A bump? More like a mountain in my small state. No competition, slashed provider options, more expensive for less care, rationing (with another name of course). It's a disaster...........and I say that as a democrat. I'd have voted republican for the first time in my life because of it if they hadn't served up the likes of Trump, which is not an option. True single payer.
40
The difficulty is that it has to be required for EVERYONE. They have been going very easy on those who opt-out. These people tend to be healthier than those who really have to have insurance. That's PART of the problem.
The other part of the problem is that health care does not a commodity like a pair of shoes or a new iPad. The for-profit system is at odds with the goal, which is a good medical outcome. And if there is one thing that Americans WILLFULLY choose not to learn, is that the capitalist model does NOT work for everything.
The other part of the problem is that health care does not a commodity like a pair of shoes or a new iPad. The for-profit system is at odds with the goal, which is a good medical outcome. And if there is one thing that Americans WILLFULLY choose not to learn, is that the capitalist model does NOT work for everything.
70
Bernie was right after all. Would Prof. Krugman agree to that?
54
The Huffington Post through a FOIA request brings Aetna's threat out in the open for all to see: give us the merger we want or we will take it out on people covered by the Affordable Care Act. Here is a link to the PDF hosted on the HuffPo website:
http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf
This despite the fact that Aeta told shareholders that participation in the ACA was good for the company's bottom line just this April.
http://arstechnica.com/science/2016/08/aetna-isnt-being-honest-about-why...
Mark Bertolini is acting like a petulant child and is playing with the health and finances of millions of innocent people. He should be ashamed of himself.
http://big.assets.huffingtonpost.com/AetnaDOJletter.pdf
This despite the fact that Aeta told shareholders that participation in the ACA was good for the company's bottom line just this April.
http://arstechnica.com/science/2016/08/aetna-isnt-being-honest-about-why...
Mark Bertolini is acting like a petulant child and is playing with the health and finances of millions of innocent people. He should be ashamed of himself.
102
I see we're trying the old, "Obamacare doesn't do ANYTHING about the doc shortage! OBamacare started the doc shortage!!"
1. That started about twenty years ago. The vaunted free market system started driving docs into specialities (much higher pay!) at the same time docs started aging, and more baby boomers started becoming geezers.
2. We don't have a doc shortage, exactly: we have a GP shortage, at a time when the elderly pop is zooming. This will correct itself after us geezers croak, by about 2040.
3. obamacare doesn't provide for new docs or anything, huh? really?
http://www.rwjf.org/en/culture-of-health/2013/01/the_affordable_care.html
I'm curious: you guys willfully stupid, or just lying for purposes of advancing a political agenda?
1. That started about twenty years ago. The vaunted free market system started driving docs into specialities (much higher pay!) at the same time docs started aging, and more baby boomers started becoming geezers.
2. We don't have a doc shortage, exactly: we have a GP shortage, at a time when the elderly pop is zooming. This will correct itself after us geezers croak, by about 2040.
3. obamacare doesn't provide for new docs or anything, huh? really?
http://www.rwjf.org/en/culture-of-health/2013/01/the_affordable_care.html
I'm curious: you guys willfully stupid, or just lying for purposes of advancing a political agenda?
15
PK, you should stick to economics. Everything necessary to build stable individual risk pools lies either in the Administrative Regulatory Authority PBO already has, or in bills that the REPUBLICANS have introduced. Here are the only fixes that matter.
1. Remove the 28 exemptions to the Individual Mandate. Yes, I said 28, everyone added by a lobbyist through the regulatory process in the last 3 years. Nobody is buying coverage because of THIS threat.
2. FIX the age rating in pricing, which currently charges a 21 year old 75% more in premiums than he should pay, to provide an 11% discount to 64 year olds. Thanks AARP for nothing. (Repubs have already intro'd bill)
3. FIX the special enrollment process (regulatory). No documentation required up front for special enrollment. They will chase you down later, maybe. Avg special enrollee uses 400% of avg cost, only stays 5 months.
4. STOP letting kids stay on mom/dads policy to age 26. They should be buying through www.healthcare.gov from 21 yrs old onward.
5. MAKE risk corridor payments to carriers. Discretionary budget authority exists in CMS/HHS to do this as well. Worked for cost sharing reductions.
No new President required. No Congressional persuasion required. Fixes are real, available, and being IGNORED by the admin for political reasons.
WR
1. Remove the 28 exemptions to the Individual Mandate. Yes, I said 28, everyone added by a lobbyist through the regulatory process in the last 3 years. Nobody is buying coverage because of THIS threat.
2. FIX the age rating in pricing, which currently charges a 21 year old 75% more in premiums than he should pay, to provide an 11% discount to 64 year olds. Thanks AARP for nothing. (Repubs have already intro'd bill)
3. FIX the special enrollment process (regulatory). No documentation required up front for special enrollment. They will chase you down later, maybe. Avg special enrollee uses 400% of avg cost, only stays 5 months.
4. STOP letting kids stay on mom/dads policy to age 26. They should be buying through www.healthcare.gov from 21 yrs old onward.
5. MAKE risk corridor payments to carriers. Discretionary budget authority exists in CMS/HHS to do this as well. Worked for cost sharing reductions.
No new President required. No Congressional persuasion required. Fixes are real, available, and being IGNORED by the admin for political reasons.
WR
40
"Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
How can anyone take you seriously after a comment like that?
How can anyone take you seriously after a comment like that?
38
Mark Bertolini, Aetna's CEO, had total direct compensation in 2015 of $27.9 million ($107,005 per day). He says "Aetna, I'm glad I met ya!"
30
Mr. Krugman: I support the ACA and am proud of President Obama and the Democrats for getting it through. The ACA makes our country a better place. But there is a persistent problem: for people just short of Medicare age (mid 50s to 64) the premiums on the individual market are really high. You see it in the comments section of most articles about the ACA, so it's not just anecdotal, it's a real thing. Can you write something about this issue in the future?
35
Nobody wants reforms to fail, and nobody wants corruption to succeed. Corruption is not rare and it is not cheap.
7
Krugman seriously linked to the White House website as "proof" health care cost slowed. While pretty much everyone agrees the opposite is true.
Why is Krugman still a "thing?" Hasn't he pretty much been wrong about everything in the 20 years? (You know, the Internet is a fad).
Why is Krugman still a "thing?" Hasn't he pretty much been wrong about everything in the 20 years? (You know, the Internet is a fad).
40
Obamacare hits a bump...also known as the TRUTH.
40
Wow - if Krugman is admitting a problem, you can be sure it is way worse than he is discussing. BCBS in Illinois just announced 45% increases so not just the small states are having problems. Perhaps if the law wasn't crammed down based on lies (keep your doctor/insurance/etc) and under the table deals (Louisiana/Nebraska/etc) on a purely partisan and unprecedented basis - and was actually supported by the American people - there might be some cooperation.
42
If the subsidies need to be bigger, that would account for why it’s under budget.
8
What happened to of, by, and for the people?
13
ACA Obamacare is a perfect example of how holding a health insurance card in America doesn't ensure access to safe, quality affordable healthcare.
Corruption at its best.
www.wendellpotter.com
Corruption at its best.
www.wendellpotter.com
33
Government for the corporation, by the corporation.
33
Silly me! What a surprise that rates are going up and insurers quitting when one creates a cohort of folks without previous coverage all into the same pool---even i could figure out that there would be cost problems.
24
Honestly Paul?
It's insulting to the American people to have some smug, ivory tower, self-important Obama liberal elitist misleading the public like you're attempting.
Oh don't worry, this is just a bump...nothing to see here...
There are 32 million Americans who have fallen out of the middle class into the working poor since 2014 when the Obamacare mandate kicked in. I need to repeat that.
People who were in the middle class before Obamacare, are now working poor because of Obamacare. Four in 10 Americans who have dropped out of all coverage and opted to pay the tax penalty did so because the premiums and deductibles were MORE than they could afford.
A new underclass of working poor, plus 114 million Americans who gave up on finding jobs during the Obama presidency.
Barack Obama? You built that.
Obamacare hasn't hit a bump, it's hit a brick wall.
It's insulting to the American people to have some smug, ivory tower, self-important Obama liberal elitist misleading the public like you're attempting.
Oh don't worry, this is just a bump...nothing to see here...
There are 32 million Americans who have fallen out of the middle class into the working poor since 2014 when the Obamacare mandate kicked in. I need to repeat that.
People who were in the middle class before Obamacare, are now working poor because of Obamacare. Four in 10 Americans who have dropped out of all coverage and opted to pay the tax penalty did so because the premiums and deductibles were MORE than they could afford.
A new underclass of working poor, plus 114 million Americans who gave up on finding jobs during the Obama presidency.
Barack Obama? You built that.
Obamacare hasn't hit a bump, it's hit a brick wall.
45
Obamacare "Hits a bump"? And it got a little warm on the Hindenburg.
32
Krugman has discovered a fix for socialism. Karl Marx, call your office! Venezuela's toilet paper shortage will be dropped into the dustbin of history. Socialism is a shriek of horror and hatred of man's independent mind, the basic cause of production.
17
"Obamacare Hits a Bump"
The Titanic hit a bump too I guess. In Krugman's world if you don't fix the Democrat's arrogantly imposed mistakes for them you are evil. The man is ridiculous.
$20 Trillion in debt and counting.
The Titanic hit a bump too I guess. In Krugman's world if you don't fix the Democrat's arrogantly imposed mistakes for them you are evil. The man is ridiculous.
$20 Trillion in debt and counting.
37
Obama did it to himself by totally refusing to even consider single payer. Too late he will never listen to the voice of the People. Never because he is on a path set up by neoliberalism. He fooled almost all of us. I hear that everyday. But truly what did Obama ever do for the people (excepting the uber rich and corporations). He is a disgraceful president and his legacy should include that.
34
Me Krugman needs to face his words. Please support your assertion that "most of the news" over the last two and a half years has been good. Higher costs, less coverage, fewer insured, fewer insurers, cancelled plans. All the goals were missed, so where's the bright side?
25
The only answer is single payer health care. Period.
31
Conspicuous by its absence is any mention of ColoradoCare - the Colorado State Health Care System Initiative, also known as Amendment 69, that will be on the November 8, 2016, ballot in Colorado as an initiated constitutional amendme.
I would submit that a thorough PK analysis of this initiative is in order.
I would submit that a thorough PK analysis of this initiative is in order.
4
Since when does a "market-based" solution guarantee that every provider makes tons of profit in every aspect of the market? Some are capable - - some are not. Shouldn't that make the GOP happy?
6
"... previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
Pronoun trouble; "we", when you really mean "I". Anyone with half a brain predicted precisely this result.
The news about the ACA has been uniformly bad. Most folks admit that its alleged positive effects have little to do with the law, but advocates, like the author, engage in post hoc ergo propter hoc arguments which allege that any positive developments MUST be due to the law, while negative developments are in spite of it.
The "remedy" you propose is exactly what one would expect from leftists: more money. Hundreds of billions in new taxes and trillions in new debt aren't enough. Only ever increasing handouts -- and more draconian force -- will do.
We should consider the "public option" right after you specify how Medicare proposes to fund its current deficits and its long-term $30 trillion unfunded liability.
How about this? If we have a Dem POTUS, maybe she will act like her husband, and not obstruct good policies, like tax cuts and spending restraint. Indeed, if HRC acted like Bill, took GOP ideas, and made them her own, she, too, could reap the credit for the resulting economic boom.
As respects the states, GO FOR IT!! Maybe VT could reconsider. Nothing would make Republicans happier. If blue states adopted such policies, within a decade, we'd have conclusive proof of just how destructive leftism is.
Pronoun trouble; "we", when you really mean "I". Anyone with half a brain predicted precisely this result.
The news about the ACA has been uniformly bad. Most folks admit that its alleged positive effects have little to do with the law, but advocates, like the author, engage in post hoc ergo propter hoc arguments which allege that any positive developments MUST be due to the law, while negative developments are in spite of it.
The "remedy" you propose is exactly what one would expect from leftists: more money. Hundreds of billions in new taxes and trillions in new debt aren't enough. Only ever increasing handouts -- and more draconian force -- will do.
We should consider the "public option" right after you specify how Medicare proposes to fund its current deficits and its long-term $30 trillion unfunded liability.
How about this? If we have a Dem POTUS, maybe she will act like her husband, and not obstruct good policies, like tax cuts and spending restraint. Indeed, if HRC acted like Bill, took GOP ideas, and made them her own, she, too, could reap the credit for the resulting economic boom.
As respects the states, GO FOR IT!! Maybe VT could reconsider. Nothing would make Republicans happier. If blue states adopted such policies, within a decade, we'd have conclusive proof of just how destructive leftism is.
21
Too rich and too funny.
At least when it comes to Krugman.
All the rest of us can suck a lemon but at least Krugman is right always.
At least when it comes to Krugman.
All the rest of us can suck a lemon but at least Krugman is right always.
11
This is what happens when the public elects a government that cannot function. Democracy was never meant to work well with a fully ignorant, mean electorate. You vote for Republican anti-governmentalism and that is what you get.
14
Government is the answer? Let's ask the Venezuelans, Cubans and survivors of the Soviet Gulag.
21
The funniest comments here today are those that loudly trumpet about how Donald Trump will fix all this, no doubt because of his remarkable attention span, concern for poor and working people, knowledge base, and ability to work with others.
i've seen toddlers hopped on sugar with more ability to focus. The guy's never cared one whit for anybody who wasn't rich or an imported model, unless it was some old lady he wanted to run out of her home or a union leader asking for another fifty cents an hour. And as for the notion that this fool knows stuff and works great with, say, Congress...
Well, good grief.
i've seen toddlers hopped on sugar with more ability to focus. The guy's never cared one whit for anybody who wasn't rich or an imported model, unless it was some old lady he wanted to run out of her home or a union leader asking for another fifty cents an hour. And as for the notion that this fool knows stuff and works great with, say, Congress...
Well, good grief.
10
"shouldn't be hard to fix"
from a man that has done nothing but sit in an ivory tower and babble. hilarious.
from a man that has done nothing but sit in an ivory tower and babble. hilarious.
38
For the 35th time since 2014:
Obama liberals, please stop shrugging your shoulders like toddlers and saying "oh well, now its time for the public option."
It. Would. Be. Illegal. To. Convert. Obamacare. To. A. Single. Payer. Program.
The ONLY way to get to a single payer plan is to repeal Obamacare in its entirety. Why? Because Obamacare preempts any legislation that attempts to amend or fix it to eliminate the exchanges or cut private insurance companies out of the pig trough of our tax dollars.
A national healthcare plan would eliminate private insurance companies, who thanks to Obama now have a suable stake in this. The only way to fix Obamacare is to scrap it. Wish all you like, but the law is the law.
Obama liberals, please stop shrugging your shoulders like toddlers and saying "oh well, now its time for the public option."
It. Would. Be. Illegal. To. Convert. Obamacare. To. A. Single. Payer. Program.
The ONLY way to get to a single payer plan is to repeal Obamacare in its entirety. Why? Because Obamacare preempts any legislation that attempts to amend or fix it to eliminate the exchanges or cut private insurance companies out of the pig trough of our tax dollars.
A national healthcare plan would eliminate private insurance companies, who thanks to Obama now have a suable stake in this. The only way to fix Obamacare is to scrap it. Wish all you like, but the law is the law.
20
This is no "bump". It is the predictable end of a flawed plan. And lost in all of this is the attempt to extort a favorable merger ruling for Aetna from the UDS government (or Aetna would pull out of the ACA, which they are now doing). And why shouldn't Aetna try to shake down Obama and his administration? Obama and his administration have knuckled under to Wall Street and Big Pharma every time they could have (and should have) stood up to them (and for US citizens). Aetna knows they will not be punished in any meaningful way for pulling out of the ACA and since they did not get the favorable merger ruling it demanded, they are in fact, leaving. The Obama administrations refusal to prosecute any Wall Street companies and criminals after the 2008 financial disaster is a decision that will cripple the country and embolden these corporate crooks for years to come.
28
Single=payer here we come. Remove the for profit companies from the system and it will work better at lower cost.
21
Single payer? The government isn't paying its bills now. $20 trillion in debt and growing. The debt service on that is about to swallow the country. Single payer...hahahaha....
12
The govt preventing the merger of big health insurance companies is probably a good thing. The only benefit I can see with a big merger is that the surviving insurer will have too many top executives - which they will have to lop off themselves. This is before the govt comes along and cuts their legs off (public option..).
4
Madame president needs to fight tooth and nail to get health care system improved a couple of steps further as she has promised. And that's regardless of who holds court in the Congress. It didn't stop Obama. No excuses please. Fight for what's right - better health care for all. We're not quite there yet.
7
One of the problems with insurance obtained through the exchanges is that, at least in New York City, where my daughter and her family live, many doctors and some hospitals will not accept insurance from any insurer if purchased through the exchange rather than through an employer. This leaves all independent contractors and workers out in the cold. My daughter, who has a number of long-standing health problems, has had to abandon all the physicians who had previously treated her and knew her case.
21
Because Obamacare was, by design, funded by redistributive tax policy--substantial increases in direct taxes to high wage-earners, in addition to huge subsidies from general tax revenues, are what pay for coverage for low-income people--it depends on continued financial and political support from those required to shoulder the costs of it. This support won't be forthcoming if premiums and deductibles continue to skyrocket ridiculously, while networks of available care providers and hospitals continue to shrink. This whole model of increasingly hitting higher earners directly to subsidize others--which is also entrenched in higher-ed tuition and other markets--has limits, especially when the gross inefficiencies of those markets are so obvious. Instead, deep structural reforms that increase the quality of health care, higher education, and other social goods for as many people as possible, are necessary. These reforms must eliminate huge layers of middlemen--insurance companies in the case of health reform, superfluous administrators in the case of higher ed--to achieve efficiencies that will reduce cost and improve quality.
20
Our healthcare system was a broken mess before the Affordable Care Act. I support healthcare reform, but the ACA has been bad for my family so far. We were on an individual PPO plan before, now we pay a much hugher premium for a terrible HMO. We loat some of our doctors. Our deductible did go down (from $10,000 to $6,000), even though we've been fortunate enough not to have to meet it. We barely don't qualify for any subsidies, and we feel the pain of rising premiums every year.
Considering our premiums rise about 20-30% every year, even when we shop around on the Marketplace, what will our premiums look like ten years from now? At this rate we will be slaves to Blue Cross, turning over half our take home pay to feed this insurance monster. And sick visits aren't even covered, so it's not like we even go to the doctor unless there's a broken bone or a very high fever (104 ).
I just wish our country would adopt a single payer, Medicare for all system and push the insurance companies out of existence. Then, as so many other countries have done and are doing, we could get some kind of control over healthcare costs. It wouldn't be perfect, but it would be darn better than this mess of a system.
Considering our premiums rise about 20-30% every year, even when we shop around on the Marketplace, what will our premiums look like ten years from now? At this rate we will be slaves to Blue Cross, turning over half our take home pay to feed this insurance monster. And sick visits aren't even covered, so it's not like we even go to the doctor unless there's a broken bone or a very high fever (104 ).
I just wish our country would adopt a single payer, Medicare for all system and push the insurance companies out of existence. Then, as so many other countries have done and are doing, we could get some kind of control over healthcare costs. It wouldn't be perfect, but it would be darn better than this mess of a system.
29
It's time for the insurance companies to get their actuarial houses in order, create some reliable high quality plans, and compete with Kaiser and other integrated systems for customers. Lower cost comes from hard bargaining with providers, creating narrow but good networks. Higher revenue comes from assuring customers they can get good care at a decent price. That is what insurance companies should do. The old ways of passing along high costs are killing us.
3
Mr. Krugman, you attribute Ocare with two often repeated successes: increasing the number of insured and controlling costs. Such Democrat hocus-pocus is a great disservice to your readers. There is no evidence that increasing the number of insured has translated to better indigent healthcare. Poor people still obtain their healthcare in emergency rooms, which, anyway, was being provided to them for free before Ocare. Controlling health costs? Effective costs for all other Americans (counting higher deductibles) has skyrocketed. In addition, any basic control of fundamental costs is not attributable government efforts, but instead is the direct result of heightened diligence by the employer-funded healthcare programs. Obamacare is a disaster, and as always, your so-called economic analysis is nothing but pure, political justification....otherwise known as propaganda.
26
In my opinion a couple of things have to happen:
1. The government agreement with the drug companies that the Government cannot shop for the lowest available drug price was simply a fraud on the people of the USA must be rescinded.
2. The agreement that every drug approved by the FDA must be made available to every patient has to be rescinded. The idea that end of life patients (Medicare) are able to have access to $10,000. per month drugs is ridiculous. Most are approved based on keeping the patient alive maybe 3 months longer than otherwise.
3. The medicare system could be used to administer and pay claims that the insurance companies do saving all their huge administrative salaries and 20% profits off the top.
Just some suggestions but as long as the politicians take campaign contributions from the drug and insurance companies the FIX will stay in place. Doesn't really matter which party is in power unfortunately as long as that goes on.
Krugman's idea of a Presidential Executive action would be great but is probably illegal.
1. The government agreement with the drug companies that the Government cannot shop for the lowest available drug price was simply a fraud on the people of the USA must be rescinded.
2. The agreement that every drug approved by the FDA must be made available to every patient has to be rescinded. The idea that end of life patients (Medicare) are able to have access to $10,000. per month drugs is ridiculous. Most are approved based on keeping the patient alive maybe 3 months longer than otherwise.
3. The medicare system could be used to administer and pay claims that the insurance companies do saving all their huge administrative salaries and 20% profits off the top.
Just some suggestions but as long as the politicians take campaign contributions from the drug and insurance companies the FIX will stay in place. Doesn't really matter which party is in power unfortunately as long as that goes on.
Krugman's idea of a Presidential Executive action would be great but is probably illegal.
6
Krugman, I don't know what planet you're on where Obamacare did so much good, but its not where I am. I, a very liberal lower-middle class American working for a major national corporation saw my deductible go from $500 in network/$1000 out of network to $5500 in network/$10,000 out of network.
And my premium went up by $150 a month at the same time. Most of my medical care related to my disability at the Dr I have been seeing suddenly went through the roof, and they are requiring I go to an in network Dr to get a referral to my Dr that Ive been seeing for 12 years, of course they won't pay for it. Nevermind the fact that no matter how much I pay for my care in a year, theres absolutely no way I can make the annual deductible since its so high.
So my medical costs went from about $2600 year + my easy to cover $120/mo premium to about $8000 + $250/mo premium. All told, my medical care is nearly a quarter of my take home pay.
And my story is the most common one I've heard from working/middle class people who have chronic conditions or surprise hospital visits. A friend is paying $550 a month to insure her spouse and 2 kids, with the same garbage plan. She had a medical emergency and walked out of the hospital with a $7500 bill. Sure, less people are uninsured, great. But whats the point if the insurance is all but useless? I cant stand the Republican mindset, except they are right about this one thing. Obamacare took a broken system and broke it even further.
And my premium went up by $150 a month at the same time. Most of my medical care related to my disability at the Dr I have been seeing suddenly went through the roof, and they are requiring I go to an in network Dr to get a referral to my Dr that Ive been seeing for 12 years, of course they won't pay for it. Nevermind the fact that no matter how much I pay for my care in a year, theres absolutely no way I can make the annual deductible since its so high.
So my medical costs went from about $2600 year + my easy to cover $120/mo premium to about $8000 + $250/mo premium. All told, my medical care is nearly a quarter of my take home pay.
And my story is the most common one I've heard from working/middle class people who have chronic conditions or surprise hospital visits. A friend is paying $550 a month to insure her spouse and 2 kids, with the same garbage plan. She had a medical emergency and walked out of the hospital with a $7500 bill. Sure, less people are uninsured, great. But whats the point if the insurance is all but useless? I cant stand the Republican mindset, except they are right about this one thing. Obamacare took a broken system and broke it even further.
44
I actually think that your experience was intended and is common to most of us. By increasing deductibles - the system creates incentives to keep your controllable costs below the deductible level. The effect of the law will help keep total medical costs down - but only by shifting the burden to the taxpayers who make over the minimum subsidized amount - in other words, folks who already had decent insurance. Krugman is a smart guy - he fully appreciated this when the law was being developed.
7
If you are getting employer sponsored health insurance, your ire needs to be directed at the employer.
It was your company's choice to cut your benefits.
I'm an insurance broker. Many companies still offer platinum and gold plans.
It was your company's choice to cut your benefits.
I'm an insurance broker. Many companies still offer platinum and gold plans.
4
In the first place, you're whining about a family of four paying $6600 a year in premiums?
Good grief; the national average family premium is north of $16, 000 a year.
And $7500 for a genuine emergency? Come on, already. That's nothing, compared to what that cost.
Your prob, and hers, is that you're being pennywise and pound foolish. You're underinsured: you're doing what many do, which is to obsess on the premium rather than sitting down rationally and looking at total yearly cost.
AND! You're skipping options. Look at an HSA plan. Look at a good HMO, or other managed care organization.
And for pete's sake, jump on kff.org and read their primers and surveys and analyses. For one thing, these deductible increases have been tending for twenty years.
Good grief; the national average family premium is north of $16, 000 a year.
And $7500 for a genuine emergency? Come on, already. That's nothing, compared to what that cost.
Your prob, and hers, is that you're being pennywise and pound foolish. You're underinsured: you're doing what many do, which is to obsess on the premium rather than sitting down rationally and looking at total yearly cost.
AND! You're skipping options. Look at an HSA plan. Look at a good HMO, or other managed care organization.
And for pete's sake, jump on kff.org and read their primers and surveys and analyses. For one thing, these deductible increases have been tending for twenty years.
4
Hold on - what about the US district court decision by Judge Rosemary Collyer? She ruled in May that the government could not subsidize insurance companies that had enrolled sicker people than anticipated. In the ACA the government was supposed to provide subsidies to those insurers doing business in counties where higher proportions of poorer, sicker folks might cause excessive losses to the insurers. In a lawsuit promoted by our house of representatives, the court ruled against that part of the ACA that would have kept these very insurers in the market. Naturally most of the poor, sick counties are rural and many overwhelmingly white and in red states - so the tea party folks will get their wish when they many lose the first health insurance they ever had.
4
yes, but.
but you leave out an important component of "the fix": removing obstacles to increased competition in the health care services markets. if competing hospitals are allowed to merge, if medicare is prohibited from negotiating drug prices, if generic drugs are delayed from entering the market, if physician groups are allowed to collude--the cost of health care will continue to escalate, so the cost of insurance will increase as well.
yes, a public option would be (and would have been) a major addition to the aca. public pressure during this election campaign and after will be necessary to get to that point. and more editorials from people like you also will be helpful. thank you for this one.
but you leave out an important component of "the fix": removing obstacles to increased competition in the health care services markets. if competing hospitals are allowed to merge, if medicare is prohibited from negotiating drug prices, if generic drugs are delayed from entering the market, if physician groups are allowed to collude--the cost of health care will continue to escalate, so the cost of insurance will increase as well.
yes, a public option would be (and would have been) a major addition to the aca. public pressure during this election campaign and after will be necessary to get to that point. and more editorials from people like you also will be helpful. thank you for this one.
8
Health care is 20% + of our economic output after adding in safety, dentistry, sports industry.
It is justifiable to consider a separate 4th branch of government governing it since it is actually bigger in dollar terms than the rest of government. Moreover, it touches every human in a very tangible way from cradle to grave. Even an entirely healthy person interacts with friends, relatives, co-workers who are not healthy.
It is justifiable to consider a separate 4th branch of government governing it since it is actually bigger in dollar terms than the rest of government. Moreover, it touches every human in a very tangible way from cradle to grave. Even an entirely healthy person interacts with friends, relatives, co-workers who are not healthy.
2
Irony of ironies here--it would be much more politically feasible to get Obamacare fixed, even including a public option, if Trump were elected. Krugman admitted as much, in observing that Republicans wouldn't work with Hillary. But they would with Trump. And he's not the "tear government down" tea-party sort that populates Congress on the Republican side of the aisle these days. He doesn't believe government is necessarily bad. He just thinks he should be running it. He'd love to get credit for fixing Obamacare. It'd be huuuge.
The situation has a historical analogy--the only way the welfare and criminal justice system could be reformed was with Clinton (Bill) as President--which to further the ironies, his wife is being excoriated for now.
So, what's more important to Democrats--electing their cherished icon of the entrenched status quo knowing full well that doing so will doom Obamacare? Or electing Trump and working to get it fixed? If Obama wants to save his legacy, maybe he should start stumping for Trump.
Smart Democrats ought to know that a) there will be no Democratic majority in Congress sufficient to fix Obamacare, and b) electing Hillary will ensure it doesn't get fixed. Are there enough smart Democrats to hold their nose and pull the lever for Trump? Or do they throw Obamacare under the bus?
The situation has a historical analogy--the only way the welfare and criminal justice system could be reformed was with Clinton (Bill) as President--which to further the ironies, his wife is being excoriated for now.
So, what's more important to Democrats--electing their cherished icon of the entrenched status quo knowing full well that doing so will doom Obamacare? Or electing Trump and working to get it fixed? If Obama wants to save his legacy, maybe he should start stumping for Trump.
Smart Democrats ought to know that a) there will be no Democratic majority in Congress sufficient to fix Obamacare, and b) electing Hillary will ensure it doesn't get fixed. Are there enough smart Democrats to hold their nose and pull the lever for Trump? Or do they throw Obamacare under the bus?
15
That assumes that Donald Trump could focus on any issue long enough to actually try to work it through Congress, and that Congressional Republicans would listen to him any more than Hillary Clinton.
Given that Hillary Clinton has already tried to get a national health care system in place, I trust her more to try to make Obamacare work.
Given that Hillary Clinton has already tried to get a national health care system in place, I trust her more to try to make Obamacare work.
16
Let me see if I the logic here.
Krugman has written many times that Trump's policies would bring economic disaster upon us, but since he'll fix Obamacare we'd better vote for him.
We should also vote for Trump because Congress will continue to hold the country's legislative process hostage if Clinton is president.
Do I have that right?
Appeasement is positive feedback. If Republicans in Congress earn a treat for misbehaving, then they'll just continue misbehaving.
Krugman has written many times that Trump's policies would bring economic disaster upon us, but since he'll fix Obamacare we'd better vote for him.
We should also vote for Trump because Congress will continue to hold the country's legislative process hostage if Clinton is president.
Do I have that right?
Appeasement is positive feedback. If Republicans in Congress earn a treat for misbehaving, then they'll just continue misbehaving.
4
Yeah, her attempt went over well, as I recall. But you're right--she'd surely try to get it fixed. Probably about as effectively as she tried to get a national health care system in place to begin with.
Don't complain when Hillary fails again.
Don't complain when Hillary fails again.
5
The for-profit healthcare industry offers absolutely nothing of value to the people of this country. Their sole purpose is to skim profits.
Very often, decisions have to be made on how to maximize these profits.
If a new treatment comes along that would be cheaper and more effective, what does the industry decide?
In far too many cases, the financial rewards are there for those who choose profits over people.
We simply have to get the profit motive out of healthcare.
Very often, decisions have to be made on how to maximize these profits.
If a new treatment comes along that would be cheaper and more effective, what does the industry decide?
In far too many cases, the financial rewards are there for those who choose profits over people.
We simply have to get the profit motive out of healthcare.
31
If a new treatment were to come along that would dissolve cataracts without surgery, what would happen? Would the industry embrace it, or would they fight it somehow?
If a more effective anti-depressant were to come along, would the medical industry feel financially threatened? What would they do?
Who trusts the industry to do the right thing?
This is the dilemma in the for-profit healthcare industry.
In the system that we have today profit is the ultimate goal.
If a more effective anti-depressant were to come along, would the medical industry feel financially threatened? What would they do?
Who trusts the industry to do the right thing?
This is the dilemma in the for-profit healthcare industry.
In the system that we have today profit is the ultimate goal.
17
They'd charge for it. Case in point: the new Hep C drugs work, mirabile dictu.
They also cost $60 grand and up per patient, with some bells and whistles--like several pharma companies eat some or all of the costs, for the small number for whom the drugs don't work within a set period of time.
Why is this okay? Because a liver transplant costs five times that much.
They also cost $60 grand and up per patient, with some bells and whistles--like several pharma companies eat some or all of the costs, for the small number for whom the drugs don't work within a set period of time.
Why is this okay? Because a liver transplant costs five times that much.
6
Forty years ago cataract surgery was difficult, time consuming, and complicated, requiring general anesthesia. Now cataract surgery is done under topical anesthesia in just a few minutes and with outstanding results. Like most posters on this site, you are a liberal idiot who doesn't have any idea what you are talking about.
8
Krugman seems to have missed one factor affecting the cost of private insurance. Our system of empolyer provided health insurance insures a healthier segment of our population plus provides it at a full tax deduction. This is at a substantial cost advantage to the cost of private individual insurance. Eliminating the employer health care tax deduction plus implementing the public option would substantially lower healthcare costs and be more equitable to all. This would have to be implemented incrementally to distribute massive layoffs of insurance company staff, a major present cost of our present healthcare.
3
You must have gone to the same school of economics that this idiot Krugman went to. The cost of health insurance is simply added to all the other costs of hiring an employee. It is cheaper only because employers can negotiate with insurance companies for volume discounts.
Your Marxist hero, Obama, had a veto-proof majority the first two years of his term. He could have easily made Medicare available to all residents with no premiums - single payer health care insurance for all. So why didn't he do it? (Hint: even this dim witted excuse of a president knew that it would be a financial disaster). Again, if "single payer" is so great, why didn't Obama and his veto-proof Congress simply ram that down our throats and get it over with?
Your Marxist hero, Obama, had a veto-proof majority the first two years of his term. He could have easily made Medicare available to all residents with no premiums - single payer health care insurance for all. So why didn't he do it? (Hint: even this dim witted excuse of a president knew that it would be a financial disaster). Again, if "single payer" is so great, why didn't Obama and his veto-proof Congress simply ram that down our throats and get it over with?
13
Prof. Krugman:
thank you for this timely discussion concerning the bad-actors at some of the largest "non-health-care-insurance-companies" in the land.
'tis a bump indeed right-about now ...
if the current-course can-be-stayed through this storm,
and thru the next,
and the one likely to follow that-one,
the result will become a transition to a single-payer system of some type
that may mimic the Swiss at first, and then perhaps to the Norse thereafter,
or even a better-one designed by the progressives in this country.
this nationwide disease of the republican'ts will not be allowed to prevail in the long run.
for we are too strong and too determined for any other result.
now:
if your-discipline could please address how this transition should take place;
in particular:
how to claw-back all of the premiums pre-paid into the "insurance" companies
to prime-the-pump of the replacement program;
perhaps we could expand and accelerate the processes needed for reformation.
your suggestions and comments, please: _______.
Gee whillikers, I get tired of fake lefties cheerfully demanding that we just stick it to insurance companies, and then wipe them out. Especially when they have no idea what this stuff really does cost.
6
May experience with ACA is this. Our base premiums and co-pay rose substantially in 2014. As I went to part-time work in 2015, a generous subsidy of more than $1000 kicked in. The problem is, it phases out quickly, almost all at one, at around $60K combined for my wife and I. (In the Bay Area where we live, $60K doesn't go that far.) It would make more sense to me if it started to phase out more gradually, starting at a lower income level and ending at a higher income level.
"In Aetna’s case there’s reason to believe that there was also another factor: vindictiveness on the part of the insurer after antitrust authorities turned down a proposed merger. That’s an important story, but not central to the broader issue of health reform."
Wow, an economist that doesn't understand the economy of scale. Aetna wanted the merger to ameliorate its bleeding.
Obamacare was designed and intended to do two things, destroy the individual policy market and it has done a bangup job of that, and two bring about an insurance crisis which it is in the process of doing. We should not forget who shoved this mess down our throats. The Democrats own this. Not one Republican vote was made for this. It is possible the most partisan piece of legislation ever passed since the civil war.
The government will be back offering us a solution to the problem they created. It will be single payer government healthcare and it will be worse than ObamaCare.
Wow, an economist that doesn't understand the economy of scale. Aetna wanted the merger to ameliorate its bleeding.
Obamacare was designed and intended to do two things, destroy the individual policy market and it has done a bangup job of that, and two bring about an insurance crisis which it is in the process of doing. We should not forget who shoved this mess down our throats. The Democrats own this. Not one Republican vote was made for this. It is possible the most partisan piece of legislation ever passed since the civil war.
The government will be back offering us a solution to the problem they created. It will be single payer government healthcare and it will be worse than ObamaCare.
11
"It is possible the most partisan piece of legislation ever passed since the civil war"
Actually, this plan was Romneycare, first instituted by republican Mitt Romney in Massachusetts. His plan was based off of the conservative Heritage Foundation plan, which was created as a market based alternative to universal healthcare in the 90s.
Don't let facts get in the way of good extreme partisanship and fact denial though.
Actually, this plan was Romneycare, first instituted by republican Mitt Romney in Massachusetts. His plan was based off of the conservative Heritage Foundation plan, which was created as a market based alternative to universal healthcare in the 90s.
Don't let facts get in the way of good extreme partisanship and fact denial though.
12
Private health insurance had already priced itself out of the market. Only a select few can afford $800 a month or more, per person, for a bare-bones health insurance plan. (That's assuming the insurance company hadn't rejected you for "pre-existing conditions" like hay fever.)
Obamacare was made to provide an alternative for people too "rich" for Medicaid and too "poor" for private plans. In other words, the middle class who didn't happen to get insurance through their employers.
I wouldn't weep much for the insurance companies. They're sitting on literally billions of dollars in reserves, and paying their senior managers small fortunes.
Obamacare was made to provide an alternative for people too "rich" for Medicaid and too "poor" for private plans. In other words, the middle class who didn't happen to get insurance through their employers.
I wouldn't weep much for the insurance companies. They're sitting on literally billions of dollars in reserves, and paying their senior managers small fortunes.
13
"Wow, an economist that doesn't understand the economy of scale."
No, more like an "economist" that doesn't understand the first thing about economics.
No, more like an "economist" that doesn't understand the first thing about economics.
3
Larger subsidies for the private market? I am sure the the elite members of the top 1% tax bracket won't mind paying s little more in taxes! Or maybe reining in executive pay! Might bring those premiums down a bit.
But let us be serious. With swarms of health industry lobbyists, not to mention the Grover Norquist adherents on the hill, most of us realize the futility of these proposals.
But let us be serious. With swarms of health industry lobbyists, not to mention the Grover Norquist adherents on the hill, most of us realize the futility of these proposals.
1
Professor Krugman is correct. As long as the elected leaders get together and agree to spend more money to provide subsidies, Obamacare will work. Just like Princeton can continue to raise tuition as long as the Government will lend an ever-increasing amounts of money to the students.
I would like to offer an investment option for Professor Krugman's retirement plan. Invest your retirement funds in an Obamacare plan. Under the current rules, his return would be capped at 5% (well below the long-term rate of return on most Retirement Plans), but he would have to fund unlimited losses based upon the wishes of our leaders in Washington DC. Would he take that deal? Neither would insurance companies.
The increased, inefficient expenditure of OPM (Other People's Money) is always a solution to those on the receiving end. The ACA blew up an insurance market that wasn't working correctly in the first place. Maybe there are Economists somewhere who can understand this.
I would like to offer an investment option for Professor Krugman's retirement plan. Invest your retirement funds in an Obamacare plan. Under the current rules, his return would be capped at 5% (well below the long-term rate of return on most Retirement Plans), but he would have to fund unlimited losses based upon the wishes of our leaders in Washington DC. Would he take that deal? Neither would insurance companies.
The increased, inefficient expenditure of OPM (Other People's Money) is always a solution to those on the receiving end. The ACA blew up an insurance market that wasn't working correctly in the first place. Maybe there are Economists somewhere who can understand this.
10
Funny how the terminology has changed now that Obama is on the line for those high premiums. Problems are now referred to as "bumps". Before Obamacare, when people couldn't afford their health insurance, it was a dire situation, life and death, in fact.
Now? Just a little blip. All the fault of republicans, naturally.
Now? Just a little blip. All the fault of republicans, naturally.
18
Anyone certainly has the right to criticize Dr. Krugman's use of more gentle language here than he employs to talk, say, about the proposals of austerity hawks. But is that all this is about? Dr. Krugman's semantics? When you don't have any ideas, attack the person, I always say. Not a word in the above comment concerning Dr. Krugman's proposals or what the Republican response to them should be. What should we replace the ACA with that still keeps the number of insured at at least the level it is now? What would Aetna suggest? (Well, I'd go for a public option, but since Congress wouldn't, what would AACNY suggest?) Should we go back to the old system because we think it's a good idea for 20 million more Americans to be uninsured and potentially sick, missing work more often, unable to work or study, bankrupt? We don't want that, do we? I repeat, we don't want that, do we? We don't want more sick Americans just so we can pay lower premiums ourselves and buy other things with that money and Aetna can make more billions by choosing to insure only the healthy, do we? Recognizing that at this point in human development we are not 100% of either, do we want to act more like animals (which we are biologically) competing to see who gets to pass on his/her DNA or the Good Shepherd (whom so many of us claim to revere) sacrificing for others?
2
This would be because compared to what was going on before Obamacare, this really IS just a bump on the road.
You could get on kff.org and read up a little so you'd know what the heck you're talking about, but of course, you won't.
You could get on kff.org and read up a little so you'd know what the heck you're talking about, but of course, you won't.
1
Liberals who go along with the ACA want to judge its success in terms of its ostensible purpose: whether it can provide decent healthcare coverage for everybody. It’s impossible for the ACA to do that, so they are forever discussing which incremental changes might provide a little more coverage for a few more people—until the next election, when we can get a really progressive president, yada..
Meanwhile, the insurance companies focus on what was always the real measure of Obamacare’s success: whether it can provide sufficient profitability. The defection of large insurers means that Obamacare is failing in this, its prime objective. So, the "death spiral" has arrived. It is not—It was never going to be!—the objections of liberal or conservative critics, but the objections, and ultimately the withdrawal, of its founding business partners, that would put an end to Obamacare. The point of the program is to allow the private health insurance companies to make more profits. If they don’t, it fails, in its own real capitalistic (as opposed to its ostensible humanitarian) terms. That day has come.
The inevitability of this failure was inscribed in the ACA's fundamental contradiction: It is impossible to provide universal, affordable, quality healthcare on the condition of satisfying the profit demands of capitalist corporations. The logic of social health and the logic of the market are irreconcilable.
See http://www.thepolemicist.net/2014/01/whos-boss-obamacare-deception.html
Meanwhile, the insurance companies focus on what was always the real measure of Obamacare’s success: whether it can provide sufficient profitability. The defection of large insurers means that Obamacare is failing in this, its prime objective. So, the "death spiral" has arrived. It is not—It was never going to be!—the objections of liberal or conservative critics, but the objections, and ultimately the withdrawal, of its founding business partners, that would put an end to Obamacare. The point of the program is to allow the private health insurance companies to make more profits. If they don’t, it fails, in its own real capitalistic (as opposed to its ostensible humanitarian) terms. That day has come.
The inevitability of this failure was inscribed in the ACA's fundamental contradiction: It is impossible to provide universal, affordable, quality healthcare on the condition of satisfying the profit demands of capitalist corporations. The logic of social health and the logic of the market are irreconcilable.
See http://www.thepolemicist.net/2014/01/whos-boss-obamacare-deception.html
11
Hilary Clinton will be elected and will bring in majorities in both Houses of Congress. This will be a 2-year window of opportunity to fix what is broken in Washington, including the Affordable Care Act.
If the insurance companies are pulling out, then it is an opportunity for the government to step in. The federal government should offer a competitive single-payer plan for people who cannot get private insurance or do not want private insurance.
Ironically, Donald Trump, one of the least capable people that has ever run for President, will be responsible for allowing the enactment of a better universal health insurance system. The disaster of his bigoted candidacy will allow the Democrats to legislate.
So let's not forget to make gerrymandering illegal for Congressional elections.
If the insurance companies are pulling out, then it is an opportunity for the government to step in. The federal government should offer a competitive single-payer plan for people who cannot get private insurance or do not want private insurance.
Ironically, Donald Trump, one of the least capable people that has ever run for President, will be responsible for allowing the enactment of a better universal health insurance system. The disaster of his bigoted candidacy will allow the Democrats to legislate.
So let's not forget to make gerrymandering illegal for Congressional elections.
7
1. Half the prob was and is gerrymandering. The other prob is that us lefties, esepcially younger lefties, just don't show up to vote.
2. You have no earthly idea what a pure single-payer option would cost. Or how difficult it would be politically and structurally.
By the way--pure single payer is very rare. Great Britain has it; Canada does.
They ration care. They limit your networks. And they deal with healthier people.
2. You have no earthly idea what a pure single-payer option would cost. Or how difficult it would be politically and structurally.
By the way--pure single payer is very rare. Great Britain has it; Canada does.
They ration care. They limit your networks. And they deal with healthier people.
4
You do realize, don't you, that Obama had a two year window of opportunity to install government funded universal health insurance. Simple as pie - just offer Medicare to every resident without premiums. So come on, genius, tell us why he didn't do it. Why should we believe it work now when they didn't believe it would work then?
10
The for-profit healthcare industry offers absolutely nothing of value to the people of this country. Their sole purpose is to skim profits.
Very often, decisions have tobe made on how to maximize these profits.
If a bew treatment comes along that would ve cheaper and more effective, what does the industry decide?
In far too many cases, the financial rewards are there for those who choose profits over people.
We simply have to get the profit motive out of health care.
Very often, decisions have tobe made on how to maximize these profits.
If a bew treatment comes along that would ve cheaper and more effective, what does the industry decide?
In far too many cases, the financial rewards are there for those who choose profits over people.
We simply have to get the profit motive out of health care.
8
Here are some of the problems that Krugman says are "easy to fix"
1) The ACA cuts payments to safety net hospitals like the ones in NYC.
"HHC estimates cuts to federal Disproportionate Share Hospital funding will grow from $180 million in fiscal year 2017 to more than $508 million in 2018. The system’s projected losses will grow to $2 billion in 2019 from $1.1 billion in the current fiscal year, according to the state comptroller."
2) The ACA penalized hospitals that care for the poor.
"A new study from Harvard Medical School found that safety-net hospitals that treat many low-income or uninsured individuals are being penalized more for hospital readmission rates than other hospitals."
3) The ACA plans have high deductibles so people avoid health care.
"sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage."
http://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-...
4) The ACA is costs more than expected
"The Office of the Actuary of the Center for Medicare and Medicaid Services has projected that Obamacare will result in an additional $274 billion in administrative costs alone over the period of 2014 through 2022."
Krugman blames republicans for all these problems, but the real issue is Obama rushed poorly written legislation that was only supported by democrats. Once again, Krugman scapegoats instead of searches for solutions.
1) The ACA cuts payments to safety net hospitals like the ones in NYC.
"HHC estimates cuts to federal Disproportionate Share Hospital funding will grow from $180 million in fiscal year 2017 to more than $508 million in 2018. The system’s projected losses will grow to $2 billion in 2019 from $1.1 billion in the current fiscal year, according to the state comptroller."
2) The ACA penalized hospitals that care for the poor.
"A new study from Harvard Medical School found that safety-net hospitals that treat many low-income or uninsured individuals are being penalized more for hospital readmission rates than other hospitals."
3) The ACA plans have high deductibles so people avoid health care.
"sky-high deductibles that are leaving some newly insured feeling nearly as vulnerable as they were before they had coverage."
http://www.nytimes.com/2015/11/15/us/politics/many-say-high-deductibles-...
4) The ACA is costs more than expected
"The Office of the Actuary of the Center for Medicare and Medicaid Services has projected that Obamacare will result in an additional $274 billion in administrative costs alone over the period of 2014 through 2022."
Krugman blames republicans for all these problems, but the real issue is Obama rushed poorly written legislation that was only supported by democrats. Once again, Krugman scapegoats instead of searches for solutions.
24
Well, Obama himself is searching diligently for a solution... on the golf courses of Martha's Vineyard. Krugman, on the other hand, couldn't find his rear end with both hands.
12
Since the ACA has been in effect the problem I've seen is a shortage of doctors and a greater reliance on nurses and medical assistants. I'm not sure if that's to do with cost management, my state's population, increased demand, or if there are less doctors for Medicaid/Medicare patients than private insurance, or all of the above.
The Association for American Medical Colleges has a website lobbying for expanded funding for residency training to handle the increased demand for medical care from an aging population. They are projecting a shortfall in doctors of 90,000 by 2025 and remind us that medical training takes 7 years.
http://www.thedoctorshortage.com/pages/shortage
The Association for American Medical Colleges has a website lobbying for expanded funding for residency training to handle the increased demand for medical care from an aging population. They are projecting a shortfall in doctors of 90,000 by 2025 and remind us that medical training takes 7 years.
http://www.thedoctorshortage.com/pages/shortage
7
This shortage has zero to do with Obamacare, and started back in the 1990s. It also isn't what you're saying it is.
One causal factor: the very high costs of med school, and then malpractice insurance, and the very high rewards for specialization, pushed docs towards...specialization.
Then there's the baby boomer goat in the anaconda, and the aging of the doctors along with it.
The upshot: more elderly patients, fewer general practice docs, which is where the problem is.
It's also why Obama are dumped money into doctor, and physician assistant training.
One causal factor: the very high costs of med school, and then malpractice insurance, and the very high rewards for specialization, pushed docs towards...specialization.
Then there's the baby boomer goat in the anaconda, and the aging of the doctors along with it.
The upshot: more elderly patients, fewer general practice docs, which is where the problem is.
It's also why Obama are dumped money into doctor, and physician assistant training.
3
Play it again, Sam. Another column from Obamacare apologist Paul Krugman propping up this completely disastrous law. What Krugman fails to mention are the devastating compliance costs ACA inflicts on employers with 50 or more employees. The ACA compliance cost end (government rules and regs that employers must implement) is wholly apart from the increasing plan premiums that are forcing companies to reduce plan coverage. To be sure, the compliance costs alone that employers are incurring, dealing with ACA, could easily cover all chronically sick and uninsurable Americans. But leave it to Ivory Tower analysts, like Krugman, who have no experience in real world issues to blame the private sector companies, and not the technocrats that devised this poorly thought-out, calamitous law. Surely, it will only get worse.
24
"To be sure, the compliance costs alone that employers are incurring, dealing with ACA, could easily cover all chronically sick and uninsurable Americans."
Easily?? Please explain. And use actual numbers, facts, studies, etc. I'll wait.
Easily?? Please explain. And use actual numbers, facts, studies, etc. I'll wait.
1
In the first place, you conveniently somhow forgot:
1. That businesses with fewer than 25 employees are completely exempt;
2. That subsidies are available for businesses up to 50 employees;
3. That the penalties don't kick in unless you refuse to offer insurance;
4. That the costs are start-up costs, on paperwork.
You know, these "government overregulation," tirades are darn tiresome, and have been ever since the Civil Rights acts.
Don't want regulation? Stop behaving like jerks.
1. That businesses with fewer than 25 employees are completely exempt;
2. That subsidies are available for businesses up to 50 employees;
3. That the penalties don't kick in unless you refuse to offer insurance;
4. That the costs are start-up costs, on paperwork.
You know, these "government overregulation," tirades are darn tiresome, and have been ever since the Civil Rights acts.
Don't want regulation? Stop behaving like jerks.
5
We are talking billions of dollars companies/employers across the country are paying in the form of attorney fees, soft ware consultants, payroll admin fees to comply with Obamacare rules and possible penalties. As a healthcare consultant for companies, I deal with it every day. It is really unbelievable.
6
The pursuit of affordable healthcare is an exercise in futility as long as one or both arms of congress is in the grips of republicans. The only way the poor can get the coverage they need is in a single-payer, government-run system like the NHS in Britain. As difficult as it is for me to say this, the only person who has the influence over the republican base to push a single payer system is Trump. He seems to have enough political capital to override the republican crony-capitalists in congress. It is crazy because these are a really loud minority who are Trump's supporters think they are a silent majority. How this country became beholden to such a small, radical group of people is a mystery. I must give them credit, they are by far the most politically activated group in America.
2
The poor are already receiving free care which doesn't support your argument for the utopian 100% government run system.
4
The real lesson to be learned is that a major entitlement shouldn’t be rammed down the throat of the country with a majority of the population opposing the law and a political party set against it. The entitlement is now failing, exactly as its detractors predicted. This does not mean that the policy should be doubled down on, but that the obtuse supporters of this failed policy need to show humility and admit their errors. It’s time to end Obamacare and move toward a freer market. The failure of a massive government intervention is not evidence that more government is needed, it proves the opposite.
16
There simply is no such thing as a free market when it comes to health care. The insurance industry has their lobbyists and so do the pharmaceutical companies, medical companies and professional groups. Who is lobbying for patients?
8
Parker: Obamacare was not "Rammed" down the throat of America. It was passed using budget reconciliation because the republicans in congress absolutely hate the idea of an African American President.
What is your source for the statements you through out, like "a majority of the country oppose the law?"
The "entitlement" as you call it, is not failing. the supporters are not "obtuse," and your snide, sarcastic, and totally erroneous choice of words and phrases are devoid of any actual facts.
Your use of the word "Humility" is a word that does not even exist in the the Republican lexicon.
I remember your "free market insurance" where insurer's got to charge whatever they wanted and gouge sick people under the threat of "Pay or Die!"
Obamacare is not a "massive government intervention." it is a health program for all Americans. I fear your Bachelor's degree in hate from Fox News isn't going to bode well for your future.
What is your source for the statements you through out, like "a majority of the country oppose the law?"
The "entitlement" as you call it, is not failing. the supporters are not "obtuse," and your snide, sarcastic, and totally erroneous choice of words and phrases are devoid of any actual facts.
Your use of the word "Humility" is a word that does not even exist in the the Republican lexicon.
I remember your "free market insurance" where insurer's got to charge whatever they wanted and gouge sick people under the threat of "Pay or Die!"
Obamacare is not a "massive government intervention." it is a health program for all Americans. I fear your Bachelor's degree in hate from Fox News isn't going to bode well for your future.
1
"The only thing that makes this hard is the blocking power of politicians who want reform to fail."
Republicans wanted Romneycare to work, when Obamacare was theirs.
The problem is partisanship above all else. Our system itself is sick.
The candidates we've gotten are only some symptoms of that.
Trump could make it work, with help from a Congress that would oppose Hillary doing the same things. That is not because of Trump, it is the sickness.
Republicans wanted Romneycare to work, when Obamacare was theirs.
The problem is partisanship above all else. Our system itself is sick.
The candidates we've gotten are only some symptoms of that.
Trump could make it work, with help from a Congress that would oppose Hillary doing the same things. That is not because of Trump, it is the sickness.
4
Except.
Trump.
Won't.
He's already promised to repeal and to privatize and to deregulate.
Nor has he ever been the sort to gove a damn about--or even so much as notice--anybody who's not rich, unless it's some old lady he's trying to run out of her home.
Trump.
Won't.
He's already promised to repeal and to privatize and to deregulate.
Nor has he ever been the sort to gove a damn about--or even so much as notice--anybody who's not rich, unless it's some old lady he's trying to run out of her home.
2
Trump has vowed to replace Obamacare.
2
More argument for a single-payer system -- or at least the "public option" which Hillary seems to be proposing.
Americans should not be subjected to private health-care providers and pharmaceutical companies whose top priority is to provide maximum return to their stockholders, not their clients.
Americans should not be subjected to private health-care providers and pharmaceutical companies whose top priority is to provide maximum return to their stockholders, not their clients.
13
Many people in this country do not understand anything about health insurance and the ramifications of so many being uninsured. I say this from experience, having worked for thirty years in healthcare. They do not understand the Affordable Care Act and dont try to learn. They dont understand Medicare, Medicaid or their own choices for that matter.
Remember the "Death Squads?"
Guess what? Most of them support Trump.
Remember the "Death Squads?"
Guess what? Most of them support Trump.
7
You condescendingly inform us that we don't "understand anything" about health insurance, but then you refuse to enlighten us. If you understand this so well, why don't you let us in on a little bit of your wisdom? You slur Trump supporters, but you ignore the fact that the program called Obamacare is a miserable failure and you supported it.
7
Before you accept Aetna's claim that they are losing money, we should all check their financial statements and disclosures.
Aetna's CEO just received a pay increase and stock bonuses based on increase share prices of a total of 18 MILLION a year. That doesn't sound like a company in trouble. Stock is up 3 times what it was 4 years ago. Annual financial statements required by SEC and regulated by law indicate the PR statement is a lie since Net Profits have been up almost every quarter.
Corporations are resembling organized crime and protection racket schemes seem to be normal business practices.
Aetna is making money: They just want MORE, MORE, MORE.
Aetna's CEO just received a pay increase and stock bonuses based on increase share prices of a total of 18 MILLION a year. That doesn't sound like a company in trouble. Stock is up 3 times what it was 4 years ago. Annual financial statements required by SEC and regulated by law indicate the PR statement is a lie since Net Profits have been up almost every quarter.
Corporations are resembling organized crime and protection racket schemes seem to be normal business practices.
Aetna is making money: They just want MORE, MORE, MORE.
27
As I understand it, Aetna claims to be losing money on PPACA, and it protecting their owners interests by avoiding losses in that portion of their business. To do otherwise would be foolish. But facts don't have the same emotional effect as your statement, so I don't expect as many thumbs ups.
6
The U.S. needs to get out of the business of having employers pay for health insurance. Why do employers want to continue with this hassle? Why aren't they lobbying for single payer? And with all of that money saved, think of the healthcare we could afford. I had hoped that the ACA would make it easier for people to become entrepreneurs because they wouldn't have to worry about losing the doctors, including the in-network discounts, of their choice. Unfortunately, we're going right back to problems we had before (lack of choice, unaffordable healthcare unless you go to the doctor the insurance company wants you to use). This will stunt the growth of entrepreneurism. Just like other developed countries, we need the equivalent of Medicare (including good PPOs) for all! I know there is a cost, and I would have no issue with paying for the same choices I had a few years ago.
9
Agreed, Helen! Gradually lowering the Medicare age would relieve problems in both employment and health coverage, for everyone.
Re: Aetna trying to sabotage Obamacare because they weren't allowed to buyout Humana. What happened to not negotiating with terrorists?
9
See Iran re: $400 million.
6
My forebears moved here from Canada about 200 years ago. I wonder if Canada will take me back?
I think that the USA will eventually and painfully realize that it needs a public system, but I'm not sure I will live long enough to benefit from it (and I'm not yet Medicare age).
I think that the USA will eventually and painfully realize that it needs a public system, but I'm not sure I will live long enough to benefit from it (and I'm not yet Medicare age).
5
Aetna insurance has declared war on
Americans, with death and suffering of
Americans a real threat.
And partisan Republicans cheer Aetna on.
Don't count on these Republicans to have
your back under any circumstances.
Americans, with death and suffering of
Americans a real threat.
And partisan Republicans cheer Aetna on.
Don't count on these Republicans to have
your back under any circumstances.
5
Krugman admits,
"previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
But couldn't deduce this from the higher death rates among poor Americans? Those statistics are compelling.
The real problem with Obamacare is that it made NO PROVISION for expanding the number of doctors that would be needed to provide expanded coverage. And the cost of that was bound to be significant.
