Bill Supporters Still Can’t Say “Affordable”

This post from Nate is just weird.

As you recall, in my last post on affordability issues, I basically accepted Nate’s selected source for family expenses–BLS data–and showed that even still this plan was unaffordable for a middle class family with child care costs.

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 post completely ignored that part of my post, completely ignored that I had used BLS data for housing, completely ignored that I had eliminated all income taxes for this family, completely ignored that I specifically backed out BLS data for health care and replaced it with an unrealistic 7.9% charge (indeed, that was one of the big mistakes he had made in adopting the BLS data in the first place, as I pointed out in my post) and still shown the program to be unaffordable.

Either Nate has now decided that the BLS data is no longer valid, or he doesn’t want to engage with that part of my post.

But on his other costs, here are some points.


Nate argues that my original estimate for taxes was too high (which, of course, I accepted in the second post). But then he has calculated those taxes making them less than the FICA taxes (7.65%) for this family. And he does that even while hypothesizing that one of these family members might be self-employed, which means the family would face FICA taxes of 15.3%. Note also, Nate assumes that this family owns their house and calculates mortgage deductions accordingly, which is probably an unsafe assumption for all middle class families in this day and age; 27% in the BLS data, for example, are renters. So while I’m happy to use the BLS numbers (which, after I got rid of all income taxes became basically just FICA), let it be said that Nate ignores two possibilities that would make those taxes go much higher.


Here’s what Nate says about housing:

Housing: This is still the most significant difference — I had figured housing costs at about $10,000 based on BLS data, versus Marcy’s estimate of $19,275. Marcy points out that the a higher propotion of people in the BLS dataset I used will have paid off their mortgage, but that’s still just one-fifth of the BLS’s sample, so it’s not going to make a huge difference. But let’s bump up my estimate to $12,000 — or an even $1,000 per month — to account for this, as well as for the fact that a family with two children might want some extra square footage.

Now, if you just figured out what the BLS numbers gave you without the people in the sample who owned their own home outright, it would show that the remaining 80% would pay $12,577, already higher than Nate’s estimates. And that’s assuming the 4-person families are living in the same size housing that all the singles in the BLS sample are living in, so on that basis, the number is still likely higher.

But let’s do this another way. I live in a house that was–when I bought it in 2002–almost exactly the average price of a house in this country. After losing value over the last several years, it is now worth somewhere between the average national price and average price for a midwestern house. I have not refinanced since I bought it, but when I bought it I put 20% down and had near perfect credit–almost certainly far better off than the middle class families we’re talking about. Admittedly, Ann Arbor’s property taxes are crazy, which adds a lot to monthly payments. So assume my better-than-average mortgage cancels out Ann Arbor’s exorbitant tax rates. And yet I still pay a few thousand more than the $12,577 you’d get off of the BLS numbers. And my house is average or below average in other ways, too–it’s 50 years old, in average condition, just 1,000 square feet, has just one bathroom, and the third bedroom makes a much better office than a bedroom. All three families who lived in this house before I did were just like the middle class families I’m talking about (though one was a single mother). In other words, this almost perfectly average house, with higher property taxes but lower credit costs, costs several thousand more than Nate has calculated.

Child Care

Here’s what Nate says about child care:

Child Care: Marcy’s data says that pre-school care costs $6,216 per year, and infant and toddler care costs $7,936 per year. Assume that each child needs three years of infant care and three years of pre-school care out of an 18-year childhood. If that’s the case, the family will spend $2,358.50 per year per child on average, or $4,717 on average for two children. Also, while Marcy asserts that her estimates are high, not all families will have to pay for day care. Even if both parents are working, some families may be fortunate enough to have a free or discounted child care program available to them via a church, employer, or municipality, or may have older relatives living nearby to take care of the children during the daytime. Or, if one or more of the parents works from home — which will be the case fairly often for someone in the individual market — they may be able to take care of the toddlers themselves and still earn a paycheck.

Now aside from the fact that Nate strains to average this out–ignoring that if both these kids are in child care in a year the costs will be at least $12,432, meaning this family would have to find a way to pay for much higher rates in several years of that average, there are several other bizarre assumptions Nate makes to bring child care costs down. He assumes that a family that doesn’t get health care through an employer might get child care through that same employer. He assumes that several discounted child care options aren’t included in the child care averages I used. Most curiously, he assumes that children don’t need after school care between the time they go into kindergarten and the time they turn 13, when most states consider them capable of watching themselves (after school care for two in Ann Arbor’s school system would cost at least $100 a week, or about $3,900 for the school year, and that doesn’t account for summers). He has basically chosen to just eliminate many of the realities that working families face when trying to care for their children and in so doing uses an estimate several thousand lower than it probably is.

Also note what Nate has done with the BLS data. He has ignored all the other costs included in it. I guess that means he has ceded my point–that these middle class families aren’t spending the $2,936 BLS says they would on entertainment (not even on cable TV). But that also means he is dismissing the $2,343 BLS says a family of 2.7 (with just .7 kids) would use on housekeeping and clothing, as well as the $1,322 BLS says this family would spend on personal care products, reading, and education.

Finally, one outright error in Nate’s post that would impact affordability. Nate suggests the government is subsidizing insurance that has an actuarial value of 80-85%:

There’s simply no way that you can provide $6,000 or $7,000 per year in subidies to a family like this one, for insurance that has an actuarial value of 80-85%, and leave them worse off — not unless the family has better genes than Brett Favre.

It’s not. If it did, it’d be a whole lot more affordable and I might not be harping repeatedly on affordability, because it’d mean families would use up out-of-pocket expenses more slowly, and could afford to actually use the care they had paid for in premiums. Instead, the Senate bill bases subsidies on silver plans, which have an actuarial value of 70%, which means families will have to pay a lot more for actually using the care they had paid for than Nate envisions.

Now, these quibbles about data would be meaningless except for one thing. Setting aside differences on taxes, setting aside the $6,601 in costs for a family of just 2.7 that BLS includes that Nate ignores, and just focusing on the two biggest differences between us–housing costs (using my own costs) and child care, which together amount to about $4,000–and this family would still be required to spend more in out-of-pocket charges then they had left over after their other expenses under the Senate bill. So even assuming (as Nate appears to have) that this family would live in a one-bedroom house and have kids watch themselves after school, this family is still going into debt with a significant medical event. Add in the $6,601 in charges that Nate ignores but BLS includes, and this family quite literally has almost no money with which to pay any 30% out-of-pocket costs.

Now, just two final points on this passage in Nate’s post.

I don’t want to get drawn into a sematic debate about what is “affordable” — particularly when I agree with Marcy that the health insurance for working families should be made more affordable before President Obama signs this bill.

Nate appears to want to retreat into the question of whether this is “better” than the status quo (as I said in my last post, we’re addressing different issues). But that allows him to avoid a very big question. We are mandating that this family pay for premiums. But–even according to BLS data–this family would simply not be able to fully use the service they had paid a significant amount of money for. That means we are asking them to use up their remaining discretionary cash but not ensuring they’ll get the care they need in return, because the plain math of it (assuming they’re not relegated to a one-bedroom house with young kids taking care of themselves after school) shows they will have little money left over to pay the 30% out-of-pocket expenses. Sure, they’d use the health care in catastrophic events, they’d get yearly check-ups in exchange for their premiums, but they simply would have to forgo care that wasn’t emergency care, because actually getting much care would put the family into debt. In MA’s similar program (PPT), 21% (about 19% of whom must have insurance) forgo care, and over 16% of families are struggling with medical bills. Where have we come as a society when we are taking away $5,000 dollars from a family that can ill-afford it (and allowing insurance companies to use 20% of it on profit and marketing) with the understanding that they won’t actually be able to use what they’re supposed to be getting in exchange?

Then, finally, there’s Nate’s claim this bill should be made more affordable for working families before it becomes law. How does he propose doing that, after having spent the last couple weeks pushing the Senate bill? The House bill is actually worse for people at this income level than the Senate bill, and Nate has spent a lot of time explaining that the Nelsons of the world won’t accept substantive changes. At the very least, improving on affordability requires discussing it as such, rather than dismissing it as semantics.

145 replies
  1. dakine01 says:

    Nate is a statistician. Statistician’s don’t always have that much of a grasp on the components of everyday life in the US and the world.

    Numbers are so much cleaner than real people doncha know.

  2. wavpeac says:

    I think the most important point you make is that this segment of the population will be paying for health care…and that they will have no discretionary income left to pay a hospital bill if a child breaks an arm or a leg or gets sick from H1N1 requiring hospitalization. One hospitalization requiring 20% payment would break the family in this segment. They would not be able to pay that hospital bill. The hospital will still not get it’s money and the cycle continues.

