Republicans Will Help President Obama

  • tongun18

    Posts: 593

    Nov 12, 2010 8:34 PM GMT
    If you are a Barack Obama supporter you should be glad the House of Representatives is changing to Republican. For this is likely to make Obama a better president.

    Bill Clinton was ineffective in the first two years of his presidency, with Capitol Hill debacles on health care and the forgotten BTU tax. Then Clinton’s party lost the House in 1994: and his performance as president began to improve.

    Sure, there was some kind of fuss between the White House and the House regarding somebody named Monica. But all of Clinton’s signature achievements — welfare reform, the Good Friday Agreement, conversion of federal deficits into surpluses, the Camp David summit — came after the Democrats lost the House.

    Once the Democrats no longer had full control of Congress, Clinton no longer could spend his time mediating disputes among the party’s interest groups – disputes regarding the various handouts and special deals various factions were demanding. Clinton needed to broaden his appeal and leadership style, plus acquire genuine concern for his opponents’ positions. He went from being president of the Democrats to president of the nation.

    Losing the House was essential to the maturation of Clinton’s presidency. The same can happen for Barack Obama.

    So far, President Obama has devoted most of his time and energy to trying to be leader of the always-complaining, always-hands-outstretched internal factions of the Democratic Party. For Democrats to hold the White House, Senate and House, plus have two fresh appointments to the Supreme Court, arguably has made Obama less effective than he otherwise might have been.

    Open squabbling over giveaways — the $800 billion stimulus bill might have been called Interest Groups Spoils of Victory Act of 2009 — has made the Democrats look foolish. Possessing near-total control of Washington, Obama’s party nonetheless has made wacky claims of conspiracies against it. Nancy Pelosi’s assertion that “secret money” beholden to mysterious foreign powers is really running the U.S. government is the daffiest thing anyone’s said in years, but hardly the only contention along these lines. Losing the House of Representatives should cause the White House, and at least some Democrats, to get their feet back on the ground.

    Obama needs to become the leader of all Americans. As happened with Clinton, this will require broadening his leadership style and finding genuine concern for his opponents’ views and positions.

    In a democracy, steamrolling the opposition may work once in a while, but cannot be a basis of governing. Consensus must be sought. Losing the lower chamber of Congress means the White House can’t steamroll any more – and this will be good for the Obama presidency.

    Millions of Americans agree with and like President Obama — but millions also don’t. Obama needs to come to terms with that, and show that he cares just as much about his opponents as about his party’s interest groups.

    Barack Obama is the most gifted natural leader since Ronald Reagan — who also stumbled and struggled in his first two years as president, and who also took a shellacking, in terms of losing House seats, in his first national election while president, which in Reagan’s case was in 1982.

    Clinton in 1994, and Reagan in 1982, woke up and realized they needed to become president of everyone. Both grew in empathy, and improved as leaders, as a result. The same can happen for Obama.

    Election postscript 1:
    There was obvious voter anger about the cost and bureaucratic-nightmare aspects of ObamaCare. Since most of the reform has not yet taken effect, consensus-seeking amendments to the legislation could improve health care reform — as long as Republicans are sincere in saying they want to improve the reform, rather than just use the issue as a political battering ram.

    But bear in mind –– hardly any of the benefits of ObamaCare have been felt. Voters are very aware of the costs and red tape — they haven’t yet experienced the benefits. Once they do, even most Republicans may conclude that Obama mainly was right about health care. Fixing the “preexisting conditions” fault of health insurance, for instance, is a tremendous reform that will spread benefits across all social and income classes.

    Election postscript 2:
    Have Republican leaders even read the health care reform bill they denounce? The party’s pre-election Pledge to America says of the Republican agenda, “We will make it illegal for an insurance company to deny coverage to someone with prior coverage on the basis of a pre-existing condition, eliminate annual and lifetime spending caps, and prevent insurers from dropping your coverage just because you get sick.” All these points are already covered by Obama’s legislation!