So as a result, "some insurers are simply pulling out of the system."
Of course Krugman blames "vindictiveness on the part of the insurer."
But maybe part of the problem lies with defective economic theorem, which treats resources as unlimited in spite of our living on a finite planet.
US population grew by 36% in the period 1980-2010. The number of positions in medical schools grew at about half that rate. Population growth has exceeded our ability to provide the education for the proportional number of new doctors. So of course there are shortages and health care costs continue to explode.
If we want a safety net that covers ALL of our own poor, we need to stop the exponential increase in the number of poor.
We need to stop illegal immigration. We need to end the hidden incentives in our welfare system that encourage the poor to have children that middle class citizens CAN NO LONGER AFFORD.
Liberals deny finiteness of resources, and declare that those who suggest resources are limited are RACIST.
"previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
But couldn't deduce this from the higher death rates among poor Americans? Those statistics are compelling.
The real problem with Obamacare is that it made NO PROVISION for expanding the number of doctors that would be needed to provide expanded coverage. And the cost of that was bound to be significant.
So as a result, "some insurers are simply pulling out of the system."
Of course Krugman blames "vindictiveness on the part of the insurer."
But maybe part of the problem lies with defective economic theorem, which treats resources as unlimited in spite of our living on a finite planet.
US population grew by 36% in the period 1980-2010. The number of positions in medical schools grew at about half that rate. Population growth has exceeded our ability to provide the education for the proportional number of new doctors. So of course there are shortages and health care costs continue to explode.
If we want a safety net that covers ALL of our own poor, we need to stop the exponential increase in the number of poor.
We need to stop illegal immigration. We need to end the hidden incentives in our welfare system that encourage the poor to have children that middle class citizens CAN NO LONGER AFFORD.
Liberals deny finiteness of resources, and declare that those who suggest resources are limited are RACIST.
15
"If we want a safety net that covers ALL of our own poor, we need to stop the exponential increase in the number of poor."
To do that we need to deport every illegal alien already in the US and stop the influx of Central American and Middle Eastern "refugees".
To do that we need to deport every illegal alien already in the US and stop the influx of Central American and Middle Eastern "refugees".
6
And it's conservatives who fight birth control, Blaise! You want to take away the "welfare incentives" for having children AND, paradoxically, access to the most reliable methods of not having them!
IUDs and hormone implants are long-term and nearly 100% effective, but also cost hundreds of dollars up front. The pill simply does not work for everyone, even when taken on achedule. I remember a time in the '60's and '70's when Republicans like the Bushes were big supporters of birth control and abortion rights for the reasons you mention. That dropped away when they courted the votes of the religious right.
If you think married women should be abstinent along with single women, or that moralizing will overcome the deepest, most powerful instinct underlying human survival over millions of years, stay with the conservative Republicans. If you actually want to give poor people RELIABLE tools to manage their fertility, then join the liberal Democrats.
IUDs and hormone implants are long-term and nearly 100% effective, but also cost hundreds of dollars up front. The pill simply does not work for everyone, even when taken on achedule. I remember a time in the '60's and '70's when Republicans like the Bushes were big supporters of birth control and abortion rights for the reasons you mention. That dropped away when they courted the votes of the religious right.
If you think married women should be abstinent along with single women, or that moralizing will overcome the deepest, most powerful instinct underlying human survival over millions of years, stay with the conservative Republicans. If you actually want to give poor people RELIABLE tools to manage their fertility, then join the liberal Democrats.
3
Bi-partisan cooperation indeed. The Republicans were never invited to the table to discuss the original highly flawed ACA. To ask them to partake of this dog's breakfast of bill now that it is plainly sinking under its own weight is like asking an opponent in a duel if you can use his ammunition, because you wasted yours. The majority of the American public has never approved the ACA . Why revive a mess that deserves to be put away?
15
Simply not true, Bob. You do not get to rewrite history to fit your fiction.
First, "Obamacare" is actually "Romneycare" writ larger. It was a Republican plan from the get-go. They rejected their own plan as soon as it was adopted by a Democratic president who might become popular if it worked.
Second, the Republicans were given numerous invitations to come to the table, but refused because it was more important to damage a Democratic presidency than to help Americans get secure access to health care.
Third, the idea was popular with the public until a targeted campaign by right-wing and libertarian tycoons demonized it for ordinary Anericans. For example, the Kynect exchange was popular in Kentucky with the same people who "hated Obamacare" -- they never realized Kynect WAS Obamacare.
Finally, Obamacare includes a lot of things "approved" by the part of the public who never buy from exchanges -- no lifetime caps, no pre-existing conditions, adult children on policies, and more. However, the idea of extending it to others...yeah, that was a problem. I'm self-employed -- apparently that makes me a freeloader.
If this is a duel, the GOP shot themselves and the American people in both feet, and are now asking for more ammunition to use us for target practice. Obamacare saves lives (or for me, my eyesight). Until YOU have something better to propose, save your breath.
First, "Obamacare" is actually "Romneycare" writ larger. It was a Republican plan from the get-go. They rejected their own plan as soon as it was adopted by a Democratic president who might become popular if it worked.
Second, the Republicans were given numerous invitations to come to the table, but refused because it was more important to damage a Democratic presidency than to help Americans get secure access to health care.
Third, the idea was popular with the public until a targeted campaign by right-wing and libertarian tycoons demonized it for ordinary Anericans. For example, the Kynect exchange was popular in Kentucky with the same people who "hated Obamacare" -- they never realized Kynect WAS Obamacare.
Finally, Obamacare includes a lot of things "approved" by the part of the public who never buy from exchanges -- no lifetime caps, no pre-existing conditions, adult children on policies, and more. However, the idea of extending it to others...yeah, that was a problem. I'm self-employed -- apparently that makes me a freeloader.
If this is a duel, the GOP shot themselves and the American people in both feet, and are now asking for more ammunition to use us for target practice. Obamacare saves lives (or for me, my eyesight). Until YOU have something better to propose, save your breath.
3
The whole thing was a Republican idea. Jeez.
We have to decide whether the health of the country or a few people's profits hold more sway.
To this point, trying to satisfy greedy predators has been our goal.
Maybe it's time to try something different.
To this point, trying to satisfy greedy predators has been our goal.
Maybe it's time to try something different.
9
It's really unfortunate that the Republicans in Congress are cheering stuff like this rather than being upset about all the people who will be affected. If they cared, they might be able to sit down with the Democrats and figure out what needed to be changed in the ACA so stuff like this didn't happen, or to force the insurers not to drop out. Of course, so far as Republicans are concerned, the only revision to the ACA they will accept is the outright repeal. Sad.
3
Strangely, one thing that no one mentions in these debates are how Americans are consuming more healthcare due to ACA. Aetna's loss is due to sick people going to doctors. Think about that for a moment - ACA has enabled sick people to take care of themselves, the same folks who had been thrown under the bus by the profiteering racket. It is a good thing that people are going to their doctors to improve their health.
6
Mr Krugman,
If possible, it would interesting to see a direct comparison between the premiums, deductibles and co-pays that people have to pay through the insurance exchanges under the ACA, and what is being offered through employers to their employees. In one of the comments tagged as a NYTimes Pick, a person who gets insurance through the exchange complains mightily about the high premium, deductible and co-pays they are paying and seems to blame the ACA. However, the numbers are not that different from what we are having to pay to get insurance through our employer, which has nothing directly to do with the ACA (though there is no doubt some cross-contamination on pricing).
If the pricing is similar, I think it would make it clear that the problem is not the fault of the ACA but rather the fault of high healthcare costs generally (particularly for drugs where the profit-taking is out of control) and substantial profit-seeking throughout the industry, including insurance companies. As many have said, the main disappointment with the ACA is that it did not really address the fact that costs are out of control. Why should an EpiPen cost $700 here and $130 in Canada? Why should an MRI cost $1000 here and $300 in France?.
While I support the idea of a public option, even that is doomed to fail unless we address costs head-on first. Don't put the cart before the horse.
If possible, it would interesting to see a direct comparison between the premiums, deductibles and co-pays that people have to pay through the insurance exchanges under the ACA, and what is being offered through employers to their employees. In one of the comments tagged as a NYTimes Pick, a person who gets insurance through the exchange complains mightily about the high premium, deductible and co-pays they are paying and seems to blame the ACA. However, the numbers are not that different from what we are having to pay to get insurance through our employer, which has nothing directly to do with the ACA (though there is no doubt some cross-contamination on pricing).
If the pricing is similar, I think it would make it clear that the problem is not the fault of the ACA but rather the fault of high healthcare costs generally (particularly for drugs where the profit-taking is out of control) and substantial profit-seeking throughout the industry, including insurance companies. As many have said, the main disappointment with the ACA is that it did not really address the fact that costs are out of control. Why should an EpiPen cost $700 here and $130 in Canada? Why should an MRI cost $1000 here and $300 in France?.
While I support the idea of a public option, even that is doomed to fail unless we address costs head-on first. Don't put the cart before the horse.
6
How about a little objectivity? Obamacare and the expansion of Medicaid are two different things. "HHS's 2015 estimate of newly insured, those who have coverage who wouldn't have before the ACA, was 16.4 million." "33 Million Americans Still Don't Have Health Insurance | FiveThirtyEight". Obamacare reduced the number of uninsured by one third.
Single payer which both Obama and Clinton oppose is the only way to get a universal, quality, affordable health care system for this country.
Single payer which both Obama and Clinton oppose is the only way to get a universal, quality, affordable health care system for this country.
2
Most of the newly insured are on Medicaid. Essentially, Obama disrupted everyone's health insurance just to move people onto Medicaid. You have to wonder about the competence of someone who does that.
8
No matter how many good ideas & logical ideas are floated, as long as we have a recalcitrant congress who seems to be invested in making sure any healthcare insurance plan is a failure, nothing is going to happen.
Do all the members have stock in Aetna ?
Aetna appears to behaving like the NRA, including alleged "blackmail".
Do all the members have stock in Aetna ?
Aetna appears to behaving like the NRA, including alleged "blackmail".
4
Change Medicare so that it can be sold to people age 50-64, then use those premiums to help pay claims like a private insurance company. Continue fining adults with no health insurance at least $500/yr. to be taken from their tax refunds and turn that money over to Medicare. This may not be a cure all but it's something.
I like the good Dr's solution - just pour more 'free' government money into it.
I was hoping he might have explored how artificially linking least cost and highest cost option might distort the insurance marketplaces
On the other hand - as a good economist - maybe he thought explaining soviet-era macro management elements of Obamacare were self-evident to all of us.
I was hoping he might have explored how artificially linking least cost and highest cost option might distort the insurance marketplaces
On the other hand - as a good economist - maybe he thought explaining soviet-era macro management elements of Obamacare were self-evident to all of us.
7
Free government money? Hmmm... other countries do it. BTW, it ain't "free government money." The majority of US citizens (but not of Republican senators and representatives, because they're essentially gerrymandered into office even with a majority of voters who vote for Democrats) support single payer. That means they actually recognize that they will have to pay higher taxes to cover it!
Can you believe it? People so unselfish that they're willing to pay more taxes to help themselves and others! I know, for someone with your views, that must seem terrible, even un-American.
Can you believe it? People so unselfish that they're willing to pay more taxes to help themselves and others! I know, for someone with your views, that must seem terrible, even un-American.
2
A bump? Had I saved $2000 per year instead of the promised $2500, I would consider it a bump. My rates went up 30% plus my $250 deductible was raised to $2500 along with my primary care doctor not in my new plan.
The ACA hid the true costs with insurance company subsidies and other accounting gimmicks including delayed tax penalties for four years to get Obama past the second term election. The failures we see now were predicted by many.
This is a problem created by Democrats who passed a deeply flawed law without any Republican votes.
The ACA hid the true costs with insurance company subsidies and other accounting gimmicks including delayed tax penalties for four years to get Obama past the second term election. The failures we see now were predicted by many.
This is a problem created by Democrats who passed a deeply flawed law without any Republican votes.
18
We've lost doctors, plans and now insurers and seen our rates rise.
Democrats like to talk about the "newly insured". Conveniently, they never mention how they basically dumped all over those who had insurance that met their needs.
Democrats like to talk about the "newly insured". Conveniently, they never mention how they basically dumped all over those who had insurance that met their needs.
5
Guess you did it wrong.
I know a couple who hate Obama. But they bought a policy under Obama care, because they could not find such an affordable policy outside it. (They have the money to buy outside ACA.)
I know a couple who hate Obama. But they bought a policy under Obama care, because they could not find such an affordable policy outside it. (They have the money to buy outside ACA.)
1
This is a problem create by Republicans who refused to cooperate in crafting a law that could have worked better AND who refused to expand Medicaid in the states they control.
2
But isn't this The Plan?
The Left's Pavlovian drool over Obamacare continues. Conditioned reflex, facile punditry and picaresque prose that practically writes itself.
I'm surprised the Left doesn't see the hypocrisy—the Left's central demagogic premise is autonomy over one's own body.
The Left must pay closer attention. Barack Obama and his chief health-care policy adviser, Ezekiel Emanuel, have repeatedly told us what the plan is:
"In the Lancet, Jan. 31, 2009, Dr. Emanuel and coauthors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. 'Ultimately, the complete lives system empowers us to decide fairly whom to save. When implemented, it produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest & oldest people get chances that are attenuated.'"
Do you really believe age is Emanuel's only criterion? Will a 68-y-o elite from Chappaqua get that kidney ahead of the 30-y-o nobody from Harlem…or even from Park Slope, for that matter? This is dangerous stuff.
10
Marian, Emanuel has no control over UNOS, the United Network for Organ Sharing, and its criteria for distributing organs. So far as I can tell, the only reason anyone gets a kidney transplant (and I donated, so I learned something about it), is that dialysis is a federal mandate and very expensive, so a working transplant pays for itself in a couple of years. (Assuming the recipient can afford the anti-rejection drugs; at one point, my recipient needed my help to pay for them! This is simply nuts.)
Bodily autonomy is not the same as choosing from an unlimited menu. We already ration scarce resources, essentially by wealth and access to good insurance. Is that morally better than other proposals for allotting care -- or simply different? Are proposals less beneficial to me personally necessarily more immoral? Never xonsidering the question has its own dangers.
PS. Living kidney donation could put an end to the UNOS list. I donated successfully to a coworker 15 years ago, with a minimal match. Any reasonably healthy adult can be screened and probably donate to someone, with about the same recovery as for an appendix removal. The recipient's Insurance covers the costs, except lost work, which enployers may pick up. Call your nearest transplant center -- save a life!
Bodily autonomy is not the same as choosing from an unlimited menu. We already ration scarce resources, essentially by wealth and access to good insurance. Is that morally better than other proposals for allotting care -- or simply different? Are proposals less beneficial to me personally necessarily more immoral? Never xonsidering the question has its own dangers.
PS. Living kidney donation could put an end to the UNOS list. I donated successfully to a coworker 15 years ago, with a minimal match. Any reasonably healthy adult can be screened and probably donate to someone, with about the same recovery as for an appendix removal. The recipient's Insurance covers the costs, except lost work, which enployers may pick up. Call your nearest transplant center -- save a life!
Very true. Elderly Dick Cheney finally got a heart.
1
Certainly no surprises, let alone good ideas, here!
1
Fact: More people who never had coverage now do by subsidies and the public option.
Fact: EVERYONE I know, many previously very pleased with their insurance plans, has experienced significant and major escalations in the cost of their plans and--contrary to what Mr. Obama said--many did NOT get to keep their current health plan.
Fact: Brand name pharmaceuticals (and many generics as well) have seen astronomical pricing changes since Obamacare.
There is NO question that implementing the ACA has been tantamount to categorically taxing many to pay for others, which has contributed in a major way to rising costs of living. I do not blame the insurance companies from pulling out! If you were in that business, wouldn't you?
Fact: EVERYONE I know, many previously very pleased with their insurance plans, has experienced significant and major escalations in the cost of their plans and--contrary to what Mr. Obama said--many did NOT get to keep their current health plan.
Fact: Brand name pharmaceuticals (and many generics as well) have seen astronomical pricing changes since Obamacare.
There is NO question that implementing the ACA has been tantamount to categorically taxing many to pay for others, which has contributed in a major way to rising costs of living. I do not blame the insurance companies from pulling out! If you were in that business, wouldn't you?
12
do you work for aetna? united? You're the only person I know who defends insurance companies in this country other than the insurance companies. let's pray hillary improves the system, not throws it out. it is better but still a disgrace.
3
There is no public option, so your first "fact" is incorrect. Your second "fact" is anecdotal; are these all people who buy insurance privately? who make too much money for subsidies? Who bought "insurance" that barely covered anything before and now have to buy more adequate insurance? Polls have shown that over 85% of people who are enrolled in the ACA are pleased with it. As to your third "fact", it is true that drug prices are rising, but where is the correlation between that fact and the implementation of the ACA? Global temperatures have also been rising during this time. It's hard to know why drug prices are rising--pharmaceutical costs are not--and there is nothing in the ACA which would cause those prices to rise. As to your last statement, I know of nothing that suggests that there has been a "major" rise in the cost of living. Inflation has been virtually flat for years, and wages are starting to rise, albeit modestly. The fact that some insurance companies are pulling out of the ACA is a non-sequitur, anyway. Why would a rise in the cost of living cause them to do so? No, they are pulling out for the reasons Dr. Krugman has stated: the people who are being covered are sicker than were expected, while younger and healthier people are still sitting on the sidelines.
4
And younger and healthier people are sitting on the sidelines precisley because the ObamaCare policies being offered to them are great deals for older, sicker people. But they aren't good deals for young healthy people with no children. The policies are mispriced.
This was all predicted both by conservatives with partisan axes to grind and honest people of any political persuasion who understood how markets work.
This was all predicted both by conservatives with partisan axes to grind and honest people of any political persuasion who understood how markets work.
3
Privatized health, education ,incarceration, water and why not air.
There's nothing the Free Market can't "improve" , with its inverse Midas effect.
There's nothing the Free Market can't "improve" , with its inverse Midas effect.
6
Wrong!
Capitalism distributes wealth in a society upward to the wealthiest: concentrating wealth and increasing inequality. Read Thomas Piketty, "Capital in the Twenty-first Century."
"We can have democracy in this country or we can have great wealth concentrated in the hands of a few, but we can`t have both."
--Supreme Court Justice Louis D. Brandeis
"Poverty is the parent of revolution and crime."
-- Aristotle
The Founding Fathers wanted a more perfect union. Read US Constitution.
Capitalism distributes wealth in a society upward to the wealthiest: concentrating wealth and increasing inequality. Read Thomas Piketty, "Capital in the Twenty-first Century."
"We can have democracy in this country or we can have great wealth concentrated in the hands of a few, but we can`t have both."
--Supreme Court Justice Louis D. Brandeis
"Poverty is the parent of revolution and crime."
-- Aristotle
The Founding Fathers wanted a more perfect union. Read US Constitution.
3
This is real world - We were promised that we could keep our doctors, and for a healthy premium, I was able to do that. But no longer. Now that the ACA is a few years old and the insurance companies in Illinois are all pulling out of covering the good doctors and hospitals for individual and small business plans, there will be no way to be able keep my doctors without paying the super-inflated full price. (When you're out of network, there are no discounts.) Why did this happen? Money promised to the insurance companies through the ACA was never paid by Congress. Assumptions regarding costs were all wrong. And the majority of insurance companies are not interested in giving people what they need/want (think Blue Cross); they're only interested in making money. What really annoys me is that I have no choice. There is now no option at all to keep my doctor. Contrary to what Professor Krugman says, this system is not working for those of us in some states, e.g. Illinois, who once had a decent (super high deductible and expensive) PPO and want to keep it. We need to have good choices and we need Medicare for all!
14
I live in Illinois and I still have the same doctors. I also pay less than I did three years ago and a BIG plus is that I have 90% fewer hassles getting claims paid. So I am quite pleased with ACA plus morally I am happy millions of people now have coverage that did not before. Emergency rooms can now treat emergencies instead or crowded rooms with people who have no other alternatives for medical care. Morally it is disgusting that a nation with our wealth is willing to let the poor go without regular health services.
Since Millionaires controlling Insurance companies are suffering, I suggest we end the misery by letting their companies die or letting them compete with universal health care like medicare whose overhead is about 3% instead of the 20% limit we allow insurance companies to rake off the top.
Since Millionaires controlling Insurance companies are suffering, I suggest we end the misery by letting their companies die or letting them compete with universal health care like medicare whose overhead is about 3% instead of the 20% limit we allow insurance companies to rake off the top.
5
I have the same doctors and my premiums haven't increased nearly as fast as they did before ACA.
1
Obama was the chief "salesman" for the ACA. Like a slick salesman, he had a weak grasp of the facts and was really good at snow jobs. Unfortunately, we, as consumers, had no choice but to buy what he was selling.
By the time the mid-terms came around, it was too late. We could only provide a "shellacking" to Congress.
By the time the mid-terms came around, it was too late. We could only provide a "shellacking" to Congress.
4
The public option was the only real long lasting solution. Allowing insurers to opt out of the system for self interested non Obama Care reasons calls into question the reliability of insurers to stand by the insured. Since the system is set up where yearly renewal is required. After the giant subsidies given to incentivize the insurers to join we have heard the insurance companies complain that they need to exorbitantly raise premiums to be profitable. The problem seems to be that private insurers services are a luxury the US can not afford.
6
By now, any reasonable person should see that the Republicans' scorched earth policy not only is aimed at any and all Democratic initiatives but it also is at the expense of the health and happiness of the very people who comprise much of their party's base. That these unfortunate Americans continue to support candidates and policies not in their best interest is evidence of the destructiveness of the right wing campaign of lies and distortions directed at Secretary Clinton over the last two decades.
13
No Republican voted for ObamaCare. They lost just about every court case they brought against it. The ObamaCare implosion is not because of Republican opposition. It's because of Democratic refusal to understand that incentives matter in the market place. The Democrats own this mess, not the Republicans.
6
Insurance is not a business. It is, and has always been a racket. The purpose of any insurance company is to make a profit for the share holders. Anything it has to do with improving or protecting the public health is an expense that limits profits. So Aetna claims that it has to pullout because too many people are actually sick and it cant make enough profits. Profits come after costs and costs include the enormous salaries and endless bonuses of countless "managers". We are talking about a racketeer that wants to buy another racketeer for $37,000,000,000.00.
It is stunning that human misery and pain can be used as a profit generating opportunity. There are some few doctors, frequently more of an
entrepreneur than a doctor, who feed at this trough, but this issue is 95% an insurance scam thing.
Insuring the Public Health is the public's responsibility. It is not a for profit thing at all. We need to get rid of these pigs who feed at the public's expense and then get all huffy if we try to limit their greed field.
It is stunning that human misery and pain can be used as a profit generating opportunity. There are some few doctors, frequently more of an
entrepreneur than a doctor, who feed at this trough, but this issue is 95% an insurance scam thing.
Insuring the Public Health is the public's responsibility. It is not a for profit thing at all. We need to get rid of these pigs who feed at the public's expense and then get all huffy if we try to limit their greed field.
17
Prof. Krugman,
It saddens me to see you, a stalwart champion of progressive economic policies, turning a blind eye to the extremely unprogressive elements of the ACA. Creating a healthcare market for the exchanges comprising many people who were either too poor to afford insurance, (or working for employers who could not afford to buy insurance), or too sick to find affordable coverage, likely means that the less financially secure among us were expected to subsidize the healthcare costs of a higher needs population. The "solution" to guarantee affordability, high deductible policies, marketed as more "affordable" are a way for healthy people to avoid subsidizing sicker ones, and narrow networks are a means by which providers can lower quality by avoiding competition.
As your former Princeton colleague Uwe Reinhardt, points out, we have been in the process of establishing the rationing of healthcare by income class for some time, https://www.princeton.edu/~reinhard/pdfs/ALTARUM_JULY_2016_XX_7-18-2016.... .
Many people fought mightily to prevent the ACA from changing the trajectory. We are still at a crossroads, and I wish you would use your perch to loudly demand progressive changes and warn of the potential pitfalls.
It saddens me to see you, a stalwart champion of progressive economic policies, turning a blind eye to the extremely unprogressive elements of the ACA. Creating a healthcare market for the exchanges comprising many people who were either too poor to afford insurance, (or working for employers who could not afford to buy insurance), or too sick to find affordable coverage, likely means that the less financially secure among us were expected to subsidize the healthcare costs of a higher needs population. The "solution" to guarantee affordability, high deductible policies, marketed as more "affordable" are a way for healthy people to avoid subsidizing sicker ones, and narrow networks are a means by which providers can lower quality by avoiding competition.
As your former Princeton colleague Uwe Reinhardt, points out, we have been in the process of establishing the rationing of healthcare by income class for some time, https://www.princeton.edu/~reinhard/pdfs/ALTARUM_JULY_2016_XX_7-18-2016.... .
Many people fought mightily to prevent the ACA from changing the trajectory. We are still at a crossroads, and I wish you would use your perch to loudly demand progressive changes and warn of the potential pitfalls.
2
The point here is that the oroblem is eminently fixable--increase the subsidies, look at a public option--except that we're stuck with a yahoo-stuffed Cingress. So, please go vote.
Unfortunately, there are some other probs. First, people are kidding themselves about the Holy Private Insurance market. They don't know its history over the last 20 years, and they don't understand that they want the kind of "boutique," insurance they cannot remotely afford. Oh, and the ignorance of what the PPACA is, goes on forever.
And the single payer folks, all too similarly, have zip idea what Medicare is, let alone what it'd cost. Medicare, boys and girls, a) requires that most pay into it for decades first, b) has premiums of $100-200 a month, minimum, c) has a deductible, d) has co-pays, pharmacy costs, and is an 80/20 plan--you pay 20% of hospital costs.
The single biggest driver of current federal budgets? medicare, until about 2040, when the last of the Boomers croak. New Hampshire tried single payer: couldn't afford it.
Oh, and by the way: at least a third of our costs are driven by our being fat, stressed, sloppy, and demanding.
Unfortunately, there are some other probs. First, people are kidding themselves about the Holy Private Insurance market. They don't know its history over the last 20 years, and they don't understand that they want the kind of "boutique," insurance they cannot remotely afford. Oh, and the ignorance of what the PPACA is, goes on forever.
And the single payer folks, all too similarly, have zip idea what Medicare is, let alone what it'd cost. Medicare, boys and girls, a) requires that most pay into it for decades first, b) has premiums of $100-200 a month, minimum, c) has a deductible, d) has co-pays, pharmacy costs, and is an 80/20 plan--you pay 20% of hospital costs.
The single biggest driver of current federal budgets? medicare, until about 2040, when the last of the Boomers croak. New Hampshire tried single payer: couldn't afford it.
Oh, and by the way: at least a third of our costs are driven by our being fat, stressed, sloppy, and demanding.
3
"fat - stressed - sloppy - demanding"
You left out "arrogant" - then again, on rereading, perhaps you didn't
You left out "arrogant" - then again, on rereading, perhaps you didn't
3
Those are all very astute observations. It's amazing that people don't remember what life was like before the ACA when it was only 3 years ago. The Republicans' position is that it should be jettisoned because it isn't perfect yet can't even come up with a lame idea for a replacement.
Medicare for all isn't practical either IMHO, since, besides the budget busting aspect, there is no way to assess value of services without some market forces and therefore is likely to lead to significant misallocation of resources in a huge, heterogeneous country like ours.
Medicare for all isn't practical either IMHO, since, besides the budget busting aspect, there is no way to assess value of services without some market forces and therefore is likely to lead to significant misallocation of resources in a huge, heterogeneous country like ours.
1
Mr. Krugman seems to forget that the Affordable Care Act was passed by democrats without republican buy-in. The law is starting to break, and now the democrats are asking the republicans to fix their broken bill that they chauvinistically forced on everyone. I want to move to medical savings accounts, and see the Affordable Care Act as a distraction.
14
Misrepresenting history serves no purpose. You make it sound like the democrats rammed through the act without considering alternative views, without having an honest, healthy debate in the Congress. As if. Republicans weren't just opposed to health care reform, they were universally opposed to anything that came out of Obama mouth. They have simply opted out of adult conversation on anything of substance. I'm no fan of Obamacare because it pretends insurance companies are necessary and bring something of value to the table. This is nuts, and I am celebrating the departure of the parasitic Aetna cry babies because this spotlights the need for a public option.
8
Medical savings account may work for those who can save. Bear in mind the vast majority cannot.
2
You seemed to have a defective memory. It's not that the ACA was forced on the Republicans without their input. Obama gave them every opportunity to help fashion it (since it really was a Republican idea from the beginning and pretty much the only reason the public option wasn't included from the beginning is because the Republicans didn't want it) but because after all that they all voted against it in lockstep anyway.
4
Why can't the administration tell insurers like Aetna who pull out of the Obamacare marketplaces that they no longer are eligible to participate in Medicare supplement or advantage plans?
50
Or even the exchange! They didn't fully pull out. They remained in profitable (healthier) counties. So they're taking profits away from other insurance companies that didn't abandon unprofitable counties and would use those profits to offset losses.
3
Bravo to you for explaining the untenable position of millions of Americans under 65. I am in complete agreement.
However, I think it was time to get the job done during the Obama years. Hillary Clinton never wanted to get it done in 1992, because her husband left her to be attacked, and she wilted. She hasn't changed.
Obama has put into place the self-imploding ACA, and it is the fine print which is now killing it. Obama thought that was all he could get. He is almost as spineless as both Clintons.
It may seem counter-intuitive to say, but, if elected, Clinton will never make good on any of health care promises she has made as a result of pressure from the Bern. The same greedy corrupt Republicans now fighting Donald Trump know they stand a better chance to keep the money flowing to their corrupt superPACS if they have Clinton. Donald Trump will fix it without the phony promises..
We have a better chance of getting better and cheaper private health care from Trump than ANYTHING from Clinton. It is another inconvenient truth which is emerging in this long presidential campaign.
Personally I favor national health insurance, but if these greedy republicans keep up their obstreperous behavior despite the entreaties of their presidential candidate, I predict a President Trump will not only kill the ACA but replace it with something much better for the demographic of the under 65 population with health care issues.
I no longer trust Clinton or Obama, at all.
However, I think it was time to get the job done during the Obama years. Hillary Clinton never wanted to get it done in 1992, because her husband left her to be attacked, and she wilted. She hasn't changed.
Obama has put into place the self-imploding ACA, and it is the fine print which is now killing it. Obama thought that was all he could get. He is almost as spineless as both Clintons.
It may seem counter-intuitive to say, but, if elected, Clinton will never make good on any of health care promises she has made as a result of pressure from the Bern. The same greedy corrupt Republicans now fighting Donald Trump know they stand a better chance to keep the money flowing to their corrupt superPACS if they have Clinton. Donald Trump will fix it without the phony promises..
We have a better chance of getting better and cheaper private health care from Trump than ANYTHING from Clinton. It is another inconvenient truth which is emerging in this long presidential campaign.
Personally I favor national health insurance, but if these greedy republicans keep up their obstreperous behavior despite the entreaties of their presidential candidate, I predict a President Trump will not only kill the ACA but replace it with something much better for the demographic of the under 65 population with health care issues.
I no longer trust Clinton or Obama, at all.
3
No matter how we slice it for every uninsured American we will pay 10k per person. they say 12M have no insurance? so 12M X 10K = 120,000,000,000 or 120B per year added to taxes. For every 1M illegal immigrant that is 1B per year added to taxes. So why should the American public as a whole be on the hook for 120B or more per year?
Democrats would let you believe the rich should pay for it, yet how is that fair? Middle class should not have to pay for it so in the end who will pay the 1B per million in extra healthcare costs for people who cant pay,
Democrats would let you believe the rich should pay for it, yet how is that fair? Middle class should not have to pay for it so in the end who will pay the 1B per million in extra healthcare costs for people who cant pay,
6
Where do you get 10k per person? I am insuring 5 in my family, including dental and eye care at 25k without any subsidies. So, the cost should be on the order of 30B per year or less for basic health care for the uninsured. If we control the cost of drugs and other exploding health care costs, we can probably pay for this out of savings (remember waste fraud and abuse?).
Time for an Overhaul from top to bottom. It was a wreck coming out of the gate and everyone and their brother knew it. I'm sure Hillary knows this better than anyone.
8
It seems that Paul Kruman is not above disingenuous quibbling. Quote Krugman today: "More than two and a half years have gone by since the Affordable Care Act, a.k.a. Obamacare, went fully into effect."
Uh, Paul, we note the use of the word "fully", a Clintonesque qualifier to be certain. How about 6-years, the law was enacted on March 23, 2010.
Oh, you mean it took over 3-years to fully implement and only now are you and other pundits grudgingly offering your analysis of this unmitigated policy disaster.
Designed int the ACA law are additional dire consequences that will manifest only after the 2016 elections? Any of those Holiday gifts you would like to opine on now?
Give us all a break, you are turning out to be just another phony balogna.
Uh, Paul, we note the use of the word "fully", a Clintonesque qualifier to be certain. How about 6-years, the law was enacted on March 23, 2010.
Oh, you mean it took over 3-years to fully implement and only now are you and other pundits grudgingly offering your analysis of this unmitigated policy disaster.
Designed int the ACA law are additional dire consequences that will manifest only after the 2016 elections? Any of those Holiday gifts you would like to opine on now?
Give us all a break, you are turning out to be just another phony balogna.
12
@hla3452
Bravo to you for explaining the untenable position of millions of Americans under 65. I am in complete agreement.
However, I think it was time to get the job done during the Obama years. Hillary Clinton never wanted to get it done in 1992, because her husband left her to be attacked, and she wilted. She hasn't changed.
Obama has put into place the self-imploding ACA, and it is the fine print which is now killing it. Obama thought that was all he could get. He is almost as spineless as both Clintons.
It may seem counter-intuitive to say, but, if elected, Clinton will never make good on any of health care promises she has made as a result of pressure from the Bern. The same greedy corrupt Republicans now fighting Donald Trump know they stand a better chance to keep the money flowing to their corrupt superPACS if they have Clinton. Donald Trump will fix it without the phony promises..
We have a better chance of getting better and cheaper private health care from Trump than ANYTHING from Clinton. It is another inconvenient truth which is emerging in this long presidential campaign.
Personally I favor national health insurance, but if these greedy republicans keep up their obstreperous behavior despite the entreaties of their presidential candidate, I predict a President Trump will not only kill the ACA but replace it with something much better for the demographic of the under 65 population with health care issues.
I no longer trust Clinton or Obama, at all.
Bravo to you for explaining the untenable position of millions of Americans under 65. I am in complete agreement.
However, I think it was time to get the job done during the Obama years. Hillary Clinton never wanted to get it done in 1992, because her husband left her to be attacked, and she wilted. She hasn't changed.
Obama has put into place the self-imploding ACA, and it is the fine print which is now killing it. Obama thought that was all he could get. He is almost as spineless as both Clintons.
It may seem counter-intuitive to say, but, if elected, Clinton will never make good on any of health care promises she has made as a result of pressure from the Bern. The same greedy corrupt Republicans now fighting Donald Trump know they stand a better chance to keep the money flowing to their corrupt superPACS if they have Clinton. Donald Trump will fix it without the phony promises..
We have a better chance of getting better and cheaper private health care from Trump than ANYTHING from Clinton. It is another inconvenient truth which is emerging in this long presidential campaign.
Personally I favor national health insurance, but if these greedy republicans keep up their obstreperous behavior despite the entreaties of their presidential candidate, I predict a President Trump will not only kill the ACA but replace it with something much better for the demographic of the under 65 population with health care issues.
I no longer trust Clinton or Obama, at all.
9
Trump is the ultimate profiteer who brags about the millions he made from the Florida housing crash at the expense of thousands of families who lost their homes. It is delusional to think he offers any real hope to the man on the street.
3
I am sick of this mess. Americans are stupid to continue to pay insurance companies and drug companies to rip them off. Thank goodness I finally aged into Medicare but I hate that my children have to suffer. I have encouraged them to find another country just for the healthcare.
16
Health Insurance, corporate hospital systems, and Pharmaceuticals are today's wild, wild, west.
Price gouging at its finest . . . Out of control, no oversight, NO MORALS . . . Only the bottom line counts and those darn analysts on Wall Street that all theses executives seem to be liking up to for affirmation!
Price gouging at its finest . . . Out of control, no oversight, NO MORALS . . . Only the bottom line counts and those darn analysts on Wall Street that all theses executives seem to be liking up to for affirmation!
5
Let's hope your children take you with them when they leave the country.
3
What about the opposition to a single payer system by a timid president who only found his voice when he had nothing to lose. Who's to say that Clinton, the ideal Republican president per Dowd, won't cave to the insurance lobby once (if) she's elected.
10
So right!
1
HRC is 68, so doesn't have much of a reason to try to increase her wealth, and has a historical interest in health care. Insurance lobby doesn't have as much leverage as they did with Obama now that a federal health care system is in place. So, why should she cave?
1
We were lied to about Obamacare:
1. If you like your doctor you can keep your doctor - no, many, many doctors will not accept Obamacare insurance. In fact many doctors are not accepting ANY insurance.
2. You will save $2500 a year for a family - No - premiums went up double digits for the last 3 years. At least $2000 per month in NY
3. There will be more competition, more insurers in the marketplace - No, they are leaving in droves. Only 3 left in the NY marketplace in my zip code
4. Husband and wife small business that previously had cheaper group rates - Gone and no longer allowed. Obamacare architect Dr. Gruber emailed me that he doesn't know why that happened for out of Obamacare private insurance. Well, the state of NY said that there couldn't be a 2 tiered system, so when Obamacare forbid these small groups, NY forbid them too.
5. Redefined what is covered - If you have no condition a test is covered. Once you get that condition - no longer covered?????
No wonder people are disgusted!
1. If you like your doctor you can keep your doctor - no, many, many doctors will not accept Obamacare insurance. In fact many doctors are not accepting ANY insurance.
2. You will save $2500 a year for a family - No - premiums went up double digits for the last 3 years. At least $2000 per month in NY
3. There will be more competition, more insurers in the marketplace - No, they are leaving in droves. Only 3 left in the NY marketplace in my zip code
4. Husband and wife small business that previously had cheaper group rates - Gone and no longer allowed. Obamacare architect Dr. Gruber emailed me that he doesn't know why that happened for out of Obamacare private insurance. Well, the state of NY said that there couldn't be a 2 tiered system, so when Obamacare forbid these small groups, NY forbid them too.
5. Redefined what is covered - If you have no condition a test is covered. Once you get that condition - no longer covered?????
No wonder people are disgusted!
26
Everything you said is an argument for single-payer. Thank you.
6
margherman:
Irrelevant. Obamacare isn't single-payer. Obama lied.
Irrelevant. Obamacare isn't single-payer. Obama lied.
4
The first thing Prof. Krugman doesn't want to admit, and he uses the "more people are insured" sleight of hand to do it, is that health insurance is not health care. You can have health insurance that is too expensive to buy, or, more commonly under the ACA, too expensive to *use* due to high deductibles/copayments. Many more people may have "insurance," but in name only. Increasing subsidies address the symptom, not the cost problem of the system.
The second thing Prof. Krugman doesn't want to admit, and every other civilized country has figured this out, is that the only real solution is to stop treating health care as a market commodity and treat it as a public good. A "public option" is an amorphous construct whose usefulness depends entirely on how it's constructed - considering the Democrats passed the ACA, they would likely construct it to take the sickest, most expensive, and least profitable patients off insurance companies' hands, the public option would then fail financially, and Republicans would point to it as an example of the *wrong* lesson; that public health care didn't work (like the ACA, the problem is it was never attempted.)
The third thing he doesn't want to admit is that the Democratic candidate he backed to the hilt (Hillary Clinton) is the one under whom his political necessities (a wave election to retake the House, or a public mandate) are impossible. She's the 2nd-most disliked candidate ever, behind Trump, and she's running on not being Trump.
The second thing Prof. Krugman doesn't want to admit, and every other civilized country has figured this out, is that the only real solution is to stop treating health care as a market commodity and treat it as a public good. A "public option" is an amorphous construct whose usefulness depends entirely on how it's constructed - considering the Democrats passed the ACA, they would likely construct it to take the sickest, most expensive, and least profitable patients off insurance companies' hands, the public option would then fail financially, and Republicans would point to it as an example of the *wrong* lesson; that public health care didn't work (like the ACA, the problem is it was never attempted.)
The third thing he doesn't want to admit is that the Democratic candidate he backed to the hilt (Hillary Clinton) is the one under whom his political necessities (a wave election to retake the House, or a public mandate) are impossible. She's the 2nd-most disliked candidate ever, behind Trump, and she's running on not being Trump.
10
HRC might talk about a public option to woo genuine liberals and minimize the effect of Stein’s candidacy. Nevertheless—as Dr. Krugman well knows—every time Sanders talked during the primaries about moving toward a single-payer system, HRC disingenuously accused him of attacking Obamacare, indicating that what we have now is the best we can hope to have under an HRC presidency. The corporations have bought and paid for HRC. The idea that she will somehow actually work for a public option (or any meaningful expansion of healthcare reform) is wishful thinking. Again, Dr. Krugman knows this, but since he worked relentlessly to thwart Sanders and relishing scoffing at Sanders’ supporters, he has little choice but to promulgate the fiction that voters can take HRC at her word.
6
Paul Krugman lost credibility long ago. Saying that most of the healthcare news has been good is simply a lie. Since Obamacare's inception, prices have increased even more than before its passage and health care insurance availability has plummeted. Supposedly more people are covered, but they refuse to release figures on how many people joined the exchange(s) after being forced off of the policies they already had and were happy with. Oh... Don't forget the cost of Obamacare is exponentially higher than projected. Obamacare is truly a failure, but Obama, Krugman, and their ilk refuse to admit it.
12
Interestingly the ACA forces those not in Medicaid, Medicare to have insurance or else pay the penalty, which can be steep. But it does not force the Insurers to do their job - provide coverage.
And to make matters worse, there is still a steep residual cost to the insurance buyers in the ever-increasing deductibles and out of pocket maximums. In addition to high premiums (unless one qualifies for subsidies).
Lets hope public option can come through and if it does, it will significantly bring the total cost down.
And to make matters worse, there is still a steep residual cost to the insurance buyers in the ever-increasing deductibles and out of pocket maximums. In addition to high premiums (unless one qualifies for subsidies).
Lets hope public option can come through and if it does, it will significantly bring the total cost down.
1
Calling the out-of-pocket copayments and deductibles a "residual cost" seriously downplays their significance. These are substantial hidden costs associated with Obamacare and ignored by those promoting the lower "cost" of health insurance by focusing on the premium alone. There are also real practical public health issues associated with these upfront costs. Everyone who is sick will ask themselves "is it worth paying the out-of-pocket to go see the doctor for this?". How many people are not seeking treatment and then end up worse off?
5
Totally wrong. Obamacare requires insurers to offer "minimum essential coverage."
https://www.healthcare.gov/glossary/minimum-essential-coverage/
The smartest guy in the room, and his Democrat buddies, designed this mess all by themselves.
https://www.healthcare.gov/glossary/minimum-essential-coverage/
The smartest guy in the room, and his Democrat buddies, designed this mess all by themselves.
6
Vindictiveness? Are we in high school? You've got to do a better job backing up your accusations before I consider that any executives would be willing to risk their corporate earnings, shareholder lawsuits and public shame. We should all keep in mind that it's government agents who can more easily act on a grudge and not pay a price.
10
I don't know what statistics former Enron-advisor Krugman is looking at in making the judgment that medical costs are rising less than expected under ACA. How about asking average Americans how their policy premiums and deductibles are holding up under Obamacare? I dare say most are disgusted with the double-digit percent increases in premiums and much higher deductibles which - despite Obama Admin assertions - are a true cost to the consumer.
7
Not being of the richest .1 percent. I have noticed.
6
Bump is a generous description of the problem - How about Pot Hole.
4
"...all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."
Health care is a right, not a privilege. In the United States, the rights of shareholders come before the rights of people in need of medical care. So much for the most profound statement in the Declaration of Independence.
Health care is a right, not a privilege. In the United States, the rights of shareholders come before the rights of people in need of medical care. So much for the most profound statement in the Declaration of Independence.
4
Health care is a privilege if you are not paying for it and expecting someone else to pay for it. Just looked we have 13.4% of the population or 43M roughly without healthcare. Cost about 9k to 10k per person for the healthcare system. So 430B for those to have healthcare or close to as much as we pay for the DOD budget. How is it fair on the rest of the nation to keep adding these bills to our plate when we are already struggling?
3
We need national health care on a not-for-profit basis- that doesn't mean "free stuff" as most right wingers like to describe it.. We are the most backward nation in the developed world in this regard.
1
Yes, let's offer a public option, so we can punish the insurance companies that have remained in the exchanges. If necessary, let's do it by executive order, so we can make Washington even less divisive and partisan!
If Hillary is such an expert on healthcare policy, let's hope she can come up with common- sense improvements that will get some support from both parties. And maybe try to address the issue of rising health care costs? Eight years ago, I thought that both parties agreed that health costs were a competitive disadvantage for American companies. What happened to that?
If Hillary is such an expert on healthcare policy, let's hope she can come up with common- sense improvements that will get some support from both parties. And maybe try to address the issue of rising health care costs? Eight years ago, I thought that both parties agreed that health costs were a competitive disadvantage for American companies. What happened to that?
2
you would think such a supposedly learned economist as Krugman could see a BASIC fact: Obamacare cannot work. our traditional system of health care cannot work, not for social or political reasons but for economic ones. our health care "system" is one unique in the economy. Every other major sector operates - and controls prices - through fair market competition or, in the case of monopoly or cartel, prices set by regulators. in health care, the major players - providers, hospitals, labs, pharma set the prices they charge with ZERO regard for what their customers can afford. every other industry spends considerable time researching what prices are possible through market analysis. not health care. We have been manipulated for decades now into arguing about WHO will pay the ever increasing prices, not WHY things cost what they do. instead we count on the ionsurance companies to provide an illusiion of competition, which is silly, they are just part of the delivery mechanism. it is like purchasing an very expensive TV online, and blaming UPS for the final price tag when it is delivered. you would think a celebrated economist would see that ANY system that has no competition among the providers and unlimited income will always consume all the funds available.
4
"previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized"
Who is the "we" in this phrase? The we that I belong to was warned over and over again that this was the biggest risk of the ACA. The warnings were clear that either healthy people would have to pay a very high cost to subsidize the newly enrolled unhealthy, or the federal government would have to subsidize (all taxpayers pay), or insurance companies would drop out. The "we" that Krugman belongs to also knew the risks but repeatedly downplayed them to sell the bill to the public. The result should not be a surprise to anyone paying attention. The fact that the American public was lied to should also not be a surprise.
Who is the "we" in this phrase? The we that I belong to was warned over and over again that this was the biggest risk of the ACA. The warnings were clear that either healthy people would have to pay a very high cost to subsidize the newly enrolled unhealthy, or the federal government would have to subsidize (all taxpayers pay), or insurance companies would drop out. The "we" that Krugman belongs to also knew the risks but repeatedly downplayed them to sell the bill to the public. The result should not be a surprise to anyone paying attention. The fact that the American public was lied to should also not be a surprise.
5
I guss it's the European countries that are the truly exceptional countries. They can make good healthcare available and affordable to their pople but we can't. One party, the republicans, are totally in the pocket of the corporate world and the other is partially in their pocket. The people here have to make a decision. Do they want to continue letting corporations run our country? If no, the first thing they have to do is stop electing republicans.
4
Your comments are hilarious. There is a reason we have the best healthcare in the entire world by far. European countries are going broke because of their failed healthcare systems.
3
Really? You know for a fact that this is the (sole?) reason they are going broke? Can't think of any other reasons? Think real hard.
3
Your comments are delusional. Who is this "we"? Those who are wealthy get the best health care, in any country. The non-wealthy buy a lottery ticket or go bankrupt, only in America
3
Mr. Krugman you say, "In Aetna’s case there’s reason to believe that there was also another factor: vindictiveness on the part of the insurer after antitrust authorities turned down a proposed merger. That’s an important story, but not central to the broader issue of health reform."
I totally disagree. Corporations are trying to own America and Aetna is blackmailing authorities to try to create a larger monopoly in the health care field. I would call that THE important story of health care in America as it is today. Power and Profit at all cost.
I totally disagree. Corporations are trying to own America and Aetna is blackmailing authorities to try to create a larger monopoly in the health care field. I would call that THE important story of health care in America as it is today. Power and Profit at all cost.
17
US healthcare costs about $9,500 per person per year. This is an immutable fact. If employers pay for healthcare, this reduces the amount they could pay to persons as salary or interest or dividends. If the government pays for it, they must collect this amount as taxes. In the end, this is the amount that US citizens pay for healthcare either directly or indirectly.
For the average American that pays for healthcare through the ACA you should expect to pay about $9,500 per person per year. If you pay less than that you will not be fully covered
The fundamental problem is that this cost is very large relative to the costs in other developed nations where the average cost is about $5,000 per person per year.
For the average American that pays for healthcare through the ACA you should expect to pay about $9,500 per person per year. If you pay less than that you will not be fully covered
The fundamental problem is that this cost is very large relative to the costs in other developed nations where the average cost is about $5,000 per person per year.
9
thank you for presenting it so clearly. Now if we take into account the fact that 30% of the premiums we pay go to overhead, profit and, yes, fraud, while 3% of the cost of Medicare pays for the overhead and yes, the fraud, we can easily save $2,565 per person in the United States, or $800 Billion per year, by increasing taxes to pay for our medical care instead of paying it to the insurance companies. While it's true that all of those insurance company workers will be out of a job, we have just defined them, and the overpaid executives who run the companies, as non-productive.
Your figures are basically right, but you failed to mention the reason healthcare is cheaper in other countries. We don't want their failing systems.
3
"For the average American that pays for healthcare through the ACA you should expect to pay about $9,500 per person per year. If you pay less than that you will not be fully covered."
You're confusing the average cost of healthcare with the cost of health insurance. Most Americans pay less than $9,500 in health insurance per person per year and are fully covered. Insurance companies can still make a profit because some people have medical expenses less than $9500/year.
You're confusing the average cost of healthcare with the cost of health insurance. Most Americans pay less than $9,500 in health insurance per person per year and are fully covered. Insurance companies can still make a profit because some people have medical expenses less than $9500/year.
1
But wait, who is surprised to learn how sick the American public is? Don't people already know we are among the sickest nations on earth? Didn't the healthcare wonks conduct accurate assessments of how sick the US population is when crafting Obamacare?
Paying subsidies to cover the unforeseen sickness of the American public is government provided public sector healthcare. Ergo, we really need medicare for all, a single-payer healthcare system that is administrated by the US federal government.
Paying subsidies to cover the unforeseen sickness of the American public is government provided public sector healthcare. Ergo, we really need medicare for all, a single-payer healthcare system that is administrated by the US federal government.
6
It looks like retaliation over the elimination of pre-existing injury and thus the coverage-averse litigation, designed, it often seemed, to expand the labyrinth of contractual complexity increasing required to reliably fix the scope contingencies in play.
3
States can save money and ' solve' both health care and crime issues by giving the people involved, and their families, one-way bus tickets to CA, NY, MA etc.. Problems ended for red states!
3
Americans seem to confuse health insurance with health care. They are diametrically opposed. Health insurers only exist to try to deny you coverage, it is the source of their profits.
6
Obamacare was the outcome of a struggle in which Republicans, unable to kill it altogether, decided to give it the worst possible chance of success. If the American people want decent health care -- and heaven knows we collectively pay enough for our population to have it -- they are going to have to vote in a Congress, as well as a President, who actually want it to work for the patients (i.e., all of us), beyond just wanting its giant corporation purveyors and their CEOs to make a lot of money.
7
"Obamacare was the outcome of a struggle in which Republicans, unable to kill it altogether, decided to give it the worst possible chance of success."
Not a single Republican voted for Obamacare or had any input into its design.
Put all the credit on this where it belongs -- Obama and the Democrats.
Not a single Republican voted for Obamacare or had any input into its design.
Put all the credit on this where it belongs -- Obama and the Democrats.
4
Aetna insurance has declared war on American, with death and suffering of Americans a real threat.
And partisan Republicans cheer Aetna on.
Don't count on these Republicans to have your under any circumstances.
And partisan Republicans cheer Aetna on.
Don't count on these Republicans to have your under any circumstances.
6
The fundamental problem is the unfair redistricting of states by whichever party controls the state legislature, most often the GOP. That's why the GOP has been able to block Obama since 2010.
4
Yeah. That darn Democracy gets in the way all the time.
Maybe Obama can issue an executive order and eliminate it.
Maybe Obama can issue an executive order and eliminate it.
5
3 months left Barry
get lots of golf time in
then call the movers for estimates
pack
and leave
get lots of golf time in
then call the movers for estimates
pack
and leave
8
It is a disappointing that an economist does not understand the fatal flaw in the Affordable Care Act: it's the economics!! Let's take a step back and understand that what we are talking about is medical CARE and not medical INSURANCE. Insurance is merely a mechanism, a means of transferring funds between those who pay for the medical CARE and those who receive it. The ACA focused on this go-between and not the underlying medical care systems, its inefficiencies, the over-charging, etc. It also neglects the critical fact that health care is a local business. Every one of the hundreds of metropolitan areas in the U.S. have different competitive environments in terms of hospitals, clinics, physician practices on the one hand and employers, self-employed, government payers, etc. on the other. One size does NOT fit all. We need to get back to a basic tenet of economics: competition. We need to have policies that create competition at the metropolitan area level, that strengthen coordination of care, reduce excess testing, eliminate the gamed system of reimbursements. The ACA would need a major overhaul from the bottom up at the metropolitan level. Single-payer is NOT the answer.
5
"The ACA focused on this go-between and not the underlying medical care systems, its inefficiencies, the over-charging, etc."
Incorrect. ACA is a huge piece of legislation, so it's understandable that you would be ignorant of many of its cost saving and outcome improvement provisions, such as incentives to reduce Medicare Readmissions, incentives to reduce Hospital-Acquired Conditions, Pay-for-Value Programs for Hospitals and Physicians, Bundled Payments, and Accountable Care Organizations.
In fact, as Dr. Krugman has pointed out, since the initiation of ACA, "the growth of health costs has slowed sharply, so that the law is costing both consumers and taxpayers less than expected."
Incorrect. ACA is a huge piece of legislation, so it's understandable that you would be ignorant of many of its cost saving and outcome improvement provisions, such as incentives to reduce Medicare Readmissions, incentives to reduce Hospital-Acquired Conditions, Pay-for-Value Programs for Hospitals and Physicians, Bundled Payments, and Accountable Care Organizations.
In fact, as Dr. Krugman has pointed out, since the initiation of ACA, "the growth of health costs has slowed sharply, so that the law is costing both consumers and taxpayers less than expected."
1
Shareholders's health and people's health are mutually exclusive.
8
Why is it that single payor is impossible but billions of $$$$ of subsidies are not? Why are we subsidizing for profit companies whose main goal is to avoid paying claims and when they are forced to they stomp their feet and say I'm out of here.
Obama's choice of the for profits route and Hillary's embrace of the same make it clear that profits for corporations are their primary focus not health care for unincorporated humans!
Obama's choice of the for profits route and Hillary's embrace of the same make it clear that profits for corporations are their primary focus not health care for unincorporated humans!
6
And the possiblility of getting single payer through a Republican Congress was what??? Even this flawned ACA has been flogged in the courts 19 times. Stop blaming Obama and start looking at Congress who is in the pocket of the insurers. $27.9 million to Aetna's CEO? Criminal. How many could we insure if we cut out the middleman and his bloated exec compensation?
1
"Why is it that single payor is impossible but billions of $$$$ of subsidies are not? "
Um, because the Republicans made it clear back in 2008-2010 that they would filibuster that option during the debate on the bill. As it was, with insurance industry support and Democratic majorities in both houses of Congress, ACA barely passed in 2010.
The Senate *may* revert back to Democratic control in the upcoming election, but it looks extremely unlikely that they will regain the House. So, single payer doesn't look feasible next year.
There's no magic here. You need the votes in Congress.
Um, because the Republicans made it clear back in 2008-2010 that they would filibuster that option during the debate on the bill. As it was, with insurance industry support and Democratic majorities in both houses of Congress, ACA barely passed in 2010.
The Senate *may* revert back to Democratic control in the upcoming election, but it looks extremely unlikely that they will regain the House. So, single payer doesn't look feasible next year.
There's no magic here. You need the votes in Congress.
1
Why do I read Krugman? Because he tackles the difficult problems of the real world and makes clear what is really occurring, in plain, simple, easy-to-understand language. His columns are such a remarkably important resource for those of us who are confused, concerned and worried about what is going on, and how it directly affects all of us. This column, for instance, lays bare the truth about the Affordable Care Act. I find this very reassuring, that we have a man who understands what people want to know. He always seems to clear a path to what is going on in the real world. This is very comforting for those of us who don't comprehend the intricacies of the economic reality of these our times.
4
If the monthly price was cheaper, more healthy people would have insurance. In Texas it's about $300 a month to have healthcare through the marketplace. The only reason that many of us have it is that the government will penalize you for not having it. It's absolute garbage that American citizens are compelled to purchase something -- to pay into a system that you don't regularly use. I'm essentially being forced to waste my money. I could be putting that money into a savings account, so I can buy a home. We should be able to pay doctors directly for services -- as we need them -- and not be forced to interact with a middleman.
2
what happens when you need care but can't afford it? what about preventive care? the list goes on... but it's let your position is both shortsighted and selfish.
1
1. You honestly believe that $300 a month is an extravagant premium.
2. You honestly think you could afford to just pay out of pocket.
Good grief. Just so's ya know, the new Hep C drugs? Which work? Well, they cost $60-$100 grand per patient.
Good luck.
2. You honestly think you could afford to just pay out of pocket.
Good grief. Just so's ya know, the new Hep C drugs? Which work? Well, they cost $60-$100 grand per patient.
Good luck.
If you own a car by law you must have car insurance. Most of the time you don't need it but it's there if you do. Same thing with health insurance. It's protection in the event you need it. Most of us couldn't afford the cost of a catastrophic injury or disease. Further, many people can't afford routine exams, etc. I think it's perfectly reasonable to expect all of us to have health insurance. The ACA was imperfect from the beginning because Republicans wouldn't do anything to advance it - even though, and this can't be stressed enough, the program was based largely on the Massachusetts model which then-Governor Romney helped craft. By the way, if you can afford to, then pay the penalty. Then save the rest of your money for other stuff - but you better be self-insuring in the event that catastrophe occurs...
Another piece of evidence that Single Payer is the way to go--Medicare for all. For-profit insurance companies can't be entrusted with providing health care--they've got to turn a profit, it's why they exist! On the other hand, it's our tax dollars that are involved here. Why spend them on Aetna and their ilk? (And by the way, why elect politicians who are paid for by Big Insurance?)
8
What gets overlooked in these discussions is the fact that providers are consolidating at the local level to avoid competition. Consequently, when insurance companies look to bargain with hospitals and other providers, they have less leverage. I am not disagreeing with Krugman about the necessary fixes, but competition among providers also needs to be maintained by limiting the continuing consolidations of hospitals and other providers.