    Also, I keep harping on this but the fact that there is no income left for this segment of the population to put their kids in sports programs or for a membership at the local YMCA is a juxtaposition with the health care crises. Their are scholarship programs for folks who make much less, but I never qualified for any of these programs as a single working mom. We are suppose to get in shape…this idea is constantly berating us…making us feel guilty if we have a health problem or if we don’t have our kids in sports…but there is no income left for a family to put their kids in sports.

    It may seem like a luxury but every semi educated parent I know…is very aware of how important this is today. Most parents I know think of this as a necessity…whether “spoiled” or not…it will feel as if it is being “taken away” for folks who are in this group…if one parent loses a job and health care.

    The expenses that I faced as a single mom, that would bring me nightmares, but felt absolutely necessary are the following:

    1) child care full time before kindergarten (whether it’s preschool or child care it costs the same there is no state paid pre school for kids without disabilities in my state).

    2) before and after care for kids until age 13.

    3) braces, dental and orthodontia that are not covered. What’s the average??? I would like to know because it’s important. Some kids need fillings, or root canals that will have a large portion uncovered…are you going to skip the root canal as your kid is agonizing in pain. This happened with two of my kids. (two have perfect teeth and two did not…same brushing and dental care).

    4) Eye care. (my daughter was screened at school and they required she get an exam…she had a lazy eye. In a custody battle this is a bone of contention if you don’t provide this for your child.) Fine…the eye screening might be covered but glasses are not. (and if you don’t provide the care a child needs…you are a bad parent…poverty or not).

    5) sports.

    6) college savings funds.

    If this bill requires that people have to give up any one of these…I can tell you it will cause a tremendous tension. My thinking back when I was struggling and broke, stupid or not, was to stay in the moment. If the expense was about right now…I did it…if it was about the future or potential future expense I skipped it. (car insurance and medical bills). Sorry but that’s the truth. I went without car insurance frequently. I was lucky because I never got caught or go in an accident while uninsured…but I had all kinds of tricks to get around it…and I put my kids in sports instead of buying car insurance. It’s not a happy decision to have to make…one felt like more of a gamble than the other.

    • Rayne says:

      Good god. Even I’d forgotten the before-school childcare.

      Our school system will not permit students on the premises any earlier than 10 minutes before the bell rings. If the earliest you can drop a student is 7:30 am and you must be at work at 7:00 am, you are screwed and must pay for some form of childcare.

      Think you can simply leave a school-aged kid a little earlier at the bus stop? Hell no. There was a lawsuit here in my state within the last couple of months about this very issue; a neighbor called the police, claiming another neighbor was running an unlicensed daycare because the second neighbor had simply agreed to keep an eye out on a third neighbor’s kids who were left at the bus stop a few minutes earlier because of commute time. It was ugly even if it was ultimately resolved; there was legislation written to protect parents who must do this.

      But what parent really wants to do this, except out of absolute financial or logistic necessity? Who wants to risk having to deal with the cops and the child protection agency to defend their position because they can’t afford early morning care? It’s these parents who are already victimized to the hilt, and we’re going to victimize them some more?

  3. behindthefall says:

    Thought you might get a kick out of this: I looked up “mandate” in the Shorter OED to see whether there are meanings I wasn’t aware of, and there are several, mostly obscure and rooted in law. The good ol’ “mandate” that we know and love, though, was there. “4a. The commission as to policy supposed to be given by the electors to their elected representatives; support for a policy or measure regarded by a victorious party, candidate, etc., as derived from the wishes of the people in an election; gen. a commission ..” And the example of usage they give?

    Tucson Magazine It’s all right to screw the people as long as you were given a large mandate in the previous election

  4. Phoenix Woman says:

    Is what Nate’s doing called “moving the goalposts”, “burying the goalposts and erasing the line markers so nobody can see them”, or is it some combination of the two?

  5. Rayne says:

    I’m sorry but Nate is getting downright sloppy. Really. He’s averaging childcare costs over the duration of a child’s time with family? WTF???

    And if he can find me cut-rate, community-funded childcare, please, fill us in. Because the only time people can get that kind of assistance is when they are already collecting other welfare. In Michigan the limit for earnings was $20,0000 for a single mother with two kids; if she earned one penny above that in 2002-2003, she lost ALL state funding for childcare.

    Which was and remains a powerful disincentive not to achieve let alone work — if you did any better than 20K, you could lose more than half of those GROSS earnings right off the top to childcare expenses. A mandate on top of this would force even more people, mostly women, into enduring serfdom.

    How averaging these costs is supposed to make this roughly 6-year window of economic pinch any better is only something a single guy without kids could ever dream up.

    The notion of corporate-subsidized childcare is also a pie-in-the-sky dream which would be available to such a small number of employees to be news. Just go through Working Mother Magazine’s annual Top 100 Companies for working mothers and take a look around. The overwhelming majority of these companies only offer improved flexibility for working parents, NOT childcare stipends or childcare facilities or even reduced childcare.

    Bank of America is one example; it has 200,000 employees across the country, but only nine childcare centers. How many tellers are women of childbearing age, and yet they have only nine centers??

    A better if rare performer is Price Waterhouse Cooper, which does give childcare subsidies to the tune of $1,000 each year. But at PWC, employed parents likely earn well in excess of $60K annually on average and have corporate-funded health insurance.

    And in both cases, BOA and PWC, they will likely offer corporate-plan insurance. These kinds of employers just don’t enter the equation.

    Agh. All makes me wonder about Nate’s contact with the real world.

  6. BayStateLibrul says:

    I guess the real issue is mandates.
    If you believe the Department of Revenue in Boston, the mandates in Massachusetts are working.

    I just can’t get my head around how the Federal Health Plan will work.
    There are so many assumptions.
    Can’t we wait and see how they will work?
    There will be plenty of chances to make technical corrections.
    Based on my reading of the political landscape, this is our last hope.
    If it fails, it fails.
    I just want the discussion to end, and move on….
    I’m very fortunate to have a good medical plan…
    I’d like to see it for all Americans…

    • Phoenix Woman says:

      The problem is that the “corrections” most likely to be made — barring a total overhaul of our political system — are going to make it even worse.

      Mary Landrieu’s already said that if the House Dems try to make any changes to the Senate bill, she’ll vote against it and thus kill it. (Of course, this wouldn’t be an issue if Harry Reid would just use reconciliation. But he won’t as then PhRMA would release the hounds and start running “Harry and Louise” ads 24/7.)

    • AlanSF says:

      One of the problems with expecting “corrections” is that the bill’s main provisions don’t go into effect until 2014. It’s not likely they’ll revisit the bill they just passed when it hasn’t even taken hold yet. After 2014, it will take at least another two or three years to see how it’s working, and, if it isn’t, another two or three years for political pressure to build up enough to force a revisit. Then, assuming a correction is somehow passed, it could potentially not go into effect for several years more.

      It’s impossible to know how this will play out, but given these factors, it seems likely that we’d be stuck with the bill’s many shortcomings for at least another decade, if not longer.

      Senate bill defenders like Nate Silver believe that there’s a 100 percent chance that if passed the bill will be revisited quickly, while if it fails, and health care costs continue to bankrupt America and destroy wages, the issue will nonetheless not be revisited for 20 years. This simply doesn’t make sense and is not supported by experience or any particular argument; it just is.

      • earlofhuntingdon says:

        It certainly won’t be revisited before 2012. This president and Senate leadership want to shout a success, not fix something that hasn’t gone into place yet. That’s one reason it won’t go into affect until half way through Obama’s hoped for second term.

        Meanwhile, fiscal drama scolds of both parties will continue to want to cut its weak public provisions, while expanding its aid for an already profitable industry. If the GOP take control of the House or Senate (would it make a difference?), they will certainly advertise that they will seek to gut it, if not bring up legislation actually to do so.

        • solerso says:

          right. and if the bill cant be “fixed” by nixing the mandate then the 2012 election must become, and WILL become a referendum on this horrible bill, and guess what obama apologists? HE – WILL – LOSE. . He will lose to the hated republicans and the dems will fall so low that it will be another generation or two before they can win a SCRATCH OFF ticket again

  7. wavpeac says:

    Yes, but if it fails it might take me and my family with it. Right now many millions of americans are perched on the edge of despair…they aren’t willing to take a risk…that’s my guess and that’s why the polling numbers show they are against it. I am not willing to risk my whole life on whether or not this might work. It’s too costly for me. If it fails, it means more debt for me, it means less flexibility and it might mean forgoing real health care. It doesn’t seem like a risk worth taking for someone like me. And I think there are a lot more folks out there like me. I don’t have any credit card debt…but I know an awful lot of folks who we could “blame” if we wanted to, for running up the debt…but who are making HUGE payments each month to credit card companies…too many middle class people are already skating on thin ice. Too many fear losing a job. Every single person I know has fear that they will lose their job. Downsizing is happening every where. The fear alone about this will prevent people from getting on board with it.

