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Krugman and I differ on Obamacare

This is sad.  I really like Paul.  We agree on so many things.  He’s one of the few people who is getting a clue about the myth of structural unemployment.

But with Obamacare, he’s hopeless.

I think it has to do with his own social isolation.  He lives in Princeton surrounded by some of the most successful individuals in the world.  Of course, all around him is the detritus of 6 years of dismantling of the R&D industry.  He only has to cross Route 1 to visit the now shuttered lab where I worked for 15 years. Some of the smartest people I know are having a really hard time figuring out what just happened to them.  But it’s unlikely that Krugman knows many of them, or any of the less accomplished people I know.

Here’s the part of Paul’s latest Conscience of a Liberal post on Obamacare that I resent most:

The current state of public opinion on health reform is really peculiar. If you’ve been following the issue at all closely, you know that the Affordable Care Act is one of the great comeback stories of public policy: after a terrible start, it has dramatically exceeded expectations. But hardly anyone seems to know that.

It’s easy to understand how that happens for Fox-watchers and Rush-listeners, who are fed a steady diet of supposed Obamacare disaster stories.

Um, I HATE Fox News and Rush Limbaugh.  I consider them to be on the same par as pneumonic plague.  They spread misinformation quickly and the effect is always malignant.  I don’t watch cable news of any kind and I don’t listen to Rush.  So, where could I have possibly gotten the crazy idea that Obamacare is a disaster waiting to happen??

Maybe it’s from my own data and observations.  Maybe it’s because the plans are not so great for the price.  Maybe it’s because some of us could afford the lousy premiums if we could get a subsidy but our incomes are too low to qualify (could someone please explain how that even makes sense??).  Maybe it’s the persistent feeling that Obamacare is leading to a less secure job market.  Maybe it’s because for some of us, it’s a choice between cashing in some of our IRA and facing a steep tax penalty to pay for our premiums or being forced into Medicaid where the state may collect our estates from our heirs when we are dead.  There are a million reasons why Obamacare might not be working so well for the rest of us, 40 million approximately.  If Obamacare is only reaching 7 million new subscribers, doesn’t that leave most of the 47 million uninsured still uninsured?

Here’s my take on Obamacare: It’s full of poison pills.  There’s just enough in it to help people with pre-existing conditions and some self-employed people to thrill the cockles of the liberal’s heart.  For everyone else, cost controls are not in place, there are no mechanisms to force competing carriers in a local market to cooperate with each other leaving the unsuspecting facing steep out of network costs, the unemployed are still mostly not covered (and they can’t afford the premiums anyway without a subsidy) and to get any kind of public option, aka Medicaid, you have to give up nearly everything you own and have spent your whole life working for.

This is not a good plan, Paul.  Most people do not live in Princeton or NYC.  They live ordinary lives with ordinary wages and this plan seems to have bypassed many of them.  Obamacare was cobbled together by a chief executive who seemed to want to wag his penis around instead of actually pushing for a well crafted piece of legislation.  Then it was severely compromised by Congress, first by Republicans who are malignant narcissists and then by Democrats who repeatedly sold out their constituents in a desperate attempt to prop up a guy who was not ready to be president.  Why the push to ram this extremely flawed piece of legislation through so quickly?  Why was it more important to save Obama’s ass than to ask him to do a good job?  Why aren’t enough liberals asking those questions?

Don’t insult us, Paul, especially those of us who are die-hard liberals who find the right wing utterly repugnant.  It’s not going to make Obamacare better and won’t help the party.  It reminds me of the days when anyone who saw through Obama in 2008 was called a racist.  It’s not fair and it’s beneath you.

16 Responses

  1. All that …. and the teeny-tiny networks. Where there is no nationwide access to the major research hospitals. Where your survival rates depend on where you live. What if you live ‘just’ outside a metropolitan area with a cancer center? Nothing. That’s what. If your local hospital isn’t up to date, it’s all over.

    Also, this story from a couple of days ago — It’s my opinion that ObamaCare is extortion, not insurance:

    “But when she started to call surgeons covered by Blue Shield, she ran into a roadblock. Surgeons who were covered by her insurance operated out of hospitals no longer covered by her insurance — or vice versa. Friedlander spent days on the phone, hours on hold, making dozens of calls across Southern California, trying to match a surgeon with a hospital that would both be covered. In total, she reached out to 20 surgeons and five hospitals.

    “No one could help me. Some expressed sympathy,” Friedlander, 40, told The Huffington Post in an email. “They told me, ‘I’m so sorry — it’s all just so new. You’re a victim of the changes. No one knows what they’re doing.'”

