Proof Texting the ACA

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Richard Hershberger

Richard Hershberger is a paralegal working in Maryland. When he isn't doing whatever it is that paralegals do, or taking his daughters to Girl Scouts, he is dedicated to the collection and analysis of useless and unremunerative information.

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  1. Avatar DensityDuck
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    says:

    Again, the claim appears that the text doesn’t actually matter, what matters is the intent behind the text.

    So I guess 1300-odd pages of text could have been replaced by a single sentence: “We resolve that all the problems will henceforth be solved.” Anything else is just minor details that you’re quibbling over, really, not raising serious objections to, and you’re only doing it because you’re a racist–I mean, you’re partisan.

    “All the indignant huffing and puffing at the ruling is the same as the huffing and puffing we get in the church: Words have meaning! ”

    So if I call someone a retard and Rose gets angry, I can tell her that she’s just huffing and puffing about how words have meaning and it doesn’t matter what actual words I used, only the intent, and parsing out individual bits of text and pretending they’re important is a useless distraction from the larger matters at hand which only goes to show how she’s a child that shouldn’t be taken seriously.Report

    • Avatar nevermoor in reply to DensityDuck
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      says:

      I’ll engage with you as soon as you engage with the actual argument, instead of your imagined argument.Report

      • Avatar Richard Hershberger in reply to nevermoor
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        says:

        Hence my lack of a reply.Report

        • Avatar Tod Kelly in reply to Richard Hershberger
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          says:

          OTOH, I think that might well be the purest distillation of primal screaming I’ve heard on the ACA to date. It’s like an entire afternoon of talk radio, put through the crucible and rendered into something approaching mov-con purity: Random protests of racism accusations not related at all to the topic, straw man razing, slippery slopes carried through to absurdity, gratuitous use of the r-word seemingly for the sake of pissing off liberals.

          I think it’s kind of genius. If it had a brief pause in-between the first and last two paragraphs to tell me to call 1-800-Goldline, it would be perfect — but even without that, it’s pretty close.Report

      • Avatar DensityDuck in reply to nevermoor
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        “I’ll engage with you as soon as you engage with the actual argument, instead of your imagined argument. Words have meaning! This snippet of text I have dredged up and yanked out of context is perfectly clear! You pointy-headed liberals are denying clear TRVTH! feh. This is barely fit for the kiddie table. The adults are trying to hold an adult conversation.”

        primal screaming, eh? lol.Report

  2. Avatar Kazzy
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    says:

    Damn, bro. Awesome!Report

  3. Avatar Tod Kelly
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    says:

    Huh. I’m not entirely sure I agree with the thesis, Richard, but I’m not yet sure why. This is a fascinating comparison.Report

    • Avatar zic in reply to Tod Kelly
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      Yeah; I’m not sure I agree, but it is fascinating.

      I do think that ‘proof texting’ is a real thing; but I’d say it’s rooted in confirmation bias, and something we’re all prone to doing. That it rears its head in religious themes more often than most isn’t surprising to me, since most religious belief of old texts rests upon appointing specific texts as holy and then using those texts to make your point, confirming your bias.

      ETA: great post, Richard; something to chew on. Thank you.

      But I think it’s as much to do with confirmation bias as anything; which was the funny of Roberts using Scalia’s arguments on ACA against him yesterday.Report

      • Avatar Richard Hershberger in reply to zic
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        Oh, proof texting (which is most definitely a thing) is all about confirmation bias. There is no question about that. (I know because I found a text that says so…) It is a particularly pernicious form in the religious context, combined as it frequently is with the claim to a “literal” reading of the text (or its weasel sibling, “plain meaning”). You have your favored proof text. You also hold that its meaning is plain. There is no need for any further investigation or analysis. Quite the contrary, the intent behind any further investigation or analysis can only be to obfuscate what is plainly true. The only possible reasons anyone can disagree with you is that they are fools, dupes, or liars. There is no point in engaging any argument: only in denouncing it.

