Maybe he was going to retire anyway and Bucc was the one who's making the correlation between that decision and Obamacare. I don't know. But IF the doctor is making an unethical money grab, and IF he's only in the position to do so because he has Obamacare as a scapegoat, AND if that type of moneygrab is widespread, then I don't see why that's not something we should be at least concerned about. Maybe the rest of Obamacare makes up for those setbacks, or maybe that type of behavior should be regulated or somehow mitigated. I just think we shouldn't disregard those indirect impacts as someone else's problem. Sometimes good policy causes indirect problems. Maybe the policy is so great it overcomes the problems, or maybe the policy can foresee and mitigate those problems.

Maybe this is all just because I've worked in criminal justice for so many years. I'm always concerned with the impact of the criminals and the assholes. Medicaid fraud is a huge issue. That doesn't mean we should disband medicaid. it does mean we should hire a few hundred more people to investigate and prosecute it. Even if the problem is someone else's doing. If medicaid fraud had no enforcement or prosecution mechanism, it would be a worse policy. Even if it's criminals that made it worse. Unethical doctors shouldn't be in a position to ruin Obamacare. If there's not that many of them, and it's not a problem, great. If there's a lot, then we have to regulate that behavior so Obamcare works as intended. We can't just say, "well, that's not Obamacare's fault, so we're not going to do anything about it."

That is a post-mortem detemination, after a project had been implemented. Only small portions of the ACA have been implemented to this point. We'd be a the point in an IT project where the equipment was being scoped, and there would be those opposed shouting "The StuxNet virus will bring down this system", when there aren't any Iranian centrifuges as part of the project. Later on another heretofore unknown virus may indeed bring the project down, but it wouldn't have been for reasons due to StuxNet.

Why not just blame the doctor who's taking the action instead of the policy? Because it's easier to blame something that's big and faceless?

Blame the doctor too but what does that accomplish? If enough doctors did this so that the American healthcare system is damaged (I haven no idea if that will happen), then it's an issue that should be addressed. It is a weakness of the policy. Not a moral weakness, but its a weakness that should be addressed and mitigated to the extent possible. The end-game of any policy should be actually benefiting people, not just coming up with a good theoretical idea.

How is this a weakness of policy?

This guy has a right to switch his business model and the only solution to that is forcing him to work, which I think we'd both be against. I question his excuse for doing this, but I don't think the excuse is the reason for his action. He wants some combination of fewer hours worked/more money and he has a right to make that choice.

I think your mistake is seeing the excuse for an action taken as the reason for the action.

I don't think he's taking it as the reason for the action. I think he's saying that if the excuse is what gives him the gumption to do it, then the action happens because the excuse is there.

Right, and we don't know for sure either way. Maybe he would have done it anyway but he's just using Obamacare as an excuse because he doesn't have the balls to tell his patients the truth and have them be mad at him. Net impact the effectiveness of policy as a whole would be almost zero in that instance, except maybe that a bunch of other doctors would be encouraged to do the same thing, but even in that case, maybe it's not a big deal. But, if the policy encouraged many doctors to do something they wouldn't otherwise do, to the detriment of their patients, then that would be an issue with the policy worth addressing or mitigating. it wouldn't really matter to the spurned patients, or the healthcare system as a whole, whether Obamacare directly influenced a sincere response, or whether the doctor was full of shit.

But I don't think the policy provided anything more than a post-hoc excuse. It's hard for me to imagine this guy looking for less hours/more money but deciding not to because he didn't have a national healthcare law to blame it on. He'd blame it on his previous carrier or Medicare or frivolous lawsuits.

Exactly.

The other, more potentially problematic place this has come up in the past is how Obamacare might impact the behavior of small business owners. There's been expressed concern that smaller business might lay people off or move them to part-time to get under the 50 full-time employee threshold. No doubt, there will be business owners who really don't HAVE to take those actions, but they'll just take the opportunity to lay people off in a manner where they can deflect the blame somewhere else. Should policymakers be concerned with that potential response, and should they account for it (even if they just ultimately conclude, "that will probably happen, but its a necessary evil to get where we want to go"), try to mitigate it, or should they disregard it because it's indirect, and possibly insincere or unethical?

Then it wouldn't be a problem. But just for fun, what if he hypothetically did see this as a great opportunity to scale down much more dramatically than he otherwise would have? You wouldn't see that as an issue with Obamacare anyway, right? So really it's an irrelevant distinction. You only want to consider direct, intended impacts of the policy in evaluating it. Which pretty much guarantees that it will be a success in your mind.

The later - disregard it due to its insincerity and make that known.

I don't think he'd say, "Ah, I'd like to cut back and get more money, but there's no health care reform, so forget it." But, I could see him thinking it's not worth pissing off 2400 patients for, or that he won't get enough people to pay this VIP rate to make it worthwhile, then deciding that he can do it because Obamacare is a politically charged item that makes a good scapegoat, and could convince more of his patients to accept his VIP rate instead of telling him to screw off.