    • BayStateLibrul says:

      You’ve hit the crux of the matter.
      The future is unknown…
      I guess I still have enought faith in my senators and Feingold and
      many others (Bernie Sanders) that the doomsday option will not happen.
      But, each one needs to make that decision.
      If it’s too risky, it’s too risky, but in my opinion, health care will eat us up if we do nothing.
      Right now it’s a matter of faith, and for the time being, I still have
      faith in the Democrats.

  8. klynn says:

    In MA’s similar program (PPT), 21% (about 19% of whom must have insurance) forgo care, and over 16% of families are struggling with medical bills. Where have we come as a society when we are taking away $5,000 dollars from a family that can ill-afford it (and allowing insurance companies to use 20% of it on profit and marketing) with the understanding that they won’t actually be able to use what they’re supposed to be getting in exchange?

    At the very least, improving on affordability requires discussing it as such, rather than dismissing it as semantics.

    (my bold)

    And here is the guts of your post.

    wavpeac and Rayne make some spot on points!

    The next round of numbers to crunch will be a projection of how many businesses will fold with this hit to the middle class. This will be a hit similar to the auto industry hit but in reverse. Instead of the loss from the industry down it will be from Main Street and up through the economic chain.

    Imagine all the financial failure Wall Street will be able to gamble on.

  9. stevedw says:

    If we can’t get Medicare for all, we should nationalize the entire health insurance industry. In California, there is a non-profit insurance company providing Medicare HMO-type supplemental coverage for only $29 or $39 per month. The $29 version even includes membership at 24-hour Fitness. I don’t understand why Medicare doesn’t cover the healthier, younger population.

    For me, I am a healthy 49 year old paying $196 a month for coverage with a $2,500 deductible. I’d be happy if I could have the privilege of paying the copays that go with the Medicare supplemental…. My insurance today is not for me. It is for keeping my family in the house in the event of a catastrophic medical event. It almost has nothing to do with health care. You can call it house insurance.

    • fatster says:

      I have a deep suspicion (and that is exactly what it is) that they are purposefully keeping Medicare separate because, once they round up all non-Medicare-covered folks and make them funnel gazillions into the insurance industry, they’ll then sing the praises of this wonderful new FUBAR creation of theirs, and get energetically to work on bringing all the Medicare folks into it, too, since it’s just so peachy keen. Medicare has been, despite all efforts to the contrary, an amazing success.

  10. yknoodled says:

    Hey Marcy, get REAL!

    You’ve done a wonderful job of zeroing in on the “average” family, but few of us have such a straight forward situation. For instance, I know this guy (Heh!) who used to make 120k, health insurance and a company car to boot. It’s a family of three, with an adult dependent for good measure. In 2010, he will make about 80k, no car, no health insurance, and here is were it will go: 12,240 for SS, 8k for Fed and State taxes, 24,360 for mortgage, etc., 1.5k for life and car insurance, electric 1.5k, phones (don’t ask!) 3k, two cars 6k, food & household 10k, Pets (3 horses, 3 dogs, 6 cats, not MY idea) 4k, cloths 2k, alcohol (he NEEDS this) 1k, credit cards (3k). That’s 76,600. More than the rest goes towards “stuff” that comes up, for instance when the adult dependent needs a prescription filled, food for the week, his wisdom teeth pulled…

    So this guy I know would tell Nate Silver to shove it up his arse! Many are trapped in a life built in the 90’s and destroyed in the oughts. So the 19k per year Cobra payments will buy a lot of real health care as opposed to crap insurance and this guy ain’t gonna play this mandate game.

    • emptywheel says:

      Yeah, as I keep saying, this middle class family is doing remarkably well, and doing a damn good job at keeping within USDA rates for food and BLS rates for clothes and other stuff.

      • klynn says:


        I am serious about the “Main Street” number crunch.

        An example…Asked my hairdresser how his business was doing with all the layoffs around Columbus six moths ago. He said, “Actually good. In fact, business is up.”

        “Wow. That’s amazing,” I replied.

        Six months later (two weeks ago), I asked the same question.

        “My accountant just informed me that I just lost $25,000 in the last quarter. I am trying to figure out how to make that up,” he said.

        That is a huge hit in one quarter; especially, for a business that has been around for over 30 years.

  11. drational says:

    Aren’t the mandates most meaningful for people who don’t have employer-provided insurance? What percentage of families at 300% of the poverty level do not already have insurance?
    2009 BLS statistics indicate that >80% of top 3 quartiles of wage earning have access to employer-sponsored healthcare; I am not sure what that translates to in terms of your middle class family, but can you tell us what percentage of your middle class families lack coverage and would potentially suffer from the mandate? I think it makes a difference in describing who would be likely to suffer from the bill as written.

    • emptywheel says:

      I’d have to find the cite, but about 15 million would be covered entirely, leaving about 15 who would be exposed to some kind of mandate. I haven’t run the numbers for those in the next subsidy level down–the 250% to 300%, but in some ways they are even more screwed. The family I’ve been focusing on almost certainly would be able to opt out, bc there is no way they’re going to find health insurance for the $4,686 that would get them to the opt-out rate of 8% of income. But for those in lower groups, they would. (That is, they’d get to the subsidy level before the 8% level, so could not opt out without penalty.)

      But note, there are going to be a whole lot more people not getting employer provided health care by 2014. As many as 9% of employers are considering scrappy HC bc of rising costs.

      • bmaz says:

        Personally, I am not all that dissimilar to yknoodled up the thread. No way in hell we will ever qualify for subsidies and have a sizable monthly gig to maintain, even doing it at relatively austere levels compared to how things used to be. My wife, daughter and I, like yknoodled all have personal BC/BS policies that protect (theoretically) us and our home etc from the event of something catastrophic. They have very high deductibles ($5000) but we get some prescription and office visit use out of them for semi-reasonable co-pays. It works for us because the policy premiums are cheap. I have the distinct impression that when the mandates kick in, these kind of policies will disappear and people like me and yknoodle will be forced into much more expensive coverage that we get no more out of and, in fact, may not be able to use as much as we use what we have now. By what I have seen, I could easily be forced to pay $10,000-$12,000 more out of pocket for coverage than I am now. That will be a killer.

        • BayStateLibrul says:

          My dad used to say “Jack, the most important thing you have is your health.”
          When people start messing with health, it stirs up justifiable emotion and fear.
          I’m just saying, how much is fear, how much is truth, how much is bullshit.
          My point is that evidently folks have lost faith in the Dems to do the right thing…
          When Jay Rock talks about West Virginia, I believe him, when Mrs. Kennedy
          cries at the vote, I believe her.
          Call me a do-gooder, but I believe the insurance companies will be forced
          to reign in costs.
          The questions and answers are different for everyone dpending on each story.
          My point is: will more be helped with legislation or not?
          I don’t think there will be a Second Act. As Updike says of Teddy Ballgame “Gods do not answer letters.”
          The die is cast.

        • emptywheel says:

          I don’t think the question really is “will more be helped,” because it assumes there will be no reaction to this legislation. Even assuming everyone loves this and Dems get great new turnout among those Medicaid recipients who will be most helped, even assuming this reels in health care costs for employers (though it’s only designed to reel in amounts of care) without leading more employers to cut health care entirely, this will set off another reaction.

          As in MA, in a number of years they’re going to start chipping away at subsidies. In any case, the amount of premium families pay will go up as health care costs go up. And unless the House succeeds at making this a strongly enforced national plan, it’ll make the insurance companies far more powerful in DC than they aer today.

          Oh, and jobs will continue to go elsewhere bc this doesn’t bring down costs. And the deficit will continue to grow, chipping away at other programs.

        • tbsa says:

          I don’t understany why anyone thinks the insurance companies will do the right thing. They will not pay for critical treatment for my child which I have to pay for out of my pocket that costs 1,000+ per month. Why aren’t they doing the right thing for him? You have no idea what that expense does to my family and our bottom line. There are thousands like us. Spare me if I don’t have faith in the insurance companies. They are not in business to do the right thing, they are in business to make money. Without cost controls they will do whatever the hell they please.

        • solerso says:

          I don’t believe anyone thinks that. Not anyone that has to pay an insurance company belives that, its a cynical and deeply offensive feature of this argument that the defenders of the bill keep on pushing the bill as if that were true. The bill is a complete and total wealth grab, and nothing else and it benefits the insurance industry, thier stooges in washington and wal st. and no one else. but for the obama administration the senate and wal st, no one else but they count for anything anyway. we are merely cash livestock.

      • ManwithaParachute says:

        “But note, there are going to be a whole lot more people not getting employer provided health care by 2014. As many as 9% of employers are considering scrappy HC bc of rising costs.”

