DFL economist, 7A candidate Schultz dissects MNSure news

Jennifer Schultz, DFL candidate for House 7A seat in east Duluth.

Jennifer Schultz, DFL candidate for House 7A seat in east Duluth.

It’s been a long time since a candidate for office sent me a press release that was both substantive and informative. Jennifer Schultz is a health care economics professor at the University of Minnesota-Duluth. She’s also the DFL candidate for the open seat in State House District 7A in eastern Duluth.

Tonight she sent out the following press release, which I am sharing verbatim (something I normally avoid with politicians) because I think it’s a helpful perspective on today’s news that one of the top insurers in MNSure is pulling out of the state’s Affordable Care Act exchange:

Health Economist Schultz reacts to PreferredOne leaving MNSure

“As an economist, I am not surprised at seeing one of the insurers involved in MNsure leaving the program,” said Jennifer Schultz, DFL candidate for Minnesota House District 7A and professional health care economist.

“The Affordable Care Act and MNsure are programs based on market capitalism,” said Schultz. “The program was developed twenty years ago by the very conservative Heritage Foundation. In market capitalism, we expect that some players will find difficulty in competing and make mistakes. We expect the market to weed them out.”

“Of the more than 327,000 Minnesotans who are insured through MNsure, only 10% are insured through PreferredOne. These customers do not need to be alarmed by this development.”

“It is especially important to note that no customers will be uninsured as a result of this change. Again, customers do not need to be alarmed. PreferredOne will continue to insure their customers until the end of 2014, at which point customers will have the choice of buying other companies’ plans inside MNsure. Customers also will have the choice of continuing insurance through PreferredOne outside of MNsure, but choosing insurance outside the exchange will mean loss of access to the federal subsidies available to customers in the exchange.”

“To get the financial benefits of MNsure, including the federal subsidies, assessment of the best choice for insurance, and assessment of eligibility for free or low cost government insurance programs, customers must use the exchange.”

“People insured through PreferredOne should use the exchanges during the new open enrollment period starting November 15th, where they will find many other choices, all offering the federal subsidies that make insuring through the exchange more affordable.”

“MNsure is already planning to notify its PreferredOne customers about the choices they will have. Customers should expect to hear by mid-October.”

“The most likely reason for PreferredOne leaving the program is that its clients, obviously enrolled because PreferredOne was the lowest cost insurer, are the most price sensitive, and if PreferredOne found itself unable to match prices of other insurers in the exchange, they probably stood to lose a large part of their market share.”

“I am surprised that people are surprised by this development. That shows lack of understanding of how markets work. I am very suspicious that most of the excitement we are seeing is pure opportunism on the part of political partisans hoping to gain an advantage by acting like this is a crisis. Pizza Hut recently closed up in Duluth and across the country, but you can still order a pizza without trouble. Health insurance is obviously a much more critical product, but it is still a product in a functioning free market, with many choices available to customers.”

Schultz pointed out that this is not the first time in recent history that insurers have left markets in Minnesota.

“A few years ago,” she said. “Two insurers who were low cost entrants in the Medicare Advantage market left the state following problems with creation of provider networks. The Medicare Advantage market went on without any problem, but some customers had to scramble to find replacement policies. The good thing about MNsure is that it is specifically designed to deal with problems like this. People looking for replacement insurance will be able to find many choices in the exchanges, either on their own or with the help of navigators. This is actually much easier than traditional markets, where accurate market information can be much harder to locate.”

Schultz pointed out that despite PreferredOne having the largest enrollment based on its low price, it is actually one of the smaller health insurers in Minnesota.

“I suspect they may have had trouble forming provider networks that they could deal with at the prices they wanted,” said Schultz. “I obviously am not privy to the internal workings of the company, but large insurers and large provider groups in Minnesota have long standing relationships that PreferredOne may have had difficulty penetrating.”

Schultz does not expect to see radical changes in the MNsure market because of this.

“I am suspicious that PreferredOne found itself no longer the lowest price alternative in the 2015 market,” she said. “Obviously, insurance prices always rise because the cost of providing health care always rises, whether we are dealing with completely private markets, programs like MNsure, or Medicare and Medicaid. I will be surprised if those rises are high enough to be disruptive, since we have been in a period of slow growth in health care costs.”

“The big lesson is that free markets will be subject to market changes, which is in no way surprising to anyone who has even the most basic understanding of economics.”

“This is not the end for MNsure,” she said. “I actually doubt it will be a major problem once it shakes out completely, though it would be better to have more insurers competing to keep premiums low. Other insurers will be more than eager to have PreferredOne’s customers. ”

Obviously, opponents of the very concept of universal health care coverage will not necessarily like what Schultz has to say, but I was impressed with her willingness to go deeper into an issue not just to win votes, but to explain a difficult concept to the public. This is the kind of thing we need more of from our leaders, elected or otherwise.

