Why Can’t Bill Supporters Say “Affordable”?

Like Nate, I appreciate having a discussion based in facts and details. And Nate says several of the cost estimates I used to show why the health care bill is unaffordable for middle class families “are on the high side.” I appreciate him checking my numbers–as I have said on several versions of the post I have done on affordability, I’d like to have a real discussion about these costs.

Nate’s numbers are too low

Nate uses a different method than me; rather than building costs up from individual estimates as I did (indeed, Nate never shows what my hypothetical family’s budget would look like), he looks at BLS data, and argues that either, “this is significantly more than most two-child families will be spending on these services — probably by a margin of $10,000 or so,” and/or my hypothetical family, “does not have a reasonable and responsible gameplan to begin with.”

Now, Nate hasn’t actually shown that. Instead, his primary source of numbers shows what the average family in this income bracket ($50,000 to 69,999) would spend. And that family is older (average adult age of 47) and smaller (2.7 people, with just .7 kids) than the family I was discussing. That’s significant in ways that make his costs too low on several counts. For example, over a fifth of the people in the BLS estimate own their home outright. A significant portion are single or couples. Adding older home-owners and singles needing smaller homes into his consideration almost certainly means Nate’s housing costs are too low for a family of four or even three. Similarly, Nate’s figures for food expenses are low by $1,324 (and his average family eats out, which USDA assumes my average family of 4 does not for its calculations).

Plus, Nate doesn’t point to the places where my estimates (based on real expenditures) are quite low, according to the numbers Nate uses. I said this family spent $1,500 a year on heat, electricity, and water; his numbers say the average 2.7 member family would spend $2,823. I said this family would spend $1,200 for all telecom services; Nate’s data says this 2.7 member family would spend $1,253 on telephone services alone, with cable, at least, presumably included in the $1,141 of audio and visual equipment and service. So, accepting Nate’s numbers for these services would mean both my costs and probably his, too, for utilities and telecom are still too low for a 4-person family.

And the BLS data Nate uses appears to not account for child care at all (please correct me if I’m wrong here). Nate points out rightly that, “not all families will have a pre-school aged child. The typical child spends 3-4 years in pre-school, but then 12-13 years in the public school system,” but doesn’t account for the fact that I used costs for just one kid in child care, and not the more expensive infant or toddler rates. Also, if these kids were school aged, it would mean the family would spend $1,353 more on food because of the growing kids’ higher calorie requirements. Also, note these costs don’t necessarily have to include child care. Unmanageable college loan debt, unplanned major house repairs, existing medical debt, or credit card debt could all get my middle class family into the same plight without any child care costs and without, necessarily, making this family at all unusual or frivolous.

And then there’s the most ironic place where Nate’s calculations–finding my estimates $10,000 too high–are themselves too low: health care. The BLS data Nate uses shows this family of 2.7 spends $3,229 yearly on health care. Yet, the majority of this pool would get health care through work, a significant number are single, and some (though not many) are on Medicare.

Even Nate’s numbers show this plan is unaffordable for a middle class family

But what’s remarkable is that, even assuming Nate’s numbers are correct and mine are high, those numbers still show that this plan is unaffordable for a family of three paying some child care.

Nate’s numbers show the average income in this bracket is $59,319, with $58,610 left after taxes (note, a family of 3 at 301% of poverty would make $55,131, so this hypothetical 2.7-member family would still fall into the same income bracket I used in my original post). This average family would spend $50,465 a year. So to show what happens when this average family has to pay child care and spend 7.9% of its income on mandated insurance, I’m going to take out the BLS health care costs and add in the 7.9% this family would have to spend under the mandate. And because I argued earlier that these families aren’t spending all that much on entertainment (and therefore couldn’t save money by cutting entertainment expenses), I’m going to back out entertainment costs too. And because Nate said my estimates for taxes were too high, I’m going to take out those, too (though not FICA, which this family would have to pay).

$50,465 (total expenditures)

-$3,229 (less health care expenses)

-$2,936 (less all entertainment costs)

-$709 (less income taxes)

$43,591 (Nate’s numbers less health care, entertainment, income taxes)

+$4,686 (7.9% of $59,319 in income–or the amount paid before opt-out became possible)

+$6,216 (child care for just one four year old in MI)


$4,826 (total income less total expenses)

In other words, this family would have just $4,826 left to spend on entertainment (what Nate originally said this family could cut back on) and out-of-pocket health care expenses.

That says a family expected to pay 30% of out-of-pocket health care expenses would blow their entire discretionary budget after $16,086 in medical costs. More than what my other hypothetical family might spend, but still not a catastrophic medical event. And this hypothetical family would have to go $3,147 in debt before government subsidies would pick up the rest of their out-of-pocket expenses. And that’s assuming the family just misses the ability to opt-out. Supposing this family pays the 9.8% the government asks them to pay before subsidizing premiums, the family would spend $5,813 on premiums, blow through their discretionary funds after $12,330 in medical costs, and go $4,274 into debt before out-of-pocket subsidies kicked in. And even if this family got a tax credit of $1,243 for child care rather than paid nothing in income taxes (as I’ve figured here), this family would still go into debt under this plan.

Note, the biggest differences between Nate’s numbers and my earlier scenario are 1) his doesn’t account for all the people in my average family, and 2) his doesn’t account for child care costs.

So let’s look at child care costs. I used data from an industry group–which, since it pushes for tax breaks, may have an incentive to push those costs higher (though mothers in threads say those costs were realistic some years ago). But calculate those costs another way: while this number came from costs for day care for one four-year old in 2005, assuming this family had two children, it would mean a family would spend less than $60/week per child care per child ($120 total). Which even assuming some of them were school age and just needed after school care, wouldn’t be unreasonable amounts.

So even using Nate’s amounts, this family would go into debt because of a significant, though not catastrophic health event; in addition, this family would go into debt before the government subsidies for out-of-pocket expenses kicked in.

Now, Nate says my analysis is “painting an incomplete picture — and somewhat missing the forest for the trees.” You might say of his that he misses the struggling individual middle class families for aggregate data that includes singles and seniors not facing some of the challenges that middle class families are facing. Or you might more charitably say that Nate and I are just talking about totally different things.

But there is one thing that Nate still doesn’t address: affordability of care. He doesn’t use the word “affordable” in his entire post. He does suggest this family–which would go into debt to pay for care–would avoid the problems of such middle class families now.

Marcy is basically treating the $5,243 per year as though it’s a tax hike. That’s not what it is — at all. It’s a deeply discounted — albeit mandatory — service that they’re purchasing. And it’s saving them a lot of money: it either saves them a lot of money every year if they’re already buying insurance, or a lot of money on average if they’re not buying insurance.

And in either case, because of the caps in out-of-pocket expenditures — it also provides them with a lot more certainty in forecasting their income stream. It allows them to come up with a reasonable gameplan.

But he still assumes something that–the MA experience shows–is not true in all cases: that this family will be getting a service in exchange for the 7.9% or 9.8% of its income spent on insurance premiums. 21% of those surveyed in MA said they still couldn’t get the health care they needed because they couldn’t afford it–precisely the situation this hypothetical family would be in. That is, they would have paid for a service–health insurance, but not health care–but still face the choice between going into debt or forgoing necessary care, even with the insurance.

And that’s the complaint. It’s one thing for the IRS to serve as the insurance industry’s collection agency (still allowing the insurance companies 20% in profit and marketing expenses) if, in exchange, you guarantee that health care won’t continue to put middle class families into debt. But for middle class families that have any of a range of fairly typical middle class challenges (like child care costs or leaky roofs or exploding ARMs or college debt), this plan doesn’t do that.

I’m grateful that Nate is beginning to look at how this plan will interact with other middle class expenses. I’m happy to revise these numbers if he or someone else provides more detailed costs for such a middle class family. Perhaps the next conversation we should have is what happens to middle class families like these who–predictably, given the costs involved–will opt out because the plans are too expensive.

But the point I’m trying to make is that this plan does not solve the health care debt problem middle class families are experiencing now–and will still experience under the Senate plan. This plan is not affordable for the middle class. And since we’re talking about mandating these costs, we ought to be having a discussion about what is affordable.

170 replies
  1. klynn says:

    But the point I’m trying to make is that this plan does not solve the health care debt problem middle class families are experiencing now–and will still experience under the Senate plan. This plan is not affordable for the middle class. And since we’re talking about mandating these costs, we ought to be having a discussion about what is affordable.

    (my bold)

    And, this is not whining. This is a discussion exploring the facts on hand. Facts that could send the economy into a further spin if not addressed and fixed.

    And if neither party wants to have a discussion about fixing the bill, then neither party is “pro family or “pro child.”

    Both will wear the mantle of pro health care industry and pro banking industry. And we’ll get to watch the propagana as they both try to blame each other while never addressing real issues on health care for the middle class.

    • Phoenix Woman says:

      And, this is not whining. This is a discussion exploring the facts on hand. Facts that could send the economy into a further spin if not addressed and fixed.

      Exactly. If we can numerically analyze poverty in the US sufficiently to justify setting a poverty line, either for individuals or for families, the concept of affordability can be analyzed, too.

  2. bmaz says:

    …or my hypothetical family, “does not have a reasonable and responsible gameplan to begin with.

