The GOP’s Endless War on Obamacare-and the White House Delay

The GOP’s Endless War on Obamacare-and the White House Delay

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The official reason given by the Administration for delaying, by one year, the Affordable Care Act’s mandate that employers with more than 50 full-time workers provide insurance coverage or face fines, is that employers need more time to implement it. The unofficial reason has more to do with the Republicans’ incessant efforts to bulldoze the law.

Soon after the GOP lost its fight against Obamacare in Congress, it began warring against the new legislation in the courts, rounding up and backstopping litigants all the way up to the Supreme Court. Meanwhile, House Republicans have refused to appropriate enough funds to implement the Act, and have held a continuing series of votes to repeal it. Republican-led states have also done what they can to undermine Obamacare, refusing to set up their own health exchanges, and turning down federal money to expand Medicaid.

The GOP’s gleeful reaction to the announced delay confirms Republicans will make repeal a campaign issue in the 2014 midterm elections, which probably contributed to the White House decision to postpone the employer mandate until after the midterms. “The fact remains that Obamacare needs to be repealed,” said Senate Republican leader Mitch McConnell, on hearing news of the delay.


Technically, postponement won’t affect other major provisions of the law — although it may be difficult to subsidize workers who don’t get employer-based insurance if employers don’t report on the coverage they provide. But it’s a bad omen.

The longer the Affordable Care Act is delayed, the more time Republicans have to demonize it before average Americans receive its benefits and understand its importance. The GOP raged against Social Security in 1935 and made war on Medicare in 1965. But in each case Americans soon realized how critical they were to their economic security, and refused to listen.

Robert Reich, former U.S. Secretary of Labor and Professor of Public Policy at the University of California at Berkeley, has a new film, “Inequality for All,” to be released September 27. He blogs at www.robertreich.org.

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177 Comments on "The GOP’s Endless War on Obamacare-and the White House Delay"


Admin
Jul 11, 2013

Prediction #1

Repeal becomes THE story early next year. I am guessing much of the maneuvering around this has to do with making sure any effort does not succeed. The administration is electing to look stupid now (unavoidable, when you think about it) rather than suffer a resounding defeat next year …

Guest
Al
Jul 11, 2013

“…has more to do with the Republicans’ incessant efforts to bulldoze the law.”

Please, you are an educated man. The ACA was pushed through knowing that almost no one knew what was in it and the fact that the bill was half baked and not ready for passage. Among other things it passed only because of promises never to be realized and special waivers.

Now after this unripe bill was passed you wish to blame someone else. That represents grade school thinking where one refuses to take responsibility and is compelled to always blame someone else.

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Kate
Jul 11, 2013

Agreed!

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Pat
Jul 13, 2013

Agreed!

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pmanner
Jul 14, 2013

“We have to pass the bill to find out what’s in it.” Sorry. That wasn’t from a Republican.

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Lisa
Nov 10, 2013

The ACA depends on the private sector (insurance companies) to set premiums. How the prices roll out will make or break the ACA system. The law can be modified, but ultimately this is a test of whether using the private sector is a workable solution or not. If you go to the website and compare the rates from North Dakota to the same person if they live in Wyoming, you will see what I mean. Right now I wish I lived in North Dakota.

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Al
Nov 11, 2013

What are you talking about? The private sector is only private when it creates the prices it charges for its goods and services.

The ACA is a rule book set by ignorant and ignoble people that should disappear from the public arena. They don’t have the slightest idea of how goods and services are produced nor do they know how to distribute them.

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Kate
Jul 11, 2013

“The longer the Affordable Care Act is delayed, the more time Republicans have to demonize it before average Americans receive its benefits and understand its importance”

Don’t you mean the longer it’s delayed the more chance there is of the truth about how horrible the ACA really is, has of coming to light? The ACA was pushed through by people who are supposed to represent the people and they have no clue what is even in the bill. They pretended that this was what was best for America, but they really were just spewing the party line talking points. The reality is the ACA is already having crushing affects on smaller business, who are scrambling to try and figure out whether to let people go or let their business go under. Doctors are choosing to either retire or stop taking insurance all together. The writing is on the wall and the Administrations “reprieve” is nothing but a thinly veiled attempt to convince people that they care about small business. Those of us who aren’t drinking the koolaide can see it clear as day.

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Peter1
Jul 12, 2013

” The ACA was pushed through by people who are supposed to represent the people and they have no clue what is even in the bill.”

Have you read the bill Kate?

