dave23 said:

cramer said:

 gerritn - I meant that the far-left, and it really is just some on the far-left, are still arguing that Russia didn't hack. It's almost as if they're making Putin's case for him. 

 It's a very small minority, but it is there. It's where Paul, Nan, Greenwald, etc. meet the alt right.

One of the tactics Russia used was to release emails that would help to drive a wedge between Bernie supporters and candidate Clinton. They aimed to make them disgusted enough with the process that they either voted third-party or sat on their hands.

The far-left wouldn't want to acknowledge that they were duped, too. So therefore it must be something else.

For every single Trump disaster, the following has proven to be true:

1) If you expect the GOP to now finally start to correct him: you are wrong. They will continue to support and enable him.

2) If you expect that he now has finally hit rock bottom, and cannot possibly do anything worse than this: you are wrong. He will find even more outrageous things to do.

Vacanculo said:

 And the poor way the affordable care act was passed and rolled out caused that. This country is a round whole and congress is a square peg. It is time we all sing the same tune.

 Yes, Obama and the Dems took a big hit for helping millions of people while Republicans did--and continue to do--everything they could to prevent struggling Americans from getting help.

gerritn said:
For every single Trump disaster, the following has proven to be true:
1) If you expect the GOP to now finally start to correct him: you are wrong. They will continue to support and enable him.
2) If you expect that he now has finally hit rock bottom, and cannot possibly do anything worse than this: you are wrong. He will find even more outrageous things to do.

 3) Some "centrists" will decry "both sides" as if there is a Trump equivalent on the Democratic side.

dave23 said:

gerritn said:
For every single Trump disaster, the following has proven to be true:
1) If you expect the GOP to now finally start to correct him: you are wrong. They will continue to support and enable him.
2) If you expect that he now has finally hit rock bottom, and cannot possibly do anything worse than this: you are wrong. He will find even more outrageous things to do.

 3) Some "centrists" will decry "both sides" as if there is a Trump equivalent on the Democratic side.

Good point, and they already do that without a Trump equivalent on the Democratic side (see Vacanculo's posts earlier in this thread)

"Putin's reference to George Soros was a dog-whistle to far-right anti-Semites"

https://www.vox.com/2018/7/16/17576760/george-soros-putin-trump-helsinki

After the indictments were released on Friday, I was thinking of a joke about Trump asking Putin "What should I say?" 

After yesterday's performance by Trump, it wasn't a joke. 

"During today's meeting, I addressed directly with President Putin the issue of Russian interference in our elections."

"I felt this was a message best delivered in person. I spent a great deal of time talking about it and President Putin may very well want to address it and very strongly, because he feels very strongly about it and he has an interesting idea."

dave23 said:

Vacanculo said:

 And the poor way the affordable care act was passed and rolled out caused that. This country is a round whole and congress is a square peg. It is time we all sing the same tune.

 Yes, Obama and the Dems took a big hit for helping millions of people while Republicans did--and continue to do--everything they could to prevent struggling Americans from getting help.

An Impossible Mandate

The slowdown in the rate of increase in health care spending over the past decade is welcome news, but no one is predicting that health care spending will not exceed the growth of income in future years. In fact, for the past 40 years real, per capita health care spending has been growing at twice the rate of growth of real, per capita income. That's not only true in this country; it is about the average for the whole developed world.

You don't need to be an accountant or a mathematician to know that if something you are buying is growing faster than your income it will crowd out everything else you are consuming. Health care spending will take more and more of the family budget; it will take an ever larger share of workers' gross pay. The Affordable Care Act (ACA) did not create this problem. But it limits our ability to manage it by restricting our ability to choose a smaller package of benefits, more cost sharing, etc. In short, the health reform law is trying to force us to remain on an unsustainable path.

Further, there are three "global budgets” in the ACA and (ironically) they are likely to make matters worse for ordinary citizens. The law restricts the growth of total Medicare spending, the growth of Medicaid hospital spending, and (after 2018) the growth of federal tax subsidies in the health insurance exchanges to no more than the rate of growth of real GDP per capita plus about ½ of a percent. This means that as health care costs become more and more of a burden for the average family, they will get less and less help from government through time.

