Politics Obamacare

Another special interest deal?

Labor might have just gotten a pass on an Obamacare fee

Why did we need to totally disrupt the healthcare insurance market? We could have simply purchased a healthcare policy for every uninsured person and implemented a tax for it (minus all those savings we are going to supposedly get because uninsured people will have insurance - they tell us we pay for it anyway), or simply put them on medicaid. It would have been simpler, easier to do, and I bet less costly. I doubt one of the primary goals of the ACA was to address the uninsured problem.

 

I'd like to see how many large employers with self-insured AND self-administered plans are exempt in addition to labor union plans. Personally, I wouldnt exempt any. The reinsurance fee (tax) is a sensible way to help spread the risk that will result from no longer denying coverage for pre-existing conditions.

To put the uninsured on Medicaid would require (1) over-turning the Supreme Court decision that states could not be forced to expand Medicaid (even when paid for by federal $$) and (2) then forcing red states to expand Medicaid.

The goal of addressing the uninsured is already being achieved, with millions of low income people (in blue states) pre-qualified for Medicaid, requiring coverage for those with pre-existing conditions, and offering afforable alternatives for those with junk plans who would like greater coverage, particularly if they have a less that perfect health history.
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On a more amusing but ignorant note, Rick Santorum compared the ACA to apartheid:

Nelson Mandela stood up against a great injustice and was willing to pay a huge price for that, and that’s the reason he is mourned today, because of that struggle that he performed…and I would make the argument that we have a great injustice going on right now in this country with an ever increasing size of government that is taking over and controlling people’s lives, and Obamacare is front and center in that.​

Ted Cruz compared the ACA to Nazi appeasement. Other right wing extremists have compared it to slavery.

Shades of Reagan's apocalyptic prediction in the 60s that Medicare would be the end of the freedom as we know it (and stolen and updated by Sarah Palin in her reasoned and rational critique of the ACA and its death panels.)

You would think at some point, intelligent Republicans who might oppose the law would be embarrassed by these ignorant and offensive comparisons, but in fact, most seem to love it.

 

I suspect that intelligent Republicans see the comparisons as appropriately defiant and provocative, and justified by the evil they see in Obamacare. Extreme statements like these are rooted in the desperate anger they feel.

Imagine seeing the world from the standpoint of a person who thinks the enactment of Social Security was a tragic mistake. From that perspective, government is ruinous because it takes away one's money and gives it to the undeserving.

If you take your overriding moral lesson from the fable of the grasshopper and the ants, it's morally wrong to shield anyone from the consequences of their bad choices, or even their bad luck.

This whole framework used to include the word "hardworking" as a positive term to characterize the ones who were entitled to keep the fruits of their labors. That has been quietly dropped, because nowadays, the hardest working segment of our society are the working poor, laboring long hours at minimum wage.

Billionares who lead lives of leisure are deserving, because after all, they can afford it. Janitors and farmworkers, who can't get decent health care without government help, are undeserving, because they can't.

 

I thought this was interesting and on point.

Why Republicans Will Never Reform Health Care

 

And time wounds all heels.

Yup.

 

Another one of those little know ACA provisions that will potentially have significant positive impact. In this case, for the elderly with physical and/or mental disabilities...making it easier (and cheaper to taxpayers) for these elders to stay at home rather than be forced into nursing homes.

ACA Spurs State Shift in Long-Term Care

These numerous little known provisions, affecting consumers of all ages, eventually add up to big savings AND better care.

 

Is this good? Will we get below 15% with a law that makes in mandatory to be insured? Any predictions? I think before year-end we will be at 16.0% - we disrupted the market in ways unnecessary when other measures would have addressed the uninsured more efficiently.



APNewsBreak: Poll finds drop in uninsured rate - Yahoo News

 

You still dont get it, Ace.

Covering the uninsured is not the full measure of success of the ACA, particularly given that most red states have refused to expand Medicaid as part of the ACA program to cover those marginally above the poverty level.

Equally important is the fact that all of us with insurance have new patient/consumer protections for the first time.

And numerous programs are being piloted or funded to help bring down the cost of health care.

 

I never believed the rhetoric about the uninsured when the ACA was being debated - I did believe when some said that they just wanted to get something into law, get people on-board with the benefits while dealing with the costs and fixes later. I did not like being mislead. Just like the Medicaid debate is misleading. Many states can not afford their costs now and eventually federal subsidy will diminish. The result is many states will face tough budget choices. This should be a basis for honest debate on this question - over the long-term how is it going to be paid for.

First time? There are new protections for the first time - but they also come with a cost. The industry has been heavily regulated with consumer protections in place.

