% prefer a Canadian-style single payer plan; but I argued for that on McArdle’s blog, when that discussion was going down in real time, and I lost that argument. ACA is what I’ve got. I don’t think I’m wrong to want the very thing that needs to happen — young people enrolling — if there’s any chance that we can wrangle this into something better. (And I also said I thought it was a start, not an end in and of itself.)

        If the the old folk’s consternation between the ferns encourages a few more young ‘uns to sign up (it did my younger sprout, when my nagging didn’t,) all the better. Gobama.

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      • You’ve argued about how people argue instead of actually talking people’s arguments this whole thread. For instance your conversation with Michael Drew on the same thread.

        Christ, zic, don’t just make shit up. For one, it was Drew that instigated an argument about how I was arguing, not me starting after him, so don’t use that conversation as evidence against me.

        Second, you’ve conveniently ignored the substantive comments I made, which is a nice little bit of rhetorical trickery worthy of right-wing talk radio.

        But this would all blow over if you’d just back off your pretense that you can determine me just from my present stage in life. I’m pretty fucking sure–from the things you’ve told us–that your past plays one hell of a big role in shaping your views. So does mine–the fact that I haven’t chosen to share it with you doesn’t mean it’s irrelevant, so if you want to define me by just my present position in your life, that’s going to be a whole lot more revealing about you than about me.

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      • I don’t pretend to be a nice guy. I’m just a guy who is pretty fucking blunt about calling bullshit on bullshit arguments.

        Re-read the thread. Why didn’t I call bullshit on Tod Kelly, even when I was disagreeing with him? Because he responded to the actual arguments I made, and made some pretty damn good arguments in response. Zic didn’t actually address my arguments, and then she tried to argue that my position was just based on my “elitist tower.” That’s bullshit, so I call it out. Your “gifting” was bullshit, so I called it out. Tod’s arguments? No bullshit, no call-out.

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      • As one who’s generally exasperated by James’ penchant for making it about the arguers and their tendencies to exhibit various argumentative failings at least in addition to, and sometimes rather than, the substance at hand, I feel zic’s reaction to his doing that this time.

        But in this instance, I have to cop to bringing up a point about argumentation myself. It went directly to a point he had previously made about argumentation that he was now in clear contradiction of (I suppose unless he was looking to simply embrace assholery by his own telling in this case), but I did indeed bring it up. So he can hardly be blamed for that part of the conversation’s focus on argument for its own sake.

        Of course, if he had never raised an issue with people saying what they think other people really think/mean to say and then contradicted himself, I certainly would not have brought it up here.

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      • Drew, I don’t even know what the fuck time you think you’re talking about. Is this about my argument with Stillwater on that issue? Can you cite, because seriously, you’ve got me in the dark.

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      • Oh, geez. I thought that was clear.

        It’s when you said I was an asshole for saying I thought you actually knew I did understand what you really thought was the reason we allow religious exemptions for laws. I said I didn’t actually tell you what you thought, because I said “I think…” but you {rolled eyes} at that.

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      • You can eye roll; it seems pretty clear that you said what you think some other people think who weren’t saying it. I know you think the difference is that you’re right. Would you accept that as a justification coming in the other direction?

        As I say, it’s fine with me; I think what I said was okay too.

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  12. I’m pretty fucking sure–from the things you’ve told us–that your past plays one hell of a big role in shaping your views.

    I never said they didn’t.

    And I clearly said, from what we do know about you, that you fit a statistical model that’s benefitted from employer insurance. So even if you don’t, and I don’t know (and I really don’t care, either,) for the sake of discussion a professor on faculty at a university makes a good comparison to a self-employed computer programmer, musician, freelance writer, or fashion designer in terms of “what are the differences pre-ACA and post-ACA?”

    So if, by any stretch of the imagination, you think I got too personal, that I shouldn’t have used James as a symbol, I do profoundly apologize.

    But I do not for one minute apologize for suggesting that people who’ve benefitted from subsidized employer-provided insurance are living in glass houses when they complain about subsidizing insurance through tax policy for those who had to buy their own, people who didn’t have a that same employer-based tax subsidy. That’s just whining that some other people are getting what they had all along.