    Election postscript 3:
    The big question about incoming Tea Party types is, what exactly will they cut? It is hard to imagine tackling the deficit without cuts in Social Security, MediCare and Pentagon spending. So far no Tea Party senator- or representative-elect has offered anything even remotely specific about how the deficit might be pared. It’s a lot easier to denounce than to govern.

    Republican Jim DeMint, a Tea Party favorite just re-elected to his second term in the Senate, said on Meet the Press on Sunday that reductions in Social Security and Pentagon spending won’t be required because “we can cut hundreds of billions of dollars a year at the federal level” by eliminating “administrative waste.” If DeMint knows of “hundreds of billions of dollars a year” — this is about the same as Medicare spending — in “administrative waste,” how come he never moved to do anything about it during his first six years in the Senate?
  • tongun18

    Posts: 593

    Nov 12, 2010 8:45 PM GMT
    Just looked this over and saw the citation was left off.

    Greg Eastbrook
    Reuters

    Thought this was interesting. I tend to prefer split government, I get nervous when one party controls the White House and both chambers of Congress.

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    Nov 12, 2010 9:12 PM GMT
    I think the difference between Clinton and Obama is that Clinton was willing to more towards the center and offer compromises to get things done. We don't know yet about Obama, but the indication is he is more ideologically driven and will not compromise on anything substantive. He is, at least publicly, misinterpreting the election results as not reflecting public opinion on his ideology or agenda.

    The other point you made is the public is more aware of the costs of the health care law, but not its benefits yet. I think the public at large is not yet aware of the costs, but over the next several months when premiums rise for more Americans, as they have already started to do, the anger will intensify.

  • tongun18

    Posts: 593

    Nov 12, 2010 9:32 PM GMT
    socalfitness saidI think the difference between Clinton and Obama is that Clinton was willing to more towards the center and offer compromises to get things done. We don't know yet about Obama, but the indication is he is more ideologically driven and will not compromise on anything substantive. He is, at least publicly, misinterpreting the election results as not reflecting public opinion on his ideology or agenda.

    The other point you made is the public is more aware of the costs of the health care law, but not its benefits yet. I think the public at large is not yet aware of the costs, but over the next several months when premiums rise for more Americans, as they have already started to do, the anger will intensify.



    I think you're right about the first part, Obama has been more ideological. I'm hoping that stems from the fact that his party had such large majorities in both chambers of the legislature. Hopefully the inroads the Republicans have made will ground him a bit more and infuse a more pragmatic approach to his leadership. Maybe he'll be able to corral more of the Democrats now that they've felt a bit of an electoral sting.

    On the second part, I think Americans are all too aware of ObamaCare's costs. It's all they've heard about from Republicans and the Tea Party mushroomed as a movement based in large part on opposing those costs.
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    Nov 12, 2010 9:37 PM GMT
    tongun18 said
    socalfitness saidI think the difference between Clinton and Obama is that Clinton was willing to more towards the center and offer compromises to get things done. We don't know yet about Obama, but the indication is he is more ideologically driven and will not compromise on anything substantive. He is, at least publicly, misinterpreting the election results as not reflecting public opinion on his ideology or agenda.

    The other point you made is the public is more aware of the costs of the health care law, but not its benefits yet. I think the public at large is not yet aware of the costs, but over the next several months when premiums rise for more Americans, as they have already started to do, the anger will intensify.



    I think you're right about the first part, Obama has been more ideological. I'm hoping that stems from the fact that his party had such large majorities in both chambers of the legislature. Hopefully the inroads the Republicans have made will ground him a bit more and infuse a more pragmatic approach to his leadership. Maybe he'll be able to corral more of the Democrats now that they've felt a bit of an electoral sting.

    On the second part, I think Americans are all too aware of ObamaCare's costs. It's all they've heard about from Republicans and the Tea Party mushroomed as a movement based in large part on opposing those costs.
    On the second point, yes there has been much in the news, but I'm thinking it won't really hit home until the insurance premium bills start arriving.

    BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking.
  • tongun18

    Posts: 593

    Nov 12, 2010 10:57 PM GMT
    socalfitness said
    tongun18 said
    socalfitness said
    On the second point, yes there has been much in the news, but I'm thinking it won't really hit home until the insurance premium bills start arriving.

    BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking.




    I think I understand, you're saying people are only aware of the costs in terms of this unfathomable number with regard to the national debt. They have yet to personally feel the effect of the law on their wallet or paycheck. That may very well be. It will be interesting to see how people react in the coming months/years as the effects begin to take hold.

    Socal, is there anything positive you see in ObamaCare? (I'm assuming you oppose it.) Keeping in mind, as indicated above, the Republicans are pledging to do much of what has already been done by the bill. Did you agree that health care needed to be fixed or were you ok with the status quo?
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    Nov 12, 2010 11:21 PM GMT
    "BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking."

    Socal, perhaps you are unaware that you are both Conservatives. icon_rolleyes.gif

    Really, save this kind of posturing for topics where liberal and conservatives have constructive conversations without personal attacks. When one happens, then your statement will have meaning.
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    Nov 12, 2010 11:30 PM GMT
    meninlove said "BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking."

    Socal, perhaps you are unaware that you are both Conservatives. icon_rolleyes.gif

    Really, save this kind of posturing for topics where liberal and conservatives have constructive conversations without personal attacks. When one happens, then your statement will have meaning.


    icon_lol.gif
  • tongun18

    Posts: 593

    Nov 12, 2010 11:31 PM GMT
    meninlove said "BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking."

    Socal, perhaps you are unaware that you are both Conservatives. icon_rolleyes.gif

    Really, save this kind of posturing for topics where liberal and conservatives have constructive conversations without personal attacks. When one happens, then your statement will have meaning.


    Hahaha, I was gonna say something along those lines but I though "why kill the mood".

    Though I would take issue with being called a conservative. I believe in smaller government. Conservative's like to say they believe that as well but they don't typically practice it. Fiscally, I'm conservative yes but socially I'm a liberal. And I'm actually a registered Democrat.

    Meninlove, what do you guys think about the article?
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    Nov 12, 2010 11:32 PM GMT
    tongun18 said
    socalfitness said
    tongun18 said
    socalfitness said
    On the second point, yes there has been much in the news, but I'm thinking it won't really hit home until the insurance premium bills start arriving.

    BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking.




    I think I understand, you're saying people are only aware of the costs in terms of this unfathomable number with regard to the national debt. They have yet to personally feel the effect of the law on their wallet or paycheck. That may very well be. It will be interesting to see how people react in the coming months/years as the effects begin to take hold.

    Socal, is there anything positive you see in ObamaCare? (I'm assuming you oppose it.) Keeping in mind, as indicated above, the Republicans are pledging to do much of what has already been done by the bill. Did you agree that health care needed to be fixed or were you ok with the status quo?

    Agree status quo not good. Needs to be fixed. About Obamacare, I haven't seen anything that I like about it. There are two things people talk about that is good that I don't like:

    1) Staying on parent's policies until 26. I don't like govt intrusion, and the net effect as I understand it is all premiums will rise to cover this. I don't like having to pay more for this. Would rather see more pro-business policies so guys age 26 can get jobs and get health care through their employer and I don't have to help pay for them.

    2) Eliminating pre-condition restrictions - There is a better way to address this without the mandate to force everyone to buy insurance. Keep in mind insurance is a pool of us sharing risk. The insurance company administers and makes a profit. There are two ways this can be abused. First, by insurance companies canceling or not allowing renewal of someone who has paid into the pool. Not fair to the person, and should not be allowed per insurance regulations. Second, by not paying into the pool until you need coverage, then joining, i.e a pre-existing condition . Not fair to those who have been paying, as it will increase all premiums. What I would envision is give someone the choice of not having insurance, but if they have some medical emergency or condition requiring expensive care, I would allow them back into the pool only if they pay retroactively the equivalent of premiums for some period - say 1 or 2 years, or the period they were without coverage, whichever is less. Not perfect, but what is?

