[The Soup Nazi]

Wasn't this asshole "worth ten billion"? At this that's one of the lies he tried to sell us in 2016. Snake oil tycoon can't even come up with half a billion. Say goodbye to your New York shit, motherfucker!

[The Soup Nazi]

From the NYT (1/2)

Why does Obamacare work as well as it does?

By Paul Krugman
Opinion Columnist

We’ve just passed the 14th anniversary of the enactment of the Patient Protection and Affordable Care Act, a.k.a. the Affordable Care Act, a.k.a. Obamacare — although many of the law’s provisions didn’t take effect until 2014.

In its early years, Obamacare was the subject of fierce criticism from both the left and the right. Actually, as I pointed out in my most recent column, politicians on the right are still saying the same things they said a decade ago, pretending that their predictions of doom haven’t been falsified by events. But Obamacare has survived, greatly expanding health insurance coverage without busting the budget. Critics on the left complain that it hasn’t produced truly universal health care, which indeed it hasn’t. But it has done a lot and has become quite popular:

 

So why has Obamacare worked as well as it has?

The thing is, critiques of Obamacare from the left have a point. If your goal is to give people access to health care, why not just give them access, by instituting a single-payer system in which the government pays the bills? This was, in fact, what we did for seniors when Medicare was created in the 1960s.

The A.C.A., however, created a complicated system in which people have to buy their own insurance, although in many cases the government picks up much of the tab. And the complexity of the system, combined with the fact that important parts of it are run by state governments, some of which are controlled by conservatives who want Obamacare to fail, means that a lot of people fall through the cracks: 8 percent of the U.S. population is still uninsured, although that’s a lot better than the pre-A.C.A. situation:

 

Why, then, didn’t we go for single-payer? Politics. It wasn’t just a matter of buying off the insurance industry by keeping it at the center of American health care, although that was part of it. More important, I believe, was the perceived need to avoid disturbing Americans happy with their existing health coverage, mostly those getting insurance via their employers. Rather than reforming our whole health insurance system, Obamacare sought to fill the holes in our system by adding new stuff. In particular, it tried to create a working marketplace in which individuals not covered by their employers could find affordable health insurance.

Many people, especially but not only on the right, expected this effort to fail. I don’t want to get too deep into the weeds here, but the A.C.A. prohibited insurers from denying coverage or charging higher premiums to people with preexisting medical conditions. This kind of regulation can cause a “death spiral”: Too few healthy people buy insurance, so the risk pool gets worse, which drives up premiums, which drives out still more relatively healthy people, and so on.

Initially, the A.C.A. included a “mandate” — a penalty on Americans who didn’t have insurance — but it’s not clear how effective the insurance mandate ever was, and Republicans eliminated the penalty in 2017.

Yet Obamacare didn’t collapse. Why not?

Here’s how I’d put it: In practice, Obamacare has ended up functioning a lot like a single-payer system after all — and such systems aren’t subject to death spirals.

First, a large part of the rise in health coverage came from an expansion of Medicaid, the government health insurance for lower-income Americans — single-payer, although less generous than Medicare:

 

Second, individual purchase of insurance on the A.C.A.-created marketplaces is subsidized. In fact, last year 91 percent of marketplace enrollees were receiving so-called premium tax credits. In many cases these credits cover a large part of an individual’s premium. Also, crucially, the subsidies don’t take the form of lump-sum credits. Instead, the law specifies a maximum percentage of income that enrollees can pay for insurance (that percentage itself depends on your income) and makes up the difference if premiums exceed that maximum.

This isn’t single-payer, exactly, but it does mean that the government is the marginal payer, in the sense that even if premiums rise, most people don’t pay more — the government picks up the extra bills. This in turn means that a death spiral basically can’t happen, because even if healthy people drop their insurance, costs for most enrollees don’t rise.