3
The premium increases are not across the board. They are in the portion of the market place that was supposed to get more private insurance involved rather than relying on the government. Contrary to the willful ignorance spewed from the right, Obamacare at its full implementation will rely more on private insurance than government.
Realizing that the population of uninsured that would enter the market place would be difficult for actuaries to determine rates and therefore many companies would have losses, the ACA set up funds to support the companies until they could set premiums based on good actuary data. The republicans defunded this and of course we see the result.
The increased premiums and increased out of pocket expense we are seeing are the bedrock of republican approach to controlling healthcare costs. Unfortunately for the republicans, people will begin to realize that the private insurance companies like Aetna are proving that they are unable to cover the millions of people who need healthcare but cannot access it until they get government based care. We are headed for a single payer system thanks to the republicans and companies like Aetna (who may have other motives for leaving the marketplace)
Realizing that the population of uninsured that would enter the market place would be difficult for actuaries to determine rates and therefore many companies would have losses, the ACA set up funds to support the companies until they could set premiums based on good actuary data. The republicans defunded this and of course we see the result.
The increased premiums and increased out of pocket expense we are seeing are the bedrock of republican approach to controlling healthcare costs. Unfortunately for the republicans, people will begin to realize that the private insurance companies like Aetna are proving that they are unable to cover the millions of people who need healthcare but cannot access it until they get government based care. We are headed for a single payer system thanks to the republicans and companies like Aetna (who may have other motives for leaving the marketplace)
4
The private health insurers are holding onto their position of control over healthcare in the USA like grim death. While they were handed a monopoly and expanded market by the mandated coverage in the ACA they continue with the assistance of the Republican party as well as Blue Dog Democrats to wring maximum profits out of the system at the expense of healthcare consumers and physicians by reducing their reimbursement rates and narrowing their networks for the cheapest plans or raising premiums for plans with access to a wider network of healthcare providers. Where they can't make the profits they would like they exit the ACA marketplace in effect taking their ball and going home. They can still operate off-exchange. It remains to be seen if a collapse of the Republican party will allow some legislative fixes to the ACA for the future. It's entirely possible their worst nightmare will emerge in the form of first a public option and ultimately, Single Payer.
3
Please explain to me why New York, the state in which you and I both live, and which is reliably blue, does not have its own single payer health care system.
Do we have a situation which is " difficult to resolve even with a knowledgeable, leader if he/she faces scorched-earth opposition from a hostile Congress."
If Democrats spent as much energy working on the problems of the states which they control, as they do bashing Republicans, I am pretty sure my life would be much better and perhaps yours too.
Do we have a situation which is " difficult to resolve even with a knowledgeable, leader if he/she faces scorched-earth opposition from a hostile Congress."
If Democrats spent as much energy working on the problems of the states which they control, as they do bashing Republicans, I am pretty sure my life would be much better and perhaps yours too.
7
Rohit, see the Republican-controlled NY State Senate, which would block the sensible solution you suggest, should it be proposed. But how could this be, after candidates who identified as Democrats were elected to a majority of the State Senate--TWICE?! And twice, enough of them defected and sided with Republicans to build their own personal power and deny the majority needed for progressive action. I can't speak for other states, but in NY, Will Rogers old saying lives on: "I'm not a member of any organized party. I'm a Democrat."
1
NYS has some of the highest Medicaid costs with some of the worst outcomes. It's not exactly a shining example of health care delivery.
3
The public option is in fact a good one but I don't expect to see it in my life time - I am 79. In America it is of the corporation and the well to do, for the corporation and the well to do, and by the corporation and the well to do.
Having failed in their most important effort - to make Obama a one term president, their effort is going to be even worse for a President Clinton who, unlike Obama who has almost no major scandal through his life, comes, unfortunately, with lots of baggages.
Having failed in their most important effort - to make Obama a one term president, their effort is going to be even worse for a President Clinton who, unlike Obama who has almost no major scandal through his life, comes, unfortunately, with lots of baggages.
5
It remains my belief, and I would like to hear PK delve into it, that a successful, single-payer system/universal healthcare is possible for a very big reason: while personal taxes (payroll, probably) would rise to pay for this program, not having insurance premiums cutting into ones monthly budget would more than make up for the higher taxes.
Portions of other existing taxes could also be used to support the program where the poor may not have other options such as payroll taxes/deduction.
Indeed, the current health insurance industry is simply a vehicle for lavish compensation to ravenous executives. Universal healthcare would be a non-profit entity with government executives not dependent on shareholder largess. And since there is already a large workforce (from the insurance industry) ready and able to handle the "paperwork", who understand how the medical providers are paid and how to negotiate fees, recruiting for these professionals would simply be a matter of becoming federal employees rather than private sector.
Perhaps a collection of localized companies whose sole function is to PROCESS the paperwork without providing insurance coverage could speed up payments to medical providers who are concerned about the tardiness of Medicare and Medicaid from the federal government. Healthcare providers may go along with assurances of more timely payments for their services.
The scam of the health insurance industry is: profits before coverage.
Portions of other existing taxes could also be used to support the program where the poor may not have other options such as payroll taxes/deduction.
Indeed, the current health insurance industry is simply a vehicle for lavish compensation to ravenous executives. Universal healthcare would be a non-profit entity with government executives not dependent on shareholder largess. And since there is already a large workforce (from the insurance industry) ready and able to handle the "paperwork", who understand how the medical providers are paid and how to negotiate fees, recruiting for these professionals would simply be a matter of becoming federal employees rather than private sector.
Perhaps a collection of localized companies whose sole function is to PROCESS the paperwork without providing insurance coverage could speed up payments to medical providers who are concerned about the tardiness of Medicare and Medicaid from the federal government. Healthcare providers may go along with assurances of more timely payments for their services.
The scam of the health insurance industry is: profits before coverage.
7
Private, for-profit health care is essentially a pre-existing, corporate condition - i.e., it's always been this way. But as other countries prove, there is no reason that decent health care should be a profit-making enterprise. The care is neither better nor the medical costs cheaper under private enterprise. Republicans will revolt, but as Loomy/Australia has already said, there are bigger issues here than the profits of giant corporations and the salaries of physicians. A great country cares for all its citizens, not just its corporations.
10
You are correct. I go further in saying the for-profit system is amoral. Those involved are making a profit from sick people. It doesn't get much worse than that. Interesting in a country where so many brag about how moral they are because they are "Christians".
2
I agree with PK. In fact the insurance companies and Big Pharma are holding us hostage and have been for 25 years or more. Lower the Medicare eligible age incrementally until everyone is eligible and expand the most effective health care delivery system in the world.
8
Krugman fails to acknowledge that President Obama has raised taxes like no other President before including the massive increase in taxes represented in Obamacare. (Ordinary income moved from 35% to 43.4% and capital gains moved from 15% to 23.8% - this includes a 3.8% healthcare tax under Obamacare). He speaks to the benefit of Obamacare without acknowledging that the massive increase in taxes - $1T in new taxes - has had a negative effect on economic growth in the US resulting in the one of the worst recoveries on record
13
Obama based increased taxes like of other president?
FDR raised taxes to 91% at $400,000 i.n 1935 dollars. Eisenhower convinced Republicans not to cut taxes rates doing his administration.
please be informed and honest.
FDR raised taxes to 91% at $400,000 i.n 1935 dollars. Eisenhower convinced Republicans not to cut taxes rates doing his administration.
please be informed and honest.
3
My taxes weren't raised
1
FDR was a war tax - "grave national danger"
1
I dispute your assertion that Hillary Clinton is competent. Her claims of responsibility for child health insurance are false, the credit goes to Ted Kennedy and Bill Clinton opposed it. Her much touted health care law was so bad it was rejected by a democrat controlled congress. That leaves us with her turn as a hawkish Secretary of State, the bad taste of which is still with us in the form of Libya and Syria and a mishandling of secrets and a pay for play scandal.
To the extent that Obamacare expanded medicaid and insured millions of uninsured who qualify under the expanded income limits it is good. Those who must buy individual policies face high deductibles, high premiums and reduced choices. None of those people have better coverage they have worse coverage - amounting to little more than emergency insurance that only kicks in if you are sick enough to pass the $3,000-6,000 deductible.
The notion that the private insurers were to benefit by millions of new young healthy customers forced into ACA was always a chimera. Obama pushed through ACA on a straight party line vote. In American politics it is always unwise to enact such a large and wide ranging law without bipartisan support. The Democrats now own this mess all by themselves and they should stop whining about an uncooperative congress.
To the extent that Obamacare expanded medicaid and insured millions of uninsured who qualify under the expanded income limits it is good. Those who must buy individual policies face high deductibles, high premiums and reduced choices. None of those people have better coverage they have worse coverage - amounting to little more than emergency insurance that only kicks in if you are sick enough to pass the $3,000-6,000 deductible.
The notion that the private insurers were to benefit by millions of new young healthy customers forced into ACA was always a chimera. Obama pushed through ACA on a straight party line vote. In American politics it is always unwise to enact such a large and wide ranging law without bipartisan support. The Democrats now own this mess all by themselves and they should stop whining about an uncooperative congress.
9
Single payer is the answer. Everyone needs to pay 75% of their pay to the government and hope that they will receive something in return. Hopefully the waste, fraud, corruption and greed in government will leave enough for you to see a doctor. Hone fully they will have enough to fund a network of doctors.
4
During Florida governor Rick Scott’s prior tenure as CEO of Columbia/HCA about a decade ago, the hospital company was fined $1.7 billion for Medicare fraud.
It is private enterprise and Republicans that defraud Americans.
It is private enterprise and Republicans that defraud Americans.
2
All that was missing from this propaganda piece was "It's Bush's fault."
22
Well, it's not his fault. And that's why Krugman didn't say it. Things that claim are true you have evidence-based reasoning for. When the facts change, you acknowledge that. See, that's how things work in reality over here.
1
Now that the exact things that Republicans warned about from the beginning with Obamacare are coming to pass, liberalism's most dishonest defender is first in line to utter "No big deal."
17
Actually we have records of the things republicans warned about. They said it would destroy job creation, but we've had record job growth and 4.9% unemployment. They said no one would sign up, but millions in fact have. They said the costs would skyrocket, but they've actually come in less than expected. They said it would blow up the deficit, but the deficit has gone down over 60% under Obama from the record set by Bush. They said it would create "death panels", but unsurprisingly that conspiracy theory never manifested itself in the real world. They said it would be a government takeover of the healthcare system, but in reality it's been a bunch of private insurers organized around a reasonable government maintained marketplace with some smart, long wanted regulations. They said it would cause everyone to be forced into part time work, but the preexisting trend in part time work has not changed at all since the law's implementation.
If you guys get every single thing wrong for so many years, why should anyone listen to you now? Especially when you're not suggesting a single solution.
If you guys get every single thing wrong for so many years, why should anyone listen to you now? Especially when you're not suggesting a single solution.
20
It's "no big deal" because "yes, we can!" Now kindly get the cuff out of the way.
1
"...there’s nothing wrong with Obamacare that couldn’t be fairly easily fixed with a bit of bipartisan cooperation." Good one, Paul! Remembering Rodney King: "Can we all get along?" Apparently, the answer was "no." So if we can just get the Republicans to "cut it out!" we'll be fine. Let's go to them and say "Basta! Enough!" Here's a challenge: Name *any* problem in the USA that couldn't be "fairly easily fixed with a bit of bipartisan cooperation" and a pinch of decency and respect for the American people. The deeper problem is class conflict, and it isn't going away.
12
Why is creating a public option the only way to fix the problem? If it's because the government is better at providing affordable insurance than the market is, then Krugman should advocate for single payer. If there's an important role for the market to play here (and not just that the insurance companies are too powerful to oppose politically), then Krugman should explain why the government needs to step in to meet this need.
14
Because private insururers haven't and aren't meeting the need.
11
When the Democrats get the House and the Senate Obamacare rules get written to squish corporate health insurance.
1
Risk pools. Ideally, you want everyone in the same risk pool and you dilute the the effect of those that need expensive and/or constant medical attention, we know this works because it works in Europe. Theoretically, it is the basis of insurance. Not complicated. Republicans are opposed to one risk pool because their goal is to exclude sick people from the pools and, thus, from the health care system. By excluding the sick you maximize profit because you only have money coming in, not going out. Republicans don't want a health care system (except for themselves and their family, of course) they want a money generating system for the private sector through insuring healthy people
2
People who are not on Medicare have an overly rosy picture of how wonderful it is. The reality is that "traditional" Medicare, which used to be an "indemnity" plan, as opposed to Medicare Advantage, is actually an HMO plan. Medicare routinely refuses to pay for routine treatments and tests. Adding insult to injury, there is no mechanism to find out why a claim was denied, other than opaque boilerplate like "medical necessity." The allow/deny process is performed by for-profit contractors, and there is no mechanism to communicate with them, other than filing a formal appeal, which one has to do without knowing exactly why a claim was denied. There is no way to determine in advance whether a test or procedure will be covered. Medicare's customer service organization is as useless as tech support in Bangalore. With private insurers, ultimately it is possible to communicate with decision makers, though not necessarily easy, and insurers can be swayed for example by worrying about bad publicity, something Medicare bureaucrats couldn't care less about.
So, for those of you wanting "Medicare For All," be careful what you wish for. The US is not France or the UK.
So, for those of you wanting "Medicare For All," be careful what you wish for. The US is not France or the UK.
8
I have just hit age 65, and my own experience is that it is almost impossible for a person to know what is going to be covered or not covered. The current Medicare system, is not working well.
1
No, this is the United States and it has three systems as Mr. Krugman has explained in the past. The VA is much like the system in the UK and Medicare is much like the system in Germany. So , let's be like Germany. Seems to be working just fine there.
This guy Krugman is a "dreamer" if he thinks Obamacare needs "just a quick fix".
Let's all start an insurance company business that offers "coverage" for people after the auto accident or house fire. Nobody can be turned away as a customer.
And after the claims are paid the customer opts out for coverage until the next accident or fire.
This scenario is Obamacare explained 101.
Let's all start an insurance company business that offers "coverage" for people after the auto accident or house fire. Nobody can be turned away as a customer.
And after the claims are paid the customer opts out for coverage until the next accident or fire.
This scenario is Obamacare explained 101.
14
With Aetna's retreat, isn't it time to finally ask the question: what is the role of insurance companies and what value do they add to the supply chain? I think part of that answer is obvious: they are intermediary cost centers that offer no real value in delivering actual health care services to consumers. If given the mandate to cover all people (including those with pre-existing conditions), the majority of them are unable to deliver a viable business model. For those who believe the free-market is the ultimate judge, the market has spoken: insurance companies have nothing to offer. If they can't make enough money to pay for their stadium naming rights and exorbitant executive pay, they're out. Hopefully this will now move us toward some form of a nationwide public option - a system that doesn't have to fund bloated intermediaries through high co-pays, premiums and deductibles, and one that more closely resembles that of every other developed country, with per-person health care costs that are half of what we have now.
59
And of course the government worshiping "progressives" would love to eliminate all of these evil for-profit insurance companies and replace them with a government bureaucracy that would allow them to add even more useless, parasitic, self serving, bureaucratic vermin to the millions that already infest every level of government. Even the government loving NYTs has said on numerous occasions that "government is always inefficient and usually corrupt" so why would anyone want more government?
5
Yes, please. As the evidence shows, market-based approaches leave millions uninsured and overcharge the rest of us, where as single-payer leaves those corporate profits in the tax payers' pockets'. Posing a rhetorical question based on a fake quote doesn't pass muster anymore. Go away.
5
Because the health insurance companies are more parasitic, self-serving, and corrupt than the government--which is the heart of the problem.
Obamacare helps those who were uninsured the most. Sure, it isn't perfect but it's far better than being uninsured and being petrified of getting sick and not being able to afford care.
11
Yes, Obamacare helped the uninsured. The problem is how it mistreated those who were already insured -- a much larger number. For these people, doctors, policies and affordability are all critical success factors for health insurance satisfaction. Obama managed to mess them ALL up.
Using uninsured statistics while ignoring the impact on the already insured is deceptive advertising on the part of Obamacare cheerleaders.
Using uninsured statistics while ignoring the impact on the already insured is deceptive advertising on the part of Obamacare cheerleaders.
3
I supported the ACA and begged my congressman to vote for it, which he did and then promptly got defeated in his 2010 reelection bid. Now I don't go to the doctor because I have no idea how much it's going to cost, as I have a deductible that's about 3 times as much as I used to spend on health care in a year - plus the multi-hundred-dollars monthly insurance payment, of course.
I sometimes wonder why I keep voting for Democrats who always seem to turn around and gut-punch me afterward. Then I look at the Republicans and remember why. Then I look at Bernie and wonder why Democrats gut-punched him and his supporters so viciously. Then I look at Wall Street and remember why. Then I start over. It's a vicious cycle.
I sometimes wonder why I keep voting for Democrats who always seem to turn around and gut-punch me afterward. Then I look at the Republicans and remember why. Then I look at Bernie and wonder why Democrats gut-punched him and his supporters so viciously. Then I look at Wall Street and remember why. Then I start over. It's a vicious cycle.
41
Two things. Those plans would still cost more, probably much more, without ACA and people with pre-existing conditions would be uninsured.
The answer is the public option. But if we can't get even that passed why is anyone thinking we could get more? That's so illogical to me.
Also, on another level, if we think even that won't solve it....if the insurance companies play games like this, then they also make the argument for universal health care much, much easier. Because then they prove that in fact they can't do it better than the government. We've tried it their way. But first we have to do that.
The answer is the public option. But if we can't get even that passed why is anyone thinking we could get more? That's so illogical to me.
Also, on another level, if we think even that won't solve it....if the insurance companies play games like this, then they also make the argument for universal health care much, much easier. Because then they prove that in fact they can't do it better than the government. We've tried it their way. But first we have to do that.
10
Your congressman voted for ACA, as you requested. Then he was defeated in the next election, presumably by a Republican in a scorched earth campaign promising to repeal Obamacare. Then the private insurer raises rates and manipulates coverage so that you are paying more for less. Yet you blame Democrats for that! Don't the Republicans have anything to do with this mess? How about the psycho-billionaires who finance the messaging and sponsor the politicians who do their bidding? How about your friends and neighbors, who watch Fox News all day and buy into the rightwing propaganda? Finally, how about your own actions? Did you, like so many independents and fair-weather Democrats, sit on your hands while the rightwing political machine went full-bore after every Democratic candidate on the ballot in 2010 and later?
1
Counting the numbers of people who are insured has been the US a false sense of accomplishment. Many of the plans are extremely expensive and have high deductibles. If you are older and don't have insurance through you job the plans are impossibly expensive. The ACA is a failure, since it hasn't made healthcare more affordable. Insurance isn't healthcare.
11
'Back in the day,' being a physician was 'a calling', a passion, and being a physician was who and what you were.
Today it is none of those things. Ask a physician if they are happy and what their job satisfaction is and you will not be happy with their answers.
To paraphrase: When the doctors are not happy, ain't no one gonna be happy (or as healthy as they could be.)
Today it is none of those things. Ask a physician if they are happy and what their job satisfaction is and you will not be happy with their answers.
To paraphrase: When the doctors are not happy, ain't no one gonna be happy (or as healthy as they could be.)
7
Clinton isn't campaigning for Obamacare. The election is not a referendum on Obamacare. Even Obama in 2012 didn't center his campaign on his major achievement, Obamacare. He played defense. Clinton plays defense. She attacked Bernie Sanders for playing offense. You don't have to adopt Bernie's single payer, medicare for all to defend Obamacare. Just close your debate with, if you want to keep Obamacare, vote for me, if you trust Trump instead with your healthcare, vote for him. There are no congressman doing that either. The first and last one who did was Harris Wofford in Pa 1991. Bill Clinton observed the effect and picked up the issue as a very important component of his candidacy. Then he handed it to Hillary, and vastly underestimated the challenge.
Hillary and congress could win in a landslide and have a mandate to do what? Nothing. The campaign is a referendum on Trump, no substantive issues need apply. A semi-competent, somewhat tainted, Wall Street friendly, center left woman running for president without clear goals, and suspect priorities. Bent left to deal with Sanders insurgency. Her financial transaction tax, changes in capital gains are actually favored by hedge funds, though the will take a hit from carried interest, but what's 10% more of income in taxes when you're making a billion.
Hillary and congress could win in a landslide and have a mandate to do what? Nothing. The campaign is a referendum on Trump, no substantive issues need apply. A semi-competent, somewhat tainted, Wall Street friendly, center left woman running for president without clear goals, and suspect priorities. Bent left to deal with Sanders insurgency. Her financial transaction tax, changes in capital gains are actually favored by hedge funds, though the will take a hit from carried interest, but what's 10% more of income in taxes when you're making a billion.
4
Campaign promises and governing are very different things. I respect that Clinton has toned down the promises
2
Obamacare works for Paul Krugman because he'll never have to use it.
Everyone else should go read the very revealing comments attached to Margot Sanger-Katz' piece titled "Think Your Obamacare Plan Will Be Like Employer Coverage? Think Again" on this site. You'll meet plenty of people for whom Obamacare has been a disaster. That number will only grow.
Krugman is past the point where he can be an honest voice on this. He's too all-in, and too arrogant to ever admit he was wrong.
Everyone else should go read the very revealing comments attached to Margot Sanger-Katz' piece titled "Think Your Obamacare Plan Will Be Like Employer Coverage? Think Again" on this site. You'll meet plenty of people for whom Obamacare has been a disaster. That number will only grow.
Krugman is past the point where he can be an honest voice on this. He's too all-in, and too arrogant to ever admit he was wrong.
14
Compared to no coverage at all? OK, Obamacare isn't perfect, it isn't even Medicare. But to say that Obamacare is worse than no coverage at all because, well, hospitals still have to treat you and will then write off the bills when you don't pay them, is no complaint at all. It in fact, is pure fantasy.
5
Just remember that if you have insurance, the company negotiates a rate that is sometimes 1/3 of the "real" rate for service. So, if you have insurance, even if you have to pay, you're paying the negotiated rate and not the "real" rate. Paying the negotiated rate before my deductible was met has meant paying about $700 instead of $2400. And that's just in the last six months. Let's reform insurance companies... Oh wait, that won't happen either.
1
It was far worse before Obamacre. That's what you forget and the premiums were skyrocketing each year.
1
What is left unsaid in this piece is the price of co-pays and deductibles, not to mention the narrow networks of low rated physicians that are the true gouge of Obamacare. While I am grateful for the abolition of denial for pre-existing conditions and lifetime caps, Obamacare without the subsidies is a terrible deal. $6,000 a year in premiums plus another $6,000 in deductibles for a healthy person is outrageous. $100 co-pay just to see the doctor not to mention the follow-up for another $100? I go to the doctor less now than before Obamacare because I can't afford to be sick. Whatever it is, public option or medicare for all, if my premium goes up any faster (doubled in two years) I'll just stop carrying insurance all together. And by the way, I live in CA where Covered CA, the organization that runs the exchange actively campaigned against a ballot proposition that would have allowed the CA Insurance Commissioner to deny exorbitant rate hikes. So no, CA is not doing better. Bending over backwards to please the insurers, yes.
12
How much more did you go to the doctor before the ACA? And how much did you pay? Meaningless without comparisons. Did you recently lose a job that carried health insurance? Also, why would low rated doctors be gouging the ACA, as compared to the rest? Please try to be clearer.
1
I went to the doctor when I was sick. Now I wait and hope it clears up. I have a chronic condition I cannot treat because I cannot afford to go to the doctor repeatedly and pay for tests. It isn't going to kill me but makes my dad to day existence extremely uncomfortable. My deductible was $30 before Obamacare. I have always paid for my own policies and never had employer coverage. My premium was $275 a month for a policy that allowed for more coverage at lower rates before Obamacare than now. Satisfied?
5
It seems clear that before the opportunity passes, Hillary Clinton should explain the problem and ask for a mandate and the Congress that will help to fix it. Without a Congress willing to do its job, we will fail in providing a health care system worthy of our country.
4
For all of you who like beating up the insurance companies for wanting to earn profits:
An insurance company's primary aim, like all other publicly held corporations, is to make money for their owners. If they cannot do that, they should (and will) go out of business.
Just about anyone with a pension or 401K owns some shares of these companies (union members, listen up!)
As far as a Single Payer Option goes: be aware that not all doctors or hospitals accept Medicare or Medicaid insurance.
It will be the same with a Single payer option.
Wait times will go up.
Oh, and if the President promises you that won't happen, just remember when he promised "if you like your doctor, you can keep your doctor".
Be careful what you wish for, you might get it.
An insurance company's primary aim, like all other publicly held corporations, is to make money for their owners. If they cannot do that, they should (and will) go out of business.
Just about anyone with a pension or 401K owns some shares of these companies (union members, listen up!)
As far as a Single Payer Option goes: be aware that not all doctors or hospitals accept Medicare or Medicaid insurance.
It will be the same with a Single payer option.
Wait times will go up.
Oh, and if the President promises you that won't happen, just remember when he promised "if you like your doctor, you can keep your doctor".
Be careful what you wish for, you might get it.
5
as you accurately point out, the goal of insurance companies is to make profits for their owners/ investors. and that goal is antithetical to the individuals who buy their policies for the purpose of protecting their health. you have made the perfect argument not only for a single-payer system but also for a National Health Service.
7
Medical insurance companies are financial leeches. They serve no purpose. They move money around and rake off a share, money that should go directly to medical personnel, not to individual capitalists' bank accounts.
Medicare for all!
Medicare for all!
17
Most doctors do accept Medicare and most will accept single-payer because that'll be the main insurance available. Most people aren't rich enough to pay out of pocket.
I'm willing to wait a little longer considering the price of single payer is about 1/3rd cheaper. No more co-pays, premiums, in and out of network, co-insurance, etc is worth it.
I'm willing to wait a little longer considering the price of single payer is about 1/3rd cheaper. No more co-pays, premiums, in and out of network, co-insurance, etc is worth it.
7
As a self employed person I understood and thought it was a good idea.
Now, I find my healthy wife and I, with few bad habits, have had our insurance rates triple and access to the wide network of providers we were able and willing to pay for , no longer available.
You may think it's great, but the little guy that has always been responsible and taken care of himself has been given the short end of the stick.
Now, I find my healthy wife and I, with few bad habits, have had our insurance rates triple and access to the wide network of providers we were able and willing to pay for , no longer available.
You may think it's great, but the little guy that has always been responsible and taken care of himself has been given the short end of the stick.
9
How shameful that we don't have great healthcare for everyone like other western countries. Healthcare should not be "for profit" anymore than the prison system. How sad that the lobbies have so much influence.
22
"Healthcare should not be "for profit" anymore than the prison system. "
For the government worshiping "progressives", everything should be run by their great god government and all of the useless, parasitic, self-serving, political connected bureaucrats that infest it.
For the government worshiping "progressives", everything should be run by their great god government and all of the useless, parasitic, self-serving, political connected bureaucrats that infest it.
3
No. This isn't complicated Charles. If the consumer can walk away from the purchase, capitalism is the way to go. If the consumer can't walk away, socialism is the way to go. You can have both in the same society as evidenced by the Europeans.
2
Charles,
Have you had healthcare overseas? I've had healthcare in many different countries and it's cheaper and better than the US, for most people. We're ranked 37th in the world except for the top 3% who don't care what they pay. We spend 2.5 times as much as most countries because the US system is for profit. There is very little bureaucracy in a single payer system. The US system killed my wife in 2 months and 10 days when she probably would have had 2 or 3 years in Australia or many European countries.
Have you had healthcare overseas? I've had healthcare in many different countries and it's cheaper and better than the US, for most people. We're ranked 37th in the world except for the top 3% who don't care what they pay. We spend 2.5 times as much as most countries because the US system is for profit. There is very little bureaucracy in a single payer system. The US system killed my wife in 2 months and 10 days when she probably would have had 2 or 3 years in Australia or many European countries.
Corporate health insurers participating in ACA are private operators in a social insurance scheme. There would not be a problem with that if they were simply paid a fee for administrative services, although such services would appear largely redundant. But that is not how it's done.
Insurers get to keep whatever is left in a risk pool after medical costs are paid. That gives them an incentive to do whatever they can to avoid paying for medical costs while charging as much as they can get for insurance. That led to all kinds of gaming and obfuscation in the past. ACA eliminated a lot of that, and with it, insurer's profits.
The business model of for-profit insurance is at cross purposes with the purpose of medical care, which is to deliver high quality care to every participant who needs it and preventive services to the rest at the lowest possible cost. Insurers do have valuable roles to play in society, but participating in the health delivery system isn't one of them. I think we all knew that the days of private health insurance in ACA were numbered when we passed it.
Insurers get to keep whatever is left in a risk pool after medical costs are paid. That gives them an incentive to do whatever they can to avoid paying for medical costs while charging as much as they can get for insurance. That led to all kinds of gaming and obfuscation in the past. ACA eliminated a lot of that, and with it, insurer's profits.
The business model of for-profit insurance is at cross purposes with the purpose of medical care, which is to deliver high quality care to every participant who needs it and preventive services to the rest at the lowest possible cost. Insurers do have valuable roles to play in society, but participating in the health delivery system isn't one of them. I think we all knew that the days of private health insurance in ACA were numbered when we passed it.
26
Someone else that gets it! One of the roles that the ACA has played is to show how inefficient and, thus, unnecessary private insurers are. The funny thing is how Aetna and the other big opt out insurers are exposing themselves and contributing to their own demise. They would be smarter to eat the extra costs from the ACA plans and keep their seat at the table long term.
I go to virtually any doctor, pull out my green Carte Vitale -- the French social security card -- pay their fee and the cost is magically reimbursed back into my bank account in a couple days. If I was really sick I wouldn't need to pay anything. I'm fortunate enough to work for a large insurer that offers a Mutuelle, a supplemental policy, and my out of pocket cost for anything typically ranges between nothing and negligible (poor people have a Mutuelle from the government). When we first moved here, before our cards were processed, we paid out of pocket and costs for everything were lower, especially drugs, the same drugs by the same drug companies sold in the US. The whole system costs much less overall and everybody is healthier.
The answer is obvious: Medicare for all with supplemental policies and the ability for Medicare to negotiate prices and set rates. No networks. No more "out of network assistant surgeons" billing six-figures. The same drug prices as everybody pays. There are some doctors and hospitals that charge more but they're rare - we pay a small premium for a US-trained pediatrician - but that's only something like an extra €10 per visit - but that's the exception, not the rule (it's also unnecessary: the French doctors are great - we just like that he's a native English speaker - we don't think the quality of care is any better).
Single payor works.
The answer is obvious: Medicare for all with supplemental policies and the ability for Medicare to negotiate prices and set rates. No networks. No more "out of network assistant surgeons" billing six-figures. The same drug prices as everybody pays. There are some doctors and hospitals that charge more but they're rare - we pay a small premium for a US-trained pediatrician - but that's only something like an extra €10 per visit - but that's the exception, not the rule (it's also unnecessary: the French doctors are great - we just like that he's a native English speaker - we don't think the quality of care is any better).
Single payor works.
40
Spot on. I have twice required medical care while on extended stays in France (while visiting my in-laws with my wife). The last time I had a doctor's visit, a doppler echo scan, and blood tests, with a total bill of less than $180. You might also have added that medical school in France is essentially tuition free, hence doctor's don't have mountains of debt when they graduate.
"The story so far: Since Obamacare took full effect in January 2014, two things have happened. First, the percentage of Americans who are uninsured has dropped sharply. Second, the growth of health costs has slowed sharply, so that the law is costing both consumers and taxpayers less than expected."
And what of the people whose premiums shot up? Whose plans were cancelled? Obamacare is achieved the goals, namely to enroll the uninsured at the cost of the insured, to cripple the insurance market to open the door for single payer care, and to get Americans used to the idea of healthcare rationing. Obamacare was always a Trojan horse, designed to fail. If it was actually intended to succeed, then the fine for not buying insurance would have been 150% of the average cost of insurance in their zip code. As is, people can buy insurance when they need it and pay the fine when they don't.
And what of the people whose premiums shot up? Whose plans were cancelled? Obamacare is achieved the goals, namely to enroll the uninsured at the cost of the insured, to cripple the insurance market to open the door for single payer care, and to get Americans used to the idea of healthcare rationing. Obamacare was always a Trojan horse, designed to fail. If it was actually intended to succeed, then the fine for not buying insurance would have been 150% of the average cost of insurance in their zip code. As is, people can buy insurance when they need it and pay the fine when they don't.
6
Do you have any facts to back up what you say. Many people say what you are saying but I've never seen them back it up with facts.
1
Have you noticed how the already insured who had their services dramatically disrupted are never mentioned by Obamacare cheerleaders?
The newly insured are compliments of Obama. The disruptions, all blamed on republicans.
The newly insured are compliments of Obama. The disruptions, all blamed on republicans.
3
If there is a wave election and the Dems take bothe the Senate and House, do you think they would pass more Obamacare legislation without a single Republican vote and risk losing both houses again in another schellacking?
1
"Much of the new system is doing pretty well??"
Perhaps the good professor, with generous, university employer coverage, thinks that coverage is "Affordable". Down the road, In the Philadelphia market, where 2 insurers (one being Aetna) control the ACA market, and where Silver level individual coverage for people like me, in older age categories, is about $900 a month (for those not subsidized by taxpayers), I don't think that many would agree.
Since when does such price levels, in a huge metro area, dominated by 2 insurers, constitute a "market" that is "doing well" either with respect to the consumer or an efficient marketplace"??? When I studied economics, a market dominated by 2 competitors was considered oligarchic. When Aetna exits the "market" and we have one dominant insurer, I think that is what used to be known as a monopoly. I guess that the good professor must have discovered some new Economic theories.
Perhaps the good professor, with generous, university employer coverage, thinks that coverage is "Affordable". Down the road, In the Philadelphia market, where 2 insurers (one being Aetna) control the ACA market, and where Silver level individual coverage for people like me, in older age categories, is about $900 a month (for those not subsidized by taxpayers), I don't think that many would agree.
Since when does such price levels, in a huge metro area, dominated by 2 insurers, constitute a "market" that is "doing well" either with respect to the consumer or an efficient marketplace"??? When I studied economics, a market dominated by 2 competitors was considered oligarchic. When Aetna exits the "market" and we have one dominant insurer, I think that is what used to be known as a monopoly. I guess that the good professor must have discovered some new Economic theories.
6
In regards to this subject including the recent news that Aetna and other Health Insurance providers are withdrawing or reducing their presence in Healthcare Markets there are bigger issues at stake here including matters of decency, morality and whether a country can truly lay claim to either greatness or success when it measures such things by GDP or Military Might but not by how well its people are doing and what the richest Country on Earth provides its citizens for making it such?
Having every American covered for their Health expenses is a better and more valued attribute and measure of America's greatness/success than the size of its Military just as the fact of being the Richest Country in the World means little if the top 5% are getting most of those riches, as 80% of its people are either going backwards or becoming poor.
Too many other countries in Europe, Oceania, Asia and The Americas are providing ALL their citizens with Universal Health Care Coverage and do so at a far cheaper cost and with better results and outcomes than America does and where at least 15% of its people are not covered at all.
Sorry America on this alone it does not befit either success or greatness and when added to by poverty rates higher than most other advanced countries as well as one of the highest levels of income inequality in the World and the highest prisoner population and incarceration rate in the World, just to name a few...having the most money and/or weapons, means squat.
Having every American covered for their Health expenses is a better and more valued attribute and measure of America's greatness/success than the size of its Military just as the fact of being the Richest Country in the World means little if the top 5% are getting most of those riches, as 80% of its people are either going backwards or becoming poor.
Too many other countries in Europe, Oceania, Asia and The Americas are providing ALL their citizens with Universal Health Care Coverage and do so at a far cheaper cost and with better results and outcomes than America does and where at least 15% of its people are not covered at all.
Sorry America on this alone it does not befit either success or greatness and when added to by poverty rates higher than most other advanced countries as well as one of the highest levels of income inequality in the World and the highest prisoner population and incarceration rate in the World, just to name a few...having the most money and/or weapons, means squat.
193
Saying out loud the word "decency" does not fix all the fatal flaws baked into Obamacare. Emotionalism about what "ought" to be does not compel health care providers and health care insurance providers to magically turn into altruistic unicorns dancing in the fondest dreams of liberals and socialists. What obviously was going to happen from the beginning of this ill-conceived legislation from the beginning, has come to pass, as anyone with even a rudimentary knowledge of insurance and morbidity tables could have told you from the beginning. Unfortunately Nancy Pelosi and the Democrats in congress were not concerned by such realities, and so Obamacare is experiencing exactly the fate of all wrong headed schemes: failure.
4
Medical-financial phenomena are so simple--exactly not.
Well, the GOP often mentions eliminating State boundary lines re the medical insurance market: if they do this to cofuse if not to demagogue, I can't be overly surprised:
Their multi-repeated shameless objective is to delete Obamacare, no matter its Heritage Foundation's/Romney-care's semi proven concept, which Obama had emulated, apparently sensibly inferring the GOP would become amenable rather than angrily shutting-down the federal government and so crazily politically toying with denouncing (denying? not renewing?) and/or the decision-delaying of extending the admittedly ominous NATIONAL DEBT.
Moody's or Standard & Poor's was not amused, lowering our credit rating.
Single payer health insurance would eliminate a guesstimated twenty-percent of the overall wretched expense.
Therefore, as many have predicted: eventually, bye-bye medical insurance companies.
Well, the GOP often mentions eliminating State boundary lines re the medical insurance market: if they do this to cofuse if not to demagogue, I can't be overly surprised:
Their multi-repeated shameless objective is to delete Obamacare, no matter its Heritage Foundation's/Romney-care's semi proven concept, which Obama had emulated, apparently sensibly inferring the GOP would become amenable rather than angrily shutting-down the federal government and so crazily politically toying with denouncing (denying? not renewing?) and/or the decision-delaying of extending the admittedly ominous NATIONAL DEBT.
Moody's or Standard & Poor's was not amused, lowering our credit rating.
Single payer health insurance would eliminate a guesstimated twenty-percent of the overall wretched expense.
Therefore, as many have predicted: eventually, bye-bye medical insurance companies.
4
Insurers leaving the market should pay an exit penalty, and all insurers not participating in making Americans healthier should pay a monthly tax to support the ACA.
8
Long term this is a potentially self destructive move by Aetna. This will only increase the pressure for the government to include a Public Option... and after that happens why would anybody buy Aetna's product?
8
I think it's a little disingenuous to suggest Aetna's move to leave the ACA exchanges is the result of "vindicitiveness" over the blocked Humana merger. The DoJ asked Aetna how the Humana decision would affect the company's participation in the exchanges. Aetna answered, in response to a DoJ query (e.g. Not making a proactive threat), saying that it would cease an unprofitable line of business unless it was able to subsidize its ongoing exchange losses with savings from the merger. The merger was blocked, and Aetna made a sound decision to exit an unprofitable line of business. Where is the "vindicitiveness" in that?
3
They lied. They're worth 50 billion and want to do a 40 billion merger. And they're whining about 400 million? Not buying it. The insurance industry has too much power and the ACA didn't solve that problem. The answer is to take that power away with a public option. Which requires throwing Republicans out of power.
7
you left out the part about increasing the penalties for those who don't comply w/ the law. Young healthy people, quite sensibly, choose to pay the penalty while healthy, knowing they can always go into the system if they get sick. Another problem is that people who sign up, have a costly procedure done, and then drop out. I don't think the system is actually as easy to fix as you imply, but it's the only system that has every become law, in spite of efforts going all the way back to Truman. So yeah there are problems, and we should fix them. If problems for our healthcare system that were created by the "fringe benefit" throw in of employer provided health care during WWII, were 75 years in the making, we can't expect the solution to be simple
2
But young healthy people are crazy to think the way you are thinking. One can only join ACA at a certain time of the year; you can't just jump into it. They could lose thousands and thousands of dollar with a serious injury or illness. We either must educate them in this regard or just do what is suggested in this article and raise the penalty. Sorry, but any insurance scheme must have rules and they must be workable for the goals of they system.
Of course we need a government plan for everyone; that's where it's heading as many point out that is the way the ACA was designed. Obama may have been smarter than we think.
Of course we need a government plan for everyone; that's where it's heading as many point out that is the way the ACA was designed. Obama may have been smarter than we think.
Very fascinating conflict of interest at display here , those who need insurance , the "healthy" people who might not need insurance at the current cost (price), insurance companies always working for maximizing profit no matter what , and then you have health care providers who mostly work for their bottom line.
In my humble opinion if Obama care is going to work out , the above interests should be aligned, through public policy dictated by electoral dynamics , technological breakthroughs that drive healthcare cost down and of course economic growth. I think this will play out for year and years to come.
In my humble opinion if Obama care is going to work out , the above interests should be aligned, through public policy dictated by electoral dynamics , technological breakthroughs that drive healthcare cost down and of course economic growth. I think this will play out for year and years to come.
3
If health costs have dropped sharply as Paul asserts then why do premiums keep going up and insurers keep dropping out saying they are losing money?
Being an economist it would seem that Paul would realize the numbers don't add up to back his assertions.
Being an economist it would seem that Paul would realize the numbers don't add up to back his assertions.
3
Paul doesn't assert that health costs are dropping: they're rising less quickly than anticipated. Big difference.
3
"Unless it’s such a wave election that Democrats take the House, or at least can claim an overwhelming mandate, the obvious fixes for health reform will be off the table."
Wave election? With HRC as the nominee? You might as well hope for pink unicorns or Republicans with a strong sense of civic responsibility, both of which are fantasy. (Although we'll see the former before we see the latter.)
Wave election? With HRC as the nominee? You might as well hope for pink unicorns or Republicans with a strong sense of civic responsibility, both of which are fantasy. (Although we'll see the former before we see the latter.)
3
Dr. Krugman, having twice heard you speak at economics conferences, I am puzzled by your death grip on salvaging the Affordable Care Act. Health care in the U.S. is a classic market failure--a good or service that cannot be allocated efficiently through a price mechanism. Subsidizing it for some of the population, while others bear a higher and higher burden, has only driven up the cost of premiums. High deductibles, even for those receiving subsidies, make many people afraid to use a healthcare system for which they are already overpaying. It is an enormous drag on the economy, as most families have far better things to spend their money on than sky-high premiums/deductibles.
As with any market failure, the only workable solution in the long run is to make health care a public good. All citizens should pay for it through taxes and the profits should be eliminated as they are for any other public service. This single change would provide an enormous stimulus to the economy--something you have written about frequently over the past decade.
As with any market failure, the only workable solution in the long run is to make health care a public good. All citizens should pay for it through taxes and the profits should be eliminated as they are for any other public service. This single change would provide an enormous stimulus to the economy--something you have written about frequently over the past decade.
13
The author is so blinded by political partisanship that he cannot see that all the economic premises of ObamaCare are collapsing. Insurers were induced into providing underpriced plans because the law provided a means for government to cover their losses for 3 years and they of course wanted to please their government masters. Now the training wheels are coming off and the bicycles are falling over.
The exchanges have only enrolled half the number of subscribers that the Obamacrats planned. And those that have enrolled are sicker than expected, while the younger healthier people have figured out that they can just pay the meager tax penalty and wait to enroll when they get sick, using one of the dozens of "life circumstance" exceptions to open enrollment. This process undermines the entire "insurance" premise of the scheme.
Aetna is leaving most markets, most of the co-ops have gone bankrupt, and the financial outlook for others is grim. If Congress does not come up with a multibillion bailout of ObamaCare next year, more will leave. The few that remain will be high-deductible, bare-bone plans that are essentially catastrophic insurance of the type that ObamaCare was supposed to replace.
ObamaCare was sold to the public with lies and deception and now it is imploding.
Meanwhile Obama is playing golf with billionaires on Martha's Vineyard. . .
The exchanges have only enrolled half the number of subscribers that the Obamacrats planned. And those that have enrolled are sicker than expected, while the younger healthier people have figured out that they can just pay the meager tax penalty and wait to enroll when they get sick, using one of the dozens of "life circumstance" exceptions to open enrollment. This process undermines the entire "insurance" premise of the scheme.
Aetna is leaving most markets, most of the co-ops have gone bankrupt, and the financial outlook for others is grim. If Congress does not come up with a multibillion bailout of ObamaCare next year, more will leave. The few that remain will be high-deductible, bare-bone plans that are essentially catastrophic insurance of the type that ObamaCare was supposed to replace.
ObamaCare was sold to the public with lies and deception and now it is imploding.
Meanwhile Obama is playing golf with billionaires on Martha's Vineyard. . .
6
All presidents get a vacation once in awhile. You seriously begrudge Obama's, when Bush took much more time off?
The only problem with ObamaCare is that it didn't go far enough, and we do need a public option. As Krugman pointed out, many of the uninsured were in bad shape - no doubt from years of going without the basics of preventative treatment.
To try to rip away ObamaCare from them means you would consign them to ill health and even death. That's the Republican healthcare option - go ahead and die. Insurance company profits before people.
No thank you. Some of us care more for our fellow Americans than that.
The only problem with ObamaCare is that it didn't go far enough, and we do need a public option. As Krugman pointed out, many of the uninsured were in bad shape - no doubt from years of going without the basics of preventative treatment.
To try to rip away ObamaCare from them means you would consign them to ill health and even death. That's the Republican healthcare option - go ahead and die. Insurance company profits before people.
No thank you. Some of us care more for our fellow Americans than that.
2
Speaking of billionaires, former CEO of UnitedHealth Group was granted a $1.7 billion severance package on his retirement in 2006. Before ACA UnitedHealth was denying insurance due to preexisting conditions and dropping sick clients due to coverage caps.
Wasn't private American healthcare insurance great?
What is the satisfaction in seeing fellow Americans dying in the streets; in supporting billionaire healthcare executives?
Wasn't private American healthcare insurance great?
What is the satisfaction in seeing fellow Americans dying in the streets; in supporting billionaire healthcare executives?
5
Healthcare is a basic right. Health Insurance on the other hand is a for profit scam. Only when the country understands this difference and chooses the former will we see things starting to go in the right direction.
10
Do us a favor and please stop using the term "basic right." That sounds like something out of the bible or guaranteed by some great cosmic scheme. There is no such thing as a basic right; I dare you to find the logic for that.
We know what you mean. You mean it is a critical need in life and it should not be involved with the capitalist profit motive. Just as police or the military should not be run by capitalists for profit we should have medicare for all. really good "medicare for all" as most Western nations do.
We know what you mean. You mean it is a critical need in life and it should not be involved with the capitalist profit motive. Just as police or the military should not be run by capitalists for profit we should have medicare for all. really good "medicare for all" as most Western nations do.
1
Me: male, 58, healthy.
My plan:bronze
My ACA premiums: $750/mo
My ACA deductible: $6000
I must pay $15,000 per year before my insurance begins to cover my costs.
I'm a non-subsidized consumer who's stuck in the small risk pool of previously untreated consumers whose medical needs is now known to be far greater than originally thought. Great.
It gets worse. I'm a realist. I know I'm buying bankruptcy insurance and I'm somewhat willing to pay "a bit" more to help out, but if and when I need emergency hospital care there is no guarantee that everyone providing service in the hospital is in my plan so after I wake up I can still be stuck with huge, huge bills from individual out of network specialists who treated me while I was unconscious.
I also travel frequently. What if I need emergency care while on the road? Out of state?
In truth, ACA Doesn't even provide true bankruptcy insurance. Is it time to self insure and pay the penalty?
My plan:bronze
My ACA premiums: $750/mo
My ACA deductible: $6000
I must pay $15,000 per year before my insurance begins to cover my costs.
I'm a non-subsidized consumer who's stuck in the small risk pool of previously untreated consumers whose medical needs is now known to be far greater than originally thought. Great.
It gets worse. I'm a realist. I know I'm buying bankruptcy insurance and I'm somewhat willing to pay "a bit" more to help out, but if and when I need emergency hospital care there is no guarantee that everyone providing service in the hospital is in my plan so after I wake up I can still be stuck with huge, huge bills from individual out of network specialists who treated me while I was unconscious.
I also travel frequently. What if I need emergency care while on the road? Out of state?
In truth, ACA Doesn't even provide true bankruptcy insurance. Is it time to self insure and pay the penalty?
12
What??? Paul Krugman says that Obamacare is working well? It has just hit a little bump in the road? Nothing that throwing more taxpayer dollars at won't solve!
Wait? 50% of the people who purchase Obamacare policies get no subsidies? Those people have seen their premiums and deductibles skyrocket in cost?
No problem in the hyper partisan fantasy world of Paul Krugman!
Wait? 50% of the people who purchase Obamacare policies get no subsidies? Those people have seen their premiums and deductibles skyrocket in cost?
No problem in the hyper partisan fantasy world of Paul Krugman!
6
Amen.
7
Paul, your comment is the problem, in a nutshell. I am one year older but have a very similar bronze plan, with a $6500 deductible. I avoid using it, and avoid the healthcare system as much as possible. If I face a medical emergency, I can only hope that someone is there to insist on "in-network" providers lest the cost bankrupt us.
6
Private health insurers are in the business of making as much profit as they can. They are not set up to serve the health interests of the American people--frequently doing just the reverse helps to increase their profits. And Krugman's solution? Increase the subsidies so the health insurance companies can enjoy more comfortable profits and the ACA can limp along, that is until the next time the private insurance companies choose to extort more money from us.
We need some form of Medicare for All--we have needed that for a long time. Colorado is voting on a single payer option this fall. Support their efforts, demand politicians provide us with real solutions that finally cut the private health insurers out of the system. As long as our health care system is driven by profit margins we all will suffer.
We need some form of Medicare for All--we have needed that for a long time. Colorado is voting on a single payer option this fall. Support their efforts, demand politicians provide us with real solutions that finally cut the private health insurers out of the system. As long as our health care system is driven by profit margins we all will suffer.
8
Aetna is a large enough entity for their choice to be a concern. However, as you've mentioned, no major piece of legislation is perfect out of the gate. It is imperative that ACA be modified to provide appropriate choices and incentives / penalties. A public plan would provide an obvious alternative and create a market incentive to be more efficient as well as keeping costs down. Not permitting a public option is an anti-free market concept as it permits oligopolies to control pricing and creates no incentive for efficiency. If private insurers are more efficient than a public program, then prove it!
For those whining about the cost of being required to get insurance when they don't have any, I have no sympathy for you. While my employer provides a plan, it is far from free. You are making me pay your premiums, because your uninsured expenses (and unpaid doctors bills) are passed on to me. I think the penalty for not getting insurance should be forced placement insurance AND a fine.
In the end, health insurance should be treated more like a utility - insure a consistent profit is made, but incent greater efficiency through competition and a public plan. Regulatory change and requiring all Americans to have health insurance just like auto insurance if you have a car would end the cost issue. It would also help keep down Medicare / Medicaid costs.
For those whining about the cost of being required to get insurance when they don't have any, I have no sympathy for you. While my employer provides a plan, it is far from free. You are making me pay your premiums, because your uninsured expenses (and unpaid doctors bills) are passed on to me. I think the penalty for not getting insurance should be forced placement insurance AND a fine.
In the end, health insurance should be treated more like a utility - insure a consistent profit is made, but incent greater efficiency through competition and a public plan. Regulatory change and requiring all Americans to have health insurance just like auto insurance if you have a car would end the cost issue. It would also help keep down Medicare / Medicaid costs.
6
So what has Aetna or any of the insurance companies done to improve their business model? What have they done to streamline their operations, improve the efficiencies in their companies or improve the quality of their product? Can they present factual arguments showing despite doing all the afore mentioned things that they are still losing money. If you business model is based on getting massive government subsidies, then you need a new model. Is it not the free market that picks the winners and losers? Why are they not trying to expand their markets into more states to increase their customer base? Seems by quitting the the exchanges they are putting themselves on a path with self-fulling prophecy of smaller markets, reduced number of customers and less profits. Where are all the really smart MBAs with clever ideas on how to improve this industry? Seriously?
3
A single payer system is the answer.
6
Exactly. If there is a silver lining to the recent decisions by insurance companies it's that we'll see more support for the public option. IMO, Obamacare was never a realistic solution to this problem, and was only proposed / passed as a way to walk the line between decreasing costs while decreasing the number of uninsured, and allowing insurance companies to rake in ever-increasing profits. Healthcare should be a right, not a privilege. If it was actually viewed that way by our elected leaders and their insurance industry overlords, we wouldn't be talking about this now.
1
Yep.
"If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold."
"President’s weekly address, June 6, 2009
Every statement a lie.
"President’s weekly address, June 6, 2009
Every statement a lie.
10
To be lies, the President would have to have known these statements were false when he made them. It's much likelier that he believed in his plan's rosy predictions, and that if all had gone as planned they would have turned out to be true. He didn't foresee the extent of the damage that the Republican Congress, and Republican state governments, would inflict on his health reforms, in order to make them fail.
3
Don't forget "we have to pass the bill to see what's in it".
If the US wants to nationalize healthcare then buy out the stockholders for the major insurers (a la eminent domain) and take over those businesses. But don't use the power of the purse to bankrupt these companies or otherwise drive them out of business.
If the US wants to nationalize healthcare then buy out the stockholders for the major insurers (a la eminent domain) and take over those businesses. But don't use the power of the purse to bankrupt these companies or otherwise drive them out of business.
4
"Every statement a lie."
Expecting truth from a professional politician is a definition of insanity.
Expecting truth from a professional politician is a definition of insanity.
3
If the government permits insurers to compete across state lines, forces hospitals to disclose the costs for their services in advance, and prohibits all drug advertising campaigns, we may begin to see some de-escalation of costs.
We must address the problem - a system that is built to reward and protect the providers of health care, rather than the recipients.
We must address the problem - a system that is built to reward and protect the providers of health care, rather than the recipients.
6
Yes!! You have captured a big part of what I believe is the solution precisely and concisely. And think how wonderful it will be to not have to listen to ads for drugs that apparently help sufferers of illnesses that didn't exist 20 years ago and that have "side-effects that include hives and vomiting, weight gain and sometimes death. Don't use if you are sick in any way as this drug may make your symptoms worse....."
1
Dr Krugman now asks for bipartisan cooperation. If President Obama had called the Republicans to the table in 2010 and asked them what he could do to get their support for Obamacare, Dr Krugman's suggestion would be reasonable. But Mr Obama told the Republicans then that their input was unwanted. We should not forget "You have to vote for it to find out what's in it" or "If you like your doctor you can keep your doctor".
Certainly other economists have argued recently that jobs are not being created as fast as they could be due to Obamacare's requirements. While many people now have insurance, their deductibles make their coverage almost useless unless they are facing catastrophic illness.
In 2010, the president promised the insurance companies profits for the first 3 years on the taxpayers' dime.
He and Dr Krugman continue to argue that this program is a success because the rates for so many people are subsidized; they conveniently forget to mention that *someone* has to pay the bill. The insurance companies thought it was going to be the taxpayer; now they realize that is only partially true, and that they have to eat some of the cost too. And they are not happy about it.
The fact is that Obamacare is a perfect example of this president's advisors (Dr Krugman included) thinking they are a lot smarter than everyone else, and that if they invented it, it must be good. It's time to realize this emperor has no clothes.
Certainly other economists have argued recently that jobs are not being created as fast as they could be due to Obamacare's requirements. While many people now have insurance, their deductibles make their coverage almost useless unless they are facing catastrophic illness.
In 2010, the president promised the insurance companies profits for the first 3 years on the taxpayers' dime.
He and Dr Krugman continue to argue that this program is a success because the rates for so many people are subsidized; they conveniently forget to mention that *someone* has to pay the bill. The insurance companies thought it was going to be the taxpayer; now they realize that is only partially true, and that they have to eat some of the cost too. And they are not happy about it.
The fact is that Obamacare is a perfect example of this president's advisors (Dr Krugman included) thinking they are a lot smarter than everyone else, and that if they invented it, it must be good. It's time to realize this emperor has no clothes.
4
You hit the nail on the head! When the Republicans attempted to have their ideas heard on healthcare the President said.. "THERE WAS AN ELECTION, AND I WON!"
The democrats and their media sycophants like Krugman celebrate the vast expansion of medicaid. Medicaid is nothing more than healthcare welfare. Shouldn't we as a country be working towards REDUCING the medicaid rolls as opposed to expanding them? Shouldn't the goal be a population that is self sufficient as opposed to families that have been on welfare for generations?
Bill Clinton could not be elected President today. His sensible Welfare reforms have been rolled back by this president through regulations.
What is happening in our country is a disgrace.
The democrats and their media sycophants like Krugman celebrate the vast expansion of medicaid. Medicaid is nothing more than healthcare welfare. Shouldn't we as a country be working towards REDUCING the medicaid rolls as opposed to expanding them? Shouldn't the goal be a population that is self sufficient as opposed to families that have been on welfare for generations?
Bill Clinton could not be elected President today. His sensible Welfare reforms have been rolled back by this president through regulations.
What is happening in our country is a disgrace.
1
"Obamacare" was bipartisan-its 2 major features, the Individual Mandate and insurance pools, were originally conservative/GOP ideas. Dozens of GOP amendments were also included in the bill.
In the spring of 2002 my senator, Chuck Grassely, was on Fox News advocating for the Individual Mandate. Funny thing though: once Obama was for it too, in Sen. Grassely's eyes somehow the Individual Mandate suddenly morphed into Intolerable Big-Government Socialism. This is the kind of atitude Obama has had to deal with throughout his presidency.
In the spring of 2002 my senator, Chuck Grassely, was on Fox News advocating for the Individual Mandate. Funny thing though: once Obama was for it too, in Sen. Grassely's eyes somehow the Individual Mandate suddenly morphed into Intolerable Big-Government Socialism. This is the kind of atitude Obama has had to deal with throughout his presidency.
2
As if the Republican's offered to support Obamacare! The reality is that the Republican Party has chosen to oppose every single proposal that the Dems have put forward since 2008. The Party of No has put party above country, guided, as Trump has shown, that it is powered by racism.
1
Paul has the rose color glasses on again.
ObamaCare is on an unsustainable trajectory.
Major insurance companies are fleeing the market, premium rates are prohibitively high and will go substantially higher, the coverage offered is declining significantly.
ObamaCare is on an unsustainable trajectory.
Major insurance companies are fleeing the market, premium rates are prohibitively high and will go substantially higher, the coverage offered is declining significantly.
5
Heh, sounds like the same tired arguments that plagued Social Security since the day after its inception. Zombie facts that don't have enough common decency or human empathy to go away after they have been proven wrong again, and again, and again....
2
ObamaCare has crashed and burned.
Unless you qualify for the subsidy, the premiums are prohibitively high.
My Florida workplace Blue Cross COBRA cost is 60% lower than the equivalent ObamaCare HMO option.
Unless you qualify for the subsidy, the premiums are prohibitively high.
My Florida workplace Blue Cross COBRA cost is 60% lower than the equivalent ObamaCare HMO option.
2
Taxes are raised to protect us from other countries, criminal elements even feral cats, why shouldn't they be used to protect us from microscopic germs, cancer and fractures? If taxes can be used to fix a broken bridge, why not a broken leg. We need a universal single payer option. If I had to lose one of the following from my health care: Doctor, nurse, technicians, or insurance executive. Which one could I lose and still recover?
