Links for September 23rd

Published by Waldo Jaquith

Waldo Jaquith (JAKE-with) is an open government technologist who lives near Char­lottes­­ville, VA, USA. more »

47 replies on “Links for September 23rd”

  1. How is Perry’s response any different than your own? Not sure I see “as an American and a Christian” is any different a value statement than “as an American and without any religious sentiment whatsoever” — both are legitimate statements with different consequences (I agree), but it’s not a unworthy viewpoint — just one that differs from your own.

    My thoughts on it anyhow…

  2. Shaun, the question isn’t whether an expression of a Christian religious affiliation is or is not morally equivalent to an expression of no religious sentiment, it’s whether the practice of diplomacy and international relations ought to be a venue for the expression of an individual’s religious beliefs or personal interests at all. Would it be an equally valid viewpoint to frame one’s opinion on the Arab/Israeli conflict “as an American and a vegetarian?” Or “as an American and a practitioner of yoga?”

    Both international diplomacy and national security are supposed to be about strategically-pursued national interests. If you want to be the nation’s next head of state and commander in chief, answer such questions as an American only and leave your personal interests at the door.

  3. As an employer who provides health care insurance benefits, we are seeing lower premium costs due to Obamacare requirements that 80% of health care premiums actually go to health care services. Cost containment at work. Thank you Mr. President, and Congress!

  4. I agree with Sam. I tried to add to it and realize that Sam had said it exactly right.

    It’s a little scary to me when some Conservatives do not seem to understand this.

  5. “Both as an American and as a person who likes rocky road ice cream, I am going to stand with Israel.”

    That statement probably doesn’t stir up as much sentiment and raw feelings (except of course, pistachio ice cream fans) in the Middle East. That lack of sensitivity shows that Texan spirit shouldn’t be back in the White House anytime soon.

  6. I think the point to take away from the insurance statement is that these young adults are being added back to their parents policy and not obtaining the PCIP policies available to them. My read into this, that the parents took initiative and automatically enrolled them on their policy. The kids it seems, would have stayed uninsured if the parents hadn’t taken action. They just don’t think about healthcare costs.

  7. Also worth wondering about (and it’ll take time for the data to be available): how many of those million young people who got (re)insured needed the coverage. That is, for how many of them has it been a benefit?

    I’m entirely for universal coverage and I’m thrilled for any expansion in coverage; I simply wonder how much it helped that specific group.

  8. one of the most important things you can do in your life is to establish baseline data for your health.

    later on…5, 10, 20 years down the pike – that baseline tells the doctor a lot about your current health relative to what it was years before.

    If you get a CBC test – it shows readings for about 30 blood components and a range for each one.

    some folks test out right at the boundaries or slightly over – but the question is did you always test that way or has something changed?

    A baseline can save you money and heartache.

  9. Not to be the crotchety old man here, but I’ve known quite a few folks under the age of 26 to take advantage of mom and dad now being able to keep paying for their insurance because they complain about the costs. Yet the very same folks have their fancy smartphones and $100+ phone plans that they pay for without batting an eye.

    One of the issues facing health care coverage is a personal priority of costs. Those under 26ers who are getting health care? Mom and Dad have picked up the bill. It’s extended their adolescence for a large number of them. But that’s more a statement on “kids today” than anything else.

    Just a brief broad brush observation.

  10. I don’t doubt such people exist—I recall sitting at a downtown bar at the age of ~20, attempting to convince a friend why she should a) quit smoking and b) use that money to buy health insurance—but the problem remains the same. We cannot expect people to instantly become rational actors at the age of 18. Instead, there’s a transitional period to responsibility, and recognizing that is important to set policy accordingly. We know that medical expenses are the leading cause of bankruptcy, and we also know that medical expenses without health insurance can be financially devastating. And whatever the cause of that lack of insurance, we know that this new policy has successfully provided insurance for 1M people, and there’s no doubt that’s a net win, collectively.

    And, of course, there are lots of people for whom your example does not apply. I can’t locate immediately the unemployment rates for 18–25-year-olds, but it’s awfully high. These, of course, are the very people who this policy is intended to benefit the most.