Schultz faces Republican Becky Hall in the Nov. 4 election to replace outgoing State Rep. Tom Huntley (DFL-Duluth).


  1. We don’t get it Aaron, why is Obamacare “a difficult concept to explain to the public”.

    We were told by the president himself that our health care costs would drop by $2,500 per person and we’d get to keep our existing doctors and health plans if we wished. What’s so difficult to explain? Why does Jennifer need thousands of words to say the same? Why are you Soooo impressed?? Us ordinary Balsamites don’t get what you’re saying…

    • We’re using the royal “we,” now, are we Robert? Before the Affordable Care Act, our country’s privately delivered health insurance was “a difficult concept to explain to the public.” The key difference is that the system we have now — still frustratingly opaque (I rather prefer a single-payer system) is less barbaric. People are covered. People who get diseases can get treatments. Costs are shared across broader pools to control costs. Don’t ask me to call it perfect. Or done. (It isn’t). But I’ll take it over what we had. It’s a start.

      I think what bothers me most is that you think people who don’t agree with you do so because they’re stupid. They’re not, Bob. I don’t think you’re stupid because we disagree. I do think you’re frightfully mean. Worse yet you’re impersonating a Balsamite on the internet. Shame.

  2. You again avoided the simple question I asked Aaron. However, if you want to get wordy as Jennifer and you prefer:

    “The largest insurer with the lowest premium rates on Minnesota’s Obamacare exchange is dropping out because the government health-exchange is unsustainable”, the company announced Tuesday.
    PreferredOne Health Insurance told MNsure, the state-run exchange, Tuesday morning that it would not continue to offer its popular insurance plans on the marketplace in 2015. It’s “purely a business decision,” spokesman Steve Peterson told KSTP-TV. The company is losing money on costs for plans offered on the bureaucratic and glitchy government exchange.

    Part of the problem, according to PreferredOne, is that MNsure hasn’t even been able to verify its customers’ information. PreferredOne said that some of its customers have turned out not to even live in Minnesota.

    Insurers are required to accept customers who’ve been approved by the exchange for coverage, but states and the federal government have been struggling for months to determine which applicants are actually eligible for the benefits.

    “Our MNsure individual product membership is only a small percentage of the entire PreferredOne enrollment but is taking a significant amount of our resources to support administratively,” the company said in a statement. “We feel continuing on MNsure was not sustainable and believe this is an important step to best serve all PreferredOne members.”

    PreferredOne was Minnesota’s largest exchange insurer with 59 percent of individual MNsure sign-ups, according to KSTP.

    This leaves Minnesota Obamacare customers in a tricky situation. PreferredOne had significantly lower rates than any other insurer on the exchange. When these plans disappear, customers will see a significant rate hike if they choose to continue on the Obamacare exchange, independent of yearly rate hikes.

    Minnesota is scheduled to announce premium rates for 2015 Obamacare plans in October and signs point to looming price hikes that will hit Minnesotans doubly hard. – Sarah Hurtubise, reporter 9/16/2014

    I prefer simple though. Where’s my $2,500 and my old plan that I liked, both which I was promised?

    Oh, I do speak for many, many Balsamites. Ask Mike next time you frequent the Scenic Pines if he didn’t happen to talk to me just yesterday, at his place, while I was buying gas, and other items. Surely you patronize the Scenic Pines…right?. While you’re there, ask him what he thinks of Obamacare…and how it’s impacted him as a small business owner.

  3. Oh and Aaron, I came to realize early on in life NEVER to call, or think, anyone stupid. So I haven’t since grade school. It’s not me but a tribute to my folks, the way I was raised. It would also be against George Washington’s 110 Rules of Civility (#65) – “Speak not injurious words neither in jest nor earnest; scoff at none although they give occasion”.

    However, if I were to call someone stupid, the line from “A Fish Called Wanda” comes to mind…Wanda: “Oh, right! To call you stupid would be an insult to stupid people! I’ve known sheep that could outwit you. I’ve worn dresses with higher IQs. But you think you’re an intellectual, don’t you, ape?” A great, funny line. Reminds me of Robin Williams.

    But again, I’d never go there. I’ve too many good, blessed family members, friends and neighbors I might insult.

  4. Limited experience with Preferred One, admittedly, but Preferred One would NOT be my first choice were I to be shopping the open market at this time. I think some outstate hospitals will be quietly smiling at this news.

    As regards the rest of this interchange, R47 seems very pleased to point out inconsistencies between Schultz’ release and what (some) news outlets have released, in an apparent attempt to define the debate…or perhaps derail it. I’m not buying in; in my eyes the ACA is a step forward on the road to a more reasonable and equitable cost-containment strategy. What we are replacing is too expensive and artificially “difficult”…rigged to favor certain players. While the ACA isnt perfect, I see no workable alternatives thus far.