The traditional idea of a global budget is to restrict overall spending. The global budgets in the ACA only restrict the government's outlays.

An obvious solution is to jettison the whole idea of a defined benefit. Instead, make a defined (tax subsidy) contribution to each family and let competition determine what benefits the market can provide.

Unworkable Subsidies

A family of four at 138 percent of poverty is able to enroll in Medicaid in about half the states and obtain insurance worth about $8,000. Since the coverage is completely free, that's an $8,000 gift. If they earn one dollar more, they will be entitled to go into a health insurance exchange and obtain a private plan that costs, say, 50 percent more in return for an out-of-pocket premium of about $900. That's a gift of more than $11,000.

At the same time, the employees of a hotel earning pretty much the same wage will be forced to have an expensive family plan and they and their employer will get no new help from the government. After calculating the value of employers' ability to pay premiums with pre-tax dollars, let's call that a newly created $10,000 burden. This is only one of scores of ways in which ACA's treatment of people is arbitrary and unfair.

But the biggest problem is not unfairness. It is the real impact these differential subsidies will have on our economy. As businesses discover that almost everyone who earns less than the average wage gets a better deal from the federal government in the exchange or from Medicaid and most people who earn more than the average wage get better deal if insurance is provided at work, they will change their employee benefits radically and maybe even restructure the organization of entire firms.

The incentives for small businesses to stay small and for employers to prefer part-time workers, contract labor, and outsourcing to full-time employees are all very real. And there are many other perverse incentives as well. All these perversions have a common source: treating people at the same income level very differently depending on where they get their insurance, how many hours they work, how many other employees they work with, etc.

Again, there is a straightforward solution: make the tax subsidy for health insurance the same regardless of where people get their health insurance. It would be even better if we let people use their tax credit to buy into Medicaid and let people on Medicaid leave and claim the tax credit to buy private insurance instead. At a minimum, this would liberate the job market from the arbitrary burdens of health reform.

Perverse Incentives For Insurers

In the exchanges, insurers are required to charge the same premium, regardless of health status and they are required to accept anyone who applies. This means they must over-charge the healthy and under-charge the sick. It also means they have strong incentives to attract the healthy (on whom they make a profit) and avoid the sick (on whom they incur losses).

The result has been a race to the bottom. In order to keep premiums as low as possible, the insurers are offering very narrow networks, often leaving out the best doctors and the best hospitals. They are also opting for higher deductibles than what most people are used to.

The insurers apparently believe that the healthy buy on price – ignoring other features of the plan. By contrast, only people who plan to spend a lot of health care dollars pay close attention to deductibles and which doctors and hospitals are in the insurer's network. By keeping deductibles high and fees so low that only a minority of providers will accept them, the insurers are able to lower their premiums.

A race to the bottom doesn't happen in normal markets. What makes the ACA exchanges different? Answer: the incentives of buyers.

If I am healthy why wouldn't I buy on price? If I later develop cancer, I'll move to a plan that has the best cancer care. If I develop heart disease, I'll find a plan with the best heart doctors. And by law, these plans will be prohibited from charging me more than the premium paid by a healthy enrollee – if they can stay afloat in the market, that is.

Incidentally, the problem here is not merely one of narrow networks and high deductibles – defects that you might suppose are fixable. The more general problem is that in any system of managed competition insurers have an incentive to under-provide to the sick.

Again, there is a better way. In a market with "health status insurance," when I leave one plan and join another I am charged a real premium that reflects my real risk. I pay only an average premium out of pocket. However, if I am a high-cost enrollee, the plan I leave makes a payment to the plan I enter to cover my above-average expected cost.

Other Perverse Incentives For Buyers

As is well known, the fines for being uninsured are relatively low. The IRS can't do much to collect them other than withhold a refund and millions of people are exempt from the mandate anyway. In fact, 90 percent of the uninsured will be exempt from the mandate in 2016, according to government estimates.

That raises an interesting question: why do we have a mandate in the first place? Clearly we don't want people to game the system. If they can wait until they get sick to insure, then pay the same premium as a healthy person, then drop their insurance after they get care and the bills are paid – the whole insurance system will collapse. But with a semblance of a mandate in place, we seem to be getting this kind of gaming anyway. Early indications are that the people buying insurance in the exchanges are older and sicker, while a lot of healthy people are sitting on the sidelines.