  11. Waldo –

    “Instead, there’s a transitional period to responsibility, and recognizing that is important to set policy accordingly.”

    And this is where we fundamentally disagree. It is not the role of government to save people from themselves.

    We’ve started the slippery slope of allowing a family plan to subsidize folks who may otherwise be perfectly capable of taking care of themselves but now not having to. What’s 26 today may be 30 tomorrow. I mean, why not? We can’t expect people to suddenly be rational actors at 26.

    My biggest issue with all of this is in the end there is nothing that addresses the overall cost of care. The eventual end result of the entire process is to create an infinite (well, 300+ million) demand for a finite product. And while there’s a savings for those under 26 by being on a family plan that cost is going to have to be picked up by those not on said plan.

  12. And this is where we fundamentally disagree. It is not the role of government to save people from themselves.

    I don’t believe that, on the night of somebody’s 18th birthday, they are instantly capable of assuming all the responsibilities of an adult. (Developmental research is basically unanimous on this.) Nothing magic happens. I think it’s important to establish our policies not based on an idealized version of reality, but, y’know, reality. Remember, too, that this isn’t government saving people from themselves—it’s these people’s parents.

    To expand on my quoted point, this is one of the points where social conservatism meets economic conservatism. If you find it distasteful for an 18-year-old to gain health insurance via her parents via a private insurance company via a federal mandate, but the evidence showed that there were significant cost savings as a result of that provision of health insurance, would you favor it on economic grounds, or oppose it on social grounds?

  13. virtually every industrialized and developing country in the world has mandatory payroll taxes for people to pay into for their health care and retirement.

    It’s true that it’s not the govt role to look after those that will not but the problem is that we will pay their costs anyhow when it gets to the point of them dying in the street.

    That’s why we have EMTALA and MedicAid – and as long as we have it – people will view it as last-resort “help” from the “govt” – i.e. other taxpayers.

    and the really cruel part here is that a good number of recipients are kids – kids who have no choice in the matter and are at the mercy of other taxpayers …

    I know of no other industrialized or developing country in the world that does not have mandatory payroll taxes and universal health care – paid for by those mandatory taxes.

    I would ask this of those who don’t agree.

    List the top 3 countries in the world that do not have mandatory payroll taxes and universal health care.

    if you can’t name 3 – then are we advocating for something of which there is no real world analog?

    if you can’t name 3 – then how about naming the 3 that come closest to meeting that criteria?

    if you can’t name 3 that come close – then what does that mean?

    I’m not opposed to American taking the lead and innovating on these issues but right now we spend twice as much per capita for health care and we have the lowest life expectancy and the highest infant death rate of other countries that do have universal health care.

    at some point – we have to ..or we should WANT to deal with practical REALITIES and not theoretical ideology…

  14. Waldo – If not at 18 why at 26? Why not 30? Or 40? We’ve just institutionalized the idea that 26 is an OK age to finally be an adult. And wasn’t the previous regulations allowing up to the age of 23 as long as the child was still a student?

    The issue we are facing is that at its fundamental core health insurance is not a right. Health CARE should be accessible, but insurance itself is a different beast. And there has been nothing to bring down the cost of care, we’re setting ourselves up for a bottomless pit of costs that have to be picked up somewhere. Or the socialization of the system. Which is working great for Eurozone countries right now…

    LarryG – Here’s three nations with systems you’re talking about: Greece, Spain, Portugal. Great group to wanna join there.


    Admittedly, I’m playing a lot of devil’s advocate here because I see the other side of this. If I were a parent and could help my kid pick up some of their insurance costs, sure, let’s do that. Having spent most of my 20s uninsured, I get the need. But when the issue for a good number is a priority of cost and extension of adolescence with no real means to ensure lowing long term costs of care, how is that a win? The immediate result is 1 million under 26 year olds being insured, great. But at a discounted rate that will have to be made up elsewhere in the near future.

