“And then, one day, health care for all came up.
Just as the Little President had known it would.”
Arthur Applbaum sends the following.
The Health Care Seed
With apologies to Ruth Krauss and Crockett Johnson
A Little President planted a health care seed.
The Speaker said, â€œIâ€™m afraid they wonâ€™t sign up.â€
The Senate Minority Leader said, â€œIâ€™m afraid they canâ€™t sign up.â€
And the Supreme Court Justice said, â€œThey shanâ€™t sign up.â€
Every day the Little President pulled up the bugs
around the seed and sprinkled the ground with facts.
But no one signed up.
And no one signed up.
Everyone kept saying “No one signed up!”
But he still pulled up the bugs around it every day
and sprinkled the ground with facts.
And then, one day,
health care for all came up.
Just as the Little President had known it would.
Those of an earlier vintage may wish to substitute
The Little Healthcare.gov That Could.
Author: Mark Kleiman
Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out.
Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken)
When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist
Against Excess: Drug Policy for Results (Basic, 1993)
Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989)
View all posts by Mark Kleiman
21 thoughts on “The Health Care Seed”
The Little President could use some help.
Here is a challenge aimed particularly at Mr. Pollack and his interviewing skills:
I’d like to hear an interview with some folks who are grateful for Obamacare.
As big media is blowing the cotyledons hard the other way…
And working overtime to convince me that we are nothing but a nation of ingrates, libertarians, and barbarians.
I’ve seen some more in-depth pieces featuring people who found better and cheaper plans on the exchanges. They’re definitely out there. Pretty much any self-employed person with pre-existing conditions, is my guess.
I am now eligible for the stigmatized, barely kept alive Medicaid program, for which I am at least somewhat grateful. It’s hard to be really grateful for something that is so grudgingly and resentfully given, but I’ll work on it. Haven’t signed up yet.
“Iâ€™d like to hear an interview with some folks who are grateful for Obamacare.”
Here’s a chart, based on “brainwrap”‘s work at Daily Kos, that summarises the data on signups since the official data on November 2:
“brainwrap” – an ACA supporter – reconciles his data against the ACA-hostile site Enrollmaven, so they look reliable.
The updates are only available for supportive states that set up their own exchanges (plus outlier Oregon which set up its own exchange that does not work at all). For these, things are going OK. The pace of enrolments has more than doubled in the first half of November. Unfortunately, HHS has not released interim data for healthgov.com, and the states concerned aren’t supportive and are not releasing updates either. So take your pick: healthgov started so badly that it can’t catch up with the independent state sites; or the fixes are good enough that healthgov’s November will be even better than California’s. Nailbiting stuff.
To evaluate these figures, it is necessary to know how many people are eligible to use he exchanges, as opposed to sticking with whatever satisfactory policies they already have. Are those numbers available somewhere?
While I think that ultimately the problems will be solved and the country will have a much improved health insurance system, I still maintain that much of the criticism of the rollout is justified. The Administration dropped the ball here, and kicked it around a bit before finally, I hope picking it up. Some initial problems were to be expected, but what happened smacks of a poor implementation plan, badly managed.
“brainwrap”‘s spreadsheet, to which I linked, has the numbers and percentage of uninsured by state, and a comparison with the takeup curve of Romneycare in Massachusetts.
I don’t agree that the percentage takeup is a very interesting metric just now, compared to the growth rate. A lot of people wait till the last minute; a tendency reinforced for ACA by the severe teething problems of the ACA websites. John Boehner tried to fail an ACA application recently in Washington DC – to his embarrassment, he (or rather his assistant) sailed through.
A little President wanted to plant healthcare seeds. But so much of the ground was already covered with healthcare other people liked, that there was no room for them.
So he got out his little bottle of Roundup, and told the people it was fertilizer. And began spraying. Amd as he sprayed, he planted his own seeds.
After a while, the existing healthcare started turning yellow, and drying up. But the seeds he planted didn’t sprout when he expected them to. So a lot of people died because of his killing off their healthcare.
But it was substandard, so that was ok. The end.
“So a lot of people died because of his killing off their healthcare.” I’m curious. How does this work, for junk policies? You suppose there to be a large set of people with cancelled policies who can’t afford minimum ACA-compliant ones even with subsidies, will prefer to pay the fine, get sick, go untreated, and die?
Yes, actually, it does appear to be the case that a lot of people are losing their policies, and finding that the cheapest legal one is prohibitively expensive. The ACA destroyed a lot of policies held by people who didn’t qualify for any subsidy. In many cases, we’re talking expensive enough that they’re having to chose between insurance and feeding their families.