Guest
Jul 12, 2013

As the ACA doesn’t apply to small businesses under 50 employees, it’s pretty hard to see who Kate is talking about. Or are national fast food chains small businesses?

And BTW it’s only the stupidity of our political system that makes such a trivial change to our insurance system, as in the ACA, impacting well under 10% of the population a massive “revolutionary” change

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Aurthur
Jul 12, 2013

Mr. Holt, Please stop embarrassing yourself. If you are unaware of The Act’s affects on under 50 employee groups, you should be silent. Thanks.

Admin
Jul 12, 2013

To be fair, Arthur is right. Because I can now buy into the Covered California Exchange my company (with under 50 employees) can purchase insurance at about 30% less than we currently pay. How that hurts me, I’m not sure.

Of course when I said the ACA didn’t apply to under 50 employee businesses I meant that the employer mandate didn’t apply. Still I’m sure Arthur knows way more about buying insurance for a small business than I do. I’m just a schmuck who writes Healthnet a check for my company’s insurance that has become 30% larger EVERY YEAR for the past 5 years.

But surely the ACA will make that worse.

And yes doing anything else than paying for health insurance out of generalized income tax is stupid, but welcome to America….

And the chances of me being silent are low…perhaps Arthur will identify himself and his vast experience and expertise in the matter?

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Kate
Jul 13, 2013

Not everyone lives in California. I live on the East Coast and pretty much what I am hearing from everyone is that their premiums have already gone up 50-100% and their employers are telling them it’s only going to continue to go up. So how is that beneficial to anyone who currently has insurance? I understand that people who were not previously “insurable” are finally going to be able to get insurance and that is great for them, but the cost across the board is high for everyone.
Add to that the fact that employers are having a really hard time trying to figure out what exactly they are required to do (b/c the bill was so well written and all) that they are wasting hundreds of hours of man time on this.
Are there issues with the insurance system in the US? Absolutely. But you will not convince me that the ACA, as it is now, is the answer. Anytime the government decides to take control of something and force it down the publics throat, it never ends well.

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Kate
Jul 12, 2013

Matthew-I did not say small business with less than 50 employees, I said SMALLER business. Meaning none national corporations, local companies that may be bigger than 50 employees but still not have the cash flow to withstand all the requirements of the ACA. My husbands job requires that he interact with 10-15 different companies each day over an area of 3 different states. The negative impact on these companies is real. It’s not exaggerated, it’s not hysterics, it’s not political. The owners are from both political parties, and they are upset and worried.

Admin
Jul 12, 2013

Well they should have got behind a tax-funded health insurance system when they had the chance. 99% of all businesses would be better off with such a system, but I must have missed the massed ranks of large and medium sized businesses demanding one in 2009.

And dont get me started on the NFIB, I said enough about them back in the day and it’s still true

http://thehealthcareblog.com/blog/2010/05/18/will-the-nfib-please-go-away/

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Aurthur
Jul 12, 2013

Mr. Holt. Thank you for pointing out I am right and you were wrong. However, you cannot buy into Covered California now…172 days 18 hrs 13 mins

Until New Coverage Begins for Millions of Californians

Health care coverage begins January 1, 2014

Unless most of your employees are older, sicker, in a higher risk industry, and in a higher cost area of California then the average, your insurance will not be 30% less.

If your employees are younger, healthier, in a low risk industry, in a low cost area of California, your rates will increase 30 to 100% since The Act outlaws private carriers from offering your employees discounts for these favorable factors.

Yes, I do know more about buying insurance (health) for a small business than you do. I do not consider you a schmuck, necessarily. However, if it turns out your costs going through the exchange when the plans are available, is 30% higher than your current arrangement with Healthnet, then I believe you should also admit The Act is a failure. I am curious to hear. Thanks.

Admin
Jul 12, 2013

Well funnily enough CURRENTLY in California, groups between 2-50 buy into what’s essentially a community rated pool. So where Arthur’s low risk, young employer group is buying with rates that are going to go up 30% when Covered California’s rates are lower than my group of young, community rated employees currently receives, I await to hear with interest. Especially as Covered California has been aggressively getting plans to reduce pricing in a way the small employee pool cannot.

And unless you were a proponent of a single payer globally budgeted system, or another that effectively got employers out of buying heath care and turned it over to the tax payer, criticizing the ACA is just intellectually dishonest. It’s all that could be got through our ridiculous system of government and even this minimal change barely passed and only because there were amazing 60 Democrats in the Senate. And that included such wild-eyed lefties as Baucus and Lieberman.