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    • The weight of the argument on that last paragraph is dependent on whether or not they believe that their own subsidy is justified. I’m not particularly outraged by the subsidies to individual market recipients, as I do tend to believe that subsidy should be all or none. But “none” is not a hypocritical or whining position.

      Back before insurance costs had reached what they are now, I basically liked the idea that the government paid the average portion currently paid for by employers. Which would definitely fall into the “all” category. In retrospect, I fear that might have actually induced prices to go up even further. Which puts me at a general loss as to what my favored policy trajectory is. Whatever it is, it does involve severing employment and health insurance. Which is not an uncommon position, and is JH’s preference as well. The problem, as I mentioned elsewhere, is that there is a lack of agreement on what should replace it. So in many ways, the employer-insurance connection remains in tact not because people support it, but out of inertia.

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    • That’s so progressive. I’d be a lot more impressed if you all quit trying to make up justifications that don’t fly, and just said,

      “Yeah, ACA’s a piece of crap, but if that’s what it takes to provide health insurance for those who can’t afford it, then by god my liberal principles say that’s so important that if I can’t manage to squeeze the rich, then it’s regrettably necessary to squeeze those middle class young kids until their pimples pop, and by god we hope enough people find the benefits so desirable, but the structure so bad, that down the road the public will demand movement to single payer.”

      Because I think that’s your real argument.

      You set up a false equivalency, discarding everything I had said because as an progressive, I’m lying and not worthy of respect if I don’t go full bore on the single payer.

      This is your answer to my pointing out that that customers in the individual market benefitted pretty early from ACA, and you twisted that into the poor.

      Every single person who’s got a big-fat employer-provided premium lived in that elite tower, James. When my husband went back to work teaching (he’d worked at the same school previously,) his co-workers were all in a huff about the $2,000 deductible they now had to pay, even though that money was put into an HSA account by the employer. We were dancing in the streets that, for 1/2 the cost, (the amount taken out of his paycheck,) we now had a $2000 deductible with money to pay it instead of a $15,000 deductible and a $6,000 HSA that we paid into each year directly out of our earnings, on top of our premiums.

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      • That was directed not directly at you. It was directed against the combination of inaccurate claims that were being made. And I stand by my point, because both you and someone else up above corroborate it–you don’t really like ACA and want national health care. I wasn’t criticizing that. I was just pointing out the irony that you all were put in the position of having to defend a plan you didn’t want, and that’s resulting in some very bad arguments.

        as an progressive, I’m lying and not worthy of respect

        Yeah, I didn’t say that. But you’re beginning to make me wish I had.

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    • You’re doing a great job of just not getting it.

      First, I’ve been that person without health insurance, ok? I was even that person who ended up in the emergency room without health insurance, ok? I lived that experience, so your pretense that my position is all about my current nice health insurance is your convenient delusion.

      Second, I’m not complaining about me subsidizing anyone through tax policy. Read back through the thread–at no point did I complain about that. So why don’t you address what I did say, instead of this straw man?

      for the sake of discussion a professor on faculty at a university makes a good comparison to a self-employed computer programmer, musician, freelance writer, or fashion designer in terms of “what are the differences pre-ACA and post-ACA?

      Which might have been a good point, if at any point I had been talking about that. But since I wasn’t, you’re just throwing your pet peeve argument against me on the ill-founded assumption that they have some relevance to anything I was saying.

      Tell me, zic, since I was talking explicitly about the young person who can afford to pay but doesn’t, where exactly does that person fit into the college prof vs. musician comparison?

      This is why I’m pissed off, zic; you keep throwing shit at me that’s got nothing to do with anything I was arguing.

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      • That’s my kids, James.

        And they don’t have to pay much, at all.

        They’ve also been footing their own medical bills for a while now without insurance, and they know that they’re getting a good deal. One will be paying off a broken collar bone for years. You’re only comfortable not having health insurance if you figure you’re not going to have to pay the bills, and that catches up with your credit rating pretty quickly.

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      • You’re only comfortable not having health insurance if you figure you’re not going to have to pay the bills,

        Or if you like your odds of not having bills.

        Ultimately, though, I’d say that comfort or discomfort is secondary. The question is whether the discomfort being uninsured causes is outweighed by either (a) the discomfort of not having that money to spend on other necessities or (b) the joy of spending that money on non-necessities.