This is smart policy design; among other things it protects the A.C.A. from hostile politicians. Soon after taking office in 2017, Donald Trump declared that “the best thing politically is to let Obamacare explode.” And while his attempt to repeal the law failed, his administration engaged in acts of sabotage, in effect trying to induce a death spiral. But the subsidies frustrated this plan. In 2019 I asked Nancy Pelosi about how politicians like her had interacted with the clever policy wonks who devised such a robust system. “I am a wonk,” she replied.

Obamacare, then, has defied the doomsayers. But what about warnings that it would prove unsustainably costly? As I noted in the column, federal spending on health care is currently considerably lower than the Congressional Budget Office projected before the A.C.A. went into effect, despite the expansion of coverage. How was this possible?

[The Soup Nazi]

(2/2)

Part of the answer is that before Obamacare went into effect, the uninsured in America consisted disproportionately of relatively young adults — and the health costs of younger people are, on average, much lower than those of seniors (who were already covered by Medicare). So covering many of the uninsured was never going to cost all that much, unless the policy design was fatally flawed, which it wasn’t.

Beyond that, the enactment of the A.C.A. coincided with a sustained slowdown in the growth of overall health care spending:

 

We don’t know exactly why this happened. The A.C.A. contained a number of measures intended to control costs, which may partly explain the bending of the curve. It’s worth noting, however, that health costs have leveled off across the advanced world. It’s possible that the direction of technological progress in medicine has shifted, generating fewer ways to treat the previously untreatable and more ways to deliver care more cheaply. And to some extent we may be seeing the effects of Stein’s Law: If something cannot go on forever, it will stop. Health spending couldn’t absorb an ever-growing share of national income, so at a certain point insurers and providers began to take cost control seriously.

In any case, Obamacare has worked. It didn’t provide universal coverage, but it did provide health insurance to millions of Americans, some of whom desperately needed that safety net — and it did so without breaking the bank. Predictions that the A.C.A. would be unworkable have been proved wrong. At this point, the only serious threat the program faces — and it is a serious threat — is political: People who kept insisting, wrongly, that health reform would die of its own accord may simply step in to kill it.

Quick Hits

45 million people.

Republicans still really hate Obamacare.

Some states (including Massachusetts and New York) have close to universal health care.

Arguably it should be called Pelosicare.

[The Soup Nazi]

Actual cover of the New York Post this Sunday:

 

Y'know, when you're too much even for the NY fucking Post...

[!@#$%!]

��hahahahahaaa! that fucking donkey. i'd be glad to see her laughed away from congress (the weird signs are meant to be a finger emoji pointing upward but this board won't read it)

==

SO, THE BRITISH ELECTION IS ON THURSDAY, HUH? you guys have weird schedules

who will you vote for? what are their chances?

(and btw, how is brexit treating ya? everything coming up roses? )

[The Soup Nazi]

Originally Posted by !@#$%!

the weird signs are meant to be a finger emoji pointing upward but this board won't read it

Use the circumflex diacritic or caret character. It's official internet slang.

^ Awesome answer. See?

[!@#$%!]

 

it's not even close

(especially when mtg is the subject)

[_tunic_]

Originally Posted by !@#$%!

SO, THE BRITISH ELECTION IS ON THURSDAY, HUH? you guys have weird schedules

who will you vote for? what are their chances?

(and btw, how is brexit treating ya? everything coming up roses? )

I'm not British, but afaik there aren't any elections there any time soon. At least no general elections, perhaps something local?
Oh wait, google says it's local elections this Thursday, nevermind. It hasn't been in the news yet where I live. Apparently nobody in mainland Europe gives a shit about the UK after brexit

[!@#$%!]

Originally Posted by _tunic_

I'm not British, but afaik there aren't any elections there any time soon. At least no general elections, perhaps something local?
Oh wait, google says it's local elections this Thursday, nevermind. It hasn't been in the news yet where I live. Apparently nobody in mainland Europe gives a shit about the UK after brexit

lol i hear ya on the post-brexit level of concern

so yeah it's just local but apparently rishi sunak's hide is at stake or something? (or not, not sure really)

it's supposed to be a sea change in favor of the labor party and a loss of various tory constituencies, but since its mostly a domestic matter that gets little international reporting i'm not well informed (but still i'm curious)

i mean it's an early signal of what the results might be in their next general election (which i think it's next year but again, i don't understand their schedules lol)

[Toilet & Bowels]

It's local government elections this week. General election at some point later this year tbc, sunak is holding off from setting a date for it because he's hoping for a miracle to turn the consevatives ratings around but in reality the longer the conservatives hold on to power the more and more loathed they become.