But, of course, those are just actual facts scattered on the ground, not Mark’s childish fantasy where everything works out in the end for people who are faced with somehow living through the time before that beautiful end.
People earning over 400% of the federal poverty line – the upper cutoff for subsidies – who are “having to chose between insurance and feeding their families”? That’s $78,120 for a family of three, more for a bigger one. Credible examples please, or cut the crocodile tears.
There are of course plenty of such families in the states rejecting Medicaid expansion, earning below 100% of the federal poverty line ($19,530 for the family of three) but above the stingy old state cutoffs for Medicaid. That’s your team’s fault, not ours.
It’s my team’s fault that their policies became illegal? How, because we didn’t fight the ACA hard enough?
BTW, are you aware that the subsidies don’t actually cover the entire difference between your old policy, and the new one?
There are, of course, winners as well as losers. The winners don’t make the losers cease to exist.
There are, of course, winners as well as losers. The winners donâ€™t make the losers cease to exist.
This seems to be the prevalent sloppy opinion of the glib web. Nothing wrong with letting the lazy web do your thinking for you I guess. But for me Obamacare is a win-win. I get to buy affordable health care where before there was none. That’s a win. And there aren’t anymore shoddy half-assed insurance policies out there. How is that a win for me too? Well the public (that’s me) won’t have to dole out the money when some cheapo libertarian shoots himself in the leg and needs emergency room care and his half-assed policy doesn’t cover it. That’s a win for me too.
Let me get this straight: Because you’re a winner, I’m spouting glib nonsense by saying that there are winners AND losers?
Let me get this straight: Because youâ€™re a winner, Iâ€™m spouting glib nonsense by saying that there are winners AND losers?
Wake up and do a reread. I know you are a libertarian and think the world, and thus that post, is all about you. It’s 99% not. It’s about winners and free riders masquerading as losers because they (said losers) now have to carry something akin to basic “collision insurance” on their bodies rather than pass that cost off onto the public when a calamity strikes.
The “winners and losers” thing is cheap thinking that hides the free-riding of the freeriders, much I suppose, as Ayn Rand hid behind a different name when she hopped onto the Medicare roles.
Brett: what you wrote was this: “The ACA destroyed a lot of policies held by people who didnâ€™t qualify for any subsidy. (My italics.) In many cases, weâ€™re talking expensive enough that theyâ€™re having to chose between insurance and feeding their families. ” I showed that this was incredible. Your response is to change the subject. You lost.
The whole signup thing is kinda silly. This is the sort of ill that time heals.
Six weeks or so ago the open enrollment period for Medicare drug plans started. I went online and put my prescriptions into the shopping site. https://www.medicare.gov/find-a-plan/questions/home.aspx
It was apparent that at least some of the plans had not entered info into the system since my current plan showed up as the best deal at its last years premium–I knew the premium had changed since I had gotten a U.S. Mail notice from the company about the change.
Since this was the first day of the shopping and open enrollment period I decided to let things ride.
A few days ago I went back to the site, found lots more info and a cheaper, new plan.
It wasn’t hard.
Of course, it would have been better if everything had been completely ready on day one but sometimes it take a little while to get things rolling.
Patience is a virtue.
“The whole signup thing is kinda silly. This is the sort of ill that time heals.” I couldn’t agree more. However, a lot of Democratic pols and pundits have got the jitters just now from the media doom circus. Posting the not-so-bad numbers (which I also did here) may calm them down.
Courtesy of Andrew Koppelman at Balkinisation, a free paper by Kentucky law professor Nicole Huberfeld arguing that the state resistance to Medicaid expansion has been overestimated in press reports. There are only six really firm holdouts: Alabama, Louisiana, Mississippi, North Carolina, South Carolina, and Texas, the core of the old Confederacy. All the others are pursuing alternatives like Arkansas’ approved scheme, studying options, or split between governor and legislature. The availability of pots of federal money has created wide prospects for movement.
My family currently has no health insurance because we can’t afford it (even though my pre-existing conditions are no longer an issue!). After getting subsidies, come January 1st, we will all have access to health care. I can’t begin to tell you how thrilled we are. As are our friends and family. They know we aren’t just “moochers” and are trying our best.
The bugs will be ironed out, millions more just like us will sign up for quality plans after seeing how incredible the subsidies are. Universal coverage will become the new norm and people will wonder why it wasn’t always so.
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