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      • I’ve spent a lot of time here discussing the individual market here. Do you know why? And why, specifically, I’ve discussed it in response to your concern for younger adults without insurance?

        Because if they’re not already getting insurance through a job (or family), that’s where they have to buy insurance. On the individual market. So there’s really no difference between the person working a part-time job and taking a couple classes at the local community college and the person who’s working as a freelance writer. Or a musician. Or an independent computer programmer. They all purchase individual health-insurance policies.

        /I thought that was obvious. Obviously, it wasn’t.

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      • You’re only comfortable not having health insurance if you figure you’re not going to have to pay the bills, and that catches up with your credit rating pretty quickly.

        Which still doesn’t address my point.

        Look, I’m going to give a very grudging half-apology. I had something quite shitty and upsetting happen at work today. I should have just stayed off the blog, because I know I over-reacted, and I apologize for that. But…and the but always nullifies everything, which is why this is a very grudging half-apology…I am not backing off one millimeter from my argument that you have never addressed the one single point I was actually making, and that your shifting to a focus on my present health insurance status, and then the implication that I’m complaining about me subsidizing others through tax policy, is completely unjustified and a very bad faith argument. Since I’m not that young healthy guy who can afford health insurance but chooses not to get it–a guy who will not be subsidized, since by our very definition he can afford it–just how the hell could my argument fairly be painted as me complaining about my tax dollars subsidizing others? Especially after I said I wasn’t against helping those who could not afford it?

        Why don’t you go back and trace the argument, and see if you can find any place where my arguments suggest they’re about me not wanting my tax dollars to subsidize health care for those who can’t afford it, whether poor or working class. You show me just what I said that justifies that claim on your part.

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      • I’ve spent a lot of time here discussing the individual market here. Do you know why? And why, specifically, I’ve discussed it in response to your concern for younger adults without insurance?

        Because if they’re not already getting insurance through a job (or family), that’s where they have to buy insurance. On the individual market.

        So? What does that have to do with the group of healthy young people who can afford it, but choose not to buy it. Where could they have afforded it, on the individual market, of course. So I don’t see what you’ve said that addresses that group–the group that has the choice–which is the group I was talking about. Hell, in my very first comment I specifically referenced “choice.”

        I think in this whole discussion you’ve insisted on arguing with me about some group that was never the focus of my argument, a group that doesn’t have that choice. I might very well might agree with you about that group, but it’s not the group I was talking about.

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  13. down here.

    I am assuming that I can assume that you will assume this is asked in good faith. So… in your preferred policy regime, what would happen to someone who shows up at an emergency room with an obvious inability to pay?

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      • Hmm… this isn’t meant as a gotcha, but… what if he dies (with no or minimal property)? Or winds up disabled? Or any other scenario where reimbursement isn’t possible or practical?

        See, tne proplem with your preference here is that your postulated fellow that’s choosing to assume the risk really isn’t. At best, he’s assuming some part of the risk, unless he’s really wealthy, or is effectively so by having wealthy parents or something. The same is true for carrying junky, inadequate insurance.

        It’s about moral hazard.

        And more specifically, it’s about moral hazard in a decent society composed of citizens with a normal mmoral sensibility that says that healthcare isn’t just a consumer good and ulimately you will receive the healthcare you need regardless of your ability to pay for it. You don’t have to see it as right or wrong in some abstract sense; it just is what it is.

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      • EMTALA. If we decide it’s an important social policy, then society should bear the cost. Dumping the cost on the hospital just forces them to make it up in other ways, leading to overpricing of services and increased opacity of bills.


        That covers part of your critique as well.

        As to who carries the risk, that’s been a social choice to carry that risk. If every time we decide to cover someone’s risk we also decide that justifies in dictating their choices, we’re back to banning big gulps.

        The moral hazard part is a bit weird, since moral hazard is actually a consequence of being insured. It’s true we create moral hazard by agreeing to cover everyone’s risk, but again, that’s a social choice, so we’re back to the point in my prior paragraph.