    The considerations that appeal most to me are
    A) a workaround to “portability” issues
    B) allowing a large number of subscribers to effectively “group”
    c) less important, but still visible is the possibility of driving cultural change: health insurance has become a “hook” that less-enlightened employers have used to retain workers that might otherwise seek better conditions or even better bosses. Crummy, low-paying jobs will continue to exist, but narcissistic, inconsistent and self-important bosses may not.

  5. Minnesota’s uninsured has dropped by 40% through private and public plans leaving 4.9% still uninsured. This is great progress and I hope it continues until we have 0% uninsured. The fewer Americans uninsured, the healthier our economy becomes. I don’t see how anyone can argue with that.

    Virulent opponents of MNSURE and ACA don’t have viable affordable alternatives to provide health care coverage to the uninsured although they have had years to do so. We used to hear repeal and replace ACA constantly, heavy on repeal, feather light on replace, resulting in about 50 repeal bills but I don’t recall any serious replacement efforts other than vague “ideas”. Repeal ACA sounds great to conservative voters on the campaign trail but with millions now insured and insurance companies heavily invested, it’s an extremely unrealistic promise with no plans for what then?

    I can’t imagine that some people long for the days when millions of Americans couldn’t get insured because of cost, pre-existing conditions, lifetime coverage caps and much more but it appears that some do. Why?

  6. Obama sold Obamacare on costs coming down for all, not just for those who receive illegal subsidies. How can you possibly trust this guy to run your “health care” when he said we’d all see a savings of $2,500 and we all could keep our plans if we wished?…while all along he knew he was lying. How can you possibly trust him with ANYTHING?

    And Aaron, when you say – “Don’t ask me to call it perfect. Or done. (It isn’t). But it’s a start”. My God man, how many more pages of do’s and don’ts impacting your lives, in addition to the 2,800 pages we already have, is it going to take to get beyond “it’s a start”? Let alone get to and end.

    I want my old health care plan and I want it for $2,500 less as B.O. promised….without another 2,800 page bill. Is that unreasonable to expect?

  7. R, 5-1/2 years ago when Obama was campaigning, he said, “we’ll lower premiums by up to $2,500 for a typical family per year…..we’ll do it by the end of my first term as president”. So, you take every presidential or other candidate’s wish list “promise” as literally set in stone, iow, actually believe every candidate including those you support will be able to deliver on their “promises” exactly as they campaign on? That would be naive. Goals are not the same as done-deals which should be obvious. Later in 2009 when ACA was being debated (ACA didn’t pass as a law until 2010), Obama met with insurance and drug co reps discussing their pledges to reduce health care spending along with other reforms and said this “COULD result in…savings of over $2 trillion a year…and COULD save families $2,500 per family in the COMING years”. Big difference but don’t let that get in the way of your preconceived beliefs.

    Did you lose your previous health care plan and if so why? Was it a private plan offered at your job? Obama said we could keep our plan if we liked it. Some private health insurance companies did drop plans but that was nothing new before ACA. Private health insurance companies have always dropped unprofitable plans, kicked off people that require expensive care, changed benefits or raised prices.

    People who bought health insurance for themselves before ACA may have thought their plans were OK until they incurred big hospital bills and medical expenses for the first time finding out plans didn’t cover much. Many of these people were bankrupted. The individual insurance market was typically one year contracts and they could do practically whatever they wanted when one year was up.

    We have job offered insurance so no need to seek out a different plan at this time. We are glad about the long needed financial protections and more coverage of basic medical benefits which I won’t list, easy to find but doubt you’re interested. If ACA and all it’s consumer protections went away, do you seriously think you could have your exact old plan back and the insurance company would keep it at the same price, same coverage, same deductibles, etc. every year thereafter?

    I have no idea what you mean by “those who receive ‘illegal’ subsidies” but don’t think I want to. I’m sure it’s a doozy.

    ACA was always going to be a work in progress but it is working. I think a single payer health system, Medicare for all, would have been a better option with everyone covered. I think that will eventually happen. I hope so for our children’s and grandchildren’s sake.

  8. Health care is not a right kissa, regardless of how many times Obama lies to prop it up as one, or how many “2,800 page Obamacare in the middle of the night bills” he passes. Thankfully for the sake of our kids & grandkids, the vast majority of American people are against it being a right and therefore against Obamacare…as every poll since the “bill no one read” passed. Why??

    If health care is a constitutional right, then everything associated with good health would fall into the civil rights category. So your entire environment, house, food (including B.O.’s wife school food program which schools are dropping due to the “central planning” plague it is), clothing, transportation, mental health would all have to be paid for by the state if you could not afford it. That’s communism. No country can afford those payments without seizing the assets of everybody else. It’s impossible. The American people don’t want it, thank God.

    Regarding the illegal subsidies…if you don’t know this, you should. Either way, let me update you.
    In late July, the D.C. appellate court in Halbig v. Burwell, ruled that the federal government isn’t authorized to administer insurance subsidies in the 36 states that refused to set up their own Obamacare health insurance exchanges. That means its illegal…according to the Obamacare law itself! Isn’t that a hoot? I’m sure it leaves supporters of the bill wishing they’d read it first.