9
As a retired physician, I worked hard in campaigning to pass the ACA. But, I did feel that it would not reduce the overall cost of healthcare without a "public option" in it; but, with the attitude of the Congress during the past 7 years in opposing all bills that the President proposed, it was quite evident that ACA could not have been passed. Also, President Obama had to make really unpalatable compromises to appease the profit oriented healthcare insurance companies to win their support and of some moderate Republicans and also some Democrats! Still even with record profits, United Healthcare, Aetna and others are now crying wolf, because they were not allowed to merge further into massive monopolies! Even then, I had hoped the Congress would show some leadership in correcting the omnibus bill, which is usually the case in every such massive piece of legislation in the past! Instead the 'do-nothing' Congress of the past 3 cycles has spent money and time in trying to repeal 60 plus time the ACA! The only way to save this essential bill to be perfected is to elect ethical, humanistic and truly patriotic legislators who care for ALL the citizens of the nation and not just those chosen from artificially divided districts with extreme views on legislating and leading the country!
283
"Also, President Obama had to make really unpalatable compromises to appease the profit oriented healthcare insurance companies to win their support and of some moderate Republicans and also some Democrats!"
HUH???? The law passed without a SINGLE repbulican vote. The reason there is NO PUBLIC OPTION is because there was not support for it within the democratic party
Please be honest about these issues. Haven't enough lies been told by the President?
HUH???? The law passed without a SINGLE repbulican vote. The reason there is NO PUBLIC OPTION is because there was not support for it within the democratic party
Please be honest about these issues. Haven't enough lies been told by the President?
3
And the only way to elect better lawmakers is to support initiatives like MAYDAY to get corporate money out of the electoral process, and to elect a president who will appoint Supreme Court judges who will reverse the shameful Citizens United decision, which allows corporations to contribute unlimited amounts of money to the electoral process.
Dr. Ballal did not say that President Obama withheld the public option in hopes of winning Republican support for ACA. Rather, he said that the President made unspecified compromises to win their support - which, as you rightly observe, he failed to get anyway - a miscalculation, based on optimism. Ballal agrees with your view that Democrats (he says "some Democrats," you seem to think it was more than "some." But you're vague on how many - surely not ALL) opposed the public option. His ambiguities can be interpreted as lies only by someone determined to find bad faith in his comments. He's no more a liar than you are.
It all costs way more than it should. Lots of parasites in the system.
4
90% of all government is composed of useless, parasitic, self-serving, politically connected bureaucrats who are only interested in their own power and pay.
1
I am a person of the far left who needs health care and supports the President. Obamacare has been garbage from day one because it is insurance. It doesn't work. Period.
5
The continued jagged lines of red state - blue state will pull apart ACA at all possible seams. So it succeeds and fails at the same time. Interesting thoughts about 'vindictiveness' being central to Aetna's pullout. Not only the presidency is needed to steer this more public, but so is congress and the state governors. VOTE for all those who will support universal care!
2
"VOTE for all those who will support universal care!"
And of course paid for by somebody else, as Maggie Thatcher said, "Socialism works great until it runs out of other people's money".
And of course paid for by somebody else, as Maggie Thatcher said, "Socialism works great until it runs out of other people's money".
2
We could have had a progressive, comprehensive health insurance program that would have radically lowered costs and provided universal health care for all Americans. But instead we got--via the Republican Mitt Romney, with his Massachusetts plan--a neoliberal plan from Democratic President Barack Obama and the Democratic Congress. They wanted to protect private industry. They did that. What they could not stop was the incentive for greed, Republican intransigence, etc.
When Mrs. Clinton wins in November, and if the Democrats win back the House, even by a few seats (because they'll retake the Senate), they should have a number of votes ready to go. One would be confirming President Obama's Supreme Court nominee. Next should be a vote for infrastructure spending and development. Third should be a comprehensive immigration reform bill. And fourth should be a bill to address the various aspects of the ACA that need fixes. Medicare for All or a public option should be part of the mix. Aetna and every other insurance will get its act together faster than you can say "single payer."
When Mrs. Clinton wins in November, and if the Democrats win back the House, even by a few seats (because they'll retake the Senate), they should have a number of votes ready to go. One would be confirming President Obama's Supreme Court nominee. Next should be a vote for infrastructure spending and development. Third should be a comprehensive immigration reform bill. And fourth should be a bill to address the various aspects of the ACA that need fixes. Medicare for All or a public option should be part of the mix. Aetna and every other insurance will get its act together faster than you can say "single payer."
10
The missing part of this story is that the plans in the exchange marketplace set their own prices and that Aetna either cannot, or doesn't want to raise its price. The cannot is that if it raised its premium price, exchange members would choose a lower cost plan that had a lower price. We call this competition and Aetna has apparently competed poorty.
It is the case that the premium prices are filed with either the State or CMS and that they have to approve them, and increases higher than 10% must be accompanied by a justification, but higher prices would have been approved if there was a justification (higher costs due to sicker people).
The "marketplaces" were designed to work as markets.
It is the case that the premium prices are filed with either the State or CMS and that they have to approve them, and increases higher than 10% must be accompanied by a justification, but higher prices would have been approved if there was a justification (higher costs due to sicker people).
The "marketplaces" were designed to work as markets.
2
"They’re problems that would be relatively easy to fix in a normal political system, one in which parties can compromise to make government work."
That would be compromise of the same sort that the authors of the bill demonstrated in getting it passed, such as partnership with and deference on some important issues to the minority party to ensure that a bill of the ACA's impact would have bipartisan support, right Doc? That would be ensuring that all proper lawmaking procedures were strictly followed during the bill's enactment to ensure that a law reshaping 1/6 of the U.S. economy would have the ongoing favor necessary from both parties to pass its inevitably needed adjustments and fixes, right Doc?
Not quite. The ACA was rammed through Congress by the brute force of majority Democrats, against popular opinion (which remains squarely against it today), against the will of every member of the minority party and even by resorting to parliamentary trickery (reconciliation) to get the final bill through the Senate. It was one of the most nakedly hostile, partisan exercises in American legislative history.
The ACA was the bludgeon with which supermajority Democrats laid waste to the last vestiges of collegial and collaborative U.S. federal lawmaking in recent history. What possible reason would lead any thinking person to expect a G.O.P. treated in such a manner, with a politics so toxic, to ever try and fix such a bill?
Alice was more in touch with reality in Wonderland.
That would be compromise of the same sort that the authors of the bill demonstrated in getting it passed, such as partnership with and deference on some important issues to the minority party to ensure that a bill of the ACA's impact would have bipartisan support, right Doc? That would be ensuring that all proper lawmaking procedures were strictly followed during the bill's enactment to ensure that a law reshaping 1/6 of the U.S. economy would have the ongoing favor necessary from both parties to pass its inevitably needed adjustments and fixes, right Doc?
Not quite. The ACA was rammed through Congress by the brute force of majority Democrats, against popular opinion (which remains squarely against it today), against the will of every member of the minority party and even by resorting to parliamentary trickery (reconciliation) to get the final bill through the Senate. It was one of the most nakedly hostile, partisan exercises in American legislative history.
The ACA was the bludgeon with which supermajority Democrats laid waste to the last vestiges of collegial and collaborative U.S. federal lawmaking in recent history. What possible reason would lead any thinking person to expect a G.O.P. treated in such a manner, with a politics so toxic, to ever try and fix such a bill?
Alice was more in touch with reality in Wonderland.
5
Wow! So well said. The law was rammed through against the will of the majority of Americans. A disgraceful display of ideology trumping (no pun intended) all.
3
If our's is to become a healthy country, in every respect: emotionally, spiritually, physically, mentally… The only viable option is the Public one. Insurance companies are not the answer. Everyone has personal stories about how their insurance company has thrown up roadblock to their necessary treatment and/or diagnosis. It happens over and over. The companies are not interested in promoting a healthy society. They want a frightened one, who will pay through the nose for health care for when they really become ill. Preventative care? Forget about it.
2
"The only viable option is the Public one. Insurance companies are not the answer."
This is a common statement, but one proven false by the excellent 2008 PBS Frontline program called "Sick Around the World". It showed that the well functioning health care systems in Germany, Switzerland, and Japan were not single payer systems, but instead systems that used private insurance companies as payers. But it noted that in each of these three countries the insurers were non-profits and that they, and medical costs, were highly regulated by the government.
"Sick Around the World" was an amazingly explanatory show. I emailed the White House two or three times during the health care debate telling them that "Sick Around the World" did a better job of explaining, in a form understandable by a large audience, how to to improve medical care than any other messaging I had heard. I said they should organize to have tens of millions of Americans to watch it. I don't think they ever did.
This is a common statement, but one proven false by the excellent 2008 PBS Frontline program called "Sick Around the World". It showed that the well functioning health care systems in Germany, Switzerland, and Japan were not single payer systems, but instead systems that used private insurance companies as payers. But it noted that in each of these three countries the insurers were non-profits and that they, and medical costs, were highly regulated by the government.
"Sick Around the World" was an amazingly explanatory show. I emailed the White House two or three times during the health care debate telling them that "Sick Around the World" did a better job of explaining, in a form understandable by a large audience, how to to improve medical care than any other messaging I had heard. I said they should organize to have tens of millions of Americans to watch it. I don't think they ever did.
2
Mr Krugman is a reliably consistent delusional partisan hack. My families health insurance through the exchange has increased 20 percent annually. Family of 4 is up to $1,850 monthly this year. Our insurer has announced it's exit from the exchange next year. Anticipating a huge increase. "Affordable Care Act" Not so much...
9
Spot on. Our family has seen both our premiums and deductibles skyrocket in cost. Mr Krugman is indeed a delusional partisan hack. A faux economist. Nothing more than a cheerleader for the left.
5
The coming political realignment will boost opportunities for ACA retooling. While healthcare reform is still in its beta stage — it is largely fulfilling its purpose notwithstanding misc. bugs in the system.
4
..the American taxpayer cannot afford to pay for top quality medical care for all its people. ( See Greg Ip WSJ article).
--- Tiered care with rationing is the only solution.
The desire of the left to enslave all the Doctors to the state is a miserable, wretched approach.
--If you absolutely sure that you want to be operated on by a poor, bitter resentful surgeon-- then you are a braver man than I.
--- Tiered care with rationing is the only solution.
The desire of the left to enslave all the Doctors to the state is a miserable, wretched approach.
--If you absolutely sure that you want to be operated on by a poor, bitter resentful surgeon-- then you are a braver man than I.
3
Healthcare for all is a laudable ideal, and we are certainly closer to it than before Obamacare. However, we seem to forget that most working Americans obtain their health insurance through their employer; whether this is a good or bad arrangement, is not currently the point. If we, through our new president, decide to bring our infrastructure into the 21st century, then we will engender millions of new jobs. Most will come with health insurance. Hence, the need for Obamacare will be lessened, and the "cost" of this will be diminished. Certainly, this is a win-win situation for all.
Perhaps, even the trains will run on time (although I doubt it).
Perhaps, even the trains will run on time (although I doubt it).
2
Health insurance is a basic right. How can a government, whose only job is to look after the welfare of all its people, determine which law abiding citizens shall live or die because they can or cannot afford healthcare.
In the 21st century this is a moral issue.
And further, without the American taxpayer, the research that is the bedrock of today's medical 'miracles', would not have been possible. Every person in this country is owed access.
In the 21st century this is a moral issue.
And further, without the American taxpayer, the research that is the bedrock of today's medical 'miracles', would not have been possible. Every person in this country is owed access.
3
Right. Don't worry, be happy. It's only a bump.
For years now, Paul Krugman has been assuring us that the pundits who said ACA wasn't working were full of it. Now the chickens are coming home to roost.
Just before the VA scandal burst into full view he was touting it as the solution to the troubles of U.S. health care ("And yes, this is “socialized medicine” — But it works").
Just before scandals erupted over overpayments by Medicare, Krugman was telling us that "Medicare actually saves money — a lot of money — compared with relying on private insurance companies."
Now it is the turn of Obamacare.
Krugman's proposed fix is predictable. Just apply more taxpayers' money and more government use of force.
Krugman is that rare economist who doesn't understand incentives. As the WSJ's Gregg Ip points out, ACA's "problem isn't technical or temporary; it's intrinsic .... [It] incentivizes insurers to misprice risk."
We are seeing Krugman's future, and it doesn't work. That future is one where government policies incentivize people to act in self-destructive ways. It is Greece, Puerto Rico, Detroit, Illinois and scores of bankrupt municipalities. It is tottering behemoths like the VA, Medicare, and Obamacare. Our kids will be picking up the tab.
That is the trouble with people who believe in stimulating the economy by throwing money at it. They don't reckon with the perverse incentives that this free money creates.
For years now, Paul Krugman has been assuring us that the pundits who said ACA wasn't working were full of it. Now the chickens are coming home to roost.
Just before the VA scandal burst into full view he was touting it as the solution to the troubles of U.S. health care ("And yes, this is “socialized medicine” — But it works").
Just before scandals erupted over overpayments by Medicare, Krugman was telling us that "Medicare actually saves money — a lot of money — compared with relying on private insurance companies."
Now it is the turn of Obamacare.
Krugman's proposed fix is predictable. Just apply more taxpayers' money and more government use of force.
Krugman is that rare economist who doesn't understand incentives. As the WSJ's Gregg Ip points out, ACA's "problem isn't technical or temporary; it's intrinsic .... [It] incentivizes insurers to misprice risk."
We are seeing Krugman's future, and it doesn't work. That future is one where government policies incentivize people to act in self-destructive ways. It is Greece, Puerto Rico, Detroit, Illinois and scores of bankrupt municipalities. It is tottering behemoths like the VA, Medicare, and Obamacare. Our kids will be picking up the tab.
That is the trouble with people who believe in stimulating the economy by throwing money at it. They don't reckon with the perverse incentives that this free money creates.
3
So well put! Krugman's solution to EVERY ILL?
Throw more taxpayer dollars at the problem!
Medicare and Social security have tens of trillions of unfunded liabilities. We can't pay for the promises we have already made. Krugman's solution. Create another HUGE welfare program in Obamacare that will end up costing 5x's the predicted cost!
Throw more taxpayer dollars at the problem!
Medicare and Social security have tens of trillions of unfunded liabilities. We can't pay for the promises we have already made. Krugman's solution. Create another HUGE welfare program in Obamacare that will end up costing 5x's the predicted cost!
A tale of two patients (who of course will remain nameless):
Many years ago I had a patient with "TMJ" disease, a kind of arthritis of the jaw. She saw a surgeon and was told that she needed a $10,,000 operation. She then signed on to an insurance plan in which the surgeon participated. Her first month's premium was at the time about $200. She saw me under her plan to get a referral to that surgeon. She thought that she could pay $200, get the operation at the insurance company's expense, and then drop the insurance. She was disappointed to learn that there was a pre-existing condition clause that prevented her from doing this.
Several years ago I had a patient sign on to an Obamacare platinum plan that cost at the time $630 a month. During his first month on the plan he had a complete physical with blood work, complete pulmonary function testing, a full dermatological screening exam, a colonoscopy, an orthopedic exam of his back with an MRI scan. I don't remember what else. In short he had over 10,000 worth of care. I am not sure if he paid the first month's premium or not, but I know that he did not pay the second month's. He then allowed the insurance company to drop him from the plan. Those of you who under Obamacare have been paying high premiums with high deductibles, I am sure that you are not happy to learn that you have been paying for his care.
Many years ago I had a patient with "TMJ" disease, a kind of arthritis of the jaw. She saw a surgeon and was told that she needed a $10,,000 operation. She then signed on to an insurance plan in which the surgeon participated. Her first month's premium was at the time about $200. She saw me under her plan to get a referral to that surgeon. She thought that she could pay $200, get the operation at the insurance company's expense, and then drop the insurance. She was disappointed to learn that there was a pre-existing condition clause that prevented her from doing this.
Several years ago I had a patient sign on to an Obamacare platinum plan that cost at the time $630 a month. During his first month on the plan he had a complete physical with blood work, complete pulmonary function testing, a full dermatological screening exam, a colonoscopy, an orthopedic exam of his back with an MRI scan. I don't remember what else. In short he had over 10,000 worth of care. I am not sure if he paid the first month's premium or not, but I know that he did not pay the second month's. He then allowed the insurance company to drop him from the plan. Those of you who under Obamacare have been paying high premiums with high deductibles, I am sure that you are not happy to learn that you have been paying for his care.
88
The individual mandate addresses the second scenario. Everyone is required to pay into the system, either by purchasing insurance or by paying a penalty, or tax, wtvr you want to call it. The individual mandate fee just hasn't fully kicked in yet.
Were all those tests strictly necessary? If so, financial stress brought on by excessive "tests" that have become far more numerous than in years past has most certainly added to his health woes. Would they have performed so many tests in Canada or another single-payer system? Don't doctors take into account the patients ability to pay when they are deciding a course of treatment? I believe I have been reading a lot of stories lately about unnecessary testing that was extremely lucrative for the physicians, the insurance companies, the labs, and the hospitals, but not for the patient so much.
So doc, tell me why you went into medicine. Was it to help people or to make a pile?
So doc, tell me why you went into medicine. Was it to help people or to make a pile?
2
If something had been wrong, I'm sure he wouldn't have dropped the coverage. But he could have been hit by a car the week after he dropped his coverage and he'd have a mess. There are people who always try to game the system. And most people cannot afford $630 a month, plus the horrendous deductible he probably had on that plan.
I have Aetna Medicare supplement insurance and Humana drug insurance. Not next year.
3
Yes, Republicans crippled Obamacare. But they couldn't kill it because one of their own, Chief Justice Roberts, stood in the way.
Just One prominent example, like the Khans, who benefited from Obamacare without which they would have died may be enough for the public to turn against the Republicans, and to have a public option added to it to make it at least as untouchable as Social Security & Medicare for seniors.
Nevertheless, if president Obama were more diligent as LBJ or GHW Bush, these hiccups wouldn't have happened. Then again you can't change a President's basic modus operandi.
Just One prominent example, like the Khans, who benefited from Obamacare without which they would have died may be enough for the public to turn against the Republicans, and to have a public option added to it to make it at least as untouchable as Social Security & Medicare for seniors.
Nevertheless, if president Obama were more diligent as LBJ or GHW Bush, these hiccups wouldn't have happened. Then again you can't change a President's basic modus operandi.
2
President Obama could not ignore the private profit-focused health insurance market when launching Obamacare. It's size and influence were too significant a force to eliminate. As a consequence it had to be build within a existing system that would eventually become unworkable as we're seeing now. Instead of dealing with insurance on a national basis, it was set up on a state level and as has been pointed out, in small states, it defeated the very essence of how insurance must work; the law of large numbers: there has to be enough people in the pool to make it economically viable.
It is correctable. But that's going to involve Hillary and the Democrats taking back the Senate and large segment of the House. The Republicans have never produced a viable option/alternative system. Therefore, all those touched by the benefits of Obamacare must get out and vote to make sure Hillary and the Democrats get into office so they can tweak and make the changes to keep it viable, as well as finally evaluating the mechanics of conversion to Medicare for ALL.
It is correctable. But that's going to involve Hillary and the Democrats taking back the Senate and large segment of the House. The Republicans have never produced a viable option/alternative system. Therefore, all those touched by the benefits of Obamacare must get out and vote to make sure Hillary and the Democrats get into office so they can tweak and make the changes to keep it viable, as well as finally evaluating the mechanics of conversion to Medicare for ALL.
4
Perhaps I am the only one in the US happy with my affordable care. I am paying roughly $250/month for a silver plan with pretty high deductible (2000+). The upside is that I get access to drugs, I go to a counselor, and I get labs and stuff done for my doctor (who is not a participating doctor).
My blood pressure is getting worked on, I had an infection in my leg, now gone, and I am working with my counselor on long-term plans for better employment (and working through some grief).
$250 a month is a stretch. AND I would be hit hard with a serious illness. However, a serious illness would not cost me my house. Or my retirement.
The bid prior to "Obamacare" to cover me? A delightful 1500/month!
For me, it has been a blessing. And such a relief in my mid-50s.
My blood pressure is getting worked on, I had an infection in my leg, now gone, and I am working with my counselor on long-term plans for better employment (and working through some grief).
$250 a month is a stretch. AND I would be hit hard with a serious illness. However, a serious illness would not cost me my house. Or my retirement.
The bid prior to "Obamacare" to cover me? A delightful 1500/month!
For me, it has been a blessing. And such a relief in my mid-50s.
7
Are the Health Insurance Companies that are leaving the Market or reducing their presence due to losses caused by a “too many older expensive insurance holders vs. Younger Healthier Insurance Holders ratio” being audited or checked in regards to the veracity of their statements/reasons?
i.e. are these "Losses” actual losses or something else such as a reduced profit than previously and are these losses in fact due to the reason at hand and not some other factor, area or result of the companies accounting or business practises?
Aetna “...warning the Justice Department last month that the company would curtail its participation in the exchanges if the government sued to block its acquisition of Humana, a major competitor...”* is completely unacceptable and gives doubt to its reasons for withdrawing from health markets.
* From NYT article on Aug 17 "As Insurers Like Aetna Balk, U.S. Makes New Push to Bolster Health Care Act"
I really hope these Companies are given the scrutiny needed to ensure that their actions are valid and acceptable given the importance and need of every American deserving such a basic right as medical coverage not just those who can afford it or whether an Insurer decides it is worth their while or not.
There are bigger issues at stake here.
i.e. are these "Losses” actual losses or something else such as a reduced profit than previously and are these losses in fact due to the reason at hand and not some other factor, area or result of the companies accounting or business practises?
Aetna “...warning the Justice Department last month that the company would curtail its participation in the exchanges if the government sued to block its acquisition of Humana, a major competitor...”* is completely unacceptable and gives doubt to its reasons for withdrawing from health markets.
* From NYT article on Aug 17 "As Insurers Like Aetna Balk, U.S. Makes New Push to Bolster Health Care Act"
I really hope these Companies are given the scrutiny needed to ensure that their actions are valid and acceptable given the importance and need of every American deserving such a basic right as medical coverage not just those who can afford it or whether an Insurer decides it is worth their while or not.
There are bigger issues at stake here.
4
I thought I would never come back to comment on a PK oped/blog since Jan/Feb. But here he goes! PK and others killed even a discussion of single-payer (note: he doesn't mention single-payer even here...) to prevent a truly progressive candidate from being the Dem nominee. He & others knew that single-payer has been working well for years in many countries but refused to acknowledge this data, something you don't expect from professional economists. ACA has exposed the real issue with private insurance: when people who can't afford insurance but really in need of care buy from ACA, profits tank. PK & others didn't see this coming? Even before Aetna, others (like United Healthcare) started leaving many markets. PK now shamelessly mention public option and suggest Hillary is/was for it! PK and others are true examples of hypocrisy & academic dishonesty.
4
Obamacare hits a bump? How many elections do democrats have to lose before they understand? The majority of taxpayers think Obamacare stinks. It's been an utter disaster. Throwing more money at it is not the answer. End it, and then design a welfare medical program for the poor that provides basic services.
5
Democrats won the last two presidential elections and are going to win this one. Obamacare does not "stink," and has not been an "utter disaster." We already have a health insurance "program for the poor," called Medicaid. (Are you unaware of this?) We now have a comprehensive health insurance program for nearly all Americans. There's a huge difference between the two!
4
And my family premiums went UP fron under $ 500 per month (for just one individual) to OVER $ 1,100 per month.
So, tell me who exactly is putting their hands in our wallets every month.
So, tell me who exactly is putting their hands in our wallets every month.
7
The Insurance company
2
A bump? You mean l like an unwanted pregnancy? I assume that progressives will have no problem with an abortion.
6
Given that the public option was dropped due to insurance industry opposition at a time when both the House and Senate had Democratic majorities, what hope is there for it now, indeed? Republicans deserve their considerable measure of blame for opposition to making access to health care equitable and affordable for all of us, but so, too, do the Democrats, who had a number of successful models of universal healthcare delivery from which to choose, both here and abroad, and instead stuck us with the Heritage-Foundation-derived ACA.
6
A "bump"! I guess that's one way to put it.
"But they won’t get resolved if we elect a clueless president (although he’d turn to terrific people, the best people, for advice, believe me. Not.). And they’ll be difficult to resolve even with a knowledgeable, competent president if she faces scorched-earth opposition from a hostile Congress."
That describes precisely the rock and the hard place between which America is caught. The choice is a Trump presidency or continued political dysfunction, and, sadly, dysfunction is the better option.
"But they won’t get resolved if we elect a clueless president (although he’d turn to terrific people, the best people, for advice, believe me. Not.). And they’ll be difficult to resolve even with a knowledgeable, competent president if she faces scorched-earth opposition from a hostile Congress."
That describes precisely the rock and the hard place between which America is caught. The choice is a Trump presidency or continued political dysfunction, and, sadly, dysfunction is the better option.
2
Not really. We should have had a public option in the first place that would be triggered if the private insurers played footsie with the ACA. This is why, as a true conservative, I'm voting for Clinton and urging all my fellow conservatives, if they are real conservatives, to vote for her, give to her, and shout her name to the heavens.
6
The concept of "conservatism" has been grossly distorted, twisted like a pretzel. rendered unrecognizable. Hillary is far closer to being a true conservative than any of the Republican presidential candidates were. Americas desperately needs a return to true conservatism. Good for you.
Obamacare hits a bump--erected by the very institutions that were "subcontracted" by the government to deal with insuring the health care of Americans under the age of 65.
It is long past time to say this Plan A is not working. Our privatization of health insurance is the most expensive in the world with only mediocre outcomes for patients. What business or corporation would tolerate and pay for such poor performance?
When the insurance companies can no longer be counted on to do the job, then it's time to move to Plan B. So, wherever insurance companies cannot, do not, or will not do their job in a responsible way and where the American people and the sick are being harmed, then this may be the time for the government to step in and provide a single-payer government plan (put the uninsured on expanded Medicare). Later give all Americans the choice of paying into a government single-payer system or buy the private health insurance.
When Obamacare was set up, we should have had the option of choosing to pay for either private insurance or an expanded Medicare plan. Then see which works out better for the citizenry.
How much of our taxpayer dollars is the government paying out in subsidies to the private insurance companies now for Obamacare?
It is long past time to say this Plan A is not working. Our privatization of health insurance is the most expensive in the world with only mediocre outcomes for patients. What business or corporation would tolerate and pay for such poor performance?
When the insurance companies can no longer be counted on to do the job, then it's time to move to Plan B. So, wherever insurance companies cannot, do not, or will not do their job in a responsible way and where the American people and the sick are being harmed, then this may be the time for the government to step in and provide a single-payer government plan (put the uninsured on expanded Medicare). Later give all Americans the choice of paying into a government single-payer system or buy the private health insurance.
When Obamacare was set up, we should have had the option of choosing to pay for either private insurance or an expanded Medicare plan. Then see which works out better for the citizenry.
How much of our taxpayer dollars is the government paying out in subsidies to the private insurance companies now for Obamacare?
7
If you think a completely government run health insurance program is the answer, you should ask some of the Verterans getting their health insurance from the VA how it's working out for them . . .
3
As a military retiree I get my care through government provided Tricare. It has been great! The VA is being underfunded!
13
I did, and my dad is quite satisfied with the care he receives at the VA.
9
Medicare for all is not a a completely government run health insurance program. I'm on Medicare with a supplemental. I've been thrilled with my medical care. I would literally be dead without Medicare. There is no reason why we can't do this except that the private insurers don't want us to. It would cut into their profits.
1
Paul Krugman opined that as the public would get to know the ACA it would get to love it. The opposite happened. When the law went into effect, more Americans were favorable towards the law than unfavorable, now it is reversed.
The reason is simple: It is bad legislation.
Instead of copying what works, e.g. the German system based on private, non for profit, well regulated companies, in force since 1883, the President made a foul compromise with the insurance and drug manufacturers. That, while having majorities in both the House and the Senate.
Then he sold the bad package in with : ""If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold."
The opposite happened.
Time to start from scratch.
Either copy the German and Swiss System, or convert to Medicare for all.
The reason is simple: It is bad legislation.
Instead of copying what works, e.g. the German system based on private, non for profit, well regulated companies, in force since 1883, the President made a foul compromise with the insurance and drug manufacturers. That, while having majorities in both the House and the Senate.
Then he sold the bad package in with : ""If you like the plan you have, you can keep it. If you like the doctor you have, you can keep your doctor, too. The only change you’ll see are falling costs as our reforms take hold."
The opposite happened.
Time to start from scratch.
Either copy the German and Swiss System, or convert to Medicare for all.
6
The German system includes both public and private sickness funds, with more than 70% of costs being paid by the public sector.
4
Still, I'd be willing to bet the farm their costs (equivalent to premiums in our system) are still smaller. I don't want something for nothing. I'll pay for my healthcare, I just don't think it's right that I be bankrupted after using it. I can only speak for myself, but I suspect there are many others who believe the same.
The insurers, left untouched by Obamacare—lest their power doom the law in the first place—was going to be a problem, sooner or later. And rather than address the unregulated, frivolous pricing of health care by providers, rather than turn its power on this, the real issue, insurers instead, once again, put the burden on consumers. Especially those least able to protect themselves. We have to stop thinking any industry is "too big to fail." Banks, insurers, "health systems" (e.g., just another big business) and drug makers are the problems, not the source of anything good for consumers and the economy.
5
Krugman's rewriting history: "The idea of allowing the government to offer a health plan directly to families was blocked in 2010 because private insurers didn’t want to face the competition"
Actually, Obama dropped the public plan, much to the chagrin of Democrats in congress, where support for the populist policy was surging. It was a situation that would be repeated dozens of times over the next several years: centrist Obama overrules a liberal congress.
http://www.huffingtonpost.com/miles-mogulescu/ny-times-reporter-confirm_...
Yes, Hillary is saying that she is considering a public plan in response to the Aetna betrayal of Obama' pact with the big insurers. Has anyone noticed that the Democrats love to make populist promises knowing full well that they have no chance of getting through the Republican House?
When Sanders spoke of his New Deal policies, centrist pundits like Krugman derided it as the stuff of "fairies and unicorns", but apparently, when Clinton speaks of instituting government programs, it's sober realism.
The time to institute a public plan was 2009 when the Dems held both chambers. That was the time to enact many worker-friendly policies, but the Dems didn't. Now all they can do is promise that next time will be different.
And pundits like Krugman recognize that there is a problem with promises in the absence of enacting substantive policy - that's why he's rewriting history.
Actually, Obama dropped the public plan, much to the chagrin of Democrats in congress, where support for the populist policy was surging. It was a situation that would be repeated dozens of times over the next several years: centrist Obama overrules a liberal congress.
http://www.huffingtonpost.com/miles-mogulescu/ny-times-reporter-confirm_...
Yes, Hillary is saying that she is considering a public plan in response to the Aetna betrayal of Obama' pact with the big insurers. Has anyone noticed that the Democrats love to make populist promises knowing full well that they have no chance of getting through the Republican House?
When Sanders spoke of his New Deal policies, centrist pundits like Krugman derided it as the stuff of "fairies and unicorns", but apparently, when Clinton speaks of instituting government programs, it's sober realism.
The time to institute a public plan was 2009 when the Dems held both chambers. That was the time to enact many worker-friendly policies, but the Dems didn't. Now all they can do is promise that next time will be different.
And pundits like Krugman recognize that there is a problem with promises in the absence of enacting substantive policy - that's why he's rewriting history.
9
"the next several years...centrist Obama over rules a liberal congress"? While I would agree Obama is "centrist" in today's political climate, I think you are forgetting that the Democrats had a filibuster proof Senate majority for a little over one year. There was a very small window of time to get health care reform done, never mind any broader liberal agenda.
3
For all their pro-union and anti-inequality talk, they refused to bring the Employee Free Choice Act up for a vote or increase the minimum wage to a reasonable level. They could have attempted to stop the tax credits to offshoring corporations.
Just a partial list of their non-accomplishments with which they could appeal to working people - as it stands now, all they have are promises and a health care reform that just marginally improved the previous much despised system. Thankfully, their opponent this time around is a ridiculous blowhard billionaire.
Just a partial list of their non-accomplishments with which they could appeal to working people - as it stands now, all they have are promises and a health care reform that just marginally improved the previous much despised system. Thankfully, their opponent this time around is a ridiculous blowhard billionaire.
Are the Health Insurance Companies that are leaving the Market or reducing their presence due to losses caused by a “too many older expensive insurance holders vs. Younger Healthier Insurance Holders ratio” being audited or checked in regards to the veracity of their statements/reasons?
i.e. are these "Losses” actual losses or something else such as a reduced profit than previously and are these losses in fact due to the reason at hand and not some other factor, area or result of the companies accounting or business practises?
Aetna “warning the Justice Department last month that the company would curtail its participation in the exchanges if the government sued to block its acquisition of Humana, a major competitor...” is completely unacceptable and gives doubt to
its reasons for withdrawing from health markets.
I hope these Companies are given the scrutiny needed to ensure that their actions are valid and acceptable given the importance and need of every American deserving such a basic right as medical coverage not just those who can afford it or whether an Insurer decides it is worth their while or not.
There are bigger issues
i.e. are these "Losses” actual losses or something else such as a reduced profit than previously and are these losses in fact due to the reason at hand and not some other factor, area or result of the companies accounting or business practises?
Aetna “warning the Justice Department last month that the company would curtail its participation in the exchanges if the government sued to block its acquisition of Humana, a major competitor...” is completely unacceptable and gives doubt to
its reasons for withdrawing from health markets.
I hope these Companies are given the scrutiny needed to ensure that their actions are valid and acceptable given the importance and need of every American deserving such a basic right as medical coverage not just those who can afford it or whether an Insurer decides it is worth their while or not.
There are bigger issues
5
The ACA is one big disaster of the democrats making ONLY. They had super majorities in both houses of congress and the Whitehouse. Any and all of Obamacares faults fall squarely on the Obama, Pelosi and Reid. My coverage in Ohio for a Bronze Wellness HSA compliant plan went from under 300/per month to 1100.00 per month with an increased deductible from 10k to 12k. How anyone can say Obamacare is controlling costs probably don't buy their own insurance. Not to mention, All the 30-35 hours per week people that had their hours cut to under 30hrs to skirt the law's force to provide health insurance. It was designed to collapse and have us clamor for a single payer.
What a joke.
What a joke.
7
Vote in representatives that would expand Medicare to at least compete with the private insurers.
5
Competition involves a level playing field. How would private companies compete against the govt plan that can run deficits as far as the hubble space telescope can see??? Kinda like we are doing now.
Mr. Krugman, please let's hear about the real problem facing us and health care.
Calvin Coolidge said, "The Business of America id Business. I think it could now be changed to, "The Business of America is Profiteering."
Atlantic Magazine: New Health Rankings: Of 17 Nations, U.S. Is Dead Last
http://www.theatlantic.com/health/archive/2013/01/new-health-rankings-of...
What is wrong with us? What is it about "American Exceptionalism" that makes us the stupidest people in the developed countries? Why are we consistently being squeezed dry by profiteers. Why do we allow our health to be a commodity for enriching corporations. Our lifestyle is unhealthy because it pays for corporations keep us unhealthy. We have become addicted to fats, sugars and salt because it's good for business. Profiteers have us exactly where they want us.
The answer is very complicated; however, it is exacerbated by an ignorant, foolish people who think they are exceptional. Yes, exceptionally stupid and open to manipulation.
Calvin Coolidge said, "The Business of America id Business. I think it could now be changed to, "The Business of America is Profiteering."
Atlantic Magazine: New Health Rankings: Of 17 Nations, U.S. Is Dead Last
http://www.theatlantic.com/health/archive/2013/01/new-health-rankings-of...
What is wrong with us? What is it about "American Exceptionalism" that makes us the stupidest people in the developed countries? Why are we consistently being squeezed dry by profiteers. Why do we allow our health to be a commodity for enriching corporations. Our lifestyle is unhealthy because it pays for corporations keep us unhealthy. We have become addicted to fats, sugars and salt because it's good for business. Profiteers have us exactly where they want us.
The answer is very complicated; however, it is exacerbated by an ignorant, foolish people who think they are exceptional. Yes, exceptionally stupid and open to manipulation.
8
But with DT telling us that people won't die in the streets... I feel better already, believe me!
2
Krugman, you are such a shill. You never cease to amaze me. When I hit that bump my doctor, my health care plan and my $2500 annual savings flew right out of the window. Guess I'm going to have to read that bill to see what's in it so I can figure this out.
6
Americans have long passed the point where they are willing to sacrifice anything for the greater good. For example how many are willing to pay a little more in health care costs as part of helping others to afford it? Probably a lot less then you would think. People are inherently selfish. That is why we do not have a direct democracy. People would just vote their own self interests regardless of the impact to the country as a whole. Leaders in contrast have to consider the welfare of all.
The bottom line with health care costs is that Americans demand more care than we can afford. And as the population ages it will just get more and more costly. The only answer is to have a government run single payer system with intelligent rationing built in. But Republicans continue to peddle the "you can have it all and not have to pay for it" snake oil. It's what people want to believe and helps Republicans hold onto power. There is no hope until the Democrats get control of all three branches of government. Until then things will just get worse and worse. Bigger and bigger deficits driven by broad tax cuts and austerity budgets.
The American people will continue to be punished with their short sighted voting selections. They will need to be punished a hell of a lot more before they wake up. A turn to support Trump was the first sign that they acknowledge that Republican policies are not working. Unfortunately Trump is not the answer. Her will only make things worse.
The bottom line with health care costs is that Americans demand more care than we can afford. And as the population ages it will just get more and more costly. The only answer is to have a government run single payer system with intelligent rationing built in. But Republicans continue to peddle the "you can have it all and not have to pay for it" snake oil. It's what people want to believe and helps Republicans hold onto power. There is no hope until the Democrats get control of all three branches of government. Until then things will just get worse and worse. Bigger and bigger deficits driven by broad tax cuts and austerity budgets.
The American people will continue to be punished with their short sighted voting selections. They will need to be punished a hell of a lot more before they wake up. A turn to support Trump was the first sign that they acknowledge that Republican policies are not working. Unfortunately Trump is not the answer. Her will only make things worse.
1
Krugman you have no intellectual integrity. You have become a political hack. I know multitudes of people who have attempted to buy insurance through Obamacare but have found it prohibitively expensive and thus are forced to pay the fine. When you subtract the number of people who lost their insurance when the plan was implemented from the number of people who signed up for coverage, the people who are actually newly covered is minuscule. Furthermore it is a huge drag on the economy. You are wrong on almost every count because you aren't using facts you are using rhetoric.
7
Vote in people who will expand Medicare.
3
Most people just don't realize how comfortable it is to live in a smart, Democratically controlled state, such as California, where Republicans have been competitive but have been essentially vanquished. In California, the state negotiates the details of the plans on the Exchange, leaving customers to choose among networks on the basis of price, doctors, and performance reputation. (The Exchange displays star ratings based on patient satisfaction, like most online sales sites. Who'da thunk it?) It makes things easy. If you prefer a particular doctor or hospital, you inquire what plans he or she is on and choose accordingly, balancing your preference against price. As there are numerous insurers in the marketplace, this brings greater choice even with more narrow-network HMO plans in the mix. My wife and I first chose a somewhat more expensive plan based on a particular specialist she wanted for a surgical procedure. For Californians, it seems odd, almost unbelievable, that there are states where it is any other way. The same with all those pictures of inexplicably long lines at the polls we see every cycle from other states. Please, please don't move here. We have enough. But that's a hint for November, folks. More sensible government may be as close as removing the do-nothing, anti-government Republicans nearest you.
24
It is far past time to get profits completely out of our health care dialog.
Not just in health insurance, either.
I am referring to the poisons in our food
pesticides in our children's clothes
high fructose corn syrup
gun related deaths and maimings
We have allowed a____________(fill in the blank) industrial complex to completely take over our government and our economy and it is destroying the nation and it is destroying capitalism itself.
It is time to return to a real market economy, not one so invested in subsidies.
Not just in health insurance, either.
I am referring to the poisons in our food
pesticides in our children's clothes
high fructose corn syrup
gun related deaths and maimings
We have allowed a____________(fill in the blank) industrial complex to completely take over our government and our economy and it is destroying the nation and it is destroying capitalism itself.
It is time to return to a real market economy, not one so invested in subsidies.
3
There many things that can be done to improve health care.
The best would be to extend Medicare to all.
Conservatives do not want ACA . They have tried to repeal it many times.
They do not want Medicare or even Social Security.
The main objection is simply that these programs tax the rich to provide benefits for the non-rich.
The GOP program for health care is to ration care by ability to pay and if people die as a result of not getting preventative /screening care [which the ER does not do] then too bad.
The best would be to extend Medicare to all.
Conservatives do not want ACA . They have tried to repeal it many times.
They do not want Medicare or even Social Security.
The main objection is simply that these programs tax the rich to provide benefits for the non-rich.
The GOP program for health care is to ration care by ability to pay and if people die as a result of not getting preventative /screening care [which the ER does not do] then too bad.
9
"And I’m hearing suggestions that states may be able to offer their own public options; if these proved successful, they might gradually become the norm."
This would be a great tool to move closer to single payer. If states start
taking the reigns and provide public plans, slowly pushing out the insurers one by one, we could get there.
This would be a great tool to move closer to single payer. If states start
taking the reigns and provide public plans, slowly pushing out the insurers one by one, we could get there.
7
Sir,
Are you crazy? "Easily fixed?!"
Did you read the other article about ObamaCare in this week's Times? The most important thing to consumers is cost of premiums. If I did not have employer-provided health insurance, my premium would be more than my house payment. Therefore, I would be uninsured, and my government would fine me for having the temerity to not have enough income to pay their ridiculous charges.
"Easily fixed" my foot!
Are you crazy? "Easily fixed?!"
Did you read the other article about ObamaCare in this week's Times? The most important thing to consumers is cost of premiums. If I did not have employer-provided health insurance, my premium would be more than my house payment. Therefore, I would be uninsured, and my government would fine me for having the temerity to not have enough income to pay their ridiculous charges.
"Easily fixed" my foot!
7
Let's expand Medicare. Don't vote for anyone who doesn't support this single payer system.
1
She's "competent?" At what? Had she less hubris as First Lady, we might be enjoying the public option now. Then again, as First Lady she came under ire on a Bosnian tarmac. "Not." Not so much a failure as Senator, more of a Do'Little, though the NY Times ran a piece noting her proficiency at fetching coffee for senior male colleagues. Her stint at State is appalling for its bellicosity, short-term thinking with no follow through, and inability to appreciate the sure-to-follow stinkstorm her use of a private email server would beget. Of course, she told the truth about that throughout. "Not."
She has a great résumé ... until you look past the job titles.
She has a great résumé ... until you look past the job titles.
6
Krugman writes
"And many of these private insurers are now finding themselves losing money, because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
In fact this is the most essential subject about health care, In all over the world.
Two things are vital in this system
1-Profit based health care doesn't work for large populations.
2-America is the 4th largest population on the planet.
Private insurers and their philosophy cannot be sustainable in the quasi universal (Obama care) or full Universal system.
Health care will never be profitable period for very large populations.
Look You can run a private hospital with profit, that si most and best can be achieved.
Once you reach health care for masses, you have left 2 options.
1- Private insurers which dictate vast swath of population cannot be insured due to health conditions.
2- Universal insurance system which ensure mass population wellness but economical burden should be hauled by government.
In small nations population less then 10 million and developed economy, yes private system works.
But 320 million population USA , private insurers cannot operate, it is just not possible.
"And many of these private insurers are now finding themselves losing money, because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
In fact this is the most essential subject about health care, In all over the world.
Two things are vital in this system
1-Profit based health care doesn't work for large populations.
2-America is the 4th largest population on the planet.
Private insurers and their philosophy cannot be sustainable in the quasi universal (Obama care) or full Universal system.
Health care will never be profitable period for very large populations.
Look You can run a private hospital with profit, that si most and best can be achieved.
Once you reach health care for masses, you have left 2 options.
1- Private insurers which dictate vast swath of population cannot be insured due to health conditions.
2- Universal insurance system which ensure mass population wellness but economical burden should be hauled by government.
In small nations population less then 10 million and developed economy, yes private system works.
But 320 million population USA , private insurers cannot operate, it is just not possible.
4
We MUST eliminate networks, which stifle competition and limit choice. In my area, we just have a couple of insurer options, but my doctor was taken over by a big network, which only takes insurance from one of them--the more expensive one! These large hospital-based networks, which tend to swallow everything in their path, are helping to drive up costs for patients.
Another factor is that you can't go to any doctor with your insurance, a real problem while traveling.
We should be able to use ANY insurance with ANY doctor or hospital ANYWHERE in the US.
I'm skeptical that insurers are pulling out just because "Americans are..sicker.. than we realized." Most of the newly insured have, like me, very high-deductible policies--they probably won't go near a doctor because they still have to pay a huge sum out of pocket.
Another factor is that you can't go to any doctor with your insurance, a real problem while traveling.
We should be able to use ANY insurance with ANY doctor or hospital ANYWHERE in the US.
I'm skeptical that insurers are pulling out just because "Americans are..sicker.. than we realized." Most of the newly insured have, like me, very high-deductible policies--they probably won't go near a doctor because they still have to pay a huge sum out of pocket.
4
Medicare controls reimbursement costs successfully for an ailing population that utilizes health care more than young and healthy individuals. Private insurance companies control enrollment more than costs.
Medicare works and always did while the private insurers are now financially challenged. Obviously, the "Free Market" is more costly.
Medicare works and always did while the private insurers are now financially challenged. Obviously, the "Free Market" is more costly.
6
Well thank the stars it's merely a bump, like the parking lot variety, rather than a rapidly expanding sinkhole of a jerry-rigged system borne in a sausage factory attended to by unskilled butchers and doomed to a death by design. Whew, what a relief.
4
Aside from the issue of whether healthcare should be a business at all, it's quite clear how committed the Insurance Companies are to free market capitalism.
They don't want to deliver the product they market if they can't extort maximum profits. They don't want competition but will only play if they can have a near monopoly.
In truth all the companies funding the GOP want those things .
They don't want to deliver the product they market if they can't extort maximum profits. They don't want competition but will only play if they can have a near monopoly.
In truth all the companies funding the GOP want those things .
164
The insurance companies lobbied to keep their oligopoly on health insurance and against single payer. They got what they wanted and now they are saying it's not enough??? To hell with them.
6
There is nothing "affordable" about the Affordable Care Act unless you happen to be someone who was included in expanded Medicaid coverage in your state or whose entry-level commercial insurance premium is heavily subsidized by the federal government because your income level meets the requirements. As a disabled patient who qualifies for Medicare (highly government -subsidized), I pay less than $400 per month for Medicare, a supplemental policy and Part D drug coverage. Purchasing coverage for my 52 year old wife to replicate the health insurance she had while I was working cost $567 per month in 2014, then $788 monthly in 2015, now $1008 per month in 2106. These figures don't include deductibles or copays. At the current rate of annual percentage increase, we'd be paying nearly $5,000 per month for her health insurance before she qualifies for Medicare at age 65, assuming we could manage it financially. How this meets anyone's criteria of "affordable" is beyond comprehension.
120
I am sure what you say is true for you and your household. But it's difficult to assess your situation without knowing what it would likely have been had Obamacare not passed -- whether the increases would have been higher and the changes in existing policies would have made them much less attractive; or whether they'd even be available to you at any price. In the private market, I recall that 17% (1/6) of all policies were cancelled or re-written each year before 2010. Sounds to me that your family would benefits from a simpler system, like Medicare or single-payor.
David --
Your and your wife's experience -- as unfortunate as it is -- tells the real story. It offers factual data and numbers religiously ignored or avoided by proponents of the ACA, like Paul Krugman.
Family coverage offered by my company’s insurance plan is $17K/year -- plus a $3K deductible. Even though the company pays 40%, that still leaves the employee with more than $10K in premiums and then another $3K in deductibles before the family actually begins benefitting from its health insurance.
$13K/year in out-of-pocket costs range btw 25 and 30% of one's salary.
This is not health coverage. Call it health insurance if you like, but if you’re honest you ned to call it by its real name: Extortion.
And middle class families trying to be responsible members of society are taking a terrific financial beating.
Your and your wife's experience -- as unfortunate as it is -- tells the real story. It offers factual data and numbers religiously ignored or avoided by proponents of the ACA, like Paul Krugman.
Family coverage offered by my company’s insurance plan is $17K/year -- plus a $3K deductible. Even though the company pays 40%, that still leaves the employee with more than $10K in premiums and then another $3K in deductibles before the family actually begins benefitting from its health insurance.
$13K/year in out-of-pocket costs range btw 25 and 30% of one's salary.
This is not health coverage. Call it health insurance if you like, but if you’re honest you ned to call it by its real name: Extortion.
And middle class families trying to be responsible members of society are taking a terrific financial beating.
2
I'm very sorry that you live in a state that is doing everything in its power to make ACA a failure,
In New York, we have had a very different experience.
I am a broker on the NY State of Health marketplace. We originally anticipated signing up a lot of 26-40 year olds who work at jobs with no group insurance.
Instead we have many new members who are married to people over 65 (on Medicare). They now can get affordable single coverage and choose among many different providers...my county has 5 insurers participating and keeping costs down. I have enrolled women married to retirees who can now retire themselves before age 65; freelancers who now have the freedom to pursue their goals of working independently; small business owners, who were pleasantly surprised that cost for individual plans has fallen (to match the government subsidized plans).
It is a godsend for those who cannot afford COBRA when they lose their jobs. Marketplace insurance is often less than half of COBRA for a similar plan.
You choose to live in a state that seems to place political expediency above the needs of its citizens. That's sad.
In New York, we have had a very different experience.
I am a broker on the NY State of Health marketplace. We originally anticipated signing up a lot of 26-40 year olds who work at jobs with no group insurance.
Instead we have many new members who are married to people over 65 (on Medicare). They now can get affordable single coverage and choose among many different providers...my county has 5 insurers participating and keeping costs down. I have enrolled women married to retirees who can now retire themselves before age 65; freelancers who now have the freedom to pursue their goals of working independently; small business owners, who were pleasantly surprised that cost for individual plans has fallen (to match the government subsidized plans).
It is a godsend for those who cannot afford COBRA when they lose their jobs. Marketplace insurance is often less than half of COBRA for a similar plan.
You choose to live in a state that seems to place political expediency above the needs of its citizens. That's sad.
The biggest problem with the ACA is the need for a stronger individual mandate. Increasing the penalties for not purchasing health insurance will shift the incentive for more young, healthy people to make the rational decision to purchase health insurance policies. For insurance companies, this will result in overall improvements in the health of both their pools of insured individuals AND their bottom lines. Further, it will reduce the number of uninsured people walking into hospital emergency rooms for expensive care that’s currently subsidized by private insurers, government funding, and hospital charity.
As for a public option, we'd almost certainly have one if Joe Lieberman didn't see the need to suck up to private insurance companies in 2010.
As for a public option, we'd almost certainly have one if Joe Lieberman didn't see the need to suck up to private insurance companies in 2010.
4
This is just so depressing. Unless we have a "wave" election, nothing will change. Guess what? Nothing will change. The repuglicans have paid no price for their scorched earth obstruction and sabotage. None! But we have; in the form of Donald Trump. And even he isn't repellent enough to override the gop gerrymandering. Like I said... so depressing.
BTW... In today's Upshot, the Obamacare plans are accurately described as medicaid plus, with high (and getting higher) deductibles and narrow (getting narrower) networks. Maybe a column on these realities??
BTW... In today's Upshot, the Obamacare plans are accurately described as medicaid plus, with high (and getting higher) deductibles and narrow (getting narrower) networks. Maybe a column on these realities??
3
Sir, the republicans had nothing to do with the enactment of Obamacare. We'd all be better off if they had been able to obstruct Obamacare, or at least have had some input, which is failing badly. If the dems had had their way about everything in the last eight years we would bed far more deeply in debt than we ares now.
2
Madame, no, they didn't. But that was their choice. Complete obstruction. The unwillingness to work with a popularly elected president who ran on passing health care.
Of course, the whole stupid plan was hatched in the back rooms of the Heritage foundation for a republican candidate, Bob Dole who ran on this exact plan and had the support of the gop establishment, you know, the exact same folks who decided that making the Black man in the White house fail on day one would be the best thing they could possibly do as the nation was hemorrhaging 800,000 jobs per month, the auto industry was on the verge of extinction and the stock markets had lost more than half their value taking most peoples retirement saving with it... oh, and the housing mortgage crisis... and of course, 48,000,000 uninsured americans.
But you're right, the republicans had nothing to do with passing this ridiculous giveaway to the insurance industry and big pharma. They certainly had no interest in helping the 48 million during the Bush years (six of the eight with unified gop congress). But, to give them the credit due, the last administration did start two wars, one, based on lies - off the books - while giving two huge tax breaks to the wealthiest among us.
Maybe you should tell the 28,000,000 newly insured americans that they were better off without access to healthcare.
Of course, the whole stupid plan was hatched in the back rooms of the Heritage foundation for a republican candidate, Bob Dole who ran on this exact plan and had the support of the gop establishment, you know, the exact same folks who decided that making the Black man in the White house fail on day one would be the best thing they could possibly do as the nation was hemorrhaging 800,000 jobs per month, the auto industry was on the verge of extinction and the stock markets had lost more than half their value taking most peoples retirement saving with it... oh, and the housing mortgage crisis... and of course, 48,000,000 uninsured americans.
But you're right, the republicans had nothing to do with passing this ridiculous giveaway to the insurance industry and big pharma. They certainly had no interest in helping the 48 million during the Bush years (six of the eight with unified gop congress). But, to give them the credit due, the last administration did start two wars, one, based on lies - off the books - while giving two huge tax breaks to the wealthiest among us.
Maybe you should tell the 28,000,000 newly insured americans that they were better off without access to healthcare.
1
Interesting that the bump that Obamacare is hitting was predicted by those opposing the terms and conditions that were being proposed.
Sadly, the Democrats in Congress, Barack Obama, and even Dr. Krugman, were too arrogant to listen...
They are the ones, and the only ones, to blame for the mess and the messes still to come.
Sadly, the Democrats in Congress, Barack Obama, and even Dr. Krugman, were too arrogant to listen...
They are the ones, and the only ones, to blame for the mess and the messes still to come.
6
An article appeared yesterday exposing real problems with the ACA.
My comment on the article began:
"Never fear, Krugman will soon write another glowing missive about the massive success of the ACA."
The next day we have this clap trap from Krugman.
If only the NYT's partisanship were not so predictable.
My comment on the article began:
"Never fear, Krugman will soon write another glowing missive about the massive success of the ACA."
The next day we have this clap trap from Krugman.
If only the NYT's partisanship were not so predictable.
6
Turns out hypocrites throw rocks at windows, but never pay to fix them. It'll rain,
2
As predicted, it turns out that paul is a hypocrite!
He said hillary could get things done, but Bernie couldn't, even with a republican congress. Now? Not.
He said hillary could get things done, but Bernie couldn't, even with a republican congress. Now? Not.
5
The Aetna story made me cringe. I could hear all my republican friends blaming Obama. They blame Obama for the rate hikes, the loss of their doctors, and the other issues that surfaced when the law went into effect. All I know is the insurance companies must have a powerful lobby in Washington and must spend a ton of money on media advertising because nobody criticizes where the real problem lies. IT'S THE INSURANCE COMPANIES, STUPID. They had a great run for many years by only insuring the relatively healthy. Large employers got the best deals and when rates were raised who cared. The employee didn't care, they weren't paying anything for it, the employer didn't care they just received a larger tax reduction. The medical industrial complex didn't care they could charge $50 for an Advil. If Trump wins and the republicans take the senate and keep the house we will go back to the republican healthcare plan. If you get sick or are sick go off and die somewhere. And once they cause medicare to go bankrupt, don't you dare raise the cap on medicare taxes, if you get old, go off and die somewhere.
185
Why is there any blame for Republicans? They did not vote for any part of this?
4
There's another obvious solution. Large Claim Pooling - providing a fund that collects a fixed small premium from every exchange issued plan that reimburses insurance companies for large claims. Effectively the exchange providers can get reimbursed from the fund whenever a claim exceeds a specified amount, say $100,000. This protects insurers from the misfortune of being randomly selected by future heart attack victims. The law contemplates this need - it's called "risk corridors" and it just needs an administrative and pricing fix to provide downside risk protection for exchange participants. It worked in Medicare Part D.
But i think there's another aspect of the economics that the professor may want to consider. It appears that the smaller players are exiting the market - Aetna is leaving those places where their market share is 16%, for example. It could be that the price sensitivity of exchange plans means only the insurance companies who negotiate the deepest discounts will survive. Blue Cross might report losing money on exchange plans, but the additional covered lives gives them negotiating power that benefits them with the non-exchange plans. We might be in a system where there can only be 2 - 4 exchange players, because less than 20% market share lacks the negotiating power to get the discounts from doctors and hospitals sufficient to remain price competitive. Aetna's leaving might not be a canary in a coal mine, but rather the weakest of the herd being culled.
But i think there's another aspect of the economics that the professor may want to consider. It appears that the smaller players are exiting the market - Aetna is leaving those places where their market share is 16%, for example. It could be that the price sensitivity of exchange plans means only the insurance companies who negotiate the deepest discounts will survive. Blue Cross might report losing money on exchange plans, but the additional covered lives gives them negotiating power that benefits them with the non-exchange plans. We might be in a system where there can only be 2 - 4 exchange players, because less than 20% market share lacks the negotiating power to get the discounts from doctors and hospitals sufficient to remain price competitive. Aetna's leaving might not be a canary in a coal mine, but rather the weakest of the herd being culled.
2
This is the problem with healthcare for profit. Another issue is all the mandated tests - that cost $1000 per test: bone density, annual mammograms even for those not at risk, drugs when healthy habits would alleviate many. The healthcare companies would save money by cutting advertising, executive wages and unecessary testing and drugs.
2
Barrbara, are you aware that the current prices of 3-D imaging systems for mammography are half-a-million dollars PLUS installation and maintenance costs. On top of that, there are the employee costs to operate them and the administrative support needed to schedule and to bill patients?
Do you think that the manufacturers of these devices just give them away?
Do you think that the hospitals should just eat ALL of the costs?
Do you really think that a "free" health care system won't be responsible for paying the bills?
How do you think the "free" health care system is going to get the money that they need to stay in business?
How much do you think the taxpayer is going to be willing to pay? Please note that Vermont in the recent past gave up on universal health care because the residents of the State were unwilling to pay the bill.
So, please outline for us the mechanisms that you believe will deliver universal health care at price that The People are going to be willing to support?
Being specific would help our understanding of your proposals.
Do you think that the manufacturers of these devices just give them away?
Do you think that the hospitals should just eat ALL of the costs?
Do you really think that a "free" health care system won't be responsible for paying the bills?
How do you think the "free" health care system is going to get the money that they need to stay in business?
How much do you think the taxpayer is going to be willing to pay? Please note that Vermont in the recent past gave up on universal health care because the residents of the State were unwilling to pay the bill.
So, please outline for us the mechanisms that you believe will deliver universal health care at price that The People are going to be willing to support?
Being specific would help our understanding of your proposals.
1
I donated to, campaigned for, and supported Mr. Obama specifically because of the need for medical care insurance for all. Although I think he has done a number of things correctly, the ACA is not one of them.
