Gyroscopic Investing

Now that it's actually being experienced, Obamacare is turning into a disaster--surprise surprise. When my liberal friends and family members are complaining that the websites don't work and the coverage is still unaffordable, something is terribly wrong.

If the Republicans hadn't shut down the government and stupidly redirected attention away from the slow-motion train wreck, I think the backlash would be even more severe.

Here's what I think Democrats could do to salvage the situation:

Step 1: agree with Republicans that Obamacare isn't working and needs to be repealed
Step 2: propose to uncap the eligibility age for Medicare, transforming it from a single-payer system for only old people into a single-payer system for everyone
Step 3: propose repealing Medicaid and SCHIP, and uncapping the Medicare payroll tax to pay for the expansion

This seems like is a politically feasible approach given that Democrats want single-payer, and Republicans like Medicare. Arguing against anything related to Medicare will scare old people, so Republicans would have to tread lightly. I think it could just work.

Step 1 (agree with Republicans that Obamacare isn't working and needs to be repealed) reminds me of alcoholics step 1 i.e. admit you have a problem, a BIG problem.  in other words you are asking democrats who passed this without any republican help or input to admit they screwed up, BIG time.  Do you really think this is likely?  I am skeptical.

Step 2 creates the gov't as a single payer system for all.  I don't even know if you'd get enough Rhino/establishment republicans for this, and the tea party would of course not be happy.

I have heard that if large numbers of people don't sign up for this (which seems very possible) it crashes and burns on its own.  In any case, I suspect that we will have to hit bottom (in more than one way) before things get shifted.

PS,

How would they deal with the insurance companies who would find themselves suddenly out of customers? From a purely cost perspective, if they can't compete with something like Medicare one might say they deserve to be put out of business....but I'm sure their CEOs, boards of directors, major shareholders, and the PACs they contribute to will see otherwise and make such a plan a political nonstarter from the get-go.

Remeber, candidate Obama was in favor of a single-payer system and said that "ithe only way to really be sure everyone is covered is something called a single-payer system"; the reason President Obama chose to go with ObamaRomneyDoleHeritageCare instead was the political reality that single-payer or Medicare-for-all couldn't pass in the first place.

The only way you MIGHT get the big insurers to go along is to buy them all out (with taxpayer money) at a big premium to their current share price. Without even considering the morality or fairness of such an act--only looking at it purely from a political feasibility perspective--one has to conclude that it would be seen as a giant bailout of the big health insurers and that it would end up as one of those "the optics on that are just terrible" type of things that would probably never pass either house of Congress.

Also, merely uncapping the Medicare tax rate wouldn't begin to pay for this. If all current contributions to health insurance were redirected to paying for Medicare that probably would go a long way towards paying for it; the reality is that some kind of flat tax (with at least some level of personal exemption and that taxed LAL income and not just payroll income) or VAT (or mix of the two) would most likely be required...although it would be compensated for by the fact that people weren't paying for health insurance any more--or rather in most cases that there employers weren't doing so on their behalf any more--which would mean more money in their pockets with which to pay the tax that funded Medicare-for-all)

The above is all a moot point, though, because Medicare-for-all would never pass muster with the Tea Party (they'd look at it as even more of a "government takeover" than PPACA was which I guess it would be) which effectively means it would never pass muster with the Republican Party which in turn means that it's DOA in the House.

And finally...I can't believe Pointedstick (of all the people on this forum) is proposing this....did Doodle hack into your account and post as you or something? 

D1984 wrote: And finally...I can't believe Pointedstick (of all the people on this forum) is proposing this.

In his defense, he started with reality as it is now, and made a practical suggestion for fixing the problem. 

Benko wrote:
I have heard that if large numbers of people don't sign up for this (which seems very possible) it crashes and burns on its own.  In any case, I suspect that we will have to hit bottom (in more than one way) before things get shifted.

This was something I was wondering about myself...the financial incentives to NOT sign up for coverage if one is (relatively) young and healthy are overwhelming (the mandate is a small fraction of the premium and the IRS can't garnish your wages, lien your assets, sue you, or even so much as blacken your credit if you don't pay it; all they can do is seize a tax refund check which just means always end up owing money come April 15th--by underpaying so that you'll have to send the IRS a check instead of them sending you a refund--and then they'll never have anything to seize in the first place), especially if one is not eligible for a subsidy due to being "rich" becuase they make more than $46K in MAGI.

