My aunt on FB. Dammit. De-bunk help?

[Igel]

18. You can't debunk it without figuring out what it means.

1. My employer changed health plans already because of the ACA. Some of my doctors aren't in network. Can I still see them? Sure, if I want to pay them out of pocket. Nothing's going to prohibit it. Not yet, anyway.

2. One penny of taxes to whom? The guy who doesn't get insurance but could? He'll pay. That may not be me. But if he gets insurance, no tax--even if he's now spending $1200 because of the government that he wouldn't. Is government-driven behavior a tax? Depends on how strictly you want to define "tax."

I'm a teacher. My contract says I teach 187 days, and gives duty hours. Last year there was a required 4 day training I had to attend that wasn't part of the 187. This summer I'll be attending 10 1/2 days of trainings that aren't part of the 187. These really feel like unpaid work days. Some, strictly speaking, aren't required--but I have to get in X hours of training, and can do it after duty hours or during the summer. But, really, my contract says I teach 187 and gives my duty hours. They're not unpaid work days, not at all. These are mandatory volunteer days to satisfy conditions on my contract and state requirements. Not work days at all. And that doesn't count all the non-duty hours in lesson preparation, planning meetings, student tutoring, paper grading ... Depends how strictly you want to define your terms. And that reminds me, I have online training I have to do and need to prepare a couple of units' worth of lesson plans and materials for my team for the fall. Just part of being on vacation.

3. Obama said he would sign a bill that added even a dime to the deficit.
What deficit? If I make $20k/year and budget $25k for next year I'm $5k in the hole compared to income in I spend all $25k. That's a deficit. But if I spend $25k then I'm entirely on budget and there is no deficit. A deficit is when I spend more than budgeted.

Obama planned a 10-year budget that included $900 billion increases in federal health care spending. Any bill that says it'll spend more than that would add the deficit. Alternatively, you can figure out, given what he assumed revenues would be, how much of a deficit was assumed. Any bill that says it'll spend more than that, you add to that deficit. Different numbers, but notice the sleight of hand? I'm stressing over a small amount as you swallow a huge sum, you might say. No: You've accepted that what the bill says it'll spend is what's important, which is what Obama meant. You probably thought how much money will actually be spent over 10 years was important. Perhaps to some people. Not to Congress.

In fact, Obama's promise is incoherent the way people interpreted it. Unless the ACA became law, there'd be no way to know how much it spent/saved in 10 years. Who can model that to within 20% of the true number, much less a "dime"? And if we wait for 10 years to find out he lied--big honking yippee. But he even boasted that he kept his promise. Say what?

Congress wrote a bill. They had a handicap of $900 billion to play with over 10 years. They looked at projected expenses, minused $900 billion, and got a total. Then they pulled together projected savings and revenues and got a total. Savings/revenues had to be greater than expenses. If they weren't, that would be a deficit. Then they just found more revenuesor savings. "Say 60% of ER patients go their GP. Oops. We don't save enough. Okay, make it 70%. 75%? Okay, that's good." Revenues for health care were pulled from a range of fees and revene "enhancements": a black liquor tax deduction was fought over. Projected savings from the federal student loan program reorganization is a health-care revenue source. In the end the CBO said the assumptions were wrong. But in the end, the Congress wrote the figures into the bill and the CBO had to follow the language of the bill. Congress jiggered the numbers to come in under $900 billion in increased spending for 10 years, and so the bill didn't add one dime to the deficit. Then again, Romney retired in 1999 as of 2002, so we know there's a bit of a disconnect between the real world and what the legal niceties of a situation are.

No. Obama didn't lie. But his promise was vacuous. And absurdly easily misunderstood.

4. The ACA will strengthen Medicare, it says, and make it a better program.
As before, are you going to say the law lies? But "strengthen" and "better" are weasel words. You can find definitions that make it a lie or not. Foolish to argue either way.

"Hurt seniors." That's impossible to prove.

Process: Board sets cost for procedure. Medicare has to use that price unless Congress pays the difference by saving money some place else. Congress fails to do so, and as a result doctors don't order that procedure. Quick: Who's responsible? The independent board? Medicare regulators? Congress? Stingy taxpayers? Greedy doctors? Right. Distributed responsibility makes it hard to blame anybody. Esp. since a lot of the pain will result from increased health care costs.

Note that Medicare is also partially separately funded and partially funded with dedicated taxes. There is no "Medicare," there are parts to Medicare. Some are better off than others. Some intentionally wasn't included in the ACA; some is. Medicare gets screwed up, they can just point and say, "No, it's the funding that *wasn't* in the ACA that we're cutting." Go figure. They already did figure.

5. Obama knows what he meant. I assume. I certainly don't.

We already ration healthcare. I have a deductible, copays, the doctors are only in their offices so many hours and there are only so many in-network. It may not be a person saying, "You get 23.4 minutes of doctor face-time per year, can order 3 tests of no more than $100 this year ..." but it's rationing. Those without insurance have it rationed even more tightly. We ration food in the same way. If filet mignon were free demand would be huge and we'd need rationing. I can't afford it. Oops. It's already rationed. My ration is very close to 0. Who said rationing doesn't work?

Nobody thinks that the ACA says that everybody gets all the healthcare access they want. Where would all the doctors come from? We already were expecting a shortfall in GPs, now we're saying we'll have 30% more patients for them? We won't ration healthcare. But we certainly we will. It's just a question of how. Will we have bureaucrat-staffed boards reviewing each decision? "Great-aunt Mabel won't get her liver pills this month, Gertie can't have hospice care more than 4 months this year"? No. But there will be a way of making sure that only available staff and money are used. One way will be cutting payments to doctors. They can work harder.

A huge amount of government health-care money goes to a relatively small # of younger patients and a small % of elderly. You cut costs where you have expenses. You spend 70% on food and need to cut 10% of your budget, that remaining 30% covers a lot of ground--clothing, transportation, shelter, etc. You can't cut any or all of them by 33% to save that 10% without being naked or homeless. Similarly, superusers of health care will have to either take cuts or pay more, or the cost of the service will just have to go go down overall. Same output, more output, same pay. That's a chunk of the ACA.

When you're working and you need to make more faster, it's a speed-up. When you're waiting in line for your latte, you want the counter help to hurry and make more faster it's "better customer service." Let's just hope that the doctors don't form an actual union.