Essentially the entire population of the US, at least the citizens of the US, was delivered, bound hand and foot, to the medical insurance companies. The public option, which I felt was very much needed, was deleted at the request of those companies. All the people who were told that their medical insurance could be kept found out they'd been lied to, and their premiums, promised not to rise, indeed did rise.
I've practiced medicine since 1982, and nothing I've ever experienced or seen has made me trust medical insurance companies or drug companies. Not only are they quite greedy, they are also very canny, and in this instance, cannier than the President and the government.
Perhaps Aetna can be replaced. If so, it may not be such a loss. It isn't as if they are a benign outfit, and it isn't as if they have anyone's interest other than their own financial one, close to their heart.
Essentially the entire population of the US, at least the citizens of the US, was delivered, bound hand and foot, to the medical insurance companies. The public option, which I felt was very much needed, was deleted at the request of those companies. All the people who were told that their medical insurance could be kept found out they'd been lied to, and their premiums, promised not to rise, indeed did rise.
I've practiced medicine since 1982, and nothing I've ever experienced or seen has made me trust medical insurance companies or drug companies. Not only are they quite greedy, they are also very canny, and in this instance, cannier than the President and the government.
Perhaps Aetna can be replaced. If so, it may not be such a loss. It isn't as if they are a benign outfit, and it isn't as if they have anyone's interest other than their own financial one, close to their heart.
6
This article proves once again Krugman lives in an alternate reality. One tainted by happy talk supporting anything and everything liberal and critical and naysaying about anything that's not. He is wrong about one significant fact... The full effect of Obamacare happens in 2017... purposely designed that way so the current occupant of the WH would be out of office. Insurers are pulling out because the poorly designed law was built on financial fantasy and the strategy, admitted to by it's chief architect, of reliance on the stupidity and naivete of the American people.
4
Saying Obamacare has hit a bump is like saying Lincoln hit some lead at Ford Theater. The ACA was fundamentally flawed from the start and destined to fail without bipartisan support. Yes, there are fewer uninsured, but all of them could have been covered through an expansion of Medicaid, which is essentially what the ACA has done. Despite its name, the ACA has done nothing to make health care more affordable for middle income and those whose income is just 1 SD above the mean. Professor Krugman is being willfully disingenuous when he links a decline in health care costs to the implementation of the ACA. Analysts from both sides have agreed that costs were already declining prior to the ACA. Whether the ACA contributed to any more declines is debatable. It is equally possible that the marketplace was already leading to caps in health care spending. I actually support a single payer system (just like PK used to -- read posts from the 90's), but I'm pessimistic that we'll ever see this in the USA.
6
I believe that we should have totally socialized medical health care, and totally do away with the health care insurance businesses.
In 1950 the nation spent less than 1/2% of the GDP for medical care.
Now medical care costs are over 18% of the GDP, growing rapidly, and predicted to be 20% in the next few years. How much can the nation afford to spend on Medical Care before the nation becomes bankrupt?
In 1950 the nation spent less than 1/2% of the GDP for medical care.
Now medical care costs are over 18% of the GDP, growing rapidly, and predicted to be 20% in the next few years. How much can the nation afford to spend on Medical Care before the nation becomes bankrupt?
6
You really can't compare the cost of medical care in 1950 to medical care today. I have stage 4 inoperable cancer. In 1950 I would have had an X-ray and been told to go home and wait for death. Today I am receiving treatment that has stopped the cancer, but the cost of my care provided by private insurance is over $120,000 per year.
Yes healthcare is more expensive than in the past, what we need is both parties to get together in a positive way to ensure that as many people are covered as possible in the most efficient way possible. One example, letting medicare negotiate drug prices.
Yes healthcare is more expensive than in the past, what we need is both parties to get together in a positive way to ensure that as many people are covered as possible in the most efficient way possible. One example, letting medicare negotiate drug prices.
1
The problem with health care reform is that it is so complex that no one is willing to address all the issues. There is no silver bullet for reform. In the U.S. healthcare is another big business, out to maximize profits for the few. While Obama’s initial intent was noble, he failed to take into account that there is more to healthcare reform than insurance, and he blew it completely by flipflopping on the public option.
It isn’t enough to impose single payer. The entire system needs to be sliced and diced and then reconstructed to something that offers patients affordable care with choices. The model has already been used in Israel, Canada and Europe. Medicare for all is another option. Any flaws can be fixed. Many countries have universal health care and the option of paying an additional fee for supplemental care. And then there’s the issue of discrimination. Ask an epidemiologist where outcomes differ among racial groups.
Now let’s discuss some of the costs. Progress is expensive. We’ve known for years that a good portion of health care expenses is administration. Reduce it. Hospital CEO pay should also be reduced. Hospitals are good because of the doctors, not because of the CEOs. A community hospital cannot compete with a university teaching hospital such as Yale. The salaries are not far apart, but the quality of treatment is not comparable. Drug prices high because of R&D? Come on! Big Pharma gets Big Money from Big Government to develop and test new meds.
It isn’t enough to impose single payer. The entire system needs to be sliced and diced and then reconstructed to something that offers patients affordable care with choices. The model has already been used in Israel, Canada and Europe. Medicare for all is another option. Any flaws can be fixed. Many countries have universal health care and the option of paying an additional fee for supplemental care. And then there’s the issue of discrimination. Ask an epidemiologist where outcomes differ among racial groups.
Now let’s discuss some of the costs. Progress is expensive. We’ve known for years that a good portion of health care expenses is administration. Reduce it. Hospital CEO pay should also be reduced. Hospitals are good because of the doctors, not because of the CEOs. A community hospital cannot compete with a university teaching hospital such as Yale. The salaries are not far apart, but the quality of treatment is not comparable. Drug prices high because of R&D? Come on! Big Pharma gets Big Money from Big Government to develop and test new meds.
5
So what happened to the penalties that were supposed to be levied upon non-participants? Isn't that the crux of the problem? Maybe those penalties aren't stiff enough. Everyone should have insurance and contribute to the pool, healthy or not. Even if it were universal, everyone would have to pay for it, one way or another. It can be called a tax, or it can be called a premium.
2
The real problem with the Affordable Care Act is that it does not have sufficient provisions to force costs down to a reasonable and equitable level; or to say this in a more colloquial manner, it cannot tame the all-consuming greed of the drug companies, the hospitals, the doctors, and the medical equipment suppliers.
As Mr. Krugman points out, the ACA has slowed the increase in medical costs, but America will spend 17 percent of GDP on healthcare this year, and even at the current level, the rate of increase of medical costs still surpasses the growth in GDP, which means that costs will continue to take a larger and larger share of America's wealth. How much longer will Americans allow this to continue, while pressing national needs go unmet because of lack of funds?
America spends twice as much as any other major industrialized country on health care, and our outcomes are no better than any of these other countries. The healthcare lobby is extremely strong, but at some point the American people have to stand up and proclaim that "enough is enough".
As Mr. Krugman points out, the ACA has slowed the increase in medical costs, but America will spend 17 percent of GDP on healthcare this year, and even at the current level, the rate of increase of medical costs still surpasses the growth in GDP, which means that costs will continue to take a larger and larger share of America's wealth. How much longer will Americans allow this to continue, while pressing national needs go unmet because of lack of funds?
America spends twice as much as any other major industrialized country on health care, and our outcomes are no better than any of these other countries. The healthcare lobby is extremely strong, but at some point the American people have to stand up and proclaim that "enough is enough".
3
There is only ONE option: Medicare For All.
Forget all the other "reasonable compromises", they're all just variations on for-profit health care, which is at the very root of the problem. Somewhere along the line Americans - or a great many of them - bought into the idea that it's one of "Nature's Laws" (Law of the Jungle?) that profit should be made off of people's misfortune. Isn't that the epitome of capitalism - taking advantage of someone when they have no choice (despite the free use of the word choice" in all the insurance schemes and plans)?
But the very nature of society - the banding together of people to derive strength in numbers, where the weakest can be protected by the strongest - proves that conservative theory wrong. The only solution is Single Payer. If, due to politics, we have to transition to that by having a "Public Option" as the quickest route, then let's do it. Obama and the Dems blew it when they wasted their control over Congress and the WH in 2010. Let's take back that control from the Obstructionist Party and get this long over due fix done.
Forget all the other "reasonable compromises", they're all just variations on for-profit health care, which is at the very root of the problem. Somewhere along the line Americans - or a great many of them - bought into the idea that it's one of "Nature's Laws" (Law of the Jungle?) that profit should be made off of people's misfortune. Isn't that the epitome of capitalism - taking advantage of someone when they have no choice (despite the free use of the word choice" in all the insurance schemes and plans)?
But the very nature of society - the banding together of people to derive strength in numbers, where the weakest can be protected by the strongest - proves that conservative theory wrong. The only solution is Single Payer. If, due to politics, we have to transition to that by having a "Public Option" as the quickest route, then let's do it. Obama and the Dems blew it when they wasted their control over Congress and the WH in 2010. Let's take back that control from the Obstructionist Party and get this long over due fix done.
7
If ever we needed a government for, by, with, and be responsive to the needs of the people it is now. Republicans have no (apparent) dog in this fight. They play only when it's time to suck money from the Public sector. That's what patriotism apparently means to these lawmakers. Evey vote cast against a republican this coming election is a step in reminding that being an elected official is to represent all the constituents, not just the wealthy.
5
The ACA barely made it through Congress after Democrats in Name Only inserted enough poison pills to kill a horse. Even the dubbing of the law as Obamacare was a poison pill planted in the media to cause 40 percent of the public to hyperventilate anytime they see or hear the name.
The ACA was so tilted in favor of the insurance industry that it is a wonder the ACA is still alive at all, but if not for that tilt, the law would never have made it past a Republican-stacked Supreme Court. After the DINOs in Congress were replaced by Koch-funded hard-right Republicans in the next election cycle, the prospects for course correction vanished; President Obama and true Democrats in Congress have had to fight just to keep Republicans from repealing the law and have watched in dread as the nebulous challenges work their way through Republican-stacked lower courts provide further opportunities for the Supreme Court to wreck the ACA.
The future of health care in this country hinges on the upcoming presidential election. A Democrat in the White House and a Democratic Senate could end the Republican jihad against health reform through the courts, provided the Senate remembers that it is there to represent the people, not a handful of psycho-billionaires. We may see many legislative changes until the House changes hands, but Americans have to start now if we want to correct the problems with ACA.
The ACA was so tilted in favor of the insurance industry that it is a wonder the ACA is still alive at all, but if not for that tilt, the law would never have made it past a Republican-stacked Supreme Court. After the DINOs in Congress were replaced by Koch-funded hard-right Republicans in the next election cycle, the prospects for course correction vanished; President Obama and true Democrats in Congress have had to fight just to keep Republicans from repealing the law and have watched in dread as the nebulous challenges work their way through Republican-stacked lower courts provide further opportunities for the Supreme Court to wreck the ACA.
The future of health care in this country hinges on the upcoming presidential election. A Democrat in the White House and a Democratic Senate could end the Republican jihad against health reform through the courts, provided the Senate remembers that it is there to represent the people, not a handful of psycho-billionaires. We may see many legislative changes until the House changes hands, but Americans have to start now if we want to correct the problems with ACA.
173
Republican jihad......Who voted for obamacare? Who controlled the WH, Senate and House in 2009 when this monstrosity was passed? Did any repub vote for it??? NO.....and all the issues fall squarely on the Dems.
2
Well said. As a life long registered Republican who voted twice for Obama, you've nailed it. Paraphrasing Regan's famous remark, "I didn't leave the Republican Party, it left me." And a whole lot of other Americans.
1
Wait a minute! Not to long ago, as a reason to not vote for pie in the sky Sanders, this two-face said hillary could, as opposed to Bernie, get things done even with republicans in charge of the Congress. Guess that line didn't work out for you, eh paul? Health care for all is the answer, not some convoluted scheme that enriches insurance companies. Oh, wait , you can't get that with Congress as it is, so don't even TRY. Just sit back and let the republicans rule, with the neo-republican hillary in the whitehouse.
4
Republicans have turned the health care issue into a political football - private insurers continue to gouge, and the Republicans get a wedge issue - match made in Hell for the rest of us. That way they never have to lift a finger, and can complain about the work done by anyone who does. It's ridiculous that we have to wait for the rare combination of a Democratic President, a 2/3 Democratic Senate, and a Democratic-majority House just to work on this issue, but that has proven to be the case.
5
So, we have to support the down ticket candidates. I've sent small donations to every Democratic candidate for Senate, and some for the House, in all the "battleground" states. I've never done that, previously, but this year seems to be a huge turning point for our country. We must sweep out self-serving obstructionist Republicans. Maybe, then, we can get something done that will benefit most Americans.
1
Thank you Dr. Krugman. The answer is to elect Hillary Clinton as President and a Democratic Senate (at least). It is time for Republicans who need health care to wake up and understand that insurance companies that must make a profit for their shareholders cannot help them.
Paying for health care should be a responsibility of all of us, ie: the government.
Paying for health care should be a responsibility of all of us, ie: the government.
6
We need a single payer system that marginalizes or even eliminates the likes of Aetna.
9
This is good news. It is only with a crisis like this that the needed reforms get pushed through. We need single payer health care.
12
Obamacare is a bit of a red herring: of course health costs are going to be high, the average American has a crap diet, not much exercise, and a ton of stress.
If we spent half as much effort on fixing the societal causes of these health issues as we do fighting over their treatment, costs wouldn't be such an issue.
If we spent half as much effort on fixing the societal causes of these health issues as we do fighting over their treatment, costs wouldn't be such an issue.
2
I thought Paul Krugman was smart.
For all his supposed genius, Mr. Krugman missed the economic analysis, the macroeconomic fallout of the Affordable Care Act. I'm a Black lawyer in Washington DC, Krugman is supposed to be the economist, how did he miss this?
We aren't seeing a "bump" with Obamacare, this is actually the smoothest part of the pavement. Aetna entered into the unholy alliance of liars with Obama, Gruber and a team of insurance and healthcare industry types. There were negotiations and agreements before all parties signed on.
Clearly Aetna's payoff was the ability to slither around within the confines of Obamacare, forming monopolies by snatching up other insurance companies so they can corner the market on price gouging. Aetna agreed to lose a few million as the ACA got started in exchange for being able to deal openly in their own interests.
The Aetna merger was blocked, another betrayal and lie from Obama who had to promise Aetna they could get away with stuff like this to get Aetna on board in the first place.
So Aetna made a macro decision. Cut the long term losses by leaving these exchanges in the short term. With United Healthcare already out, this blows an even bigger hole in the ACA's skeletal structure.
It's falling apart.
For all his supposed genius, Mr. Krugman missed the economic analysis, the macroeconomic fallout of the Affordable Care Act. I'm a Black lawyer in Washington DC, Krugman is supposed to be the economist, how did he miss this?
We aren't seeing a "bump" with Obamacare, this is actually the smoothest part of the pavement. Aetna entered into the unholy alliance of liars with Obama, Gruber and a team of insurance and healthcare industry types. There were negotiations and agreements before all parties signed on.
Clearly Aetna's payoff was the ability to slither around within the confines of Obamacare, forming monopolies by snatching up other insurance companies so they can corner the market on price gouging. Aetna agreed to lose a few million as the ACA got started in exchange for being able to deal openly in their own interests.
The Aetna merger was blocked, another betrayal and lie from Obama who had to promise Aetna they could get away with stuff like this to get Aetna on board in the first place.
So Aetna made a macro decision. Cut the long term losses by leaving these exchanges in the short term. With United Healthcare already out, this blows an even bigger hole in the ACA's skeletal structure.
It's falling apart.
8
Dr. Krugman you will receive plenty of flak for this column but I believe your report on Obamacare is accurate and you bring positive news. I suspect your thesis on the Aetna announcement being an act of vindictiveness is probably true.
For me, this column pointed out the one good reason to vote for Mrs. Clinton and for Congressional candidates who support Obamacare. However, many Americans confuse health insurance with healthcare. What America wants is good healthcare. American's should not be concerned about whether or not the private health insurers are making a good return on investment for shareholders. Americans need to turn their attention to providing accessibility to good healthcare.
The public option should be available to all, and States should get out of the insurance business. Everyone knows that the public option or single payer is the only sensible way for American's to obtain adequate healthcare. Allowing private insurers to insert themselves into this perfect natural monopoly was a mistake. Private health insurance days are numbered and investors should put their money in true healthcare enterprises, not private healthcare insurance companies.
For me, this column pointed out the one good reason to vote for Mrs. Clinton and for Congressional candidates who support Obamacare. However, many Americans confuse health insurance with healthcare. What America wants is good healthcare. American's should not be concerned about whether or not the private health insurers are making a good return on investment for shareholders. Americans need to turn their attention to providing accessibility to good healthcare.
The public option should be available to all, and States should get out of the insurance business. Everyone knows that the public option or single payer is the only sensible way for American's to obtain adequate healthcare. Allowing private insurers to insert themselves into this perfect natural monopoly was a mistake. Private health insurance days are numbered and investors should put their money in true healthcare enterprises, not private healthcare insurance companies.
5
Aetna has never been in the business of providing healthcare, only in the business of collecting premium. Most subscribers would be happy to tell us that. They must belong to the Party of NO.
2
"it’s important to realize that as far as anyone can tell, there’s nothing wrong with Obamacare that couldn’t be fairly easily fixed with a bit of bipartisan cooperation. The only thing that makes this hard is the blocking power of politicians who want reform to fail."
These two sentences are the gist of PK's entire column. The ACA is easily fixable, but the GOP Congress won't do it. What Krugman doesn't say is that unwinding the ACA after the GOP force it to fail will be catastrophic, far beyond what Republicans think.
But, then again, Republicans have shown for 35 years that they are incapable of recognizing the inevitability of unintended consequences, and how they mess things up when you don't anticipate them happening. Because they ALWAYS do.
These two sentences are the gist of PK's entire column. The ACA is easily fixable, but the GOP Congress won't do it. What Krugman doesn't say is that unwinding the ACA after the GOP force it to fail will be catastrophic, far beyond what Republicans think.
But, then again, Republicans have shown for 35 years that they are incapable of recognizing the inevitability of unintended consequences, and how they mess things up when you don't anticipate them happening. Because they ALWAYS do.
2
Is a bi-partisan fix on Obmacare going to solve the problem of giving jobs to people so that they can pay for the ever-increasing premiums?
No?
I didn't think so.
But it was a nice straw man, Dadof2.
No?
I didn't think so.
But it was a nice straw man, Dadof2.
2
Actually, ending the hemorrhaging of jobs that Bush left us with in 2009 is fixing THAT problem. Fact: When George W. Bush came into office the UI was just about where it is now. When he left office it had nearly doubled and was exploding like a ruptured aorta. Obama sealed that rupture and has spent 7 years SUCCESSFULLY reversing it.
Or are you going to play "move the goalposts" and talk about those that dropped off the unemployment rolls?
See, with a Democratic President we have slow growth and economic healing. With the last Republican President, we had catastrophic collapse. Trump will re-ignite that collapse Which do YOU prefer? Personally since those are my choices, I prefer slow growth to catastrophe, but that's just my own prejudice.
Or are you going to play "move the goalposts" and talk about those that dropped off the unemployment rolls?
See, with a Democratic President we have slow growth and economic healing. With the last Republican President, we had catastrophic collapse. Trump will re-ignite that collapse Which do YOU prefer? Personally since those are my choices, I prefer slow growth to catastrophe, but that's just my own prejudice.
What Aetna has done is despicable. What Republicans have done, to impede the availability and access to healthcare for all ages, genders, and tax brackets (except the wealthy and their colleagues of course), is equally despicable. People should be disgusted, and angry, and repulsed by the actions of this Congress, but unfortunately the GOP and its cohorts are all too pleased with themselves that they have stemmed the progress of available healthcare to the American people. It plays right in to their hands. The ACA caused premiums and deductibles to rise. It must be a total failure, right? It has to be replaced, right? They repeated the lie enough, and the people ate it up.
The way the American people - ESPECIALLY members of the bizarre and contradictory coalition that makes up the Republican Party - will consistently vote against their own self-interest is mind-boggling and infuriating.
A suggestion for the new GOP slogan: "Keep the people poor, and sick, and stupid. It is the New World Order."
The way the American people - ESPECIALLY members of the bizarre and contradictory coalition that makes up the Republican Party - will consistently vote against their own self-interest is mind-boggling and infuriating.
A suggestion for the new GOP slogan: "Keep the people poor, and sick, and stupid. It is the New World Order."
208
The integrity of the commenters on this article are at be laughable. Republicans bear NO RESPONSIBILITY for obamacare. NONE whatsoever!!!!
2
You are right, republicans do not bear any responsibility for Obamacare because they have obstructed it from its inception. 178 Republicans in the House and 39 in the Senate voted against the ACA, and have tried to roll it back at every opportunity. They insist, all along, that there are better alternatives that they can offer.
These alternatives, as delivered by Paul Ryan, include all of the popular provisions of Obamacare (because it works) but suggest that it limits patient choice (it doesn't, companies like Aetna leaving exchanges does), increases consumer costs (it doesn't, insurers provide arbitrary deductibles and premiums in response to profit loss), and that the system is now over-regulated (yes, to protect the consumer. Normally the purpose of regulation legislation).
There are no meaningful alternatives, just obstruction and indifference to the American people who needed Healthcare and could not get it. Credit should be given when credit is due, and there is no due credit for the Republicans involved in Congress since 2010. That credit belongs to President Obama and the Democrats who were not short-sighted.
These alternatives, as delivered by Paul Ryan, include all of the popular provisions of Obamacare (because it works) but suggest that it limits patient choice (it doesn't, companies like Aetna leaving exchanges does), increases consumer costs (it doesn't, insurers provide arbitrary deductibles and premiums in response to profit loss), and that the system is now over-regulated (yes, to protect the consumer. Normally the purpose of regulation legislation).
There are no meaningful alternatives, just obstruction and indifference to the American people who needed Healthcare and could not get it. Credit should be given when credit is due, and there is no due credit for the Republicans involved in Congress since 2010. That credit belongs to President Obama and the Democrats who were not short-sighted.
But don't rich, white liberals living in some gated community in Upstate New York also vote against their own interests when they support Democrats who blatantly state they'll be raising their taxes? Why do progressives assume that what's in the poor's interests is not a thriving private sector creating plentiful jobs but instead a government willing to dish out freebies? Maybe we should try to build a Danish social democracy; but I have my doubts. ... Or mightn't we simply have a, you know, REVOLUTION and transfer the ownership of the means of production to workers, like Sanders, in his heart of hearts, wants? Then we can all be equal -- equally poor.
1
"And they’ll be difficult to resolve even with a knowledgeable, competent president if she faces scorched-earth opposition from a hostile Congress."
You might want to replace the word "if" with "when" in that sentence, doc. This was known before she decided to run. So, assuming she is the next POTUS, we have another 4-8 years of absolute gridlock, thanks to you and her other champions.
We not only have obstinate republicans to blame for the dysfunction in our political system, but we also can blame the complacent, cud-chewing wing of the Dem Party, you yourself being a member.
You might want to replace the word "if" with "when" in that sentence, doc. This was known before she decided to run. So, assuming she is the next POTUS, we have another 4-8 years of absolute gridlock, thanks to you and her other champions.
We not only have obstinate republicans to blame for the dysfunction in our political system, but we also can blame the complacent, cud-chewing wing of the Dem Party, you yourself being a member.
3
And your proposed solution to partisan gridlock is..? What can Democrats do other than win more Senate and House races? Do you have a magic formula to accomplish that?
I HAD a magic formula. It was called nominating a candidate that electrified the dem base, carrying in more dems of his stripe on much bigger coattails. Those coattails are now extremely small with an electorate that is about as anti-establishment as it's ever been.
1
Some observations:
There was a public option in the original law. It was killed in committee with one Democrat, Kent Conrad, siding with the Republicans to kill it. He did not do this to please conservative constituents because his constituents booted him out at the next election over this issue. During the whole show Obama made no detectable effort to turn his vote. He is now a lobbyist thank you.
State run insurance companies have about as much likelihood of working as the insurance cooperatives of the origiaal law. too small and too little experience and expertise.
Clinton's proposal is only for people over 55.
The public option would work but in order to get it wen need not only to elect Democrats, we need took make a nice big fire and hold their feet to it. Otherwise the insurance companies will win and we will get some more lame excuse and unfilled progressive promises.
There was a public option in the original law. It was killed in committee with one Democrat, Kent Conrad, siding with the Republicans to kill it. He did not do this to please conservative constituents because his constituents booted him out at the next election over this issue. During the whole show Obama made no detectable effort to turn his vote. He is now a lobbyist thank you.
State run insurance companies have about as much likelihood of working as the insurance cooperatives of the origiaal law. too small and too little experience and expertise.
Clinton's proposal is only for people over 55.
The public option would work but in order to get it wen need not only to elect Democrats, we need took make a nice big fire and hold their feet to it. Otherwise the insurance companies will win and we will get some more lame excuse and unfilled progressive promises.
4
"There should also be a reinforced effort to ensure that healthy Americans buy insurance, as the law requires..."
Or, in other words, what Mr Krugman is demanding, are further draconian efforts to force Americans to buy a service they neither want nor need just to keep the authors of Obamacare from looking like complete, lying, fools.
The Stamp Act of 1756 was a similar act of extortion. It led to a revolution.
Or, in other words, what Mr Krugman is demanding, are further draconian efforts to force Americans to buy a service they neither want nor need just to keep the authors of Obamacare from looking like complete, lying, fools.
The Stamp Act of 1756 was a similar act of extortion. It led to a revolution.
6
Rather than an analogy to the Stamp Act, what about requirements for automobile insurance? Surely this is a better analogy. Insurance only works when risk is shared. Indeed, it is inconceivable to think about insurance without some population sharing risk. And we all at some time or another need health care.
2
Government enforced car insurance should be repealed. Government has no business demanding, at gun point, how free citizens should spend their money. There is no end to this style of government control.
State-required auto insurance--liability insurance--indemnifies others against any damage or injury you or your car causes. Whether or not you pay to protect yourself with things like collision insurance is entirely up to you. Obamacare is like forcing people to buy collision insurance whether they want it or need it or not.
I'm very curious about what Trump's plans are for health care after he repeals Obamacare. I'm sure he has no idea.
1
Mr.Krugman finally fell off the bed. After ignoring his own newspaper’s repeated reports about insurance companies’ multiplying demands for sharply increased insurance premiums, Krugman finally confronts the true roots of the ACA debacle. “Obamacare”is a fully market based reform that deals essentially with health insurance, not with the true cause of high health care expenditure, which is the absolutely wild, unregulated and unreasonable cost of health care providers’ services and products. You just cannot defend blindly a failing, market fundamentalist reform, just because Republicans attack it. In the first years of implementation of the ACA, health insurance costs have been relatively contained because insurance companies did not want to kill the proverbial goose that lays the golden egg. The ACA provided them with a huge business expansion. It was in their own best interest to keep premiums low in the immediate aftermath of the reform enactment. Yet, as just another huge market gamble, Obamacare did not provide any effective mechanism to prevent insurance companies from reversing the trend anytime they deemed it necessary (see the market failure to provide a public service here, anyone? More sick patients than expected = high increase in premiums?) to do so. For reason! The same economic-lobbying forces that prevented such mechanisms to be introduced are obviously at the origin of the failure to pass the public option, as PK himself amply acknowledges.
7
"They’re problems that would be relatively easy to fix in a normal political system..."
No, they're problems that can't be fixed at all because every significant aspect of Obamacare is based on lines, trickery, and an arrogant willingness by Democrats to cram things down the throats of Americans "for their own good."
If any American business had lied so egregiously in order to sell something, that business would be in severe legal trouble.
No, they're problems that can't be fixed at all because every significant aspect of Obamacare is based on lines, trickery, and an arrogant willingness by Democrats to cram things down the throats of Americans "for their own good."
If any American business had lied so egregiously in order to sell something, that business would be in severe legal trouble.
5
First of all American businesses lie ALL THE TIME and so do political representatives!!! I for one know what Insurance companies did to me personally. Pre-existing conditions, threat of cancelation if your cancer returns, charging outrageous premiums and then not covering the pre-existing condition. Fortunately I lived to retire and am on Medicare, but I feel sorry for any poor soul that would have to depend on an money grubbing insurance company to come through for them if the ACA "Obamacare" was discarded.
130
Amazing. A fundamental concept in conservative capitalism is lying and cheating, as long as you do not get caught. Why do you think that eliminating regulation and oversight by the government are key conservative priorities.
I know. It inhibits creativity. If it weren't for oversight and regulation, we would all die far too soon of food poisoning, collapsed architecture (building, bridges etc) poisonous pharmaceuticals etc.
Of course you are being humourous about 'severe legal trouble.' These are billion dollar industries, always pursuing growth and profit.
Who pays for those billion dollar settlements?
I know. It inhibits creativity. If it weren't for oversight and regulation, we would all die far too soon of food poisoning, collapsed architecture (building, bridges etc) poisonous pharmaceuticals etc.
Of course you are being humourous about 'severe legal trouble.' These are billion dollar industries, always pursuing growth and profit.
Who pays for those billion dollar settlements?
4
An Universal Healthcare would bring an end to this endless discussion - in NY Times, on TV talk shows, elections, Congress and anywhere else. But more importantly it would end the worries of 350 million Americans about their health care.
6
I hope and pray (praying is still legal in America isn't it?), that this unmitigated disaster called Obamacare dies a quick death. I can't go to the doctor that I used to have before, I'm paying more, and every procedure that has been recommended for either me or my family has been scrutized beyond belief and many have been declined, but of course I can pay for them out of my pocket if I want. Welcome to Obama's "fundamentally transformed" America. I knew that he would be terrible, I had no idea that he would be this bad.
5
http://seekingalpha.com/article/4000830-economics-healthcare-insurance?p...
Here is a more sobering and factual analysis for those among the readership who value realism over rhetoric and favor solutions over sloganeering.
Here is a more sobering and factual analysis for those among the readership who value realism over rhetoric and favor solutions over sloganeering.
1
Just to to get this out of the way, I am Paul Krugnan fan. Ok if you want to stop reading, you can but I an tell you predictions for the ACA one of which will come true. Read Megan McArdle at Bloomberg Views. There is no escape. One out 8 will happen. As for the public option, remember this: neither Medicare nor Medicaid collects premiums. That will have to be built and it will be very expensive. Good luck with that, neoliberalism may be dying but Republicans will squeeze your children for as long as they can. I would tell the iron law of the McArdle predictions but I am running out of battery and characters, but do yourself a favor, BloombergView, Megan McArdle, 8 possible fates for Obama Care exchanges. Read them and weep.
1
I didn't need health insurance until I did. I'm sure that is the case for many people, even Republicans.
5
"Why not let the government step up?" you ask Mr. Krugman. Aside from the fact that just one company who seems to otherwise know what it's doing still managed to lose $400 plus million dollars providing coverage for just a few hundred thousand people (never mind what the total losses are on the tens of millions of exchange insured people), if you want a preview of government provided health care, just look at how the Veterans have fared. And keep in mind that Veterans are held up as our most honored citizens, worthy of extraordinary medical care, provided by a federal agency dedicated to only serving Veterans. That experience does not bode well for the average Joe on the street I'd say.
3
As I recall, the Public Option was withdrawn when the Senator from Connecticut, Joe Lieberman, said he would not vote for the ACA with it in the bill. In the face of the unanimous Republican opposition and the 60 votes the Democrats needed to overcome their filibuster, Joe had his way and we were left holding the bag.
As Dr. Krugman stated, the ACA needs fixes, just as Social Security needed 75 years ago. A reasonable GOP would cooperate to fix it not discard it. Electing Clinton will not be enough to make progress unless her coat tails sweep in a cooperative Congress. Good luck with that hope. Chances are, she will have to keep her finger in the dike to prevent the GOP from drowning the ACA and other valuable social legislation.
As Dr. Krugman stated, the ACA needs fixes, just as Social Security needed 75 years ago. A reasonable GOP would cooperate to fix it not discard it. Electing Clinton will not be enough to make progress unless her coat tails sweep in a cooperative Congress. Good luck with that hope. Chances are, she will have to keep her finger in the dike to prevent the GOP from drowning the ACA and other valuable social legislation.
6
The leadership vacuum in this country is appalling. Both government and corporate.
The public option is the only option that makes sense. This is the 21st century version of public education. Education and health are foundational to pursuit of happiness envisioned by the founding fathers for the people of the United States. Not to mention really really material to a healthy and growing economy.
The option should be national in scope in order to create the scale necessary to enable sustainable economics.
If we had government leaders instead of political hacks in our Congress, the public option would be defined in operational and financial terms as health insurance. The ACA needs some work and both the republican congressional dysfunction and the hold that such companies as Aetna have on state & county level coverage dynamics amplify ACA flaws. Guess what? All plans uncover operational flaws during implementation. Just as true of Social Security's implementation as Microsoft's shift to cloud computing.
It's the responsibility of management, whether elected or named by the BOD, to fix the flaws.
Right now, both corporate management and, needless to say, elected government political hacks are failing their implied fiduciary responsibility to the American people.
But, no worries. The propaganda machines are out in force and the hacks will be voted back in office and the CEOs will be granted another $10m in stock awards.
The public option is the only option that makes sense. This is the 21st century version of public education. Education and health are foundational to pursuit of happiness envisioned by the founding fathers for the people of the United States. Not to mention really really material to a healthy and growing economy.
The option should be national in scope in order to create the scale necessary to enable sustainable economics.
If we had government leaders instead of political hacks in our Congress, the public option would be defined in operational and financial terms as health insurance. The ACA needs some work and both the republican congressional dysfunction and the hold that such companies as Aetna have on state & county level coverage dynamics amplify ACA flaws. Guess what? All plans uncover operational flaws during implementation. Just as true of Social Security's implementation as Microsoft's shift to cloud computing.
It's the responsibility of management, whether elected or named by the BOD, to fix the flaws.
Right now, both corporate management and, needless to say, elected government political hacks are failing their implied fiduciary responsibility to the American people.
But, no worries. The propaganda machines are out in force and the hacks will be voted back in office and the CEOs will be granted another $10m in stock awards.
3
The basic idea behind Health insurance is to spread the risk among all insured. Then the private insurance companies began to penalize people who used the insurance as opposed to those who did not. Then they began to reject enrollment of unhealthy individuals. Now the insurance companies are dropping entire counties to maintain a population of the most healthy. So the insurance companies have gone from discriminating against individuals to discriminating against entire counties. Aetna plans to drop about two thirds of the counties they cover. They might be cleaning house before the election that might see a big change. Not only was the public option a good idea that was impeded by the insurance company representatives in Congress, but it may soon become vital and necessary to cover those who are dumped by the insurance companies.
The auto insurance companies do the same thing. They impose surcharges if you use the insurance and insurance is supposed to spread risk equally, and on top of that, the insurance companies enjoy a government mandate to exist and profit. So you see, the basic premise of insurance is a fantasy in practice.
The auto insurance companies do the same thing. They impose surcharges if you use the insurance and insurance is supposed to spread risk equally, and on top of that, the insurance companies enjoy a government mandate to exist and profit. So you see, the basic premise of insurance is a fantasy in practice.
6
"Not only was the public option a good idea that was impeded by the insurance company representatives in Congress, but it may soon become vital and necessary to cover those who are dumped by the insurance companies."
Or maybe people could just do the honourable thing and pay their own bills.
Or maybe people could just do the honourable thing and pay their own bills.
Glad someone knows the facts. Thanks
Wow, what a tortured attempt by Krugman to avoid simply saying that he was wrong about the economics of Obama Care. He is repeating the big lie that Aetna did this because they are vindictive; they did it because they are a private company and they were hemorrhaging money. Is it a surprise that when a company insures people with serious pre-existing conditions that they spend more than they collect? He also fails to mention that the quality of the plans being offered are of a much poorer quality than traditional employer offered plans (a fact highlighted in another column on the front page today). And of course we all know the the promise that if you like you doctor you get to keep your doctor was a lie.
5
Sorry Krugman but this bump was predicted long ago. Obamacare is a failure and there is no fixing it - it needs to be repealed and replaced.
In general Krugman your ideas have been invalidated, just look at gdp growth based on your ideas for the last several years. It has been stagnant, with the only thing propping it up is that which you oppose - hydrocarbon energy extraction.
In general Krugman your ideas have been invalidated, just look at gdp growth based on your ideas for the last several years. It has been stagnant, with the only thing propping it up is that which you oppose - hydrocarbon energy extraction.
6
I am 73 years old and have Aetna besides Medicaid. In November I will cancel my Aetna and go with another insurer.
1
This is one area where Krugman's Very Serious Person side is in full effect. This 10,000 foot view of Obamacare leaves out the nitty gritty details of how crappy most of the insurance offered actually is. Yes, you have some coverage but are now free to pay a high deductible (which is like having no insurance at all), co-pays (which can be exorbitant for some drugs or procedures), and co-insurance (a pox on whoever thought of that usurious idea). So, Obama care is great if you rarely, if ever, get sick. The reality is the over 20% of those under 65-with insurance- are still struggling to pay their medical bills . It is time to grow up and go for single payer.
7
What part of denying Affordable Heath Care don't Trump-supporters, and all GOP loyalists, not understand? Iron=ically, Universal Heal Care had been a Republican goal--all the way back to 1972, when President Nixon sent a letter to every member of Congress, recommending it. Bob Dole, Mitt Romney, Newt Gingrich all recommended it, and with a Universal Mandate.
The GOP hang-up with ACA is that Obama pushed for it long enough, and hard enough, to get it passed. Oh, how could he do that with their Program. It surely would fly if they stopped trying to misrepresent it and, by getting in touch with reality, younger participants would get on board.
Do what's best for America--and Americans--for a change!
https://thetruthoncommonsense.com
The GOP hang-up with ACA is that Obama pushed for it long enough, and hard enough, to get it passed. Oh, how could he do that with their Program. It surely would fly if they stopped trying to misrepresent it and, by getting in touch with reality, younger participants would get on board.
Do what's best for America--and Americans--for a change!
https://thetruthoncommonsense.com
2
Mr. Krugman, are you entirely sure that Aetna and others are actually "losing" money...or as I suspect just not making enough of a profit? With the culture of immediate and constant quarterly rise in profits the bedrock of the US corporate ethos why would these behemoths not just move their investments into say pig farming if the return were higher? Some of these vultures care not of the larger interest....some proved it during the financial crisis and as Alan Greenspan himself noted his mistake which relied on the simple notion of protecting their self interest but greed overtook their better instincts.
2
Not all aspects of a multi layered economy should be "For Profit". Healthcare cannot and the proof of it will always surface. The single payer system here provides the for profit market share to operate @20%. There is plenty of "profit" in this percentage and less risk. The trouble is that American corprotocracies want what they want, when they want it and they want it now. Just big babies who don't play well with others.
4
That the Affordable Care Act is a lifeline to millions of Americans who previously couldn't afford health care is fact. And no, it has definitely not sent the economy or job market into a death spiral. Yes, the Affordable Care Act is highly politicized and blamed for all the ills that still exist in the American health care system, namely annual increase in health care insurance premiums which has occurred like clockwork for decades, whether subsidized through an employer or purchased privately. Reading anecdotal accounts of personal experiences, both good and bad, attributed to the Affordable Care Act, verifiable or not, is mostly pointless since the effect of the Affordable Care Act must be viewed in the aggregate to determine its impact. Millions more Americans have access to health care as a result of this plan and overall health care costs have indeed slowed, both good outcomes but the critics refuse to let up on the doom and gloom predictions surrounding Obamacare. We as a nation still have a lot of work to do to rein in health care costs compared to other industrialized nations which experience better overall health care outcomes among its citizens. Private insurers & to a lesser degree the legal system in this country are great places to start some serious reform. Eliminating shareholder driven private insurers altogether from health care would seem to yield the biggest benefit but Congressional Republicans will be the biggest obstacle once again to real reform
4
Blaming the for-profit insurance companies for this problem is only half right. Most of the blame falls squarely on healthcare providers engaging in price gouging. Though many balk at using that term, it is exactly what they are doing. Just look at the example from this week of the price spike of the Epi-pen. A device that costs very little to produce is being sold for $600+ for a package of two. What is a reasonable markup? 100%? Certainly not $500%, right? There are plenty of other examples: hospitals billing $15 for an ibuprofren or $25 for a $.89 pair of rubber gloves.
Single payer, public option, whatever we want to to call it, it's the only way to get price gouging under control.
Single payer, public option, whatever we want to to call it, it's the only way to get price gouging under control.
5
This is hilarious! Paul's solution?
"It seems clear that subsidies for purchasing insurance, and in some cases for insurers themselves, should be somewhat bigger "
Throw MORE taxpayer dollars at the problem. What a joke.
"It seems clear that subsidies for purchasing insurance, and in some cases for insurers themselves, should be somewhat bigger "
Throw MORE taxpayer dollars at the problem. What a joke.
5
I have to agree with you (see my price gouging rant above).
Any more tax payer dollars thrown at this problem will only end up lining the pockets of healthcare, pharmaceutical company and insurance provider shareholders and executives.
Any more tax payer dollars thrown at this problem will only end up lining the pockets of healthcare, pharmaceutical company and insurance provider shareholders and executives.
I'm not going to vote for Trump, but I have to admit that he has a certain appeal when he lambasts other NATO countries for not contributing 2% of their GDPs. As he correctly points out, the United States is only 1 of 5 countries that contributes at least 2%. In fact, the US contributes 3.61%. The other 22 countries fail to meet the 2% mark. The US has a huge economy, so a drop from 3.61% to 2% would be a substantial amount of money - more than enough to pay for the increase in subsidies Dr. Krugman proposes. Imagine how much better our healthcare system would be if we weren't constantly shouldering the military costs for the rest of the world. How about other NATO countries step up so we too can have the wonderful healthcare those other underpaying countries have.
4
Sorry. Nope.
The end result will be a Single-payer.
This current version is just the straw to finish sucking everyone's milk shake. When We The People finally look up and see what real Health Care as a Right is around the world then we will shake off these shackles.
Till then, keep empting your wallets/purses to pay for something you cant afford to use.
American'ts, as Hillary calls us, pay more in $% of GDP than any other OECD nation, and has the lowest, worst results. We are being scammed and played.
But Hillary thinks Single-payer is too hard. Till she was pushed by the Unicorn and Puppies candidate. Now that people are starting to question, she'll promise to study it. Till then, keep paying peons.
You all do know who advises her right? You all do know who pays her correct?
Dang, who would have thought these fleas were so blood thirsty. Why again did we lay down here?
The end result will be a Single-payer.
This current version is just the straw to finish sucking everyone's milk shake. When We The People finally look up and see what real Health Care as a Right is around the world then we will shake off these shackles.
Till then, keep empting your wallets/purses to pay for something you cant afford to use.
American'ts, as Hillary calls us, pay more in $% of GDP than any other OECD nation, and has the lowest, worst results. We are being scammed and played.
But Hillary thinks Single-payer is too hard. Till she was pushed by the Unicorn and Puppies candidate. Now that people are starting to question, she'll promise to study it. Till then, keep paying peons.
You all do know who advises her right? You all do know who pays her correct?
Dang, who would have thought these fleas were so blood thirsty. Why again did we lay down here?
3
Mr. Krugman.
Do you know what we call a car that has foreseeable problems repeatedly cropping up?
A lemon.
Nice try professor.
Do you know what we call a car that has foreseeable problems repeatedly cropping up?
A lemon.
Nice try professor.
7
One could argue that a car having foreseeable problems could also be planned obsolescence, meaning planned by the car manufacturer so you have to buy another car, thereby increasing their profits. WalMart runs the same business model: You buy their cheap junk, made with cheap materials, and since it is so cheap, you have to go back and buy another the next year. So, rather than, for example, buying a quality wrench and being able to use it for years, you can buy one for much cheaper. The trade-off, though, is you have to buy one every year after the last one breaks. This allows WalMart to at least maintain profits by continuing to sell the same junk to the same people. I think this analogy can apply to the insurance companies who are "planning" to drop Obamacare. This is planned obsolescence by the insurance companies in an effort to kill Obamacare and fall back to their former business model.
More like Obamacare went over a cliff. Can't wait to pay $20k a year for healthcare.
4
You will see that if you elect Trump.
Americans tend to forget that the function of government is to enable us to live together in harmony. We pay taxes for essential services that we all need such as street repair, garbage collection and in many places in America today, water and sewage services. The cost of these services are not shared equally nor should we expect them to be. Looked at exclusively from an individual’s point of view, those services for which an individual has little use may seem over priced in our tax bills whereas those that we use a lot of are a bargain.
Healthcare in every industrial nation except ours is considered an essential service of government. Whether it is delivered by a single payer plan, regulated private insurance, or a mixture of the two, does not matter if government’s role is to make the system work for all citizens regardless of their need.
The blockade to compromise that exists within the Congress today is the result of a party of the right that has forgotten why governments exist.. Healthcare is essential, it is not a luxury offered only to those who can afford it. Until the Republican party recognizes its share of this government responsibility and willingly compromise to achieve it, these stumbling blocks will continue to be one of the less desirable markers of American exceptionalism.
Healthcare in every industrial nation except ours is considered an essential service of government. Whether it is delivered by a single payer plan, regulated private insurance, or a mixture of the two, does not matter if government’s role is to make the system work for all citizens regardless of their need.
The blockade to compromise that exists within the Congress today is the result of a party of the right that has forgotten why governments exist.. Healthcare is essential, it is not a luxury offered only to those who can afford it. Until the Republican party recognizes its share of this government responsibility and willingly compromise to achieve it, these stumbling blocks will continue to be one of the less desirable markers of American exceptionalism.
3
Forgive me if this has already been mentioned but once the previously unisured, very sick portion of our population regain their health through Obama Care,won't premiums for all of us even out somewhat?
2
Medicine is a business and has the problem that business has. I did research on AIDS for 13 years and know something about what is really going on which is not know very well. As a matter of fact there is a problem in writing about the subject. Besides who wants to be with Edward Snowden in where he lives. This claim about democracy is not all that true as now big brother is watching or maybe big sister will be also if Hillary heads the government. Krugman statements about debt are going to become a problem as other governments find investing in our government notes is causes a loss. So this will caused problems as debt increases and the loss of outside of notes stops. Trump idea of not given full value of notes may happen. Than we will start to look like Greece. But this is long-term problem. And in long-term we will all be dead or some will. So Krugman ideas were good short term but long-term not so good. As for Obamacare did somebody forget the doctor?
Should medicine be a "business"?
Voters will reject a Trump dictatorship in massive numbers. GOP down ticket candidates are scrambling to separate themselves from this ignorant, vulgar, xenophobic, racist, huckster who cannot stop lying.
The GOP policies have seriously damaged this country and given us the lie that presidents are legitimate only if they are conservative Republicans. The simple fact is that in this country there is one set of rules for the wealthy, large corporations, big political donors and Republicans and another far more restrictive for everyone else. That’s why we never talk about Colin Powell’s emails using a private server.
This election is the best chance of correcting and repairing all or most of that damage in president Clinton’s first two years in office. With a Democratic Congress we can enact the public option and make health care a government guaranteed right and join the rest of the industrialized world..
We can also enact a new and simplfied tax code with a 60% to on estates over 10 million dollars. We can enact a new voter’s rights act and automatically register all citizens over 18 in federal elections.
With a change in SCOTUS it can reconsider Citizens United and it can make it much easier to vote. We can enact sensible gun safety laws. For a stressed working class we can raise the minimum wage to $15/hr.
All this and more if Trump tanks the down ticket candidates and voters give president Clinton a congress she can work with.
The GOP policies have seriously damaged this country and given us the lie that presidents are legitimate only if they are conservative Republicans. The simple fact is that in this country there is one set of rules for the wealthy, large corporations, big political donors and Republicans and another far more restrictive for everyone else. That’s why we never talk about Colin Powell’s emails using a private server.
This election is the best chance of correcting and repairing all or most of that damage in president Clinton’s first two years in office. With a Democratic Congress we can enact the public option and make health care a government guaranteed right and join the rest of the industrialized world..
We can also enact a new and simplfied tax code with a 60% to on estates over 10 million dollars. We can enact a new voter’s rights act and automatically register all citizens over 18 in federal elections.
With a change in SCOTUS it can reconsider Citizens United and it can make it much easier to vote. We can enact sensible gun safety laws. For a stressed working class we can raise the minimum wage to $15/hr.
All this and more if Trump tanks the down ticket candidates and voters give president Clinton a congress she can work with.
1
Hate to ruin your day, but the last three polls have Hillary Clinton "leading" with 41%, 41% and 39% of the vote. Why so low? Because she is the second most reviled presidential candidate in the history of polling. Which means that the most reviled candidate (Trump) still has a very good shot of winning, despite the "dictatorship" you think he's going to enact.
1
This was a scam from the start. The administration lied to the America people to get this law enacted. The administration knew all along that the market would fail. Their next step is to rush in to "save" the program by having the government provide healthcare.
This was predicable. The Left waste no disaster, even if they have to direct them.
This was predicable. The Left waste no disaster, even if they have to direct them.
3
Are we allowed to mention that Aetna paid compensation to its top 5 executives $44, 661,241 in 2015? That in 2013 CEO Mark Bertolini took home salary and stock options worth $30,725,409? Just him. And that the Bush administration set Big Pharma up with a Medicare D RX plan that didn't require negotiated discounts?
9
With the Left, it's always someone else's fault.
Obamacare is a disaster. United, Humana, and now Aetna have pulled out of this disastrous communist scheme because they have suffered millions of dollars in losses. Obamacare care has fundamentally transformed health "insurance" into an entitlement. While liberals swoon over this transformation, it doesn't change the laws of economics.
Healthcare is a service that costs money and somebody has to pay for it, not that Krugman understands the laws of economics.
Healthcare is a service that costs money and somebody has to pay for it, not that Krugman understands the laws of economics.
4
The disaster was the old status quo that denied affordable and reliable health insurance to all but the healthy and the wealthy. Obamacare has extended coverage to 15 million Americans and made it impossible for insurance companies to cancel your coverage if someone in your family gets sick. The flaw in Obamacare is that it still relies on private, profit-seeking insurers to deliver care. That has never worked and never will. We need a public option for everyone to force competition and contain costs but, of course, the insurers and the GOP are dead set against it.
3
@Registered
And how does one afford the old system. Capitalism is a complete failure for providing Health Care. And anyway Communist? Really? Sounds like the Cold War. Your candidate is getting pretty cozy with the Neo Communist Vladimir Putin. I guess you'll have no problem with this arrangement?
And how does one afford the old system. Capitalism is a complete failure for providing Health Care. And anyway Communist? Really? Sounds like the Cold War. Your candidate is getting pretty cozy with the Neo Communist Vladimir Putin. I guess you'll have no problem with this arrangement?
There should be other areas of the market place where the government can and should retaliate to punish bad actors in a crucial market that people's lives depend on to remain healthy enough to provide an income.
1
There is. Offer medicare at its actual "cost to provide" to everyone and let it compete with the private insurers. The we will have REAL and VERIFIED evidence whether the for-profit providers with their $10 Million plus salaries are actually a more efficient provider than the government agencies that have administrative costs of less than 4% is the most efficient provider of health insurance for the citizenry.
That's not an existing option. I agree that changing Obamacare, especially by big insurance will bring us around to "single payer Medicare" which will put a damper on the private sector's profit line.
The tourniquet is starting to slip.
Obamacare can only be described as a temporary emergency solution and the time limit is quickly expiring.
The problems;
- Obama disallowed Medicare ability to negotiate drug prices with Big Pill and turned the drug reform over to Billy Tauzen. . . Billy Tauzen!
- Single payer was tossed off the table before negotiations even began.
- POTUS nonchalantly one day removed the Public Option!
The ACA is in dire need of reform already. Adding a Public Option and allowing Medicare to negotiate would be two good steps. Minimum that will require a Dem Cong and POTUS.
GOP still gets the lions share of blame in all this. Never have I seen such a malevolent group holding the levers of power in America.
Obamacare can only be described as a temporary emergency solution and the time limit is quickly expiring.
The problems;
- Obama disallowed Medicare ability to negotiate drug prices with Big Pill and turned the drug reform over to Billy Tauzen. . . Billy Tauzen!
- Single payer was tossed off the table before negotiations even began.
- POTUS nonchalantly one day removed the Public Option!
The ACA is in dire need of reform already. Adding a Public Option and allowing Medicare to negotiate would be two good steps. Minimum that will require a Dem Cong and POTUS.
GOP still gets the lions share of blame in all this. Never have I seen such a malevolent group holding the levers of power in America.
3
Campaign finance reform is essential to keep corporations like this from controlling our elected people. The public option is the only solution and that won't happen until our corporations stop bribing our elected people. In the meantime divest your Aetna stock. Health insurance provides NO services. They have no purpose and exist only to make corporations rich. Health CARE is needed - not health insurance corporations whose job it is to deny the patient care in order to increase profits.
4
Underlying costs and public option pricing need a closer look.
I do wish Krugman would address the issue of underlying medical costs in addition to the price to the consumer, including the insurance middlemen. In the balance of negotiation power, I believe the balance has shifted from the insurance companies to the providers - hospitals, and large physicians groups, etc. The cost seems high.
A second concern is that Medicare, the public option "provider" may be under pricing its payments to purchase care for its clients. I suspect that many doctors and hospitals could not survive on current Medicare payments alone, and if the more expensive private insurance payments were eliminated, there would be a mass exodus from the industry. So the taxpayer would probably be subjected to an increase in Medicare taxes to support a viable public option. Has this element been considered?
I do wish Krugman would address the issue of underlying medical costs in addition to the price to the consumer, including the insurance middlemen. In the balance of negotiation power, I believe the balance has shifted from the insurance companies to the providers - hospitals, and large physicians groups, etc. The cost seems high.
A second concern is that Medicare, the public option "provider" may be under pricing its payments to purchase care for its clients. I suspect that many doctors and hospitals could not survive on current Medicare payments alone, and if the more expensive private insurance payments were eliminated, there would be a mass exodus from the industry. So the taxpayer would probably be subjected to an increase in Medicare taxes to support a viable public option. Has this element been considered?
1
You are 100% correct in both comments
1
for those who vilify aetna, here's a pop quiz: list the blue chip corporate citizens you trust more. now cross out the ones that are less than a hundred years old. erase those recently bailed out by taxpayers, or socked with $billion fines in lieu of criminal prosecution.
those who dismiss the giant insurers as "middlemen" don't understand what these institutions are all about -- that is, the culture of long-term risk assessment, the care and feeding of specialized human capital, the vigilance to maintain financial stability in the face of economic chaos.
those who dismiss the giant insurers as "middlemen" don't understand what these institutions are all about -- that is, the culture of long-term risk assessment, the care and feeding of specialized human capital, the vigilance to maintain financial stability in the face of economic chaos.
The question is not whether we can offer affordable health insurance to individuals, but whether we as a nation can afford to establish another entitlement program. We are an aging nation, and social security, medicare and now Obama care will drain our resources and the nation will struggle in perpetual penury.
1
Sorry Paul, but this time you're wrong. My wife is self-employed. For years, the insurance she purchased cost roughly $550 per month. That remained true in 2014 when she was forced to use the New York State health exchange. But In 2015, this year, her premium shot up to $650. Further Blue Cross has applied for a 26% increase for next year. The rate of climb is unsustainable.
2
Your wife has coverage that can't be cancelled if she gets sick and there is no lifetime limit on the cost of care. She might be glad to know that other people in her community now have coverage too. An added $100 per month doesn't seem exorbitant for that. Don't assume that costs would not have gone up anyway. They went up every year for decades while dropping anyone with known health issues. That was unsustainable. The recent threatened cost increases by insurance companies suggest that the process of containing costs is incomplete. Much more work needs to be done. It may also be evidence that the private insurers cannot be trusted to administer an effective national healthcare program.
Our nation will heal and grow, healthcare included, when the last Republican is removed.
6
“If Republicans control one or both houses, it’s all too likely that they’ll do what they do best — try to sabotage a Democratic president through lack of cooperation.”
This isn’t lack of cooperation, it’s treason.
This isn’t lack of cooperation, it’s treason.
5
"This isn’t lack of cooperation, it’s treason."
No, if Republicans keep the Democrats from further damaging the country, they'll only be doing what they were elected by a majority of us to do.
No, if Republicans keep the Democrats from further damaging the country, they'll only be doing what they were elected by a majority of us to do.
Here comes another DNC propaganda from Krugman. Good thing is that he does not try to hide it anymore.
5
Most Republicans have NO idea the havoc that will be created by ending the ACA even as they cheer Republican obstruction of a simple fix, without which it probably WILL fail.
What will that mean? Think there will just be a switch and we'll go back to the old way where you and I get employer-subsidized health care, while 47 million Americans go back to having none?
Sorry, pal, it won't happen that way. Too many changes and too many companies have restructured their businesses around the ACA and unwinding that is going to be catastrophic. If you thought health care was too expensive BEFORE the ACA, and believe the propaganda that the ACA has driven up costs, you will HATE what happens to them after the GOP shuts down the ACA.
Are you one of those folks who say "Keep your government hands off my Social Security and Medicare!" ?
What will that mean? Think there will just be a switch and we'll go back to the old way where you and I get employer-subsidized health care, while 47 million Americans go back to having none?
Sorry, pal, it won't happen that way. Too many changes and too many companies have restructured their businesses around the ACA and unwinding that is going to be catastrophic. If you thought health care was too expensive BEFORE the ACA, and believe the propaganda that the ACA has driven up costs, you will HATE what happens to them after the GOP shuts down the ACA.
Are you one of those folks who say "Keep your government hands off my Social Security and Medicare!" ?
1
@Dadof2
This comment you're responding to is just another troll argument. You can always tell because they off no plan of their own. Throwing rocks at windows won't keep the place dry in a rain storm. Everyone will have their own version of "Rain Keeps Fallin' on their Heads". And because of your argument, Obamacare's not going to get repealed anytime soon. Let's remember that the Supreme Court has held it up twice now. The likelihood of a republican becoming president is approximately 14%. The down ticket candidates are also liable to lose in key states which turns the Senate back to the Democrats, plus, a number of house seats will make this election close as to recapturing the House.
This comment you're responding to is just another troll argument. You can always tell because they off no plan of their own. Throwing rocks at windows won't keep the place dry in a rain storm. Everyone will have their own version of "Rain Keeps Fallin' on their Heads". And because of your argument, Obamacare's not going to get repealed anytime soon. Let's remember that the Supreme Court has held it up twice now. The likelihood of a republican becoming president is approximately 14%. The down ticket candidates are also liable to lose in key states which turns the Senate back to the Democrats, plus, a number of house seats will make this election close as to recapturing the House.
Having health insurance is not the same thing as having health care. Having high premiums, deductibles, co-pays, and other out-of pocket expenses price people right out of getting care, when they are sick.
131
amen
2
Yes, but we can feel good knowing that we're helping a CEO have a better life. Isn't that why the middle and working classes exist? We pay and they play.
Having managed a small medical center and lived and been treated in other countries, I can confirm how bad our healthcare system for most people. There are some valuable links here on the facts about Obamacare, as well as the documented arguments to vote for Clinton. Please share--read by 12,049: https://www.linkedin.com/pulse/open-letter-sanders-supporters-scott-s-sm...