Here's something everybody seems to be ignoring. We have already found effective ways to deal with this problem without mandates. Medicare Part B, Medicare Part D, and Medigap insurance are all guaranteed issue and community rated. But if people don't enroll when they first become eligible, they are penalized.

Lack Of Access To Care

One interesting finding from the first year’s experience under the ACA is that there has been no surge in doctor visits and other efforts to seek medical care. If the economic studies are correct, however, the newly insured will eventually try to consume twice as much health care as a result of their insurance. Along the way almost everyone else is being forced to have more generous insurance than they previously had and with these new benefits they are likely to seek more care. Bottom line: we are in the process of greatly expanding the demand for care while doing virtually nothing about supply.

As waiting times grow longer, those who can afford it will turn to concierge care. But every time a doctor elects to become a concierge doctor, she gives better access to about 500 patients while leaving 2,000 to fend for themselves. Add to this the growing pressure by third-party payers to keep fees down and the doctor response is predictable. Those who are in plans that pay below market will be the last patients the doctors see. And unfortunately these are the most vulnerable populations: the elderly and the disabled on Medicare, the poor on Medicaid, and low-income families with newly subsidized private insurance.

To make matters worse, about half the newly insured will be in Medicaid. The recent study of Oregon's experience affirms what previous research had already shown: Medicaid enrollees use the emergency room about 40 percent more than the uninsured. So traffic to our safety-net institutions will be going up, not down, at the very time the ACA will be reducing federal subsidies to these facilities for uncompensated care.

To top it off, provisions of the ACA that mandate preventive care without any deductible or co-payment make it impossible to give enrollees financial incentives to use non-doctor services, which could expand the supply of care while maintaining quality.

There are many things that need to be done to correct all of this. But for starters consider this: Under the ACA the federal government is offering millions of people tax credits for the purchase of health insurance and a great many of them will turn that offer down. Under current law, unclaimed tax credits simply fatten the Treasury's bank account. Instead, these unclaimed subsidies should be sent to safety-net institutions in the communities where the uninsured live. (See an extensive explanation of this idea here.)

Impossible Burden For The Elderly And The Disabled

About half the cost of the ACA is paid for by cuts in Medicare spending and the only practical way those cuts can be made is by reduced fees to providers. The Medicare actuaries have noted with alarm that Medicare fees to doctors will drop below Medicaid levels in the near future and the combined effect of lower Medicare and Medicaid hospital spending will drive one in seven hospitals from the market in the next five years.

Although the administration talks about making Medicare more efficient, three separate reports by the Congressional Budget Office (CBO) have concluded that the pilot programs and demonstration projects that are supposed to find these efficiencies are not working. In fact the only place in Medicare that shows any promise at all is in the Medicare Advantage (MA) program. But the administration is determined to proceed with cuts in MA subsides and appears to be paying no attention whatever to the efficiencies MA entrepreneurs are discovering.

Because no serious budget analyst believes the Medicare spending cuts can withstand the inevitable political backlash and because they don't believe the pilot programs will work either, both the CBO and the Medicare Trustees are annually publishing "alternative forecasts" in an effort to predict how Congress will cave. But if Congress does cave and restores the previous Medicare spending path, that means that the ACA isn't paid for; and that, in turn, means large unfunded liabilities stretching out indefinitely into the future and increasing federal debt.

There is no simple way out of this financial bind. But at a minimum is it time to consider some fairly radical changes to Medicare. Tom Saving and Irecommended nine changes that we think will save taxpayers money, but will also be pleasing to elderly enrollees. We need to do all of that and much more.

Cite As

• “Six Problems With The ACA That Aren't Going Away, " Health Affairs Blog, June 25, 2015.DOI: 10.1377/hblog20150625.048781

I'm searching for my own random three-year-old blog post to copy and paste. Please hold.

dave23 said:
I'm searching for my own random three-year-old blog post to copy and paste. Please hold.

 I can't wait. I won't read that one either.  

dave23 said:
I'm searching for my own random three-year-old blog post to copy and paste. Please hold.