    Unable to match a hospital and a surgeon that were both covered, Friedlander started haggling between doctors for a cash price for the surgery. She chose a surgeon who wasn’t covered by her insurance but who operated in a hospital that was covered. She expects her insurance to pay the hospital bill, but she had to pay for her surgeon’s bill herself. In the end, she had to take out two credit cards so she could pay $16,000 out of pocket.”

    • The only thing I object to about that article is the heading. If you’re on a plan within any of the Exchanges, you face this. It’s not “some”. It’s all.

    • Also, Mr. Krugman is equally to blame as Rush and Faux on the charge of spreading disinformation regarding Obamacare.

  2. Riverdaughter. Did you know that the term “public option” was invented by insurance companies, and it was/is part of a disinformation campaign which hopes to confuse people as to what makes healthcare affordable and what does not.

    1.) Making any healthcare program that is not already public any more public is banned by at least three – probably more free trade agreements. So there could not be any kind of truly “public option” without rrenegotiating those trade agreements which is unlikely because the US largely wrote them -to stop other countries which had not already (in the mid to late 20th century) set up their own public systems. It appears that there was some kind of global resolution among the wealthy countries that they wanted to roll back the safety nets in preparation for the structural changes being driven by IT, basically massive shift to automated business. The logic goes that if so many people will be out of work, there will be a period when those people are still in the wealthy countries but have no income. Rather than rise to the challenge I think that their goal is basically to drive the ever growing numbers of unemployed to go somewhere else where they can live on their “guaranteed income” checks and their children will no longer be citizens of the rich countries, etc. Either that or contract out for their care to some country which could use the money, maybe Nauru or Cambodia etc. (two countries Australia has negotiated deals to house refugees in) But anyway, what I wanted to emphasize is that the term “public option” is part of a trap[. Because there is no savings whatsoever attached to public at all, and in fact, all other things being equal, the fact that a public plan would need to take all the people who were not employed or all the people with pre-existing conditions, or all the people who for one reason or another could not afford the cherry picking plans, (higher UPFRONT cost) would be (as is happening now) shunted into the “ACA” plans, with their extremely narrow provider networks.

    Why narrow provider networks. because they are trying to force down the legal standard of care without being too obvious. Nowadaye there are a minimum of three healthcare systems There is the modern hospitals and doctors offices in places like New York, Princeton, etc. many of which increasingly dont take insurance. Or only take a subset of insurers who are on the highest tier PPOs etc. Many doctors wont deal with HMOs any more. Because the HMOs force them to sign contracts which restrict them from even discussing certain tretments with patients. This is part of a well organized push by the HMOs to preent progress on what is considered to be adequate care to avoid a lawsuit. Numerous papers have written about this – that the US appears to have stopped moving forward while the rest of the world keeps improving.

    And then there is the system (or no system) for people who have no insurance. the people who have to serve as the example of what happens to those who dont have the money to cough up their share of tribute to the insurance black hole. They have to be punished and humilated and bankrupted for the system to function.

    But- please let me again say, public option is a nothing, a scam. Invented by insurance companies as a single payer killer. Every time you say that word you’re hurting affordable health care.

    There cannot be a public option that works because

    1. It cannot negotiate prices on drugs or services like every country that has a top quality healthcare system does BECAUSE the US Constitution prohibits the government paying less than market rate for anything, and that rate is easy to manipulate.. As long as they are still in the market they can do all sorts of things to cherry pick the profitable people and dump them when they get sick (which they are also of course going to do in the PRIVATE ACA plans, after taking their money for years they will get dumped as soon as they make claims, get swamped with bills and miss a apyment.

    But to reiterate, its essential toget cots under control that the government be ble to pay a global average price. This is anathema to the drug companies. This is why they backed Obama – to stop that- Any “option” will be blocked by the FTAs, TPP, etc, probably numerous trade agreements, from having any clout on drug and services prices.That optional status will lead to QUITE sbstantially higher prices (as much as several times higher) relative to global average drug and service (like MRI services – price of MRI- US $30000 Japan $149) prices for the whole country.

    2.) It VASTLY increases complexity for absolutely no reason to have tiered system. One could argue that its main PURPOSE was to increase costs and profits for no reason, while hiding the fact that the existence of this system itself and its inefficiency pushing up costs- was what its proponents were pointing to as its justification. Also, when a system is as complex as ours it becomes easier to hide the fact that for >50% of all Americans the system is completely broken. I think the tiered system probably doubles costs- really – There’s no argument its adding some very very large percentage of cost to healthcare while adding absolutely no value.