    Other things allow insurance companies to compete across state lines, and put limits on malpractice settlements. Also, deal with the number of citizens who are too poor to have insurance. Target them with some type of assistance instead of current plan.
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    Nov 12, 2010 11:44 PM GMT
    meninlove said "BTW - whatever your politics may be, this thread is an example of what discussions should really be like, i.e. friendly, not attacking."

    Socal, perhaps you are unaware that you are both Conservatives. icon_rolleyes.gif

    Really, save this kind of posturing for topics where liberal and conservatives have constructive conversations without personal attacks. When one happens, then your statement will have meaning.

    The fact is, I did not know his politics, and it wasn't important because we were discussing specific issues without ideology thrown in.

    I see Christian-boy could not resist taking a break from his menial existence and following me and making himself seen, if only with an emoticon. One big advantage of him blocking me, which he has mentioned at least a dozen times, as if I should care, is he will not see the thread I started on Fannie and Freddie. Anything that cuts the flow of effluent into a thread is indeed welcome.
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    Nov 12, 2010 11:49 PM GMT
    We're both at home today, thanks for asking for our take. We think the article makes very good points and clarifies some history. Both of us are not fond of bloated governments. When it comes to taxes we gladly pay them, but get a little soured if much of it goes to administration rather than programs, infrastructure etc. A poor analogy, but kind of like giving to a charity and finding out the recipients are only getting a small amount of what you donated.

    Majority governments are also something we've never been fond of. That said, we despise opposition opposing good ideas etc for the sake of being opposition.

    Thanks for posting this article from Greg Eastbrook!

    -Bill and Doug

    PS
    I loved his comment about daffiness. It exists in just about every political party on the face of the planet, lol!

    -just Doug
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    Nov 13, 2010 12:21 AM GMT
    socalfitness said
    2) Eliminating pre-condition restrictions - There is a better way to address this without the mandate to force everyone to buy insurance. Keep in mind insurance is a pool of us sharing risk. The insurance company administers and makes a profit. There are two ways this can be abused. First, by insurance companies canceling or not allowing renewal of someone who has paid into the pool. Not fair to the person, and should not be allowed per insurance regulations. Second, by not paying into the pool until you need coverage, then joining, i.e a pre-existing condition . Not fair to those who have been paying, as it will increase all premiums. What I would envision is give someone the choice of not having insurance, but if they have some medical emergency or condition requiring expensive care, I would allow them back into the pool only if they pay retroactively the equivalent of premiums for some period - say 1 or 2 years, or the period they were without coverage, whichever is less. Not perfect, but what is?
    ...Also, deal with the number of citizens who are too poor to have insurance. Target them with some type of assistance instead of current plan.


    OK, you lost me there with your reasoning. You're completely right in all of the above. So why are you against the health care law which basically addresses all of these points, if not more? Remember, one of the the main loopholes which is to be fixed by the health care law is that there aren't enough healthy people paying premiums; this is exactly the same point decried by people like SB who do not want to buy something they don't need right now.

    You're perfectly right--the main problem right now is that people are not paying into the pool, and therefore having everybody who can buy into the system doing so is the only logical solution, short of universal coverage. If people can't or are unable to pay into the system, they default into government assistance programs (Medicaid, SCHIP) or charity work (hospitals, clinics, and volunteers).

    If people can't or don't want to pay premiums, what would make them pay even higher sums (1-2 years worth of premiums) in critical situations in a lump sum? (some of my patients owe me so much co-pays that we have to stop seeing them, since they have no intention of even making a payment plan. Correction: I still see them, but in the local clinic where I practise for free) Of course they would go into bankruptcy so that they can qualify for assistance programs. Remember when they show up in health care facilities they still need to be taken care of. It's not a matter of buying or not buying something optional. One way or the other, somebody has to pay to take care of them. Your phrase, "target them with some type of assistance" basically defaults into EXPANDING government involvement in healthcare, which you're against, right?

    So, I ask you again, what is wrong with having more people buy health insurance?