        This may seem like a caricature, but it is the standard M.O. in many fundamentalist circles.Report

        • Avatar Tod Kelly in reply to Richard Hershberger
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          says:

          @richard-hershberger Now that I’ve had some time to think about it, I think I’ve figured out why your comparison seems not quite perfect to me: Intent.

          When I read instances of people who do proof texting, I have a tendency to trust in their sincerity, if not their scholarship. I think David Barton, for example, or even someone like Brian Fischer, as fairly unreliable sources — but I never have a sense that they don’t truly believe that what they believe have uncovered is God’s own truth.

          The case of King, however, seems more to me like an attorney trying to get a case thrown out on a technicality. I never had a sense that the plaintiffs or those arguing on their behalf ever believed they had found anything but a mis-wording that they could leverage into having the entire law scrapped.

          Still, even with that criticism on my part, I still actually find your comparison oddly on target, and think there is a great deal of truth to it.Report

          • Avatar Richard Hershberger in reply to Tod Kelly
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            says:

            I was writing more about the shouting in response to the ruling than about the people who brought the case in the first place. In the religion context, these are the people who are always ready to quote the selected proof text for whatever topic is at hand. The vast majority of them didn’t search through the Bible and find those texts themselves. These texts were fed to them, for later regurgitation. In the case of the ACA, these people are primed for the argument by the long experience of Biblical proof texts.

            As for the originators of the argument, I don’t think it matters whether or not they are sincere. Is David Barton sincere? I don’t know. Nor do I particularly care. Sincerity is the cheapest of virtues. If you can make shit up while sincere, sincerity clearly is not that big a deal.Report

            • Avatar Tod Kelly in reply to Richard Hershberger
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              says:

              In that light, I like your comparison even more.

              As to the sincerity part, I don’t think it matters much in terms of the actual scholarship. I do think it matters to me, though, for admittedly personal reasons. Someone who disagrees with me about, say, SSM because they have sincere religious beliefs is someone I can try to find common ground with to see how to better work together. On the other hand, someone who really doesn’t have a problem with SSM but uses it as a wedge issue for political ends — what need do I have to talk to that person?Report

              • Avatar aaron david in reply to Tod Kelly
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                @tod-kelly
                So you are saying that all opposition to the ACA is only about it as a wedge issue?

                I find that to be a very bad faith understanding of a huge percentage of the country.Report

              • Avatar Saul Dregraw in reply to aaron david
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                says:

                @aaron-david

                I’ve said it before and I will say it again but I just don’t get how a welfare state is incompatible with notions of liberty and democracy.

                I am willing to give ACA opponents the sincerity of their beliefs that a welfare state and democracy are incompatible but I think they are wrong. Not only that, they are wrong in a way that just seems to come from Mars to me.

                Then again, I generally think I use a very different definition of liberty and freedom than many Republicans.Report

              • Avatar aaron david in reply to Saul Dregraw
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                says:

                Well, forcing me to buy something I have no need for != welfare. I don’t think that they are incompatible in theory (welfare and democracy) but this ain’t it.

                What i am mostly referring to is Tod and Richard seemingly not accepting that others might legitimately feel that this is a horrible law that is not a plus for the country. And I suspect that if an anti abortion law were passed, both would support any and every possible legal method used to fight it.

                This strike me as highly disingenuous.Report

              • Avatar Tod Kelly in reply to aaron david
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                says:

                Again, I have zero idea how you went from what I said to what you say I said.

                You know that there’s a pretty long track record on this site that says that *I* think the ACA is a terrible law, yes?Report

              • Avatar aaron david in reply to Tod Kelly
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                says:

                Actually, I have never read anything by you saying you didn’t like the ACA.

                I am guessing that I just missed it.Report

              • Avatar Tod Kelly in reply to aaron david
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                says:

                Ah. I’m now wondering if maybe you weren’t a regular back when the ACA was all we talked about round here.