    3.) “Competition” among for profit entities in a market results in costs going up, not down. Thats just one of dozens of knowing lies they have been repeating to try to make people think that Obamacare has soem way to save money when in fact it can’t and wont (and doesnt even want to – Shhhh!)

    4.) There is a fundamental conflict between tying jobs to employers and employment. Given that by mid century we will probably (barring some miracle of educational investment) be flirting with 60-70%- or even 80% unemployment, its exceedingly stupid to financially disincentivise employers from hiring, and encouraging them to lay off older workers in preference to younger ones when the older ones often hav efamilies and mortgages which were pushed by the conspicuous consumption culture.. What Obamacare seems to be trying to do is keep people buying and avoiding the crowd out that would occur if people were confronted with the real cost of nongroup insurance, while at the same time its powerless to make that cost actually go away. So they are pushing this quite restricted insurance which tries to lower the standard of care and which maintains the hierarchy of health-
    Ive gotten into arguments about this, at the core of the argument against single payer is a sort of Amlthusian elitism which beleives that the poor are unworthy of life prolonging treatments beyond some mimimal level to avoid societal chaos.

    Some people actually resent any medical care (or even public education) “being wasted on the poor”. One person at a Silicon Valley party (NOT A TYPICAL OPINION) a few years ago said to me, casually, when i was arguing for a huge shift of resources to education.. said “it will just give people unrealistic expectations”.

    Giving quality medical care to everybody is what the medical profession does best. To pervert it the way they are is causing massive health problems among doctor and making many of themquestion the profession’s direction.

    However, thereis one patient that really should have been allowed to die.

    The biggest mistake was keeping the broken insurance model alive on life support.

    The last year I saw figures, only the richest 14% of us could afford adequate enough nongroup insurance not to lose it when they got a serious illness. 14% – And nothing has fundamentally been changed.

    However, if everyone had to pay what adequate nongroup insurance costs, by making the premiums abnormally low, and then socking people with truly unmanageble cost when they get sick.

    The OOP Max limits their yearly cost to the premium plus $6300 for singles or $12600 for others (unless they have two plan managers which lets them double that but ony in 2014)

    Chronically ill are really being screwed in Obamacare because they will pay that OP max every year. That is their cost, not the artificially low premiums- So, they will hit their deductible every year each year and insurance companies for the next three years at least will get some kind of reinsurance but honestly, I think the cap on OOP costs wont last because its going to be very expensive. Also, I think that the quite substantial increases expected next year 10% to 300% depending on who you ask) will be passed on to the people, where else would they go. For all these reasons as well as the one thats most important to me, the fact that we need to prevent a cutting off of our ability to pick single payer by GATS and other free trade agreements”lock in”provisions (which mandate privatization with almost no exceptions once a public competes with a private, so any option anything is going to fall into the mandated privatization trap) These one way streets to privatization in the FTA’s effectively make all privatization motion one way only, its a bit like a noose hence the name “ratchet effect”-) .. which could happen very soon, due to the investor state provisions. (as soon as any multinationals enter the market we’re going to find it to be impossible to ever get rid of them without paying the biggest fine in history to insurance companies in “compensation” – a right they never ever had had before, anywhere) That would make it impossible to ever change course. If that happens expect the WTO, as soon as it gets jurisdiction to be petitioned by the firms entering the market that all the “good parts” of the ACA are against WTO or other FTA rules of one kind or another (and they are) and have them struck down. We wont have any way out at that point and their scheme will have succeeded in stealing the country’s future in a way that no future elections can fix. Only emigration will save the 90% which is what they probably want, they would like to drive most of the people out of the country now that they are o longer needed to man the machines of industry.

    But, I’m getting off track, We should not tie employment to jobs as it discourages businesses from hiring, a very stupid thing to do when automation already is so attractive. Its especially stupid to encourage them to let people go when they turn 40 or 50 (when rates change)

    5.) User fess that discourage people from seeking needed care (co-pays, deductibles, “cost-sharing” etc.) ACTUALLY INCREASE COSTS IN THE LONG RUN- because they “insure” that people wont go to the doctor until they are really sick, and even then if they are in medical debt they won’t/can’t. The use patterns of those in medical debt are identical to those of the uninsured. So its likely those subsidies will be going to pay for premiums of people who wont be able to use this faux-insurance, LOWERING THE COSTS FOR THE WEALTHY, not the poor.

    6.) Lowering the legal standard of care, delivering care so unnecessarily by wealth levels and lying to cover up the true reasons in the free trade agreements – the desire to make higher profits irregardless of the human cost- while subverting discussions of value, basically the commons necessary to democracy, with numerous methods like online drownvoting, is clearly a crime aginst humanity.