        The 9% will grow as soon as this mandate happens. Why incur the cost when it is now law that the individual has to. The mandate provides the cover. Nate’s floating criteria on the numbers is startlingly perverse. Nate is a smart and thoughtful man but, he is fudging numbers to create an illusion. Todays numbers are from yesterday’s cost and tomorrow’s numbers will be from today’s cost and all we know for sure is that tomorrow’s cost will be greater. I have not seen any calculations for inflation in the wage to subsidy scale. There is no calculation for the current economic situation as the results will appear down the line. What do you think will happen to this economy when gas prices go up again. They will and I believe we are going to see this move sooner rather than later with an accelerated curve towards the elections. Most folks commute far beyond the average of the transportation cost Nate used. And this does not account for the Oh Shit moments when you need repairs to the car. In the average year, practically all families at this annual salary range experience at least one unforecasted financial burden. This mandated expense will absorb all flexibility in the family budget. And no matter what they plot out in their numbers, they have not factored the broader economic damage cause by snatching 8% of the salaries of the consumer and shifting it to a completely unproductive element in society. How many jobs will be lost now because the little people have nothing to spend? How many credit card will be defaulted on because Aetna was given our money? How many new cars will be purchased when the money evaporates into the bonuses of the insurance companies. This mandate will cripple this nation.

  12. TarheelDem says:

    On mortgage costs. Mortgages can run up to 30 years. That means that the mortgage payments people have depends on when they bought the house. Refinancing complicates this because people are borrowing at a lower interest rate on a lower principal. About the only way to simply get this data is through surveys, and people might not know how much they pay for housing, just how much their mortgage is.

    Had I bought a house thirty years ago that was the equivalent of what I now live in, my mortgage payments would be 40% of what they currently are. Had I bought the same house yesterday, my mortgage payments would be 150% of what they currently are. That is a broad range of variation. If I had bought in California instead of in North Carolina, that range would be entirely different.

    Estimates require some disclosure of the expected variability of the estimates. I am surprised that Nate does not do this.

    What is affordable generally in one place for a family of four might be signficantly unaffordable elsewhere.

    I’ve seen no cost model that is remotely sophisticated enough to be persuasive in either direction on this bill.

    And the whole notion of affordability is kinda elastic. And operational definition might be a comparison to healthcare costs (provider + insurance + taxes) in a benchmark country, say France, as compared to the Senate bill. If doing nothing is maintaining a cost 200% of the benchmark country, then will the Senate bill come in at 150%, 130%, or 250% of that benchmark. Note that I am not using real data in this example.

    • fatster says:

      Regional analyses would be great, I agree. Right now, though, EW is one of the few trying to get a grasp on what “health care reform” will do to the average (mean) family. Also, people keep bringing up their own personal situations and how they differ from the mean. Those individual situations are certainly interesting, but in doing this kind of analysis, they have to be ignored (other than noting that differences from the mean are to be expected). Showing a range would help, but, as I said, this analysis is just getting underway and I think EW has done a masterful job in trying to find and use the best data at hand.

      If I understand what this fellow of whom y’all speak is doing with bringing in variations in child care, it is an excellent example of having your cake and eating it too. When using mean figures, you don’t try throwing in all the variations–even outliers–you can think of to shore up your point. You go with the data you got.

      • yknoodled says:

        Sorry Fatster, I won’t be ignored. If all y’all want to just survive to serve your masters, then peace on ya, but it ain’t me. I’m just pointing out that beyond the Medicaid folks, this bill is a POS. Now, I would love to see the poorest covered, but not on my back please. And that’s what this bill does. The middle middle pays for the poor and the haves laugh yet again.

        I would much rather self-insure, because if something nasty happens to anyone in my family we will likely loss everything, insurance or not.

        • fatster says:

          I never wished you to be ignored. I doubt there’re few here who are interested in serving masters. As you say, this bill is a POS, pure and simple, and the analysis EW has undertaken is to explore the impacts it will have on the “average” family; that is, she is documenting as best available data will allow the hardships it will place on the average family. My apologies for whatever it was I wrote that made you think I was in any way defending “health care reform” as currently framed (in more ways than one) by our Congresscritters.

      • coral says:

        Median would be more useful. My family has been at median household level, or slightly below for 20 years, during which time we raised 2 kids, through college. For about half that time we paid health insurance out of pocket, because we were self-employed. I was able to get HMO, so despite high monthly payments, we got all the medical care & check ups we needed. Still, no prescription drug coverage, and kid with asthma, meant $100 every month for meds. We had mortgage, which we refinanced several times. For about 5 or 6 years I paid about $5000 per year per kid for childcare. There was some kind of tax credit, but taxes weren’t the problem. It was the self-employment tax, the health insurance, the child care that almost killed us. We had used cars and drove them until they died (all Toyotas, sorry Marcy, lasted nearly 300,000 miles).

        Our children are out of college as of this year (went on scholarship, but it still drove us deeper into debt).

        We barely hung on, and we were very lucky compared to lots of people we know in same income bracket. No major medical events. My feeling is that people pushing these mandates don’t have experience of trying to live on very moderate incomes, with all the expenses that just keeping your kids safe, in school, and getting to work and back, demand.

        People pushing the mandates are very well off, and I would bet that most if not all have employer-provided insurance. I doubt that many of them have worried all night long about how to pay the monthly insurance premium so the kid with asthma will be able to continue treatment or how to pay the monthly daycare bill in order to be able to continue working.

        It’s not that they are heartless, they are just clueless.

        • fatster says:

          It would be wonderful to have the median, wouldn’t it? We seem to all too frequently, whatever the subject of interest, to end up with the mean, though. I don’t intend to over-praise, but the effort EW has undertaken here is very impressive and I very much sympathize with the frustrations she must have with the data that are available, having been there/done myself more times than I can remember now.

        • yknoodled says:

          You had me right up until that last sentence. I do think many are clueless, but I am also quite certain many are heartless. Barry included.

        • Blutodog says:

          My wife and I are in a very similar place as you except I just had a major heart attack & if she hadn’t gotten a full-time job the month before the attack we’d be screwed right now since our Health Ins. was as they say less then adequate in such an event. It was a COBRA policy from my last employer, it was expensive and it sucked. On top of that we have two kids in College. Obama’s so called health plan from what I can see will only add to our burdens. Personally , I hope it never passes. We don’t need to make things worse then they already are.

  13. jo6pac says:

    This bill isn’t health care any one can afford. If it isn’t free than it’s reform that’s needed but more corp. health care welfare. Yes I sound like a broken record for those who remember what a record is.

  14. tbsa says:

    Supporters can not say affordable because the word they are searching for is wellfare. As in corporate wellfare.

  15. perris says:

    macy, how does nate deal with the issue of forcing individuals to buy into private monopolies?

    doesn’t he have statistics that demonstrate prices rise when people are mandated into using private corporations that are not subjected to regulatory restrictions?

    does he argue this bill is better with the mandate or without one?

  16. indiepro says:

    I continue to lose respect for people like Nate Silver as they continue to polish up this ugly reform.

    If nothing else we are learning who the progressives, liberals and reformers are, and who the establishment and party-line mouth pieces are.

    • ManwithaParachute says:

      “If nothing else we are learning who the progressives, liberals and reformers are, and who the establishment and party-line mouth pieces are.”


  17. ThingsComeUndone says:

    Nate’s been bought off I suspect he is doing secret polling for the Dems on issues and getting paid to argue for healthcare.

    • perris says:

      I think he’s just wrong and doesn’t want to admit it yet

      this is a conversation he’s having with marcy, let’s see where it goes before we draw that conclusion

      you’re not going to belive this tcu but I myself have made mistakes in the past (it’s true, I swear)

      nate’s made some, we’ve made some, let’s see where this winds up

      • behindthefall says:

        Well, yeah, I’ve been joking with myself about that, but actually I’m serious: I don’t know what this health care “mandate” term means. I’ve just missed the explanation and haven’t had time to search for it. But it ain’t in the dictionary, AFAIK.

        Oh well.

        • fatster says:

          Hope this helps.

          “1 : an authoritative command; especially : a formal order from a superior court or official to an inferior one
”2 : an authorization to act given to a representative 

          “3 a : an order or commission granted by the League of Nations to a member nation for the establishment of a responsible government over a former German colony or other conquered territory b : a mandated territory”

          Merrian-Webster On-Line.

        • behindthefall says:

          No, it doesn’t, and that’s my point. What the new meaning of the word? It’s being used like “conditional requirement” or some such. Well, this is definitely EPU-ed.