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    Nov 13, 2010 12:28 AM GMT
    http://healthpolicyandreform.nejm.org/?p=3582The changes made by the ACA to stabilize the insurance market are fundamentally economic. The legislation’s core is its mandate to end pervasive discriminatory insurance practices while making care affordable. But such change is not possible without an individual mandate. If people who are in better health can opt out of the market and effectively gamble that they can pay for whatever health care they need at the point of service, prices rise for those who are in poorer health, leading to an “adverse selection” spiral that raises insurance prices for all. This is not an idle conjecture. Five states have tried to undertake reforms of the nongroup insurance market like those in the ACA without enacting an individual mandate; those five states are now among the eight states with the most expensive nongroup health insurance.


    And I do think underinsurance requires targeting by the government. So yes, programs like SCHIP need to be expanded.
    http://healthpolicyandreform.nejm.org/?p=12178
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    Nov 13, 2010 12:29 AM GMT
    The only Republican who will help Obama in 2012 is Sarah Palin.
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    Nov 13, 2010 12:36 AM GMT
    q1w2e3 said
    socalfitness said
    2) Eliminating pre-condition restrictions - There is a better way to address this without the mandate to force everyone to buy insurance. Keep in mind insurance is a pool of us sharing risk. The insurance company administers and makes a profit. There are two ways this can be abused. First, by insurance companies canceling or not allowing renewal of someone who has paid into the pool. Not fair to the person, and should not be allowed per insurance regulations. Second, by not paying into the pool until you need coverage, then joining, i.e a pre-existing condition . Not fair to those who have been paying, as it will increase all premiums. What I would envision is give someone the choice of not having insurance, but if they have some medical emergency or condition requiring expensive care, I would allow them back into the pool only if they pay retroactively the equivalent of premiums for some period - say 1 or 2 years, or the period they were without coverage, whichever is less. Not perfect, but what is?
    ...Also, deal with the number of citizens who are too poor to have insurance. Target them with some type of assistance instead of current plan.


    OK, you lost me there with your reasoning. You're completely right in all of the above. So why are you against the health care law which basically addresses all of these points, if not more? Remember, one of the the main loopholes which is to be fixed by the health care law is that there aren't enough healthy people paying premiums; this is exactly the same point decried by people like SB who do not want to buy something they don't need right now.

    You're perfectly right--the main problem right now is that people are not paying into the pool, and therefore having everybody who can buy into the system doing so is the only logical solution, short of universal coverage. If people can't or are unable to pay into the system, they default into government assistance programs (Medicaid, SCHIP) or charity work (hospitals, clinics, and volunteers).

    If people can't or don't want to pay premiums, what would make them pay even higher sums (1-2 years worth of premiums) in critical situations in a lump sum? (some of my patients owe me so much co-pays that we have to stop seeing them, since they have no intention of even making a payment plan) Of course they would go into bankruptcy so that they can qualify for assistance programs. Remember when they show up in health care facilities they still need to be taken care of. It's not a matter of buying or not buying something optional. One way or the other, somebody has to pay to take care of them. Your phrase, "target them with some type of assistance" basically defaults into EXPANDING government involvement in healthcare, which you're against, right?

    So, I ask you again, what is wrong with having more people buy health insurance?

    The issue I have is the Government forcing people to buy something. First of all, I would advocate education announcements encouraging people to get insurance. With my plan, people who did not choose to join the pool would have to pay an admittance or re-admittance fee. I was not suggesting it be a lump sum. It could be recouped by adding to their premiums, or possibly some type of loan, possibly at low interest if they were poor. I could see the Government providing some type of support or guarantee in this case. For those citizens who really are too poor to pay the premiums (versus those above some income level who choose to not pay), I would not be against the Government providing some type of support. In other words, fixing specific problems instead of negatively impacting all who already have insurance.
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    Nov 13, 2010 12:44 AM GMT
    socalFirst of all, I would advocate education announcements encouraging people to get insurance


    Lol, all the education announcements in the world will not work. See what happened to cigarettes and government announcements. Nothing will work until the FDA is allowed to regulate it, which just recently happened.
    http://cancergrace.org/lung/files/2008/11/smoking-trends-in-us.jpg
    smoking-trends-in-us.jpg
    (in case you're wondering, the cut-off part shows a completely flat curve for more recent years)

    I can count the number of people I've seen recently for "preventative care."