We will see. Premiums for some have gone down for others premiums have gone up - some have insurance for the first time other will pay a fine - etc. The key measure will be actual out of pocket costs for healthcare relative to the quality of care. A strained system can not handle increased demand, lower costs, and improved care. Something has to suffer. Typically, Medicaid his the worst health care available - in some cases worse than not having coverage.

 

Basically, you can't stand it, no matter what, and you are eager for it to fail.

Almost every worthwhile thing comes with a cost. In this case, the cost/benefit ratio is small.

An extremely necessary part of the ACA.

By that measure, we could hardly do any worse than the pre-ACA system. The U.S. pays far, far, far more for health care than any other country in the world, bar none, and gets worse health outcomes.

Medicaid recipients, by definition, are the poorest and unhealthiest. Blaming that on Medicaid is just sophistry.

 

I am in it. My previous high deductible individual family plan got grandfathered but the increase in premium was not worth keeping my old plan. Now I have a new plan, structured differently. It will take some time to determine if my net out of pocket costs are down or up. It is not in my interest for the costs to go up, I don't want it to fail...but...I am not blind, I know that as a 53 year-old I need young healthy people in the system to keep costs down in the long-run. There are better ways to fix the system and I do think it is unfair that young people pay more so that I pay less. If you are young why would you support such a system? You should pay your true costs (based on sound actuarial models) and I should pay mine.

I would like them to be honest about it. For example unlimited life time caps - add what percent to the premiums we pay. Let us decide if we want it or not.

Some studies are a bit misleading. Wealthy people spend large amounts on elective costs that are not adjusted when comparing to other nations. I bet if we deducted SoCal's breast implants and botox that would move the needle - and about needles how much do we spend on Viragra compared to other nations. As to worse outcome - I would never voluntarily get medical care in another nation - would you?

No, there are actual findings that show Medicaid recipients in some situations actually get inferior outcomes compared to all other categories, including the uninsured. Here is a link to an article on the issue:

Medicaid's awful results: Column

 

I strongly disagree with this. Regardless how young and healthy I am, it is in my interest that services be available and affordable when I need them. Because I will.

By the same principle, we all pay for public schools, even people without children.

You're on thin ice here. Have you read Steven Brill's stuff on medical costs in the U.S.? We pay enormously more for things that are cheap elsewhere. Not because what we get is any better, but because profiteering has been allowed and even encouraged.

Of course I would. The UK? France? Canada? Germany? Sweden? Japan? All of those nations (and probably many others) have medical care at least as good as ours.

It has long been demonstrated that health correlates with income -- the more affluent you are, the more healthy. Poor people are less healthy across the board, no matter what system you have in place. Probably this is some combination of lack of resources and education with the same attitudes and circumstances that led them to be poor in the first place.

Comparing Medicaid recipients (poor people) with uninsured people (who are by definition more affluent) is apples and oranges.

 

There are capital costs and operation costs. In the school example we build a school using debt that is paid off over time, like with a 30 year bond - so the actual cost is not absorbed in any single year or by a group of current residents. Then we have operation costs, for example teachers salaries, that are paid in the year they are incurred this cost is paid by current residents.

In health care what is happening is that you are paying a portion of the capital costs I should pay. When you are 53, you will have payed more than your share of the capital costs (using the term as an example) - what then? Do you have your children pay more than their fair share? Does it ever end? Personally it bothers me that I would be a burden to my son. I would rather pay more to make it easier on him.

Some get services for low or no cost and other pay more than they should. Not fair.

I am not saying the study is perfect. Just something to consider. I think extra effort is needed to make sure Medicaid recipients don't get treated like second class citizens. Nothing in Obamacare addresses this in a direct manner in my opinion. I frequently hear about doctors not taking Medicaid patients.

 

How many children are not going to be able to stay on the parent's healthcare insurance plan because of this?

Health Law Is Tricky For Parents Of Medicaid Children

Are children being forced into Medicaid a good thing when they could be covered on their parent's plan? Are these children at risk of inferior healthcare? What is the fix? why wasn't this addressed before the roll-out of the ACA? Was this the original plan? Will there actually be gaps in coverage for these children until the issues are resolved? Is this the fault of the Tea Party too? Is it no big deal, because only a small percent may be impacted? What is the talking point on this?

 

Ace...I agree (and have remarked repeatedly) that the ACA will need minor fixes to addresses issues like the above.

Much like Medicare has gone through transformations to "fix" problems that may not have been envisioned. As have SCHIP and Medicaid and most every social program ever enacted.

But Tea Party types are only interested in the more extremist approach of "throwing the baby out with the bath water" rather than enacting simple "fixes" to deal with coverage gaps or other easily solvable issues to strengthen the law.