        • perris says:

          don’t know if anyone’s answered you yet, but obama’s bill forces everyone to have health coverage bought from private industry

          progressives in general were somewhat ok with this so long as there was a public option and a person didn’t have to buy from these monopolies (I have never been ok with it, I”ve always had a problem with it even with a public option)

  18. tbsa says:

    It’s not that they are heartless, they are just clueless

    They are bought and paid for. They care not one iota how much you worry, or if your child’s life depends on healthcare. After 9 months of debate in this country on HCR you would have to have been hiding under a rock to be cluecless. Sorry but I don’t buy that argument for one second.

  19. joanneleon says:

    I’ve been watching Nate’s posts recently. Between these analyses on health care costs, and the way he jumped in two weeks ago and started trying to refute and/or obfuscate the upward trends in health insurance stock prices, I’ve been having a lot of WTF moments.

    It’s hard to keep myself from speculating about who is paying him.

    Lastly — I had three children in a five year period, so there were some seriously expensive years there with daycare, summer programs, etc., and I even had help from family. But now I’m looking at Nate’s analysis and Hey! I didn’t know that I could have mortgaged/amortized my child care costs! Damn. ;)

    • Rayne says:

      Yeah, me neither…I don’t remember seeing that chapter on amortizing childcare costs in either What to do when you’re Expecting, or What to do: the Toddler Years.

      Damn, and I spent all that time worrying about spending $25 a week on diapers and $10 week on formula and another $10 a week on baby food and $100-$120 a week on the sitter and whether I’d have any money left at the end of the paycheck. I could have amortized it all until I started paying for glasses and braces. Huh.


  20. bonedog84 says:

    Hi Marcy,

    Your work is considerably more comprehensive. I now come to your blog instead of 538 . First he calls progressives batshit without calculating the cumulative cost of insurance company malfeasance (just add up the bars in his graph and you can see the problem). Now he’s averaging child care costs over 18 years of childhood, plugging in Marietta GA housing numbers, and all around… well, being batshit crazy.

    One thing I’d like to see, now that you are my preferred stats guru, is a rundown of what happens if the insurance industry doesn’t make it’s estimates. That was the key point in favor of a public option imo, keeping insurance companies honest (God knows that theme was beat into my head enough… but there’s a reason). Here’s the kind of math I’m talking about and, since Nate apparently rebuts your arguments, perhaps you could make them for me.

    From his 12.15 post, just add up the total cost of healthcare, which is the so-called “cost curve” we’re trying to break. By the insurers own admission, compared to the Senate bill with a public option, they would make costs $290 higher per annum per family (just a few hundred million dollar giveaway, nothing to make a fuss over). He then mentions in passing:

    “And remember: these are based on estimates of premiums provided by the insurance lobby. I have no particular reason to think that they’re biased, but if they are, it’s probably on the low side.”

    Really? No reason to think these are biased? My school pays extra just so insurers keep premiums from increasing more than 15% YEAR OVER YEAR! And Nate takes their word for it.

    What happens if you don’t? What if they miss by:

    2%- an additional $392 per family, $682 over the costs estimated with a public option, net giveaway (assuming just 1.5 million families of 4 effected): $1 Billion
    3%- an additional $588 per family, $878 over the costs w/ public option, net giveaway: $1.3 Billion
    5%- an additional $980 per family, $1270 over costs w/ public option, net giveaway: $1.9 Billion
    10%-an additional $1960 per family, $2250 over the costs w/ public option, net giveaway: $3.4 Billion
    15%-an additional $2940 per family, $3230 over the costs w/ public option, net giveaway: $4.85 Billion
    25%- an additional $4900 per family, $5190 over the costs w/ public option, net giveaway: $7.8 Billion

    And so forth. Basically, if the insurance companies want to make more money, without a cheaper option, they can. Just like they do now. These percentages are the result of compounding just once over the 6 year period, heaven help us if they miss by 15% per year, which our school PAYS them extra not to do now!

    Why is nobody talking about insurance industry dishonesty? Why do you and Nate even use their estimates as if they mean something?

    Just wondering,

    4th year PhD Candidate in Chemistry Theory, Caltech

    • emptywheel says:

      Oh, let me make it very clear. I am anything but a stats guru.

      In fact, I don’t think Nate is operating in bad faith here. I think he’s acting like a stats guru when it’s precisely in the individual stories that this bill must be understood.

      I’m not even all that good at math. It’s just that my neighbors–the ones paying more than me for our perfectly average houses–include a lot of the craftspeople and small business owners and house cleaners and bus drivers that will get stung on this issue.

  21. pmonet says:

    I love the Firedoglake community. I have stood in a peace vigil for 6 years. I am a union officer. AND I think it is time we support Obama, almost in lock step the way the right loons support their crazy ideas and leaders. I listen to Amy and Rachel and read all the greatl leftie blogs, but we need to get a strategy to silence and marginalize the right wingnuts. Here is my thinking: they always stay in line, get full-on coverage and seem our equals. We on the progressive left look the “she said” of “he said, she said”.. we are the active base of the dem party, and we are attacking Obama, so there is no one there to defend him and his policies against the right wing crazy machine. If we jump on board, start realizing we could be the voice of the party the way the tea partiers are for the right, and find ways to defend the Democratic party policies, insterad of always criticizing, we would influence much more what comes about. Holding his feet to the fire is one thing, but he needs our support NOw or he will be a one term president and we will lose all influence for a generation.

    • ManwithaParachute says:

      “I love the Firedoglake community. I have stood in a peace vigil for 6 years. I am a union officer. AND I think it is time we support Obama, almost in lock step the way the right loons support their crazy ideas and leaders.”

      Let me suggest to you that supporting anyone in lock step (goose stepping)ALWAYS results in CRAZY IDEAS AND LEADERS. You are suggesting we do as the Republicans do. I will defend Obama against lies and the racist crap slung all around but,I will not support the federal government being a tax collector for multinational corporations. Obama and company are attempting to take your money and give it to a foreign entity with zero allegiance to anything but quarterly reports. Are you going to support Obama when he suggests that they go after 10% of your income for alternative fuels? Would it make a difference if the government wanted everyone to shore up the business model of Sears and the rest of the retailers?

      Goose step your way into the fascist new world

        • hctomorrow says:

          I’m not sure about that reply either, but I don’t think it’s ever healthy to be in lock step with a government of any kind. In a Democracy particularly, you’re not *supposed* to be satisfied, and even if you were for some reason, for Eris’ sake don’t let your government find out.

        • ManwithaParachute says:

          “He is entitled to his opinion.
          Your retort, in my opinion doesn’t make sense…”

          Everyone is entitled to their opinion. Obviously, I lost you in my ramble. If you indulge me, here it is simply.

          The senate bill will use the IRS to take your money and distribute it to the insurance corporations. Some of which are not simply U.S. owned. If someone exclaims we should lock step our support for the man who will sign this into law, I will attempt to identify what is really happening. It is the insurance industry today. Tomorrow it will be some other industry.

          At the very least this is a case of Robin Hood in reverse.

        • BayStateLibrul says:

          Fair enough, but that’s not the way I view Government…
          I wouldn’t mind National Health Care like the European countries.
          I supported the “robust” public option.
          My ideas did not win the day.
          In a democracy, we play by the rules.
          We lost.
          We can have a revolution, yes.
          I just don’t see your domino theory working…
          I can’t demonize everyone since I lost…

        • BayStateLibrul says:

          Are you talking enactment (i.e. the House will not go along with
          the Senate) or lawsuits challenging the constitutionality of “mandates”)or
          something else?

        • solerso says:

          How is acknowledging that we’re about to be robbed “demonizing” anyone? anyone that isnt already “demonic” anyway, to borrow your metaphor. The bill sucks, its a rip off, and yes, thats the way our goverment works. The way the German government worked in 1940 was, anyone who was close to hitler could get any rule made, or any bribe proffered or any man woman or child killed they wanted to. and many people just accepted that it “works” that way. that dosent mean they were right to do so, and it didnt save them from going down with the “demons” in the end either

        • ManwithaParachute says:

          “My ideas did not win the day.In a democracy, we play by the rules.We lost. We can have a revolution, yes.I just don’t see your domino theory working…
          I can’t demonize everyone since I lost…”

          I suggest your ideas never had a chance. In order for the ideas to have a chance it appears you have to pay for them to be heard by the people who have the power. The idea of “in a democracy, we play by the rules. We lost.” assumes the game has played out. This battle is certainly is a loser for now. But, I believe (hope) it will lead to a rising in populist involvement. There were several incidents prior to WW2 involving US losses. It took Pearl Harbor to get to go all in.

