• There are still many, many uninsured in the US

    Matt Miller is a little ticked off. He wrote a piece yesterday where he accused the Republicans of abandoning the uninsured. There’s lots to love or hate about his piece given your political persuasion, but I found one paragraph stunning (emphasis mine)

    Here’s what you should do, Mr. President. In the debates this fall, pull out a small laminated card you’ve had made as a prop for this purpose. Then remind Mitt Romney that the ranks of the uninsured today are equal to the combined populations of Oklahoma, Connecticut, Iowa, Mississippi, Kansas, Kentucky, Arkansas, Utah, Oregon, Nevada, New Mexico, West Virginia, Nebraska, Idaho, Maine, New Hampshire, Hawaii, Rhode Island, Montana, Delaware, North Dakota, South Dakota, Alaska, Vermont and Wyoming.

    Read that list slowly, Mr. President. Then ask your opponent: Would America turn its back on the citizens of these 25 states if everyone there lacked basic health coverage? That’s what we’ve been doing for decades. You knew it was right to act when you were governor of Massachusetts, Mitt. How can you pretend we don’t need to solve this for the nation? And how can you object with a straight face when your own pioneering plan was my model?

    I, along with others, have recently been spending a lot of time focused on the cost of health care. For my part, it’s because I’ve believed in my heart that we’ve made significant progress on the access issue (or at least we will in 2014). Yes, there will still be too many uninsured people in the US, but the ACA will reduce the number of uninsured people in the US by a significant number:

    But with the recent Supreme Court decision to make the expansion optional, and many governors claiming they will forego it, leaving millions uninsured, access isn’t getting better as much as we thought. Moreover, if the ACA is repealed, then access isn’t helped at all.

    I have to agree with Matt on one other thing. I’m more than willing to consider any plan put forward by anyone that manages to increase coverage to the extent that the ACA does. But if no such plans are coming forward, then it’s hard to see how we can do well by simply going back to the way things were before.


    • At what cost?
      I don’t think anyone really can say yet.
      I’m not debating whether or not this coverage should expand, but I have’nt seen anything that accurately describes what the total increase in cost will be and how it will be covered.

    • More than a decade ago, the NCPA showed you can have universal coverage without mandates (1), an approach based on the Goodman/Pauly refundable tax credit (2) and reflected in the McCain/Coburn/Ryan health reform. John Goodman has updated that idea at his blog (3). Additionally, the Congressional Health Care Caucus has posted on their website a Health Contract with America (4), fashioned by Goodman, detailing a pragmatic form of universal health coverage (5).

      (1) http://www.ncpa.org/pub/st242/
      (2) http://content.healthaffairs.org/content/14/1/125.full.pdf
      (3) http://healthblog.ncpa.org/universal-coverage-without-mandates/
      (4) http://web.archive.org/web/20161226201515/http://health.burgess.house.gov/uploadedfiles/health_contract_with_america.pdf
      (5) http://www.ncpa.org/pdfs/ib110.pdf

      • I’ve read them. They haven’t been independently scored as reducing uninsurance by tens of millions as far as I know.

      • ObamaCare contains many of the aspects of the NCPA proposal. It clearly subsidizes though who have insurance and penalizes those who don’t. It starts to equalize the tax treatment of individually purchased insurance and employer-sponsored insurance. The penalty through the shared responsibility payment is used to offset much of the cost of uncompensated care that goes almost exclusively to uninsured people. The subsidies for use on the exchanges will reduce the net cost of uncompensated care. Many people will choose not to get insurance because they feel it is not worth the cost. When you look at it from this perspective, it seems like ObamaCare is actually a pretty good start. So what’s the problem?

      • Nikki, if you offered people a tax credit for signing up for insurance, how would you pay for that? Wouldn’t you have to raise everyone’s taxes a little bit to have enough revenue to write them significant tax credits? Wouldn’t that be imposing a tax on EVERYONE that we can’t just avoid by buying health insurance?

    • Disappointing to see people going back to the “opponents of PPACA want people to die” theme

      • I’m letting this kind of thing through once. Show me anything in my post that made that claim…

        If you’re talking about Matt’s post, go complain to him.

    • I feel like health-care reform is a three-pronged fight:
      1) Increase access
      2) Increase quality
      3) Reduce (or contain) cost

      While this blog serves as a continual reminder of how far we have to go in terms of numbers 2 and 3, its nice to have a reminder of just how big a deal the PPACA is/was in terms of number 1.

    • You’re writing about policy. Therefore, you’re always going to be frustrated with the Republican Party. Republicans don’t care about policy.

      The Bush administration gave us Medicare Part D, No Child Left Behind, the executive’s asserted power to wiretap and to detain & torture US citizens without charges or a warrant, surpluses turned into deficits, Raich v Gonzales, and also the invasion for bogus reasons & failed occupation of an arbitrarily selected Middle Eastern country.

      I am at a loss to determine exactly which strain of conservatism compelled these actions.

      What was the response of Americans to all this? Well, as Bush left office, he had a 28 percent approval rating from independents– and a 75 % rating from Republicans,according to Gallup. According to an ABC/WaPo poll, Bush left office with 34% approval from independents, and 68% from Republicans– but 82% from self-professed “conservative Republicans”. Over the course of his presidency, Bush rarely received less than 80% approval from “conservative Republicans”.

      Those same conservative Republicans, now refashioned as the “Tea Party”, maintain today that they are very preoccupied with the deficit and with federal & executive power. But we know they don’t care about those things, because they were Pres. Bush’s most loyal supporters.

      In the Obama era, longtime right-wing ideas like the EITC, housing vouchers, the individual health insurance mandate, cap and trade, etc., have suddenly become completely toxic to the GOP. That’s because Republicans don’t care about policy. They care about winning. As Reagan adviser Bruce Bartlett put it, today’s GOP is ”the greedy, sociopathic party” driven by an “ambition to retake power so that they can reward their lobbyist friends with more give-aways from the public purse.”

      The number of uninsured, the cost of health care– these are policy issues. Therefore, the Republican Party doesn’t care. What’s another 20 million uninsured Americans worth, compared to control of the Senate?

    • So no disenting view allowed to distract the reader from your conclusion.

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

        • Aaron your confusion will be lifted and my above post will make sense when you learn i’ve made Two post on this subject. The first did not make it past the censors sparking the comment you found so Curious

          • I see all comments, approved or not. None from you exist that haven’t been posted. Try again.