    People are fundamentally short-sighted unless they are forced to think ahead by what touches them the most, i.e. their pocketbooks.
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    Nov 13, 2010 12:48 AM GMT
    socalIn other words, fixing specific problems instead of negatively impacting all who already have insurance.


    Another big assumption on your part. With more people paying for insurance, it's going to be cheaper in the long run.

    And lest the insurance companies run away with their profits with more people paying premiums, there's a part of the ACA that deals with the "medical-loss ratio," i.e. how much of the premiums must be used for medical care rather than non-medical costs (administrative costs, or profits for the companies).
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    Nov 13, 2010 1:01 AM GMT
    q1w2e3 said
    socalIn other words, fixing specific problems instead of negatively impacting all who already have insurance.


    Another big assumption on your part. With more people paying for insurance, it's going to be cheaper in the long run.

    And lest the insurance companies run away with their profits with more people paying premiums, there's a part of the ACA that deals with the "medical-loss ratio," i.e. how much of the premiums must be used for medical care rather than non-medical costs (administrative costs, or profits for the companies).

    I agree with your point on people not listening - buying that new car versus insurance payments.

    As far the cost going up, maybe an assumption, but companies (both those who provide insurance to employees and insurance companies) have started advising of higher premiums based on projections of the cost. It might also be noted that the Government has tried intimidation tactics on those reporting. Despite any such efforts, within the next few months, more projected costs will become known. I suspect this will further inflame public opinion against Obamacare. No need to debate it. We will see what unfolds - I predict it will be quite interesting.
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    Nov 13, 2010 1:08 AM GMT
    Fallacy:
    A: Obamacare is passed
    B: Health insurance premiums go up
    A caused B

    Here's a plain-language explanation without the jargon (I can quote another NEJM article but you must be getting sick of them):
    http://www.mydesert.com/article/20101109/LIFESTYLES03/11090302/Health-insurance-premiums-on-rise
    So what's driving the spike in premiums?

    Many experts point to increased medical spending — more doctor visits, more prescriptions, more hospitalizations. Lower employer subsidies and the health care reform law play minor roles, they say.

    “Hospital costs have trended upward by an average of 8 percent per year over the last decade,” said Patrick Johnston, president of the California Association of Health Plans.

    “The big cost drivers are name-brand medications, in-patient hospital care, diagnostic equipment and elective surgeries such as knee replacements.”

    Susan Pantely, a San Francisco-based actuary who works with health insurance companies, pegged the increase in hospital costs at 10 percent.

    “Drug utilization, drug costs and hospital costs — those are really the big drivers,” Pantely said.

    “There are a lot more high-cost drugs on the market, those specialty ones. If you get cancer, it's $10,000 per month, and how can you tell people they can't have the drug.”

    Eisenhower Medical Center in Rancho Mirage declined to provide information on its rate increases over the past year.

    But spokeswoman Lee Rice said the hospital “is doing everything possible to reduce costs in ways that improve efficiency while keeping patient quality, needs and safety our top priority.”

    Compared to the major medical costs, rate hikes linked to the Patient Protection and Affordable Care Act — a flash-point for Republicans and many voters in Tuesday's election — are relatively modest.
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    Nov 13, 2010 1:10 AM GMT
    In fact, the insurers WANT you think think that A caused B:
    NA-BH825A_RATEH_NS_20100907211302.gif