          Casting aside the particulars of this issue and dealing with the politics only, I believe the Democratic party is going from first to worst. Where a year ago the nation was experiencing a high from the impending end of Bush and the historical precedence of Obama taking office, we have traveled to an unraveling of the Democratic base. We did not get here by accident or happen stance. We are here because of very specific circumstances. There is a large portion of the Republican base which is all white. Some are so white they can reach legal drinking age and never have seen a person of color. These people are easy to “feed” and rally to a foaming lather. This is a nation which still has white churches and black churches. Racism has been built into segments of society even in a religious context. The GOP simply had to stand up to the black guy in order to charge these people up. We, as a nation, have spent far too much time allowing the bigotry to gain deeper penetration into the fabric of this country. Obama and company decided to avoid the issue after failing at real opportunities. The GOP interpreted this as weakness. This perception was reinforced consistently with the administration saying one thing ineptly and then backtracking immediately at the first sign of GOP distress. If you want to put the bigots in their place then you must confront them simply and directly. This administration appeased them at every turn. One of the realities of forensics is that your argument is not intended to convince your opponent, it is intended to convince the audience. Given Obama’s intelligence, suspect much of this loosing streak was due to bad advice. Regardless, a party with all this “power” can’t cry about the opposition unless they wish to reinforce the incompetence view. Appeasing the bad guys and shunning the good guys makes one with the bad guys.

  22. mwfolsom says:

    While I can’t say lots about cost of childcare and other things Nate’s estimates on housing are way to low. I would think $1,000 a month would be the bare minimun and frankly that’s not enough – my guess is that you would need to add $200 to $400 a month on top of that for utilities and taxes.

    When the disaster starts up we will see exactly how unaffordable it is and of course the Dems will be blamed.

    • emptywheel says:

      We’re both generally calculating utilities as a separate budget item. I agree on taxes (did I mention Ann Arbor has ridiculous property taxes that allow us to have lots of parks and the best public schools in Michigan?), but that varies greatly across the country. I pay more in taxes than my bro and my Mom in CO, both of whom have/had houses worth several times what mine is.

  23. joanneleon says:

    Let’s say that I could (or did decide to) amortize my child care costs over 18 years. Is Nate taking into consideration the financing costs?

    If you did finance these costs over 18 years, the total cost of child care effectively doubles.

    $4,717 avg/yr x 18 yrs = $84726 total cost child care, (assuming 2 children)
    Finance $84726 over 18 years @ 8% interest rate:
    Total payments = $160,125
    Total interest paid = $75,399

    • emptywheel says:

      Oops, you forgot the after school care, which using Nate’s system of amortization puts it up over $6200 a year, even amortized.

      So yeah, that’s a lot of debt.

      • joanneleon says:

        Okay, so now it’s $111,600 over 18 year term @ 8%:

        Total cost: $210,915
        Interest paid: $99,315

        And of course it’s not $6200/year anymore either. Monthly payments are $976, so it becomes (976 x 12) $11,712 per year.

        If Nate wants to amortize those costs, he has to include the financing.

  24. jcc2455 says:

    Great post Marcy! A general thought: Nate seems to really, really, really want to say “yes!.” Who’da thunk the guy who we all look to for ruthlessly accurate poll analysis would start to swoon? Shows how powerful the will to believe is. Specifics:

    1. Averaging child care costs over the course of someone’s childhood is profoundly dishonest. Those costs accrue in real time, and must be accounted for in real time. Nate is essentially assuming that families will be able to magically amortize those costs. The only way to do that is borrow money, which means:

    a. We’re now defining “affordability” to mean “a manageable increase in debt load.”
    b. You have to go back in and account for years worth of interest costs. Some lucky families will be able to find programs that allow them to amortize child care costs inexpensively, but having just tried to do so, I can assure Nate that there are not a lot of financial institutions rushing to lend people money for child care. That leaves credit cards, and so Nate’s child care costs must be multiplied by 20% apr compounded daily over the period (presumably 18 years) for which he would have us amortize those costs. Unless of course, BLS accounts for those costs in its averages, which brings us to:

    2. The assertion that BLS somehow misses discount programs in their averages is also dishonest. He’s saying “you must use the BLS numbers! They’re the gold standard!! Er, ah, um, except where they undermine my argument, in which case, by fiat, I get to assume all sorts of elementary errors in the BLS data.”

    3. You’re conceding too much on the other points. Hammer him.

  25. solerso says:

    Silver is above all a salesman. He learned very young how to sell his statistics skills (not typical of your average kid – math whiz) and hes been self promoting ever since. Also not a typical personality trait of the normal boy genius math nerd type. Nate likes this running argument because it falls right into his domain. As long as the “argument” goes on he and 538 remain esepecially relevant and in the spotlight and he benefits personally. Im not saying nate dosent care, im just saying that as long as its just argument, whats the harm in caring and profitting too, right Nate?

  26. earlofhuntingdon says:

    Calling your repeated differences with Nate “semantic” is a derisory, tradmed dismissal of significant issues. It’s like Jonah Goldberg saying he’s too busy to comment about the issue of the day because he’s doing something important. A few themes suggest themselves by these repeated exchanges.

    1. Charlie is devoted to the tradmed view of journalism, including hauteur about criticism from non-tradmed critics, who couldn’t possibly know as much or analyze as well as he does.

    2. Charlie is devoted to “statistics” that promote his point of view.

    We all have that tendency. Trained scholars, Marcy included, are among those most aware of that tendency and least susceptible to it. Journos do not often have that background, and today’s standards prize speed and “personality” over depth or accuracy of reporting.

    3. By definitions, statistical averages are intellectual constructs.

    Averages always differ from real world examples, sometimes in crucial ways. It is physically impossible to have 0.7 children. It is financially impossible to pay 70% of the cost of raising one or for 70% of a tax or utility bill.

    Policy makers use statistics to calculate governmental costs. They must also analyze examples of real families – because they pay actual, not imaginary, costs. They analyze what proportion of the whole those families represent. That’s necessary to gauge the real pain or benefit of what they propose to do.

    4. Charlie has adopted the role of government advocate, another tradmed characteristic.

    All governments use “statistics”. They interpret or just lie about them, by omission or comission, in the ways that spin the best possible drama for what they’ve done or plan to do. That’s true whether it’s body counts in Vietnam, accomplished missions in Iraq, or prescription drug care for the elderly that costs hundreds of billions more than disclosed. It’s also true about the most important reform of this generation, regardless of how badly that reform is being implemented.

    5. Charlie seems stuck defending himself, yet another tradmed behavior, instead of accepting that there may be multiple, valid interpretations of what this bill will do. That does a disservice, not to his readers, who can look elsewhere, but to the Americans who may be stuck for decades with a piss poor bill that keeps them indebted to their government, to their rapacious credit card and to the fickleness of fate.

  27. OldFatGuy says:

    Hope everyone is writing down the screen names of all those posting in support of this trash. Because they OWN it too.

    Remember that folks, five or seven years from now. Remember it well. And oh, I’m OldFatGuy, and I’ll gladly buy a web cam and eat my hat five or seven years from now online live (if I’m breathing) if I’m wrong.

    Not too worried about buying a web cam though.

    This bill is NOT health care. It doesn’t provide anyone with HEALTH CARE, it provides some with health INSURANCE. Wanna take a guesstimate as to how many millions of families in the last decade alone WITH HEALTH INSURANCE became financially ruined?

    This is poor policy, paid for regressively, and includes a mandate to be a customer of an industry WITH A AN ANTI-TRUST EXEMPTION. Soak that in. Forced to be a customer of an industry that can, in theory, legally price fix.

    Make all who support it OWN it.

    • gesneri says:

      Exactly. It’s really simple: most people aren’t going to be able to afford the costs mandated under this bill. There are going to be substantially more of these people in 2014 than there are now. There is going to be an increasingly large number of angry citizens looking for redress in the years between say 2015 and 2020 as the true costs start to hit home. Subsidies will prove to be vastly inadequate due to flawed indexing and the fact that the subsidies will become prime targets for deficit hawks, costs will explode, and outraged citizens will be looking for someone to blame.

      I think it’s going to get very ugly.

  28. earlofhuntingdon says:

    As many have said, the idea of a mandate has been divorced from its pubic utility. A mandate is useful and may be necessary – as one of several tools – to distribute high-risk people across insurers (public or private).

    Rahm and this bill have bastardized it; it’s now a funnel to force fees to private insurers. Since these remain wildly under-regulated – eg, they are allowed to spend only 70% of revenue on actual health care – a mandate also funnels huge profits to those same companies.

    Rahma & Bahma and virtually every Congresscritter must hope that they will be retired or personally insulated from the political and social consequences from such a poorly and brutally designed piece of legislative sausage. Even if true, their party won’t be.

  29. fuckno says:

    DCCC Chair: GOP Opposition To National Security Funds Will Be Issue In 2010

    I think not, and neither will be health care which even if it passes will never see the light of day other than it’s tax collection part.

    The Issue in 2010 might not even be ‘the economy, stupid’, as it is likely by then to have imploded.