That part about making that known is actually not disregarding it, I think you're advocating a information-based approach. That maybe if you can convince enough people that businesses who react in a certain way are full of shit, you can undercut the motivation of that action some. It won't eliminate it all, but it would be one rational response. So I think you're agreeing with me. it might be a tough sell because people have their heels dug in so much on this stuff, but I guarantee part of Obama's strategy is getting accurate information to the public in a way they can access it. That is, guess what, a response to the danger and reality of indirect negative consequences to the policy. Without such communication, the policy as a whole would be a worse policy, even if the harm the communication seeks to mitigate is someone else's fault in a direct sense. Such communication and information only matters at all if there's some concern about mis-information.

This is much different because it clearly connects to policy. Making a hard cutoff and then having people slide under the cutoff is clearly connected. Having a guy switch private insurance carriers and then blame it on a law that makes no requirements on who he works with clearly isn't connected.

There's no point in wasting time imagining what BS complaints people will make while writing laws. It's hard enough trying to foresee the substantive problems.

In other words, there are enough problems with health care and this law that we don't need to make up imagined bullshit scenarios and attribute fake problems to the law.

I just can't figure out how the hell the Democrats didn't see what a mess they were going to make on the employment front when this law was implemented (if it ever does get implemented). The unemployment and part-time employment figures are especially telling.

WOLF: Obamacare's panicked Democrats - Washington Times

At least we're getting reasoned analysis here:


I wonder if the fugitive slave law is #2?

Did someone really just link to the Washington Times?

I'm really surprised at the damage VA Gov. McDonnell has done to himself with the gifts given to him and family members. I really thought he was a strong candidate for Pres in 2016, but with even Cuccinelli backing away from him, he looks done.

Being out of Richmond, I've missed this story. What's up?

SI

This is a pretty good summary,

http://www.foxnews.com/politics/2013...tting-145k-in/

Basically, he and his family were given a lot of gifts by a wealthy businessman and the gifts weren't disclosed. The state and feds are investigating.

Washington Times = Moonie paper. Not worth the paper it's printed on.

MBBF

Alright, the point still remains. Ignore the obvious bias of the Times. How in the hell did the Democrats (or any lawmakers who were involved with crafting the bill for that matter) not see this underemployment debacle coming when they wrote it?

Actually, the point doesn't remain. You think underemployment is new? Kelly Services is the 2nd largest employer in the US. That didn't happen overnight. The trend of part time employment began decades ago. As such, there's no "debacle". Not to mention that the statistics quoted are outright fabrications. They can't even bother to make their numbers add up to the correct number of new jobs added in June! As I said, it's not worth the paper it's printed on.

The only way to prevent stuff like this is to entirely disassociate health care from employment (something I advocate). Medicare for all is just fine by me.

THOSE ARE JUST FANCY LOANS!

What is the "correct answer" to the political strawman equivalent of "does your mother know you pick your nose?"

SI

Too bad that even if this passes the Senate, it has no chance in the House.

Warren Bill To Bring Back Glass-Steagall - Business Insider

I'd be curious to see the actual details. But, yeah, DOA

SI

I'll admit to having to read the article to remember what G-S actually covered.

One bit I particularly enjoyed was this naivety

Umm ... no, that's not the focus of our financial system, nor has it ever been. That would be more aptly described as "people with money making a profit off people who want money".

Congrats to fiscal conservatives in the GOP. Yesterday they passed @200 billion in farm subsidies and 0 for food stamps.

Because we can't afford food stamps.

No big deal Obama has a veto and all democrats would have to oppose this so you have nothing to worry about.

It won't pass, but it deserves to pass. Simply put, if G-S were still in play, we wouldn't have had the housing/financial crisis that we did. It simply wouldn't have been possible given the way the financial markets would have been structured.

Too bad the dumbass Republicans can't learn from two major recessions/depressions something that the Democrats learned back in 1933.

Agreed.

Clinton's signature and a host of other Democrat ones were on GLB. Obama's fiscal policy is owned by Wall Street. Democrats are not blameless in this one.

SI

Also true.

So, for the State Senate abortion bill debate going on tonight in Austin, concealed handguns are allowed to be brought in, but tampons aren't.

I'm sure if you get a concealed carry permit for your tampons, they would let you bring them inside. Otherwise you should just use pads. :D

They weren't letting pads in either, believe it or not.

Um... wha?

SI

Only a good guy with a tampon can stop a bad guy with a tampon - The Maddow Blog

It sounds reasonable. I mean, what are the chances someone is going to throw a gun at a state representative?

A supporter but a couple things go through my mind - can these insurers really make money from these low rates and what do their plans cover or not cover. Still, a good trend.

Health Plan Cost for New Yorkers Set to Fall 50% - NYTimes.com

good direction regardless. It might not look like this in a straight line and itll be fits, starts and changes but the direction is good. Im sure that this is occurring in spite of Obama, not because of him.

Their chart is comparing the most expensive current plan with the most expensive health exchange plans. If you look at the cheapest plans, those rates are going to be significantly higher. Of course, the benefits might be better for the bronze plans. People are still going to have to pay more for them.

From article

Individual mandate at work.


That's a system that's clearly broken.

They're obviously waiting for the 2013 Steam Holiday Sale to buy.