Of course, the big risk then would be that one would get sick and then couldn't buy insurance until the next Obamacare open enrollment period started the following autumn. But, government being government (i.e. not always too bright and not inclined to think things through 100%), they--probably quite unintentionally--came up with a helpful solution to this risk that free-riders would otherwise just have to accept. It's called a "qualifying life event". What is a Qualifying Life Event under PPACA? Well, it includes things like getting married, getting divorced, having a child, moving across state lines to another state, moving to a state that has its own exchanges vs moving to one with Federal exchanges, losing a job that previously provided coverage, etc.

The kicker is that (as far as I can tell--from talking to two different insurance agents and from reading the sections of the government  Heathcare.gov website dealing with this issue) these "qualifying life events" don't merely enable one to purchase insurance that now reflects your new life situation (for instance, allowing you to buy a policy that adds your spouse as an insured if the "Qualifying Life Event" was you getting married) but are essentially full open enrollments that allow you to purchase any policy available on the exchanges! You don't even have to have had previous "creditable coverage" before the Qualifying Life Event took place i.e. you could have been previously uninsured but you still get to purchase a policy no questions asked if you experience a qualifying life event!

If this is true, then the financially savvy thing to do would (assuming one is pretty healthy and expected medical expenses are few if any) of course be to not buy insurance and then if one got cancer or diabetes or any other costly disease, simply get married (i.e. a sham marriage to a trusted friend just to be able to legally satisfy the QLE requirements by being married) and then get divorced as soon as you have bought the policy and it goes into force (i.e. as soon as you get the certificate of coverage indicating it is in force). Or, if your job allows it, take a quick leave of absence, "move" yourself (don't actually move all your furnture and belongings, just rent a cheap apartment for a month or two and use it as your new address) to the next state over, change your forwarding address with the PO to your new address, and voila...you have "moved to a new state"...new open enrollment time!

The only real issue for such a person would be something like a sudden car crash that requires IMMEDIATE (expensive) medical attention. I'd suggest upping the medical coverage on one's car insurance if one is worried about this; it will probably be a lot cheaper than actually buying full Obamacare coverage since car insurance doesn't have to cover expensive chronic diseases.

Let the adverse-selection death spiral begin!!

D1984 wrote: How would they deal with the insurance companies who would find themselves suddenly out of customers? From a purely cost perspective, if they can't compete with something like Medicare one might say they deserve to be put out of business....but I'm sure their CEOs, boards of directors, major shareholders, and the PACs they contribute to will see otherwise and make such a plan a political nonstarter from the get-go.

They would need those insurance companies to manage the Medicare-for-all program.  The insurance companies that currently manage Medicare can only do so for the seniors and disabled people currently enrolled in it.  If suddenly there are 300+ million enrollees, they will have to get additional insurance companies to manage their claims. 

I substantially agree with Pointed's suggestion. Obamacare looks like a train wreck. But the GOP will NEVER EVER go for a single payer system. They want to either return to the status quo ante-Obamacare or quite a few would like to dismantle the entire social safety net.

Ad Orientem wrote: I substantially agree with Pointed's suggestion. Obamacare looks like a train wreck. But the GOP will NEVER EVER go for a single payer system. They want to either return to the status quo ante-Obamacare or quite a few would like to dismantle the entire social safety net.

What is your goal for changing the system?  Healthcare could have been given without cost to every person who wants it, without the need for changing everyone else's healthcare. 

Ben Carson, very accomplished surgeon criticizes Obama publicly and by coincidence is very soon audited by the IRS.  The same IRS that was clearly used for political purposes around the last presidential election.  This same IRS is involved in Obamacare (and could obviously obtain access to one's personal medical info). So the real goal of everyone being involved in Obamacare, is so they can be kept in line, one way or another.  I don't think this was how JFK liberals in 1960 worked, but this is what 'progressives today are about.  Control. 

"Medicare for all"

Is this the same Medicare that is underpaying providers, driving them to turn away patients or close up their practices?  Please, no price-fixing single payer monstrosity for me, thanks.

