mikeandgerry wrote:CBO scoring shows that the bill will save $138B in the first decade ... the savings simply come from a redistribution of wealth specifically from the wealthiest to the poorest
Um, a savings is a savings and has nothing to do with redistribution. But since you raise the issue, there SHOULD be a redistribution from the wealthiest to the poorest. It's unconscionable the huge portion of wealth in this country controlled by a tiny percentage of the population. None of us coal burners here would suffer from that kind of redistribution, believe me.
Or course it's redistribution. It's all redistribution. And not just from the wealthy to the poor, also from the middle class to the poor.
Companies big and small will be forced to offer insurance or pay penalties. Not only for full time employees, but also for part timers. Either way this comes directly at the expense of employees and customers. Employees by reducing the wages to cover some part of the added overhead costs. If the employer doesn't cut wages, they will either fire some employees to use that piece of revenue to pay for it and/or they will slow the rate of wage increases that might otherwise have happened. Customers by increasing prices to make up for the increased overhead of employment. All employees from minimum wage to middle management will get pinched.
I'd argue that premiums will be going up across the board, particularly in the first 4-8 years, probably faster than they otherwise would have. But even if we accept that premiums will be lowered as a result in the influx of new premium payers, there previously uninsured (a great many of which are poor to middle class) will be forced to start paying for insurance, an expense they didn't have before this. As this is government mandated, it is a tax by another name on precisely the people who were promised they would not see their taxes increase so many times.
Why do I argue premiums will go up? Consider the number of people who will be entering vs the number that will either have partially or full subsidized premiums. This is the much talked about 40 million uninsured. Most could not afford it even if they wanted it. This group already uses services and their cost is either payed for by taxes or by higher than ideal premiums. By giving them insurance and indeed encouraging them to use the services, they will now be using services much more often, this will necessarily lead to increased health care costs (no additional supply, but 30-40 million more demanding) for insurers and thus require increased premiums. Arguments that increased non-emergency care will lead to cost savings are not at all established by available studies and evidence, and even if one buys the argument, it is always phrased as being a long term cost savings. The idea being that preventative care cuts down on mid and later life high cost medical situations, so we've got a long time to wait until these fabled savings occur. In the mean time the non-emergency care services are demanded more and costs go up both per visit and as a result of supply/demand.
Where is the money for subsidies coming from? From a $500billion cut in medicare (which itself creates all kinds of unintended consequences) and from taxing high income earners, non-exempted "cadillac" health insurance plans recipients, and higher taxes on investment income. Maybe the first one leaves the middle class untouched, but the last two certainly do not.
And when costs overrun projections, as we all know they inevitably will? That $130+ billion deficit "savings" will vanish very quickly and require more taxation and more cutting from other areas to cover it. Or maybe we'll just keep running the debt up at astronomical rates.
The only people that stand to benefit from this are the segment of uninsured people who will be getting full subsidized care or partially subsidized who actually need the services they will now paying for (assuming they don't consider the unconstitutional mandate to purchase insurance to be a step too far on philosophical grounds). The rest get screwed in varying degrees with the promise for a whole lot more screwing when the projections don't pan out and they end up being taxed more, premiums rise even faster, or price controls go into effect reducing their availability and quality of care, or the money supply is inflated (stealing the value of their assets and prior monitized labor).