                Well then, in that case: required reading:*

                https://ordinary-times.com/blog/2013/10/09/on-obamacare-and-the-real-u-s-healthcare-crisis-part-i-a-look-in-the-rearview-mirror/

                *In this case, ‘required’ means that you are really, really bored and have absolutely nothing to do right now. 🙂Report

              • Avatar aaron david in reply to Tod Kelly
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                says:

                @tod-kelly
                I will sink my teeth into it! (Libertarian vampire soul sucking teeth!)
                And no, I was hanging around TAS then.Report

              • Avatar Tod Kelly in reply to aaron david
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                says:

                Yeah, when you said you had no memory it hit me that must be the reason. (It really was about the only thing we ever talked about roof a year.)Report

              • Avatar nevermoor in reply to aaron david
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                says:

                forcing me to buy something I have no need for != welfare

                The only universe in which you have no need for health in insurance is one where (1) there’s a single payer system so you’re covered already; or (2) you don’t mind leeching off of free emergency room service. Unless you’re the first human ever to be able to self-heal in the event of injury.

                I suspect that if an anti abortion law were passed, both would support any and every possible legal method used to fight it.

                This is absolutely not true. I can imagine democrats (as in the party and its federal representatives, not random bloggers or getting behind a theory that relies on cherry-picked textual analysis that ignores all but convenient phrases. I can’t imagine them doing so when they ALSO have to pretend that no one said something that everyone just spent years saying over and over again. Maybe that’s all changed now, the way filibuster practice has irreparably changed, but I very much doubt it.Report

              • Avatar aaron david in reply to nevermoor
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                says:

                “The only universe in which you have no need for health in insurance is one where (1) there’s a single payer system so you’re covered already; or (2) you don’t mind leeching off of free emergency room service. Unless you’re the first human ever to be able to self-heal in the event of injury.”

                As a 44 year old man married with a vasectomy, I have ZERO need for birth control. And yet, here we are. I would infinitely rather have the poor given free coverage throw the emergency services of any local, local determining the specifics. These are pretty normal positions for Libertarians to take on this subject, though we are a fractious bunch and have many other positions regarding healthcare.

                And yes, I absolutely believe that the pro-choice side (as I am one) would fight tooth and nail, every last little uncrossed t and undoted i. Just as the anti-death penalty movement does.Report

              • Avatar greginak in reply to aaron david
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                says:

                Oh FSM not this argument again. If you don’t need birth control then don’t buy it. You aren’t being forced to take BC pills just like you aren’t being forced to have a hysterectomy or have a million other cures applied that you don’t need. You don’t have cancer….GOOD….so then you don’t need chemo. Hope you never need it. But health insurance isn’t sold based on a list of million possible illnesses or injuries you might get with you picking which ones are covered.Report

              • Avatar nevermoor in reply to aaron david
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                says:

                Ok, so it’s not insurance you don’t need, just certain minimum coverages (that don’t move the dial on your monthly premiums at all). That’s certainly true.

                I would infinitely rather have the poor given free coverage throw the emergency services of any local, local determining the specifics.

                So you’re in favor of massive cost inefficiencies? And I’m not sure what “specifics” you mean, as ERs have a legal obligation to stabilize anyone who walks in the door.

                Just as the anti-death penalty movement does.

                The death penalty folks haven’t brought a case as looney as King, at least that I’m aware of. For your claim to be true, not only would such a case have to exist, it would have to be supported by all significant democratic politicians. So, [citation needed]Report

              • Avatar LeeEsq in reply to aaron david
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                says:

                @aaron-david, you might have no need for birth control but what if you get injured in an accident? The reason people have health insurance is because most people can not afford a lot of medical care out of pocket unless they are very rich and stuff happens. You can do everything possible to be in good health and still get gravely injured in an accident and need a lot of care.Report

              • Avatar LeeEsq in reply to aaron david
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                says:

                If we could actually get Medicare for all passed through Congress than we wouldn’t need to resort to the Bismarckian ACA. Since many powerful people oppose Medicare for all, we are stuck with the ACA.Report