So while I don’t think the ACA is a failure, I do think America’s system of government is.

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Aurthur
Jul 12, 2013

If by “essentially” you mean rates can vary by 20% for RAF, and 60 to 100% based on rating area (which has recently been gerrymandered into 19 areas from 9 so as to fool certain younger less likely to be covered Californians into thinking the rates are now lower for them), and you ignore current loads for very small groups and you pay no attention to the number, quality or make up of the providers in the networks associated with the plans, then OK.

Believe it or not, I no longer live in California. I do believe the two largest carriers are opting out and many carriers opting in are shrinking their networks for the products in the exchanges.

With the gerrymandering of rate areas that constitute your community, the outlawing of a 20% discount for medical conditions, and the rate compression on age factors, I remain curious to see what happens to your group’s rates when you compare today’s apples to next year’s apples. Thanks.

Guest
Jul 13, 2013

Apples to apples ours rates are going down 30% unless Peter Lee is hoodwinking me. And the two largest carriers (the 2 Blues) aren’t leaving, Aetna and United are leaving the individual and small group market as they are too SMALL in California to match the discounts that the Blues were able to get. And it’s about time someone took on California providers who have been living high on the hog for more than a decade now.

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Al
Jul 12, 2013

What type of logical response is this? Kate didn’t vote on the bill, so why should she have to read it in its entirety? It is up to you, the supporter of the bill, the one that is imposing his ideas onto others to justify its existence.

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Peter1
Jul 13, 2013

Al, I don’t support this bill or it’s meager and failing attempt (so far) to bring universal health care to America.

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Al
Jul 13, 2013

OK.

I just don’t know why anyone would expect another to read through the entire bill. I actually read almost the entire HR bill before the Senate version. Many of the important points of the bill were near unintelligible and like the Senate bill that passed (ACA) only a skeleton designating important decisions to those appointed by the executive branch.

Passage of such a poorly written bill (no matter one’s philosophy) demonstrates that our legislature is no longer able to deal with the important social issues our nation has. They have become a self serving branch of the government and that includes both parties even though the blame for this bill rests squarely on the Obama administration and the Democratic legislators.

As far as your idea of universal care, that is an idea not a program. In reality we already have universal care on a definitional basis.

Guest
Jul 13, 2013

The whole health care debate leading to total meltdown over what is a very trivial change to our system just exposed that our Constitutional system–intended to prevent foreign dictatorship in an agrarian society– is totally outdated. Why it wasnt changed after the Civil War is beyond me, but to make sensible policy requires some kind of parliamentary unified system. Fat chance of getting that, while the 0.1% runs the country and no one gives a toss about the bottom 50%.

And so we end up with the ACA being the best we can get

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Kate
Jul 12, 2013

No, I have not read the entire bill, although I have read huge chunks of it. Despite the fact that it’s not my job to read it. The fact of the matter is, our elected officials failed. They openly admit that they have no idea what the majority of the bill says.

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Peter1
Jul 12, 2013

Kate, surprise, our lofty representatives usually NEVER read the bill. In this money for hire system they hardly have time to because they’re dialing for dollars.

You want better, well read legislation, you change the bribery system of government.

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Pat
Jul 13, 2013

You need to look at the “trial” period that wiped out funding in the first 3 months. They have no idea what this will cost, nor who will pay for it. Generation Y is opting out, and taking the $90 penalty. All the sick are enrolling in droves and those already on assistance, just got more. Meanwhile the middle class which has almost become extinct (qualifying us for minority status) are getting jacked up by 42% . This is unsustainable!

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Lisa
Nov 10, 2013

Pat,
Our rates didn’t go up, they stayed the same. They were too high for poor coverage before (as an individual buying on a private exchange), and now they are too high for much better coverage. IMHO we need a catastrophic coverage option for everybody (so nobody has to face financial ruin in case of an accident) and I can pay for my own flu shot.

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SPARTEN
Jul 11, 2013

O. K. How would all of you replace the Obamacare???? What are your ideas of a new plan??? How about Ryan’s voucher plan for all. You can buy your insurance in any state AND FOLLOW THE HEALTH INSURANCE LAWS OF THESE STATES. There will be no pre-existing condition and there will be a cap on lifetime payments. These insurances will only take those who are quite healthy. Is that your way of thinking????