    I don’t believe we’re anywhere ready for what’s coming round the bend.

    • earlofhuntingdon says:

      Nor is Congress or this president inclined to help prepare us. We live in a bootstraps economic world. We’re supposed to take care of ourselves, write a book on liberal fascists or get a gig on Fox. The government only takes care of those vulnerable companies. They’re just big puppies, dontchyaknow.

  30. emal says:

    Marcy, I appreciate you and Nate attempting to to discuss the issue of affordability. I’m sorry to see Nate’s dismissive attitude here about affordability somehow becoming an issue of semantics. He loses me with that, as one persons semantics is another persons reality. And methinks many of those middle class Americans currently living paycheck to paycheck and/or choosing not to join their employer offered plans now because they are not affordable (even if they’re offered a subsidy) will still not be able to afford it. Underestimate that population and that reality at your own peril. Mandated health insurance for a population does not necessarily equal affordable health care. And my worry is that it still leaves many people one medical disaster/diagnosis away from a mountain of debt.

  31. TaosJohn says:

    I see no reason to bother with Nate. I’ve deleted my bookmarks for him, TPM, dKos, and a whole host of others. Why argue? They’re wrong, but they won’t change. Bah.

    • ManwithaParachute says:

      “I see no reason to bother with Nate. I’ve deleted my bookmarks for him, TPM, dKos, and a whole host of others. Why argue? They’re wrong, but they won’t change. Bah.”

      I found my way to all those sites and this one via Huffington Post. I found the that even in disagreement there is value if only for the knowledge of their integrity. For some in the Democratic party the issue is integrity and others it is about conviction. At the moment, they all appear cowards with no integrity. I consider myself a populist progressive and I know from experience there are populist conservatives and we have more in common than the moderates do on both sides. The independents are not moderates and it is foolish to believe otherwise. The independent status grows because there are intelligent people who recognize that the parties have been corrupted and they choose to pull away from a party which ignores them. As a populist, I want to actively bring about the change. If you really want change then you have to be willing to work for it. Speak up to people in your physical circle. Tell them what you have seen and heard. Ask them questions to make them think. Logic and truth have a way of ruining the darkness.

  32. hctomorrow says:

    I can’t stand to read Nate Silver anymore. I don’t know what the hell he’s thinking, but as these exchanges go on he gets more and more desperate, ignoring an ever larger piece of reality to try and get to the magic pony. I read the post that Marcy responds to here, and I couldn’t even get past his laughable mortgage cost estimate. I spend far more than that for an apartment that’s falling down around me! Admittedly it’s got a nice square footage, but that doesn’t help when the roof leaks or the building floods or the office staff refuses to show up for work and maintenance won’t fix things that break down. And of course, I don’t get equity.

    Nate is the worst kind of utilitarian, the sort who believes that people are interchangeable with the statistics that represent them, that you can somehow average out human misery and happiness, wave a wand and fudge the numbers until you have some aggregate measure that’s slightly better off, then declare victory. Individual stories and situations don’t matter, real world experience doesn’t matter, even, and this is the sickest part, the data doesn’t matter. What matters is producing an elegant equation, a pretty little mathematical snowflake.

    • earlofhuntingdon says:

      The insistence on mathematical elegance at the expense of real world accuracy is what Krugman calls that the fresh water school, most notably, Chicago. The salt water schools, such as Princeton and MIT still respect macro-economics and some aspects of Keynes that Chicagoans have slipt a figurative shiv into.

  33. BayStateLibrul says:

    Would never happen if we had a democratic 51 vote rule.
    Senate needs to deepsix that fucking rule.
    So many issues converged on health care…

  34. bmull says:

    Regardless of whether subsidies are adequate initially, in a few years they won’t be because the indexing is all wrong. Medical cost increases will outstrip the subsidies.

      • bmull says:

        The powers that be won’t let the economy collapse. Trillions of dollars will suddenly materialize to give to corporations. What they will do (like they did in Massachusetts) is throw poor people and immigrants under the bus. That’s why Bernie Sanders is fighting for another $14 billion for free clinics.

        • hctomorrow says:

          The powers that be (PTB) didn’t intend for the housing bubble to collapse, either. There are limits on their power, and we’re headed straight into one. We can’t spend 20% of our GDP on healthcare, but in a decade, with this bill, we probably will. That’ll kill us, no matter how many people clap their hands and chant that they believe in the free market fairy.

  35. donnadiva says:

    Nate’s averaging of child care costs reminds me of a conversation I had with a Bush supporter back in 2004. “Average taxes have gone down under Bush!” I was like, and? My taxes didn’t go down just because some millionaire’s did. Averaging like that is a Republican trick and I’m shocked that Nate is resorting to it.

  36. BayStateLibrul says:

    Maybe “ironic” is better.
    Here we have a piece of social legislation trying to improve
    health care and in the end you are comparing the results to 1940?

    • solerso says:

      Im not the one who brought in the “lock step” metaphor. and no, you sneaky bastard, im not comparing the bill to the policies nazi germany, im comparing “lock step” supporters of political personalities, to the same types, who installed a dictator, in nazi germany. if your going to argue, stick to the merits of the bill, or if you cant argue that (understandably) then at least stop attacking people who are reasonably and justifiably upset by it.

  37. nextstopchicago says:


    A couple things. On the one hand, you may be correct that your property taxes are exhorbitant, but comparing some locales on the Michigan millage estimator, using a $200,000 house:

    … I don’t find a lot of support for the idea. Ann Arbor is similar to Dearborn and Hamtramck, more than Livonia/Clarenceville; and less than Ypsilanti.

    On the other hand, almost everyone whose mortgage is older than 6 years, and most people even in the last 5, would have put 20% down. So I don’t know that your credit costs are that amazingly favorable, though surely there are many with a worse mortgage than yours.

    Based on my mortgage costs on an average mortgage including escrow to cover taxes, insurance ($150,000 loan on a $180,00 home) would be approx. $1,100/month, or $13,200/year. I’m not saying my mortgage is necessarily average. But in 2003 I was self-employed having recently started a new business; my credit rating would have been extremely good, but my income was not, and I put only 10% down.

    Mileage may vary, but I have difficulty seeing much reason to use your experience to say Nate’s BLS figures are dramatically off.

    I remain troubled by the fact that you can look at a situation in which you believe a normal middle-class family needs to spend $12,000/year on transportation, and $8,000ish on health care, and your outrage would be directed at the health care expense. I don’t happen to believe the $12,000 figure, but if I did, my rage would be channeled at those government policies, those corporate locational choices and yes, those family decisions, that make two cars per family and a 30-50 mile commute for each driver, along with driving kids to school, normal or even within reason. I have a very hard time looking at your assumptions and thinking it’s health care costs that are killing middle class families.

    • ManwithaParachute says:

      “I remain troubled by the fact that you can look at a situation in which you believe a normal middle-class family needs to spend $12,000/year on transportation, and $8,000ish on health care, and your outrage would be directed at the health care expense. I don’t happen to believe the $12,000 figure, but if I did, my rage would be channeled at those government policies, those corporate locational choices and yes, those family decisions, that make two cars per family and a 30-50 mile commute for each driver, along with driving kids to school, normal or even within reason. I have a very hard time looking at your assumptions and thinking it’s health care costs that are killing middle class families.”

      Your logic fails here in that the transportation costs(whatever they are) are currently budgeted. The $8,000 is not and it is not allocated to health care no matter how often you wish to call an insurance bill health care….IT AIN’T. The shit your selling is a lie. If health insurance were health care then, there would be no co-pay, deductible, annual limit, etc.

      People have already made their choice…without being force by some wimpy, greedy politician to buy the house, the cars. When someone forces you to come up with money you do not have and they tell you that you should make the sacrifice elsewhere that is called EXTORTION.

      Obama and the Democratic party are choosing to be the muscle and the IRS is the bag man.

        • ManwithaParachute says:

          ……And your ability to address the issue is clearly that of one selling excrement. Address the issue.

        • bmaz says:

          Okay, listen, I have some disagreements with Nextstop on this one too; but he has been involved in this discussion going back a few threads on this topic and has more than laid out his thinking. I think his views are pretty utopian and do not take into account the realities as they exist for much of America today; but he has pretty much admitted that here and posited the need to address population distribution and planning as well. On that, he is entirely correct. There is no reason for that kind of belligerence with him.

        • ManwithaParachute says:

          I appreciate your willingness to come to the defense of someone you do not necessarily agree with. Placing his statement in context of population distribution is value added but, on the belligerence concern…is it OK to call a Republican a liar when they spout a lie?

          The cost of health insurance is NOT the same as the cost for health care. This is as big of a lie as “death panels” and used to dupe people because the truth is not supportive of the goal. Did you speak up for Sarah?