              • Avatar aaron david in reply to LeeEsq
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                says:

                Well @leeesq maybe that is what the left should have spent its capital on in the first place.Report

              • Avatar nevermoor in reply to aaron david
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                says:

                You’d love for us to have blown a unique opportunity on something better but politically unachievable. I’m comfortable with the choices Obama made on this one.Report

              • Avatar LeeEsq in reply to aaron david
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                says:

                What nevermore said. There was no way to get medicare expanded to cover everybody and you know it. This was the chance for some form of universal healthcare.Report

              • Avatar Tod Kelly in reply to aaron david
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                says:

                Um… No. Not at all.

                In fact I’m struggling a bit to figure out how you got from what I said to what you said I said.

                Was that supposed to be ironic on the whole “bad faith” front?Report

              • Avatar aaron david in reply to Tod Kelly
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                says:

                No irony @tod-kelly , but see my response to Saul.Report

              • Avatar aaron david in reply to Tod Kelly
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                says:

                “The case of King, however, seems more to me like an attorney trying to get a case thrown out on a technicality. I never had a sense that the plaintiffs or those arguing on their behalf ever believed they had found anything but a mis-wording that they could leverage into having the entire law scrapped.”

                In my eyes, yes that should absolutely be enough to get it thrown out. I feel that there should be zero deference and plain reading should prevail. As do many others. But in any case that is were I got my bad faith feeling.Report

              • Avatar nevermoor in reply to aaron david
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                says:

                That’s not how the law works on any statute. It just isn’t.

                King’s side put forth one possible reading. The Government put forth another. So tie goes to the legislative intent, which was 1000% unambiguous.Report

              • Avatar Tod Kelly in reply to aaron david
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                says:

                There is a fairly large amount of real estate between saying, “this lawsuit filed against law X is based strictly on a technicality and is an example of legal maneuvering,” and saying “everyone opposed to that law is insincere in their motives.”

                Like, a LOT of real estate.Report

              • Avatar DensityDuck in reply to aaron david
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                says:

                “I find that to be a very bad faith understanding of a huge percentage of the country.”

                Some people have absolutely no trouble believing that half of America–more than half, actually–are viciously racist homophobic misogynists who honestly believe that black people are genetically inferior, that women are less intelligent, that homosexuals are degenerate perverts.

                I don’t get why; it seems like a really disheartening way to live your life, believing that most of the people you see are actively evil rather than uncaring or uneducated. But on the other hand, it offers a vast opportunity for self-dramatization, so I guess maybe that’s the angle.Report

  4. Avatar Saul Degraw
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    says:

    And then in Judaism, we have the Talmud. The Talmud is thousands of pages dedicated to debating what the Torah means:

    https://en.wikipedia.org/wiki/TalmudReport

  5. Avatar nevermoor
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    says:

    ACA Commentary Award to Nicholas Bagley:

    The plaintiffs’ position has always reminded me of an old Amelia Bedelia story. When the literal-minded but bighearted housekeeper is told by her employer to weed the garden, she decides to plant a big row of really big weeds. “She said to weed the garden,” insists Amelia Bedelia, “not unweed it.”

    When asked why anyone would want more weeds, Amelia Bedelia has to stop and think. “Maybe vegetables get hot just like people,” she says. “They need big weeds to shade them.”

    Report

  6. Avatar Jaybird
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    says:

    Has the ACA been fully implemented yet?

    Periodically, I read stories about how stuff keeps being delayed for another six months. Has that ceased, finally?Report

    • Avatar Road Scholar in reply to Jaybird
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      says:

      Jaybird,

      I believe so, yes. As originally written I believe the last pieces were supposed to take effect in 2014. There was a one year waiver granted for the implementation of some manner of compliance for employer-provided plans but that was a couple years ago. But I’m not close to being an expert.

      I’m probably gonna regret this, but why do you ask?Report

      • Avatar greginak in reply to Road Scholar
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        The employer mandate was delayed and starts next year. I say that all the states that haven’t expanded medicare to cover millions more people isn’t an ACA delay and more just a clear example of how a certain party view covering health care. But that isn’t on the ACA…the supreme court, yeah that’s on them.