    The United States is getting into some very ugly legal territiory by endorsing and blessing this behavior – and eventually the current perpetrators of such actions will be held to account for them..

    Their lack of concern about the human rights implications of what they do is troubling in every way. What are they thinking?

    Note that there is no statute of limitations for such crimes, people can and often are punished many decades after committing crimes against humanity. They are hunted down and brought to trial.

    Note: The medicolegal standard of care in the USA currently varies by area

  3. “[T]he Affordable Care Act is one of the great comeback stories of public policy: after a terrible start,…”

    Sorry, Paul, but I thought the start up problems were related to computer website failure, not public policy.

    • Exactly. He and the Democrats are doing their darndest to make it seem like all that matters is that the web site works. The web site is NOT the policy, moronic Paul

  4. My understanding of a O-care is it costs heaps of $$$ to buy a plan and then it cost even more extra $$$ heaps in co-pay before you get even an aspirin in actual care from your plan.

    It’s so freaking expensive that it only works in a person’s favor if they come down with stage 4 cancer and then one can sail pass the bastard’s absurd co -pay goal posts …otherwise …hmmm not so much

    I think it has to do with his own social isolation.

    Indeed like the social isolation of writing for NYT. Pretty much a guy with tenure from an Ivy league university needs to not lecture those left out in the cold winds of O-care asap . But the point of Paul’s job is to provide high tone sounding ” yada yada ” fig leaves as the looting goes on. He wants to keep his job and his non O care health care plan thank you very much

    The point of O care is to destroy affordable health care in this country. The end . If you cannot pay though the nose for next to nothing. Tough shit . Don’t even call us when you are shovel ready.

    Washington has become a big dead beat dad who will keep buying yachts but says he’s too broke to send child care

  5. “The Affordable Care Act ”

    This is like Bush II ‘s naming his give back to coal and oil “Clear Skies” …who say they don’t have a sense of humor?

    • Whenever I learn these insider things I’m always struck by the semi contempt that laces them.

      • Indeed.These tittles are insider jokes, that are out in the open. People cannot help telling the truth even while they are thoroughly lying. With these tittles they are telling the truth….just telling it in reverse

  6. Paul Krugman has been pushing market-above-all-else for many years, so of course he is pushing market-“care.” It’s what he does, and is all he knows. He has nothing to offer, and should be ignored. If this is all Princeton has, then we should look elsewhere for legitimate intellectual leadership.

  7. My thoughts exactly on obamacare, and on Obama as president. Obamacare is not “affordable”. The whole fiasco is turning me from a life long democrat to a libertarian

  8. Obamacare is designed to fail, but in the few years we have it, its designed to make any movement to de-privatize impossible due to a feature of the free trade agreements called “the ratchet effect”. So the statements by Reid and others that Obamacare “was s stepping stone to single payer” were lies designed to lull the opposition into inaction as a plan is implemented to make that impossible. Which is what we’re seeing play out right now. It will be similar to the US-Antigua dispute in the WTO over the US’s inadvertent “opening” to “online gambling services”. To punish us for (unknowingly) opening and then shutting our market to Antigua’s online gambling services, Antigua gets to pirate US IP and sell it for a number of years. And the “industry effected” was rather small. The fine the US would have to pay for our freedom from insurance companies in the healthcare insurance financial services market would dwarf all other fines ever levied. Since the cost of healthcare insurance in each Americans lifetime is currently over a third of a million dollars in today’s money over each of our lifetimes (probably more than half) the fine would have to be a significant percentage of that. That is the amount we would have to pay the insurance companies for our manumission to regain our freedom to enact single payer, to enact single payer after this invisible opening. Do people understand what I am trying to say here?

  9. This isn’t beneath Paul Krugman. It is exactly Paul Krugman. He supported NAFTA when his opposition would have made a difference. He supports free trade. So why wouldn’t he support Ocare? Naked Capitalism
    sometimes runs posts analyzing Krugman in detail. He stealth-supports TPP by pretending its critics are misinformed and maybe paranoid and that TPP poses no problems. So why wouldn’t he support Ocare?

  10. Maybe for one reason or another he’s being coerced?

  11. Lambert Strether has today posted at Naked Capitalism a post analysing Krugman’s article and methods in detail, and offering theories as to Krugman’s reasons.
    http://www.nakedcapitalism.com/2014/04/yet-another-shoddy-democratic-hack-job-paul-krugman-obamacare.html

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