[!@#$%!]

Originally Posted by Toilet & Bowels

It's local government elections this week. General election at some point later this year tbc, sunak is holding off from setting a date for it because he's hoping for a miracle to turn the consevatives ratings around but in reality the longer the conservatives hold on to power the more and more loathed they become.

oooh, i'm looking forward to today's results...

[!@#$%!]

labour won big, but nevertheless some protesters cut their noses to spite their faces:

https://www.msn.com/en-us/news/world...es/ar-AA1o5HMd

same thing will happen here in november i'm sure, and i'm ready for what comes

[The Soup Nazi]

This fuckin' broad.

[Bertrand]

Originally Posted by _slavo_

My home country is quietly becoming a dictatorship again. I was born in a dictatorship and might die in one too.

There was nothing about Slovakia in the French media, so I had to read a mild wikipedia page regarding the election.

Originally Posted by _tunic_

we are heading the right-wing way as well

As for the Netherlands, as it's closer, we got to hear it. With slightly less concern than in the past, when far-right leaders gathered crowds. I was surprised in Rotterdam to end up on a place named after Pim Fortuyn (murdered political leader on the far right; would it still be considered that far now?).
In France too there's concern. There's so much to say and I'm so pissed that it'd be easier to use French. The government steals from the far right leaders, blames everything on the left, and that's about it. Does it work? Partly: everything left-identified is vilified. But the struggle for power between our despised Macron and the 4 leaders on the far right doesn't seem to go in favor of the man in place - whose government lies lies lies lies lies all the time (retirement, annual budget...).
Plus weird things within the media. Heading wealth, heading right.
Not a top notch world these days.

[The Soup Nazi]

Zakaria's latest column:

The presidential election isn’t playing out how I thought it would

Christ on a stick what a downer. Those fucking numbers... Goddammit HOW STUPID CAN YOUR "FELLOW AMERICANS" BE. (Not that my country is exactly brilliant.) The horror...

On the other hand, just imagine if we win. NO MORE DEALING WITH THE ORANGE MOTHERFUCKER. LOO-ZER! Sure he's gonna be around posting bullshit, whatever, fuck him, let Jack Smith fuck him up while we enjoy a nice relaxing cuppa or sum'.

[The Soup Nazi]

Greil Marcus' prediction:

The stolen documents trial will be delayed and if not killed with a Trump victory thrown out by the stooge running it. The Georgia case will be sunk because of Fanni Willis compromising it. The DC case will be delayed until after the election. If Trump wins he will kill it. If he loses he will go to trial and he may be sentenced to prison. Which doesn’t mean he will ever go. Which leaves New York. I wouldn’t bet a penny on anything there.

[!@#$%!]

at this point i feel biden is toast. he tacked left, but the left can never be satisfied enough, is disloyal, and in spite of his concessions now has condemned him over gaza. "not pure enough!" (as if the other side was better... the orange turd moved the us embassy to jerusalem, cancelled the nuclear deal with iran, etc )

now on youtube etc im getting very puerile leftist ads about how great it is that biden stopped future lng gas exports... is that supposed to be a good thing? because the environment, greed, something? i thought europe needed the gas after breaking up with russia... but some 12 year old apparently says no. if i can find the video i'll link it

meanwhile here's how germans feel about it https://www.youtube.com/watch?v=8SXy-M32kqg
japan also needs lng btw

on inflation, sinema and manchin, branded as traitors and hounded by the left, were right: excess fiscal stimulus breeds inflation. and so the inflation reduction act has been anything but. i can't imagine what it would have been with the full five trillion