Benko wrote: What is your goal for changing the system?  Healthcare could have been given without cost to every person who wants it, without the need for changing everyone else's healthcare. 

How the heck do you eliminate cost? How do you give something to everyone and eliminate the costs?

The government has nothing to give that it hasn't already taken.

Obamacare will fail miserably. Insurance companies will go bust. The Healthcare of the nation will get worse and the FEDs are going to use this as the excuse to fully take over the system. Skyrocketing medicare costs over the next 20 years were going to be impossible for the government to cover.

By taking it all over they'll be able to ration the care, meaning people will die earlier than they would have otherwise and suffer more. The end result is going to be less Healthcare and much higher costs than we'd have if it was a free market.

After ten years everyone will be convinced that it's the government that gives us Healthcare and arguing for any type of market will be looked at as lunacy.

People here are convinced that it's the government that provides us with money. This group is smarter than the average American I think. At some point arguing against the masters will draw all your fellow Americans to accusue of wanting people to go without Healthcare. Can't wait.

Good analysis of the financial incentives to not sign up D1984. I've made the same case although with much less detail. I'm self insured so I guess it'll take cancer or something to get me to marry my girlfriend. Thanks Obama.

Kshartle wrote:

Benko wrote: What is your goal for changing the system?  Healthcare could have been given without cost to every person who wants it, without the need for changing everyone else's healthcare. 

How the heck do you eliminate cost? How do you give something to everyone and eliminate the costs?

My only point was that if the goal was as often stated (which is almost never the case), it could have been done as an entitlement and not screwed up everyone's health care.

Benko wrote:

Kshartle wrote:

Benko wrote: What is your goal for changing the system?  Healthcare could have been given without cost to every person who wants it, without the need for changing everyone else's healthcare. 

How the heck do you eliminate cost? How do you give something to everyone and eliminate the costs?

My only point was that if the goal was as often stated (which is almost never the case), it could have been done as an entitlement and not screwed up everyone's health care.

The entitlements are what has screwed it all up to begin with. Where would the money come from for any more entitlements?

The reason why I started the topic is because it's obvious to me that the status quo is unsustainable, and anything that can't go on will stop--it's as simple as that. Before health care becomes so expensive that middle-class people simply CANNOT afford it, there will be a such an uproarious clamor that politicians will be tripping over each other to try to fix the problem. We all know that politicians suck and politics results in bad outcomes, which is how we got here with all the perverse incentives created by Obamacare, Medicare, Medicaid, EMTLA, stale-level insurance mandates, and so on and so forth. Obviously this all needs to be cleared away before any sanity can return to American health care, but I just don't see us going to free-market health care anytime soon. That's just my reading of reality.

Pointedstick wrote: The reason why I started the topic is because it's obvious to me that the status quo is unsustainable, and anything that can't go on will stop--it's as simple as that. Before health care becomes so expensive that middle-class people simply CANNOT afford it, there will be a such an uproarious clamor that politicians will be tripping over each other to try to fix the problem. We all know that politicians suck and politics results in bad outcomes, which is how we got here with all the perverse incentives created by Obamacare, Medicare, Medicaid, EMTLA, stale-level insurance mandates, and so on and so forth. Obviously this all needs to be cleared away before any sanity can return to American health care, but I just don't see us going to free-market health care anytime soon. That's just my reading of reality.

Agreed. The thing is they can't fix it. There's nothing the government can or will do to fix it other than just leaving it alone (abiding by the constitution). They won't do that though. They'll come up with more problems/fixes.

They'll be taking it all over and rationing soon. Maybe 5-10 years.

I'll take it one step further.  The idiots we've elected for generations have made such a mess of things, left us with so many structural problems, that even if they stopped passing laws right now (further exacerbating the problem), we'd still be hosed.

That's why I'm a fan of the "burn it down and start over" approach.  They've been passing thousands of pages of bad legislation every year for decades and not a single one ever gets repealed.  Congress could do nothing but repeal laws for the next 30 years and we'd still have bad legislation on the books. 

Of course the problem with my approach is that the true source of our pain is the American people.  Any new government would likely reflect the new electorate reality and be as much of a mess as it is now, although it would probably be a hell of a lot more efficient. 