 Thats the issue if facts do not play defer to an obsequious response 

Of course ACA is, how to put it nicely, lacking. Well, really lacking. The biggest ACA fanboys are well-to-do liberals who don't have it.

It has helped some. But not many. Many who got suckered in are wondering what the hell is going on after they and government having paid premiums for years usually get crickets when really sick.

If ACA had a real effect we would see medical bankruptcies go down and the average life expectancy of Americans going up.

It was supposed, with subsidies, to help keep private insurers enriched. I mean, how many industries are so privileged as to get forced customers via IRS penalties? Even that they screwed up. The enrichment seems lacking.

Our real white elephant is Medicare with is lack of coverage. Long term care, vision and dental. Its estimated that 43% of our current population will need long term care, care not covered by Medicare. So, a two partner family it would be greater than 43%. What we will see is a shifting of wealth of the elderly from them to the medical industry. Their descendants will inherit less, if anything.

One of the fastest growing industries is legal elder care. The elderly trying to shift their money to prevent it from being grabbed.  Sadly, for most, by the time they look at that route its too late. The five year look back.

Obama should have concentrated on the Medicare elephant.

Vacanculo said:

dave23 said:
I'm searching for my own random three-year-old blog post to copy and paste. Please hold.

 Thats the issue if facts do not play defer to an obsequious response 

The least you could have done is read it and summarized your primary concerns as they are in 2018 (not 2015).

Anybody see Trump walk back his statement from yesterday? Apparently it is all a giant misunderstanding due to a double negative.

What a relief.

Pretty pathetic as this is so clearly a response to the very negative reception at home.

If Trump really misspoke as he says he did, then his communications people should have been broadcasting that message and clarifying whatever needed to be clarified on the plane home.  

Smedley said:
Pretty pathetic as this is so clearly a response to the very negative reception at home.
If Trump really misspoke as he says he did, then his communications people should have been broadcasting that message and clarifying whatever needed to be clarified on the plane home.  

 He's mortified by the global response, and it was more than just one word.

I don't think he gives a hoot about the global response. He does care about losing political support at home. 

Putin just issued a press release about threatening trump with release of the pee-pee tapes in their private meeting yesterday. He said he misspoke, because it is a digital file and definitely not a tape.

Smedley said:
I don't think he gives a hoot about the global response. He does care about losing political support at home. 

 He cares about being embarrassed and seen as a fraud.

I think that ship has sailed to a large extent.

Trump feeds on global consternation. If those lily-livered Europeans and whoever else disapprove, that's red meat for the MAGA crowd. Globalist ire means Trump is doing something right according to MAGAers.   

Maggots alone will not keep the House and Senate red. 

The President wrote in sharpie “THERE WAS NO COLUSION” during a meeting with congressional members.

https://twitter.com/tom__brenner/status/1019313023893327874

cramer said:
The far-left is doing high fives. Even Gingrich, some anchors on Fox, and many Republicans are condemning what Trump did yesterday, but the far-left is celebrating. 

 Who is the far-left and where are they doing high fives?  

cramer said:

author said:

cramer said:
The far-left is doing high fives. Even Gingrich, some anchors on Fox, and many Republicans are condemning what Trump did yesterday, but the far-left is celebrating. 

 Documentation ?

 Just read Greenwald, Aaaron Mate, Max Blumenthal and others on Twitter. 

 Ok, just saw the follow up.  First those people are not the far left, as to imply extreme.  They are just the left.  The hold normal and reasonable views. And they are not high fiving any one.  They are just trying to make sense of this hysteria, and put it in context of the intelligence community which lies all the time.  Some of you seem to forget that.  Not everyone is going to agree.  No need to attack and mischaracterize.

cramer said:

gerritn said:

cramer said:
The far-left is doing high fives. Even Gingrich, some anchors on Fox, and many Republicans are condemning what Trump did yesterday, but the far-left is celebrating. 

Oh please, so after this Trump performance you think the most newsworthy fact is that the far-left is basically saying "I told you so"? Well, they did, and they were right. And the GOP supported Trump and will continue to support him and therefore deserve to be voted out of office, every single one of them.

 gerritn - I meant that the far-left, and it really is just some on the far-left, are still arguing that Russia didn't hack. It's almost as if they're making Putin's case for him. 