  15. re: three nations

    I’m looking for three nations that DO NOT have mandatory payroll taxes and DO NOT have universal health care.

    Name the top 3 who don’t have either than are better off as as a result.

    you pick – but the countries you pick need to meet the criteria of better off without mandatory payroll and UHC.

    be honest now.. don’t play games.

  16. at the least Jason – you should admit that if you cannot or will not name 3 countries that you are after a system that does not currently exist.. in the world.

  17. LarryG – You’re right. I can’t. But that doesn’t mean we imitate the systems of others because this isn’t a cookie cutter problem with a ready made solution.

    Name me three countries in the world as large geographically, population wise, as diverse culturally, as economically strong, and with a similar economic culture that operates on that system.

    The practical reality is that universal healthcare is not the quick or only fix you hope it will be. Our needs are as diverse as our people. And unless we are aiming to socialize a portion of our economy (and that really should not be an option on anyone’s minds), we need to find better solutions than mandating coverage into a system when there are no measures in place to bring down costs. Again, infinite demand for finite supply will do nothing to lower costs or increase care.

  18. LarryG – But how are Spain, Portugal and Greece better off now? By making healthcare something managed by government you are making coverage and quality of care to be at the whim of whoever is in control and budgetary concerns of Washington DC. You’re taking it out of the hands of individuals putting it in the hands of political parties. So in a universal healthcare system, are you ready for certain procedures to be banned or mandated because political winds have shifted?

  19. as I said.. I’m not opposed to innovation nor the US taking the lead…

    but I’m asking for some basic evidence of your approach.

    name some places that use that approach with some success.

    right now the countries that have mandated payroll taxes and UHC beat (as far as I know) – ALL the countries that have alternative systems.

    why do you think alternative systems have a better potential beyond your own logic?

    where is the evidence?

  20. ” LarryG – But how are Spain, Portugal and Greece better off now?”

    how about the other 50 countries?

    these 3 have problems but not due to UHC.. alone…

    their entitlements are too rich for what they pay into it.

    How about Germany and Singapore?

    do you think those countries “fail”?

    why not?

  21. Health care insurance in America is designed from the ground up to be delivered through employers and fact is most parents have a job, and many young people either do not have a job, or have such a shitty little job that it provides no HC benefit.

    Working parents got their insurance through a group discount policy that provide more coverage at a favorable group-discount.

    If you are unemployed and forced to buy a private single policy you are screwed in America. If you are old and forced to buy health care insurance you are a high risk and also screwed. Obamacare solved the first problem, Medicare solved the second problem. Both Democratic/Liberal programs, both good for America!

  22. Young folk are cheaper to insure, unless they have significant health issues. I would guess that by including more young people in insurance coverage, the cost per insured would go down as the older and sicker are “subsidized” by the younger and healthier. At least that’s the way it is supposed to work.

  23. If not at 18 why at 26? Why not 30? Or 40?

    For starters, it’s pretty rare for somebody to be in a career position by the age of, say, 23. (And we’re a nation that provides health insurance via employment.) But it’s pretty common for somebody to be in such a position at the age of 30 or 40. The jobs that one can get at the age of 18 (or 20, or 22) simply don’t come with insurance.

    Any number seems arbitrary. Why four balls for an walk? Why four downs before possession turns over? Why is $83,601 the threshold for a 28% marginal income tax rate for a single person? The answer to all of these things is that a lot of people spent a long time observing the realities of each of those scenarios, and found that those numbers make the most sense.

    Eighteen makes no sense. Eighteen is the age at which one is an adult, but that does not correlate with an income level (especially in the current economy) or a continuity of employment that makes health insurance a viable option for enough people. Is 26 the correct age at which to cut off the ability to get health insurance through a parent? I don’t know. It could be 24. It could be 28. I don’t have enough information to say. But I do have enough information to know that 18 is too low.

    I would guess that by including more young people in insurance coverage, the cost per insured would go down as the older and sicker are “subsidized” by the younger and healthier.