Guest
Jul 11, 2013

Here are my “two cents” without going deep into the details: I think we all agree that the cost of healthcare in this country is unreasonably high. This realization alone prompts to take actions to reduce this cost FIRST (how – is another topic) and ONLY THEN to provide (one way or another) all the people with the insurances. Most of ACA provisions only declare but in fact do not provide the cost reductions, moreover, increased bureaucracy as always leads to cost increases.

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Uwe Reinhardt
Jul 14, 2013

Boris,

I assume that you are a young man. Were you not, you would realize that your prescription “cost control first, then universal coverage” is over three decades old. In reality, it means “forget the uninsured.”

I recall debating a US Senator on that point on the Jim Lehrer show. my suggestion was then that Congress should give up its cozy, tax-payer funded, fully community-rated health insurance and that Members of Congress should be forced to buy coverage in the medically underwritten non-group market until they have managed to enact a decent universal insurance plan. I still think it is a good idea, if only to teach Members something about the real world.

Guest
Jul 14, 2013

Uwe – thank you. I wish I am as young as you think and as I wish to be despite having two beautiful grandchildren. If things have not been done “right way” – and from your post I assume that we have similar understanding of what is right, it does not mean they have to be done “wrong way”. But you certainly sensed something different in my background – and it is my experience living in the Soviet Union. It has been many blessed years since we became citizens of this wonderful country, but I still remember very well what happens with a society where people rely on “free” stuff from the government rather than on themselves and what happens when a bureaucracy takes control over people instead of serving them as originally intended.

Guest
Jul 11, 2013

As a family physician I have already seen many of the benefits of Obamacare. Medicare wellness exams have brought in many fixed-income seniors who had not been getting preventative services prior because they could not afford the deductible and copay costs of even an office visit. Slightly better reimbursement for primary care services may, I hope, allow us to better recruit primary care providers by offering better compensation. I’ve seen no negative impacts so far, and look forward to more benefits to Americans as the rest of teh bill comes in 2014. I hope this is not the first nail in Obamacare’s coffin.

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MD as HELL
Jul 12, 2013

More cows to be milked. If they really wanted care they would have found a way.

Healthcare is too expensive because there is too much money paid out without considering the value of the purchase.

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Lisa
Nov 10, 2013

MaH, healthcare is too expensive for a lot of reasons, but wellness exams are not one of them. Early detection keeps costs down.

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Al
Nov 11, 2013

Wrong! Wellness exams might be good medicine but they have been proven to increase the total cost of healthcare.

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Greta
Jul 11, 2013

Change is hard, especially when it the change lowers your income. Why should we expect most doctors, hospitals, pharmaceutical companies and the like to be on board. The status quo has made all but the primary care provider quite satisfied.

Guest
Jul 12, 2013

Many of the Republicans who would vote for repeal have perfectly secure group coverage themselves, either through Medicare or through employment.

When Social Security and Medicare became law, many of the first beneficiaries were very poor. One had to truly have a heart of stone to oppose these initial programs, and the average voter was somewhat repulsed by the Republican opposition.

With Social Security and Medicare, the government came in with fresh money where there was no money, and no reliable insurance for seniors.
These programs started sending out money less than six months after they passed.

The ACA relies a lot more on ‘moving money around’ inside the health care
system, and the ACA also relies on private insurers a great deal.

This makes it harder for the Democrats to point to a large voting bloc as
“beneficiaries of the ACA.” So far the clear beneficiaries of the ACA have included uninsurable children under age 26, high-risk insureds in states which had no high-risk pools, and seniors nearing the donut hole in Medicare Part D.

This is not a voting bloc. Given the slow implementation of the ACA, done in large part to mask deficit spending, it is hard to rally a large group of beneficiaries right noiw. Prof Reich is a good ideological supporter, but there is no substitute for live voters who like their benefits.

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Aurthur
Jul 12, 2013

“So far the clear beneficiaries of the ACA have included uninsurable children under age 26, high-risk insured’s in states which had no high-risk pools and seniors nearing the donut hole in Medicare Part D.”

Do you consider all the insurance carriers deciding to cease offering individual policies to anyone under 18 a benefit to these children?

Do you consider the PCIP beneficial when the administration overestimated enrollment by 650%, underestimated costs by 122%, attempted to hide the program from the public, and ultimately shut the program down to new enrollees half way through the process?

Reich is a shill without courage to debate. Thanks.

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Lisa
Nov 10, 2013

Aurthur, your beef is with the insurance companies. Change was absolutely necessary and if the system isn’t working, we have nobody to blame but ourselves for not fixing it.

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Al
Nov 11, 2013

Change which may be needed can be good or bad. In the case of the ACA change is very bad.