    Regrettably, most people do not. Should they? Of course. But forcing them to make this realization and make fundamental changes to feed this insurance monster, that will still wipe them out if there is a serious medical issue in the family, is a prescription for disaster. Why should my daughter have to forego school activities for this? Why should she have to go to a community college instead of university for this? Why should I have to drive a crappy old car for this? Why should people have to give up their family homes and move into apartments for this? Where do the miserly little number crunchers and thrifty granola scolds get off telling others they will just have to adopt their own existence? The makings of a culture war are forming, you can see it right here in these threads. Republicans are going to cram this crap into every orifice available on Democrats and blow them up with it.

    • phred says:

      BTW bmaz, sorry I missed all the fun last night, that was one righteous tirade of a post and JimWhite was at the top of his game : )

    • Phoenix Woman says:

      Regrettably, most people do not. Should they? Of course. But forcing them to make this realization and make fundamental changes to feed this insurance monster, that will still wipe them out if there is a serious medical issue in the family, is a prescription for disaster. Why should my daughter have to forego school activities for this? Why should she have to go to a community college instead of university for this? Why should I have to drive a crappy old car for this? Why should people have to give up their family homes and move into apartments for this? Where do the miserly little number crunchers and thrifty granola scolds get off telling others they will just have to adopt their own existence? The makings of a culture war are forming, you can see it right here in these threads. Republicans are going to cram this crap into every orifice available on Democrats and blow them up with it.

      Oh, exactly. They’ll dust off the term “nanny state”, which they love because it conjures up images of infantilized, powerless drones passively submitting to female authority.

  3. fatster says:

    Apologies for this interruption, particularly so early on, but we won one! Hooray for the 9th!

    Taser ruling sets standards for police, claims


  4. joejoejoe says:

    (via Digby)

    Kaiser Family Foundation has a plug-and-play calculator where you put in your info and see how much you would pay for premiums. Maybe somebody with a bit more detailed knowledge than I (cough…E-Dub) can fill what kind of out-of-pocket costs might exist beyond this coverage. Some variables are still hazy as far as I can tell and the level of coverage, subsidies, and out-of-pocket limits will cause big variables in what you will pay depending on what blend of the House and Senate bills comes out of the sausage maker.

    I think Nate and Marcy are both scrupulously honest with their figures but in any argument you can pick more or less favorable circumstances to advance your case. The advantage of the KFF calculator is you can plug in test cases and get results quickly. The middle-class actually does better under the Senate bill, but the House bill is a lot more humane in delivering more care to people who have none.

    • rosalind says:

      from jon walker’s fdl post on the kaiser calculator:

      For people who the calculator currently says will receive subsidies, the relative cost of their health insurance premiums compared to their income should be similar to what it will be in 2015 when reform is fully underway (since tax credits are determined by a percentage of income). But for people who make over 400% FPL, or make less than 400% FPL, but, due to their age were told by the calculator that their premiums would be low enough they would not need tax credits, the calculation will not reflect reality.

      (emphasis mine)

    • phred says:

      In case you missed it, Jon Walker explains that the KFF calculator you link to uses 2009 cost estimates. It is expected that health care costs will continue to spiral out of control over the next several years as things currently stand, so the KFF estimate is a seriously best case scenario. Actual costs will likely be quite a bit higher.

      • bmaz says:

        It tells me I am destined for debtor’s prison just on today’s numbers; I guess by 2014 nor 2015 I will just get the guillotine. Thanks Presidents Obama, Nelson and Lieberman!

        • phred says:

          Well that just proves how beneficent our elected officials are to us lowly peasants… the guillotine! Before they would have grabbed the nearest dull axe at hand ; )

  5. Neil says:

    I can’t weigh in on your or Nate’s numbers but I love that you and he have undertaken this debate. Nothing could be more illustrative of the problems with the US health insurance subsidy bill.

    A flaw of the Senate’s solution to perennial double digit inflation in health care costs is not creating a competitive option in all markets that could put price pressure on 16% profit and marketing costs now built into the system. (16%= 20%-4% overhead accomplished by Medicare.)

    Even efficient non-profits like BC/BS MA have 10% overhead plus an additional mandatory 10% for prescription drug benefits. In other words, 6% additional overhead not built-in to Medicare. 6%-16% is significant cost increase for spending on health care (insurance premiums) that does not pay for health services, and a significant component of the 11% annual price inflation in health insurance.

    How does the bill index taxpayer health insurance subsidies to insurance inflation or are subsidies up for debate once a year during the federal budget cycle?

    • Fenestrate says:

      How does the bill index taxpayer health insurance subsidies to insurance inflation or are subsidies up for debate once a year during the federal budget cycle?

      Bet you’re wondering why no answers to this. I looked up the relevant paragraph in the Senate bill. Here it is FWIW:

      (iii) INDEXING- In the case of taxable years beginning in any calendar year after 2014, the Secretary shall adjust the initial and final applicable percentages … for the calendar year to reflect the excess of the rate of premium growth between the preceding calendar year and 2013 over the rate of income growth for such period.

      Long, long time ago, there was an initiative to use plain language in bills. Or was that just for IRS code? Anyway…. *sigh*

      • emptywheel says:

        If I understand the question correctly, once you get subsidies, your percentage of the total cost goes up as the costs go up. So if your 9.8% pays for 75% of health care premiums in Year One, in year two, you’d be expected to pay 75% of the total premium as well.

  6. MadDog says:

    …– Spending 30% of income on one’s rent/mortage as Marcy’s assumes — that’s $19,275 per year or $1,600 per month — is an aggressive assumption. The Department of Commerce estimates that people in this income bracket spend more like $10,000 per year on shelter, before utilities (which Marcy breaks out separately). In most parts of the country, $1,600 per month is going to buy you a very nice home, even if you have two rugrats to worry about…

    I see that Nate, like that “you-who-never-seems-to-arrive-in-Chicago” person, can’t seem to come to grips with things like the median price of a home in Chicago, mortgage rates, and monthly mortgage costs either.

    What is it with these people that they don’t seem to understand real housing costs and its impact on folks’ incomes and budgets?

    Heck, I’m not even using the most expensive places to live like New York, New York – $379,000 or Orange County, California – $469,900.

    Nate me boyo, what planet are you living on that you think “Spending 30% of income on one’s rent/mortage as Marcy’s assumes — that’s $19,275 per year or $1,600 per month” is too expensive?

    Nate me boyo, using a mortgage calculator, you’ll find that New York, New York family is paying $2,358.60 per month for that home (that’s $28303.20 annually if you can’t do the math) even with 20% down.

    Nate me boyo, using a mortgage calculator, you’ll find that Orange County, California family is paying $2,924.29 per month for that home (that’s $35091.48 annually if you can’t do the math) even with 20% down.

    As I said, what planet are the folks living on?

    • Mainer says:

      Nate me boyo, using a mortgage calculator, you’ll find that New York, New York family is paying $2,358.60 per month for that home (that’s $28303.20 annually if you can’t do the math) even with 20% down.

      Evidently there is an unalienable right to live in Manhattan.

        • Mainer says:

          I agree. Yes, more people live in urban areas than rural ones. But it’s also true that Manhattan is one of the most expensive counties in the country, with some of the most expensive housing. Thus I think it is more useful to do cost figures with areas that are closer to the median.

          And, yes, the subsidies should be higher. But I still think there’s an advantage to more Americans to have subsidies (as well as other elements of the bill).

        • emptywheel says:

          FWIW, I agree with you about Manhattan, but not Orange County. It’s in CA where the middle class is really facing horrible choices: driving an hour each way in commute time for a not-affordable house just to keep a decent job.

          That said, Queens or Staten Island or NJ aren’t all that much cheaper.

      • phred says:

        Peasants!!! How dare they presume to live in Manhattan. The nerve! Waiters, janitors, students, nursing assistants, dish washers, dog walkers, launderers, they have no right to live in Manhattan! Laborers at the minimum wage who keep the city running for the well-heeled glitteratti, how dare they presume to live within walking distance of their jobs??? They must reside out in the countryside where they belong. They should be grateful to be forced to to buy crappy insurance at inflated prices for the privilege of serving their urban betters!

        If they want to live in Manhattan, they can go to Kansas. /s

        • phred says:

          Ummm, because they are homeless?

          For all your pearl clutching you have yet to directly respond to anyone here. Maybe you don’t know any dog walkers, but I do. They are self-employed small business owners and they do tend to live and work in urban areas where there are people (and more importantly their pets) in need of such services.

          You are so terribly concerned about the plight of some people without any shred of concern for those who would be impoverished by this bill.

          You are equally unconcerned by the implications of what it means to have the government dictate what products we must buy from private industry.

          But what I find most galling about your comments (calling them arguments would be a real stretch) is that you are willing to cripple the electoral prospects of Democrats for at least the next 2 electoral cycles. And with that the rest of the progressive agenda goes up in smoke. No real climate change legislation. No real financial reform. No civil liberties legislation to make our LGBT community equally protected under the law. No imigration reform. No end to war. No restoration of the rule of law. And on and on and on.

          But please, don’t let me disturb your fantasies about how we are uplifting the downtrodden. I’m sure you get a lot of mileage out of them in your fevered imagination.

      • hctomorrow says:

        Nice. So if you can’t afford Obamacare, you should be forced to move out of the cities.