        So maybe there is an argument that we haven’t seen the full horror of the ACA until it’s fully enacted. And there is a just as good, if not better, argument we haven’t seen all the benefits of the ACA due to the reluctance of one party to want millions to get HC.Report

      • Avatar Jaybird in reply to Road Scholar
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        In the past, when I’ve complained about this or that with regards to the PPACA or asked questions about whether the lives saved by the plan are measurable yet, I’ve been told stuff like “it’s not fully implemented yet, it’s not fair to reach conclusions yet”, and that sort of thing.

        Now that it has passed the Supreme Court and is unlikely to be challenged to that degree again for a good and long while, I’m guessing that anyone who had been dragging their feet due to uncertainty has now had their uncertainty cleared up good and hard and the only thing keeping it from being implemented at this point would be Congress kicking the can down the road a ways again.

        Soon we will be able to ask questions about measurables for real. How much it cost and, according to the actuarial tables, how many people it helped.

        This is a good thing.Report

        • Avatar nevermoor in reply to Jaybird
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          says:

          Here’s some of that information.

          Uninsured are 7.5% in states following the full ACA plan (i.e. expanding medicaid) and 14.4% in states that prefer to cause suffering among a low-income segment of their population to make a political point.

          Enrollment is over 10 million. And maybe it’ll go up more soon since marriage is a qualifying event for starting coverage outside of open enrollment, and there may be a spike in marriages this month for unknown reasons.Report

          • Avatar Kolohe in reply to nevermoor
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            says:

            Man, y’all really don’t give a shit about intellectual honesty, do you?Report

          • Avatar KatherineMW in reply to nevermoor
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            says:

            If buying health insurance is now mandatory, how are there still so many uninsured people? Are they all subject to the penalty/tax for not buying insurance? And if they are, wouldn’t that mean that the ACA has added an additional financial burden to people who previously couldn’t afford health insurance, still can’t afford health insurance, and now need to pay a penalty for not buying it?

            I’m not claiming that is the situation, it’s just the question the stats you’ve quoted raise for me.

            In terms of assessing the ACA’s positive consequences, I’d want something other than “number of people insured”. Presumably if you require people to buy insurance, more of them will buy it; that’s not convincing evidence of improvement. Convincing evidence might involve, for a few possible examples, 1) stats on people’s health; 2) stats on the number of health-care related bankruptcies; 3) stats on average costs of health-care plans now compared to before the act; 4) stats on the percentage of their income that people are using for health care (disaggregated by income level). I’m sure there’s other possible stats too. But “we required people to purchase insurance, and more of them purchased it” isn’t by itself proof of positive effect – just proof of an effect.

            (For reference, I favour public health care, but would have vastly preferred the ‘public option’ that the Democrats initially opposed and that the Republicans shot down. It would have been better for libertarians, too, in terms of having less regulation and no mandate. It being less objectionable on numerous fronts is of course why the Republicans shot it down – if they hadn’t driven the Democrats to go for a mandate instead, as a ‘compromise’, they couldn’t have railed against a mandate. I’m concerned that the ACA is more a corporate giveaway than a means ensuring affordable access to health care.)Report

            • Avatar nevermoor in reply to KatherineMW
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              says:

              A couple things:

              1. There are people it was never intended to cover (e.g. illegal immigrants)
              2. There are people who will fail to register for various reasons (ideology, inability to follow procedures, etc.) so you’ll never see 100%
              3. And, the biggest by far, because states refusing the medicaid expansion create a donut-hole where subsidies don’t kick in but you’re out of your state’s old medicaid program. That’s on the Supreme Court. To your question, I don’t believe they are penalized for not carrying coverage because no affordable coverage exists.

              As to your other point, those other things are absolutely important. Here’s a survey looking at some of it. And the NYT’s reporting on that survey.