    With the subsidies gone, there’s much less incentive to sign up for health-care coverage and simply pay the $95 or 1% of income penalty. Once that happens, the economics for insurers won’t work (Preferred One)…and the whole Obamacare house of cards crumbles into the same ash pit of past communistic failures.

  9. If you don’t think health care is a right, what is it? A privilege? Sounds like a bunch of libertarian/objectivist hooey.

    Health care costs were going through the roof before ACA seriously affecting our economy, the US with highest health care costs of any western nation. People without health care suffering, dying, going bankrupt. Other countries manage to provide healthcare to their citizens and not even conservative politicians there would have traded their system for our pre-ACA mess nor for what we have now, for that matter.

    ACA is a private/public system. You don’t trust the private market to work or is it just the public part supported by taxes that you object to?

    If health care isn’t a right do you think police, fire, emts, public education, highways, bridges, dams, Medicare, Medicaid, VA, etc, etc, etc that most Americans from all walks of life benefit from aren’t rights either?

  10. It’s a fact kissa; “health care” is not a right. Look it up. Nor is it free…no matter how much you wish and pray (if you do) it was. And health care insurance definitely isn’t a “right”. Even you’d have to admit that sounds ridiculous…insurance – a “right”??

    I’d call health care a personal preference (we all decide if we wish to drink a 40 oz. soda, eat a Snickers Bar or how much we feel like exercising) and health care insurance is a service…available to those who wish to purchase it. Many people have no interest in purchasing such a product, some do.

    As far as costs increasing, heck, the cost of an Electrical Engineer was $10,500 per year in 1970, now they cost around $100,000 per year. Don’t sidetrack the health care discussion by complaining about how much things cost today. That’s a losing argument.

  11. One important thing, in my opinion, is that the spokesman for PreferredOne may not actually be sworn to tell the truth in spinning his company’s failure in the MNsure market.

    Four other companies apparently have found they can continue to function in MNsure, and presumably face the same difficulties as PreferredOne.

    It is very rare to see companies say that the reason they have failed is they screwed up. They always seem to find someone else to blame. However, Roger Feldman from the U of M and other specialists in health insurance have all said — in the articles in the Star-Trib and the Pioneer Press — that they were suspicious from the beginning that PreferredOne would fail. Feldman says that he thinks PreferredOne made an enormous gamble by offering the lowest insurance rates in the entire country, and failed, and that in his long career in studying health insurance he has never seen a gamble like that succeed.

    Of course it is much nicer to say that the government caused you to fail, rather than to admit you made a big mistake.

    • Of course government finds it convenient to blame the private sector rather than admit incompetence. Both business and government are staffed with flawed people. The primary difference is business can be chastened when it fails to perform.

      • Hmm, interesting. Four companies are successful, one fails, and it is the government’s fault the one failed. The government was probably responsible for the Edsel too.

        I think you have the incompetence filed in the wrong drawer.

        Just BTW, it would be hard to find a more conservative voice than Roger Feldman, and he is the one — or actually one of several experts — who is saying that PreferredOne made a big mistake with foreseeable results. All of Feldman’s work is sponsored by private insurance companies and their industry groups.

        • Actually, if you read what I wrote, I didn’t say it was the government’s fault that any particular company failed. Rather that failure occurs both in government and private enterprise. The primary difference is that private enterprise tends to be vulnerable to external correct much more quickly than government which, at best, is only corrected on an occasional or intermittent basis.

  12. .. and another thing:

    In the interests of fact versus spin, as of now several courts have ruled on the subsidy issue, and all but one of the courts that have ruled on the ACA subsidy have found it to be legal. The DC circuit decision that Ranger cites above was from a three judge sub-panal of the court, and the entire court has recently agreed to review the decision — a step that most observers think means that the the whole circuit is inclined to overturn the ruling of the sub-panal.

    This will probably go to the Supreme Court eventually, and what the Supremes will do is uncertain, given that the court is frequently closely split on exactly this type of issue.

    However, even if the subsidy for the non-state exchange states is overthrown, that will not affect Minnesota, where the subsidies involved in our state run exchange are clearly legal.

    If the court decision eventually goes against subsidies in the federal run exchanges, that will mean that once again a large number of states are depriving their citizens of a valuable benefit in order to make a political point at the expense of people who really need help. We have, unfortunately, seen this already with the implementation of the Medicaid benefits that are part of the ACA. Like with the Medicaid, I would expect that citizens of the affected states may begin to object to the fact that their leaders are willing to throw them under a bus to make a point, as we are now seeing with Medicaid, and we may well see states start to scramble to implement the program before the politicians find themselves out of work, as we are also now seeing with the Medicaid program.