        Will there be Obamavilles for them to move into? Perhaps we can officially tie people to the land like serfs, rather than doing it through the backdoor with taxes. I presume you have a gig lined up as the Viscount of Bangor or something, judging by your enthusiasm for this plan.

      • emptywheel says:

        Nate’s numbers do figure that in. It’s something I’m pretty sensitive to, bc that’s in the neighborhood of what my property taxes are.

        That said, I don’t automatically assume this family owns a house. But if they don’t, it makes it a lot less likely they will itemize and get all teh deductions available.

    • armstp says:

      Easy to pick the two most expensive real estate markets in the country, as you do to say housing is expensive, but that does not represent the average housing cost, which for an average family in America is closer to $1,000 per month, not $1,600.

      • bmaz says:

        I do not live in either of the two highest priced housing markets in the country; in fact prices are way down here and $1,600 per month does not buy you diddly squat.

        • earlofhuntingdon says:

          It would get you 800 sq. ft. (a small two-bedroom) in coastal Southern California or twice that in the Midwest’s Rust Belt. A small two-bedroom would be no place to raise a family with two or more children.

          School quality in America is also a function of housing and house prices. The better the school district, the higher the price for everything, especially housing and real estate taxes (paid, directly or indirectly, whether you buy or rent).

          Government is recycling fewer tax dollars to grade and high schools, as well as state colleges. It, therefore, becomes even more important for parents to live where their kids have a chance at better schooling. Not something landlords or house sellers miss.

      • PJEvans says:

        There are a lot of expensive areas to live in.
        If you live someplace where housing is cheap, you may end up having to drive much farther for work, for a doctor, or for many kinds of shopping. You’ll probably also pay more for food, because a lot of those fruits and vegetables are shipped long distances from the growers.

        • wavpeac says:

          I’ve made this point too… but I live where housing is relatively inexpensive. My house was 120,000.00 house about 10 years ago. However, I have a predatory lender that has wreaked havoc in my life. I pay $1485.00 a month. I pay 100 a month in PMI (mortgage insurance) and then the property taxes in Nebraska are WAY high. I pay $3000.00$ a year…which tacks about 270 a month on to my payment but is included in the figure above. I am right in the range you guys discuss if my husband were to lose his job. So…my point goes along with something that Bmaz said earlier…which is that much of the middle class is already struggling. During the 90’s I had a 750 credit rating…ten thousand in savings…a retirement plan and neither my husband or I had ever been out of work.

          That’s all changed now.

        • Fenestrate says:

          I hear you. I have a cracker-box house…county appraises it at 65k…yeah…right, like I could sell it for that. But still, my property tax is 1,500. Percentage wise, I lose. (oh, no mortgage…I flubbed up and own the house myself).

        • PJEvans says:

          I ought to ask friends what they’re paying in taxes, and what the appraiser thinks their houses are worth.
          (At least one of them is upside down on their mortgage, but they also refinanced at the peak so as to have money to live on when their jobs went away, and haven’t recovered.)

    • redstateblue says:

      On the other hand, transportation for a family of four in New York City is likely to be about $9,000 less per year than the $13,200 Marcy has assumed. This is assuming 4 monthly unlimited ride metrocards per month. Students in NYC actually ride for free or half price, depending on whether or not the school they attend is a walkable distance.

      A general question I have about his back and forth, which for the most part is just illuminating enough for me to want more information, is what percentage of Americans in a family of four live at 301% of the poverty level? What is the distribution around that figure? The US median income for a family of four is $70,354. About 65% of all households earn less than $65,000 a year. ABout 3% of households earn between 301% of poverty and $70,000 but very few of those are families of four. This is definitely a group to worry about but not one that does not appear to be very sizable.

  7. cregan says:

    Emptywheel, again, I find myself in total agreement with you the thrust of your post. I am not sure how this thing got so seriously off track. Originally, it was going to lower costs, provide an alternative and send us all in a new direction.

    Now, I didn’t agree so much with the direction, but a new direction that did something positive would have been good none-the-less.

    But, the way this is written, it is going to save me money. I’m pretty healthy, and the only reason I keep premiums up is in case I get some kind of illness (knock on wood). Previously, I would have been afraid of getting ill and then not being able to get insurance because of being turned down.

    Now, I don’t have to worry about this. I know others have commented on the fine for non coverage being low, but I didn’t realize how this would apply to me until this week. Since the only real reason I kept up payments was fear of not being able to get coverage, this plan will save this middle class person money.

    Even so, it is patently not fair to others.

    You are wasting your breath complaining about it. The bill could name a Donkey “King of America” and it would still pass in the current desperation to “pass anything with the name “Health Care” attached to it.”

    Abortion restrictions? OK. No public option? OK. Higher premiums and costs for everyone? OK. Change the moniker applied from Health Care reform to Health Insurance Reform? OK. Name Donkey “King of America?” OK.

    It really needs to be killed and begun again. This time in the open and with the right elements included.

  8. ezdidit says:

    part D-like “doughnut hole” gaps will bleed us dry.

    If seniors are dealing painkillers to make up the difference, maybe we’ll all be drug dealers soon. (see NSDUH figures for an epidemic of painkiller abuse by seniors – they’re getting multiple prescriptions and dealing what they don’t use themselves.)

    I’m sure Congress would okay us all dealing drugs as long as we can afford to keep the insurance companies in the black buying their scam policies.

    Kill the bill & start over – knowing what we know now, President Obama HAS to ring the bell on this!

    • Mainer says:

      Kill the bill and start over is a political non-starter — and makes no sense policy-wise either. What possible evidence do you have that it would start over before, well, years and years, and that it would be any better in the future. The historical template is that an imperfect bill passes and is improved.

      And this bill does bring more people into a major public program: Medicaid.

      As Waldman says in the American Prospect:

      The Senate bill expands eligibility for Medicaid to those earning up to 133 percent of the federal poverty level ($29,326 for a family of four), opening it up to 12 million people. The House bill pegs eligibility at 150 percent of poverty ($33,075 for a family of four), covering 15 million. In either case, the law would end the incredible disparity between states, which presently set their own eligibility levels. If your family of four earns more than $2,535 a year and you live in Alabama, you’re considered too rich to qualify for Medicaid. In Texas, it’s a princely $2,866. Blue states, you’ll be shocked to learn, already tend to have more generous benefits, meaning that the biggest winners from the expansion will be poor people represented by Republicans.


      • Phoenix Woman says:

        133% of the current poverty level is still pretty low, considering the officialy poverty line in this country is set way too low. I mean, really: Can a family of four live on $22,000 a year? Not in any big city, they can’t. Yet that’s the official poverty level for a family of four in this country.

        Since 133% of $22,000 is $29,260, we’re talking about not being covered by Medicare unless you’re very, very poor indeed. And EW’s diary is about how anyone above that income level — in other words, the working poor and lower-middle-class — are going to be hosed by this plan.

        • Mainer says:

          I agree. It’s absurd that folks with those income levels don’t have coverage right now. But they will under any hcr that will pass in a month or so.

          Do you think it’s an improvement for them to have that coverage? If not, why not?

        • PJEvans says:

          My experience trying to do that by myself, in Los Angeles, is that you’d need more money. ($22000 a year is LA is ‘slowly sliding into bankruptcy’ country, if you’re lucky enough to have a place that costs less than $600 a month. Any expenses more than that, and you have to give up something: healthcare, car, or food.)

      • seeker561 says:

        Expanding medicaid eligibility does not necessarily equate to access to healthcare. In Texas, medicaid has been privatized, one must select a for profit HMO. I live in a suburb of Houston and had tremendous difficulty finding a primary care physician (for my disabled adult child) within 15 miles of where I live. Adding 15 million people to the medicaid program begs the question, “Where are the doctors that will accept medicaid going to come from?”

        • seeker561 says:

          Expanding medicaid eligibility does not necessarily equate to access to healthcare.

          In Texas, medicaid has been privatized, one must select a for profit HMO. I live in a suburb of Houston and had tremendous difficulty finding a primary care physician (for my disabled adult child) within 15 miles of where I live. Adding 15 million people to the medicaid program begs the question, “Where are the doctors that will accept medicaid going to come from?”

          I keep asking this question and NEVER get an answer.

      • AlanSF says:

        Passing the bill will definitely assure that out-of-control health care costs are not revisited for many years. It will be four years before teh bill goes into effect, several more before stuff is up-and-running enough to judge it on, more time for political pressure to build enough to get a response, and then a good chance that any changes made would not go into effect for several years more.

        If the bill is killed, there’s no reason whatsoever that it couldn’t be quickly revisited and a better bill produced. I’m not saying it would happen, but there’s no particular reason it wouldn’t be, considering that health care costs would be bankrupting the nation and destroying the middle class.

        The bill’s backers simply state as fact that passing the bill would lead to it quickly being revisited and fixed, while killing the bill would result in health cost reform not being revisited for twenty years. This is just pure speculation, and I haven’t seen anyone even put forward a reason why it might be so, let alone a persuasive reason.