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Aurthur
Nov 11, 2013

Lisa, when insurance carriers cannot underwrite or manage risk, they are no longer insurance companies. And, Reich continues to be a shill and a coward.

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tom
Jul 12, 2013

I read the entire bill with amendments. At the very least, ACA needs a huge number of corrections. Anyone who thinks ACA is perfect as it stands is in for some big surprises if it goes into effect as is.

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Cynthia
Jul 12, 2013

Well folks, we are to the point where rubber meets the road with Obamacare. Clearly, it CAN’T be implemented unless the sun, the moon, and every single star line up AND unemployment is under 5%. The largest retailers and restaurants have pledged to cut employee hours to below 30 – and they can easily do that – because millions are lined up to take part-time jobs.

Here’s the thing with healthcare: it costs more than almost anything, it’s unavoidable, and no one wants to pay for it. We stumbled into employer-funded healthcare after WWII, which works well enough, but because it’s voluntary, it leaves out millions. Obamacare tries to fix that with a number of mandates, but that makes employers try to dodge it using loopholes. Single payer deals with this problem, but good luck getting that through Congress.

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Renegade Nurse
Jul 13, 2013

Cynthia, I think you have touched on something that few among us are willing to consider or to advocate. The ACA is a major political accomplishment for the Obama administration, but who are the winners and who are the losers?

So far, insurance companies are the biggest winners; they will need to staff up just to handle the demand. Close behind them are drug manufacturers, who continue charge American consumers triple what they charge those in Mexico and Canada.

Who are the losers? Healthcare providers, who will see payments slashed as regulatory oversight becomes even more burdensome, will suffer and some will go out of practice. And healthcare consumers are the biggest losers because the demand for healthcare services will increase while availablility and quality goes down.

The sad reality is that the US is without a healthcare system. What we have is a hodgepodge of competing interests, regulated by elected officials who are bought and paid for by those who are being regulated.

Perhaps a Constitutional Amendment prohibiting Americans from being denied healthcare services could set the political and judicial processes in motion to get Uncle Sam to work for us instead of the highest bidder.

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Pat
Jul 13, 2013

Another problem with obamacare is that there was no legislation for legal limits. Physicians and big Pharma have to pay through the nose because everybody sues, and lawyers are always on the prowl. It costs you nothing to sue, but millions to defend. Baddrug.com, and all the malpractice insurance gets passed along to us. Lets get lawsuit limits in place, but Obama is a lawyer, and they never think like the rest of us. This ACA has many good initiatives, I’m in healthcare IT, so I know. But until you stop the lawyers from their feeding frenzy, its going to get worse. ACA has us sharing medical charts electronically. Can you see the lawsuits start flying when physician start relying on each other? More and deeper pockets.

Guest

“…the Republicans’ incessant efforts to bulldoze the law.”
That probably won’t stop, either. This will remain a topic of discussion for a long time.

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Pat
Jul 12, 2013

There are a lot of assertions being made here, e.g. “overestimated enrollment by 650%, underestimated costs by 122%, ” with no attribution to a credible source. Then there’s people making comments like: “Anyone who thinks ACA is perfect as it stands is in for some big surprises if it goes into effect as is.” which is ridiculous. Of course detractors have been screaming it’s imperfect, but even supporters said it was when first passed and that modifications would need to be made. That was not some smoking gun of incompetence, but reality. * NO* bill is perfect when first passed. As one person here asked…where is your alternative plan to provide healthcare at reasonable cost to all Americans?

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Aurthur
Jul 12, 2013

These may not qualify as credible sources (HuffPO, Heritage, and particularly CMS), but when facts don’t matter, does it really matter if they are facts?

http://www.huffingtonpost.com/2012/02/23/pcip-pre-existing-condition-insurance-plan_n_1296952.html

http://blog.heritage.org/2012/05/04/side-effects-another-obamacare-initiative-bites-the-dust/

ACA may indeed be the most perfectly not perfect legislation ever.

p.s. All American have access to health care now and before this bill passed. Thanks.

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Pat
Jul 13, 2013

Aurthur, ‘access’ to healthcare available to all Americans? Well, I guess if you count emergency room visits access to healthcare, you are right. But access to AFFORDABLE healthcare is NOT available to ALL Americans. Even what you might consider middle class Americans have been driven to bankruptcy by medical costs.

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Al
Jul 12, 2013

Pat, there are loads of plans out their and loads of methods to manage the problem. With picking the ACA we just happen to have picked on one of the worst plans possible. I say possible because there is always something worse, but I just can’t think of anything at the moment.

