• Arkansas, Indiana, Ohio – a clarification

    Let me be clear: I’m not arguing that the feds should have denied the Arkansas expansion. I’m fine with getting more people good insurance coverage. I can live with this, just like I lived with the Senate version of the ACA bill (which had more exchange and less Medicaid), and just like I could have lived with Wyden-Bennett.

    My bafflement comes from taking the other side at their word.

    Many claimed that the ACA cost too much. They said it would raise the deficit. They opposed the expansion not only because it raised the federal price tag, but also because it was “fiscally unsustainable” for states in the long run. I took them at their word.

    I’m now surprised that they prefer a solution that costs more.

    This is not unlike my previous bafflement at arguments against Medicaid. Often, the same people would argue that (1) Medicaid costs too much and (2) Medicaid under-reimburses providers. (1) and (2) are incompatible. You can’t fix both. Choose.

    They did in Arkansas. They chose to spend more. A lot of pundits are now claiming they feel the same way. That’s fine. They’re allowed to change their minds.

    They’re claiming they haven’t, though. The problem is that the Internet is forever. Their writings are still around. And anyone with Google can see that their arguments are inconsistent. I’m just surprised more journalists can’t seem to note this.


    • “Often, the same people would argue that (1) Medicaid costs too much and (2) Medicaid under-reimburses providers. (1) and (2) are incompatible. You can’t fix both. Choose.”

      It’s only insoluble to those for whom a reduction in the scope of service of government is unthinkable.

      1. Raise reimbursements to providers to cover their costs.
      2..Shrink the eligibility for Medicaid to the point where…
      3, The total cost of Medicaid is whatever isn’t “too much:”.

      • So would you cut the kids, pregnant women, elderly poor, blind, or disabled? Cause that’s the vast, vast majority of Medicaid at the moment.

        • Would you reduce the economic productivity and incentive to toil, innovate and create of the working poor, the entrepreneurial class, or the knowledge workers who create our future? Because that’s the vast majority of the people paying taxes at the moment.

          Your heartless hatred of all progress and success, and my near-sexual glee at throwing old people out into the street taken out of the equation, that’s what we have a Congress for: to make the judgment calls and political negotiations that settle our priorities. If the program costs too much, then – barring the invention of some incredible efficiency-improving technology by the Federal bureaucracy, pause for bitter laughter – something has to give in the service arena.

          You can’t have every social benefit you want. Choose.

          • I literally have no idea what you’re talking about.

            • You said originally that there’s no way to reconcile higher reimbursements and cutting the overall program costs. I showed you how, and its very simple: reduce the scope of the program.

              Rather than recognizing that a welfare program can change to be smaller instead of just expanding year after year, your riposte was to inquire who I was going to throw out of the Medicaid program to balance its budget; I ask who you’re going to tax to pay for it. And then I note that neither you nor I need answer the question; that’s Congress’ job.

              So, original point: we can make Medicaid more provider-friendly and control its overall expenditure level; the contradiction you perceive doesn’t exist.

          • The Republicans love to suggest that the rich are innovators and job creators and the poor need to work harder, but putting aside the evidence (on the ground, not theoretical charts) that this is true, Medicare is, comparatively, a low-cost provider that most people like.

            It doesn’t matter what’s taking money out of your pocket, the taxman or the insurance company. What matters for the economy is money in your pocket/bank account.

            Therefore, the obvious solution to getting all those people to innovate and job create is to put more money in their pockets by making Medicare universal. The savings on insurance will be far greater than the extra taxes .

            • @Robert – Aaron’s question to you about who to kick off Medicaid is completely valid. We are a wealthy country and there is a minimum threshold of how we should treat the least fortunate among us. Where that threshold should be can be debated, but it is an independent question from how we pay for that level of support. I don’t for a minute believe that we can’t afford to provide for the poor – other countries far less wealthy than we are manage to do it well.

          • @Robert- If you dont want to answer the question, just say so.


            • I’m happy to answer the question. It’s just a change in topic.

              How much do you want to cut the program’s cost by?

    • I hate to sound like a broken record, but much of the opposition to health reform and the ACA are about politics, not policy. Until we get past that – and we may never be able to – there will be no consistency to the arguments.

      At the end of the day, what’s important is that we seem to be moving forward, at least in some states. Of course, the cynical side of me just knows that in a few years, some ACA opponent will point at Arkansas and say “We told you it would be expensive. Why didn’t they just let us expand Medicaid?”

    • Indiana’s policymakers may well be assuming that they will *eventually* gain large efficiencies by switching to an HSA-like model, which I think is a fair description of Healthy Indiana. If so, their insistence on the HIP approach is not inconsistent with their philosophy. But yes, it is not consistent with the evidence.

    • Let’s be honest here, it’s all about some political interests who want any taxpayer money that’s spent, to go into certain pockets in the end… if it takes helping the poor a bit, or even just pretending to help the poor a bit, as part of the process, so be it, the money’s getting where they want it to go.

      • @watermelonpunch
        yes, exactly–most people who claim to be against government spending are just against certain government spending. If it benefits corporations and the like great, poor people, not so much.

    • There are undoubtedly some people like that, and its perfectly legitimate to call those people out for their specific hypocrisies when you catch them at it. Personally, I want an effective but downsized Federal state, with many decisions devolved to the states, and I’m delighted by just about any cut to the behemoth.

      But that said,what’s your point? Those people still vote, so they are going to have some representation in the system. If their numbers are small, they are irrelevant; if their numbers are large then that would seem to argue for a liberal strategy of embracing cuts across the board; if we can’t give the poor all we’d like, at least we could stop the corporation lovers from slushing all the money to ripoffs like GM and Solyndra. The government can’t give away that which never enters its hands.