5
Let's get it right: instead of "...should also be a reinforced effort to ensure that healthy Americans buy insurance, as the law requires, rather than them waiting until they get sick..." say,
"should also be a reinforced effort to ensure that healthy Americans buy insurance, as the law requires, rather than wait until they get sick..."
More fundamentally, the continued presence of heartless, vocal morons in the system will aggravate reform as always.
"should also be a reinforced effort to ensure that healthy Americans buy insurance, as the law requires, rather than wait until they get sick..."
More fundamentally, the continued presence of heartless, vocal morons in the system will aggravate reform as always.
2
The trouble, of course, is Congress: If Republicans control one or both houses, it’s all too likely that they’ll do what they do best — try to sabotage a Democratic president through lack of cooperation. Unless it’s such a wave election that Democrats take the House, or at least can claim an overwhelming mandate, the obvious fixes for health reform will be off the table.
so just demonizing Trump keeps the GOP off the hook and gives them breathing room to do their song and dance as goodie two-shoes righteous true and out to save the nation from evil Trump and Evil Hillary
Letting them get away with that is insanity
At least I have my 10 goddesses to fall back on what about ye?
so just demonizing Trump keeps the GOP off the hook and gives them breathing room to do their song and dance as goodie two-shoes righteous true and out to save the nation from evil Trump and Evil Hillary
Letting them get away with that is insanity
At least I have my 10 goddesses to fall back on what about ye?
2
The cure for many of our national ills is the removal of the republican majorities in congress. Perhaps this will be the year Americans force the republican cancer into remission and every form of national progress will become possible.
5
Nice article from someone who has had his insurance covered by his employer all his life, and who has been a gung-ho supporter of Obamacare since the beginning and cannot admit he was wrong.
Why don't you speak to families who are above the cutoff for subsidies (I believe it's $95,000), who are paying outlandish premiums and outlandish high deductibles. And both have skyrocketed since implementation of the so-called Affordable Health Care Act.
And these families now cannot even afford to see a doctor (perhaps that's why costs have slowed). They only have if for emergencies (a broken leg) or a devastating illness (cancer).
The implosion of Obamacare is inevitable by 2020.
Why don't you speak to families who are above the cutoff for subsidies (I believe it's $95,000), who are paying outlandish premiums and outlandish high deductibles. And both have skyrocketed since implementation of the so-called Affordable Health Care Act.
And these families now cannot even afford to see a doctor (perhaps that's why costs have slowed). They only have if for emergencies (a broken leg) or a devastating illness (cancer).
The implosion of Obamacare is inevitable by 2020.
3
there’s nothing wrong with Obamacare that couldn’t be fairly easily fixed with a bit of bipartisan cooperation."
True. Now why didn't Obama do that and Krugman suggest it when the law was being crafted. Every suggestion was stiffed with the comment that, " I will listen to any reasonable suggestion" but of course none apparently was ever heard. Further all of the course corrections done administratively without input from congress would have left less of a strain on our political system if the Administration had gone further to win support from a few of the other party. Barring that deep rancor set in and persist. Is it good for either side to be so stubborn? No. But it isn't all on one side.
True. Now why didn't Obama do that and Krugman suggest it when the law was being crafted. Every suggestion was stiffed with the comment that, " I will listen to any reasonable suggestion" but of course none apparently was ever heard. Further all of the course corrections done administratively without input from congress would have left less of a strain on our political system if the Administration had gone further to win support from a few of the other party. Barring that deep rancor set in and persist. Is it good for either side to be so stubborn? No. But it isn't all on one side.
1
Monty Brown, remember the GOP? They are the ones who didn't want Obama to accomplish anything. They are in control of both houses of Congress and have been for some time. The House of Representatives has voted to repeal Obamacare rather than fix it. They have also vowed to return to the way things were which would mean that a lot of people would not be able to get any health insurance because of pre-existing conditions.
Of course the GOP doesn't want things fixed. Of course our representatives listen to lobbyists. Look at who finances their campaigns. Neither the Democrats nor the GOP were willing to cross their sponsors. And that's why we have the ACA and the mess. Single payor universal access could work if our politicians worked for us rather than their rich donors.
Of course the GOP doesn't want things fixed. Of course our representatives listen to lobbyists. Look at who finances their campaigns. Neither the Democrats nor the GOP were willing to cross their sponsors. And that's why we have the ACA and the mess. Single payor universal access could work if our politicians worked for us rather than their rich donors.
In the context of ACA, how would the public option work? Would it be able to sell insurance at a loss? That certainly would not be fair competition. How would it develop it's provider networks? Would it just set reimbursement rates like Medicare that providers could choose to take or not participate? Not so simple.
expand Medicare
Universal health care. Not likely due to big business control of too many politicians.
2
It appears that we need more than a annual penalty or *tax* to get more healthy people into the system. As Paul surely knows, a balance between those who do and do not need to make claims is what makes insurance work. Most people get back far less than they pay in, but are protected should they need it.
We need to tweak the *pre-existing condition* clause. Now that insurance is available to all, those who do not obtain it when they are healthy should pay a penalty if they suddenly discover that they need surgery and want to take out insurance.
But I don't favor a *public* option. When I turned 65, I was forced to sign up for Medicare and my premium for my Massachusetts retiree insurance reduced accordingly. This save Mass. money, but doubles the administrative costs, raising the overall healthcare cost.
I fear that with a *public* option, many employers will do something similar and we will morph into an administratively bloated semi-single-payer system. There are pros and cons to single payer. But if that's what we want, then that is how it should be designed from the start.
Personally, I prefer the kind of well-regulated private insurance they have in Germany and Switzerland.
We need to tweak the *pre-existing condition* clause. Now that insurance is available to all, those who do not obtain it when they are healthy should pay a penalty if they suddenly discover that they need surgery and want to take out insurance.
But I don't favor a *public* option. When I turned 65, I was forced to sign up for Medicare and my premium for my Massachusetts retiree insurance reduced accordingly. This save Mass. money, but doubles the administrative costs, raising the overall healthcare cost.
I fear that with a *public* option, many employers will do something similar and we will morph into an administratively bloated semi-single-payer system. There are pros and cons to single payer. But if that's what we want, then that is how it should be designed from the start.
Personally, I prefer the kind of well-regulated private insurance they have in Germany and Switzerland.
1
Our country is 19 trillion in debt and single biggest contributor to the debt is Medicare. Yet in post after post the uninformed posters suggest the true solution is Medicare for all. The simple fact is the country can not afford this option since then every single poor immigrant would be eligible for a 20,000$ insurance plan. A second grader can see this will only end in a complete financial collapse like with NHS.
2
Where are our hardworking and diligent lawmakers? On recess, the need a rest from all the legislation they passed last year. If our Congress and Senate spent as much time on legislation as they have on Benghazi we would have made America great again.
1
A bump? Surely you jest. In NC my insurance has gone from a $1,000 vanishing deductible to $6,870 one courtesy of the only insurer in the state Blue Cross Blue Shield. I had to use this insurer because it was one of the only ones my doctor accepted. Prior to Obamacare, she accepted other insurers. Last year I saw a 35% increase in my premium. This year I am expecting another double digit increase. I don't get a subsidy so it is all out of pocket. BCBS is almost making noises about leaving the entire exchange so many counties in NC will have no insurer. The other issue none of you speak about is concerige medicine. In order to keep my doctor I am paying $2,000 a year in addition. Thanks Obama. I now have to pay extra to keep my doctor. This law is a disaster.
2
All developed countries have health care program that is universal, lower cost and better quality. American exceptionalism always creTed the best product and efficient systems of the world. How come on healthcare we can not do that? Most likely there is fundamental structural deficiency in our health care system where many activities and medicines are useless and harmful. Time has come to move to Canadian type single payer system and get out of this mess and greedy for profit companies. Two actions are immediately necessary - removal of flows of medicines from out side US and allow Insurence companies to work across the boarder. This will allow the benefits of efficient companies available all across the country.
2
Paul,
What Aetna is doing is a cautionary tale about including private companies in a public concern. Those who believe in Santa Clause, the Tooth Fairy and commercials, feel that insurance companies should have as part of their mission statement actually helping people. Making a profit is, of course, important, but too often companies see making money their ONLY role. Going down this road will lead us to companies like Kemper Insurance, who, as reported on 60 Minutes, apparently sees as it's corporate philosophy cheating it's clients out of duly owed death benefits.
What Aetna is doing is a cautionary tale about including private companies in a public concern. Those who believe in Santa Clause, the Tooth Fairy and commercials, feel that insurance companies should have as part of their mission statement actually helping people. Making a profit is, of course, important, but too often companies see making money their ONLY role. Going down this road will lead us to companies like Kemper Insurance, who, as reported on 60 Minutes, apparently sees as it's corporate philosophy cheating it's clients out of duly owed death benefits.
5
If Clinton is elected, and I pray she will be, but Republicans maintain control over Congress, nothing will change. Nothing. I will still settle for that over the devastation Trump will cause. However, it will certainly not help the people who are losing health care coverage. The problem with Obamacare is the one I have pointed out time and time again. Some people have no option other than to settle for a policy that has a high deductible, which leaves them essentially with catastrophic coverage if it is the best insurance policy they can afford. Medicare for all is a system that works and it is the system that is needed. However, health care costs must be addressed or all systems will face collapse. Insurance companies are not interested in health care, they are interested in their bottom line, and will continue to opt out of Obamacare if they see profits fall.
If Congress does not remain under the control of Republicans and Clinton is elected President, now would be the time to put Medicare for all in place. For goodness sake we give money to Israel which does have health care for all its citizens. It is high time we did as much for our own. If we can put a man on the moon, and if we can spend trillions on wars, we can afford the basic necessity of health care for our citizens.
It isn't enough to elect a Democrat President, we need to shift the balance in Congress in order for this country to progress, and true, decent health care for all to finally become a reality.
If Congress does not remain under the control of Republicans and Clinton is elected President, now would be the time to put Medicare for all in place. For goodness sake we give money to Israel which does have health care for all its citizens. It is high time we did as much for our own. If we can put a man on the moon, and if we can spend trillions on wars, we can afford the basic necessity of health care for our citizens.
It isn't enough to elect a Democrat President, we need to shift the balance in Congress in order for this country to progress, and true, decent health care for all to finally become a reality.
3
Well said.
There's also some slippage in the employer-funded health insurance sector. Salaried persons - the kinds who work 60-hour weeks but are paid for a nominal 40 hours - are now paid the same amount for a nominal 30 hours and called part-time workers. This puts them out on the exchanges, or out of health care altogether. For some reason, providing health care has become a lot less attractive for employers, particularly when the employees can be considered expendable.
1
For "some reason" it's less attractive for employers to provide health care? It's called cost - the very thing that Obamacare was supposed to fix but didn't.
A patient can go to three different doctors and get three different opinions. Probably two of those opinions will be wrong. It's not just insurance, it's the whole system. Unfortunately, medicine is not an exact science. Quality healthcare is important.
2
When you have companies more interested in profit margins, because remember we are not talking about losses, we are talking about decreased profits, health care will suffer.
People who have been without insurance for years are going to cause an increase in services due to their dire need of care. Companies were allowed to be selected. They of course were going to cull the healthiest consumers of their product which means very little costs. And even when those consumers filed claims those same companies, whose greed outweighed concern for their customers, would automatically deny additional care.
The problem is not to make the insurance companies more competitive, having every individual compete for health care. These companies operate as a monopoly, a profit-generating operation designed to take in premiums and dispense as little treatment as needed. Vultures.
What we need is to remove these vultures from our health care system and institute a truly universal program. Combine the care of veterans and all Federal employees into the same pool with the nation at large. The formula for successful insurance has always been the same, the larger the pool the greater benefits to all. With everyone in the pot we, like our European counterparts, can run a more cost efficient operation, providing the care called for by doctors, not by a number cruncher working to maximize an insurance companies quarterly reports.
DD
Manhattan
People who have been without insurance for years are going to cause an increase in services due to their dire need of care. Companies were allowed to be selected. They of course were going to cull the healthiest consumers of their product which means very little costs. And even when those consumers filed claims those same companies, whose greed outweighed concern for their customers, would automatically deny additional care.
The problem is not to make the insurance companies more competitive, having every individual compete for health care. These companies operate as a monopoly, a profit-generating operation designed to take in premiums and dispense as little treatment as needed. Vultures.
What we need is to remove these vultures from our health care system and institute a truly universal program. Combine the care of veterans and all Federal employees into the same pool with the nation at large. The formula for successful insurance has always been the same, the larger the pool the greater benefits to all. With everyone in the pot we, like our European counterparts, can run a more cost efficient operation, providing the care called for by doctors, not by a number cruncher working to maximize an insurance companies quarterly reports.
DD
Manhattan
5
There is no real competition in health insurance pricing. If Medicare were able to offer plans in the marketplace, such that people could buy insurance from the medicare system, at whatever age, we would see some real competition: Medicare has much less overhead than the private for profit/not-for-profit-but-still-stuffing-it-away insurance industry.
This will never happen because the health insurance industry has more money/power than they will ever admit to, and they won't let this happen,
This will never happen because the health insurance industry has more money/power than they will ever admit to, and they won't let this happen,
2
Medicare does NOT have "much less overhead" than private insurance. The claims and customer service in many cases are handled by the same people inside an insurance company. The difference is that the government sets the rates that doctors get much lower in Medicare and Medicaid than in private insurance so that on top of your FICA, your insurance is subsidizing Medicare and Medicaid further.
discus...
While it is true that Medicaide and Medicare sometime reimburse providers at a lower rate, you still are confusing the "overhead" (i.e. cost of managing claims) with the operating costs of providing payments. Medicare operates at about a 4% "overhead" (i.e. paperwork) cost. Medicare Canada (their national health plan) is better at around 1%. And, despite all arguments about the Canadian plan, they overwhelmingly approve of it. Furthermore, if it was that bad, they could decide to pay more into it for improvement. Since they don't (and BTW, they spend considerably less than we do as a nation), it must be satisfactory
While it is true that Medicaide and Medicare sometime reimburse providers at a lower rate, you still are confusing the "overhead" (i.e. cost of managing claims) with the operating costs of providing payments. Medicare operates at about a 4% "overhead" (i.e. paperwork) cost. Medicare Canada (their national health plan) is better at around 1%. And, despite all arguments about the Canadian plan, they overwhelmingly approve of it. Furthermore, if it was that bad, they could decide to pay more into it for improvement. Since they don't (and BTW, they spend considerably less than we do as a nation), it must be satisfactory
Krugman has conveniently neglected to point out that since obamacare went into effect, for the 200m who already had healthcare, it has become less accessible, premiums are much higher, deductibles are much higher and copays are much higher. hence, for the vast majority of americans, they are materially worse off
there is not a successful high quality public healthcare system in the world, contrary to liberal public opinion. in the UK for example, everyone knows that if you are rich you get private insurance, see a private doctor/specialists, and only use the public system for simple things like vaccinations. any specialization needed is done away from the public system by the rich. and this is exactly what will happen in the US. a public system will simply herd millions of middle class and poor into a mediocre at best system, while the rich will get out of it altogether and go private. for the vast majority of americans, quality of care will decrease, while the rich will be just fine in this new bifurcated system. this is your liberal utopia.
there is not a successful high quality public healthcare system in the world, contrary to liberal public opinion. in the UK for example, everyone knows that if you are rich you get private insurance, see a private doctor/specialists, and only use the public system for simple things like vaccinations. any specialization needed is done away from the public system by the rich. and this is exactly what will happen in the US. a public system will simply herd millions of middle class and poor into a mediocre at best system, while the rich will get out of it altogether and go private. for the vast majority of americans, quality of care will decrease, while the rich will be just fine in this new bifurcated system. this is your liberal utopia.
2
Rich people don't opt out of Medicare. They use it. They like it. They understand that a program that is not top-heavy in executive compensation, marketing, and administration is probably going to be efficient. If seniors keep traditional Medicare, they are not limited to the shrinking networks which Medicare Advantage plans use to limit access and hold-down cost.
Spencer, you make too much sense!!!! This is exactly our scenario.....Almost 400 % increases in premiums on a 10k deductible increased to 12k deductible. For the first time in my adult life, I may have to forgo insurance this December depending on the cost increases. Obummercare is quite the bummer.
When we were lobbying our Congressman on this bill we argued against the use of exchanges for exactly this reason. This was NOT an unknown possibility. The state exchanges that existed before the bill passed had the same monetary problems we see now but the greater good was to provide some coverage for everyone not try for a "perfect" system. In the states the losses were covered by the state government,
Would have been better to develope something for the 15% uninsured and not mess up the other 85% which is what Obamacare has done.
Spin, spin, spin.
Obamacare mandates that we all buy coverage the vast majority of us do not need and outlawing setting premiums by group health risk spiked premiums and deductibles, making it economically irrational for the young and health to buy health insurance off the government exchanges.
Nearly all of the people who are "buying" health insurance off the exchanges are either making their neighbors pay for most of it through government transfer payments and/or are ill.
Anyone with a passing background in economics can see that this is a death spiral waiting to happen. Insurance only works if everyone participates and large numbers of healthy people are paying to treat the ill. Insurance pools with large number of ill people taking money out of the system raise costs or go insolvent. As costs increase, it becomes increasingly irrational for the healthy to participate and the percentage of sick enrollees increases. Repeat the cycle until insurers flee or go out of business.
Obamacare is by any measure the worst of a bad lot of socialized health insurance systems.
Obamacare mandates that we all buy coverage the vast majority of us do not need and outlawing setting premiums by group health risk spiked premiums and deductibles, making it economically irrational for the young and health to buy health insurance off the government exchanges.
Nearly all of the people who are "buying" health insurance off the exchanges are either making their neighbors pay for most of it through government transfer payments and/or are ill.
Anyone with a passing background in economics can see that this is a death spiral waiting to happen. Insurance only works if everyone participates and large numbers of healthy people are paying to treat the ill. Insurance pools with large number of ill people taking money out of the system raise costs or go insolvent. As costs increase, it becomes increasingly irrational for the healthy to participate and the percentage of sick enrollees increases. Repeat the cycle until insurers flee or go out of business.
Obamacare is by any measure the worst of a bad lot of socialized health insurance systems.
3
Here is an article from the WSJ on the points that you make.
http://www.wsj.com/articles/the-unstable-economics-in-obamas-health-law-...
"Anyone with a passing background in economics can see that this is a death spiral waiting to happen."
Doesn't Krugman have a nobel prize in Economics? LOL! As I have been saying for a long time. He is a hyper partisan cheerleader who is a faux economist.
http://www.wsj.com/articles/the-unstable-economics-in-obamas-health-law-...
"Anyone with a passing background in economics can see that this is a death spiral waiting to happen."
Doesn't Krugman have a nobel prize in Economics? LOL! As I have been saying for a long time. He is a hyper partisan cheerleader who is a faux economist.
As an avid supporter of Obamacare, I believe that it is time to move on. Not to repeal it, or spend huge amount of time and political capital on improving it, but to rethink how to approach healthcare reform.
The key to effectively and efficiently reforming our healthcare system is to first acknowledge that it is not really one system, but rather several autonomous healthcare systems competing with each other, with their own rules and with no oversight. There is Medicare, Medicaid, VA, HMOs, PPO, etc., etc., etc.. Each with its own set of patients and its own set of providers. This is not a healthcare system; it is a healthcare chaos!
And who has oversight of this chaos? No one!
Congress (and POTUS) can only make small ineffective changes like Obamacare.
The key to real healthcare reform is to first unify our entire system under one oversight body that is led by healthcare professionals and is independent of federal or state governments. There is precedence for this: The Federal Reserve was created over 100 years ago to regulate the US money supply. Why not have a ‘National Medical Board’ to regulate the US healthcare system?
As has been proposed by a group of healthcare professionals, we can have such a system without necessarily having a 'single payer' system. To find out more about EMBRACE- please visit: theembraceplan.org
The key to effectively and efficiently reforming our healthcare system is to first acknowledge that it is not really one system, but rather several autonomous healthcare systems competing with each other, with their own rules and with no oversight. There is Medicare, Medicaid, VA, HMOs, PPO, etc., etc., etc.. Each with its own set of patients and its own set of providers. This is not a healthcare system; it is a healthcare chaos!
And who has oversight of this chaos? No one!
Congress (and POTUS) can only make small ineffective changes like Obamacare.
The key to real healthcare reform is to first unify our entire system under one oversight body that is led by healthcare professionals and is independent of federal or state governments. There is precedence for this: The Federal Reserve was created over 100 years ago to regulate the US money supply. Why not have a ‘National Medical Board’ to regulate the US healthcare system?
As has been proposed by a group of healthcare professionals, we can have such a system without necessarily having a 'single payer' system. To find out more about EMBRACE- please visit: theembraceplan.org
5
If health care is regulated by government, how can you say it would be completely independent of it? And since government funds a lot of health care, isn't it regulating it now at least for seniors and those on public assistance. Medicare sets a standard for all health coverage. Comparing the Fed Reserve to a Fed oversight of health care is comparing apples to oranges.
1
W: The EMBRACE plan proposes eliminating all the government agencies associated with healthcare (HHS, Medicare, Medicaid, VA, FDA, NIH, etc) and shifting it to the National Medical Board (NMB). The NMB would be set up in the same way the Federal Reserve is set up, with a chairman that is appointed by POTUS but not part of the administration (and makes independent decisions). It will not be part of the administration or of the federal government.
As for financing: yes, the Congress will need to finance the NMB. However, instead of the myriad bills and initiatives that Congress currently spends months on, it would finance the NMB in one annual bill- and the NMB will then be responsible on how this is distributed.
As for financing: yes, the Congress will need to finance the NMB. However, instead of the myriad bills and initiatives that Congress currently spends months on, it would finance the NMB in one annual bill- and the NMB will then be responsible on how this is distributed.
Insurers are middlemen between the patient and medical care. As such, they generate additional non-treatment transactions (for each medical care event, there is a transaction between the insurer and the patient and one between the insurer and the care giver), thereby increasing costs and slowing the delivery of health care. Of course, they demand a profit for increasing costs and slowing delivery. Why did Obamacare rely so heavily on private insurers?
1
Obamacare "relies heavily " on private insurers because they and the corrupt government they control, wanted it that way.
Insurers SHOULD NOT and clearly DO NOT want to be in the health providing business.
Insurers SHOULD NOT and clearly DO NOT want to be in the health providing business.
1
Krugman: "And many of these private insurers are now finding themselves losing money, because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
This story regarding the previously uninsured should have been anticipated by both insurers and the government. My barber was finally, after many years of being uninsured, able to get coverage with a subsidy via the ACA; and when she did, she had two surgeries, surgeries she had postponed because she could not afford the surgical and hospital expenses when uninsured. Have to believe her story is not unique.
The ACA is only going to work if everyone gets covered, the healthy and the sick. That will not be possible until politicians, namely Republican politicians, perceive health care coverage as a right for all and not a privilege for the fortunate few.
Why all these so-called pro-life Republicans do not see this issue of protecting life via health care coverage as another right to life issue is beyond my comprehension. Of course, they insist that everyone has the right to own a gun to protect their lives but not everyone has a right to health care coverage that would do a lot more to protect lives than do guns. This is the nutty logic that prevails in our national and state legislatures, unfortunately.
This story regarding the previously uninsured should have been anticipated by both insurers and the government. My barber was finally, after many years of being uninsured, able to get coverage with a subsidy via the ACA; and when she did, she had two surgeries, surgeries she had postponed because she could not afford the surgical and hospital expenses when uninsured. Have to believe her story is not unique.
The ACA is only going to work if everyone gets covered, the healthy and the sick. That will not be possible until politicians, namely Republican politicians, perceive health care coverage as a right for all and not a privilege for the fortunate few.
Why all these so-called pro-life Republicans do not see this issue of protecting life via health care coverage as another right to life issue is beyond my comprehension. Of course, they insist that everyone has the right to own a gun to protect their lives but not everyone has a right to health care coverage that would do a lot more to protect lives than do guns. This is the nutty logic that prevails in our national and state legislatures, unfortunately.
7
Because, as someone with a disabled spouse, I can tell you that giving the best healthcare is wholly unaffordable. It won't work, and can't work. It's a ponzi scheme. His healthcare, for just one monthly treatment, which will go on for thte next 30 years or so, costs $132,000 a year. Average cost of health care in the final 2 years our lives is $500,000. That single cost is more than anyone pays in over their whole life.
For the life of me I don't understand how anyone thinks this will work when it costs multiple times more than any person ever pays in over their life. Then factor in that many aren't paying.....
For the life of me I don't understand how anyone thinks this will work when it costs multiple times more than any person ever pays in over their life. Then factor in that many aren't paying.....
1
We need single payor universal access for health care in America. No one should have to worry about being able to afford the care they need. That means diabetics, cancer patients, mentally ill patients, the poor, and the rich. There is no reason why people should be forced to switch doctors because their insurance company drops the doctor or the doctor drops off the preferred provider list. The same goes for dentists. There's no reason why people should be forced to choose between paying for prescriptions or paying the rent, or taking less than the optimal dose. And there's no reason for the doughnut hole for seniors.
Access to decent affordable medical care should be easy for the richest country on the planet. Yet our politicians, particularly the Greatly Overrated Prevaricators, refuse to admit that a workable health care system is important for all our citizens, not just those who can afford to take the time to fight for what they need and then pay for it. America is the only first world nation that puts its citizens in mortal fear of losing everything if they need medical care for something as simple as a broken bone with no complications. The health insurance companies should be eliminated since they do not have our interests in mind when they draw up policies. And our politicians should not be allowed to get special treatment when it comes to selecting their insurance. Let them go through what we go through.
Access to decent affordable medical care should be easy for the richest country on the planet. Yet our politicians, particularly the Greatly Overrated Prevaricators, refuse to admit that a workable health care system is important for all our citizens, not just those who can afford to take the time to fight for what they need and then pay for it. America is the only first world nation that puts its citizens in mortal fear of losing everything if they need medical care for something as simple as a broken bone with no complications. The health insurance companies should be eliminated since they do not have our interests in mind when they draw up policies. And our politicians should not be allowed to get special treatment when it comes to selecting their insurance. Let them go through what we go through.
2
The AHA - somewhat of a Rube Goldberg construction - is the best legislation that could have been gotten in a political environment that has given us Donald Trump as the GOP nominee. Despite its imperfections, it has transformed the lives of many previously uninsured individuals and families. Reforming it will not be easy. Scuttling it is almost impossible. With HRC as our next likely president, it will be up to her administration to take the fight to Congress by introducing that "public option" Krugman advocates. In the end, the democratic party should work toward the eventual establishment of a single-payer system in every action related to the reshaping of Obamacare.
1
Hold the annual farm welfare entitlements bill hostage to fixing the ACA.
Many of the far-right conservative radicals opposing health insurance for all Americans hail from rural and near-rural districts. Their local economies depend upon farm welfare entitlements. Make it clear to them that they can no longer enjoy farm welfare entitlements unless the rest of America enjoys health insurance. The pressure on the "scorched earth" Republicans to compromise would be intense.
Once we have their attention, make the public option simply an election to enroll in Medicare before turning 65 years of age. There be no need to create a new bureaucracy or funding mechanism. They're already there, up and running. And the private insurers will be able to expand their Medicare Supplement business.
The key is to make clear to the radical right that continuing their obstruction will come at a terrible price for their constituents.
Many of the far-right conservative radicals opposing health insurance for all Americans hail from rural and near-rural districts. Their local economies depend upon farm welfare entitlements. Make it clear to them that they can no longer enjoy farm welfare entitlements unless the rest of America enjoys health insurance. The pressure on the "scorched earth" Republicans to compromise would be intense.
Once we have their attention, make the public option simply an election to enroll in Medicare before turning 65 years of age. There be no need to create a new bureaucracy or funding mechanism. They're already there, up and running. And the private insurers will be able to expand their Medicare Supplement business.
The key is to make clear to the radical right that continuing their obstruction will come at a terrible price for their constituents.
5
The supreme irony is that many of the "Red" states with GOP representatives opposed to the ACA, are corn producers, a crop that contributes to our obesity and diabetes epidemic, as well as excessive water usage and environmental destruction. We have truly become an Idiocracy--with Iowa and Kansas leading the way.
Absolutely brilliant. You should run for congress!
We need to keep our sights on how do we get from here to there. The ACA is a pathway to "There." “There” being quality affordable healthcare benefiting us all and fulfilling our responsibility as a society.
When the ACA was enacted the “public option” wasn’t an option. Too much of our fragile economy relied, and though the economy is now far more robust, still relies upon the medical and insurance industries which had/has become a nonsensical system with multi-layers of profit taking and higher costs driving higher profits. The latest Aetna persnuffle is reminiscent of the fiasco when Blue Cross/Blue Shield won the ability to go from non-profit to for-profit status because they couldn’t compete with the for-profit insurance who could “cherry-pick” their customers (the correct answer of course would have been to do what the ACA did and make the for-profits cover all). The result then was what got us further away from “There” at higher and higher costs and which increasingly placed Affordable Care further away from more members of our society.
The ACA is imperfect, and as the framers of the Act stated at the time it was intended as a first step, not a final pathway to getting us “there.” However, until a better pathway is found it is incumbent on our Incumbents to work together to fulfil their responsibilities to keep working on what is working, improve things they have actually gotten right, and help all of us get “there” together.
When the ACA was enacted the “public option” wasn’t an option. Too much of our fragile economy relied, and though the economy is now far more robust, still relies upon the medical and insurance industries which had/has become a nonsensical system with multi-layers of profit taking and higher costs driving higher profits. The latest Aetna persnuffle is reminiscent of the fiasco when Blue Cross/Blue Shield won the ability to go from non-profit to for-profit status because they couldn’t compete with the for-profit insurance who could “cherry-pick” their customers (the correct answer of course would have been to do what the ACA did and make the for-profits cover all). The result then was what got us further away from “There” at higher and higher costs and which increasingly placed Affordable Care further away from more members of our society.
The ACA is imperfect, and as the framers of the Act stated at the time it was intended as a first step, not a final pathway to getting us “there.” However, until a better pathway is found it is incumbent on our Incumbents to work together to fulfil their responsibilities to keep working on what is working, improve things they have actually gotten right, and help all of us get “there” together.
2
Obamacare was/is bound to fail because it depends on money-grubbing private insurance companies. Elimination of insurance companies' influence on health care costs and replacement with a single payer, i.e. the federal government, is the only way to keep health care costs in control and make sure that everyone in this country has access to quality health care at reasonable cost. There's no need to re-invent the wheel. Most countries in Europe, Canada, Japan all have excellent health care covering all citizens. Why must America continue with a third-world health care delivery system at the mercy of for-profit insurance companies? Wake up Republican Congressmen and voters, it's not just your job that's at stake, it's also your life and your family's lives.
3
The problem with Obamacare is and was that it is a plan for health insurance, not actual healthcare. The two are quite different, even though the terms health care and health insurance have become synonymous. They are not.
8
The bump is the inevitable clash between profits and care. One can tweek the health care exchanges all they want and it will simply postpone the next episode of companies seeking profits another way. Whether increased deductibles, limits on types of approved drugs or refusal to pay certain procedures the company's bottom line is what is in the end what's most important.
I have private insurance through my job and in the last year I saw my co-payment more than double. My annual deductible also went up. Why? Because as my insurer signs up sicker people they shift the cost to those who use less health care to cover the cost and maintain profits.
Whenever an essential human service is treated as a profit center there will be contradictions and in our present system the drive for profit wins or the company takes its business elsewhere. There's a reason why no other industrialized country in the world has a system like ours. We have chosen a path of political expediency not one for optimal care for our people.
I have private insurance through my job and in the last year I saw my co-payment more than double. My annual deductible also went up. Why? Because as my insurer signs up sicker people they shift the cost to those who use less health care to cover the cost and maintain profits.
Whenever an essential human service is treated as a profit center there will be contradictions and in our present system the drive for profit wins or the company takes its business elsewhere. There's a reason why no other industrialized country in the world has a system like ours. We have chosen a path of political expediency not one for optimal care for our people.
8
EXACTLY. Why other people don't realize this is the case is beyond me. Corporate America's and the Vulture Capitalists' takeover of our health care system that began to infect the system when HRC first tried to "fix", it has ruined medicine, and I speak from the inside of the profession, watching over the last 38 years. A colleague just recently moved to Canada (no, not because of the threat of DT) and told me the physician salaries are quite competitive. Imagine that-- you can actually provide universal health care for citizens and still adequately (not obscenely) compensate those who have spent at least 12 years educating and preparing for their professions!
It's the cost of medical care; drugs, tests, surgeries, etc.
1
And $44,661,241 for five executives at Aetna. Not including perks.
1
Pirates and criminals like "Free" markets too.
Before the ACA became law, the Insurance companies cherry-picked people to reduce payouts. Now, I'll bet they are doing the same thing pulling out of Counties like Aetna. Some counties must be healthier than others.
Before the ACA became law, the Insurance companies cherry-picked people to reduce payouts. Now, I'll bet they are doing the same thing pulling out of Counties like Aetna. Some counties must be healthier than others.
3
What a surprise. A giant insurance company is going to pull out of Obamacare. This has happened after the Aetna' efforts to expand itself was denied as a threat to the whole insurance industry as a monopolistic takeover in some crucial markets. So basically they could care less about profit loss in the Obamacare market. They had bigger pockets to pick. The timing of the action is everything, not what the company says. If there was ever a reason to enact Obamacare this corporate misbehavior proves it.
6
"And many of these private insurers are now finding themselves losing money, because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized." I've said this from the beginning, and you wouldn't have to be Nostradamus to have figured it out. Seriously, the liberal geniuses behind this law didn't see this coming? No, they saw it coming and didn't care, from each according to his ability and to each according to his need.
1
Why not just let them die? Is that what you're suggesting? Do you want to be the one to tell that to sick and poor people? Seems like you can't wait. Dr. Krugman is suggested we find a way to make sure everyone is cared for. Are you against that as well?
Unfortunately this piece boils down to partisanship presented in the language of analysis. The problem is attributed to "vindictiveness" and "states that have small populations and/or have governments hostile to reform." Those small states are then advised that the solutions are executive action (because Congress won't act) or implementing a "public option" at the state level. BUT LOOK AT VERMONT, where the Democratic Governor is stepping down his efforts to implement a single-payer system devolved into a fiasco. Vermont isn't exactly "hostile to reform," but a Republican running to switch Vermont over to the federal exchange stands a 50/50 chance of winning the Governorship this fall -- and health care is *by far* the #1 issue.
1
Funny how Mr. Krugman suddenly promotes compromise when his policy is on the rocks. It's also hysterical how he thinks a public option is a compromise!
As we all know, a public option is a very big ask politically - right or wrong. What is Mr. Krugman willing to give it up for it? Entitlement reform perhaps?
Remember, he now is suddenly in the spirit of compromise. Wink...
As we all know, a public option is a very big ask politically - right or wrong. What is Mr. Krugman willing to give it up for it? Entitlement reform perhaps?
Remember, he now is suddenly in the spirit of compromise. Wink...
2
Listen to bernie. The youth of America listened to him. They visualize an Anerica which is just, where basic needs like health, education, higher education, are available to one and all. Please it's time we recognize how expensive health care is in America, how commercial it has become, how money minded pharma and physicians control the entire country as hostages. Cleveland clinic, Mayo clinic models have successfully shown us that physicians can receive a decent salary without ordering unnecessary tests and procedures and medications. Less wastage. Big money rules us, from top Presidential elections, to lowly politicians to pharma to doctors. Time to start over.
4
Wow, that sounds good! Let's start tomorrow! Like you are saying something every intelligent thinking person hasn't known for decades. The devil just MAY be in the details.
As long as we have the corporate interests looking to block anything that won't lead to higher profits,
and a large segment of middle and lower class America who hate Obama and Democrats, and refuse to even listen, and who continually vote for Republicans who uphold corporate masters because of secondary issues like guns, abortion, racism
and as long as some of the left holds out this utopian vision of what can come about if we just wave enough magic wands, and reject anything that doesn't meet their purity standards, and demonize democrats who can start moving things in the right direction:
We're going nowhere.
As long as we have the corporate interests looking to block anything that won't lead to higher profits,
and a large segment of middle and lower class America who hate Obama and Democrats, and refuse to even listen, and who continually vote for Republicans who uphold corporate masters because of secondary issues like guns, abortion, racism
and as long as some of the left holds out this utopian vision of what can come about if we just wave enough magic wands, and reject anything that doesn't meet their purity standards, and demonize democrats who can start moving things in the right direction:
We're going nowhere.
CLSW, you are right, we are going nowhere with Hillary. She is same old same old. She will make sure the rich stay wealthy. big pharma keeps making more money. "The pharmaceutical industry has donated $589,344 to Hillary Clinton's campaign, according to the nonprofit research group Center for Responsive Politics. That's more than any other candidate — despite Clinton's proclamation that she's proud to call the pharmaceutical industry her enemy."
http://www.cnbc.com/2016/03/10/despite-her-rhetoric-big-pharma-likes-hil...
"It's worth noting that Clinton has received the most contributions overall — not just from the pharmaceutical industry. But the drugmakers she's declared as her enemy don't appear to feel the same way."
http://www.cnbc.com/2016/03/10/despite-her-rhetoric-big-pharma-likes-hil...
"It's worth noting that Clinton has received the most contributions overall — not just from the pharmaceutical industry. But the drugmakers she's declared as her enemy don't appear to feel the same way."
1
There are many factors driving up the cost of healthcare in this country. Private insurance is only a part of the problem.
As one doctor mentioned below, you cannot forget the malpractice system and the sometimes perverse incentives it creates, profit-seeking pharmaceutical companies, a culture which values quantity of life at the end-of-life rather than quality and the doctors and hospitals who profit from that value system.
I would add that Americans are their own worst enemy too. We eat garbage and sit too much and suffer from more expensive, chronic disease as a result.
Your insurers add up the cost of treating and medicating all these sick Americans, the cost of over-treating people so they won't sue, the cost of drawn-out, gruesome end-of-life care -- and then they hand us the bill and we cry foul.
The enemy is us folks.
As one doctor mentioned below, you cannot forget the malpractice system and the sometimes perverse incentives it creates, profit-seeking pharmaceutical companies, a culture which values quantity of life at the end-of-life rather than quality and the doctors and hospitals who profit from that value system.
I would add that Americans are their own worst enemy too. We eat garbage and sit too much and suffer from more expensive, chronic disease as a result.
Your insurers add up the cost of treating and medicating all these sick Americans, the cost of over-treating people so they won't sue, the cost of drawn-out, gruesome end-of-life care -- and then they hand us the bill and we cry foul.
The enemy is us folks.
1
Professor Krugman's error is to treat insurance as a "given" in this equation. Aetna, et al., have marble facades on their corporate headquarters because they are parasites to the process of human well-being.
Conflating health care with insurance the is playing the dupe to corporations which–by their very business plans–collect the highest possible premiums while paying out the lowest possible "benefits" to a captive customers base.
Americans do not need insurance. They need health care.
Conflating health care with insurance the is playing the dupe to corporations which–by their very business plans–collect the highest possible premiums while paying out the lowest possible "benefits" to a captive customers base.
Americans do not need insurance. They need health care.
4
Krugman in la la land.
First off Paul -- people have been predicting this would happen since the act was passed. And contrary to your whistling through the dark attitude, premiums started sky rocketing the minute the law was passed, not when it went into effect. From the time the bill was passed until it went into effect, my health care premiums doubled.
And don't tell me that health care costs have slowed. Have you heard about inflation -- it's slowed too. So, what do you think, there's something unique about heath or -- like just about everything else -- it's growth in costs has slowed a little too. But don't be confused, it's not slowed to the over all inflation rate -- in fact, the ratio of health cpi to overall cpi was greater in 2015 than ever. So, you must take your speech writing lessons from HRC. What's a little lying among friends if it pushes your agenda.
First off Paul -- people have been predicting this would happen since the act was passed. And contrary to your whistling through the dark attitude, premiums started sky rocketing the minute the law was passed, not when it went into effect. From the time the bill was passed until it went into effect, my health care premiums doubled.
And don't tell me that health care costs have slowed. Have you heard about inflation -- it's slowed too. So, what do you think, there's something unique about heath or -- like just about everything else -- it's growth in costs has slowed a little too. But don't be confused, it's not slowed to the over all inflation rate -- in fact, the ratio of health cpi to overall cpi was greater in 2015 than ever. So, you must take your speech writing lessons from HRC. What's a little lying among friends if it pushes your agenda.
3
The Bottom Line..........Americans need health care as a matter of life and death.
Democrats want people to be cared for.
Republicans want to make money and stay in power by protecting the powerful insurance industry.
Timing is everything and the Aetna company is bailing out of most likely unhealthy counties to reduce payouts while their Republicans are still in Congress before the election.
Democrats want people to be cared for.
Republicans want to make money and stay in power by protecting the powerful insurance industry.
Timing is everything and the Aetna company is bailing out of most likely unhealthy counties to reduce payouts while their Republicans are still in Congress before the election.
As many point out, the fix is single payer. If this was part of the original law we would easily transitioned away from the private insurers when the dropped segments of the market. I am hoping for a democratic landslide to fix this and guns and the economy and the supreme court...
8
Obamacare, Affordable Health Care, whatever you want to call is overall a good thing. In America what a vast majority of people hate more than anything is that something like this that has the potential of keeping an entire nation generally healthy is associated with a man of color....and a vast amount of Americans hate that....Race matters
1
No ones talking about the supply side. The primary medical school in my state trains only 10 more doctors than it did in 1972 when I joined the faculty. At least half the VA care problem is a shortage of doctors. It's a closed shop than needs competition.
2
One thing that caught my eye is the vindictiveness comment. Companies are always accused of only acting in their self interest, the rest of us be damned. Now, the company is ignoring their self interest and profit and is acting in an irrational, vindictive manner. Seems like a bit of a stretch. I tend to believe that the CEO wants the company to make money, and, for them, this is a loser.
2
There's profit, and then there's PROFIT. Companies have a fiduciary responsibility to shareholders to remain profitable overall, and health insurance companies are no different. But what I see the health insurance companies doing, is trying to make themselves PROFITABLE: not only working to be profitable overall, but going through every insurance plan and business venture they control and trying to force each of them individually to be profitable; dropping the ones that aren't. And this, I think, is what makes them a bad fit for a government program like the ACA, which assumes that some plans might be profitable and could subsidize plans that aren't.
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Of course, I am not an economist or a CEO. Just a 40 something architect who has insurance through his wife's employer.
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Of course, I am not an economist or a CEO. Just a 40 something architect who has insurance through his wife's employer.
1
With any luck, the Trump Train will derail and take down the Grand Obstructionist Party with it. The Republicans that are left might decide to work with President Clinton to save their own necks.
This article reminds me of when Bush supporters were saying everything is going fine in Iraq, just a minor 'bump.'
1
Medicare for all - a single-payer system is the answer. Just ask our neighbors to the North; why do you think millions of US citizens send to Canada for reasonably-priced pharmaceuticals?
4
When polls show that a majority of Americans oppose 'Obamacare', I would be one of them, but only for the reason that it didn't achieve to become a universal public health plan as practiced in all other advanced nations in the world at less than half the cost and better health outcomes to boot.
I consider the ACA as the first step towards an universal healthcare system, and that can only be achieved with a Democrat in the White House and having more Democratic representatives and senators in the right now not very hallowed halls of Congress.
I consider the ACA as the first step towards an universal healthcare system, and that can only be achieved with a Democrat in the White House and having more Democratic representatives and senators in the right now not very hallowed halls of Congress.
219
Well said, Sarah!
1
The predictions of Obamacare's demise were also tied to Obamacare's implementation. The inevitable adverse destructive effects aren't felt yet as Obama hasn't implemented the mandate on businesses until this next year.
Obamacare is self-destructing before it's even implemented and "it can be fixed" is the response? How? Pay insurers even More to lose money via the risk corridors? Raise the deductible even more (except for those that get it free)?
While the liberal mantra is a never ending "if only we could redistribute a little more," it will never be enough. The adverse effect will continue to push up cost, and push people out of health insurance entirely.
Don't believe me, or Krugman, ask people what they're doing about health insurance and you'll find out just how many have bailed, or won't even now go to the doctor because the insurance is useless.
Obamacare is self-destructing before it's even implemented and "it can be fixed" is the response? How? Pay insurers even More to lose money via the risk corridors? Raise the deductible even more (except for those that get it free)?
While the liberal mantra is a never ending "if only we could redistribute a little more," it will never be enough. The adverse effect will continue to push up cost, and push people out of health insurance entirely.
Don't believe me, or Krugman, ask people what they're doing about health insurance and you'll find out just how many have bailed, or won't even now go to the doctor because the insurance is useless.
2
So, what is the solution, in your opinion? Perhaps a "public option", like in every other civilized country, where people can go to the doctor (because they do not need useless insurance companies)? Or what? I personally don't like the ACA very much, as a freelancer it's not been a great help and maybe it has even been damaging. But really, I don't see what else we can do to fix the system, especially if we keep this idea that healthcare is a for profit business and not a human right.
It's not a bump, Paul. It's a problem with the premise on how and what people will purchase insurance, and how and what companies will provide such insurance.
It's unsustainable without major tweaking. But you won't hear that from the people, like Mr. Krugman, who can't find any wrong in this lobbyist designed bill that was a giveaway to the pharmaceutical and insurance industry. In addition, this bill was designed primarily to help people that did NOT have insurance and couldn't pay for it either. Many middle class people and small businesses just can't afford this insurance, especially with the high deductibles.
Watch how the Obama administration will steal funds from other programs like Medicare, the CDC and anything it can get it's hands on to justify payment to insurers so that they don't leave the market. That's the truth of this matter. Stop blaming anyone but the Democrats, Mr. Krugman. They created this monster. And they need to stop the happy talk and take responsibility for the messes.
It's unsustainable without major tweaking. But you won't hear that from the people, like Mr. Krugman, who can't find any wrong in this lobbyist designed bill that was a giveaway to the pharmaceutical and insurance industry. In addition, this bill was designed primarily to help people that did NOT have insurance and couldn't pay for it either. Many middle class people and small businesses just can't afford this insurance, especially with the high deductibles.
Watch how the Obama administration will steal funds from other programs like Medicare, the CDC and anything it can get it's hands on to justify payment to insurers so that they don't leave the market. That's the truth of this matter. Stop blaming anyone but the Democrats, Mr. Krugman. They created this monster. And they need to stop the happy talk and take responsibility for the messes.
4
Time doesn't always allow for solutions to solve our problems. What better to realize than our healthcare industry. The problem is and always has been: profits. Isn't it time we go to a national healthcare system, where costs can better be managed, profits wouldn't be a factor, and our nation would have a healthier workforce. Billions are wasted today in just administering this for-profit present system we have. One gets a little tired of reading the same story over, and over again. So, Mr. PK, start talking about out-of-the-box solutions, not the same rhetoric print I see in your articles.
4
Medicare operates on about 2.5% while the major insurers won't be in a market for less than 22%.
Not sure this article is correct after reading just the first few sentences so why bother reading the rest of it? The cost to our household is ridiculous for my self employed husband who pays $670 a month, now with HIghmark (they cancelled his plan last year and we stuck with Highmark once again to our dismay), a $6,000 deductible and $80 co-pay when he goes to the doctor or a $125 co pay for a specialist!!!!!!!!!!!!!!!! In PA for our income level and for a plan that provides zero help for simple doctor visits is a complete scam!!!!!! This is highway robbery of the first degree from the insurance companies. We cannot afford this. Everywhere we turn we are getting ripped off with school taxes, property taxes, income taxes, building permit fees, telephone taxes, taxes, taxes, fees, fees.......it is crazy. WE can't escape this as a middle income couple because we are not rich enough to shelter our income and avoid taxes like the super rich. This has got to stop but I know it won't, it will be worse next year as HIghmark has already said they too will pull out of some states. How can HIghmark be ripping us off so much yet they still aren't making enough profits? Something is truly wrong and I frankly don't know what we can do about it. I am not going to vote for Trump or Clinton who both shelter their income and use "foundations" or declare bankruptcy for some of their businesses to obtain write-offs from paying their fair share of taxes. What has happened to people?
110
All of those taxes you are referring to (except the health insurance) are regressive taxes: that is, taxes that "everyone" pays and hurt middle class and poor people specifically. This is because Republicans in Congress will not raise income taxes on the upper echelons and thus, "fees" for the rest of us. I would suggest voting for Hillary Clinton and the hope of a Democratic Congress.
Hey - It is a free country. So what if we pay more than half our earnings in taxes.
1
Of course it is incorrect. The president said the average american family would save $2,500 a year in healthcare costs if we passed his law. In the warped world of Krugman and his sycophants; if costs rise 600 Zillion dollars in year 1 and only rise 500 Zillion in year 2... the rising costs have been slowed and therefore this is a SUCCESS!
1
The concept of health care as a for-profit industry is obscene, period. Time for Medicare for all.
Under the ACA, my husband and I—both self-employed—pay $1800/mo. PLUS a $2000 annual deductible (not counting a bewildering array of co-payments and co-insurance fees). That's $23,600 a year *excluding* dental and vision. Affordable? By whom?
Under the ACA, my husband and I—both self-employed—pay $1800/mo. PLUS a $2000 annual deductible (not counting a bewildering array of co-payments and co-insurance fees). That's $23,600 a year *excluding* dental and vision. Affordable? By whom?
16
Obscene is the perfect word for it. Obscene health care industry costs. Obscene amount of money that's poured into Presidential campaigns that run for obscenely long length of time.
1
GOP EXTREMIST IDEOLOGUES, Unable to get a bill passed to repeal Obamacare, have decided that they'll sabotage it another way. By opposing changes necessary to offset the withdrawal of Aetna, the corporation that apparently withdrew in a vindictive move to merge with another big corporation was blocked due to anti-trust regulations. So unwilling to tolerate Obamacare's success that the GOP would kill off a government program that has brought down expenses while helping the uninsured, that their action are not the peoples' business, but another blow in the 1% trying to have it all to the detriment of the 99%. Let's hope that there's a great landslide in November to flush down the sewers lots of filth that has accumulated in traitors to the nation strangling it to save it.
3
I wonder how many people in this country are thankful to have insurance thanks to the ACA, but will still vote for Trump and other Republicans, not realizing they'll lose that insurance if Trump & co. get their way.
Of course they'll be able to purchase insurance through the Republican plan of repeal and replace, which won't include a subsidy, otherwise known as the "unaffordable care act".
Of course they'll be able to purchase insurance through the Republican plan of repeal and replace, which won't include a subsidy, otherwise known as the "unaffordable care act".
2
Look at Kentucky, folks. Voters there were very surprised when Medicaid was rolled back, although that was exactly what their candidate said he would do.
1
Obamacare isn't working because the law did nothing to address the main problem with the US healthcare system -- rising costs. As long as drug prices keep soaring, hospitals consolidate, and we're stuck in a fee for service system, the situation will keep getting worse. So what if more people have health insurance if they're just stuck with bad plans with huge deductibles and copays? You can't blame young healthy people for opting out. I'm fortunate to live in a state (Massachusetts) with many hospitals and insurance options. But if I got really sick, I would have a hard time affording the care I needed with my current plan. And I have a good job. I would be scared to death if I were a young person, just starting out. There is one solution -- Medicare for all.
216
Amen.
1
"...there’s nothing wrong with Obamacare that couldn’t be fairly easily fixed with a bit of bipartisan cooperation. The only thing that makes this hard is the blocking power of politicians who want reform to fail."
Created without cooperation equals administered without cooperation. This is the problem of passing comprehensive reform without buy-in from both parties.
Created without cooperation equals administered without cooperation. This is the problem of passing comprehensive reform without buy-in from both parties.
How many things have we been told by Obama and Krugman about Obamacare that turned out to be lies? The cost per family, the sustainability, if you like your doctor, if you like your plan...
Krugman constantly advocates for governance by experts yet there is no yardstick to help us when experts fail, as he simply moves the goal post once again. As if the long-term structural debt of Obamacare were just a matter of shifting a few margins. As if it's an even remotely sane way to make healthcare more affordable or efficient.
It should be pointed out how anti-democratic this is: Krugman constantly advocates against the commonsense of the voters, who are largely benighted in his view, and for said voters (rubes) to trust the technocratic planners at the top. Yet there is no accountability when they fail.
"What you need to know" peppers his columns. I'm somewhat amazed at even how many self-respecting liberals take his condescension as gospel.
Krugman constantly advocates for governance by experts yet there is no yardstick to help us when experts fail, as he simply moves the goal post once again. As if the long-term structural debt of Obamacare were just a matter of shifting a few margins. As if it's an even remotely sane way to make healthcare more affordable or efficient.
It should be pointed out how anti-democratic this is: Krugman constantly advocates against the commonsense of the voters, who are largely benighted in his view, and for said voters (rubes) to trust the technocratic planners at the top. Yet there is no accountability when they fail.
"What you need to know" peppers his columns. I'm somewhat amazed at even how many self-respecting liberals take his condescension as gospel.
2
Let's hear from commenters about how to improve Obamacare. Here's some of my ideas:
1) Provide everyone with a limited Medicare plan that acts like catastrophic insurance. I've heard Republicans voice support for universal catastrophic coverage, even recently.
2) Allow full Medicare coverage to be SOLD in all markets. Throw a bone to insurers and remove profit limits. Competing with Medicare will put enough pressure on their margins
3) Ban deductibles for emergency and catastrophic care. Deductibles do serve a purpose. They create a disincentive to seek unnecessary care (and sometimes necessary care). However, if one's only options are to seek care or to die, what purpose does a deductible serve? It does lower premiums for healthy people but it does so by shifting the burden onto the most vulnerable. That makes no sense and it's cruel.
4) Reform patent law so that minor changes to drugs do not get full patent protection. If a new drug offers a higher success rate in treating a disease than what's currently available - full patent protection. But if it simply offers less side effects or different side effects- limited patent protection.
1) Provide everyone with a limited Medicare plan that acts like catastrophic insurance. I've heard Republicans voice support for universal catastrophic coverage, even recently.
2) Allow full Medicare coverage to be SOLD in all markets. Throw a bone to insurers and remove profit limits. Competing with Medicare will put enough pressure on their margins
3) Ban deductibles for emergency and catastrophic care. Deductibles do serve a purpose. They create a disincentive to seek unnecessary care (and sometimes necessary care). However, if one's only options are to seek care or to die, what purpose does a deductible serve? It does lower premiums for healthy people but it does so by shifting the burden onto the most vulnerable. That makes no sense and it's cruel.
4) Reform patent law so that minor changes to drugs do not get full patent protection. If a new drug offers a higher success rate in treating a disease than what's currently available - full patent protection. But if it simply offers less side effects or different side effects- limited patent protection.
2
5) How about we get the "real" cost of services established? Why is it insurance companies pay 10 cents on the dollar for services billed? What is the real deal?
6) Why do we need a new medical complex (usually constructed on virgin real estate) on every corner? Why an MRI on every corner? What if those testing facilities ran 24/7 instead to pay for the equipment in a more efficient manner? I think people would use testing facilities in extended hours if there were a financial incentive.
6) Why do we need a new medical complex (usually constructed on virgin real estate) on every corner? Why an MRI on every corner? What if those testing facilities ran 24/7 instead to pay for the equipment in a more efficient manner? I think people would use testing facilities in extended hours if there were a financial incentive.
1
Bump? Paul you are a very bright man and nobel laureate, but... You don't seem to grasp that, unless COST is dealt with, the ACA and anything that comes in its place, will ultimately fail. The fee-for-service payment system must be eliminated and incentives rearranged. As long as hospitals and physicians are incentivized to increase revenue by providing more services you and other policy wonks are simply whistling in the wind.
2
I've heard many young healthy adults around the country say they'd "rather pay the fine than the insurance premium" because "it's cheaper than paying the deductible". The ACA hasn't made it easy to understand how those charges work in practicality. You read the plan details and it says you will be out of pocket, like, $6,000 before it starts to pay for your care. But if you do regular tests and appointments you don't pay for them. It's not clear in the plans' gibberish descriptions how it actually works.
2
It's interesting, I guess, because he is Obama, that he can get away with lies to the American people. He promised the ACA would be cheaper; families will save on average $2500. Clearly a lie. You get to keep your doctor, another lie. What will the lie be this time Paul. Obamacare can be fixed?
3
You describe the original si of Obamacare very well - its reliance on commercial health insurance companies. This is the real problem. Your suggestions are mere bandaids! The real solution - and a more economical and efficient one too - is expanding Medicare (not Medicare Advantage) to cover our whole population.
5
And the result will be lousy doctors and care for everyone except those with enough money to pay for private care.
The health of every American is a matter of national security. Cut the Gordian Knot - nationalize healthcare, eliminate for-profit health insurance. Every man, woman and child should be guaranteed basic healthcare - both preventive services and curative care.
The United States military is not seen as a private, for-profit enterprise. Why should we be enslaved by a healthcare industry motivated by profit and driven by the greed of huge for-profit insurance companies?
The United States military is not seen as a private, for-profit enterprise. Why should we be enslaved by a healthcare industry motivated by profit and driven by the greed of huge for-profit insurance companies?
6
This is because company funded insurance distorts the market. There is no reason people should be getting tax breaks because they get their insurance from their employer. If everyone had to buy their insurance on the open market and was mandated to do so, you would see the aggressive competition that's in the auto insurance industry.
1
One of the biggest problems with Obamacare is the fact that many people don't realize they have it. I know people who have purchased insurance through the exchange who would flip out at any suggestion that they have insurance thanks to Obama and the Democrats.
Again the discussion leaves out people like me. We purchase our insurance as individuals that do not qualify for subsidaries. Our premiums has gone up double digits in the last year. This year Anthem in CT is asking for a 26% increase. Premium up. Deductible up. Coverage improved. Can't afford to use it. Net gain = zero!
This is the elephant in the room. What about all the people who purchase insurance outside the exchange because it is cheaper for now - but not sustainable. This elephant's name is "DISASTER" for the middle class self employed. You know us. We are you neighbors - we own small businesses - lawyers, accountants, web designers, plumbers, food truck owners......
This is the elephant in the room. What about all the people who purchase insurance outside the exchange because it is cheaper for now - but not sustainable. This elephant's name is "DISASTER" for the middle class self employed. You know us. We are you neighbors - we own small businesses - lawyers, accountants, web designers, plumbers, food truck owners......
6
It is strange that the millions of Americans like you and me who buy insurance as individuals, most off exchange, are never mentioned in any of the discussions by health advocates and pundits covering the problems with the ACA. In some states my research shows the unsubsidized actually outnumber the subsidized.
We are the elephant in the room because at some point - and I'm close to it - we drop coverage because the cost just outweighs the benefits and the entire structure teeters even more.
Aetna's pullback from the exchanges has attracted a lot of attention but what goes unmentioned most of the time is that Aetna has 2-3 million more enrollees in the individual market off-exchange and plans to continue to offer most of them coverage options. The company jettisoned the highest risk members - those on the exchange - and kept the lower risk population. The company can levy the high premiums, pay out less per member in medical costs and increase profits.