  9. kisfiu says:

    I think Marcy is one hundred percent accurate in saying that if there is a mandate then we should give a real strong look at affordability. Obviously, there is a lot of work to be done – i.e. this cannot be the end of health care reform.
    That said, it seems like people are argueing past each other. There are four important permutations and treating just one can obscure the benefits of the bill. These are:

    Finances of the family buying health care (with and without the Senate bill)
    Finances of the family NOT buying health care (with and without the Senate bill)

    It seems a bit of apples to oranges to compare people who are presumably not buying insurance now to those who will buy insurance when the bill goes into effect. After all they can instead pay the penalty. Finally, people like Ezra have argued that paying the penalty may be a good solution for some people – may infact be a very good deal for those who do not want health insurance.

  10. Mainer says:

    So our political work should be focused on increasing the subsidies (among other things). Who do you want to vote for in 2010 — a candidate who wants no subsidies and no increase in covering the near-poor with Medicaid or one who has gotten more folks under Medicaid (a public program, you know) and also provided subsidies for insurance.

    • Phoenix Woman says:

      Well, the Blue Dogs in the House are bailing or switching parties rather than having to be forced to deal with that issue as nominal Democrats.

      Mind you, these are people who Rahm Emanuel flooded with cash when he ran the DCCC, then propped up with more cash at the expense of more progressive (and often more viable) candidates through his ally Chris Van Hollen when they dismantled Howard Dean’s Fifty-State Strategy (oh, and did I mention Rahm hates Dean with a passion?), and who now get tons of pork for their districts courtesy of Rahm’s sitting at Obama’s right hand. And it’s still not enough to save them come next year.

      • Mainer says:

        And what political strategy do you think we should pursue?

        On the same general topic, someone on this site told me that the US should be able to have better policy than Mass. does on health care. The more I thought about that, the odder it sounded. After all, Mass. is one of the very most liberal states in the country. The US as a whole is not as liberal. So why would we assume that the representatives of a not-as-liberal constituency than Mass. pass a plan that is more progressive than what was accomplished by the representatives of a very liberal constituency? (And, yes, I use the word liberal in the context of the U.S., not compared to the world)

        • bmaz says:

          Medicare for all, a geometric increase in anti-trust enforcement, reenaction of Glass-Steagall, banning of non-transparent financial products, severe restrictions on leveraging in any domain, extreme transparency of government function and public and only public financing of all elections. That is just a start, but ought to keep you busy for a while.

        • Mainer says:

          All good items – and yes, they will keep us busy for awhile.

          But if this bill were to get killed, there would be zero chance of enactment. The possibility for future progress rests on successfully getting some reforms in place.

        • bmaz says:

          And I think the future depends on stopping this pile of junk; it will be an anvil around the neck of Democratic politics for a very long time. It will also drive many people, including my family, into debt and drive many from their homes and to cut out education. But, hey, as long as we can keep the granolas in Maine and MaxTaxs in Montana happy, the rest of us in the US will just have to suffer.

          By the way, I have done a little research on your history and am now pretty sure your sudden presence here is as political troll with an agenda and want to make sure that is clear to other commenters dealing with you.

        • Mainer says:

          I’m not sure why you going after me personally. I think I registered at this site some years ago but haven’t thought to post on it for quite awhile.

          And I wish you would explain what “agenda” you think I have other than improving people’s lives. I spent ten years of my life volunteering at a free clinic and have an interest in improving people’s lives. I agree that the subsidies should be larger.

          But look at political reality. Senator Nelson, whose views I disdain, is more to the left than his state — Nebraska is a very red state. If he were not in that seat, it’s virtually certain it would be someone more conservative. Railing against Blue Dogs does nothing to change that political reality and those realities constrain what can be achieved.

        • bmaz says:

          I am not “going after you personally” in any regard. I am merely pointing out that you came out out of the blue, having never, ever, commented at Emptywheel prior to yesterday, and have seen fit to comment on only two threads, the two blasting the affordability of the Obama healthcare plan. You, however, have been very aggressive on those two threads and have littered those two threads in a manner trying to impose certain thoughts and positions without particularly responding on the merits of other peoples points and facts. In short, you appear on a mission, not a discussion. Thirdly, I know that you are a political activist who commonly writes other places under your real name and not under a pseudonym such as you have used here. I have, actually, quite a bit more but will leave it at that.

        • Mainer says:

          I really thought I was writing in a rational way and can’t think of anything I wrote that would be offensive.

          And I don’t know who you think I am, but again, I wonder why you are responding in such a personal way. Is that the norm for posters here? In claiming that you know who I am, are you threatening to out me? Or what are you doing?

        • Phoenix Woman says:

          Bmaz said this:

          I am not “going after you personally” in any regard. I am merely pointing out that you came out out of the blue, having never, ever, commented at Emptywheel prior to yesterday, and have seen fit to comment on only two threads, the two blasting the affordability of the Obama healthcare plan. You, however, have been very aggressive on those two threads and have littered those two threads in a manner trying to impose certain thoughts and positions without particularly responding on the merits of other peoples points and facts. In short, you appear on a mission, not a discussion. go. Thirdly, I know that you are a political activist who commonly writes other places under your real name and not under a pseudonym such as you have used here. I have, actually, quite a bit more but will leave it at that.

          Do you have a substantive reply to this?

        • Mainer says:

          Might you have a response to my query about whether it is the norm at this site to go after someone personally in this way? I have not done so and I am disappointed to find this here. There’s an implication that my identity might be revealed. Is that sort of thing acceptable to people at this site?

        • Mary says:

          There’s been no implication that your identity might be revealed (although right this minute I’d go with Lindsey Lohan’s Confession of a Teenage Drama Queen character) The fact that you keep saying it over and over and over and over doesn’t make it more real – it isn’t like clapping for Tinkerbell.

          Phoenix Woman gave you the substantive response to your query – she demonstrated that what you deemed to be *going after you personally” was a post with substantive input and your response has been to recharacterize it rather than address it. NOt a huge big deal, but it’s not a trick that works with most people here, so basically you can either keep the wheel spinning in the mud with further dramatic renditions of “me me me me, I’m a victim so you must quit questioning my facts, me me me me me, I’m a victim” or you can dig in and address the substance. It’s your decision and a measure of who you are. Whichever – we’ve seen both roads taken, you’ll be nothing new.

          @57 – so you agree that the *historic template is to pass the imperfect legislation* argument is a bit overbroad, depending on what someone’s objections are? ;-) If Soc Sec had been started as a program where everyone in the country was forced to buy into a for-profit retirement fund with 30% admin costs, I’d be more swayed by the analogy.

          If you want to argue policy, argue away. Lots of people will engage and enjoy. If you want a lot of drama about implications of victimization – *yawn*

        • Mainer says:

          So much for the left caring about human beings. Of course this isn’t about me, but a poster claimed I was personally attacking people (which I wasn’t) and said they knew who I am (which they clearly didn’t, as the description doesn’t fit), and complaining about it elicits no community call that this is out of line and not acceptable, but a bunch of statements that I’m a whiner.

          I don’t expect people to agree with me. I came here to engage because this is an important issue and I respect Marcy a lot. But evidently this blog expects a lot of cheerleading for a certain set of positions and those who don’t agree aren’t supposed to say so; if they do, anything goes.

        • Mary says:

          How dare someone say you are attacking someone when you aren’t and how dare they imply they know you when they don’t.

          I didn’t understand how bad it was – so sorry. Now let me drop everything and go gather up pitchforks for “the community”

          Back later.

        • bmaz says:

          There has been no such thing, and you are flat out lying to say there has. Diversion seems to be your only play; it is a tiring one.

        • Mainer says:

          And what was this, if not a personal comment and an implication that my name might be revealed?

          I know that you are a political activist who commonly writes other places under your real name and not under a pseudonym such as you have used here. I have, actually, quite a bit more but will leave it at that.

          Others here, is this really acceptable to this community?

        • phred says:

          it will be an anvil around the neck of Democratic politics for a very long time

          Exactly right bmaz. I keep harping on this, but the people who keep telling us that the Dems need this win can’t seem to get their brains around the fact that voters will turn against the Dems for a long time to come if this goes through. Bill Clinton once famously said, “it’s the economy stupid”. If Dems pass a bill that hits people hard in the pocketbook without simulataneously reining in an out of control industry, there will be hell to pay at the polls. Are the Rethugs any better? Of course not. They are arguably worse, but they will not be the ones that pulled this heist on the public. If all those defending this bill actually gave a damn about the Dems political future, they would demand that the Dems ditch the mandate. But they don’t. Seems the political future of the Dems is not their first concern.

        • jimbo says:

          Talk, talk, talk. The issue is not the bill, or whatever else comes our way. The issue is political corruption. rahmbama, the whores lieberman, lincoln, nelson, lambeau, all the whores in the House who will soon show, are too lazy to work for re-election, sell us out instead. When we acquiesce by passing a piece of shit bill like this to cover their asses, we ensure the continuation of corruption. We should ensure that rahmbama is in its last term, along with all the known whores. Work to kill the bill, work to bring an end to corruption.

        • Phoenix Woman says:

          How about not making most Americans pay more for health insurance than they do now — especially when that insurance will cover less than it does now?

          As the pass-the-bill-at-all-costs folk keep saying, this is the best chance we’ll have in the foreseeable future for reform. If you think that this bill will get better in any way in the foreseeable future, think again — there won’t be the political will for it. (Hell, with Senator Landrieu already telling us that she’ll personally kill the bill if the House tries to fix it at all, we know already that what’s in the Senate bill is as good as it’s going to get. Of course, if Harry Reid had gone for reconciliation, this wouldn’t be a problem. But noooooo.)