industrial policy carries risks. it might work geopolitically, but there is an inherent economic inefficiency in manipulating markets, inefficiencies have costs, and consumers and businesses eventually pay for them. tariffs and subsidies may achieve certain strategic objectives but raise prices and increase deficits

the american worker is highly employed, but the american consumer keeps seeing high prices, particularly in housing and rental, which is usually the largest consumer expense (maybe from 25% to 70% of household budget depending on where you live and how much you make?). so even with full employment and higher wages coming in, workers are not feeling like they are prospering from the gains. of course in theory high employment and low prices tend to be mutually exclusive, which is why the federal reserve has a hard time finding the right balance, but good luck explaining that complexity to a crowd

here some figures:
https://www.nerdwallet.com/article/f...rent-vs-income
https://www.census.gov/library/stori...e-on-rent.html

now as a result of fed policy the economy and employment are beginning to soften, just slightly, which should drive down prices, but the concern is that we might be heading towards stagflation, whereby the economy stagnates ("stag-") and employment goes down, but in spite of diminished consumption prices keep rising ("-flation"). jay powell laughed at the suggestion by a ft journalist in his press conference after the nfp data release (showing employment had contracted) because this is nothing like the 70s, but laugh or not the current data points at such a trend, if ever so slightly. so this is a real concern for forecasters, regardless of whether the fundamentals support the hypothesis or not

finally, to go back to the ira and fiscal stimulus, the deficit has ballooned to threatening levels, which are actually perfectly manageable at low interests. but the threat is that if interests were to rise (if inflation became a real problem, and interests would have to rise to curb it, or if us treasuries were not purchased by the world), then servicing the debt could quickly become unmanageable. kinda like the difference between a 30 year mortgage locked at 2% (cheap) and a maxed out 29.99% visa card (hell)

for an example of this see japan. japan has other problems (e.g. demographic), but they are between a rock and a hard place with their monetary policy, because if they keep interests low (0-0.1% currently) the yen keeps weakening (investments seek better returns elsewhere), but if they raise interests to make their currency more desirable their debt load will eat them

krugman said once that japan was proof that the deficit doesnt matter, but foreign currency exchanges say otherwise. japan depends on foreign energy and other imports, so a falling yen makes their cost of living higher: not just for consumers but for some businesses who import their inputs. (this even though a weak yen is goods for exports: but it's a matter of balance). so the bank of japan is on a warpath trying to prop up the falling yen right now (good luck with that). does the usa want to be on a similar footing, stuck with no choices? i think not

btw before i am branded a traitor (lmao) i will clarify to partisan ideologues that this is not an argument in favor of the orange turd. it's just a brief look at the current economic situation and why it hurts biden. me personally, i'm doing great, thanks, not really feeling the inflation (i see it but don't feel it, lucky i guess)

but for low income people, while unemployment remains low, rising food costs are hurting them, rental prices are strangling them, and house ownership with undersupply and relatively (but not really) high mortgage rates is further out of reach. so i can sense their discontent

turd wants to increase tariffs (inflationary) and cut taxes (fiscally irresponsible). but biden is also a tariff raiser! except he wants to tax "corporations" (berniespeak) which actually can reduce employment ("the job creators" in palinspeak). so the turd has a more hypnotizing approach about having your cake and eating it too. which is economic bullcaca, but this is america, where the poor think they are just temporarily embarrassed millionaires, not a social class in itself

of course the crowd is not capable of advanced reasoning or analysis, and the best hypnotizer wins, so here we are now, in the throes of populist fever from both sides. and with reason out of the window the best hypnotizer wins, unfortunately

[The Soup Nazi]

Jesus, _slavo_, what the hell is going on over there?!

[The Soup Nazi]

"Bleach blonde bad built butch body"... Not a bad description.

[Bertrand]

Originally Posted by The Soup Nazi

Jesus, _slavo_, what the hell is going on over there?!

Yes, this time news reached France, and as often, the media gets interested when turn ugly, not saying why, and shift to something else (usually the ordinary Frenchman heading to the beach for a weekend break)