If you want an idea of what else is out there or the idea for another plan check out John Goodman’s plan at the NCPA. He is the father of HSA’s probably the only major program that actually worked as stated.

ncpa.org

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Peter1
Jul 12, 2013

Bob, how can they state they are “non-partisan”?

The National Center for Policy Analysis (NCPA) is a nonprofit, nonpartisan public policy research organization, established in 1983. Our goal is to develop and promote private, free-market alternatives to government regulation and control, solving problems by relying on the strength of the competitive, entrepreneurial
private sector.

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Al
Jul 13, 2013

Peter 1, I think they can say they are non partisan because they are supporting an economic theory, free markets and classical liberalism, not a particular political party.

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Pat
Jul 13, 2013

Al, in this current congress how likely are any of these plans you mention to make it into some sort of law that provides a reasonable guarantee to affordable health care? HSAs may be great if you can afford to contribute to them. For someone making $34,000 a year (an income that Mr Koch seems to think puts you in the top 1% or earners) How can anyone possibly put aside enough to pay for even routine exams and tests much less a more major procedure and provide for a family, save for retirement, college education, etc? What about preexisting condition exclusions by insurance providers? I could go on…

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Al
Jul 13, 2013

Pat, yes you could go on, but just because one is looking for a market solution does not mean the government cannot provide subsidies to those truly in need, but those subsidies need to be realistic. We don’t need to provide Viagra to a relatively young man that already has children that he is not paying for.

Thus, even with HSA’s poor people can survive. Remember they have to pay for housing, clothing, food, etc. so they are getting money somewhere. If the government provides a subsidy that can make the HSA or any insurance plan more affordable. If not there is Medicaid. Remember, there are studies demonstrating that HSA’s work in the not so affluent population as well.

In the end poor and rich, every taxpayer is paying for our bloated health care system. What lowers prices? Competition. Take note how many of the poor own cell phones, computers, air conditioners, refrigerators and all household amenities. That money comes from somewhere. I don’t begrudge a poor person’s benefits as long as the money goes for necessities, but it appears we have lost sight of reality.

If you are a responsible working person and pay taxes think of how much money would be left in your account if normal competitive forces ruled the health care market. All costs would be lower including your premiums that are likely paid in part by your employer. Part of that money could be yours.

Guest
Jul 13, 2013

Aurthur made the comment that the policies in the exchanges will have limited medical networks.

This raises a very interesting point. It hits on an issue that has been a sticking point in health reform for over 20 years.

A limited network will tend to exclude the most expensive hospitals — i.e. the UCLA Medical Center, Mt Sinai, Mayo Clinic, Sloan Kettering cancer centers, etc. Such a network may also not cover the most expensive specialists in any community.

This can save a lot of money in premiums. As a former actuarial student, let me tell you that it takes very few $250,000 claims to drive up premiums for any small or medium sized group.

But inevitably there will be one or two patients who have a rare cancer or rare blood disease who would clearly benefit from one of the top medical centers and from a blockbuster drug.

But their policy gives out, and then you have bake sales and bankruptcies and early deaths, and maybe John Grisham or Sixty Minutes covers the case too. This happened on a regular basis with some breast cancer treatments in the 1990’s.

The ‘debate’ is between the greatest good for the greatest number, versus making sure that every insured gets the best care that money can buy.

In other words, if 999 persons benefit from lower insurance costs, and one person suffers in some way, is this acceptable?

I think that if you asked Canadians, they would say “darned right it is acceptable.”

Clark Havighurst of Duke has written a lot about this problem. If a person makes a free and conscious choice to limit their insurance, but then finds out they made the wrong choice, what as a society do we do?

I think that the absolutist answer — cover everything, no policy limits, no mini-med policies, any willing provider, no exclusions — is not the right answer fiscally.

But it is a thorny issue, and neither the ACA nor its opponents tend to deal with it straight on.

Bob Hertz, The Health Care Crusade

Guest
Peter1
Jul 13, 2013

Thanks for your continued thoughtful responses Bob. I like that you are issue and problem/solution oriented, not an ideologue like some here.

Guest
Al
Jul 13, 2013

@ Bob: “But it is a thorny issue, and neither the ACA nor its opponents tend to deal with it straight on.”

Many alternative solutions have been proposed and you know that. Example: John Goodman’s solution along with many others including those that advocate single payer. You just may not like the solutions, but they exist. No solution will or can be perfect so you cannot use the excuse of imperfection to deny the existence of valid alternatives.

