Tuesday, August 7, 2012

Virginia v Sibelius: Another Such Victory and We Are Undone

A collection of notes, instead of a long piece.

Winners

Health insurance companies!!!!

Yes, everyone's favorite insurance companies will make out like bandits. In exchange for a modest reduction in gross profits (to 15-20% per insured), this weakly-regulated oligopoly will get the entire country as customers, mandated by the federal government.

Pharmaceutical and medical equipment suppliers

And these firms will make out like bandits, because they'll be getting millions of new customers and are weakly-regulated.

I think I detect a pattern here.

Obama

His signature bill survived.

John Roberts

He gets to write a largely conservative decision and saves the prestige of his institution.

Losers

People in red states, especially the poor and the brown-skinned

The working poor will get slammed because the red states are planning not to implement the Medicaid expansion. There will be people who are not covered by either Medicaid or the Affordable Care Act and this group will be disproportionately brown; for an analysis, see David Dayen, link. The same states are planning not to create the insurance exchanges that the ACA mandates, despite the law. And, finally, when those states do implement the ACA, their weak insurance regulators will be the ones overseeing its implementation. In such places, the low end insurance mandated by the ACA is likely to be insurance that can't be used at prices that can't be paid.

The Economy?

No-one I have seen has done any modeling to the end of predicting the macroeconomic impact of the ACA. The ACA mandates an expansion of health care, which might be stimulative, but it is also, in effect, a tax, which might be regressive. If the effect is regressive, full implementation could make the on-going depression worse. If the depression continues, it will also fall disproportionately on the young, who will be required to spend scarce money on insurance.

The Law

The decision is exceptionally incoherent. Future cases regarding Federal power will be hard to decide. It is likely the decisions will be arbitrary, based on politics, rather than a consistent legal or ethical basis.

Progressives

Every new Federal spending program will be subject to the incoherence of this decision, the question of how will the Court rule on it.

Wingnuts 

The didn't get their cruel decision, and the 1930s and 1940s Commerce Clause decisions stand, albeit in weakened form.

And then there's that third thing

That is, people who are both winners and losers.

The middle class and working poor

Why are these people listed last? But in fact Because they are last; Congress and the President put the insurance companies's profits before the majority of the public. Some of this group will, at long last, get needed health care. Others will get costly inadequate insurance.

Young people

Who will have to pay into this system, though their incomes are low and they are the lightest users of health care. For a minority of young people, however, the mandated insurance will be a literal lifesaver.

Women

The ACA requires that a range of women's preventative care be covered without a co-pay. This is a huge thing. On the other hand, the ACA cuts insurance coverage for abortion. Again, this will probably hit hardest in red states, but in all states it is potentially a killer.

Conclusions

Thanks, guys! We really needed this mess. Why, oh why, could Congress not have seen the way clear to Medicare for All?

2 comments:

G. Tingey said...

I THOUGHT (CHarlie told me @ a con) that the insurance cos will get screwed down-the line.
They are required (?) to show a 90%+ plough-back of their monies into health-care.
I think ONE co in the uSA gets above 85% (Kaiser??)
But it can be done.
Here in the UK the NHS manages about 96% and BUPA (A private provider) manages 93%.

Could be very interesting

The Raven said...

It's 85% "medical loss ratio," not 90%. But they will make it up on volume and on pushing unnecessary care. Tens of millions of currently uninsured people, many of them young people with few health problems, will be required by law to sign up.