        You call it “decent society.” I call it a choice, and 1) I’m skeptical of the choice because of how the logic inherent in it, as demonstrated by your moral hazard language, leads to justification for regulating ever more of our choices, but 2) if it’s necessary for a decent society, then socialize it properly, rather than trying to make hospitals bear the cost.

        An important guide to my thinking on this is the regulatory takings case of Lucas v. South Carolina Coastal Counsel. Lucas was denied a permit to develop his land on a barrier island, although others had developed there lots. The Council claimed the public benefit of open space and environmental protection. All well and good; the barrier island should have less development imo. But why should Lucas be forced to bear the cost of the public benefit? If it’s really a public benefit, then the public should pay for it; the Council should condemn his land and give him just compensation (per the 5th Amendment).

        Obviously the issue at hand here is not a regulatory taking in that sense, but the principle is a general one.

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      • James, I can’t disagree with your criticisms of the implementation of both EMTALA and ACA. They both suffer from the anti-tax fetish of the last three decades. Unless we’re throwing money at a favored corporate consrituency or waging a war of opportunity agaainst brown people somewhere nothing can ever cost anything. So instead of just paying the bill and raising taxes accordingly, both programs shift the burden internal to the affected groups.

        I agree that’s bad policy. But that’s also not liberal policy.

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      • Rod,

        Well, it’s both a liberal and a conservative policy, in the sense that liberals pushed for more, conservatives pushed for less, and this was the compromise. It’s certainly fair to say conservatives are a cause of its limitations, because they wouldn’t let liberals have anything better, but it’s also fair to say that liberals are a cause of its particular problems because they insisted on something instead of nothing. So liberals can’t entirely disclaim it as their policy.

        But that doesn’t imply that it’s a liberal policy in the sense of “this is what liberals actually wanted.” And I hope I didn’t send the message that I thought so. I was sincere above when I said that liberals real policy position was a fully national health care program. That got some weird pushback, even though all three of the OT liberals who spoke to it directly, including the one I was arguing with, essentially affirmed that as their position. I guess the comment was taken as snark or an ideological slam, but I actually meant it as a fair descriptive statement, and I think their affirmation of that demonstrates that I was not too wrong.

        And there’s the rub, the weirdness in this whole debate. Although I’m personally not a fan of national health insurance, it’s a policy preference that I understand, and that makes sense to me. I might disagree with liberals about it, but I don’t think there’s anything bizarre or logically wrong with their policy preference. It’s the defense of ACA as a True Liberal PolicyTM (if I may be forgiven a little tongue-in-cheek artistic license) that puzzles me. And especially so when the necessity of defending it pushes people into the position of arguing that people who could afford to buy health care but choose not to are actually better off now–even if they don’t know it, we can substitute our judgements for their own.

        I’m not talking about the lady who won’t accept evidence that ACA will save her money. That’s empirical evidence (I’m presuming it’s correct), and with empirical evidence we can flatly say, “You are wrong.” I’m talking about those for whom the decision is based on their subjective values, who are risk-tolerant, who gain more personal value out of other ways of spending their money than. buying health insurance.

        There are politically reasonable arguments for overriding their will, but telling them we know better than they what they do–or should–value, is not one of them.

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      • James,
        “people who could afford to buy health care but choose not to are actually better off now–even if they don’t know it, we can substitute our judgements for their own.”

        Quantify that shit, please. How much of a drag on our economy is it for a percentage of these folks to declare medical bankruptcy each year? How much money do they put back into the economy through not buying health care?
        Are we (society) getting a better return on investment from them not buying health care?

        These are just primary effects. Can we please step this out of the realm of opinion? [I am not the economist here, I do not know which FED has this information, or if anyone’s done the analysis ever. But someone ought to have.]

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      • Kim,

        In general, I decline to respond to you anymore. But here I will point out that your criticism simply elides the point I was making, so I have a specific reason for disdaining to respond substantively, in addition to my general reason.

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  14. James,
    I’m pretty sure most of the “20somethings who could afford insurance, but don’t want to purchase it” are a reasonably small part of America. Sure, we are abridging their rights, to some degree. But we’re giving a lot of people substantially more economic freedom — including those 20somethings, as they’re substantially less likely to go into bankruptcy, which would impact large scale buying decisions down the road.

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