It's painful to have to keep reminding myself that WE are the problem.  WE did this to ourselves and WE got the government we deserve.  We elected these people and allowed them to implement a system that encouraged the election of even worse individuals and so on and so forth (gerrymandering, two-party system, primaries, etc., pay to play campaign contributions).  By refusing to take action to correct the system, either political or otherwise, we're like a victim of a B&E who can't be bothered to call 911 or pick up the gun next to their bed and shoot the armed intruder.

Sorry for the tangent, back on topic.  I think they'll just let things collapse and then push for single payer while what's left of the GOP fights it.  The Dems will win, we'll be stuck with some wretched single payer system that's worse in every way than what we have today, our quality of life will continue it's downward slide and I'll be looking for other places to move to.

RuralEngineer wrote: I'll take it one step further.  The idiots we've elected for generations have made such a mess of things, left us with so many structural problems, that even if they stopped passing laws right now (further exacerbating the problem), we'd still be hosed.

That's why I'm a fan of the "burn it down and start over" approach.  They've been passing thousands of pages of bad legislation every year for decades and not a single one ever gets repealed.  Congress could do nothing but repeal laws for the next 30 years and we'd still have bad legislation on the books. 

Of course the problem with my approach is that the true source of our pain is the American people.  Any new government would likely reflect the new electorate reality and be as much of a mess as it is now, although it would probably be a hell of a lot more efficient. 

It's painful to have to keep reminding myself that WE are the problem.  WE did this to ourselves and WE got the government we deserve.  We elected these people and allowed them to implement a system that encouraged the election of even worse individuals and so on and so forth (gerrymandering, two-party system, primaries, etc., pay to play campaign contributions).  By refusing to take action to correct the system, either political or otherwise, we're like a victim of a B&E who can't be bothered to call 911 or pick up the gun next to their bed and shoot the armed intruder.

Sorry for the tangent, back on topic.  I think they'll just let things collapse and then push for single payer while what's left of the GOP fights it.  The Dems will win, we'll be stuck with some wretched single payer system that's worse in every way than what we have today, our quality of life will continue it's downward slide and I'll be looking for other places to move to.

What places are you thinking? I've heard good things about Chile and obviously places in Southeast Asia. The key will be figuring out how to make money but anywhere were the market is more free, employment will be a lot easier. Just figure out what is needed and possibly start your own business.

A lot of alternative places of residence have relatively young governments, which means that they're prone to instability.  Who can say that something that is appealing today won't succumb to a leftist revolution and look like Argentina in 20 years.  The one good thing about the U.S. is that the decay pushing me toward emigration is a relatively slow process.  Once I reach the limits of tolerance, I'll have plenty of time to evaluate the state of affairs in the world and pick the least objectionable place to live.

As a mechanical engineer, my skills are more transferable than average, although perhaps less so than those in the medical field.

RuralEngineer wrote: The one good thing about the U.S. is that the decay pushing me toward emigration is a relatively slow process.  Once I reach the limits of tolerance, I'll have plenty of time to evaluate the state of affairs in the world and pick the least objectionable place to live.

Unless it speeds up all of a sudden. Just because it's been slow doesn't mean it will stay slow. Is the decay picking up speed from your perspective? The next ten years are gonna see a lot of people going on the dole. Currency controls could be put in very quickly to ensure the golden goose doesn't get away.

How tolerant are you? I think you have to be early because you can't be late. That's why I'm in Gold and Stocks exclusivley. We might have another bout of deflation or even several but at some point I think they'll crank up the presses so big the dollar/bond holders are going to be the ones taking the huge losses.

Thinking about relocating but I'd feel more secure if I got my gold out of the country now. 2014 project.

Libertarian666 wrote:

RuralEngineer wrote: I'll take it one step further.  The idiots we've elected for generations have made such a mess of things, left us with so many structural problems, that even if they stopped passing laws right now (further exacerbating the problem), we'd still be hosed.

That's why I'm a fan of the "burn it down and start over" approach.  They've been passing thousands of pages of bad legislation every year for decades and not a single one ever gets repealed.  Congress could do nothing but repeal laws for the next 30 years and we'd still have bad legislation on the books. 

I'm right with you so far.

RuralEngineer wrote:
Of course the problem with my approach is that the true source of our pain is the American people.  Any new government would likely reflect the new electorate reality and be as much of a mess as it is now, although it would probably be a hell of a lot more efficient. 