  13. R47, I have been talking about private plans for purchase which you would know if you read instead of skimming. I did not say anything about “free” plans. Even low income people, the working poor pay taxes but that doesn’t mean they could afford to buy health insurance even when they wished to. Now more can. I don’t have a problem with taxes funding those who can’t. It’s a lot more costly to hospitals and the rest of us to treat people without any health care who are sick and just get sicker.

    Is being suddenly paralyzed by an injury or incapacitating illness something anyone “decides” on like eating a Snickers Bar? That can happen to anyone, even you. Aren’t you relieved to know that you or yours can’t get thrown off your insurance plan if/when your care gets too expensive?

    The wages of an EE in 1970 vs 2014 ($1 buying power in 1970 = over $5 today) has nothing to do with our health care costs being over twice as much per capita as other developed nations with no better health outcomes.

    DG, “Rights don’t require someone else to give you something” means what? I’ve heard versions of that before followed by complaining that people getting assistance are taking your taxpayer money. I’m assuming you are referring to taxes. It’s not a zero-sum game where what one party gains, the other party exactly equally loses. Our tax dollars pay for police and fire protection. Should they not be required to protect everyone?

    Gerald S. Glad you brought up Medicaid. States refusing Medicaid money are costing their state budgets billions and hospitals are closing. Tragic decisions.

    • > I’m assuming you are referring to taxes

      I’m referring to logic. Rights are inherently not something that requires someone to give you something. Your comparison with police protection is apples and oranges.

  14. DG, Oh, I would be surprised if you did not have “something” on your mind that you don’t think is required to give to someone else.

  15. “Rights are inherently not something that requires someone to give you something.”

    I know that this is basically just spitting in the wind, but here goes.

    There are a lot of rights that cost money and are paid for out of public dollars, the most striking being K-12 education. Streets, police and fire protection, the protection of the US military, border and immigration enforcement, the courts and the legal system, public lands used for recreation, clean drinking water, sewer service, protection of food and drugs from poisons and infections, and so on are things most people would consider a right. The reason this seems “like apples and oranges” is that middle class and upper class people tend to think that the things they want and need are not an example of the same sort of things as what lower income people, the disabled, and so on want and need, and they tend to think their benefits have some sort of different status.

    The most striking example I know off the top of my head is medical doctors. Medical doctors are all beneficiaries of about $500,000 in today’s dollars of subsidy from federal and state government during their training — this is over and above the money they pay in tuition and any grants, loans, or service payback programs connected with that. Once in practice they continue to benefit from government paid research that develops new and often lucrative techniques, drugs, and devices, government promotion of their services and government protection from uncertified charlatans, not to mention the 45% of health care costs paid for by the government. Many specialists, orthopedists for example, get between 35% and 60% of their income from direct payment from the government through Medicare and other programs — payment for services that often used to be given for free in the old days.

    Despite getting government benefits that dwarf the most highly paid welfare client, many doctors are then only too happy to tell you that they are rugged individualists who made it on their own, that the payments they get are not only earned but are too low, and that we should all vote for conservatives who will cut their unjustly high taxes, all the while of course belonging to specialty groups that are lobbying vigorously in Washington to protect and increase their payments from the government.

    I am not arguing that our government and taxpayer investment in medical doctors is not worth continuing. We all expect to be able to find doctors when we need one.

    What it boils down to is that for many people a right is what I get, and socialism is what you get.

  16. DG, As I expected, you and also Ranger, can’t resist playing deflection dodgeball.

  17. Gerald S., Your last sentence says it in a nutshell.
    Now I’m bored with spitting in the wind.

  18. >There are a lot of rights that cost money and are paid for out of public dollars, the most striking being K-12 education. Streets, police and fire protection, the protection of the US military, border and immigration enforcement, the courts and the legal system, public lands used for recreation, clean drinking water, sewer service, protection of food and drugs from poisons and infections, and so on are things most people would consider a right.

    Not if they are reasonably well educated. If public K-12 education exists equal access is a right but the education is not. Police protection is not something that is given to individuals, ditto the military. Etc. Now perhaps most DFLers think of those things as rights but then we’re back to my first sentence. Wanting something doesn’t make it a right. It can be good policy for government to provide something but the fact that it may be good policy doesn’t make it a “right.”

    You have a right to speak. You do not have a right to elocution lessons. You have a right to equal access to the law. You do not have a right to free legal services whenever you want to go to court. You have a right bear arms. You do not have a right to have someone give you a gun. You have a right to free exercise of religion. You do not have a right to have someone provide your church with a free building to meet in. Etc.

    If you don’t like the wind when you spit then perhaps you should turn around.

    • Turning away from the wind would require not addressing you 😉
      Sorry, too great of a temptation to resist.

      First, let me point out that you are in fact saying that there are what you concede are rights that do cost money. The school building, the courts, and so on, so we are no longer arguing about the question of whether a right can cost public money.

      Nonetheless, when you decide to describe anyone who disagrees with your premise as uneducated, you are missing a whole two centuries of the evolution of the definition of human rights.

