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Krugman provides more fodder for Obama apologists on health insurance reform

Since the usual suspects will be linking to Krugman's column today, check the comments, because they make lots of great points. Krugman writes:

For people on the left who think this is all a big nothing, consider the subsidies.

Heh. After the Marx Brothers, we get Seinfeld! As I wrote over at Avedon's place:

Krugman's assuming a can-opener. In this case, that the subsidies will be enough. We know they won't be, for two reasons: (1) the bill doesn't control costs, so the subsidies are always going to lag needs, and (2) means test + subsidy = welfare, meaning that the precedent for the program is not SS but AFDC, so the program will be under constant assault from "entitlement reformers" in the Dem party rightward.

And then there's the whole 2014 thing, which nobody, including Krugman, has even been able to explain let alone justify.

Professor, you say "do the math," but you're assuming the numbers you write on your chalkboard are real! Less "economics" -- and less "politics" -- and more "political economy" please! What's your story?

NOTE See also Hipparchia, here.

UPDATE Scarecrow explains the underlying, moral and intellectual issues more clearly than I did:

The problem with these comparisons is that they assume the affected population is composed of people who would have bought insurance without reforms. But the relevant population consists of those who aren’t insured now and likely wouldn’t be in the future. What matters to them is whether they can actually afford the payments they’ll be required to make under the mandate. What they would have paid without reform and mandates is not relevant, because they wouldn’t have bought insurance — they’d be part of the 45-50 million uninsured.

The payments the affected population would be forced to make consist of both the premiums net of subsidies and the out-of-pocket co-payments and deductibles they would have to pay before receiving treatment. That’s a critical piece of what folks like Jon Walker and Marcy Wheeler (see her estimates on affordability) are insisting Congressional Democrats confront and fix. And if some folks can’t afford those payments in 2013-2014, it’s obvious that even more folks would have problems as the costs rise over time, which they are virtually guaranteed to do without sufficient price regulation, provider cost controls and/or competition from a viable public alternative.

The only relevant question for these otherwise uninsured folks is whether they can afford to make the total payments required by the mandates, year after year, given the bill’s weaknesses. If they can’t, then they’re not really "covered," and the mandate is unjustified. They’ll be stuck paying the penalty, and they still won’t have insurance.

To be sure, some unknown percentage of this group of uninsured may be able to afford meaningful insurance that provides real care with the subsidies, but these tables don’t answer that question.

Krugman and others who keep creating these charts surely understand that affordability is critical. Democrats should demand it as a condition for imposing any mandate. But by continuing to present charts that partly avoid or obscure the mandate and affordability issues, they make it harder for those of us still fighting to improve the final bill. And I don’t think Krugman et al really mean to do that.

I think that, in fact, they do "mean to do that," because they feel that a win for their preferred legacy party in 2010 and/or 2012 is the main priority (no doubt for the best of reasons). After all, "we can always fix it later." (That is the talking point that framing the bill as SS, and not AFDC, is meant to support.) Unfortunately, in the short run some of us are dead, because neither making a federal crime out of being uninsured nor the junk insurance they're forcing on us will get us care, but will leave us even more impoverished. Jam yesterday, jam tomorrow, but never jam today.

No votes yet


Submitted by Anne on

probably never will:

Why are subsidies being treated as if they are the answer to all our health care woes, and why has there been little to no questioning of whether it makes any sense at all for the government to shovel billions of dollars into the giant insurance company maw without ever first examining the premium structure - are they fair, do they provide value for the investment, what is preventing them from being artificially jacked up between now and implementation so as to exponentially increase their bottom line? And what happens when it becomes obvious early on that the government will simply not be able to maintain the subsidies?

Health insurance does not equal health care - just ask the millions who have the former, but still cannot afford the latter. How can this not be obvious - or is this a case of if it is allowed to be obvious, the little people might actually be able to prevail?

I feel like Krugman has gone from Shrill to Shill, is lobbying for an Obama administration job, and I fear that he is being set up to be the apologist for the next Obama project: dismantling Social Security and Medicare.

madamab's picture
Submitted by madamab on

For expanding Medicaid coming from?