It's painful to have to keep reminding myself that WE are the problem.  WE did this to ourselves and WE got the government we deserve.  We elected these people and allowed them to implement a system that encouraged the election of even worse individuals and so on and so forth (gerrymandering, two-party system, primaries, etc., pay to play campaign contributions).  By refusing to take action to correct the system, either political or otherwise, we're like a victim of a B&E who can't be bothered to call 911 or pick up the gun next to their bed and shoot the armed intruder.

Sorry for the tangent, back on topic.  I think they'll just let things collapse and then push for single payer while what's left of the GOP fights it.  The Dems will win, we'll be stuck with some wretched single payer system that's worse in every way than what we have today, our quality of life will continue it's downward slide and I'll be looking for other places to move to.

I agree that the system is doomed to failure due to the incompetence of the electorate.

However, WE (most of the people on this forum) aren't the problem. The problem is that everyone gets what the average person deserves.

Yes self-identifying with everyone else is actually part of the problem. When people start thinking of themselves as part of the collective you get all the problems that collectivist thinking brings. Namely, people rise up who like to appeal to the collective mindset. They offer things they can never deliver on and require your servitude as payment.

""WE are the problem.  WE did this to ourselves and WE got the government we deserve."

Libertarian666 wrote: The problem is that everyone gets what the average person deserves.

While I agree with much of what is said above, keep in mind that:

1. Since the takeover of the universities in the US by the left, the youth of this country has been programmed and dissenting opinions not exactly welcomed.  This does not exempt people for responsibility for their own actions, but the continued leftward shift of the country and the resultant consequences seem inevitable. 

2.  Becoming a citizen of Australia is difficult after 50 years age and New Zealand difficult after 55 years of age.  And yes it takes several years to become a citizen of NZ, but there is an intermediate step (forget the terminology) which gives you rights to gov't provided e.g. healthcare.  I just returned from NZ and I highly recommend it, as long as a slower pace of life fits you.  Otherwise Australia, which is more popular as a place to move to, may be preferable.  I don't think either place will let you become a citizen if you have significant health problems.

Benko wrote: 1. Since the takeover of the universities in the US by the left, the youth of this country has been programmed and dissenting opinions not exactly welcomed.

Very true. But for some of us, it has the opposite effect.

Pointedstick wrote: Step 2: propose to uncap the eligibility age for Medicare, transforming it from a single-payer system for only old people into a single-payer system for everyone

I remember that was part of the opening salvo by Obama et al, but the Republicans (and of course the insurance company lobby) trashed that idea very quickly.

What I never quite understood:  why create this crazy, expensive, mind-twisting scheme with the individual mandate and all associated baggage, when you could simply provide vouchers via tax credits (means tested, like the Earned Income Credit) for people to buy their own insurance?  Paul Ryan had the idea to do this for the over 65 set, which was an unbelievably stupid idea because private insurance for the elderly would necessarily be prohibitively expensive, but it's perfectly sensible for people younger than that.

I very much liked the idea of insurance exchanges, to give individuals more clout in the health insurance market.  Undoubtedly these won't work perfectly right out of the box, but eventually I expect that the problems will be worked out.  The problem is their coupling to punitive tax treatment for people who fail to navigate them successfully even before said problems have been fixed.

Of course, this assumes that private insurance is a Good Thing.  Which personally I don't believe.  It just creates a complex playing field that some can turn to their advantage, and that ends up hurting everyone else.  Not saying that Medicare is better, it's just that single payer would make life so much easier and remove a lot of inefficiencies.  I could accept Medicare's brand of insanity if it meant not having to deal with all the others.

Libertarian666 wrote: I agree that the system is doomed to failure due to the incompetence of the electorate.

However, WE (most of the people on this forum) aren't the problem. The problem is that everyone gets what the average person deserves.

If I could vote myself my own personal government, I'd likely be more than happy to abide by whatever those who frequent this forum came up with.  However, that's not how any system of government works anywhere, that I'm aware of.  We're stuck with exactly what you pointed out, what the average person deserves.  And in a democracy that will always be the case.  Since I haven't yet emigrated or taken up arms against the government, I'm part of the "We."