Guest
Jul 13, 2013

The single payer ideology does relieve the individual from bad choices.
Single payer systems would put the large academic hospitals onto global budgets, and there would be no insurance denials.

In this system, the hospital might not have enough money for a proton beam device to cure prostate cancer. The system as a whole might refuse to buy a cancer drug that costs $100,000 a year.

So some individuals would not get the best health care money can buy. I am OK with that, but I see massive resistance in public opinion not to mention the courts.

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Al
Jul 13, 2013

@Bob: “The single payer ideology does relieve the individual from bad choices.”

No it doesn’t. It opens the gate to further politicizing medical care. Look at where federal grants go and note the inequality of the money that seems in many cases to be based upon political rather than scientific needs.

Single payer really doesn’t provide what many think. All it does is control prices and ration care. That is not very much different from an insurance company that sets the payment and determines that something is not medically necessary.

Single payer does not provide for true competition, reduces innovation, etc. It also prevents patients that are willing to pay for better care from getting that care. It leads to cases like Chaoulli v. Quebec where the Supreme Court intervened claiming “Access to a waiting list is not access to health care,”

It seems what you are asking for is universal insurance.

Guest
Jul 13, 2013

Single payer systems do have global budgets, but that doesn’t mean that high cost care isn’t available. It means they are careful where they spend their money and how much they pay for products and services. Take, for example, Michael Seres of the UK. He received a small bowel transplant at a UK hospital and follow up care that has not bankrupted him. Would he be able to carry on his productive life if he had the same medical condition in the U.S.? I don’t know, but I’ve seen diseases such as his cause people here to claim disability because they are unable to find employment that has generous enough health insurance to afford to work, even though they still could. And the UK pays roughly half of what we do in the U.S. The ACA does not even begin to fix this. You can’t have an open ended system where both insurance companies and provider organizations get paid for whatever they demand, which is essentially what we have now.

Guest
Al
Jul 13, 2013

I was not referring to care within the system. See Chaoulli v Quebec. Take note of what was written by one Supreme Court Justice.

“This virtual monopoly, on the evidence, results in delays in treatment that
adversely affect the citizen’s security of the person. Where a law adversely
affects life, liberty or security of the person, it must conform to the principles of fundamental justice. This law, in our view, fails to do so”

Guest
Peter1
Jul 13, 2013

Al, the Quebec Supreme Court decision (touted by conservatives here), that Quebecers should be able to buy individual health insurance did NOT result in widespread purchasing of private insurance. If you search you’ll find the truth that hardly anybody has done it – BECAUSE IT’S TOO EXPENSIVE AND THAT IT DOES NOT PROVIDE BETTER THAN THE PROVINCIAL PLAN.

http://www.cbc.ca/news/canada/montreal/story/2009/03/30/mtl-health-insurance-interest-0330.html

Guest
Al
Jul 13, 2013

Peter1, no one said anything of the kind. I quoted the statement because it explained the danger of monopoly in very explicit terms “results in delays in treatment that adversely affect the citizen’s security of the person.”. Perhaps the Canadian temperament is more forgiving than mine and is not as impatient so waiting on line is no big thing. Alternatively for those that don’t want to wait too long can cross the border and pay cash. No big deal. Canada is different than the US and requires different solutions, but Canada just like all western nations has to deal with the sustainability issue.

By the way people jump the queues all the time in Canada.

Guest
Peter1
Jul 13, 2013

Al, Quebec never restricted a person from seeking treatment in the U.S. or anywhere else. Wait times in Canada have been improving. I wonder how long the wait time is for an uninsured person here needing elective surgery?

No one gets a bill in Canada, access is selective, after all it,s free. Yes, people jump the que, but if they wanted to pay themselves they could go anywhere.

You might want to read this:
https://secure.cihi.ca/free_products/WaitTimesSummary2012_EN.pdf

Guest
Al
Jul 14, 2013

“Quebec never restricted”

Peter1, no one said that Canada restricted Canadians from crossing the border. I merely quoted a Supreme Court Justices opinion and from that quote you are making all sorts of explanations that do not pertain to this quote. I am happy that Canadian wait times are improving, but that is the problem of the people of Canada and they know better than I what their needs are. Even Robert Reich doesn’t suggest that as a foreigner he tell Canadians what to do.