We are the elephant in the room because at some point - and I'm close to it - we drop coverage because the cost just outweighs the benefits and the entire structure teeters even more.
Aetna's pullback from the exchanges has attracted a lot of attention but what goes unmentioned most of the time is that Aetna has 2-3 million more enrollees in the individual market off-exchange and plans to continue to offer most of them coverage options. The company jettisoned the highest risk members - those on the exchange - and kept the lower risk population. The company can levy the high premiums, pay out less per member in medical costs and increase profits.
"And many of these private insurers are now finding themselves losing money, because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
Well, we can't have that stand in the way of profits! Sick people: "I'd like to help you, but you're... sick."
That's what Capitalism is all about, isn't it? Health care delivery is important only when there is a great profit to be made so insurance companies can continue to build skyscrapers - it's always been about that, so why the big surprise?
As for bipartisan support, when have the poor ever received anything but bipartisan neglect? Now the neglect has spread to the middle class, which has found premiums skyrocketing.
What we need is Trump's healthcare plan, TRUMPcare, which covers everybody with health-promoting, jammy gobbledygook, Trump's own brand of yesnomaybe, the Greatest HealthCare Plan ever. We will all be so healthy we never realized what health was.
Well, we can't have that stand in the way of profits! Sick people: "I'd like to help you, but you're... sick."
That's what Capitalism is all about, isn't it? Health care delivery is important only when there is a great profit to be made so insurance companies can continue to build skyscrapers - it's always been about that, so why the big surprise?
As for bipartisan support, when have the poor ever received anything but bipartisan neglect? Now the neglect has spread to the middle class, which has found premiums skyrocketing.
What we need is Trump's healthcare plan, TRUMPcare, which covers everybody with health-promoting, jammy gobbledygook, Trump's own brand of yesnomaybe, the Greatest HealthCare Plan ever. We will all be so healthy we never realized what health was.
3
The private health insurance companies put a bonus, stock options, profits and a bureaucrat between Americans and their doctors, nurses and aides giving them the best quality healthcare. That is not a bump. That is a titanium wall paid for by their lobbyists soliciting and buying the services of our elected legislators and executives.
The reality is that all of us are going to age, sicken and die when, where and how we are supposed to. Depending on your perspective you are living or dying. No matter which you are doomed to leave.
The Union North won the Civil War over the treacherous rebel Southern confederates. But the dang gone rebels have not accepted their crushing defeat by the Great Warrior Abraham Lincoln using the "terrible swift sword" of government power.
In contrast the health insurance companies represent a "hobbit" threat. The solution to their bump is "single payer" basic affordable quality healthcare for all as a human right.
Cast the money changers from the humane healthcare temple. Their business is collecting premiums, limiting coverage and denying claims. That is Satan's business.
The reality is that all of us are going to age, sicken and die when, where and how we are supposed to. Depending on your perspective you are living or dying. No matter which you are doomed to leave.
The Union North won the Civil War over the treacherous rebel Southern confederates. But the dang gone rebels have not accepted their crushing defeat by the Great Warrior Abraham Lincoln using the "terrible swift sword" of government power.
In contrast the health insurance companies represent a "hobbit" threat. The solution to their bump is "single payer" basic affordable quality healthcare for all as a human right.
Cast the money changers from the humane healthcare temple. Their business is collecting premiums, limiting coverage and denying claims. That is Satan's business.
8
Krugman fails to talk about the freerider problem:
1) Those who don't ever buy insurance do get care and aren't penalized enough to pay the premium
2) People who do buy insurance, run through a lot of care and then drop it when their illness is over.
These people need to be in the risk pool over the long haul through much more severe penalties and policing.
1) Those who don't ever buy insurance do get care and aren't penalized enough to pay the premium
2) People who do buy insurance, run through a lot of care and then drop it when their illness is over.
These people need to be in the risk pool over the long haul through much more severe penalties and policing.
4
Krugman conveniently forgot to mention that premiums and deductibles are too high. The system is impractical.
Pull the private insurers out of the equation and install government control of drug prices.
If the companies howl, let them move to Luxembourg. We'll still be their largest market. Use the market power.
Pull the private insurers out of the equation and install government control of drug prices.
If the companies howl, let them move to Luxembourg. We'll still be their largest market. Use the market power.
6
Other commentators have pointed out that the same insurance companies that are pulling out of the exchanges are making very good money indeed on the Medicaid-funded leg of the ACA, and that perhaps participation in the Medicaid element could be made contingent on participating in the exchanges as part of a solution.
Interesting though that the insurance companies are doing quite well taking money paid by the government (Medicaid), not so well in the private sector exchange. Perhaps that points to the ultimate answer: Medicare for all.
Interesting though that the insurance companies are doing quite well taking money paid by the government (Medicaid), not so well in the private sector exchange. Perhaps that points to the ultimate answer: Medicare for all.
3
My family live in Texas, a state which didn't expand medicaid. We are professional musicians so we're often out of state, but tge last PPO plan offered on the market place was discontinued last year, and our HMO plan only works with a narrow provider network. When the need for medical care was urgent, like when my husband's shoulder mysteriously froze up, it took 2.5 months of constant appointments with PCP and many tests before he could be referred to an orthopedist and receive treatment. Most of that time I spent calling doctor's offices and our insurance company to figure where the hold up in our paperwork was this time. That's a lot of uncertainty when the lack of access to medical care decides whether my husband can do his job. Musicians need their arms. So we have expensive insurance that doesn't work at all the half of the year we're touring, and when we are home that insurance seems to make it intentionally as difficult to obtain care as possible, in the hopes we'll may give up and go away. Using private insurance companies is not working. We need a public option.
12
You didn't notice that Medicaid has been quietly privatized, and as of last week, seniors on Medicare and Medicaid are being forced to choose between four insurers, one of whom is Aetna. Each insurer here in Illinois covers less than 350 providers. There are more physicians than that in the hospital where I see my doctor.
While we were fighting for single-payer and a public option, the government was privatizing what is left of public health care, substantially reducing coverage for some seniors.
Aetna should be punished, taxed, not subsidized.
Single-payer NOW.
While we were fighting for single-payer and a public option, the government was privatizing what is left of public health care, substantially reducing coverage for some seniors.
Aetna should be punished, taxed, not subsidized.
Single-payer NOW.
24
I don't know what's going on in Illinois, but Medicare is alive and well in California and beneficiaries are not asked to choose a private option...unless they want supplemental coverage.
The public option was and is essential for the program to really work. Of course insurance companies should never have been involved but without that the program would never have become law. Time for the public option.
8
My concern is that by focusing on insurance, the issue of cost keeps getting overlooked, although the comments here show just what an issue that is. Dr. Krugman's piece references how the ACA helped slow rising health care costs, but I believe this issue must be addressed more directly as well. Perhaps a bit dated now but Time magazine's article Bitter Pill highlighted how opaque the medical billing system is. A colleague of mine has a wife whose job is to cull medical bills which the state is paying, and to find where the state has been overbilled or double billed; she saves our state literally millions of dollars a year. Our congress won't let Medicare/Medicaid negotiate with pharma to reduce the cost of prescription drugs; my favorite: drugs which have been sold to Canadian companies by American companies which could then be sold to American consumers for less than we pay in our own country - except that's not allowed either! To be sure, single-payer seems a healthy alternative as do higher subsidies, but we must not forget the elephant in the room either - the cost of health care.
5
Most news about Obamacare has been good?
Says who?
I guess most liberals never talk to real people, such as the poor, who have to pay premiums and cannot even use the insurance because the basic risk fee is so extremely high that they end up having to pay for almost everything anyway.
Obamacare has been in actuality a total farce: badly organized, badly implemented, with skyrocketing rates and an almost total lack of transparency.
It is really time that liberal columnists stop trying to put make-up on what is essential legislation made to polish the legacy of bad president.
I still regret the day I voted for him.
Says who?
I guess most liberals never talk to real people, such as the poor, who have to pay premiums and cannot even use the insurance because the basic risk fee is so extremely high that they end up having to pay for almost everything anyway.
Obamacare has been in actuality a total farce: badly organized, badly implemented, with skyrocketing rates and an almost total lack of transparency.
It is really time that liberal columnists stop trying to put make-up on what is essential legislation made to polish the legacy of bad president.
I still regret the day I voted for him.
9
That's exactly right. Obamacare written in back rooms by policy wonks who r clueless on how it would effect regular Americans. Then came the lies and the 100% partisan lib vote with a few bribes included. Now our regular citizens r faces with high premiums and even higher deductibles . In 2017 the pricing will continue to worsen. So it's all come full circle with many of us not taking care of our Heath because doctor visits r too expensive. Now the lib shouts will be Medicare for all like that program is like a magic bullet.
2
Krugman tries to be more salesman than economist:
1. "Health reform didn’t cause the budget deficit to soar" - No, health reform may not have exploded government borrowing but Obama has. Our debt to GDP has exploded from 67% when Bush left to 105% - near Portugal and not too far from Greece.
2. "it didn’t kill private-sector jobs" - Again, health reform didn't kill jobs - though it is partially responsible for the lowest labor participation in decades. And Obama is certainly in the bottom half in terms of job creation.
http://blogs.wsj.com/economics/2014/12/05/in-ranking-presidents-by-job-c...
Health reform didn't do these bad things because health reform simply didn't do much. Only 11 million people have obtained health insurance through the exchanges. Even if every one of them was newly insured, that's only 3% of our population. For the most part, Obamacare is federalizing Medicaid in blue states (whose cost had been 50/50 shared with the states but is now 90% federal).
And the exchanges are failing because "guaranteed issue" and "community rating" mean that people can wait till they are sick, get cheap insurance and then cancel it right after. It's the same "death spiral" that formerly killed health reform in NY and WA.
"States may be able to offer their own public options." One of our most liberal states (VT) already tried this but balked when they found it would require a 9% hike in payroll taxes and 11% hike in income taxes.
1. "Health reform didn’t cause the budget deficit to soar" - No, health reform may not have exploded government borrowing but Obama has. Our debt to GDP has exploded from 67% when Bush left to 105% - near Portugal and not too far from Greece.
2. "it didn’t kill private-sector jobs" - Again, health reform didn't kill jobs - though it is partially responsible for the lowest labor participation in decades. And Obama is certainly in the bottom half in terms of job creation.
http://blogs.wsj.com/economics/2014/12/05/in-ranking-presidents-by-job-c...
Health reform didn't do these bad things because health reform simply didn't do much. Only 11 million people have obtained health insurance through the exchanges. Even if every one of them was newly insured, that's only 3% of our population. For the most part, Obamacare is federalizing Medicaid in blue states (whose cost had been 50/50 shared with the states but is now 90% federal).
And the exchanges are failing because "guaranteed issue" and "community rating" mean that people can wait till they are sick, get cheap insurance and then cancel it right after. It's the same "death spiral" that formerly killed health reform in NY and WA.
"States may be able to offer their own public options." One of our most liberal states (VT) already tried this but balked when they found it would require a 9% hike in payroll taxes and 11% hike in income taxes.
8
Economics: People freely buy and sell goods and services, and economists draw charts and graphs. Everyone is rational, and progress is steady.
Politics: People fight for what they believe, and are determined to destroy the opposing groups by any means necessary.
PK was an economist, but he's no politician.
Politics: People fight for what they believe, and are determined to destroy the opposing groups by any means necessary.
PK was an economist, but he's no politician.
6
Are there any data showing any reduction in taxpayer costs at the local level for uncompensated medical care expenses as a result of increased health insurance coverage? The costs paid out by the insurers under Obamacare policies cannot be all or even mostly for medical services that would not have been rendered otherwise. By law those services, or at least a substantial portion of them, cannot be denied to people in need of them. Some one has to pay for those services -- either through higher charges for paying patients (i.e. the insurance companies who pass that cost on with higher premiums) or taxpayers who subsidize the public hospitals and clinics.
1
As long as I am forced to pay tax surcharges for someone else's freebie, in addition to paying for my own family's insurance, I will adamantly oppose this nasty and immoral law.
5
But you pay twice as much for them when they end up in the emergency room. Yours is a tired and false argument that for those of us in the medical profession (I'm a doctor) have known for years. If you look at the facts you will have to admit that universal health insurance helps everyone, including those who have their own insurance, and is cheaper in the long (and short) run.
@Ernest - if they end up in the emergency room, everyone pays equally. The current system punishes only those who make good living.
1
Thank you Aetna for several important lessons.
Corporations have one god - greed.
Corporations are not patriotic.
Corporations do not care about people and communities.
Corporations are not motivated by any greater good.
It is time for corporatist politicians and their supporters to wake up and realize that corporations will never the solve the problems facing the US today - corporations are the causes of our problems.
For the non-corporatists, it is time to end the super-citizen status of corporations in our society.
Corporations have one god - greed.
Corporations are not patriotic.
Corporations do not care about people and communities.
Corporations are not motivated by any greater good.
It is time for corporatist politicians and their supporters to wake up and realize that corporations will never the solve the problems facing the US today - corporations are the causes of our problems.
For the non-corporatists, it is time to end the super-citizen status of corporations in our society.
41
Excellent points. This is the reason why most advanced capitalist nationshave a national health care system, sometimes but not always known as single-payer.
But from a moral point of view, keeping a nation healthy should not have profits as its primary bottom line.
From a health point of view, it is also clear that with the highest health care costs in the world, America lags behind other nations that have national health insurance.
Why is that? Well, Aetna is one of the reasons why, along with United Health and Humana. So it was right for the DOJ to not approve the merger and under the current configuration, the Supreme Court would probably agree with the DOJ.
Another reason not to elect Donald Trump.
But from a moral point of view, keeping a nation healthy should not have profits as its primary bottom line.
From a health point of view, it is also clear that with the highest health care costs in the world, America lags behind other nations that have national health insurance.
Why is that? Well, Aetna is one of the reasons why, along with United Health and Humana. So it was right for the DOJ to not approve the merger and under the current configuration, the Supreme Court would probably agree with the DOJ.
Another reason not to elect Donald Trump.
1
Yeah! Get rid of those employers! Bad manufacturers, bad car makers, bad bad!
Greed or capitalism? Private, companies that are based on profits should not be confused with government agencies or religious organization. No company can long maintain a losing position. Aetna recently lost 403 million dollars on the ACA. So what is a company that needs to turn a profit or even just break to do - become a charity? Unlike our wonderful, caring federal government, companies can't pay-out more than is paid-in. I would think even Mr. Krugman would understand that little concept.
1
The bump that was inevitable.
With around 85% of new enrollees under Obamacare requiring some form of Government support to pay their premiums, the natural tendency of only the sickest persons to enroll and profit motivated insurance companies running the program, Mr. Krugman’s findings were bound to happen.
The solution, as Mr. Krugman points out, is more Government support, which then tilts health insurance in the US towards the so called single payer model present in other Western countries.
Ultimately, Americans have to decide where and how they want their Government to spend their taxes.
With around 85% of new enrollees under Obamacare requiring some form of Government support to pay their premiums, the natural tendency of only the sickest persons to enroll and profit motivated insurance companies running the program, Mr. Krugman’s findings were bound to happen.
The solution, as Mr. Krugman points out, is more Government support, which then tilts health insurance in the US towards the so called single payer model present in other Western countries.
Ultimately, Americans have to decide where and how they want their Government to spend their taxes.
7
@Mike Edwards: "Ultimately, Americans have to decide where and how they want their Government to spend their taxes."
Partially right. But Americans also have to decide if giving away tax breaks to corporations and the wealthiest people is acceptable and reduce (or end) those subsidies.
Partially right. But Americans also have to decide if giving away tax breaks to corporations and the wealthiest people is acceptable and reduce (or end) those subsidies.
1
The system is based on profitability. There are two ways to create profits. One is to charge customers more and the other is to pay less. The cost of insurance is still terribly high, but the real impact is that the insurers are paying less. My policy has a $6450 deductible. I've seen some with $6800 deductibles. These policies pay for nothing until the deductible is met.
For most people, especially those that don't get subsidies, we can only afford policies with such high deductibles. In my case, getting it down to around $1500 would require premiums of close to $900. That's an insane amount of money.
Obamacare has more people covered, but we are covered with what is essentially catastrophic insurance. I used to be able to go to just about any doctor I wanted for a $30 copay. Now, forget it. Now I practice DIY medicine.
That's the bump in the road that Mr Krugman and others do not see. We are covered but we can't afford the care. The terribly sick are the ones getting treated which costs a fortune. The rest us of play the wait and see if the problem goes away on its own.
If premiums rise enough to cover the losses generated the very sick, the whole thing will collapse in on itself. The rest of us just wont be able to tolerate the premiums.
For most people, especially those that don't get subsidies, we can only afford policies with such high deductibles. In my case, getting it down to around $1500 would require premiums of close to $900. That's an insane amount of money.
Obamacare has more people covered, but we are covered with what is essentially catastrophic insurance. I used to be able to go to just about any doctor I wanted for a $30 copay. Now, forget it. Now I practice DIY medicine.
That's the bump in the road that Mr Krugman and others do not see. We are covered but we can't afford the care. The terribly sick are the ones getting treated which costs a fortune. The rest us of play the wait and see if the problem goes away on its own.
If premiums rise enough to cover the losses generated the very sick, the whole thing will collapse in on itself. The rest of us just wont be able to tolerate the premiums.
26
These policies DO pay for care before your deductible is met, Bruce.
You can get annual exams, screening for prostate cancer and colonoscopies at no charge.
I have sold ACA insurance on a seasonal basis for a large insurance company. The insurers usually offer several bronze (high deductible) plans annually. My son is a freelancer, and he chose the one that had a 6K deductible, but also included $5 co-pays to see his PCP and $5 co-pays for a group of standard generic meds. So he received an annual physical at n/c, and when he got a case of strep throat, his out of pocket expenses totaled $10.
You need to shop around and be an active consumer on the marketplace.
Of course, I'm blessed to live in a state (New York) that embraced the ACA and we have many insurers competing for business here.
You can get annual exams, screening for prostate cancer and colonoscopies at no charge.
I have sold ACA insurance on a seasonal basis for a large insurance company. The insurers usually offer several bronze (high deductible) plans annually. My son is a freelancer, and he chose the one that had a 6K deductible, but also included $5 co-pays to see his PCP and $5 co-pays for a group of standard generic meds. So he received an annual physical at n/c, and when he got a case of strep throat, his out of pocket expenses totaled $10.
You need to shop around and be an active consumer on the marketplace.
Of course, I'm blessed to live in a state (New York) that embraced the ACA and we have many insurers competing for business here.
No such policies are available in Missouri. The colonoscopy is a once in 10 year event. The annual exam is a bit of a throw away. If you don't need any additional care, the exam provides no benefit. If the doctor wants to investigate further just to be safe, thousand of dollars in tests can result, all out of pocket.
I can buy a standard set of blood tests on the internet for $60. I can buy one annual exam for $250. My premiums are $526. For three weeks worth of premiums, I can buy all that the ACA policy gives me on preventative care.
I can buy a standard set of blood tests on the internet for $60. I can buy one annual exam for $250. My premiums are $526. For three weeks worth of premiums, I can buy all that the ACA policy gives me on preventative care.
You're lucky. I'm paying $900 per month just for me and I've got a $6750 deductible. Yet the plan I picked was the only one available to me that gave me access to the top hospitals in Houston.
My guess is that in any given state individual policies could be losing money while employer plans in a state make money. The law could be changed to require underwriting state by state so profitable plans are considered with the unprofitable exchange plans for rate setting since rates are governed by state law. States could also not allow insurers to offer group plans if they pull out of state exchanges. States still control the terms and rates for all insurance policies of any kind. The federal government does not approve insurance rates. The ACA did set minimum standard for policies. I still haven't figured out the GOP's problem with the ACA. Is it the subsidies? Is it the requirement that people buy health insurance. Odd since all states require auto insurance. Is it that Obama and Democrats proposed it? Well it's based on Romney's Massachusetts plan. Is that it helps poorer and sick people? Hopefully not. Expanded Medicare for all which could be purchased from the federal government and could be allowed based on the existing ideas behind federal flood or fire Insurance. Flood and fire insurance from the federal government, a godsend in Louisiana with the horrific rains and in the California due to wildfires of late, saves thousands from homelessness. Why isn't health insurance just as important? Or it could be that giving states so much control over the health insurance industry must come to an end.
3
STATES require auto insurance. It is not a FEDERAL mandate. If you fail to get car insurance, the IRS does not come after you.
Also: you do not have to own a car! many people do not! You can take the bus -- walk -- ride a bike! or use Uber.
But nobody can just "opt out" of a health insurance mandate from the FEDERAL government -- which will punish you with huge, huge fines from the IRS.
Also: you do not have to own a car! many people do not! You can take the bus -- walk -- ride a bike! or use Uber.
But nobody can just "opt out" of a health insurance mandate from the FEDERAL government -- which will punish you with huge, huge fines from the IRS.
Obama care is a bust plain and simple. It is structurally flawed. This is not the conclusion of right wing crazies but if anyone with 5 th grade education. There is a very simple concept called adverse selection which doomed the program.
4
The best financial journalist for at least a decade has been Greg Ip of the Wall Street Journal. Yesterday he had a great, non-partisan article on this in the Journal. Read it if you want to understand thisy.
The core problem, as Ip says, is that the younger had to pay far higher rates than their risk rate justified and the older far less. Then combine this with no preexisting conditions and you have a powerful powerful incentive for the younger (healthier) to wait until they are sick.
Krugman loudly proclaimed enrollment figures when they seemed pro-Obama. Now he says nothing. There is a reason. Ip puts the enrollment at 11 million vis-a-vis the expected 22 million.
How does public option solve this? Of course, you can have Krugman's solution: increase the penalty (taxes) on the young because they are so much richer than the affluent New York Times readers and can afford them.
The core problem is that Obama wanted it revenue neutral. So he gave it to the Finance Committee to ensure that happened. Even then much of it was paid for by a cut in Medicare that took the form of a reduction of the subsidy for prescription drug coverage so the +65 would have to pay more or buy more insurance from the insurance companies.
And the core, core problem was that Obama refused to raise taxes on any but the top 1% (over $450,000) and kept the supply side taxes on capital gains and corporations while cutting the deficit. Hillary is promising no taxes on below $250,000.
The core problem, as Ip says, is that the younger had to pay far higher rates than their risk rate justified and the older far less. Then combine this with no preexisting conditions and you have a powerful powerful incentive for the younger (healthier) to wait until they are sick.
Krugman loudly proclaimed enrollment figures when they seemed pro-Obama. Now he says nothing. There is a reason. Ip puts the enrollment at 11 million vis-a-vis the expected 22 million.
How does public option solve this? Of course, you can have Krugman's solution: increase the penalty (taxes) on the young because they are so much richer than the affluent New York Times readers and can afford them.
The core problem is that Obama wanted it revenue neutral. So he gave it to the Finance Committee to ensure that happened. Even then much of it was paid for by a cut in Medicare that took the form of a reduction of the subsidy for prescription drug coverage so the +65 would have to pay more or buy more insurance from the insurance companies.
And the core, core problem was that Obama refused to raise taxes on any but the top 1% (over $450,000) and kept the supply side taxes on capital gains and corporations while cutting the deficit. Hillary is promising no taxes on below $250,000.
2
"...Obama refused to raise taxes on any but the top 1% (over $450,000)...."
Actually, Obama did want to raise taxes on incomes over $200K, but Democrats from wealthy blue states like Chuck Schumer wouldn't support it.
They did put in the Pease phaseout, which limited tax deduction for incomes over $250K, and slapped a 3.8% Medicare tax on investment income over $250K.
Actually, Obama did want to raise taxes on incomes over $200K, but Democrats from wealthy blue states like Chuck Schumer wouldn't support it.
They did put in the Pease phaseout, which limited tax deduction for incomes over $250K, and slapped a 3.8% Medicare tax on investment income over $250K.
The exchanges actually penalize OLDER enrollees -- not the young. The young are heavily subsidized.
Out of curiosity, I tried enrolling on the exchange with my real age (60) and then again as if It was 35.
The premiums for a 60 year old are roughly 3 times higher than the 35 year old.
Assuming that a 60 year old, today in 2016 -- when so many have lost jobs and been downsized! -- earns MORE than 35 year old is FALSE. My 35 year old stepson earns 3 times what I do!
Out of curiosity, I tried enrolling on the exchange with my real age (60) and then again as if It was 35.
The premiums for a 60 year old are roughly 3 times higher than the 35 year old.
Assuming that a 60 year old, today in 2016 -- when so many have lost jobs and been downsized! -- earns MORE than 35 year old is FALSE. My 35 year old stepson earns 3 times what I do!
Insurance companies prefer their wealth over your health. Executives receive multi-million dollar salaries before any claims are paid. Insurance buyers pay huge premiums and deductibles before any claims are paid. You don't need a PhD in Economics to figure this out. Greatest Country In The History Of The World? Perhaps not.
8
Time to Occupy Insurance company offices!
It's difficult to address the subject of health care and the common good when your political partner is a profitable death cult.
But that's been the state of American politics since Ronald Reagan duped America's fake heartland into believing 'government is the problem' for the love of Grand Old Profit.
Let's look at recent Republican contributions to American health care and American longevity in recent years.
Expanded Medicare Part D (Rx) under George W. Bush, but REQUIRED by law no competitive bidding of drug prices so the pharmaceutical companies can maximize their medical extortion AND provide no funding to pay for it thereby increasing the national debt; a sabotage of the US Treasury to gild Big Pharma profits; the very opposite of 'free-market' thinking.
Implemented GOP Death Panel states: Republican-governed states refused to expand Medicaid, thereby killing thousands of Americans annually who otherwise would have survived with better health care access.
Refused to provide Zika virus funding unless they could put destroy poor people's nationwide access to contraception.
In related public safety areas, Republicans sent 4500 American soldiers to die in Iraq for no reason; another 150,000 Iraqis died and they created ISIS as a bonus prize.
On the home front, Republicans stoked 2nd Amendment hysteria to ensure America's 300 million guns killed a steady stream of 30,000 Americans each and every calendar year.
Republicans want Americans to drop dead for profit.
But that's been the state of American politics since Ronald Reagan duped America's fake heartland into believing 'government is the problem' for the love of Grand Old Profit.
Let's look at recent Republican contributions to American health care and American longevity in recent years.
Expanded Medicare Part D (Rx) under George W. Bush, but REQUIRED by law no competitive bidding of drug prices so the pharmaceutical companies can maximize their medical extortion AND provide no funding to pay for it thereby increasing the national debt; a sabotage of the US Treasury to gild Big Pharma profits; the very opposite of 'free-market' thinking.
Implemented GOP Death Panel states: Republican-governed states refused to expand Medicaid, thereby killing thousands of Americans annually who otherwise would have survived with better health care access.
Refused to provide Zika virus funding unless they could put destroy poor people's nationwide access to contraception.
In related public safety areas, Republicans sent 4500 American soldiers to die in Iraq for no reason; another 150,000 Iraqis died and they created ISIS as a bonus prize.
On the home front, Republicans stoked 2nd Amendment hysteria to ensure America's 300 million guns killed a steady stream of 30,000 Americans each and every calendar year.
Republicans want Americans to drop dead for profit.
187
Holy smokes! These facts are genius!
2
When the Left says Obamacare hit a "bump" you know the reality is that Obamacare is in the crash and burn phase.
Half of the tax-exempt healthcare exchanges set up for Obamacare are bankrupt. Krugman leaves out that little detail. And these are nonprofits so all the Left's gnashing of teeth about evil insurance companies doesn't hold water.
And there will be massive premium increases for 2017. They're supposed to be released in October, just before the election, but expect Obama to delay them past the election so a gullible Democrat vote can occur.
Krugman's solution? "It seems clear that subsidies for purchasing insurance, and in some cases for insurers themselves, should be somewhat bigger" In other words, spend more taxpayer money. What a unique Leftie solution.
Half of the tax-exempt healthcare exchanges set up for Obamacare are bankrupt. Krugman leaves out that little detail. And these are nonprofits so all the Left's gnashing of teeth about evil insurance companies doesn't hold water.
And there will be massive premium increases for 2017. They're supposed to be released in October, just before the election, but expect Obama to delay them past the election so a gullible Democrat vote can occur.
Krugman's solution? "It seems clear that subsidies for purchasing insurance, and in some cases for insurers themselves, should be somewhat bigger" In other words, spend more taxpayer money. What a unique Leftie solution.
4
Even if my subsidy on the exchange was 100% of the cost....I still could not afford the $7000 a year deductible!!!
It's the DEDUCTIBLES!
THAT IS THE PROBLEM!
Krugman is in total lefty denial!
It's the DEDUCTIBLES!
THAT IS THE PROBLEM!
Krugman is in total lefty denial!
Here, in a nutshell, is everything wrong with behemoth for profit corporations involved in provision of healthcare services. The profit motives of shareholders are inherently antagonistic to and in conflict with the needs of physicians, other clinical providers, and patients. There is no secret why Aetna is complaining: most of these insurance giants deliberately low-balled their initial plan prices in an all-out war to gain new customers (oops - patients) while ignoring the obvious truth that those previously unable to access medical care would inevitably enter the system with more serious health conditions, which, equally inevitably, cost more to treat. Now they are whining and jacking up prices, albeit at a slower pace than prior to the PPACA. The solution is glaringly obvious - kick these insurance giants out of our healthcare permanently, and move to a system of Medicare for all. Yes, there must be tweaks to Medicare: which does not provide for long term care for people with irreversible conditions such as dementia, nor does it provide help for the caregivers involved. Similarly, it is time to kick Congress to the curb and demand that their refusal to permit Medicare to competitively negotiate drug prices be overturned, so that we no longer pay the highest prices in the world. Finally: let us ban all PACS and overturn Citizens United, so that corporate lobbyists and plutocrats can no longer buy Congress.
17
Obamacare will continue to hit bumps as long as Americans on Obamacare have to pay higher and higher premiums and Obamacare has no components for responsibility by patients and compliance with medical advice. Self inflicted damage to health by ignoring the surgeon generals warnings and NIH and CDC guidelines for optimal health will keep the cost of health care escalating. Americans on Obamacare should cooperate with the health care providers in keeping themselves healthy and following guidelines for healthy lifestyle. There should also be extensive counseling and education of patients in how best to prevent diseases. Ask not what the healthcare system can do for you. Ask how you can take care of your health to stay healthy.
3
Humans have known from ancient times, prevention is better than cure. Instead of preventing cancer, its treatment has become a multi billion dollar industry (i have many relatives and friends who are currently undergoing treatment at various stages with varying success). We organize runs, walks, bike rides to create cancer awareness yet we do very little about how cancer got in there in the first place. Prevention.
1
Two years ago my husband and I paid $9000 for a bronze plan with $6000 of deductible. For 2016 it rose to $12,000 with a max out of pocket potential expense of $25,000. For 2017 the premium may rise to $14,000 with about $27,000 max out of pocket potential expense.
Health costs are killing us.
Health costs are killing us.
6
If states are allowed to offer their own public options in addition to Obamacare, that would be best. The very fact that Obamacare was written with the profits of health insurance companies in mind is very revealing. Quite simply, health care for profit is immoral. Jesus did not heal for profit.
A nation's health care act should be written to provide health care for its people and a living for the doctors, nurses, and other practitioners who provide it. Administrative costs should be kept to a minimum, profit should not be a factor, and additional insurance should be made available for those who want to purchase it.
As for the Republicans, the last 24 years have clearly shown that they can't govern and have no interest in anything but obstructing the efforts of those who try to. I hope Trump does so much damage down-ticket that the Dems can momentarily reclaim both Houses of Congress. Then I hope Mrs.
Clinton remembers FDR rather than Bill and Barack.
A nation's health care act should be written to provide health care for its people and a living for the doctors, nurses, and other practitioners who provide it. Administrative costs should be kept to a minimum, profit should not be a factor, and additional insurance should be made available for those who want to purchase it.
As for the Republicans, the last 24 years have clearly shown that they can't govern and have no interest in anything but obstructing the efforts of those who try to. I hope Trump does so much damage down-ticket that the Dems can momentarily reclaim both Houses of Congress. Then I hope Mrs.
Clinton remembers FDR rather than Bill and Barack.
7
I will say, that the ACA was formulated with an attempt to get GOP lawmakers on board and therefore keeping insurers in the loop--it was a wasted effort. In addition, due to the tanking of the economy from the financial collapse was not the best time to undermine an entire industry and its employees with a drastic change. But we need to wean this country off several industries that are bad for it, insurance companies for profit over health, fossil fuel industries, tobacco giants, Big Agra, Big Pharma all should slowly but surely go the way of the dinosaur.
2
Many health insurance companies are not-for-profit, administrative costs are capped, and "additional insurance" would be the different levels of plans
My wife and I pay over $18000 per year for insurance coverage. We live in a state with no exchange and only one insurer. Obamacare would've worked better if all of the states had cooperated. Republican governors and a Republican Congress are to blame. How can voters tolerate a party that openly blocks a law intended to improve access and affordability of health insurance.
13
The basic problem is math. For insurance, of any kind, to work AND be cost effective it has to have a large pool of people making few or no claims. In the case of health care insurance it means getting healthy, mostly younger, enrollees into the system to balance those unhealthier people making claims. It's no different than the car insurance most of us have; a large pool of mostly good drivers subsidizes a smaller pool of more accident prone drivers. For the ACA to work the purchase of health insurance must be mandatory for everyone, and the penalties stiff enough to make it a no brainer for younger and healthier persons to buy into the system. After all they too will someday be older and likely sicker, and in the meantime they get the benefit just in case they get sick which does happen even to young "healthy" people. What a "public" option would offer is taking out the profit which private insurance companies must have; Medicare operates with around 2-3% administrative costs while private insurers are in the range of 15% or more. For those arguing that it's un-American to be forced to buy insurance I would say ok; that system dictates that when you do get sick and need care and if you can't pay for it out pocket then you will be denied care. Otherwise you are getting a free ride from all of us who do participate in the system. Many other issues in our health care system need addressing but the "insurance" one really has a pretty straight forward fix.
6
the ability to get coverage and only hold onto it long enough to get expensive medical care is also a problem.
2
So much focus on competition between the insurers. How about encouraging competition among the providers of health care? Require hospitals and doctors to advertise their prices and allow them to compete for business. Supply of doctors and hospitals is artificially restricted to keep prices high. (With encouragement from the medical profession, my state legislature passed a moratorium on building any new hospitals. What other private industry gets that kind of treatment? My conclusion is they don't want competition). Look at Lasik, which is allowed to freely advertise and provide services. The cost has fallen from well over $1000 per eye to $299, while quality of service has gone up.
6
I really want my health care institutions focused on healthcare not business. Jesus, why do people think market competition is the answer to everything when markets fail miserably all the time? And yes , I am addressing my question to the son of God.
Is this like saying we can do a lousy job for a cheaper price, and you'd be saving money?
The Lasik example is mixing apples and oranges. It is an elective procedure that does not need to happen in reaction to a serious medical problem. It's not practical to shop around for heart attack care, broken bones care, post-accident care, etc.
And another thing:
I have a retired friend living happily in Mexico. He invited us down to visit with the idea that it might appeal to us to do the same thing. He and his wife have a beautiful life there. One strong selling point from him is "the health care here is great, available and inexpensive". Mexico for God's sake
I also have close friends in Peru, not retired Americans, who have inexpensive health care. One, an elderly man, pays very little for excellent coverage, he pays $144 a month for complete coverage. An operation cost him nothing.
In Canada, a friend in Vancouver, BC was assigned for awhile to the Canadian Embassy in NYC. His wife needed a minor operation that cost him several thousands of US $. The same procedure in Canada would have been $200. He resigned his post and returned to Canada.
Here in the US Americans not on an employer based plan are subject to draconian options for health care in comparison.
Shame!
I have a retired friend living happily in Mexico. He invited us down to visit with the idea that it might appeal to us to do the same thing. He and his wife have a beautiful life there. One strong selling point from him is "the health care here is great, available and inexpensive". Mexico for God's sake
I also have close friends in Peru, not retired Americans, who have inexpensive health care. One, an elderly man, pays very little for excellent coverage, he pays $144 a month for complete coverage. An operation cost him nothing.
In Canada, a friend in Vancouver, BC was assigned for awhile to the Canadian Embassy in NYC. His wife needed a minor operation that cost him several thousands of US $. The same procedure in Canada would have been $200. He resigned his post and returned to Canada.
Here in the US Americans not on an employer based plan are subject to draconian options for health care in comparison.
Shame!
30
You do realize that no operation could EVER cost only $200.
The cost of that Canadian operation was subsidized by high taxes and a VAT. Most Canadians face long waits for non-critical surgery, and many come to the US for such procedures rather than wait. My local hospital's parking lot is chock full of Canadian license plates.
Canada can afford to do this, because the US provides nearly all of their military defense at almost no cost to the Canadian taxpayer.
Honestly, I do not know anyone who would willingly choose to go to Mexico or PERU for health care.
If Mexican health care is that phenomenal -- why are Americans not flooding across the border to seek health care? Why are illegal aliens from Mexico coming HERE? and leaving that "paradise"?
The cost of that Canadian operation was subsidized by high taxes and a VAT. Most Canadians face long waits for non-critical surgery, and many come to the US for such procedures rather than wait. My local hospital's parking lot is chock full of Canadian license plates.
Canada can afford to do this, because the US provides nearly all of their military defense at almost no cost to the Canadian taxpayer.
Honestly, I do not know anyone who would willingly choose to go to Mexico or PERU for health care.
If Mexican health care is that phenomenal -- why are Americans not flooding across the border to seek health care? Why are illegal aliens from Mexico coming HERE? and leaving that "paradise"?
The Democrats created a system that works for big states and big cities, i.e. where Democrats live. All of the positive effects that PK points out are concentrated in areas where Democrats live. They are shocked and saddened that Republicans did not and will not support it. This is pretty disingenuous when it is clear that the system has never worked well for small states or areas beyond big cities, where Republicans live. If Democrats want to improve Obamacare, as PK suggests, they need to be prepared to allow states to make major alterations and opt outs to the original system so that small states and areas outside of big cities can create systems that suit those areas and voters. Because Democrats have declared that they will defend every last letter of Obamacare to the death, I don't think that's likely to happen, but please do not blame Obamacare's failures on Republicans who never voted for it, and for whom the system has never yielded any improvements.
4
Be more specific about the ACA failure for small states. Admittedly, these will have fewer MDs due to fewer patients. What is needed is a program to produce more MDs or the equivalent. Maybe also upping the number of H1Bs for foreign MDs to enter the USA. But would the AMA approve of any of that?
1
Yeah - why should a health care system benefit the vast majority. Republicans are just totally innocent victims!
1
Isn't Texas a big city? Wouldn't you consider Houston, Dallas, and San Antonio big cities? The ACA ain't working there.
Why the surprise that there would be snags in the ACA's implementation? All parties had to compromise for the law to be written, insurance is a complicated industry, and "Obamacare" was treated as a bogeyman by Republicans who would just as soon see people go uncovered as allow President Obama his historic achievement. But our guaranteed healthcare has been twice upheld by the Supreme Court and it is here to stay. So we should pass the torch on to the leader who will keep working on the law's administration, not to the person who calls it terrible and simply says he will replace it with "something terrific."
2
Critics of the ACA are full of angry observations and reinforcements of their preconceived notions of its many shortcomings. The ACA as an act of Congress is, as Mr Krugman points out, imperfect. What the angry critics fail to mention is how this compromise took our totally fragmented and utterly inadequate delivery of medical treatment (can't use the words "health", "care" or "system" when describing how we as a nation deliver medical treatment) and moved it closer to providing universal access. The ACA includes a system for tracking patient history (a work in progress) It provides a pathway for those who work and barely make ends meet without health coverage and many more up the income ladder to afford access. The ACA is less inadequate, less fragmented, more inclusive and the best we could do at the time politically. That and the continued acceptance of profiting off the suffering and fear of sick people is the reality we now struggle with. That Aetna is quitting the exchanges speaks to failure of the magical market place, not the ACA. That the cost of covering the previously denied and uninsured is higher than expected is evidence of our century long failure to address universal access, not the ACA. That we still lack the political courage and will to fix this problem, a nightmare still, that millions of us must endure, is evidence of failed leadership that we as citizens tolerate and even endorse and not a failing of the ACA.
17
If the olympics had a "Mental Gymnastics" category then Paul Krugman would be the Michael Phelps of It,
Reading his many opinion pieces filled with misinformation and pseudo intelligent metaphors over ACA has been a source of great amusement
Makes me laugh out loud until my Obamacare health plan bill arrives
You know the one that was going to save me 2500 a year but in realty cost my family $6000 per year more, and the only time I see my old Doctor is if I bump into her at the grocery store.
Reading his many opinion pieces filled with misinformation and pseudo intelligent metaphors over ACA has been a source of great amusement
Makes me laugh out loud until my Obamacare health plan bill arrives
You know the one that was going to save me 2500 a year but in realty cost my family $6000 per year more, and the only time I see my old Doctor is if I bump into her at the grocery store.
10
The problem with Obamacare is that it requires the participation of private insurance companies. These companies are in business for only one reason, i.e., to make a profit on their investment. Basing a service as vital as healthcare on a money-making scheme is nonsense. Most of the advanced countries in the world understand this.
20
When I first heard that Aetna was pulling out of the exchanges, I was disappointed but not surprised. If there is one certainty in our country, it is that power and money will do everything and anything to sustain itself, even at the welfare of others. We see it in our politics and in our business practices, which are regularly in cahoots. Worse is that many of us, even those who are victimized by these practices, will bend over backwards to justify them.
But, I prefer to be optimistic. The inescapable logic of single payer, of cleaner energy, of a fairer tax structure, etc. will eventually win the day for it must. Many of us will not see these victories but they will come. So I thank Dr. Krugman for keeping us informed and all the of the commentators who offer their positive thoughts and energy to these Very Serious Discussions.
Happy Friday!
But, I prefer to be optimistic. The inescapable logic of single payer, of cleaner energy, of a fairer tax structure, etc. will eventually win the day for it must. Many of us will not see these victories but they will come. So I thank Dr. Krugman for keeping us informed and all the of the commentators who offer their positive thoughts and energy to these Very Serious Discussions.
Happy Friday!
7
O'care was never meant to go the distance without some adjustments. In caving in to the ins industry to pass it, the bill ended up like a Frankenstein created with salvaged parts in the White House basement. A hostile Congress has voted 60 times to kill the beast, but that's been like poking it with a Blue Cross Caduceus. "Thanks. I needed that." Insurance companies, useless intermediaries, manned by overpaid eight figured salaried execs who don't perform med care or research need to get out of the way. We don't need them. A single-payer plan is in the offing, although this year may be bad timing.
7
As a chiropractor, not a "real doctor," according to the ACA, there is no real coverage for my patients. And, any that does exist has high deductibles and obscene copayments which are higher than my fees, which I try to keep affordable So, with the exception of Medicare, most of my patients are cash patients which makes them think twice about coming in for care and they end up not getting the care they need. Single payer, please.
6
The subtext of many of these comments is "let 'em die."
7
Krugman believes that there is no problem that cannot be solved with increased federal spending. He believes that the deficit is too low and anyone opposed to more federal programs is by definition an obstructionist Republican. Do you recognize any limitations to your liberal ambitions, Mr. Krugman?
7
Yeah, just like Republicans believe that there's no problem that cannot be solved by free markets. Yeah sure.
1
Sorry...What he is asking for is greater sharing of medical costs, spread over the entire population that is subject to random, unexpected and unwanted health needs.
1
No. He believes some problems can. He's right.
Once Hillary is in office, she will go after the health insurers. She wanted to do this in 1994, but "Harriet and Harry" and the GOP tools of "health insurers for large profit" stopped her.
3
This is solid evidence that there ought to at least be a public option for health insurance. Health care ought not to be subject to the profit motive. The GOP is all about repealing the ACA with no good alternative, only more politics of obstruction.
The solution: #VoteAgainstAllRepublicans.
The solution: #VoteAgainstAllRepublicans.
17
"Health care ought not to be subject to the profit motive." Why, pray tell? Food and housing are subject to the profit motive.
Can't say this enough. You cant' have an entitlement society with open borders. The system will collapse under it's own weight. Look what has happened to other single payer systems. They are faltering and this will to. You are talking about expanding the Federal govt. to unfathomable proportions. Think of the amount of bureaucrats you will need to manage a system like that. Or are you so blind to you own Ideology that you can't see it. Be careful what you ask for. Why not leave it up to the individual states to design their own healthcare according to their needs? Vermont is different than California. One size cannot fit all.
6
On the contrary! Medicare is acknowledged, even by conservatives, as being far more efficient than the private insurance model.
1
Paul:
I like Medicare just fine. But if we expand for all and if we have open borders we will eventually just have a big big government with no money.
I like Medicare just fine. But if we expand for all and if we have open borders we will eventually just have a big big government with no money.
I seriously doubt that Aetna or any of the insurers are "losing" money which is code for not making the gigantic profit margins they were hoping for. Jeez, they actually had to PROVIDE payment for health care services rather than pocket your insurance dollars for distribution to top executives and stockholders! They are upset that also mandated is that a larger amount of insurance dollars collected needs to actually go for the entire purpose of their existence--covering the cost of care. Insurers are an expensive middle man that have greatly increased the cost of medical care in this country and the sooner we go single payer the better.
537
We lost 1.5 billion last year. Many of us are now losing our jobs as they are doing a major outsourcing effort - to India of course. And we are a non-profit.
1
Of course you are correct. On ALL of its business, Aetna made $790 million in the 2nd quarter alone (investor info, Aetna's own website). Their entire pool of risk is quite profitable.
Many insurance companies developed ACA look-alike policies for individuals who don't qualify for ACA subsidies, with all of the same features at the same price. (The look-alikes keep all parties from having to interact with the ACA bureaucracy.) If Aetna lost $200 million on its ACA policies, it would add insight to this debate to know how much money Aetna made or lost on its combined look-alike policies.
Many insurance companies developed ACA look-alike policies for individuals who don't qualify for ACA subsidies, with all of the same features at the same price. (The look-alikes keep all parties from having to interact with the ACA bureaucracy.) If Aetna lost $200 million on its ACA policies, it would add insight to this debate to know how much money Aetna made or lost on its combined look-alike policies.
Net income attributable to Aetna was (positive) $2.3 billion according to their 2015 annual report. The Chairman's letter brags about what a brilliant year 2015 was for Aetna. Can't have it both ways.
1
"...the law is costing both consumers and taxpayers less than expected."
And there is a Santa Claus. What universe do you live in, Paul Krugman? Oh right, the same one as the NY Times. Twist and turn the facts as you try, your pathetic defense of a failed liberal experiment will never convince those of us who are paying through the roof to have health insurance coverage.
As with most liberal economic experiments, it's merely redistribution. So now there are fewer uninsured -- but only because people like me are paying for them and doing so at the expense of my own health. And you think this is something to praise??
And there is a Santa Claus. What universe do you live in, Paul Krugman? Oh right, the same one as the NY Times. Twist and turn the facts as you try, your pathetic defense of a failed liberal experiment will never convince those of us who are paying through the roof to have health insurance coverage.
As with most liberal economic experiments, it's merely redistribution. So now there are fewer uninsured -- but only because people like me are paying for them and doing so at the expense of my own health. And you think this is something to praise??
7
Linda Lee, I don't think that that playing Scrooge is something to praise. The people whose backs you are riding on are the uninsured, who pay list price for medical care when insured's bills are around perhaps 10% and often less of list price.
The news has mostly been good? What planet has he been living on?
Almost all the expansion in coverage has been due to Medicaid Expansion, but that doesn't translate to access to quality care due to the low reimbursement rates. Most Medicaid patients just use the ER.
Where were the $2500/year cost savings based on 2008 rates?
Where did all the plans go they promised you could keep?
Where did the doctors go they promised you could keep?
By any rational measure, Obamacare has been a complete failure and burgeoning disaster.
Almost all the expansion in coverage has been due to Medicaid Expansion, but that doesn't translate to access to quality care due to the low reimbursement rates. Most Medicaid patients just use the ER.
Where were the $2500/year cost savings based on 2008 rates?
Where did all the plans go they promised you could keep?
Where did the doctors go they promised you could keep?
By any rational measure, Obamacare has been a complete failure and burgeoning disaster.
9
Mr. Krugman is right about it being very feasible to fix. As familiar with the industry I can tell you the insurance companies need to get a more balanced risk profile in the market and protect against volatility (ie more sick patients than they anticipated). The larger insurers can handle it though the smaller ones cant.
Originally there was going to be a 'risk corridor' program that did exactly that. Marco Rubio managed to ensure it wasn't funded properly and so now it doesn't exist. It's the primary reason both the large and smaller insurers are losing money this year and the reason some just went bust. Such a shame as the money is there to be used and would have ensured a stable market until it naturally stabilized more when all the early kinks of Obamacare got worked out.
Originally there was going to be a 'risk corridor' program that did exactly that. Marco Rubio managed to ensure it wasn't funded properly and so now it doesn't exist. It's the primary reason both the large and smaller insurers are losing money this year and the reason some just went bust. Such a shame as the money is there to be used and would have ensured a stable market until it naturally stabilized more when all the early kinks of Obamacare got worked out.
5
"Vindictiveness???" According to my reading of the controversy regarding Aetna's pullout, it was an attempt at extortion of the federal government by Aetna. The CEO of Aetna wrote a letter (released via FOIA) to the DOJ stating that if a merger between Aetna and Humana was not approved, Aetna would pull out of the health care exchange. The merger was not approved.
By the way, the CEO of Aetna, Mark Bertolini, would receive $131 million if the merger was approved. I assume that had nothing to do with Aetna's actions.
By the way, the CEO of Aetna, Mark Bertolini, would receive $131 million if the merger was approved. I assume that had nothing to do with Aetna's actions.
8
Your post provides no evidence that there was any reason for the government to extort Aetna; Your penultimate statement provides excellent evidence that Aetna is being vindictive.
1
Hi, Ray -
I think you got it backwards. CDW is saying that Aetna was extorting the Federal government. ". . . extortion OF the federal government BY Aetna."
I think you got it backwards. CDW is saying that Aetna was extorting the Federal government. ". . . extortion OF the federal government BY Aetna."
The AETNA letter was a response to a Civil Investigative Demand by the Justice Department, specifically asking about the impact on ACA exchanges of allowing merger and blocking merger.
Mr.Krugman should acknowledge the evident truth: Obamacare is neither affordable nor does it deliver good health care to all people.
This piece of legislation was critically handicapped from day one and now it is on life support like Terri Schiavo and Paul Krugman is taking on the role of Senator Frisk by claiming everything is just fine, "there’s nothing wrong with Obamacare".
Obama should have gone for public option when he had an opportunity based on the huge mandate he received from his election. Democrats, however, were in bed with Big Pharma, insurance companies and health care corporations. President Obama, after secretly meeting with Big Pharma, was glad to cede power to the sell-out senator from Montana, Sen.Bacchus, who killed the public option, giving Obama cover for not delivering what the American public voted for. Later, Obama rewarded Bacchus with a cushy job as Ambassador to China.
Jim Messina, who ran Baucus's 2002 re-election campaign, was Obama's White House Deputy Chief of Staff for Operations 2009 to 2011 and served as the campaign manager for Obama's successful 2012 re-election campaign.
He is currently the co-Chair of the Priorities USA, a SuperPAC, which supports the election of Hillary Clinton as President in the 2016 election.
So please stop with the Clinton propaganda. She is not serious about a public option. Just more pandering to get elected. Mark Bertolini, who's been cozy with Hillary, and the rest of her cabal, will never let that happen.
This piece of legislation was critically handicapped from day one and now it is on life support like Terri Schiavo and Paul Krugman is taking on the role of Senator Frisk by claiming everything is just fine, "there’s nothing wrong with Obamacare".
Obama should have gone for public option when he had an opportunity based on the huge mandate he received from his election. Democrats, however, were in bed with Big Pharma, insurance companies and health care corporations. President Obama, after secretly meeting with Big Pharma, was glad to cede power to the sell-out senator from Montana, Sen.Bacchus, who killed the public option, giving Obama cover for not delivering what the American public voted for. Later, Obama rewarded Bacchus with a cushy job as Ambassador to China.
Jim Messina, who ran Baucus's 2002 re-election campaign, was Obama's White House Deputy Chief of Staff for Operations 2009 to 2011 and served as the campaign manager for Obama's successful 2012 re-election campaign.
He is currently the co-Chair of the Priorities USA, a SuperPAC, which supports the election of Hillary Clinton as President in the 2016 election.
So please stop with the Clinton propaganda. She is not serious about a public option. Just more pandering to get elected. Mark Bertolini, who's been cozy with Hillary, and the rest of her cabal, will never let that happen.
12
If Trump gets elected this becomes a bigger problem, but not sure what more Hillary can do about it if she is elected. Our government's two sides are at complete odds and it's only going to get worse.
This is one of the great weaknesses of a binary political system. And as the Republicans fall apart, they're going to get worse not better. They're going to dig their heels in deeper and deeper in an attempt to save face, and execute some control as things crumble around them. But the Democrats are going to be led by the wrong person this time around. Hillary, the great comprimiser, and moderate-centrist, whose hands are deep into the pockets of Wall Street and the 1% will have an easy time rolling over and pretending her hands were tied.
I can't imagine a scenario in the future with either nominee where this really plays out well. It's a shame, and a prime example of why we needed a single-payer system. Obama tried, we got what we could, but I have no faith in either candidate really making this play out well.
This is one of the great weaknesses of a binary political system. And as the Republicans fall apart, they're going to get worse not better. They're going to dig their heels in deeper and deeper in an attempt to save face, and execute some control as things crumble around them. But the Democrats are going to be led by the wrong person this time around. Hillary, the great comprimiser, and moderate-centrist, whose hands are deep into the pockets of Wall Street and the 1% will have an easy time rolling over and pretending her hands were tied.
I can't imagine a scenario in the future with either nominee where this really plays out well. It's a shame, and a prime example of why we needed a single-payer system. Obama tried, we got what we could, but I have no faith in either candidate really making this play out well.
4
Simple solution: Medicare for all!
21
Impossible impediment: Republicans.
Krugman is trying to spin the bad news about Obamacare into a good news scenario.He conveniently omits the glaring Obamacare deficiencies.You can pay the fine and enroll after you receive a diagnosis requiring massive treatment/costs.Then after you're treated,you can drop the insurance.So all of us who pay the monthly premiums have to absorb the massive costs of the short time enrollees.You can still be treated for free courtesy of us taxpayers at the ER when you have no insurance.The public option Krugman promotes would be an absolute disaster.You only have to look at the VA to understand how bad and inefficient the public option would be.
8
Single-payer public healthcare is the norm in virtually every developed country in the world. But for a few elite clinics, healthcare options in most of the world are always public, and prices are set by the government (also known as the people). That's why a knee replacement in Europe costs about $4000 vs $100,000 in the U.S. Doctors, not insurance executives and hospital administrators, are still well paid in those countries. I have friends who are doctors in Europe. They own boats and nice cars, and live in nice homes. If that's a "disaster," sign me up please!
4
For many the fine is lower than coverage. You are right about the VA but Medicare works pretty well and is administered by the federal government. I suspect the problems with the VA is systemic from years of underfunding and a belief by many doctors that the VA is the employer of last resort.
@ Bud
So Prof. Krugman is trying to spin the bad news about "Obamacare" into a good news scenario?
You obviously do not remember that the the ACA, aka Obamacare, was modeled after Romneycare while he was governor of Massachusetts, and that very Romneycare in turn modeled after proposals from the conservative Heritage Foundation.
As to the rest of your comment, now that is what is called 'spin'.
So Prof. Krugman is trying to spin the bad news about "Obamacare" into a good news scenario?
You obviously do not remember that the the ACA, aka Obamacare, was modeled after Romneycare while he was governor of Massachusetts, and that very Romneycare in turn modeled after proposals from the conservative Heritage Foundation.
As to the rest of your comment, now that is what is called 'spin'.
1
Many, many people - perhaps the majority, maybe a vast majority - enter the medical profession not out of any altruistic motivation but purely because of the income opportunities.
These are the same people who end up in running the Pharma companies, the Insurance companies, the large medical providers, and all the way down to the small local providers. It's a medical system designed by and run for the profit of a group of people for whom "it's all about the benjamins".
As evidenced by the blatant attempt at blackmail by the insurance giant Aetna.
The "medical - industrial complex" will never be on board with lower cost, because the whole reason that the vast majority of people IN that complex got there because the want MORE profits, not better care.
These are the same people who end up in running the Pharma companies, the Insurance companies, the large medical providers, and all the way down to the small local providers. It's a medical system designed by and run for the profit of a group of people for whom "it's all about the benjamins".
As evidenced by the blatant attempt at blackmail by the insurance giant Aetna.
The "medical - industrial complex" will never be on board with lower cost, because the whole reason that the vast majority of people IN that complex got there because the want MORE profits, not better care.
4
Why are liberal utopias mandatory?
5
What dont you like about Utopia?
1
All I know is that, since the ACA was passed, with a union-provided insurance plan, my health care costs have gone dramatically up, and not because my health has gone down.
Single payer remains the only defensible system.
Single payer remains the only defensible system.
4
Not a good job of attempted back filling Mr. Krugman. You have the nerve to complain about Trump saying anything he wants with no comeuppance when you do the same thing every day in your haste to cover the ample posteriors of HRC, Obama and your divine self. I'm amazed you didn't manage to blame Trump for the disaster of Obamacare( BTW What happened to calling it the Affordable Care Act). As usual Clarissa explains it all, when it works by some really questionable self serving accounting miracle Obama and Hillary are responsible; when the reality that it is a failure starts to become apparent it's Republicans raining on the liberal parade. Right on schedule an ill wind blows from Mt. Noble Prize at the NYT.
4
The faster and harder this fails the sooner Medicaid should be further expanded. It should be set up so that Medicaid is the default fallback for whatever sectors are abandoned.
I've been through this having been booted from my small business plan after 23 years because of the ACA.
After all the anxiety about it the expanded Medicaid plan actually looks better than the Oxford plan that kicked me out.
I've been through this having been booted from my small business plan after 23 years because of the ACA.
After all the anxiety about it the expanded Medicaid plan actually looks better than the Oxford plan that kicked me out.
3
Or failure could mean nothing but employer plans if that.
Insurance companies should not be surprised that there are so many sick people out there that are in worse shape than originally thought. These are the people who needed health care the most, and were legally denied access to it for decades. They are finally getting the health care that they should have had for decades.
6
Nice try Paul. I like liberals better than conservatives but you liberals are too gullible. Why are we the only advanced Democracy in the world that does not recognize that access to healthcare is a basic human right? Why do we have the highest costs per capita for healthcare? Obama meant well, but this stupid compromise was doomed from the start. Why was the government not allowed to negotiate discounts on drug prices with greedy Pharma companies? Insurance companies are nothing but useless middle men who add no value yet drive up costs.
Now we are stuck with mandated insurance that costs too much and delivers to little. Each policy is full of gaps in coverage and exclusions that are so complex no one knows which policy to buy. We are told to shop around for coverage. If you are hospitalized and having a heart attack, is the hospital going to check with your insurer to see what you policy covers? No. They are going to do what is necessary and then you are going to get stuck with a huge bill from some specialist who isn't participating in your particular plan. It's a joke, a scam and a disgrace.