        • phred says:

          There is a reason it is called Romney care. The Dems in this state have a real flair for putting up marginal candidates for governor. I voted for Bill Weld rather than that Dem nincompoop Silber back in the day and I have no regrets to this day for doing so. Unlike the current Federal government with Dems everywhere you look, the Mass legislature had to craft a bill that a Rethug with Presidential aspirations would sign. Hence, it is not unreasonable to expect the Feds to do much much better given their majorities and the WH. Except of course for the fact that every last one of them in on the take from the corporations that they never seem to be able to properly regulate.

        • Mainer says:

          Well, I also wish that the national Democrats would do better than a liberal Mass. Republican — but my wishes can’t change where they are on the national political spectrum. Democrats who represent conservative constituencies are more conservative than Republicans who represent liberal constituencies. The US doesn’t have a parliamentary system which tends to keep their legislators united. Our system and our political parties don’t operate that way and wishing otherwise won’t make them do so.

  11. scribe says:

    EW: Just wondering….

    In all these calculations for the generic just-over-the-300% line family of four, I don’t see a separate line item for “Saving for the kids’ college”.

    So, is Rahm’s choice (the one he imposes on us) “Pay for health insurance now, or for college later”? Of course, since he’s mandated we pay for health insurance now, that leaves us no way to be able to pay for college later, right?

    It’s all well and good to be going back and forth about which model is more accurate, but if we ignore college saving as an item in the calculus, we are overlooking the elephant in the room in favor of debating the color of the mice.

    • emptywheel says:

      Right. That’s one of the reasons I keep making this argument. Because to begin with this pushes the middle class further and further into debt. But also because the health care mandate will push out other spending–such as saving for health care.

  12. joejoejoe says:

    I’m not sure the KFF calculator should take into account a predictive view of medical inflation as a rule and even if it did it’s still a useful tool for seeing where you would end up on a relative basis as you age or change income. The KFF is honest and upfront about it’s methodology and I don’t think people on the internet who use it to quickly sort out a range of outcomes should avoid it because it doesn’t take into account medical inflation vs. normal inflation.

    The Jon Walker piece everyone is linking to closes as follows.

    For some, the calculator will be a relatively accurate prediction of relative premium costs compared to income. But, for a significant segment of people, the calculator is giving individuals the false impression that their premiums would be noticeably lower than they will almost certainly turn out to be.

    If you are in the “significant segment” that “make over 400% FPL, or make less than 400% FPL, but, due to their age were told by the calculator that their premiums would be low enough they would not need tax credits” take the KFF calculator with a medical inflation grain of salt.

    I still think the KFF calculator is an excellent tool. A hammer is a flawed tool if you want to use it as a screwdriver. If you want to use the KFF calculator to predict medical inflation, it’s flawed. If you don’t, it ain’t.

  13. kgb999 says:

    A big thing that bothers me about all this is that ultimately what we’re doing here is deciding for every single American if their personal budget is “frivolous”. We’re essentially saying: you don’t NEED to spend on [x], cut [x],[y], and [z] out of your budget and you’ll be able to give plenty of money to the insurance industry – and if you don’t run your budget as we have mandated, we’ll just take the money anyway and give it to the insurance industry and you get nothing.

    It’s like taking the negative aspects of socialism and combining them with the negative aspects of capitalism. It just stinks.

  14. phred says:

    liberal Mass. Republican

    Hahahahahahahahaha… That’s hysterical. Liberal Republican. That’s a hoot. I’ll skip the oxy and go straight to moron.

  15. jerryy says:

    Dear Ms. Emptywheel,

    You are being too timid in the scope of your analysis. (If Nate wishes to poke holes in your numbers, to influence the discussion supporting his position, then use the geometric mean of first and third quartiles of the available data. This makes sure that you have a usable number not affected by data clumps).

    You are being too timid in that you have not taken into account the result of Nate’s two main thoughts: that folks can afford this if they do not go on vacation and do not eat out.

    Keep in mind that every state that borders water has an economy backed by tourism. If Americans do not go on vacation, this will be a catastrophe for Florida, North Carolina, California, etc. The costal states have already been hit hard by the recession and do not have the means to weather a serious or prolonged downturn in tourism. Someone may as well take cities like New Orleans out back and put a bullet in their heads as an act of mercy. Ditto for Las Vegas.

    Secondly, open your yellow pages phone book to the manufacturing section and notice how thin it is. Then skip over to the restaurant section and see that it is much thicker. Go ahead and rip it out of your phone book. If families do not go out to eat, those restaurants cannot stay open. Lot of jobs will be gone. To make things worse, because we are mostly in a service economy (this is why the restaurant section is so much thicker than the manufacturing section in you phone book) the service sectors that support conventions will fold with the restaurants gone. Dwelling on the cascading ripples if kind of gruesome so I will stop here.

    There really are better ways to make sure we all have access to health care, this bill is not it though.

    • Mauimom says:

      Keep in mind that every state that borders water has an economy backed by tourism. If Americans do not go on vacation, this will be a catastrophe for Florida, North Carolina, California, etc.

      You should see what the Obama-conomy has done to tourism in Hawaii.

      After all, people can’t switch from flying here to driving here*, so their choice tends to be not coming at all.

      *at least until Sarah builds US that bridge.

      • redstateblue says:

        In what way is Obama responsible for the drop in tourism in Hawaii? I am pretty sure that the economy he stepped into was bad and getting worse from day one.

        • Mauimom says:

          It’s been almost a year, and the only people who’ve benefited from Obama’s “economic action” are bankers & hedge fund folks.

          Auto workers, people with mortgages, unemployed: not so much.

          Nb: GMAC, the financing arm of GM, is getting another cash infusion. Auto workers: fuck you.

    • donnadiva says:

      When I pointed that out on Nate’s comments section I was called a right wing anti-tax nut. Seriously.

    • whodathunk says:

      Agreed. Your comment made me register here. This bill sends more people from middle/working class to poverty level, in order to avoid any inconvenience to the wealthiest.

      • jerryy says:

        You should thank Ms. Emptywheel. She is doing the heavy lifting, my observations are just in support of the good work she is doing.

        Mauimom @ 81
        “You should see what the Obama-conomy has done to tourism in Hawaii.”

        I have heard from folks that it is like Michigan after the crash. Surely your bridge will be right at the top of Sarah’s priorities.

        Donnadiva @ 133
        “When I pointed that out on Nate’s comments section I was called a right wing anti-tax nut. Seriously.”

        I am trying to understand the thinking of someone that would say that. What you are mentioning is not esoteric, pie-in-the-sky economic theory. ??? Perhaps it is just the floundering, punch drunk reaction of those that flare up over any non aligned comment.

  16. behindthefall says:

    On top of not understanding what the heck is available presently, never mind what is being proposed, what I think I hear is that families can “afford” the cost of health insurance, but they just will not have any discretionary income to spend and hardly any way to save for life’s little luxuries and bigger hardships. In other words, the cost of health insurance will sicken the economy of many, many households, whether they can “afford” it or not.

    Lucky that all our household economies are in great shape right now. Oh. Wait.

    So here we are, Democrats all, happy to be the majority party, saying, “Just don’t save, don’t spend, scrimp all you can: give it to health insurance companies, because one day you might get sick, and nobody’s going to care or lend a hand.” And this distinguishes us from “compassionate conservatives” how exactly? And this endears us to most of the populace in what ways?

    Pardon the sloppy thinking. Obviously there must be wonderful angles to this situation that I don’t see yet.

    • Mary says:

      I like the part where he calls the PResident his client, then when pushed as to whether or not he people aren’t really his client says something completely untethered like, *well yeah, so in a conflict between Congress and the President I have to choose a side*

      Umm, what happened to “the people” in that side-picking? And wasn’t the conflict with al Qaeda, not Congress? Or are you saying that in a conflict between the law and a man who wants to be lawless, as a lawyer you have to side with being lawless? And how is it picking a side when you draft the amnesty legislation for Congress to give to your murderers and torturers? And …
      never mind.

      The fact that the interview started with using “eloquent” in re: Yoo’s stylings – that gave you advance notice as to how much of the rest of it would be worth reading.

  17. Mary says:

    EW – I’m going to also toss out that I don’t know any “middle class” family with two kids who doesn’t have dental costs for one or both of those kids – which would be out of pocket. Things like school supplies, soccer team costs, etc. also come to mind as typical costs. A babysitter now and then. What scribe mentions on saving for education. Or retirment. Getting the lawn mowed. Christmas gifts. … I think if anything, you are being pretty bare to the bones on the costs they are looking at and Nate is maybe seeing things a bit rosey.

    OT – 9th Circuit has a taser ruling out – good for them.

      • Mary says:

        Thanks for including that – sorry I repeated.

        Mainer @ 17 “Kill the bill and start over is a political non-starter — and makes no sense policy-wise either. What possible evidence do you have that it would start over before, well, years and years, and that it would be any better in the future. The historical template is that an imperfect bill passes and is improved”
        So I’m guessing that was your advice to the pre-Presidential Obama on the Amnesty for FISA Felons legsislation as well? Just vote for it – imperfect that it may be, and uh, ya know, it’ll get, uh fixified later?