      The philosophical discussion of what constitutes a human right did not stop with the 18th century. The discussion advanced through the 19th and 20th century, with even conservative thinkers like Burke, Hume, and Hayek conceding the existence of social and economic rights — in Hayek’s case including health care — in addition to the traditional rights recognized by the enlightenment philosophers.

      With few exceptions the debate in the 20th century was not about the existence of these rights, but about their precedence or lack thereof over the enlightenment rights — with both fascists on the right and communists on the left generally insisting that the socio-economic rights took precedence, and the Western Democracies general insisting that the two had equal precedence.

      Health care as a right is considered non-contraversial in all of the developed western countries and their Asian counterparts like Japan, Taiwan, and South Korea. Developing countries usually recognize the right also, but frequently lack the resources to honor it. Implementing a national health care plan — and as a consequence passing the US in measures of health, longevity, and efficacy of health care — is a reliable hallmark of a country passing from “developing” to “developed” status.

      This point is accepted uniformly by political groups across the full spectrum in the developed countries, with the only debates having to do with practical implementation, not with the existence of the right.

      The US has been the sole laggard here.

      The ACA does explicitly recognize that there is a right to health care, and that it is the task of federal and state governments to see that citizens are granted that right.

      That is, of course, the heart of thinking conservatives objection to the ACA, not all the malarky about abortion, death panels. birth control, and the failure of the private contractors who designed the various exchange systems and web sites to deliver glitch free products. It is this definition of that right that they find most objectionable, and that is at the center of their frantic efforts to repeal, reverse, or sabotage it before the right becomes part of the fabric of the nation, and their traditional idea that health care is a commodity like any other goes the way of Jim Crow.

      I am not surprised that you are so adamant in insisting the right does not exist — it is completely consistent with current right wing thought, even though, as Jennifer Schultz said, the ACA is actually a right wing idea conceived by the Heritage Foundation as a response to the Clinton health initiative and implemented by Mitt Romney when he was governor of Massachusetts as a specifically “Republican approach” to health care.

      My guess is that the right is here to stay. Over 13 million Americans and over 300,000 Minnesotans are beneficiaries of it already, with more to come.

      As a Dutch friend of mine told me: “Welcome to the 20th century, Now America is only 65 years behind the times.”

      • >>First, let me point out that you are in fact saying that there are what you concede are rights that do cost money. The school building, the courts, and so on, so we are no longer arguing about the question of whether a right can cost public money.

        I’m not sure how you got that from what I wrote.

        >>That is, of course, the heart of thinking conservatives objection to the ACA, not all the malarky about abortion, death panels. birth control

        Abortion is murder, it is not malarkey. Death panels or whatever you want to call them are the result of any rationing of care, which given universal access unfettered by personal expense and a limited number of assets such as doctors and beds will invariably exist in such a system. Birth control is already cheap and widely available. The controversy is because a Christ-averse administration decided that it was more important to try and buy the votes of the gullible by abrogating the protections provided by the 1st amendment. Pretty much any civilized person will be hostile to abortion and any constitutionalist will be hostile to making people provide contraceptives in violation of their church’s teaching and their conscience. You want all those gullible people to have free contraceptives? Have the government hand them out. That would be bad policy but it would be closer to being constitutional and it was done by the state rather than the federal government it would be fully constitutional.

        >>As a Dutch friend of mine told me: “Welcome to the 20th century, Now America is only 65 years behind the times.”

        The 20th century was a time of unprecedented barbarism but the 21st century aspires to beat it. I’m not sure where the glory is in that.

        • And in a nod to Aaron’s courtesy let me expand on a statement I made. I said:

          ” Pretty much any civilized person will be hostile to abortion”

          Technically that should probably be “Pretty much any civilized person who understands what happens in abortion will be hostile to abortion.”

        • The 20th century had a lot of barbarism, but in that its main distinction was not the barbarism itself but the efficiency with which barbarism could be carried out due to technological advances. Plenty of barbarism in the previous 4000 years — I still remember Barbara Tuchman in her book about the 14th century describing the British troops in France during the 100 Years War deliberately killing all the peasants they could find — men, women, and children — on the grounds that the peasants were an asset to the French and should be destroyed just like they would burn a granary or steal cattle. And all the barbaric efficiency of the 20th century could not even begin to match the Great Plague of 1347-1350.

          However, the 20th century was also the century of antibiotics, vaccines, and the disappearance of diseases that had plagued humans for centuries, the century of agricultural and transportation efficiency that ended starvation in large parts of the world, the century of central heat, electric light, and indoor plumbing, the century of adequate sanitation and clean drinking water, and the century of the development of the devices we are all using right this minute, the 30 minute sitcom, the 40 hour work week, and the instant replay. Also the century in which US life expectancy went from 48 years to 79 years, the largest increase in history in both actual years and percentage.