    http://wonkroom.thinkprogress.org/2010/09/08/insurers-profits/
    While there may be some justification in raising rates in response to rising health care inflation (estimated to be 3.2% in 2010), substantiating an increase that comes in the context of record profits and a long history of issuers fudging the numbers to extract maximum increases is difficult. Pinning the increases on the new regulations is just absurd, particularly since the actuaries have estimated that the new policies would only slightly raise premiums by 1 to 2 percentage points.
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    Nov 13, 2010 1:11 AM GMT
    You are absolutely right about other factors driving up costs. I think the reports already out from some companies (one of the insurance companies, also Boeing, McDonalds) identified cost increases specifically due to Obamacare. Again, we will see what plays out.
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    Nov 13, 2010 1:16 AM GMT
    Except for the simple fact that Obamacare is causing the rise in healthcare premiums. These increases were predicted and came true for the same reasons they were predicted. People like you were so blinded by ideology that they forgot to read the underlying legislation - which is why there was perhaps one legislator in the last election who even bothered to defend it. While correlation is not causation, there are many reasons to believe that the premiums are the direct result of the healthcare legislation passed whose advocates (like the AARP) even now say is causing premiums to rise:

    http://www.heritage.org/research/reports/2010/09/obamacare-increases-health-insurance-premiums

    Obamacare Increases Health Insurance Premiums
    Published on September 21, 2010 by Brian Blase and Rea Hederman, Jr.

    One of the major impacts of the Patient Protection and Affordable Care Act is that individuals and families will see higher health insurance premiums. Obamacare imposes several costly new mandates and restrictions on health insurers and providers that will raise health cares costs and therefore premiums. This paper lists a dozen factors that will contribute to higher premium costs.

    1. Mandated Benefits
    Obamacare mandates that insurance companies cover a minimum package of benefits. The more comprehensive and generous the insurance, however, the more expensive it will be. The Congressional Budget Office (CBO) estimates that the benefit mandates in Obamacare—in combination with the limited cost-sharing—will increase premiums 27–30 percent in the individual market and up to 3 percent in the small group market.[1]

    2. No Cost-Sharing for Preventive Services
    Preventive services are more likely to increase costs than reduce costs. A recent article in the journal Health Affairs notes that 80 percent of preventative care services increase costs instead of saving costs.[2] By requiring more preventive services, costs will rise as health care consumption increases.

    3. Limits on Cost-Sharing (on Covered Items) and Limits on Deductibles
    Individuals who do not have co-payments or deductibles lack “skin in the game” and thus have less incentive to economize on their use of health care services. This results in higher premiums for their health insurance. The CBO concludes that a 10 percent decrease in cost-sharing typically increases health care spending by 1–2 percent.[3]

    4. Minimized Youth Discount
    The average 60-year-old consumes about six times as much health care as the average 20-year-old, but Obamacare mandates that insurers charge the oldest individuals in the risk pool no more than three times the lowest rate. As a result, young individuals will pay much more than the actuarially fair amount for their premiums. Management consulting firm Oliver Wyman estimated that premiums will rise by 45 percent for those age 18–24, 35 percent for those age 25–29, and 26 percent for those age 30–34.[4]

    5. Elimination of the Good Health Discount
    In order to charge individuals a fair premium, insurers in the individual market engage in underwriting to determine applicant risk. That is, healthy individuals are less of a risk and thus enjoy lower premiums, the same way good drivers get discounts on their auto insurance. Obamacare bans this type of underwriting to rate premiums. The result will be higher premiums for the vast majority of individuals who are relatively healthy.

    6. No Annual or Lifetime Limits on Health Benefits and Mandated Coverage of Children Under 26
    These provisions are already taking effect, and they raise the cost of providing insurance. Several insurers have attributed a portion of their annual rate hikes for this year to provisions in Obamacare. Regence Blue Cross/Blue Shield of Oregon is attributing 3.4 percent of its 17.1 percent rate increase to Obamacare, while Celtic Insurance Company in Wisconsin and North Carolina is attributing 9 percent of its 18 percent rate increase to Obamacare.[5]