        Sorry, but there is no one historic template vis a vis legislation. You can bet, though, that with the current bill the Republicans will be running on “killing it” in a fashion that will provoke very strong populist support. And yes, there are also “historic templates” for legislation coming undone via subsequent elections. The only thing that has any positive, unifying, populist appeal in the health care reform arena is the public option. Without it, there’s very little chance that you will prevent a backlash election of Republican who undo much of what was done.

        So you can build on a foundation of sand and pretend that it is fixable later, after the tides have come and gone – or you can try to get the foundation right initially so that there is something to build on later.

        But to pooh pooh those who point out that sand makes for a lousy foundation by saying they just don’t get the historic template that you throw up any crappy thing first, then go fix it later, is imo kind of trite.

        • Mainer says:

          Actually, I completely disagreed with Obama on FISA. But there are times when, in my view, you have to take a compromise and improve from there — such as with Social Security and CHIP.

  18. earlofhuntingdon says:

    As Nate should know, statistics, as in having 2.7 children, are fictional. Real families are not.

    Besides, what real family in this common income bracket has gotten there today without credit card debt, student loan debt, the costs of two employed parents.

    And how could the overtly religious and charitable ignore what friends and neighbors give or loan to those in need? Even those on minimum wage are campaigned against to donate to United Way. They give to their houses of worship because that’s what their teachings tell them is holy. They give to families and friends in need who have met with relative catastrophe or ill-luck. There but for the grace of God used to be what helped keep communities whole, not what kept a politician out of jail.

    Mr. Silver is using averages that support his views, not real world data that challenges them or this bill, or to critique the actions of those who sell it for political gain rather than to improve the lives of common Americans.

    • emptywheel says:

      I think both Nate and I are looking for acceptable numbers to use. I don’t claim to be sure I’ve got the right numbers (though I’m pretty impressed and depressed by the USDA numbers for food). So I’m willing to have an open debate about how we can represent what this will mean for middle class families.

  19. 1boringoldman says:

    I love it when pundits fight. It means the fact that I don’t get the Senate Health Care Bill is because it’s hard to get. Fight on, noble warriors…

    My take on things is that now we have something to tweak when [and if] the Republicans and Holy Joe finally find themselves in a real minority. Sand is better than a vacuum, in my book…

    And as for Karl Rove, “the family requests that its privacy be respected.” The only respect Karl Rove deserves is his right to a fair trial…

  20. Cheryl says:

    FWIW, I have been seeing an interesting trend in the last couple of weeks on the blogs. I very seldom comment on here and never on other sites. I read FDL daily and others as well.

    I’m seeing this trend of “going after” the FDL people (Jane, EW) in the comments sections and it’s interesting that almost all of the screen names doing this are names I’ve never seen at Firedoglake before. I’m reading about people “getting flak” or being asked to leave FDL, but I rarely see that. I rarely see the people here go after the commenters personally which is why I read this site daily.

    • earlofhuntingdon says:

      I think that’s an accurate observation and one reason I comment here (in addition to this site’s exceptional back-office ops, which are miles ahead of its competition). The exception is friendly taunts among regulars – intended to instigate comments rather than to stifle them – and trolls, which have expanded as Jane and this site’s popularity has expanded. You can see the same happen to Froomkin, Greenwald and occasionally, Digby.

      It is rather peckish to suggest that “the left” – not all of whom comment on this site – no longer cares about “human beings”. The hyperbole shouts troll; all that’s missing is capital letters.

  21. fatster says:

    William Greider on Obama’s “Squandered Opportunity”

    “After his brilliant beginning, the president suddenly looks weak and unreliable. That will be the common interpretation around Washington of the president’s abrupt retreat on substantive heathcare reform.

    . . .

    “. . . Obama has always been more comfortable with the center-right forces within the Democratic party–Senator Max Baucus and the Blue Dogs–and the Clintonistas of DLC lineage who now fill his administration. His real political challenge was to string along the liberals with reassuring talk until they were stuck with lousy choices– either go along with this popular president’s pale version of reform or take him on and risk ruining his presidency. This sounds a lot like the choices Democrats faced during the Clinton years. Candidate Obama said it was “time to turn the page.” We are still waiting to see what he meant.”


    • Mauimom says:

      Thanks for the link.

      In light of Katrina vandenHoevel’s screed directed @ Jane, I’m surprised she hasn’t scrubbed this from The Nation’s site.

  22. sluggahjells says:

    The excise tax debate is hitting a breaking point as well.

    Ezra Klein disagrees with Bob Herbert’s feeling that the Senate tax on the middle class family benefits is a bad thing not getting talked about.

    And Jon Gruber argues for it just like Klein. The Washington Toast continues in its spiral downward.

    • bmaz says:

      Indeed, that is exactly right. Good grief; this healthcare thing is ripping the continuum worse than the primary fight of 2008. Just wait until it passes and the GOP really starts to dogpile on. What a mess.

      • earlofhuntingdon says:

        And to phred@75, I think this is an expression of how much money is on the table in stifling health insurance reform and how much could be lost to industry should there be any. The health care needs of Americans? It’s hard to imagine that that’s a concern to any of the leadership inside the legislative process.

      • Cheryl says:

        It is a mess. The GOP will increase their efforts (if that’s is possible) to try to exploit the fears and other emotional responses to the healthcare issue of those on the left. Once the emotions and myth centers get involved, it’s hard to debate something intelligently. Just my opinion. I think that is why I like coming here to read. You, EW, Jane, Jon and so many others keep a rational discourse going and do not resort to name calling etc…

  23. Rayne says:

    Jeebus. It’s no freaking wonder 21% of citizens in state of Massachusetts forgo needed health care.

    I’d bet for many it’s related to the cost of childcare, which according to the report linked in this post is the highest in the entire country. That’s 154% to 170% higher than the cost of similar childcare in Michigan, for example.

    It might be important to look at that more closely; is the cost of insurance in Massachusetts actually driving up all other costs? or is the level of education per capita reducing the number of available childcare providers? is licensing or other requirements so prohibitive that childcare providers are discouraged?

    It’s not the only state which gives pause; I’m shocked at MN, for example. Why so much more expensive? And why are other states so ridiculously inexpensive? are childcare providers even making a living wage in those states at the bottom? how will those childcare providers purchase health insurance for themselves as small business owners?

    I’ll take it the after-school care figure is a SWAG since it’s often based on actual hours of care consumed and on the age of the child. Kids enrolled in programs attached to a school may cost less since infrastructure is provided by the school system, where younger children in preschool/early-K programs may be enrolled in wholly private care programs. The costs for the younger children may also be predicated on full-day or half-day kindergarten, too; Michigan, for example, had mandated a conversion not too long ago to full-day programs in public schools (although those may now be reversed because of costs). The figure is probably closer to an average $75 a week for after-school care.

    Yeah, it’s only $15 a week one might say. Multiply that times 52. That’s a chunk of change to the working poor.

    • wavpeac says:

      I was going to say the same thing. Also childcare…full time for summer months, and holidays is quite expensive. I think I used to pay 28 a week per kid which was 56 a week. Roughly 200 a month for 2 school age kids. They went from full time child care of 180 a week (two kids under 5 for about 5 years) to $52 a week for the next 5 years. Ten years of child care total.

      Also…I know that we act as if sports are an “option”. However, with obesity on the rise, it feels like a necessity to healthy living. The YMCA in our neighborhood (for use at all locations) costs $900.00 a year for a family of four. My kids are in tae kwan doh which is an extra 60 a week, then the costs of pads, and tournaments. Furthermore, it cost $100.00 for my son to play football, another $100.00 for wrestling. There is no doubt in my mind that these activities are good for my kids, but they are very expensive. There are lots of kids in my neighborhood who can’t afford to be in sports. And if you miss the opportunity to build those skills during the early years, there is little chance that a kid will play once they reach the junior high, high school level. I think this is an important point, because the republicans love to blame the high cost of health care on “unhealthy people”. Well…what should you do let your kid run the streets for physical health?? Just go ride a bike? (at night of course because most kids are in some kind of structured care until people get off work). It seems like the perfect irony.

      One last expense that should be figured in somewhere. Braces. Not covered…but something that has a HUGE impact on future prospects in life. I have two kids…both kids need them. We are doing it one at a time at $140.00 a month. (for the next 5-6 years). This is not uncommon…it’s pretty much standard for most the kids in my area. I mean there is easily another 100 or so a month per kid that I consider essential, and would probably be very ticked off if I had to choose between sports and health care. Or health care and braces. That’s a large chunk of time to be making that payment.

    • emptywheel says:

      Yeah, those child care numbers are eye-opening. I bet the differences in states are partly dependent on minimum adult-to-child ratios mandated by the state. But I bet the child care workers in the cheaper states are not making real living wages, either. They barely do in MI, and that’s solidly in the middle of the pack for state costs.

      • Rayne says:

        Childcare is a very tough business to make money in, no matter where one’s located. It would be safe to assume that there are tough child-to-caregiver ratios in some states, but even moderate ratios might be problematic to drawing full-time consistent pay.

        Michigan has a 6-kid ratio, and that’s spread — only two infants, two toddlers, two preschoolers per caregiver, full-time. But at any given time there are one or more openings since their parents are more likely to move because of their jobs, or to pull one or more children out of care if they are approaching a threshold of affordability (a third kid might make the difference between putting kids in daycare or staying home with them). Or seasonally a preschooler may move to an after-school program or there may be too many kids of the same age and a child may have to leave. All of these conditions work against a caregiver in this state having a full-load of six full-time kids in care.