          All in all, I would take the 20th over any other available choice. As a friend of mine once said, the goal of life since we staggered up on to two legs has been for our children to survive, and in the 20th century the children who survived outnumbered those who did not by a larger margin than any other era, even with the fact that we killed millions in war.

  19. I’m hesitant to jump back in as these things can go on and on, but I do want to point out something, and it relates to health care and more. For years, arguably decades, we’ve been moving not toward a social state like many European countries (I know RG and R47 will disagree), but a strange hybrid whereby risks are socialized and profits are privatized. In other words, the risky patients — the sick, the poor, the cancerous, the wounded, the mentally ill or handicapped — have always been paid for by the government. Since this is crushingly unprofitable, the government-run health programs are routinely blasted for their efficiency, but are nonetheless operating in an impossible situation. The profitable part of health care — drugs, insurance, research, patents, equipment, etc. — have always been in the private sector, where many billions have been made in recent decades. Some government spending goes into those things, but again only on the risk side of the ledger, not the profit side. Common folks benefit from better medicines and treatments, but until recently only if they could afford it or if their employer offered health insurance, and again only if they were not risky, did not have preexisting conditions or have the audacity to be born poor.

    So the risks reside in a socialist government, while the profits are wholly located in a capitalistic paradise. It’s the Eeloi and the Morlocks all over again. And them Eeloi don’t like the Morlocks to come out of their caves to get anything like health care, equal education, equal infrastructure, equal amenities, etc. Only when the poor or sick cross over into being healthy and somewhat more rich do they become desirable. As I think we all know, not everyone can be rich at the same time. Some people are, must be, always will be part of a lower, working class. And the arguments that liberals like me make is why, then, must they do so without basic health care, schools that give their kids an equal shot and social mobility and the decency of clean parks and safe communities? A right? Maybe not using RG’s definition, but let’s call it an earned benefit for living a life that is, believe me, not as comfortable as one lived by what’s left of the middle class and the wealthier among us. You can’t waive a wand to retroactively turn every poor person in the world into a young Warren Buffett.

    We socialize risk for other things, too, like economic development. Excelsior Energy gets socialized risk management, but if that project and our local leaders hadn’t been so monstrously stupid from the start, all the profits would have gone to a select few who didn’t stick their necks very far out of their designer golf shirts. Hell, they still made money and it was an abject failure.

    Indeed, this could go on. But those are my feelings after reading this very invigorating conversation.

  20. AB, Excellent wrap up and is going in my bookmarks.

  21. “a strange hybrid whereby risks are socialized and profits are privatized” – Aaron Brown, 9/19/2014

    The reason your premise of “risk & profits” is strange Aaron, is because it’s devoid of logic, false…a red herring. This tactic is expected from many of your posters once they’ve lost a argument and are stumped by the facts…but come on, not from you, a communications pro.

  22. Red herrings are distractions from the central argument. You have used that logical fallacy in nearly all of your posts on this blog over the past half decade. I can only be thankful you didn’t go copy some 1,000 word manifesto from some right wing news aggregator to paste here. I suspect that’s what’s coming next. In any event, I fail to see your logic and further stand behind what I said because I do think I was being quite clear, even if you disagree. I do believe talking about market forces in health care is applicable to a post about market forces in health care.

  23. As stated Aaron, your premise of “risk & profits” has no basis. Back it up. You’re telling us the whole private sector of the health care industry always makes a profit?, always rolling in the dough?, never takes losses?, never takes risks? And the “woe is me, don’t have enough money” government bureaucracy has to deal with only and all the risky stuff? B.S. (See, there you go, you derailed the core discussion). Anyway, therefore, the rest of your post is meaningless, a distraction from the issue at hand due to a false opening assumption.

  24. I’m making a larger point that is no way a distraction. You are disagreeing with me and that is a wholly different matter. Get your terminology right. You had a semblance of a coherent rebuttal, cloaked as usual in patronizing buffoonery. You sure are so smart, Bob. I sure can’t keep up with the likes of you. Golly gee. When will I learn.

  25. Aaron has made an excellent, thoughtful explanation of the situation–one that moves beyond the partisan “This sucks, and this other thing is great” vibe that characterizes a lot of these threads. I don’t think you have to be liberal or conservative to appreciate the truth in much of what AB says. Obviously, no one person will be completely right all the time about such a complex issue (except R47), but AB’s points help to expand the discussion. The United States IS a weird hybrid of socialism and capitalism. Sometimes, as in the bank and automaker bailouts of 2008, which were followed by a stock market boom that continues today, the two ideologies are so intertwined as to be indistinguishable. Today’s capital gains were underwritten by yesterday’s government spending.

  26. I guess I would join in the shout out to Aaron. Another great job. I have to say I was very impressed with Jen Schultz’ discussion too, but from what I have seen of her, she is reliably impressive. As is Aaron.

    • I would say that Aaron is less impressive for being consistently right than for consistently having good manners. That may actually be even more impressive.

