Obamacare Schadenfreude - Big Wheel Keep on Turnin'

Hot and steamy here today for the week that marks the unofficial end of summer. Supposedly the longest string of 90+ temperatures of the year.

Obamacare Schadenfreude just keeps on rollin . . .

Obamacare and Work

Over the next few years, CBO expects that the rate of labor force participation will decline about 1/2 percentage point further… the most important of those factors is the ongoing movement of the baby-boom generation into retirement, but federal tax and spending policies will also tend to lower the participation rate. In particular, certain aspects of the Affordable Care Act will tend to reduce labor force participation, with the largest effect stemming from the subsidies that reduce the cost of purchasing health insurance through the exchanges. Because the subsidies decline with rising income (and increase with falling income) and make some people financially better off, they reduce the incentive for some people to work as much as they would without the subsidies.

Much of the debate over the effect of Obamacare on work has concerned how we should think about the possibility of de-linking health insurance from employment. Some liberals have argued that it’s a good thing that Obamacare reduces labor force participation: People shouldn’t be “locked” into jobs they hate because it’s the only way they can get health insurance. But CBO has never said that reducing job lock is the main way Obamacare reduces employment. It has consistently pointed out that the structure of Obamacare’s subsidies acts as an implicit tax on work, and thus causes people to work less. It’s hard to see much to cheer in that.

It's working; or not, depending on whether you actually want people to work.

Death Panels, coming to a hospital near you. Coverage for End-of-Life Talks Gaining Ground

Medicare may begin covering end-of-life discussions next year if it approves a recent request from the American Medical Association, the country’s largest association of physicians and medical students. One of the A.M.A.’s roles is to create billing codes for medical services, codes used by doctors, hospitals and insurers. It recently created codes for end-of-life conversations and submitted them to Medicare.

The Centers for Medicare and Medicaid Services, which runs Medicare, would not discuss whether it will agree to cover end-of-life discussions; its decision is expected this fall. But the agency often adopts A.M.A. recommendations, which are developed in meetings attended by its representatives. And the political environment is less toxic than it was when the “death panel” label was coined; although there are still opponents, there are more proponents, including Republican politicians.

If Medicare adopts the change, its decision will also set the standard for private insurers, encouraging many more doctors to engage in these conversations.

Having conversations is great. Having government mandated conversations, is well, not so great. I can hardly wait until the Lois Lerner types start writing the regulations covering when "end-of-life conversations" need to be given, and what they should be:

"Dear Patient X; you're costing the government more money than you pay in taxes. Please die already."

We need some "end-of-life conversations" with politicians more.

The Republican Obamacare Battle Plan for 2015

If Republicans capture control of both houses of Congress in November, they will have a golden opportunity to lay the groundwork for a market-based health-care overhaul -- a goal that can only be achieved after the next presidential election.

Repeal of Obamacare, and replacement of it with a complete set of conservative reforms, should remain Republicans’ long-term aim. The danger is that they will squander the opportunity to make headway on useful changes to Obamacare in 2015, and instead spend the year consumed only with repealing the law, when such an outcome is impossible with Barack Obama as president for two more years.

Public opinion suggests people are more interested in “fixing” Obamacare than in completely scrapping it; and by 2015, almost 25 million Americans will be relying on it for health coverage. Those are reasons Republicans should aim to reform or replace portions of the Affordable Care Act: Realistic changes can generate momentum for bigger changes to come.

They would be wise, in particular, to focus on policies that shift the authority, responsibility and resources for health care to the states. Conservative health-policy analyst Avik Roy has made meaningful contributions toward that end with a plan that he argues will “transcend” Obamacare while restoring fiscal sanity to the health-care system. In brief, Roy’s plan does away with some of the federal regulation that drives up costs under Obamacare, disposes of the federal health-insurance exchange while promoting state-based exchanges, and proposes the first comprehensive overhaul of Medicaid since the program’s creation in the 1960s. . .

Repealing Obamacare guts, feathers and all, has great appeal to the Republican base. However, the facts on the ground are that once given, subsidies are painful to end, and as we have seen in the 20th and 21st century, a guerrilla war of attrition can succeed where a straight forward assault cannot.



Wombat-socho is on time and within budget with this weeks giant "Rule 5 Sunday: Are You Ready For Some Football?" post.