  24. In 2005 a young New Hampshire woman, a college student named Michelle Morse died at age 23 of cancer. She had been booted off of her parents health care coverage because she had become too sick to attend college, and being a student was a requirement to stay on the parents insurance. Even though sick and taking chemo she returned to school to re-establish her insurance coverage. The combination of classes, student teaching, cancer, and treatments took her. New Hampshire passed Michelle’s Law because this should not happen to anyone!

  25. 26 also makes sense from the brain development point of view. The executive functions of the brains of most humans is not fully developed until age 25 give or take a year. 26 means that brains are (for nearly all) fully developed.

    This is why it is important not to impair the growth of that executive function with mind-altering substances until at least 25 years of age. It also allows most people the chance for a failed start or two or three in finding their career.

  26. the “we don’t need no stinking Universal health Care” folks basically believe that all the countries in the world that have it are 1. socialist 2. doomed to fail.

    therefore – we should not follow that path.

    but I’ve never been clear on what path we should be following.. I hear lots of “ideas” and threats to “repeal and replace” but the ‘replace’ is mighty light on specifics… usually something about “tort reform” (Va already caps) and “free market principles”.

    but I’m never clear on what exactly all of that means and I’ve never seen A Republican PROPOSAL – an articulated ALTERNATIVE.

    Republicans/Conservatives, in general, feel that the govt should not be involved in health care anyhow…

    but the problem is … young people don’t get insurance… and later on when they inevitably will need it – there has been no money set aside to pay for it.

    that’s not unusual for young people – and it’s the very reason why all industrialized countries and virtually all developing countries have mandatory payroll taxes.

    Singapore has mandatory payroll taxes to the tune of about 30% but it’s also in the top 5 in terms of life expectancy and infant deaths.

    In fact the US ranks about 29th in life expectancy and infant deaths…

    and so I do ask.. are there better systems (or even competitive systems) in the world that don’t have mandatory payroll taxes and universal health care.

    I’m just not sure what path we’re supposed to take if we don’t believe mandatory taxes and UHC is the right path.

    I’m just not seeing a clear articulated vision from the Conservatives on this issue.

  27. As an employer who provides health care insurance benefits, I am seeing higher premium costs since Obamacare went into effect. Several friends in the same boat have had to reduce payroll by laying people off.

    Thank you, Mr. Obama!

  28. I didn’t thoroughly read this post so forgive me if this has been said, but doesn’t having a million (and hopefully more in the future) young uns in the insurance pool bring the cost down for everyone? Presuming they are mostly healthy. Isn’t that largely the point? You young uns need to pay into the system so us old fat folks don’t have to pay as much for our self-induced diabetes, etc. :-)

  29. for the folks who believe in UHC, the larger the pool, the better and the more people paying into when they are younger, the better.

    that’s why all countries who have UHC have mandatory payroll taxes to pay for it and it starts just like our payroll taxes do – as soon as you go to work.

    but the folks who are opposed to UHC…. and for that matter Social Security and Medicare believe that govt should not be forcing people to pay payroll taxes for retirement and health care and that it is a personal responsibility and if you fail to prepare for the future that you should be the consequences and not expect others to come to your aid.

    I’ve tried to fairly represent both views although I am on the side of mandatory payroll taxes because as long as we have laws like EMTALA (ERs must treat you regardless of payment) and MedicAid – ( if you are in need Medical care and can’t afford, they will step in)…..

    as long as we have those laws and the majority of voters in this country will not repeal them – then we ought to have a system that puts the least financial burdens on those who have to pay for those who would not save.

    and that’s what payroll taxes accomplish and that’s why all the industrialized countries in the world pay 1/2 what we do per capita for health care and at the same time we rank last on life expectancy and infant deaths.

    If there are other metrics for measuring health care outcomes that can be used to show how countries without mandatory payroll taxes and UHC do better than countries with – then we should know that and I would expect the folks who say the payroll tax/UHC path a wrong path – to point to other methods that are “better”.

    but to advocate REPEAL of ObamaCare without having any articulated vision of an alternative path to deal with the problems we have is – …. well .. it’ irresponsible and non-responsive to a significant threat to our economy – i.e. the continuing escalation of health care costs on ALL US US …INCLUDING those who DO HAVE insurance.

    used to be – fiscal conservatives were the grown-ups in the fiscal house – and could be relied on for practical and responsible solutions to issues like this.