Now we are stuck with mandated insurance that costs too much and delivers to little. Each policy is full of gaps in coverage and exclusions that are so complex no one knows which policy to buy. We are told to shop around for coverage. If you are hospitalized and having a heart attack, is the hospital going to check with your insurer to see what you policy covers? No. They are going to do what is necessary and then you are going to get stuck with a huge bill from some specialist who isn't participating in your particular plan. It's a joke, a scam and a disgrace.
5
A few trillion dollars can easily fix that swelling bureaucracy.
1
The idea works wonders for the1% tax cuts and Pentagon spending, both of which you don't object to.
Or we could realize that the Iraq war cost us the chance to fix health care in America.
2
Krugman's claim that Obamacare can be fixed echoes his other claim that Abenomics will save Japan.
2
"...One in which parties can compromise to make government work..."
I don't remember this happening when one party pushed through (because they could) this law in the first place. The ACA was enacted over any and all objections from the other side.
And despite claims that all is mostly well in Obama care land, the problems that are cropping up now actually were widely predicted and were uniformly ignored at the time. It's beyond ridiculous to suggest that those opposed then, should now scramble to help save this very flawed program.
I don't remember this happening when one party pushed through (because they could) this law in the first place. The ACA was enacted over any and all objections from the other side.
And despite claims that all is mostly well in Obama care land, the problems that are cropping up now actually were widely predicted and were uniformly ignored at the time. It's beyond ridiculous to suggest that those opposed then, should now scramble to help save this very flawed program.
5
I agree with what Payl Krugman is saying, at least in the short term, until we can move to a universal coverage, single payer health care system. It obviously makes sense to adjust the subsidies to account for higher-than-expected insurance premiums. And a public option could be a real help for people who can't find appropriate or acceptable coverage in the private plans.
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In addition to all of that, I would hope that the Federal Government can find a way to work directly with populous cities and counties to expand Medicaid, even when their states say 'no.' This would be a huge help here in Texas, where our stubborn (I would say stupid) State leadership has whole heartedly refused to accept the Medicaid expansion, and is instead expecting local public hospital networks to foot the bill. Bear in mind that there are more people in Harris County, than in the entire states of Wyoming and Vermont out together.
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In addition to all of that, I would hope that the Federal Government can find a way to work directly with populous cities and counties to expand Medicaid, even when their states say 'no.' This would be a huge help here in Texas, where our stubborn (I would say stupid) State leadership has whole heartedly refused to accept the Medicaid expansion, and is instead expecting local public hospital networks to foot the bill. Bear in mind that there are more people in Harris County, than in the entire states of Wyoming and Vermont out together.
6
a national health program run by insurance companies. what could possibly go wrong? just like federal prisons and schools run by private companies (but I repeat myself there) and mercenaries managing our wars. Public goods need public ownership to build cost effective programs and secure the commitment of the public, as in the UK where no politician would touch the NHS
8
The Heliocentric Theory of Health Care Reform
Before Copernicus and Kepler, people generally believed the sun and the planets revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last iteration of the Ptolemaic system was an incredible complicated mess that was almost beautiful in it's complexity.
That's what we are doing today with health care reform. We wanted a "uniquely American solution." We wanted to keep the private insurance industry. We wanted the sun to go around the earth.
So we talk about mandates, exchanges, reference pricing, death spirals, etc. The problem private insurance cos pulling out is another complication.. We need some more epicycles. We wound up with a bill with thousands of pages whose result is unknown. HR676 (improved Medicare for All) had 70 pages.
If Kepler were alive, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."
Before Copernicus and Kepler, people generally believed the sun and the planets revolved around the earth, but as we got more data it became increasing hard to reconcile this basic idea with the observed facts. People thought up the Ptolemaic system in which the heavenly bodies didn't just revolve around the earth, but they revolved in small circles called epicycles as they went around the earth. That eventually turned out not to be sufficient, so they hypothesized epicycles within the epicycles. The last iteration of the Ptolemaic system was an incredible complicated mess that was almost beautiful in it's complexity.
That's what we are doing today with health care reform. We wanted a "uniquely American solution." We wanted to keep the private insurance industry. We wanted the sun to go around the earth.
So we talk about mandates, exchanges, reference pricing, death spirals, etc. The problem private insurance cos pulling out is another complication.. We need some more epicycles. We wound up with a bill with thousands of pages whose result is unknown. HR676 (improved Medicare for All) had 70 pages.
If Kepler were alive, I am sure he would say, "If you simply give everyone Medicare, you wouldn't need all this complication, and I'll bet it would be cheaper, too."
12
1. With the possible exception of Germany, all other developed countries have tried a health insurance system based mainly on loosely regulated private insurance. None of them could get it to work. The only one using it today is Switzerland, but there the federal gov writes a basic policy which all insurances cos must offer and are not allowed to profit from it. Also while their cost per person ($6325) is much less than ours ($8713), it is still much higher than the (OECD) average ($3453).
2. As we see, when faced with the sicker patients, private insurgence cos fold. This is the trouble with the public option. The private cos will find a way to avoid the poor & sicker patients who will flock to the public option thus raising its costs. Republicans will point to its higher costs as an example of why gov. health care does not work.
In addition, one of the main advantages of a universal gov run system is that there is only one entity dealing with the problem. Insurance 101 teaches us that, statistically, the larger the pool, the more efficient the plan. In addition, there are large administrative saving. The overhead and compliance costs of private insurance cos waste over $600 Billion each year without even counting patient compliance costs.
3. The bottom line is that HR676 which simply gave an improved Medicare to everyone and was only 70 pages long would have given Americans better care at much, much lower cost. Is it to late to change our mind?
2. As we see, when faced with the sicker patients, private insurgence cos fold. This is the trouble with the public option. The private cos will find a way to avoid the poor & sicker patients who will flock to the public option thus raising its costs. Republicans will point to its higher costs as an example of why gov. health care does not work.
In addition, one of the main advantages of a universal gov run system is that there is only one entity dealing with the problem. Insurance 101 teaches us that, statistically, the larger the pool, the more efficient the plan. In addition, there are large administrative saving. The overhead and compliance costs of private insurance cos waste over $600 Billion each year without even counting patient compliance costs.
3. The bottom line is that HR676 which simply gave an improved Medicare to everyone and was only 70 pages long would have given Americans better care at much, much lower cost. Is it to late to change our mind?
19
The problems with the economics of health care in this country are numerous and extend well beyond the flaws in the ACA. First, we have enormous for-profit insurance companies, such as Aetna, that are publicly held and therefore must meet the mandates of that type of business. Above earnings, these companies must increase shareholder equity and pay dividends. I'm not a business person, but it's safe to say that the dynamics of running a business are different when you're more concerned about your earnings, investors, and stock performance than you are about your customers. Second, the pharmaceutical and medical device manufacturers in this country are making phenomenal profits on their products. The margins on drugs and devices in the US are multiples of what they are elsewhere. Again, the forces of the marketplace are in effect.
I'm not opposed to capitalism, but these businesses are serving the public trust. For Aetna to claim that it is losing revenue is nonsense: they're doing pretty well by typical analytics. They are just not making as much as they would like in that market segment. Ideally, the government could convert these for-profit behemoths into not-for-profits by essentially buying out the shareholders - rough guess at least $200 billion - but the dynamic changes and the profit motive is substantially diminished. If the government offered a public option - Medicare for all - the appeal of Aetna, Cigna, as investments would vanish.
I'm not opposed to capitalism, but these businesses are serving the public trust. For Aetna to claim that it is losing revenue is nonsense: they're doing pretty well by typical analytics. They are just not making as much as they would like in that market segment. Ideally, the government could convert these for-profit behemoths into not-for-profits by essentially buying out the shareholders - rough guess at least $200 billion - but the dynamic changes and the profit motive is substantially diminished. If the government offered a public option - Medicare for all - the appeal of Aetna, Cigna, as investments would vanish.
11
It will be interesting to find out how the "magic" of a government financed public option in the exchanges will solve the current ACA problems. Mr. Krugman, along with other supporters of this option, appear to think that the word "public" alone has some mystical effect on economic activity that is well beyond the limited capacity of the unwashed masses to comprehend. What he conveniently omits to mention is that the COOPS, ACA financed "health insurance entities", that followed the mantra of low premiums went out of business by the second year of the existence of the law. The public option he advocates is simply an alternative expansion of medicare, financed by taxes , controlled by politicians, and perennially in fiscal trouble with few cost controls -if any- in place. ACA is fixable , but lets start the discussion by talking economics instead of low level politics.
As someone with both US Medicare and Quebec Health Insurance maybe I am able to diagnose the real problem with Obamacare.
It is 2016 and an 18th century constitution doesn't come close to addressing the need of balancing the needs of society and the needs individuals in a 21st century world.
The fundamental needs of the American society cannot be addressed by its political system and 1776 must be seen as only a beginning of creating a more perfect union.
I lived through the pain of creating Canada's constitution but if America is to survive looking at 21st century constitutions such as Canada's must be part of the solution. These are not the times to visit the local barber for some strategic bleeding or the judicious application of leeches.
It is 2016 and an 18th century constitution doesn't come close to addressing the need of balancing the needs of society and the needs individuals in a 21st century world.
The fundamental needs of the American society cannot be addressed by its political system and 1776 must be seen as only a beginning of creating a more perfect union.
I lived through the pain of creating Canada's constitution but if America is to survive looking at 21st century constitutions such as Canada's must be part of the solution. These are not the times to visit the local barber for some strategic bleeding or the judicious application of leeches.
6
The affordable care act was designed to placate insurance companies and protect their interests. It's not affordable and people are still not getting the care they need. Insurance companies whine and complain and threaten to take their ball home if they don't get mo money, mo money. I say single payer for all and let them deal with that. But we are a country run by greed and corruption and the greedy and corrupt make our laws or pay our legislators to make them.
310
"OK Nancy, what SHOULD we do about it." That was said by a frustrated Pres. Obama after the Speaker of the House kept raising objections to his proposals to get the ACA finally passed. They did get it passed, but, even though they had majorities in both houses, it was a close run thing.
Of course single payer is better! All believers in health insurance reform know that! But unless the Democrats gain control of both houses of congress, and maybe not even then, the best we can do is keep duct taping the jury rigged ACA.
Of course single payer is better! All believers in health insurance reform know that! But unless the Democrats gain control of both houses of congress, and maybe not even then, the best we can do is keep duct taping the jury rigged ACA.
Ed:
Who had the congress at the beginning of Obama's presidency?
Who had the congress at the beginning of Obama's presidency?
I haven't seen much advertising for the ACA. Television ads on shows younger people tend to watch would probably persuade some people. Ads in women's magazines - especially those that appeal to younger women (think Galmour or Marie Claire) - would be good too, since women might be more likely to buy insurance than men (who think they're invincible).
1
I guess it's time for a public option to round out the meager offerings. The insurance companies must know we can do this without them
4
Professor, have you been eating those special brownies from Colorado again?
Warrior Queen Hillary is going to win and the House is going to stay in the hands of delusional Republicans so nothing is going to change for at least 4 years.
Hillary is not going to stop loving the rich and the Republicans are not going to stop hating the poor, so Obamacare is just going to keep slowly breaking down like the poorly designed machine it is.
Under our present system, if you help the 99% you cost the 1% a lot of money and with the two main political parties being owned by the 1% that is never going to happen.
The bottom line is if you want good health care for the people you will cost the 1% a lot of money, so neither the Republicans or the Democrats will do anything because both parties are owned by the 1%.
We need a new political party, that's why I'm voting Green.
Warrior Queen Hillary is going to win and the House is going to stay in the hands of delusional Republicans so nothing is going to change for at least 4 years.
Hillary is not going to stop loving the rich and the Republicans are not going to stop hating the poor, so Obamacare is just going to keep slowly breaking down like the poorly designed machine it is.
Under our present system, if you help the 99% you cost the 1% a lot of money and with the two main political parties being owned by the 1% that is never going to happen.
The bottom line is if you want good health care for the people you will cost the 1% a lot of money, so neither the Republicans or the Democrats will do anything because both parties are owned by the 1%.
We need a new political party, that's why I'm voting Green.
Great. So what is your solution? A solution that will pass Congressional muster, that is.
Remind me again why private insurance companies exist.
9
The more reason we need "Medicare for All" aka the public option. I have one thing to say to the money-grubbing private healthcare industry and their bought and paid for politicians " Let Them Eat Cake"!
7
The Ryan-McConnell blockade may be the "only" thing impeding Obamacare, but it's a big thing. And the blockade impedes a lot of other things too as it continues to refuse democracy and promote chaos. It may be that Hillary will have to govern alone with executive actions appealed to the courts as "overstepping". But a better way is to throw the bums out.
4
Mr. Krugman,
1. It was OBAMA who took single payer off the table before negotiayions even began.
2. It is NOT health care costs the have slowed; it is Health care spending - big, big difference. Spending has dropped because premiums, deductibles and copays have risen so high that many of those who have "health insurance" can't afford to pay to see a physician.
Please either get your facts straight or stop writing about things of which you have choose to slant things or little knowledge.
1. It was OBAMA who took single payer off the table before negotiayions even began.
2. It is NOT health care costs the have slowed; it is Health care spending - big, big difference. Spending has dropped because premiums, deductibles and copays have risen so high that many of those who have "health insurance" can't afford to pay to see a physician.
Please either get your facts straight or stop writing about things of which you have choose to slant things or little knowledge.
4
The "success" of Oama Care was the establishment of a new welfare program. The "winners" those who now receive free or heavily subsidized health insurance. The losers are everyone else. The middle class face higher premiums for reduced services and fewer options. Plus, as a bonus, they get to underwrite the free care for their "less fortunate" peers. We have entered an era where it is OK, in fact mandated for a certain political class, to champion parasitic existence. Self reliance is now another form of bigotry and racism. Spin it! I used to have some respect for Krugman but he has gone beyond partisan and lost any credibility. An algorithm could write his column now it is so predictable.
3
Bi-partisan cooperation = Do what Democrats want or else
3
Partisan option: Oppose everything, propose nothing.
Aetna just doesn't know how to make money without cherry picking patients who are healthy enough to work. Their move should be taken as a stunning admission of incompetence and failure to add value.
8
The first sentence is not correct, the law has not been in full effect even to this day. The Cadillac tax has not been implemented. If your going to write about an issue or have an opinion get the facts correct so at the least you have some credibility. The Cadillac tax has been delayed for political reasons, it gets pushed further and further out to prevent democrats from losing votes in elections.
2
How unfaaaair! The GOP is the God's Option Party: if the Lord wants you to get sick and die, people, amen, amen, amen (but we'll pray for you and your bereaved loved ones.)
The GOP follows the God's Option Principle across many an issue, not just health care: climate change, industry regulation, "entitlement" programs, gun control, etc.
Show some faith, Brother Paul.
The Constant Weader @http://www.RealityChex.com
The GOP follows the God's Option Principle across many an issue, not just health care: climate change, industry regulation, "entitlement" programs, gun control, etc.
Show some faith, Brother Paul.
The Constant Weader @http://www.RealityChex.com
4
I challenge any republican on Medicare to justify why seniors over the age of 65 should be 'entitled' to adequate health care over that of people from 1-64.
With few exceptions Medicare is accepted as policy and even though seniors often pay supplements to increase coverage this 'socialized' system doesn't attract the ire of most conservatives like it does for Medicaid and Obamacare.
So how do conservatives morally justify helping a 65-year old and not a 35 Y/O in need of health care?
With few exceptions Medicare is accepted as policy and even though seniors often pay supplements to increase coverage this 'socialized' system doesn't attract the ire of most conservatives like it does for Medicaid and Obamacare.
So how do conservatives morally justify helping a 65-year old and not a 35 Y/O in need of health care?
18
Because they paid for it out of every paycheck?
3
possibly because the 65 yr old has paid in for (possibly) 45 yrs. the 35 yr old seems to only want to pay in -- once they get sick. or at least some do.
1
If that is the standard for justifying support for seniors( how much they pay into it via paychecks) it fails because costs rise substantially for end of life treatment. Older Americans get covered through Medicare because Americans believe that all citizens over 65 should have an entitlement to treatment, no matter how much they paid into it.
At the same time, you never responded to the argument asking for moral justification to allow a 6-yr old to go without healthcare while a 65+ citizen gets healthcare, no matter how much or how little they paid into it.
I would argue that all citizens should be given adequate health care simply because they live in the United States of America. No doubt we need to lower medical care costs but other countries have done it showing better outcomes at less cost.
At the same time, you never responded to the argument asking for moral justification to allow a 6-yr old to go without healthcare while a 65+ citizen gets healthcare, no matter how much or how little they paid into it.
I would argue that all citizens should be given adequate health care simply because they live in the United States of America. No doubt we need to lower medical care costs but other countries have done it showing better outcomes at less cost.
"And many of these private insurers are now finding themselves losing money, because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than we realized."
This cannot be a surprise to someone who previously has won the Nobel prize in economics.
This cannot be a surprise to someone who previously has won the Nobel prize in economics.
This discussion should not have to be held among people who consider themselves as intelligent and therefore to some degree thoughtfull.
If our nation won't provide health care to its own citizenry, but can manage to provide weaponry in the form of highly sophisticated or more blunt tools of death to any nation with the money or promise of subservience how can one think our leaders would be concerned with the health of anyone?
We and other nations led and controlled by less than advanced men throughout the world whether in the West, Middle or Far East have engaged in the failed policy of brute force embodied in the braided uniforms of military "leadership" for centuries. They have never solved any social problems and never will. It is an endeavor in which some make fortunes at the expense of those who are ground up in the machine of war which only guarantees early death to many and profits to a few.
In a society such as this, health care is at best a distraction.
So long as less than advanced knuckle dragging creatures who pose as men hold leadership positions and cosequently control the discussion of human rights in a so called advanced society there is little chance anything but monies for new prisons or more "humane" ways of state mandated execution will even come up for debate.
Health care for all? Cooperation among our representatives? That might help our citizenry, but more concerning cut into the bottom line of already overtaxed providers.
Good luck!
If our nation won't provide health care to its own citizenry, but can manage to provide weaponry in the form of highly sophisticated or more blunt tools of death to any nation with the money or promise of subservience how can one think our leaders would be concerned with the health of anyone?
We and other nations led and controlled by less than advanced men throughout the world whether in the West, Middle or Far East have engaged in the failed policy of brute force embodied in the braided uniforms of military "leadership" for centuries. They have never solved any social problems and never will. It is an endeavor in which some make fortunes at the expense of those who are ground up in the machine of war which only guarantees early death to many and profits to a few.
In a society such as this, health care is at best a distraction.
So long as less than advanced knuckle dragging creatures who pose as men hold leadership positions and cosequently control the discussion of human rights in a so called advanced society there is little chance anything but monies for new prisons or more "humane" ways of state mandated execution will even come up for debate.
Health care for all? Cooperation among our representatives? That might help our citizenry, but more concerning cut into the bottom line of already overtaxed providers.
Good luck!
2
So Dr. Krugman has finally realized that there are systemic problems with Obamacare? My brother found that out several months ago, when United HealthCare (which has lost tons of money ) started turning down referrals that he needs to get a medical problem treated, while at the same time insisting that he pay premiums every month for nonexistent care. When he tries to pull out he's told that he's stuck with the United contract for the rest of the year. Facebook is full of stories like this, but the scandal has been ignored by media outlets anxious to depict Obamacare as a success and blame Republicans for any bad news.
2
The problem for the vast majority of providers is that "losing money" doesn't mean actual losses; it means less profit.
"there’s nothing wrong with Obamacare that couldn’t be fairly easily fixed with a bit of bipartisan cooperation."
This is always a laughable notion, considering Obamacare was conceived in unbridled partisanship. Democrats had huge majorities in the House and Senate. Republicans, even liberals like Susan Collins, were frozen out of the negotiations. The end product required several Senators be bought off, ala "The Louisiana Purchase" and "Cornhusker Kickback". It was so bad, a significant number of Democratic House members refused to vote for it. Nancy Pelosi and Harry Reid rammed it through anyway. Now that it's in trouble, it's time for "bipartisanship", to make a bad deal worse.
Obamacare has achieved one of Progressive's unspoken goals: Designed to fail, it's so terrible that the only option is for us to move towards a single-payer government system. After all, isn't that every liberal's dream? Imagine a "Mission Accomplished" banner, proudly flying over this wreck, with Obama (dressed for golf, not in a flight suit) smiling in the forefront.
This is always a laughable notion, considering Obamacare was conceived in unbridled partisanship. Democrats had huge majorities in the House and Senate. Republicans, even liberals like Susan Collins, were frozen out of the negotiations. The end product required several Senators be bought off, ala "The Louisiana Purchase" and "Cornhusker Kickback". It was so bad, a significant number of Democratic House members refused to vote for it. Nancy Pelosi and Harry Reid rammed it through anyway. Now that it's in trouble, it's time for "bipartisanship", to make a bad deal worse.
Obamacare has achieved one of Progressive's unspoken goals: Designed to fail, it's so terrible that the only option is for us to move towards a single-payer government system. After all, isn't that every liberal's dream? Imagine a "Mission Accomplished" banner, proudly flying over this wreck, with Obama (dressed for golf, not in a flight suit) smiling in the forefront.
4
Short term memory much? The Ds had barely a 10 seat majority in the House in 2010 and 59 seats (not sufficient under Senate rules to 'lock out' anybody). The ACA was originally a proposal by the Heritage Foundation, and when the Rs categorically stated there was no way they'd support a single payer system, this was brought out as a compromise to gain the Rs support, who then whined about item after item after item, forcing the proposal to be watered down again and again, all with the intent of gaining bipartisan support. In the end, in spite of their 2-year-old epic tantrums and getting the law watered down to the point that it didn't resemble even the original proposal, not a single R voted for it.
Yes, we should have single payer health coverage, but that's likely not achievable in the current climate. I'd settle for this however: you want to be in the insurance business? You do it as a non-profit.
Yes, we should have single payer health coverage, but that's likely not achievable in the current climate. I'd settle for this however: you want to be in the insurance business? You do it as a non-profit.
Jeff - perhaps it is you that needs short-term memory help. The ACA was passed in the House and Senate in 2009, and went into effect in March, 2010. At that time, the Democrats had a 257 - 178 advantage in the House. The Democrats had 58 seats in the Senate, plus 2 liberal Independents, giving them a filibuster proof majority. It passed the Senate 60-39. You are right, not a single Republican voted for it. Neither did 37 House Democrats, who voted against the ACA, despite threats from Nancy Pelosi. Also, the Republicans were shut out of the negotiations, so they had no way to "water" it down - the intent was to ram in through, on a partisan basis.
BTW - the Heritage Foundation is not the US Congress.
BTW - the Heritage Foundation is not the US Congress.
Healthcare is a corporate tax: companies have to provide it. Compared to other countries, this puts American companies at a disadvantage and increases the cost of employment, so moving jobs abroad.
A true, government, healthcare system would reduce this burden and improve job mobility: call it a stimulus package.
A true, government, healthcare system would reduce this burden and improve job mobility: call it a stimulus package.
9
I work with many people who on Medicare the ACA does nothing for most of them, no matter how small their S. Security checks are. I read and hear from friends that the cost of insurance and supplemental insurance is up sharply. I also read the reports that most insurance companies are raking in more cash-in the billions- every year. This complex law needs a huge make-over to assist those that can't afford medicine and other associated costs. Universal health care is the answer and this should be the goal. Here's hoping a more knowledgeable health care minded president Clinton will be able to implement
vast improvements.
vast improvements.
11
No politician wants to touch the real problem, the REAL reasons that Americans spend more for health care than other countries yet can't insure everyone. Yes, the private insurance companies gauge the system. Their lobbyists continue to make sure that the public option is not available. But there are other groups with lobbyists also fouling up the system: the malpractice bar that costs a fortune suing the wrong people for the wrong reasons, the drug companies that get away with charging Americans more for the same drugs than anyone else in the world, and also, honestly, those of us, some of whom are my colleagues, who profit from prolonging the death agony of the terminally ill in ways that are not only unreasonable and unkind, but also unheard of elsewhere in the world and at other times in the history of the world.
Medical care is over-regulated by politicians, by federal and state agencies with blinders on to the real issues. They pass laws and policies that drown hospitals in useless paper work that only serves to increase costs.
You can rearrange the way care is paid for, raise deductibles and co-payments, pay hospitals by diagnosis rather than by hospital days, but you need to lower the cost of health care, not only of health insurance.
Medical care is over-regulated by politicians, by federal and state agencies with blinders on to the real issues. They pass laws and policies that drown hospitals in useless paper work that only serves to increase costs.
You can rearrange the way care is paid for, raise deductibles and co-payments, pay hospitals by diagnosis rather than by hospital days, but you need to lower the cost of health care, not only of health insurance.
13
The United States of America have the highest survival rate from all major illnesses of any country in the world. IF you eliminate homicides and deaths in car crashes, and as a doctor I am sure you are aware those two things have NOTHING to do with the healthcare system, then the United States of America has the longest life expectancy of any country in the world. In addition over half the medical spend is elective and would continue in any event with or without single payer.
Then you must ask yourself before we try to launch ourselves into an inferior health care system, why most single payer countries have reintroduced PRIVATE health insurance and PRIVATE health care to try and improve their systems. The USA's health care system is expensive - and darned well worth it!
Then you must ask yourself before we try to launch ourselves into an inferior health care system, why most single payer countries have reintroduced PRIVATE health insurance and PRIVATE health care to try and improve their systems. The USA's health care system is expensive - and darned well worth it!
Actually the only thing wrong with ObamaCare is what has been wrong with it from the start. It relies on the profit motive of greedy corporations.
For profit enterprises have a place. They are fine for all kinds of things like . . . cell phones that take pictures, bubblegum, and baseball cards. Actually, they are probably fine for more serious things like auto and property insurance too.
But prisons? Police? The Military? Education (at least direct services)? Healthcare?
No!
For profit businesses are compelled by "the market" to offer the lowest quality product people will accept at the highest possible prices that people can pay. Again there's nothing wrong with that when it comes to pure entertainment.
But whenever health and safety is a concern that can be legitimately associated with any product or any service, profit can no longer be allowed to be the primary consideration. And for some services, profit has no legitimate place at all.
For profit enterprises have a place. They are fine for all kinds of things like . . . cell phones that take pictures, bubblegum, and baseball cards. Actually, they are probably fine for more serious things like auto and property insurance too.
But prisons? Police? The Military? Education (at least direct services)? Healthcare?
No!
For profit businesses are compelled by "the market" to offer the lowest quality product people will accept at the highest possible prices that people can pay. Again there's nothing wrong with that when it comes to pure entertainment.
But whenever health and safety is a concern that can be legitimately associated with any product or any service, profit can no longer be allowed to be the primary consideration. And for some services, profit has no legitimate place at all.
13
Aetna reported losses of $340 million in the ACA marketplace. How can the profit motive be the problem when there's no profit? How could Aetna continue to pay more money out than it takes in?
The ONLY thing that capitalism guarantees is the widest array of choices. This idea that it guarantees the lowest costs would mean that we would all be driving Hugos. The inability to understand capitalism is the problem. It is a natural non-violent way for two parties to come to agreement. School children learn to trade playing cards, that is how natural capitalism is.
If you are evolutionist, you believe in capitalism, if you are a creationist, you do not. The government thinks it can just "create" things out of thin air, like profits, or a functioning marketplace that will adhere to its wishes. Silly, silly government. People are always smarter than it, and now the government claims the people are "gaming" the system. What a laugh, after the government rigged the system.
If you are evolutionist, you believe in capitalism, if you are a creationist, you do not. The government thinks it can just "create" things out of thin air, like profits, or a functioning marketplace that will adhere to its wishes. Silly, silly government. People are always smarter than it, and now the government claims the people are "gaming" the system. What a laugh, after the government rigged the system.
Several years ago, I thought about this connection between the profit motive and critical needs like healthcare. I argued, as you do, that the profit motive is far from an ideal way to address these needs. However, I did come across a possible compromise at the time. Switzerland had a private insurance system that covered 100% of it's citizens with decent healthcare, but it did so by limiting the level of profit allowed. Australia took the concept a step further by limiting the percentage credit cards could charge businesses for each transaction. I'm not sure either system is still in effect or if either worked as intended. Research for another day.
Well once again let us remember that Obama had overwhelming filibuster proof majorities in the House and Senate when he made his deal with the devil private healthcare deniers for $70 Billion a year profits instead of even allowing Medicare Single Payer onto the table. Only after protests from Doctors and Nurses clamoring for Single-payer to be free of their own subjugation to the private healthcare deniers were any Single Payer advocates even allowed into the stacked hearings. The claim was the $70 Billion a year sop to the profiteers was required to get Republican votes. But lo and behold not a single Republican voted for RomneyCare anyway even though it was a Republican Heritage Foundation snake in the grass to begin with. Then even the public option was thrown under the plunderers bus. Many people opposed Obamacare for the very good reason that they could not afford to pay the profiteers. But 80% support SinglePayer Medicare. The upshot of that was the Democrats lost the House and then the Senate with their milquetoast Corporate policies. Single-payer Medicare would be the biggest inducement to a flowering of entrepreneurship as it would allow many, including my own friends, to start their own businesses or enterprises without the huge burden of paying off the healthcare deniers for their healthcare. Instead millions are shackled to Corporate jobs with benefits or government jobs to avoid paying for healthcare which should be a human right.
6
" ... because previously uninsured Americans who are signing up turn out to have been sicker and more in need of costly care than "we" realized."
So, please help me understand - the system ACA was designed so if things didn't work out for Big Insurance, ie not realizing the obscene profits promised by government, then Big Insurance could withdraw whenever, with no repercussions, as in no IRS penalties, like the un-American cudgel, the now legal penalty that says all Americans must have, and pay for insurance, and be dammed to freedom of choice.
And please tell me again how it is that the Supreme Court ruling permitting corporations be regarded as having the same responsibilities as human beings, since they allowed they are human beings, how is it that these "new" human beings are exempt from laws affecting we ordinary human beings, that adage "what's good for the goose, is good for the gander".
Something is rotten in paradise, don't you think, and from my inconsequential perspective, methinks the law is designed to affect living breathing walking humans, adversely, while benefiting all newly minted human corporations.
America, the land that deliberately remade it's laws, so Liberty and Justice would only apply to corporations.
Not fully coherent, as it's written in anger, but one gets the point ...
So, please help me understand - the system ACA was designed so if things didn't work out for Big Insurance, ie not realizing the obscene profits promised by government, then Big Insurance could withdraw whenever, with no repercussions, as in no IRS penalties, like the un-American cudgel, the now legal penalty that says all Americans must have, and pay for insurance, and be dammed to freedom of choice.
And please tell me again how it is that the Supreme Court ruling permitting corporations be regarded as having the same responsibilities as human beings, since they allowed they are human beings, how is it that these "new" human beings are exempt from laws affecting we ordinary human beings, that adage "what's good for the goose, is good for the gander".
Something is rotten in paradise, don't you think, and from my inconsequential perspective, methinks the law is designed to affect living breathing walking humans, adversely, while benefiting all newly minted human corporations.
America, the land that deliberately remade it's laws, so Liberty and Justice would only apply to corporations.
Not fully coherent, as it's written in anger, but one gets the point ...
8
None of you, including the Nobel-prize winning Mr. Krugman, have even mentioned the real cause for all this panic.
When the law was first being discussed, health professionals said it's refusal to deny coverage for previous conditions would be a catastrophe. People, at least the clever ones, would not buy coverage until they were sick. Then they would buy the insurance, use it to cover their costs, then cancel. The insurance companies would go broke. They were ignored.
Mr. Krugman's clumsy attempt to make that into "they were more in need of care than we realized" notwithstanding, that is exactly what is happening now.
You were warned that it would bankrupt the system, and it is bankrupting the system.
Have a nice day.
When the law was first being discussed, health professionals said it's refusal to deny coverage for previous conditions would be a catastrophe. People, at least the clever ones, would not buy coverage until they were sick. Then they would buy the insurance, use it to cover their costs, then cancel. The insurance companies would go broke. They were ignored.
Mr. Krugman's clumsy attempt to make that into "they were more in need of care than we realized" notwithstanding, that is exactly what is happening now.
You were warned that it would bankrupt the system, and it is bankrupting the system.
Have a nice day.
15
What a horrible attitude. First, insurance companies are far from broke, they are only (maybe) making less than they want on this coverage. Second, you have to understand that insurance companies only want to insure healthy people, they make more money that way. Lastly and more important is all the people who due to the insurance companies not wanting to insure them have finally been able to get insurance and perhaps a better quality of life. But I guess you don't care about anyone else. The last companies that I feel any compassion for are the health companies.
7
You can't make the claim about dastardly sick people beating up the insurance companies without providing some real verifiable facts.
Anyone able to provide his or her informed views of the accuracy of wolffjac's interesting comment?
There is a problem with the ACA that hasn't been mentioned very much, and that is the lack of a comprehensive provider network. Not all doctors will accept patients covered by the ACA. So, it's all well and good to talk about how many more people now have insurance, and that's goodness. But it's often difficult if not impossible to find a doctor who actually accepts that insurance. The result is a very thin layer of actual providers, which often makes the benefit of the ACA negligible. Perhaps this will eventually disappear as the program evolves over time. But there needs to be some sort of inducement or mandate (for lack of a better word in this context) that doctors will accept this insurance for the ACA to reach its potential.
14
From michelle Rome: "Profiteering off health is really only an American business consideration, you have to pay to stay alive is beyond cruel and what Aethna just did is disgusting."
I recall many discussions over the years about the 'proper role of the government'. In the US it is a muddled discussion at best. The Aetna CEO represents the worst element (other than the GOP congress) in the US health care charade. A vindictive major player who has only profit and control motives that exclude any real concern about American's lives gives us a real picture of the state of health care in the US.
I recall many discussions over the years about the 'proper role of the government'. In the US it is a muddled discussion at best. The Aetna CEO represents the worst element (other than the GOP congress) in the US health care charade. A vindictive major player who has only profit and control motives that exclude any real concern about American's lives gives us a real picture of the state of health care in the US.
22
Yes, I believe it was Marc Rubio who passed the stealthy amendment that refused to subsdize insurers who were getting less(yes the public option would be so much simpler and I love how republicans shouted it down, then tease us that ACA isn't as good. "If only we had the public option": hypocrites. I believe that was in fact Obama's original wish), knowing that would i deed be a bump!
But yes at the time none of the democrats realized it was a poison pill. Have to say Little Marco was no dummy, in the service of evil intent, of course
But yes at the time none of the democrats realized it was a poison pill. Have to say Little Marco was no dummy, in the service of evil intent, of course
10
Actually, the explanation of this move by Aetna is 90% attributable to the denied merger. I think if people really understood how much male ego drives politics and economics we would really have a different conversation. So many of the negative consequences. experienced by the marginalized are due to personality defects in males, mainly white, who have no conception of the common good. Or they see reasoning based upon a common good as weakness. We should really personalize our journalism so we put front and center the people who make these decisions. Press conferences , profiles, interviews.
I have no doubt two things will come to the surface if we did: the antithetical and contradictory stance the private institutions have that are responsible for providing a public good like healthcare AND that the men making these decisions are way, way closer to Trump in psychological profile than they are to , say, Obama. If you respond 'that is because they are businessmen' than you have made my argument as to why private investor driven corporations must get out of the business of securing fundamental public goods goods like healthcare, prisons, education , etc.
I have no doubt two things will come to the surface if we did: the antithetical and contradictory stance the private institutions have that are responsible for providing a public good like healthcare AND that the men making these decisions are way, way closer to Trump in psychological profile than they are to , say, Obama. If you respond 'that is because they are businessmen' than you have made my argument as to why private investor driven corporations must get out of the business of securing fundamental public goods goods like healthcare, prisons, education , etc.
19
While expanding access for millions who truly need insurance, Obamacare has proven one thing that Krugman reinforces ("fairly easily fixed"). The health care policy wonks. Hill staffers and economists think they are far more clever than they are. It is a fools errand to believe that "incentives" will motivate healthy or young uninsured to buy coverage at the same rate as heavily subsidized sick or older folks. Run all the models you want, it will not work. Likewise, a few "public option" plans--particularly haphazard deals put together by states, will wind up like the COOPs.
2
The crucial piece to the success of the public option is allowing the public plan to use the Medicare fee schedule to pay doctors and hospitals (unfortunately, there is no single fee schedule for drugs -- the 2006 law that added the Part D drug benefit made it available only via private insurers who each negotiate separately with the drug companies).
5
Years ago, our family lived for a while in northern Sweden. Our young boys were immediately folded into a state-sponsored network of good schools and safe daycare and healthcare.
Our older son (third grade) didn't quite fit. His teacher "conferenced" with me one afternoon near an enormous playground snow sculpture perforated with icy fun tunnels, and said, "I do not understand. It is as if he wants to be king!"
I tried to explain that this was not evidence of our son's national character, his Americanness. It was just a sign of his, um, personality.
But it was both.
I miss Sweden. I admire Sweden ... it's steady generosity, its egalitarian security, funded by high taxes.
But it will be very, very, very difficult to convert the contentious, competitive, divided, massive, vast, fragmented, sea-to-sea United States into a nation more like Sweden (note: the population of Sweden is approximately equal to that of New York City, with all five boroughs).
We can still try, though.
It will require taxation. Increased taxation. And the defeat of Donald Trump, Paul Ryan, and Mitch McConnell. And the end to Fox News.
What are the odds?
Aetna is despicable. This was a stupid move by Aetna.
Our older son (third grade) didn't quite fit. His teacher "conferenced" with me one afternoon near an enormous playground snow sculpture perforated with icy fun tunnels, and said, "I do not understand. It is as if he wants to be king!"
I tried to explain that this was not evidence of our son's national character, his Americanness. It was just a sign of his, um, personality.
But it was both.
I miss Sweden. I admire Sweden ... it's steady generosity, its egalitarian security, funded by high taxes.
But it will be very, very, very difficult to convert the contentious, competitive, divided, massive, vast, fragmented, sea-to-sea United States into a nation more like Sweden (note: the population of Sweden is approximately equal to that of New York City, with all five boroughs).
We can still try, though.
It will require taxation. Increased taxation. And the defeat of Donald Trump, Paul Ryan, and Mitch McConnell. And the end to Fox News.
What are the odds?
Aetna is despicable. This was a stupid move by Aetna.
40
And the end to New Democrats. It was Obama who promised no new taxes except on the top 3% ($250,000 family income) and raised them only on those over $450,000. He had total power over taxes because of the expiration of Bush tax cuts. And he fully kept the supply side tax system on capital gains and corporate taxes--and didn't even hit the loophole for hedge funds. Citigroup didn't want it, and they ran the Administration.
Hillary too will be a do-nothing President because she has promised no new taxes on those under $250,000 and speaks of taxes only on the top 1%.
Hillary too will be a do-nothing President because she has promised no new taxes on those under $250,000 and speaks of taxes only on the top 1%.
1
Interesting that the insurance industry was all in on this deal until they failed to enroll more people to balance out the risk pool. By raising rates and being belligerent (hello, Aetna!) will only make Americans wish for an option that excludes the insurance industry entirely.
23
The public option is exactly what I wish for!
2
Maybe Americans wish the federal government would get out of their lives and try something simple like screwing a 2000.00 lightbulb in.
1
On the one hand, ObamaCare has enrolled a population that is sicker than average, hence one that actually needs insurance. Ironically, the Republicans propose to expand "high risk pools" -- a function that ObamaCare is serving for many who qualify for subsidies. On the other hand, ObamaCare is proving that too many (healthier) Americans simply will not pay for insurance for myriad reasons (can't afford non-subsidized plans, don't like "government health care", prefer to take the risk, etc.). There is no "tweak" for this problem. Basic coverage needs to be compulsory and something like Medicare for all is the only solution that meets this criteria.
20
Last year, our family ended up on Obamacare. It has been interesting. First, and I speak as an educated person, with an educated spouse, it is incomprehensible. It should be illegal to run a program that is so opaque. Second, the woman hired by the gov't to explain the exchages to us, with whom we spent hours and hours, said she would gladly lose her job in return for single payer, because this system is untenable. I can't wait for Medicare but unf am in my 50s. Right now we pay too much of our take-home pay for insurance (which puts a drag on the economy), have high deductibles and are afraid to use what we have. Please single payer us. Please note that Ryan wouldn't get rid of Obamacare, only force Americans to pay more for it, to pad corporate profits. And cut more poor people off it.
90
Living in a red state makes this problem even greater to those who do not have access to employer provided insurance. The ACA helped millions but, as many here point out, it must be viewed as only a stepping stone to single payer.
A young, unemployed person (for whatever reason) living in a red state will not have access to Medicaid. No help from consultants who tell us that it is hopeless. So, they go without care which, in such a wealthy country, is criminal.
A young, unemployed person (for whatever reason) living in a red state will not have access to Medicaid. No help from consultants who tell us that it is hopeless. So, they go without care which, in such a wealthy country, is criminal.
1
It's time for us to DEMAND government that is accountable to the people that it serves. Vote for Jill Stein. Please check out her platform - it is written for helping people over corporations.
Kennedy challenged Americans to "...ask not what your country can do for you, ask what you can do for your country." The resounding answer to both questions seems to be: not much. So why aren't we asking the obvious: what can we do for ourselves?
Our political system isn't just voters, public officials, politicians, government agencies, corporate lobbyists, big donors, media pundits and pollsters. Yet they've monopolized the public agenda, deciding what's broken and how to fix it.
Left out entirely is what and who the Constitution explicitly enables: activists, advocates, dissenters, agitators, organizers, nonprofits, foundations, ad hoc and institutional citizen movements.
Behind all legislative monuments to social progress has been robust, tough-minded activism that grew into powerful movements with catalytic demand for political action. Ralph Nader forced the auto industry to build safer cars. Rachel Carson got DDT banned. There are thousands of successful activist examples.
Where are the angry protests demanding the public option the health insurance cartel killed? If Aetna bails out of ACA after rigging a captive market, why aren't the Sanderistas occupying Aetna's corporate HQ? Exhorting a consumer boycott of Aetna insurance? Assailing Aetna's management and board? Or demanding institutional divestment of Aetna stock?
If gun fetishists have Congress on a leash, why are millions who want single payer on the sidelines waiting for Godot?
Our political system isn't just voters, public officials, politicians, government agencies, corporate lobbyists, big donors, media pundits and pollsters. Yet they've monopolized the public agenda, deciding what's broken and how to fix it.
Left out entirely is what and who the Constitution explicitly enables: activists, advocates, dissenters, agitators, organizers, nonprofits, foundations, ad hoc and institutional citizen movements.
Behind all legislative monuments to social progress has been robust, tough-minded activism that grew into powerful movements with catalytic demand for political action. Ralph Nader forced the auto industry to build safer cars. Rachel Carson got DDT banned. There are thousands of successful activist examples.
Where are the angry protests demanding the public option the health insurance cartel killed? If Aetna bails out of ACA after rigging a captive market, why aren't the Sanderistas occupying Aetna's corporate HQ? Exhorting a consumer boycott of Aetna insurance? Assailing Aetna's management and board? Or demanding institutional divestment of Aetna stock?
If gun fetishists have Congress on a leash, why are millions who want single payer on the sidelines waiting for Godot?
29
Kennedy's statement was a rejection of the expansion of the New Deal. That was what he did.
1
I have wondered the same things...
@ Jerry Hough
Really? Most people I know who joined the Peace Corps cite Kennedy's speech as the reason. The general interpretation of that passage -- cribbed from the headmaster of his school -- is voluntary and patriotic service for the benefit of others. Inaugural speeches generally don't go deep on policy and Kennedy's was no different. But you're welcome to parse his phrase however you'd like. For example, "Ich bin ein Berliner" was a refutation of Bavarian nationalism, also taken to be a declaration of modesty -- that he was just one Berliner no more significant than Willie Brandt's driver. He could have said "Ich bin zwei Berliner," which would have meant he was either unhappy about the Berlin Wall (paid for by Mexico, btw) or he stood in solidarity with schizophrenics.
Really? Most people I know who joined the Peace Corps cite Kennedy's speech as the reason. The general interpretation of that passage -- cribbed from the headmaster of his school -- is voluntary and patriotic service for the benefit of others. Inaugural speeches generally don't go deep on policy and Kennedy's was no different. But you're welcome to parse his phrase however you'd like. For example, "Ich bin ein Berliner" was a refutation of Bavarian nationalism, also taken to be a declaration of modesty -- that he was just one Berliner no more significant than Willie Brandt's driver. He could have said "Ich bin zwei Berliner," which would have meant he was either unhappy about the Berlin Wall (paid for by Mexico, btw) or he stood in solidarity with schizophrenics.
Obamacare hits a bump. In other news, the arrival of the Hindenburg was slightly delayed.
15
So, to summarize, Paul wants socialized medicine run by government because it's Republicans fault that the plan that the Democrats wrote and unilaterally passed is failing.
9
It was a Republican plan to begin with. Amazing how Republicans turn against their own ideas if those ideas might, even slightly might, appear to be a "victory" for President Obama.
1
I'm sorry but Paul Krugman's call for "bipartisan cooperation" and "compromise to make government work" ring hollow. In fact, in this very same article. he refers to all who dare not share his views on the ACA as "right-wing doomsayers".
I would love to know on what ACA points Professor Krugman is willing to compromise with Republicans. He fails to indicate any matters on which he is willing to budge. To the contrary, he calls for the Public Option which he knows is unacceptable to Republicans.
Kind of seems like his calls for compromise are not sincere at all, and instead are just another cudgel to attack his partisan foes.
I would love to know on what ACA points Professor Krugman is willing to compromise with Republicans. He fails to indicate any matters on which he is willing to budge. To the contrary, he calls for the Public Option which he knows is unacceptable to Republicans.
Kind of seems like his calls for compromise are not sincere at all, and instead are just another cudgel to attack his partisan foes.
9
The public option is unacceptable to the health insurance cartel. Republicans just do what they're told.
Most realize there is nothing that would be acceptable to Republicans beyond repealing ACA. They have demonstrated that dozens of times in Congress. These are the same right wing doomsayers who claimed it would fail. Will they at least acknowledge that, in fact, it has not?
It has been clear changes were needed since the law passed. But what is the point of talking compromise when there is only one party talking about it? If there is hollowness here, it is from the party that just wants to kill it and walk away, leaving millions without.
It has been clear changes were needed since the law passed. But what is the point of talking compromise when there is only one party talking about it? If there is hollowness here, it is from the party that just wants to kill it and walk away, leaving millions without.
Fair responses, but nothing to do at all with the point that I was making. I was pointing out that Krugman's calls for compromise are disingenuous.
Knee jerk partisan responses to the contrary. nothing in my post reflected any support for Republicans or lack of support for the public option.
Knee jerk partisan responses to the contrary. nothing in my post reflected any support for Republicans or lack of support for the public option.
Let's try to imagine a health care world completely devoid of government oversight, regulation and participation in any way. Shall we?
-No more Medicare, let the elderly fend for themselves on a truly free-market exchange.
-No more Medicaid, let the poor discover the virtues of pulling yourself up by your own bootstraps.
-No more Obamacare, let the pillars of the American Insurance and Healthcare Industries dictate how our health care dollar is collected and spent.
-No more government negotiating pharmaceutical costs, drugs should cost whatever the market can bear.
-No more money for cancer research, let our proud investment class decide when, where, why and how medical knowledge and products are advanced.
-No more FDA interference into what device or drug should go into a patient's body.
-No more Veteran's Administration. Our brave servicemen and woman deserve a system based on American values, not socialist ones.
-No more redressing of grievances in court over malpractice. No more class-action lawsuits.
Truly this would be the best of all possible worlds, truly a new Golden Age of Health Care in America. Unfortunately, there are far too many interests that stand opposed to such plan. If only American Enterprise were allowed to function unfettered as the Creator intended.
Pity that. I guess we'll never know.
-No more Medicare, let the elderly fend for themselves on a truly free-market exchange.
-No more Medicaid, let the poor discover the virtues of pulling yourself up by your own bootstraps.
-No more Obamacare, let the pillars of the American Insurance and Healthcare Industries dictate how our health care dollar is collected and spent.
-No more government negotiating pharmaceutical costs, drugs should cost whatever the market can bear.
-No more money for cancer research, let our proud investment class decide when, where, why and how medical knowledge and products are advanced.
-No more FDA interference into what device or drug should go into a patient's body.
-No more Veteran's Administration. Our brave servicemen and woman deserve a system based on American values, not socialist ones.
-No more redressing of grievances in court over malpractice. No more class-action lawsuits.
Truly this would be the best of all possible worlds, truly a new Golden Age of Health Care in America. Unfortunately, there are far too many interests that stand opposed to such plan. If only American Enterprise were allowed to function unfettered as the Creator intended.
Pity that. I guess we'll never know.
20
Please ell me this is tongue-in-cheek, Sue.
It's remarkable that many wish to deprive other Americans of health care. Whatever their reasons, the end result is the same: let them die or suffer, if they can't write a check.
These same people have no problems with unlimited tax cuts for the 1%, or the nation's annual blank check to the Pentagon, or ignoring local bridge repairs.
These same people have no problems with unlimited tax cuts for the 1%, or the nation's annual blank check to the Pentagon, or ignoring local bridge repairs.
32
Vindictive. Great. And an accurate description of Aetna and United Healthcare if you have ever had health coverage from them. Aetna should be shammed in the largest online deluge yet seen. And anyone in the AARP target age group should let them know "no United Healthcare". Personally, I think it is time to simply nationalize all insurance providers. Bernie might have taken a stab at that.
20
How about the newspaper of record running a series on the High Costs of Medicine in the U.S.--monetary, human health, stress, inefficiency, investor- oriented, market share & monopolization, administrative costs
Start with Aetna's CEO, who bragged how Aetna prioritizes people and still pays its executives well.
From the Internet:A few headlines about Aetna CEO
Aetna Inc. Chief Executive Mark T. Bertolini's compensation was valued at $17.3 million last year, up from $15.1 million in 2014, reflecting higher stock and option awards. Apr 8, 2016
Aetna Chairman and CEO Mark Bertolini received $27.9 million in compensation last year, according to a filing Friday with the Securities and Exchange Commission.
Aetna CEO's $131 Million Parachute Biggest Among Health Targets ...
www.bloomberg.com/.../aetna-ceo-s-131-million-parachute-biggest-a...
Aetna's CEO Proves You Can Prioritize People And Still Earn A Huge ...
www.huffingtonpost.com/.../mark-bertolini-pay-aetna_us_570bc...
The Huffington Post Apr 12, 2016 - But he certainly gets paid like a top-brass executive. Last year, Aetna bumped Bertolini's compensation to $17.3 million — higher stock options ...
Also, let the public know that "non-profit" in medicine does not mean what they think it means.
At an international conference, a German professor shook his finger at me and said: "How can you Americans make profits out of people's illness & suffering. Don't Americans know what they are paying for?"
No, we don't! Why?
Start with Aetna's CEO, who bragged how Aetna prioritizes people and still pays its executives well.
From the Internet:A few headlines about Aetna CEO
Aetna Inc. Chief Executive Mark T. Bertolini's compensation was valued at $17.3 million last year, up from $15.1 million in 2014, reflecting higher stock and option awards. Apr 8, 2016
Aetna Chairman and CEO Mark Bertolini received $27.9 million in compensation last year, according to a filing Friday with the Securities and Exchange Commission.
Aetna CEO's $131 Million Parachute Biggest Among Health Targets ...
www.bloomberg.com/.../aetna-ceo-s-131-million-parachute-biggest-a...
Aetna's CEO Proves You Can Prioritize People And Still Earn A Huge ...
www.huffingtonpost.com/.../mark-bertolini-pay-aetna_us_570bc...
The Huffington Post Apr 12, 2016 - But he certainly gets paid like a top-brass executive. Last year, Aetna bumped Bertolini's compensation to $17.3 million — higher stock options ...
Also, let the public know that "non-profit" in medicine does not mean what they think it means.
At an international conference, a German professor shook his finger at me and said: "How can you Americans make profits out of people's illness & suffering. Don't Americans know what they are paying for?"
No, we don't! Why?
43
If Aetna is a "bump in the road", UHC is a three car accident.
First off, Obamacare has yet to be fully implemented. The excise tax on Cadillac plans implementation was delayed by Congress in December of 2015. That tax is Jonathan Gruber's back door method of phasing out the ESI tax exclusion. Remember Dr. Gruber?
An insurance plan that cost $90 per month, with an $11,000 deductible is not healthcare. It's a catastrophic insurance plan. Medicaid is a much better plan, with enhanced benefits, but the majority of Docs won't see you as they will not accept the low payments.
The vast majority of newly insured have qualified for Medicaid. They didn't buy insurance on an exchange. The ESI tax exclusion is equal to $600 billion per year, more than enough to pay for expanded Medicaid at decent reimbursement rates. Gruber begged this administration to phase it out over a period of time, stating that it was the main cause of medical inflation. The tax exclusion removes all discretionary buying in the marketplace, sort of like shopping with someone else's debit card.
I have to also disagree on the deficit, according to the CBO it will reach $600 billion this year.
But alas, we have leadership that is beholden to the donor class. The Unions would not stand for paying income taxes on employer health benefits.
But, if we elect a "clueless" President a small minority from the donor class will not be able to shape the lives of millions.
Mr. Krugman, you have failed todays' class.
First off, Obamacare has yet to be fully implemented. The excise tax on Cadillac plans implementation was delayed by Congress in December of 2015. That tax is Jonathan Gruber's back door method of phasing out the ESI tax exclusion. Remember Dr. Gruber?
An insurance plan that cost $90 per month, with an $11,000 deductible is not healthcare. It's a catastrophic insurance plan. Medicaid is a much better plan, with enhanced benefits, but the majority of Docs won't see you as they will not accept the low payments.
The vast majority of newly insured have qualified for Medicaid. They didn't buy insurance on an exchange. The ESI tax exclusion is equal to $600 billion per year, more than enough to pay for expanded Medicaid at decent reimbursement rates. Gruber begged this administration to phase it out over a period of time, stating that it was the main cause of medical inflation. The tax exclusion removes all discretionary buying in the marketplace, sort of like shopping with someone else's debit card.
I have to also disagree on the deficit, according to the CBO it will reach $600 billion this year.
But alas, we have leadership that is beholden to the donor class. The Unions would not stand for paying income taxes on employer health benefits.
But, if we elect a "clueless" President a small minority from the donor class will not be able to shape the lives of millions.
Mr. Krugman, you have failed todays' class.
8
To Hawk:
You are professing to be Teacher when you don't know the subject matter.
You say, "UHC is a three car accident" Reality: UHC covers few enrollees on the exchanges. It's withdrawal from 5 state exchanges is expected to affect premiums by only 1% on average, more in a handful of counties. http://www.npr.org/sections/health-shots/2016/04/18/474694680/analysis-m...
You must be thinking that UHC is the biggest insurer of plans supplemental to Medicare. Those plans cover part or all of enrollees' deductibles and co-insurance. Those plans increase utilization by insulating people from having skin in the game.
Next, you said "An insurance plan that cost $90 per month, with an $11,000 deductible is not healthcare." You are illustrating an individual plan with maximum premium subsidy. No deductible could be higher than $6,850. Further, an ACA enrollee paying only $90/month also qualifies for a subsidy that reduces their deductible by 94%. That would reduce the $6,850 deductible to $411.
You said about Medicaid "the majority of Docs won't " accept it. Wrong. About 70% of doctors accept Medicaid.
Your comment about the ESI tax exclusion is false equivalence. Employers cover 150 million people. You propose taking away their subsidy to cover an additional 10 million people. So, what happens when employers stop covering the 150 million?
And the US deficit in 2016 is half of what it was in 2010 - not soaring
You are professing to be Teacher when you don't know the subject matter.
You say, "UHC is a three car accident" Reality: UHC covers few enrollees on the exchanges. It's withdrawal from 5 state exchanges is expected to affect premiums by only 1% on average, more in a handful of counties. http://www.npr.org/sections/health-shots/2016/04/18/474694680/analysis-m...
You must be thinking that UHC is the biggest insurer of plans supplemental to Medicare. Those plans cover part or all of enrollees' deductibles and co-insurance. Those plans increase utilization by insulating people from having skin in the game.
Next, you said "An insurance plan that cost $90 per month, with an $11,000 deductible is not healthcare." You are illustrating an individual plan with maximum premium subsidy. No deductible could be higher than $6,850. Further, an ACA enrollee paying only $90/month also qualifies for a subsidy that reduces their deductible by 94%. That would reduce the $6,850 deductible to $411.
You said about Medicaid "the majority of Docs won't " accept it. Wrong. About 70% of doctors accept Medicaid.
Your comment about the ESI tax exclusion is false equivalence. Employers cover 150 million people. You propose taking away their subsidy to cover an additional 10 million people. So, what happens when employers stop covering the 150 million?
And the US deficit in 2016 is half of what it was in 2010 - not soaring
Obamacare hits a bump. Dialogue reported on the Titanic one cold dark evening? "What was that, Joe?" "I dunno. Felt like a slight bump."
7
Great analogy
Funny, as recently as a couple of months ago the "Public option" was just pie-in-the-sky dreaming from Bernie Sanders. Now that Ms. Clinton has the nomination it's suddenly a possibility again. It's a Festivus miracle!!!!!
11
So funny I'm rolling on the floor...Bernie didn't dream up the public option. It was in the final bill and the Senate Democrats needed every single vote for passage when Sen. Lieberman at the very last minute threatened to vote against it if the public option wasn't dropped. Obama and Reid faced the choice of no ACA or no public option. Lieberman's wife was a senior lobbyist for big pharma and the health insurance cartel owned Lieberman.
About as funny as being ill-informed.
About as funny as being ill-informed.
2
"Bipartisan cooperation," right. When pigs fly, unless the Democrats completely sweep the elections in the Senate and the House.
3
Well, the GOP tried to block all major attempts by Obama economic stimulus, DID successfully block all but the first, 2009 stimulus. (Romney centered his electoral hopes on repudiation of a deficient economic recovery, deficient because of GOP obstruction). Does it not then show an admirable consistency (abeit perhaps a small minded one) to try to maximize the likelihood that the unemployed are uninsured?
How wise too of the GOP to anticipate that the non-conservative media would be nearly as quiet on this essential aspect of our national political economy and wellbeing as the conservative media.
How discouraging that when the disproportionately victimized youth of the nation final found voice it first with an 'Occupy" movement silent on the central reality of GOP economic sabotage and second with the Piedpiperish Sanders movement. How deeply dusturbing that senior, Caucasian victims of this sabotage seem to tend electoral toward Trump.
How wise too of the GOP to anticipate that the non-conservative media would be nearly as quiet on this essential aspect of our national political economy and wellbeing as the conservative media.
How discouraging that when the disproportionately victimized youth of the nation final found voice it first with an 'Occupy" movement silent on the central reality of GOP economic sabotage and second with the Piedpiperish Sanders movement. How deeply dusturbing that senior, Caucasian victims of this sabotage seem to tend electoral toward Trump.
The GOP seems to think that it is proper to destroy healthcare in America for the sake of politics. Sad.
8