              Another metric of success you don’t mention is the ACA’s effect on the budget. There, too, the news is good. The CBO continues to upgrade its analysis of the Act’s total budgetary impact, now putting the cost of repeal at $353B over ten years.Report

              • Avatar KatherineMW in reply to nevermoor
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                Thank you! That’s very informative.

                The number of adults who did not get needed health care because of cost declined from 80 million people, or 43 percent, in 2012 to 66 million, or 36 percent, in 2014. The number of adults who reported problems paying their medical bills declined from an estimated 75 million people in 2012 to 64 million people in 2014.

                That’s…okay, but less than I would like to see. It’s a dent rather than a fix. If it’s the end result of the ACA, that’s pretty poor; if it’s the first point in a trend, with similar yearly decreases in future, it’s impressive. Since the stats are from mid-2014, and there were a lot of new enrollments in plans through the health-care marketplaces in 2015, we can have reasonable hopes that there will be further improvements.

                Another big point in the linked study that stood out is that nearly half of the remaining uninsured people would (based on income) be eligible for the Medicaid expansion. So if the remaining states would stop being recalcitrant and harming their own citizens, that would make a huge difference.

                So this indicates there’s a definite, though not massive (it’s basically gotten the status quo back to what it was in the early 2000s), positive impact from the ACA.Report

            • Avatar Road Scholar in reply to KatherineMW
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              says:

              KatherineMW: If buying health insurance is now mandatory, how are there still so many uninsured people? Are they all subject to the penalty/tax for not buying insurance? And if they are, wouldn’t that mean that the ACA has added an additional financial burden to people who previously couldn’t afford health insurance, still can’t afford health insurance, and now need to pay a penalty for not buying it?

              A lot of the remaining uninsured are due to an unfortunate quirk in the law that was made much worse by the first ACA lawsuit decision. The original intent was to expand Medicaid eligibility up to (IIRC) 138% of the poverty line with the Feds picking up 100% of the cost initially and most of it later. The subsidized exchange plans kick in at that 138% level and eventually peter out around $80k. When SCOTUS ruled that the states couldn’t be forced to expand Medicaid it left an ugly hole in the scheme for people that make too much to qualify for the un-expanded Medicaid but not enough for the subsidies on the exchange. It was likely just naivete to not consider the possibility that Republicans would actually be willing to kill their own citizens to score political points.Report

              • Avatar KatherineMW in reply to Road Scholar
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                says:

                It’s a special kind of cruel contrarianism for states to say to the federal government, “no, you’re not allowed to give money to our low-income citizens, we’d just rather they be sick and miserable even if helping them doesn’t cost us anything”.Report

              • Avatar LeeEsq in reply to KatherineMW
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                says:

                It gets worse. Rick Scott of Florida doesn’t want to expand medicaid but he wants the Federal money that would have expanded medicaid.

                http://www.lawyersgunsmoneyblog.com/2015/05/rick-scott-todays-ideal-republicanReport

              • Avatar KatherineMW in reply to LeeEsq
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                Ugh. I understand the political maneuver, because that’s a continual issue up here with Québec – “we don’t want federal funds put towards a federal program in Quebec because we think it infringes on our jurisidiction; but we DO want you to just give us the money that would have gone towards it”. Usually the feds give in and give them the money.

                However, Québec’s generally leftwards of the rest of Canada on economics, so at least when they’re pulling that kind of stunt they would generally actually provide the money/services to the people who need it, just through their own program rather than a federal one.Report

        • Avatar Road Scholar in reply to Jaybird
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          says:

          Jaybird: Soon we will be able to ask questions about measurables for real. How much it cost and, according to the actuarial tables, how many people it helped.

          We have some of that already although it depends on what questions you ask and (natch) who you ask. One articlein today’s NYT says:

          In 2014, the number of people without health insurance coverage fell to 36 million from 44.8 million in 2013, a decline of nearly 20 percent, according to data released this week by the National Center for Health Statistics.