    No more. The so-called “conservatives” these days have become essential ideologues advocating for “principles” regardless of whether or not those principles are actually dealing with real world challenges – AND solutions.

    I’d LOVE to not have mandatory payroll taxes for UHC – but what good is that if my own health care insurance and taxes continue to go up to pay for health care for those who don’t have it?

  30. oh… and how many “young uns” would actually buy auto insurance if they could choose to not to?

    I would submit that rather than people wanting young uns to pay for geezers… it’s a question of the inevitable need to have insurance as a personal responsibility and choices that those who would “gamble” make.

    How many people would have homeowners insurance or mortgage insurance if he mortgage company did not “force” them to?

    some people…. many young folks – are willing to “gamble” about insurance because it seems so much like a money-pit with no pay-back.

    indeed – you can pay thousands of dollars into insurance policies and not get one penny back and all that money you paid goes to other people.

    Some folks, especially the young believe this is inherently “unfair” and that people who are “careful” don’t need insurance… and if they do end up needing it then it’s their fault they had a problem anyhow.

    If you think this sounds like 2nd grade logic – you are correct but unfortunately – it describes many folks who really don’t care if others are harmed or others have to pay to fix what you broke…

    and that’s why we have to have mandatory insurance laws and mandatory payroll taxes.

    they are there to protect others from those who would not be responsible for costs imposed on others..

  31. Interesting, I. Publius, but, I, too, am an employer who provides health care benefits for employees and, for the first time in at least a decade, my rates and premiums have decreased.

    I really don’t know the cause, but, if you’re blaming the president, I suppose I can thank him.

  32. the fact that health care costs have been increasing a decade before Obama took office does not discourage those opposed to Obama and ObamaCare from making that assertion.

    but again.. the thing that strikes me is the total lack of an alternative solution… just keep the system we have – which totally sucks… for many, many people.

    It’s the ultimate “I’ve gone mine – screw you” mentality.

  33. Obamacare has raised the bar on health care insurers, they can no longer sell the shitty insurance coverage they used to sell to I Publius.

  34. what’s funny here is that all other industrialized countries provide UHC and in doing that – small businesses do not have that burden at all and are free to innovate and compete even against bigger companies..even internationally but the dunderheads in this country insist on a different “reality” to suit their ideology.

  35. OK, yes, this:

    I would guess that by including more young people in insurance coverage, the cost per insured would go down as the older and sicker are “subsidized” by the younger and healthier.

    Is a good point and one I’m willing to concede. If by allowing more healthy individuals to get insurance at a lower rate but then not use it you do put more money in the pool, that works.

    But in the long run, the pool is way too top heavy to be continually subsidized on the lower end. Once the kids are tapped and costs return to going up, something’s gotta keep ’em down.

    But I’ll grant that point, absolutely.

  36. Heath Care costs are driven by:
    1) Uninsured people who require health care. Hence the Mandate to have insurance.
    2) Health care delivered on fee-for-procedure rather than results-based outcome.
    3) Administrative overhead fees in a for-profit business model.

    Federal and State governments are the largest consumers of health care in the USA (medicare, medicaid, Veterans, DoD, civil service). Effective health care cost controls are a key element in successfully controlling government costs.

  37. ” If by allowing more healthy individuals to get insurance at a lower rate but then not use it you do put more money in the pool, that works.”

    my view is that some day – you may not know whether that day is soon or at you’re retirement – you ARE going to NEED health care and you need to be setting aside money to pay for it just like you are setting aside money for your retirement or buying auto insurance… going “bare” ultimately means if your luck runs out that you’re counting on others and the govt to “rescue” you.

    Each of us should be personally responsible for the needs that we will inevitably have… and stop pretending that we are paying for others.

  38. Bubby… fat, drunk and stupid is no way to go through life, son. For profit business models *necessarily* have lower administrative overhead costs than government run alternatives.