The quote: “This virtual monopoly, on the evidence, results in delays in treatment that adversely affect the citizen’s security of the person. Where a law adversely affects life, liberty or security of the person, it must conform to the principles of fundamental justice. This law, in our view, fails to do so”

Guest
Jul 13, 2013

No, I do not think any country can afford insurance that covers every treatment at retail prices.

You are totally correct — globally budgeted institutions tend to focus on procedures that have the most interest and create the best reputations for the senior doctors or senior faculty.

That leaves an interesting dilemma.

Which would you rather have:

a state-funded hospital that is free to the user, but if you have a boring disease you might be given quite cursory treatment……..

or an American system where insurance companies pay so much for many surgeries that you can top notch treatments with no waiting lists.

But you have to pay a lot for the insurance, and even more if you do not have insurance.

Not sure of the answer myself!

Guest
Al
Jul 13, 2013

“Which would you rather have:”

Bob, how nice of you to provide me only two choices, being killed with a gun or being killed with a knife when there are so many other choices. :-)

I would prefer the choice of running away and in health care means that third party payer is ended and my choice is substituted for the choice of my employer or the government. We haven’t tried that in decades so perhaps you wish to add that choice to your list.

Guest
Peter1
Jul 14, 2013

Al, you’re not making much sense. You extoll the Quebec court decision that rules on the tyranny of “monopoly” yet you want to be able to choose between employer pay or government pay – two “monopolies”.

Then you write: “The government, big business, hospitals, insurers, physicians and people that like to control your life whether you like it or not are all on one side because their profits depend upon one another.”

Tell us how you will get away from that and be free to afford health care?

You want to do away with 3rd party pay – do you favor a cash based system?

Guest
Al
Jul 14, 2013

Peter1, I don’t understand you. You are too defensive. I quote a passage from a Canadian Supreme Court Judge and suddenly you attribute all sorts of ideas to me. What is your problem?

Do I believe health care in the US, not Canada, can be better managed if we would rely more on the market place? Yes, but that doesn’t mean I am willing to let those in true need not receive reasonable health care even if I have to pay more. Since you asked for a suggestion and a complete plan would be quite lengthy (no where near the length of the ACA) I would first end the reliance upon employer sponsored health care by equalizing or getting rid of the tax deduction. You can find more complete plans at the ncpa.org website.

As far as my negative comments about the ACA that everyone gangs up on one side with financial interests that differ from the patients interest is a fact and has been reasonably proven. ACO’s for all intents and purposes have the same incentives as HMO’s. Here is what the distinguished Ware Study said about HMO care:

“Conclusions.–During the study period, elderly and poor chronically ill patients had worse physical health outcomes in HMOs than in FFS systems”

Based upon similar incentives the same will happen to those in ACO’s.

Guest
Peter1
Jul 14, 2013

Al, I’m not defensive at all, I’m trying to grasp your shifting sands of reason.

As for your NCPA link, it’s just a right wing rant site with the usual players.

“The NCPA joined with scholars at The Heritage Foundation, The Cato Institute, the American Enterprise Institute and the American Action Network to identify what most needs to be repealed and replaced in the Affordable Care Act of 2010 (ObamaCare).”

If you don’t like how the health system players gang up on patients then just remove government from the mix – something the NCPA would like to see.

Guest
Al
Jul 14, 2013

Boy, your knee jerk reaction seems to be unilateral and hyperactive on the left side with no sense of balance. You asked for ways of dealing with the health care dilemma and seem to think only one way exists. That is pretty narrow minded.

The NCPA is not right wing. It appears to come from the more classical liberal venue. In case you don’t recognize what that is you might want to read a bit of history and discover that our founding fathers relied mostly upon classical liberal values, but that did not mean that they didn’t believe in some government involvement.

The collectivist values of many that call themselves Liberals today seems to attract those that are attracted to the collectivist nations of the 20th century. The leaders of many of those nations caused the deaths of over 100 million people not due to war, rather to political expediency frequently seen by those that carry the leftist label.

Guest
Jul 13, 2013

What happens in those other countries is that people know that they have to take care of their health as they are not given much sympathy if they smoke, consume alcohol, etc. They know intensive care is not as available as in the U.S., so they work a lot harder at taking care of things themselves. And the UK is investing in creative ways to help people help themselves – something that we seem not as able to do systematically, I think. I was very impressed with this effort by the NHS:

http://www.nhs.uk/Video/Pages/mental-health-big-white-wall.aspx?searchtype=Video

They were at the most recent Datapalooza event in DC last month. What a wonderful project undertaken by very caring and professional individuals.