Archive for the ‘Politics’ Category
CBO weirdness with HR3962
Compare and contrast Table 2 from the CBO analysis of HR3962, the new House healthcare bill. Specifically note that non-group /other net enrollment increases from 24 million to 30 million between 2015 and 2019. Now compare this to the bill itself, Title II, Section 202, Page 94:
Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.
How can enrollment go up if new enrollment is disallowed outside the Exchange?
The problem is further exacerbated when you realize the new dependents born after “Y1″ (A-1-B, page 91) are not allowed onto their parents’ plans and that individual business generally has a 30-40% lapse rate annually. Granted, people may not be willing to part with the relatively cheaper grandfathered plans, so the lapse rate is likely to fall. But it can’t go negative.
Perhaps the circle is squared by the ephemeral “other” category in the analysis. But I doubt it. Compare the HR3962 score with the Baucus bill score, which separated “other” from “non-group”. In that score, those two categories moved in tandem under “current” law, and it seems reasonable to presume that the “other” category is mostly unaffected by reform (I presume it is Medicare disability, etc.).
There are many such examples like this, where you just want to shake the CBO and ask “What are you smoking? And … Can I have some of that?” I think I’ll need it.
Adventures of an Actuarial Therapist
It was a dark and stormy night. I was closing up my office, and this scraggly old man in a red, white and blue top hat came scrambling in. He called himself Sam.
Sam: Hey doc, you gotta see me. My fiscal situation is a “ticking time bomb”. We’re racing toward financial ruin, and I need to talk.
Me: Take a seat on my couch. Tell me more.
Sam: Let’s talk Medicare. In the near-term, the aging of the population is estimated to explode its costs beyond our means. In the longer-term, medical innovation and utilization patterns threaten to bankrupt the country.
Me: Sounds rough. Any ideas on how to fix the problem?
Sam: I thought I’d start by offering somewhere between a $1 trillion and $2 trillion entitlement to help working age people get insurance.
Me: I think I missed something.
Sam: No, you didn’t. I think that if we can wring a trillion dollars of revenue and cost savings out of the American public and Medicare, then we can give that extra entitlement and not speed up our impending fiscal disaster. If we are lucky, we can put private insurance companies into the same situation I am.
Me: You mean fiscally insolvent?
Sam: Don’t worry. We’ll set up a public option that will always be there if private insurance can’t survive under our new mandates.
Me: I’m still stuck on how you are going to help Medicare or your fiscal situation.
Do I want a fiscally responsible President?
I think so. But this article gives me pause. It quotes Obama:
“Social Security, we can solve,” he said, waving his left hand. “The big problem is Medicare, which is unsustainable. . . . We can’t solve Medicare in isolation from the broader problems of the health-care system.”
I suspect this quote reveals that he and I view these programs from fundamentally opposite perspectives. I see Medicare causing broader problems in the healthcare system and rarely suffering from them. The fundamental Social Security problem is how to maintain the program’s popularity with ever-declining benefit-to-contribution ratios. Both contibute to the overarching problem of how to manage the overall impact of these programs on the general finances of the US government.
I am not particularly concerned, per se, about the long-term projected deficit in Medicare, and am only moderately more concerned about Social Security’s actuarial deficit. I fear “solutions” to these problems that emphasize policy options that exploit weaknesses in the assumptions and calculations rather than focusing on the fundamental issues. Saying we can “solve” Social Security suggests to me a very narrow version of what that ”problem” really is. Saying that we must reform the private healthcare market to reform Medicare is tantamount to avoiding the tough healthcare financing issues facing that program.
I’m not unhappy yet. He vagueness leaves much to the imagination. But I am becoming concerned. Tyler Cowen is much happier.
Voting For Obama: The Long and Winding Road
March 5, 2008, seems so long ago. That was the day I pulled the lever for John McCain. The best of a mediocre lot, I had tremendous respect for his stance on national “hurricane” insurance, ethanol subsidies, the Iraq surge, nuclear power, and immigration. I was hopeful that this would be an election where I could vote for a President rather than against a candidate. How times changed.
Since then, I have morphed from a (presumed) solid McCain voter to someone who just voted for Obama. In a separate post, I’ll explore their policy positions, voicing some thoughts and perspectives I have failed to find elsewhere. This post, however, is just a summary of my sad personal road. I share to relieve my angst and because I think there are millions of conservatives struggling right along with me.