 No one is making the case that Putin did not hack.  Everyone knows that countries hack each other all the time and no one hacks more than the US.  We have interfered in something like 80 elections.  It makes sense that someone would try to hack into ours.  Also, no one is supporting Putin, the authoritarian or Trump.  It would be nice to have some other people instead of Trump and Putin, but that is what it is for now.  What is being asked is real proof of these claims.  The skepticism comes from years of intelligence reports meant to manufacture consent for more wars and regime changes.  The CIA and FBI and NSA are not benevolent entities.  They lie all the time and the possess huge power that trancend presidential terms. News sources such as CNN and MSNBC are increasingly staffed with ex-CIA personal and retired generals (like Brennan--no one should be looking to him--he's reprehensible).  These are the talking heads that thoughtfully try to convince us that the bombing of Syria is a good thing and soon that leadership in Iran needs to be replaced.  You rarely hear an anti-war sentiment. Anyway, after the WMD's in Iraq (which Robert Muller famously lied about), everyone should be skeptical of any of any claim, no matter how many people seem to agree.  A million innocent people died because of the war in Iraq. All is not forgiven just because it's Trump.  Hatred of Trump should not interfere with your critical thinking.

No one’s saying that the thing that happened didn’t happen, we’re just saying that you shouldn’t believe the people telling you that the thing that happened happened. I mean, obviously, it happened, but when THEY tell you it happened, don’t believe them.

ridski said:
No one’s saying that the thing that happened didn’t happen, we’re just saying that you shouldn’t believe the people telling you that the thing that happened happened. I mean, obviously, it happened, but when THEY tell you it happened, don’t believe them.

 Yeah, well that is the way it is.  Deal with it.  Cause when you don't people die.

nan said:

ridski said:
No one’s saying that the thing that happened didn’t happen, we’re just saying that you shouldn’t believe the people telling you that the thing that happened happened. I mean, obviously, it happened, but when THEY tell you it happened, don’t believe them.

 Yeah, well that is the way it is.  Deal with it.  Cause when you don't people die.

I think nan just killed sarcasm. May it rest in peace.

nan said:

 No one is making the case that Putin did not hack.  Everyone knows that countries hack each other all the time and no one hacks more than the US.  We have interfered in something like 80 elections.  It makes sense that someone would try to hack into ours.  Also, no one is supporting Putin, the authoritarian or Trump.  It would be nice to have some other people instead of Trump and Putin, but that is what it is for now.  What is being asked is real proof of these claims.  The skepticism comes from years of intelligence reports meant to manufacture consent for more wars and regime changes.  The CIA and FBI and NSA are not benevolent entities.  They lie all the time and the possess huge power that trancend presidential terms. News sources such as CNN and MSNBC are increasingly staffed with ex-CIA personal and retired generals (like Brennan--no one should be looking to him--he's reprehensible).  These are the talking heads that thoughtfully try to convince us that the bombing of Syria is a good thing and soon that leadership in Iran needs to be replaced.  You rarely hear an anti-war sentiment. Anyway, after the WMD's in Iraq (which Robert Muller famously lied about), everyone should be skeptical of any of any claim, no matter how many people seem to agree.  A million innocent people died because of the war in Iraq. All is not forgiven just because it's Trump.  Hatred of Trump should not interfere with your critical thinking.

nan said:

Ray McGovern, former CIA briefer of The President’s Daily Brief, and William Binney, former Technical Director at NSA critique the indictments and  Memo to the President Ahead of Monday’s Summit https://consortiumnews.com/2018/07/15/memo-to-the-president-ahead-of-mondays-summit/ With Friday’s indictments of Russian intelligence officers, Ray McGovern and Bill Binney have written an open letter to President Trump making clear that the “evidence” behind the indictments is as fraudulent as the intelligence alleging WMD in Iraq. It is being published exclusively here ahead of the Trump-Putin summit on Monday.

 Maybe I'm just a bit confused . . .

nan doesn’t get sarcasm. And she must get her facts and info from the side of a can of beans.

Nan, who exactly is dying if Trump didn’t meet with Putin at this time? Or if he, I don’t know, met with Putin but maybe didn’t disparage our country’s entire intelligence capabilities to a foreign leader? Who would have died? I’m not following.