    7. No Pre-Existing Conditions Exclusion and Guarantee Issue
    Healthy individuals will be incentivized to remain or become uninsured, saving on premium expenditures since they would be able to purchase coverage if they need medical care. A greater concentration of relatively unhealthy individuals in the risk pool will increase average premiums.
    According to an analysis by Wellpoint, a health benefits company, the guarantee issue provisions in Obamacare will be mostly responsible for the rise in premiums.[6] Furthermore, a recent academic paper found that the existence of guarantee issue regulations more than doubled premiums for individual policies and nearly doubled premiums for family policies.[7]

    8. Cost-Shifting Because of Low Medicare Reimbursement Rates
    Obamacare is set to reduce the reimbursements doctors and hospitals receive for Medicare. A 2006 Health Affairs piece finds that a 1 percent relative decrease in the average Medicare price is associated with a 0.17 percent increase in the corresponding price paid by privately insured patients. The study found that cost shifting from Medicare and Medicaid to private payers accounted for 12.3 percent of the total increase in the price of private insurance from 1997 to 2001.[8]

    9. Taxes on Insurers, Pharmaceutical Companies, and Medical Device Makers
    Obamacare includes many new taxes, including a 2.3 percent excise tax on medical devices and annual fees on health insurance providers. A tax placed on insurance companies or medical device companies will be passed to consumers in the form of higher premiums.
    The CBO expects these taxes to be passed on to consumers.[9] Anthem estimated that premiums would rise by 2.5 percent in fully insured markets because of the annual fee on health insurance providers and by 0.5 percent because of the fees on manufacturers and importers of branded drugs and medical devices.[10]

    10. Difficulty of Enforcing the Mandate
    Proponents of Obamacare argue that the individual mandate is the glue that holds the legislation together. Because the mandate was so unpopular, however, Congress gave the IRS limited ability to enforce it. It is unlikely, therefore, that the mandate will be effective at encouraging healthy individuals to purchase coverage and cross-subsidize the premiums for the old and the sick.
    According to Oliver Wyman, a weak mandate would cause “the average medical claims of members in the reformed individual market [to] be 50 percent higher than the average in the market today (not including medical inflation). This would translate into premium increases of approximately $1,500 for single coverage and $3,300 for family coverage in today’s dollars.”[11]

    11. Adverse Selection
    Since heath plans will be required to extend coverage to any qualified applicant and will not be allowed to vary premiums based on health status, healthier individuals will likely wait until they are sick before they buy health insurance. With fewer healthy individuals buying coverage, premiums will need to rise to cover the costs of the sick, which will in turn drive even more individuals in good or even fair health to drop coverage. The result could be a classic insurance adverse selection “death spiral” and an implosion of Obamacare.

    12. Increased Demand for Health Care
    The expansion of insurance coverage through Obamacare will increase the amount of health care that previously uninsured people demand. CBO predicts that a major coverage expansion would cause total demand for health care services to increase by 2–5 percent.[12] Oliver Wyman estimates that the average uninsured will use about 20 percent more in health care services than the average individual, which will raise premiums in the individual market.[13]

    Wishes Do Not Trump Common Sense
    One of the central promises President Obama made during the presidential campaign was
  • Posted by a hidden member.
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    Nov 13, 2010 1:18 AM GMT
    http://healthpolicyandreform.nejm.org/?p=3564

    This article has details what the ACA will address in terms of both reducing costs of health care, but more importantly, how to bend the curve of growth rate of such costs down.
  • Posted by a hidden member.
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    Nov 13, 2010 1:21 AM GMT
    q1w2e3 saidhttp://healthpolicyandreform.nejm.org/?p=3564

    This article has details what the ACA will address in terms of both reducing costs of health care, but more importantly, how to bend the curve of growth rate of such costs down.


    Darn those profit seeking institutions like the AARP:
    http://news.yahoo.com/s/ap/20101104/ap_on_bi_ge/us_aarp_health_plan

    "AARP's endorsement helped secure passage of President Barack Obama's health care overhaul. Now the seniors' lobby is telling its employees their insurance costs will rise partly as a result of the law.

    In an e-mail to employees, AARP says health care premiums will increase by 8 percent to 13 percent next year because of rapidly rising medical costs."

    Oops.