    But please… do go on making things up for my reading enjoyment.

  39. For profit business models *necessarily* have lower administrative overhead costs than government run alternatives.
    Our current monopoly for-profit health care business models had no necessity for lower administrative overhead…until Obamacare regulated it!

    Medicare administrative overhead costs are a fraction of the for-profit health care insurer costs. Google up the compensation for Wellpoint CEO Angie Braly, owner of Virginia’s largest health care insurer, Anthem BCBS for reason #1. Justify your wingnut dogma with that $13.5 million/yr. nut and we’ll debate the merits.

    So what kind of business do you operate? How many employees? What is their average salary?

  40. When I was still keeping track of this stuff, Medicare had 2% administrative costs while private Medigap policies had upwards of 40% administrative costs. Admittedly, that was a good while ago in the early 90’s. I’d bet real money that the figures for private insurance administrative costs have stayed the same or increased.

    The only way you have a true risk pool that keeps costs down is an “everybody in, nobody out” pool. Otherwise, insurance companies will cherry pick the healthiest and deny coverage to those with a higher chance of needing insurance.

  41. re: administrative costs –

    you’ve got dozens of private insurance companies all with their own rules and processes that each doctor’s office must cope with. when you go to your doctor – spend a minute looking at the number of people handling paper and the files that line the wall – and realize that the whole system is a CF and talking about govt “overhead” in that context is silly.

    All of these companies have “overhead”.

    look at the paper you get in the mail…from your insurance company…

    I challenge anyone to look at a summary of benefits paid and benefits not allowed and track down where in your policy it says these things…

    look at your policies when you receive updates… and tell me you understand what is going on…

    and yes this is the problem:

    ” The only way you have a true risk pool that keeps costs down is an “everybody in, nobody out” pool. Otherwise, insurance companies will cherry pick the healthiest and deny coverage to those with a higher chance of needing insurance.”

    and yes – this is exactly the way it works in every other industrialized and developing country in the world – probably near a hundred other countries that have universal risk pools and in doing that keep their per capita costs to 1/2 of what we pay while at the same time having longer life expectancies.

    I’m not oppose to another way of doing this.. as long as it proves to be equal or better to the other country’s systems but to date – all I’ve ever heard is “tort reform” and “market-based principles” and no specifics and no other countries that work that way.. so it’s basically an ideological theory with no practical existing examples and for that matter no real articulation of how it could be accomplished.

    we seem to have this vision that we can do it better but we have no clue how to …just that we believe we can do it better.

    sorry – the realities are that you must have a large risk pool and yes… that means that some people will pay and not get – that’s the way that insurance works.

    sometimes I think folks are opposed to the concept of insurance….. that “insurance” is a social evil….


  42. good debate point and good support of your point…

    the increase in health care costs though is what causes increases in health insurance premiums.

    and that has been going on for more than a decade

    but your point that insurers are reacting to having to cover the newly added (previously uninsured) is not really a shock.

    but why are we paying twice as much per capita for health care no matter whether it is covered by private insurance or Tricare or Medicare?

    What ObamaCare has done .. has increased the number of people covered but yes.. at a cost also.. and that increased cost will be used to pay benefits…

    the very same thing happens in Europe and Japan.

    the difference is that when you have everyone in the pool – the costs drop – to 1/2 of what we pay.

    it’s a chicken/egg process.

    we cannot get a larger pool without more people joining and more people paying to join (i.e higher premiums for added dependents).

    but in those added people are people who now are contributing to their eventual use of health care instead of having taxpayers pay that cost at the ER or through MedicAid.

  43. [T]he average annual premium for family coverage through an employer reached $15,073 in 2011, an increase of 9 percent over the previous year.

    …and a 10 percent decrease for us. “average” is meaningless. Health care insurance premiums are based on insured group, coverage, company size, loss history and bargaining position.

    If insurers continue to screw with affordable access to health services then employers will simply quit the game and leave them to negotiate with a single payer (the government). There need to be consequences for failure.

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