          Paul Krugman also has a piece today that adds to that:

          Massachusetts has had guaranteed health coverage for almost a decade, but 5 percent of its nonelderly adult population remains uninsured.

          Suppose we use 5 percent uninsured as a benchmark. How much progress have we made toward getting there? In states that have implemented the act in full and expanded Medicaid, data from the Urban Institute show the uninsured falling from more than 16 percent to just 7.5 percent — that is, in year two we’re already around 80 percent of the way there.

          On the spending/cost side:

          What about costs? In 2013 there were dire warnings about a looming “rate shock”; instead, premiums came in well below expectations. In 2014 the usual suspects declared that huge premium increases were looming for 2015; the actual rise was just 2 percent. There was another flurry of scare stories about rate hikes earlier this year, but as more information comes in it looks as if premium increases for 2016 will be bigger than for this year but still modest by historical standards — which means that premiums remain much lower than expected.

          And there has also been a sharp slowdown in the growth of overall health spending, which is probably due in part to the cost-control measures, largely aimed at Medicare, that were also an important part of health reform.

          Now all of this is early and there’s a lot of shaking out yet to occur but the preliminary results look encouraging. Certainly the doom and gloom faction has little actual facts on their side. I would guess that a full assessment is going to have to wait another five, maybe ten, years?Report

          • Avatar North in reply to Road Scholar
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            says:

            Basically all the preliminary signs are pretty positive. The predicted negative outcomes have so far failed to materialize, the hoped for improvements have generally come about. If the ACA were GOP sponsored legislation they’d be throwing parades in the streets over it (though the libertarian faction, in fairness, would remain appalled).Report

          • Avatar Brandon Berg in reply to Road Scholar
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            says:

            “More people have insurance” is not a health outcome. Over and over we were told that our health care system is the reason that Americans have worse health outcomes than Western Europeans. So we can expect significant convergence over the next few years, right?

            The ability of massive insurance subsidies to increase rates of health insurance participation was never really in doubt. The question is whether it will lead to actual improvements in health outcomes that justify the cost.

            Now, I’m a reasonable person. I realize that these things take some lead time. I don’t expect improvements to happen immediately. What I do want is for proponents of the ACA to make themselves accountable by making some predictions. When will, say, the gap between US and European infant mortality and disability-adjusted life expectancy shrink to half its current level? If that fails to happen, at what point will you admit that you were wrong?Report

            • Avatar nevermoor in reply to Brandon Berg
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              says:

              Hello goalpost shifting.

              The ability of massive insurance subsidies to increase rates of health insurance participation was never really in doubt.

              Not true.

              If that fails to happen, at what point will you admit that you were wrong?

              No. If the ACA isn’t net-positive on the budget, doesn’t bend the curve of health care cost increases, doesn’t cover more people, and doesn’t reduce the number of health-related bankruptcies, and doesn’t prove to be an improvement on the pre-ACA situation, then I’ll admit the policy was bad. It doesn’t rise and fall on some specific health-outcome, because it’s about, well, affordable care.

              What will it take for you to admit you were wrong?Report

            • Avatar North in reply to Brandon Berg
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              says:

              Well BB since we didn’t exactly or anywhere near adopt a European healthcare system i dunno what outcomes you can expect. But contra the conservative or libertarian predictions the bad outcomes that were predicted have so far made like Inflation for the last eight years and done gone and refused to appear. So at this point we’re arguing over how much good the ACA is accomplishing which strikes me as suggesting that the liberals have been right on this particular issue so far.Report

              • Avatar LeeEsq in reply to North
                Ignored
                says:

                But north, conservative principles say that liberalism is always wrong and will only lead us to serfdom. Sure you get health insurance but sooner than latter your going to be working for the manor born. What is good health if your not a free person? (Sarcasm).Report

            • Avatar LeeEsq in reply to Brandon Berg
              Ignored
              says:

              If more people have health insurance, more people are likely to go to the doctor sooner than latter or wait till the last possible minute for emergency room care. This will lead to earlier intervention and better health.Report

              • Avatar Brandon Berg in reply to LeeEsq
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                says:

                @leeesq Yes, I understand that there are theoretical reasons to believe that it may significantly improve health outcomes, but there are also reasons to believe that this effect will be small, even negligible.