        • PJEvans says:

          I don’t think anyone here supported Sarah. (You need to check the archives some time to see what was said about her.)

        • earlofhuntingdon says:

          I don’t know that anyone on this blog is arguing that insurance costs are equivalent to health care costs. I think EW’s point is that for the average American household, they are becoming a smaller and smaller percentage of their total health care spend. So much so that health care will remain out of reach despite this legislation. In fact, this legislation will keep that health care out of reach for more and more, despite its claims to extend it.

          You are right that health care is the ultimate goal. I think this legislation has the shape it does in order to avoid addressing that very issue.

        • earlofhuntingdon says:

          Let me rephrase that. Health insurance is covering a smaller and smaller percentage of total health care spend, while it becomes a larger and larger percentage of the average household’s budget. It’s an untenable trend. But in today’s “strip mining” mentality, businesses and industries don’t care. When one mine runs out, they’ll find another.

          Businesses today, like Barack Obama, do not reinvest in their customer base. They use them up and look for another. In Barack and Rahm’s case, they are not likely to find one.

          My prognostication is that Rahm Emanuel, who “made” $30 million via a couple of years of the Dem’s version of wingnut welfare, will make a lot more. His time as an elected politician is already over.

    • solerso says:

      lets see, assuming a car loan ( or two most of the time, since two have to work to get by now) 400-800 per month, so 5 -6 thousand per year, gas probably 2 – 5 thousand per year maintainence, insurance…where is 12 thousand anything but a very conservative estimate? assuming of course you dont use a personal vehicle for work (as i have to) ?

    • earlofhuntingdon says:

      Apples and oranges. The absolute and relative increase in health care costs is well documented. Insurers are charging more and more for less and less coverage. That’s the only way you can pay a retiring insurance executive $74 million for a job well done; you certainly can’t do it because he expanded access to health care at the expense of his own bonus.

      Addressing those climbing health and insurance costs was a principal reason for this legislation. Another was that millions of Americans have no access at all to insurance or health care. That this legislation does so much to ensconce private insurers as the only way to pay for health care, and that it so assures those insurers of increased revenue and profits, while continuing to regulate them so permissively, is a strong indicator that the stated reasons for reform are not the driving forces behind this reform.

      For whatever reason, containing health care costs themselves was not part of this step of “reform”. I suspect that was because you could not address health care costs without taking on the elephant in the living room – is health care a civic right or personal luxury. If it is a civic right, then continuing to use only private insurers would be unsustainable without regulating them beyond recognition. If it’s a luxury, or if you remain silent on the choice, you can continue to prop up the status quo, while claiming to be responsible.

      That other costs, such as transportation, continue to go up increases the need to address health insurance and health care costs.

      I have no problem with the estimate of $1000 month average costs for transportation. Those without cars would pay less, but that’s part of what makes up an average. Car payments, gas, insurance, maintenance, parking could easily reach that number, even if the car is of only average age and quality. There are few options to a car. Many jobs require it. Many towns and cities were built or expanded on the explicit, industry-favored assumption, that the only means of transport was the private car.

      • nextstopchicago says:

        >There are few options to a car. Many jobs require it. Many towns and cities were built or expanded on the explicit, industry-favored assumption, that the only means of transport was the private car

        Agreed. Much of this change over the last 40 years has been impelled by government policy, not personal choice alone. I think it’s a problem, and one that is going to crash hard when we inevitably face carbon taxes.

        I don’t mean to sidetrack the discussion. Whether transportation costs at 20% of family income is a good thing is just a little footnote for people to think about in the future.

        where health care costs fit into an overall budget is the issue. I think $12,000/year estimate is high, and found some support for that in Nate’s post. That’s something some of you debate, and you make some decent points that will apply to some and not others.

        • earlofhuntingdon says:

          Private car-only transportation was not simply a function of federal, state and city planners. Some of it was private company assumptions, such as the first builders of large suburbs, such as Levittown and many like it.

          Much of it was also a function of heavy lobbying by Big Auto. They devoted huge efforts to get towns to shut down bus and tramway routes. After civil rights shot up on the national agenda, this large-scale effort took on more explicit racial overtones, as the new middle class and their employers opted for the ‘burbs, leaving the poor and largely black and immigrant populations in the city centers.

          The movers did not want those left behind an easy way to join them. You can see it in the resulting patterns of many current public transport routes.

        • AlanSF says:

          So nice to wander off topic and discuss something other than this stinking pile of…I mean, “Health Care Reform.”

          Drivers get a public subsidy of several dollars or more every time they park for free, but the idea of giving a muuch smaller subsidy to a public transit user would be considered socialism, and wouldn’t stand a chance.

          OK, now back to the fray.

        • earlofhuntingdon says:

          Arguably, it’s not off topic, it’s a useful analogy. Big Auto corrupted city planning post-Second World War in that it pushed very hard for something many were already inclined to do: give way to the convenient and apparently cheap auto in exchange for the light, air, room and convenience of suburbs. De facto subsidies for autos came at the cost of the almost complete demise of public transport.

          Big insuresters want a similar outcome, one that for now they’ve achieved. This legislation is about to make them the only game in town – they are now. It will vastly increase their customer base without properly regulating how they service it. This new scheme will be left to 50 odd state regulators, yielding 50 very different experiences from Hawaii to Texas to Massachusetts. Think No Child Left Behind, cubed.

          Huge tax revenues will be directed toward insuresters – like the banks, with almost no cap. The new, heavily subsidized “market” will become the status quo. Unlike progressive elements, whose strings were cut away from survivors, such as the “mandate”, the PTB will keep the insurester strings tied to future reforms.

          You want cheaper insurance? You’ll still have to buy it from the privates, and pay higher taxes for the subsidy. You want national regulation, instead of a state patchwork? The insuresters’ subsidies will have to go up, but with no corresponding changes in loss ratios or other necessary insurance reforms.

          This focus on the insuresters is politically convenient, too, in that it keeps the heat away from necessary reforms in the provision of health care. Who thinks Obama will take that on before 2012 or in his second term, when he won’t have to?

        • solerso says:

          big auto post ww2 has got NOTHING on this politician/insurance industry move. this is historic. i do not think it will stand. we cant allow it to stand but youve got to aknowledge the sheer gold plated AUDACTITY. many of them will get filthier-stinkier-richer from this mess.

    • AlanSF says:

      “I don’t happen to believe the $12,000 figure, but if I did, my rage would be channeled at those government policies, those corporate locational choices and yes, those family decisions, that make two cars per family and a 30-50 mile commute for each driver, along with driving kids to school, normal or even within reason. I have a very hard time looking at your assumptions and thinking it’s health care costs that are killing middle class families.”

      Every OECD country, big or small, spends about half as much as the U.S. per capita for health care, so we know this works. I’d love to see a total reorientation of U.S. transit policies so people don’t need to spend $12,000 a year on cars — I live in the center city and mostly walk. Let’s do this too! But under the most optimistic circumstances, it wouldn’t have a major impact for a long, long time, whereas genuine health reform could slash our costs immediately, without upheaval or behavioral changes.

  38. solerso says:

    No honest person in their right mind can argue honestly, that this bill isnt placing undue hardship on the people being forced to finance it. It is, a transfer of wealth from many to the few. You can argue that such measures are sometimes needed, but you CANT argue that they tried anything else first, or that they arent placing more (all) of the burden on working people and none on the wealthy and on corporations. so really WTF is the point, and WHY besides Obama fandom, and/or a pathological need to have the last word, would any “progressive” keep defending this POS bill??

    • OldFatGuy says:


      I still can’t believe it’s being defended. By progressives??? WTF??

      Hell, you know what, I could see some progressives accepting this with a mandate if the subsidies were such that paid 100% of everyone’s premiums and the revenue came from spiking the top tax rate back up to, oh I dunno, 60%. At least that’s enriching these asshole corporations in a progressive manner.

      But this POS???? WTF???

      • solerso says:

        I really beleive, fellow old fat guy, that Obmama fandom and the need to have the last word covers most of the rank and file post-ers. there are others ( proffesional bloviators at the nation for instance) who are deeply invested in being on the side in power. that and really nothing else explains it. occoms razor slices away the bullshit and you are left with the bald truth.

  39. OldFatGuy says:

    Gonna check out. Despite my OWN IT diatribe above, I do still recognize, and believe, that most of us that post here are going to agree on far, far, far more issues than we’ll disagree on, and wanted to leave saying that. The enemy is still the right wing, not each other here.

    Hope EVERYONE has a very fun, Happy, and SAFE New Year. May the best days of your past be the worst of your future. Best of luck to All in the New Year.


  40. AlanSF says:

    Not to mention that they used their lobbying and political power to destroy a highly popular and affordable public system that was working very well.

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