      • Rather than saying consistently right what I would say he is consistently careful about the facts he cites, and consistently shows a sophisticated and honest grasp of nuance in his assessments. Obviously whether you or I think he is “right” has to do with personal opinion, but from what I have seen he does not seem to be wrong on the facts or to try to manipulate or force facts to back his opinions. That is very rare, as is his politeness, in an age when many news analysts both left and right regularly become completely unmoored from the facts in their attempts to soar toward their desired results, and seem to think acting like Don Rickles is the way to make their points. He is sort of a Northland Ezra Klein, but with Minnesota nice substituted for California smarter-than-you. And way fewer graphs.

  27. I agree with David, Aaron’s strength is his graciousness. I’m sure I’d enjoy having him as a neighbor, but might put blaze orange marking tape on the property line pipes. Just sayin’ 🙂

  28. OK, enough of giving Aaron a “performance review”. It makes him feel uncomfortable. Educators don’t use that process in their line of work.

    Here’s one thing we can all agree on.. Duluth News Tribune 9/20/2014: “1 in 4 Americans open to their states seceding from the union” – Why? “Anger with President Barack Obama’s handling of issues ranging from health care reform to the rise of Islamic State militants drives the feeling”

    With us Minnesotans having everything we need – a reasonable education system, good doctors (we’ll be free from Obamacare, our Mn doctors will take care of the poor as they always had before B.O. care), manufacturing, iron ore, steel coming soon, farmland, water and wind for electricity, we certainly don’t need the Feds. Let’s do it!

  29. Do the math. We’d have been better off simply sending a check to those who need it, each year, for the rest of their lives…vs. passing Obamacare

    By Peter Gosselin | September 24, 2014

    (Bloomberg) — Nearly five years after passage, the Affordable Care Act (ACA) and a companion electronic health records (EHR) program have run a startup tab of more than $73 billion, the Bloomberg Government analysis finds.

    Part of that total is the cost of healthcare.gov, the flawed website and related enrollment system intended to expand U.S. health insurance coverage.

    BGOV’s analysis shows that costs for both healthcare.gov and the broader reform effort are far greater than anything publicly discussed. They’re also substantially greater than what the Congressional Budget Office (CBO) initially estimated health reform would cost by this point, although not what the agency’s more recent piecemeal estimates suggest.

    Meanwhile, the changes in health-care financing and delivery on which the money is being spent remain very much in their startup phase.

    • As I am sure you know, although the web site start up costs have been above projected due to the failure of the private contractors to be able to deliver glitch free software — article about that in the Washington Post today as a sidebar to the cost figures, as well as discussed in Bloomberg cited below — the total cost of the ACA has been BELOW projections and the total number of enrollees above.

      In addition, we have seen that, far from causing problems with Medicare as many opponents tried to suggest, the start of the ACA has been accompanied by record low growth in Medicare costs as well as seeing the projected life of the Medicare trust fund extended fourteen years beyond the projections back in 2009.

      Add in that the numbers of the uninsured have fallen by 26% nationally and by over 40% in Minnesota, that the projections for young enrollees and Latino enrollees — which originally looked disappointing — have been met and exceeded projections, and that nationally — PreferredOne is a major outlier — the number of insurance companies signing up to be on the exchanges for year two has risen dramatically.

      Also reported today, the program has saved hospitals and health care groups $5.7 billion so far this year, an amount that will increase sharply as the Red States start to come around — or be forced around by their own citizens — on the Medicaid expansion. That money will be passed through eventually as savings to both public and private insurers as the costs of uncompensated care for health providers decreases.

      In addition, consumers have saved $9 billion.

      Looks like a big, big win to me, and only likely to get better.

      Here’s the link, same organization you cite: http://www.bloomberg.com/news/2014-09-24/obamacare-website-costs-exceed-2-billion-study-finds.html

  30. Consumers have saved $9 billion? B.S. !! Where’s my $2,500? Did you get yours? Not only didn’t I get a $2,500 reduction or refund, my rates went up! As I’m sure yours did also. You’re talking buffoonish…

    • The savings calculated are due to the 80/20 rule that is part of the ACA — insurance companies must spend at least 80% of their collected premiums on providing health care, while overhead and profit can account for only 20%. The first year that was in affect (2011,) it resulted in substantial direct repayments of premiums in many states, as insurers missed the target. Since then, insurers have adjusted premiums downward to bring themselves into compliance: most recently, $3.8 billion in adjustments and $330 million in refunds last year. Total adjustments and refunds is $9 billion.

      This did not happen in Minnesota, because Minnesota already had laws on the books requiring its insurers to comply with similar rules to meet their status as non-profits. Minnesota does not allow for profit insurance companies, although there are some interesting work-arounds by Medica/United Health Care, and Medicare Advantage vendors, who are regulated by the feds, not the state, can be for profit.

      I guess following the rule that if you did not see something happen personally, it didn’t happen, this is “buffoonish.”

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