I read that the Governor of NY and the mayor of NYC are livid about this bill. Apparently, it places even greater financial burdens on the states, which (unlike the federal government) must balance their budgets. NY took a huge hit after 9/11 and has never truly recovered. In the Empire State, we are looking at massive spending cuts to all the good stuff - mass transit, schools, police, firefighters - and now, state and local taxes will have to increase even more to pay for this dubious Health Whatever Bill.

By the way, doctors hate taking Medicaid patients and are currently not required to accept them. So, unless the money to pay for the care is more forthcoming after the subsidies, those on "expanded" Medicaid will probably be treated with the same disregard as those on regular Medicaid.

It's all about where the funding comes from.

I think prominent single-payer activists are going to have to start writing about the Hyde Act and how it is going to keep standing in the way of expanding Medicare until we all unite to get FOCA and/or the ERA passed/ratified. The corporate wing of the patriarchy has been well covered by SP activists, but some do not seem to understand that until women's reproductive rights are a given, SP will never happen - because the antichoicers refuse to allow federal funds to be used for abortions, and Medicare covers ALL medical procedures.

It's the elephant in the room and no one, NO ONE wants to admit it's pooping all over the carpet. But it sure fucking stinks.

basement angel's picture
Submitted by basement angel on

is to kick lower income people out of the market entirely. everyone knows that they can't afford the premiums, and deductibles even with subsidies. All they have to do is the math - even with subsidies, there is simply no money left over for whatever portion of the premium is left over. For people who make under $30k a year, it's entirely common to spend half of your income just on housing without any existing option of a downgrade.

I think what's being reformed is the ability of people like me to get healthcare. I think they are counting on the penalties to kick people right out of the system. If I'm not able to afford my premium, i'm going to wait until the last possible minute to get health care. The emergency rooms aren't going to be crowded anymore, because going to them may very well mean getting your paycheck garnished - as the IRS does to people who owe back taxes - and that would mean homelessness for a lot of people. So people like me, without sufficient income to actually cover the premiums, will drop out even farther from health care to avoid the entanglement over the government recapturing premiums. I'm going to have to be unconscious to get me to hospital from here on out.

I've come to think of this bill as the "Kill Lori Faster" reform.

In the end, this is Obama sticking it to the working class one more time. He's gambling that since he's proved the Dems don't need the working class anymore to win elections, that the resulting fall out won't hurt. It'll be an ugly day in the class war if he's right.

In California, with mandated auto insurance, over a third of drivers are uninsured. They buy a 3 month premium to bring their registration current, and then drive the rest of the year without insurance. it's how the auto insurance industry gets bad and poor drivers out of the market and transfers the costs associated with them driving to ordinary people. Because if you get hit by one of these drivers, your rates are going up.

Submitted by gob on

start ups even more. Starting your own business often means choosing poverty for what you hope is just a while, but how many will be willing and able to do that if -- on top of everything else -- you have to either buy insurance you can't afford, or jump through a zillion hoops to get a subsidy or an exemption?

If you can't choose poverty, you can't escape the corporate web. A feature that ensures the continued supply of intimidated labor, and eliminates non-corporate economic activity.

Kill the poor!

Submitted by hipparchia on

and since i've been punditizing, i'll play 'what's your story?'

1) What is your current income?
about 250% fpl

2) What is your current health insurance arrangement---premium, cost-share, employer share, family or individual coverage, etc.?
uninsured and uninsurable

3) Do you have a chronic illness or impairment?

4) Do you have a child or dependent, and if so, do they have any chronic illness or impairment?
no dependents [other than cats and dogs]. fortunately.

5) Have you ever had to spend any time without health insurance while raising a child, caring for an impaired dependent, or living through your own illness or impairment?
yes [own illness]

6) Have you ever had a family member who went a substantial period of time without health insurance?
immediate family, no. extended family, yes.

7) Have you ever had to put off going for medical care for yourself or another because you couldn't afford it?
i get almost all my medical care nowadays 'for free' from the emergency room.

letsgetitdone's picture
Submitted by letsgetitdone on

This post and all the comments on it are incredibly well-taken in my view. Thanks to every one commenting.

Submitted by lambert on

We're getting considerable pushback for being critical of Krugman's posting on this topic, but it's almost always couched in terms of the argument from authority! Quelle surprise....