  24. Blutodog says:

    The Ins. mafia just wants the FORCED MANDATE. The rest they’ll manage to drill full of holes big enough to drive their Rolls Royces through.

  25. marc5 says:

    “Un-affordable” or “barely-affordable” health care costs have the same effect: they cause medical problems to be deferred as long as possible.

    Never mind teeth or eyes, which as we all know are luxurious ancillaries not included in the human body.

    This bill is looking to be a top quality turd, served on rye with a winter tomato, a couple wilted leafs of lettuce and some greasy chips. Any nutritional benefit will be accidental.

  26. jo6pac says:

    Not sure why I need to know the numbers, this should be Free like Europe. Why is it that they can afford it and it’s citizen still have a Quality of life beyond the US. Hell they don’t extend unemployement you collect it until there jobs. If you end the lies about war and the wars than there’s enought for Health Care and not Health Care Welfare.

  27. junk says:

    a family would spend less than $60/week per child care per child.

    *Cough* $60 per week?! I would kill for daycare that cheap. That is far too generous, I pay more than 4.5 times that for my toddler.

    • tbsa says:

      My children are in campus club which is hands down cheapest thing going. At their school, school personnel and it is still 90 bucks a week.

    • emptywheel says:

      Note that the link makes it clear that toddler care is far more expensive. My estimate here may seem high to Nate, but it’s not, particularly not compared to infant or toddler care.

      • junk says:

        Yes, toddler care is more expensive. But my rates will still be several times $60 a week before my child hits public school age. Granted I do live in an expensive coastal city, I seriously doubt what I pay is such an order of magnitude over the US average. I still think you are being too generous.

  28. OldFatGuy says:

    Another great post EW.

    I have a question relating to cost also, because I’m sure my old brain must be confused. But by keeping the anti-trust exemption, doesn’t that mean that technically, the insurance companies can legally get together and set prices? Or am I misunderstanding the anti-trust exemption? And what does the ability to legally get together and price fix coupled with a government mandate that we all become customers mean? Cause it means to me that now would be a most excellent time to buy health insurance stocks.

    I know the medical loss ratio plays into this some, but I can guarantee you that they are already hiring creative accountants that will somehow be able to make $10 million executive bonuses equal medical payments. So I’m not sure how much real affect that’s going to have on putting a ceiling on prices. Plus, it’s entirely conceivalbe that with the ability to price fix, along with mandated customers, rather than deny services in the future they may actually turn it around and start approving everything in sight, including the most expensive treatments available. After all, 20% (if the MLR was say 80%) of $5 Trillion is more than 20% of $4 Trillion.

    It just seems to me this bill fails in almost every conceivable way. Or I’m a total idiot and misunderstanding the meaning of anti-trust exemptions and such. And yes, I realize the odds on favorite is the latter.

  29. aardvark says:

    When my 16 year old was an infant, childcare was $90 a week. That is in Kansas. Where anyone can get childcare for $60 is beyond me.

    Currently for myself and three children I pay $930 monthly for a $2500 per person deductible BC/BS plan. That is 18% of my gross income; I pay 14% of my gross in federal taxes.

  30. tbsa says:

    Why can’t supporters use the word “affordable”

    Because this shit they are trying to cram down our throats is anything but affordable. For some of us teetering in the edge it is going to be a disaster.

  31. semiguy says:

    I’ve never understood the basis for the ‘pass it now, fix it later’ idea.

    Are there any reasonably modern examples of this? More importantly, are there any examples where ‘fix’ means ‘strengthen to the benefit of the people of the United States’ as opposed to ‘strengthen to the benefit of corporate interests’?

    The Medicare bill argument doesn’t make much historical sense- improvements were made, but at times when bills were not written by lobbyists and industry. The most modern ‘part D’ expansion is very problematic, as we all know. Its problems haven’t been fixed.

    No apparent fixes to the draconian bankruptcy ‘reform’ legislation passed several years ago.

    No apparent fixes to Gramm-Leach-Bliley, which overturned Glass-Steagall and unleashed the banksters. (Other bills in the past 30 years have chipped away at Glass-Steagall, so there’s no useful precedent here either.)

    No apparent fixes to the Commodity Futures Modernization Act, which deregulated derivatives markets.

    No apparent fixes to… much of anthing, as far as I can tell.

    Am I ignorant here, or is it fair to suggest that ‘pass HCR now, fix it later’ is like proposing that water should flow uphill?

  32. Rayne says:

    wavepeac (87) — just started the braces this week. $4850 — $1000 down, $1500 from insurance, $198 a month for a year.

    And that’s just the first kid.

    aardvark (89) — believe the $60/week was after-school care for a school-aged kid. Not the same as full-time for preschool kids.

    • emptywheel says:

      To be clear, I used the cost for one four year old for my total child care cost. It’s clear some families would have much more to pay in child care. But I just wanted something that was in the neighborhood of reasonable if not conservative.

      Plus, in the switch form my numbers to NAte’s, I went from a four-person family to a 2.7 person (or three, in this case) family, so just one kid.

    • wavpeac says:

      There are many costs to child rearing that many middle class folks consider essential that have nothing to do with eating out or going to movies. (although I remember when I worked at a mental health hospital arguing with the psych team about a patient who was using her disability income to take her daughter to the opera…the team was angry and accusing her of “wasting tax payer money”…but that’s a whole new topic). These expenses are considered necessary for giving your children we most pediatricians, and child experts would say are necessary for a healthy successful life. They aren’t included…so in my humble opinion, EW analysis is not high. If anything it leaves out some very important costs that compete for high priority expenses. (and I understand why you did it that way…but just saying that there are many other costs that parents would think are necessary). Really, which IS more important, sports or health care? I think there is a legitimate argument for both as “very high priority for healthy living and decreasing expenses in the long term”. Hmmm child care or health care??? Remember the problem we had with “latchy key” kids. Today very few parents leave their kids unattended until they are over 12 or 13 (where they have an option not to), because we have all heard about the “golden hour” after school for troubled kids.

      • Rayne says:

        In some states it may be illegal to have latch key kids. I think the legal age here for kids to be unsupervised is thirteen; children under that age are supposed be supervised.

        Understand the drivers behind this, and yet it also means $$. Parents continually weigh out the cost versus compliance when they are on the financial bubble.

        [edit: massive understatement – haven’t even talked about the $$ needed to put a kid through 2-4 years of post-high school education. We are going to dumb down our future if we don’t get health care costs under control.]

        • bmaz says:

          That is what I have been harping on? I asked if I am supposed to send my daughter to community college instead of university; but even community college is not within this hypothetical family’s reach.

          And one more thing, the “average” figures that people, including both Marcy and Nate, have been working off of were the product of years of data when the governmental safety net and service ability was a lot more robust than it is in the emaciated, drained and bankrupt state it has been placed in over the last 18-24 months. There are no government services any more for people.

        • AlanSF says:

          Did you say “drivers”? As in a family with a teenage driver in it? Who would need auto insurance? Sorry, in Nateland the kid walks.

    • bmaz says:

      Ditto here, except it is about a $1000 cheaper but, on the other hand, no insurance contribution at all; so out of pocket about identical.

    • PJEvans says:

      on the braces: ouch!
      Not so much the total as the monthly payment. (I did it twenty years ago: $1000 down, and $70 a month for three full years; extractions were extra. Might have to do it again in the future, and so not looking forward to it.)

  33. Ryan says:

    Nate Silver and Ezra Klein both frustrate me to no ends… they’re both way too smart to be this epicly stupid. What disappointments, both.

  34. AlanSF says:

    Nate’s conclusions make the most basic of all statistical errors: Did you hear about the statisticians who drowned walking across a river with an average depth of five feet?

    In Nate’s world, no one lives in San Francisco or Boston, no one sends three children to after-school care because both parents work, nothing ever breaks, and everyone is happy with a four-day family vacation once a year.

    • nwrain says:

      Further, the argument that people who might struggle to come up with additional money for health insurance under Obamacare are spending their disposable income inappropriately and should (1) move their family to a poorer neighborhood (often with crappier schools and fewer public services); (2) stop the music/sports/art lessons for their kids; (3) stop doing things like taking the family out to dinner (such as for Mother’s day); and (4) stop spending money on charity or political contributions, etc. is certainly not realistic or a political winner. It is also a restatement of right wing arguments against any raising the minimum wage or any form of public assistance. If this is where the defenders of Obamacare have to go, then Obamacare will generate big wins for the Republican Party.

    • OldFatGuy says:


      The bottom line is how do you pay for health care. This bill uses a mandate that mandates we all pay basically the same (depending on our age, etc., with some help at the bottom with subsidies) which could be described as very regressive (in terms of % of income spent for health care), while with a single payer government program paid for through income taxes, it is progressive (at least somewhat, not as progressive as it used to be of course.) I think this alone is what blows my mind the most as to how any “progressive” can support it.

      It’s all about the rich NOT paying for it. Period. That’s it in a nutshell. Even the House’s tiny “surcharge” on the rich is nothing compared to if health care were paid for entirely through taxes.

      A class war was declared a long time ago, but whenever we in the middle or bottom bring it up we’re accused of “class warfare.” Huh, there’s been class warfare for at least a generation, and the upper class is winning every skirmish, battle, and have almost comletely won the war.