                These reasons include the fact that much of the US-Europe life expectancy gap is due to car accidents, homicide, and lifestyle issues not particularly amenable to medical treatment; the likelihood of relatively poor compliance on the part of previously uninsured individuals, reducing the effectiveness of medical treatment; the findings of the RAND health insurance experiment; the fact that even high-SES Americans have shorter life expectancy than high-SES Europeans, despite the fact the high-SES Americans have pretty good health care; and the persistence of large SES-based gaps in health outcomes even in countries with universal health care.

                Consequently, I don’t expect the US-Europe gap in life expectancy to close significantly as a result of Obamacare. I would be surprised at a 25% reduction and shocked at a 50% reduction. If anyone wants to make any bets, I’m game.Report

              • Avatar Road Scholar in reply to LeeEsq
                Ignored
                says:

                LeeEsq: If more people have health insurance, more people are likely to go to the doctor sooner than latter or wait till the last possible minute for emergency room care. This will lead to earlier intervention and better health.

                This is actually an interesting issue that isn’t quite as cut and dried as we might like to think. A few years ago a rather unique opportunity for a natural experiment presented itself. For one reason or another the state of Oregon found itself with an additional chunk of money it could spend on its Medicaid program, enough to enroll another 100k or so people. Again, for reasons I don’t recall, they decided to enroll new people using a lottery system from the pool of low-income uninsured.

                The result was what amounted to a randomized experiment complete with a control group that didn’t make the lottery cut that could be used to test some prognostications regarding health outcomes and such.

                As I recall the results weren’t as dramatic as one would hope. It turned out that cultural issues and patient education (or really, re-education) were key determinants. For folks without insurance “healthcare” was something you got when you were sick at the emergency room or free clinic. That didn’t really change for them when they gained insurance so absent some education in how to actually use the health care system like middle class consumers a lot of the predicted improvements related to prevention, early intervention, and maintenance of chronic conditions failed to materialize. Lessons learned.Report

              • Avatar gregiank in reply to Road Scholar
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                says:

                There was a big study in Mass. after the implementation of Romneycare in 06. Short version all cause mortality went down.

                Changes were largest in places where fewer people had previously been uninsured. There was a 3% decline in deaths over a four year period.

                http://annals.org/article.aspx?articleid=1867050

                http://www.nytimes.com/2014/05/06/health/death-rate-fell-in-massachusetts-after-health-care-overhaul.html?_r=0Report

              • Avatar DensityDuck in reply to Road Scholar
                Ignored
                says:

                You can give me all the free doctor visits you like, but if those doctor visits are only available during the times that I have to be on shift at Taco Bell then I’m still only ever going to the emergency room.Report

  7. Avatar LWA
    Ignored
    says:

    Proof texting is a good analogy, and forms sort of the foundation of a lot of what I call the fundamentalist viewpoint in politics.

    As in, there exists a Scripture, a Universal Truth, and our goal should be to bend ourselves to it, as our highest order objective Good.

    The scripture can be literally that, or some moral value like Fairness (favored by liberals) or Liberty (favored by conservatives).

    In modern Anglo-Catholic theology, solo scriptura is out of favor, and the “three legged stool” of scripture, tradition, and reason are used.

    So scripture can form a basis, then tempered by cultural traditions and reason to come to a just conclusion. Which seems more in line with the “living document” school of Constitutional thought than the “originalist” position.

    For my own sake, it also helps explain why I have such an aversion to the big “isms” like socialism and libertarianism- they seem rather fundamentalist in their universalist approach to things.Report

  8. Avatar Brandon Berg
    Ignored
    says:

    Kolohe:
    Man, y’all really don’t give a shit about intellectual honesty, do you?

    He used to, but nevermoor.Report

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