  35. Fenestrate says:

    I keep rereading that paragraph and rereading it. If I understand it right…as the insurance companies profits go up, your percentage goes up. Not quite the same thing.

    edit: subject of course to the Secretary’s discretion.

  36. dakine01 says:

    I was a latch key kid at age 9, back in the dark ages of the early ’60s. Dad worked for the state highway department and mom was a librarian in the school system of the next county north. My sister was in high school and got home about an hour after I did. If those anti latch key laws existed in those days, I think my ‘baby sitting’ would have been farmed out to a lot of neighbors.

    Or not

  37. Fenestrate says:

    At the risk of alienating everyone here….as I understand the discussion, folks are trying to decide if the Senate bill is only crippling or deadly. A distinction with no difference.

    There’s been some mention of how this will effect the economy. I’m thinking it will be bad, and that’s the real reason for the delay before most of it takes effect. They’re hoping the economy is well on its way to recovery before the full effects of this bill hits.

    The fact is, everytime I look under the hood of this bill….well, it feels more like looking under a rock. All sorts of creepy crawlies. From the tax changes in concert with the caddy plan tax, the indexing of subsidies, the stealth changes in the mandate penalty rules and the several new powers given to the HHS Secretary, it all stinks.

    I’m hoping I’m not the only one who smells fish. (get over your political/troll/nit-picking problems….there are problems here).

    Dang, I’m old. I no longer have the skills to properly communicate what I’m seeing. If I ever did.

  38. nextstopchicago says:

    Just thought I’d log on to say how much I appreciate you’re putting forward sets of facts to keep the debate grounded. Even if I logged in Sunday with an analysis closer to Nate’s, I really respect the fact that you put together one of the few factual, numerical analyses, which we’ve all played off to define the discussion and figure out what it would mean. Thanks.

    • bmaz says:

      You know, it is funny; you and I were going at pretty good on this the other night. Even assuming we both retain our thoughts, and I think that is a fair assumption, it is still striking the meagerness we are arguing over for the hypothetical family in the paradigm. Heck we were bantering over just the basics; under either view that family is screwed for a whole lot of things like education and a lot of other factors that have been discussed here. Bottom line is this country has to find a way to rebuild its hollowed out and gutted middle class or we are in a heap of trouble.

    • emptywheel says:


      I’m pretty convinced this is not going to work for this segment of the middle class. But I am trying to think this through, with whatever numbers actually have backing.

  39. earlofhuntingdon says:

    If health care is a social and civic right, like childhood schooling or voting, spending only discretionary “disposable income” for it is nonsense.

  40. earlofhuntingdon says:

    I defy anybody in suburban America to get quality child or day care for $60/week. At $12/day, you’ll lay awake at nights wondering when the care center will close or its staff are arrested for endangerment.

    • Rayne says:

      Read the comments above. $60 is for after-school care for older kids, although the figure may be a bit low and it may be provided by school system.

      Infant care is clearly higher, as is full-time care for preschoolers. See the report EW linked in the article.

      • earlofhuntingdon says:

        I did read the earlier comments. It is low even for older children who might occasionally be left to themselves. It is a non-starter for younger children not old enough to be given the latchkey. Many families have children of both ages. School districts and libraries are cutting back and closing. Afternoon student care is becoming one of the casualties.

        Many parents end up using the local library as “free” day care. What being left on their own so often, without parental guidance, does to self-esteem, performance and maturation is not likely to be pretty – or to make us a more productive or peaceful society.

        • PJEvans says:

          Many parents end up using the local library as “free” day care.

          Then you get the politicians and ‘public administrators’ who think that only schools need libraries, never mind that people use libraries for things like Internet access and access to InterLibrary Loan, and some kinds of hobbies require libraries ….

  41. Fenestrate says:

    You know, I’ve been following this. And I’ve been seeing a lot on numbers thrown around. Worse, I’ve had my heart wrenched to hear how folks are doing….and knowing that these are just the vocal minority. There are a lot more out there that aren’t posting.

    But dang it. The EW vs. Nate thing…..well….. it’s just less filling/tastes great. No matter how you cut it, no matter how you run the figures… this ain’t good.

    Yeah, just my two cents. But….man….get real guys.

    • bmaz says:

      That is what I was saying a few comments up. We are arguing over to what degree the hypothetical family is screwed; but they are still screwed. So are a whole lot of people. When that many people hurt, we all hurt.

      • earlofhuntingdon says:

        Excellent point, especially as we’re not talking about one region in a state, NE Ohio or SE Michigan or Panhandle Florida or Oklahoma. We’re talking nationwide and for a long time to come.

  42. fatster says:

    The older the population gets, the greater the costs for health care, right? Just consider how costs for health care are going to escalate by 2050 (the graph changes ever 2 seconds). It is foolishness to begin a national program for health care that concentrates on helping the insurance companies stay in business, rather than trying to figure out how to keep the American people “in business”, in the sense of having a decent standard of living and promise of that continuing in the future for their children. We are going to be eaten alive trying to keep the insurance companies in business. Not to mention also keeping wars going.

  43. earlofhuntingdon says:

    As many of you know, housing is most often inexpensive where jobs are fewest, most expensive where they are aplenty. Not that, anymore, compensation keeps up with local cost of living, since employees have become corporations’ most expendable asset.

  44. Fenestrate says:

    edit: I used to live in Palo Alto, CA. So I’ve seen what high property values can do to you. I now own a $65k house in Ohio and the property tax is $1,500 a year. It’s a big country, and things vary a lot from state to state.

    post script: does anyone other than me think that credit ratings are an unwarranted tyranny? I pay my bills, that’s all anyone needs to know.

    • bmaz says:

      Well, maybe. I could live with the credit ratings if they were far more transparent and if the credit rating agencies were regulated and forced to accept challenges and corrections and be liable if they unreasonably refused or screwed up. They are currently totally freaking immune and impervious. Ever tried contacting one? Good luck.

      • earlofhuntingdon says:

        Another biggie from bmaz. It deserves its own article. Credit rating agencies are as transparent as White House decision-making. While regulated at their margins, they are largely accountable only to themselves and to their most frequent users, providers of consumer credit.

        Imagine if EU privacy rules applied, requiring them to give consumers prompt and full access to their records, the right to dispute the accuracy of the information and demand its prompt, documented correction, and that failure to do so would subject them to fines and penalties. Supposedly some of those rules apply now, but so weakly that they might as well not apply at all.

        Yet, credit ratings control consumers’ access not just to consumer credit of all kinds, but increasingly to employment. Another case of “too big to fail” becoming “too big to regulate”.

        • fatster says:

          I like to think it’s more a matter of our legislators being too wimpy to regulate. Pls substitute your own choice of word (“reluctant”, “bought-off”, etc).

        • bmaz says:

          Go try to use any of those “rights” with the three bigs: Experian, TransUnion and Equifax. Seriously, just try. I am a professional dick, and am pretty good at cracking past the initial layers and getting to legal offices or supervisors etc. Not with these guys; they thumbed their nose at me like I was an illegal immigrant trying to vote at the White House. And Congress has made them effectively immune from suit too.

  45. fatster says:

    O/T: For the car people:

    GMAC Set for Another Cash Infusion
    U.S. Expected to Lend Firm $3.5 Billion to Help Cover Mortgage Losses; Aid Bill Already at $12.5 Billion


  46. channel4newsteam says:

    One thing that strikes me as I read through these comments and ponder the implications is that low socioeconomic status is highly correlated with poor health. This is true even in countries with universal health care. If the current bill places downward pressure on SES, forcing more of the middle class into poverty-like existence, then it is likely to adversely affect population health beyond just the ability to receive health insurance to cover immediate needs. This in turn would force health care costs up as the result of such a downward movement in SES began to show in the populations adversely affected. This is an issue that could take a decade or two to move onto the radar.

    For example, if people can’t afford to send their children to college as a result, then their offspring will likely wind up in a lower SES category. Thus, forcing people to carry expensive health insurance premiums in an effort to improve population health becomes an illusion as long-term consequences begin to take hold.

    Of course, going bankrupt from health care costs could have the same effect. However, as I’ve read it, people with health insurance now are going into bankruptcy from unexpected health care costs, so I don’t know how forcing more people to buy health insurance will necessarily solve that problem.

    From an epidemiological standpoint, I don’t know if this practice is going to weigh heavily on the benefit side, balance out, or tilt the scales to our collective detriment. I don’t think anyone would know until we are a few decades into the future.

    Seems a heavy gamble to force onto those struggling to maintain their middle class existence and wishing to provide the same for their offspring.

    EDIT: Sorry for the wall of text. My paragraphs were deleted after a minor edit and I can’t seem to get them back in.

    • bmaz says:

      Naw, just looks that way until you refresh your screen after the edit. As to your point, yes it is a trend that accelerates over the long run to to the growing inability of the middle and lower classes to exist and compete.

  47. channel4newsteam says:

    As to other expenses, we pay $6000 a year in property taxes on our modest home. We just happen to live in a city with high taxes.

    As an sidenote, here’s a housing affordability ranking:


    Another expense for us is $1200 per year in parking fees ($50/mo x 2). I don’t think this is an uncommon expense for people who work in a city or at a university. This is an employment expense.

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