Mr. Gruber, a one time designer of the ACA, just can't come to grips with the fact that the law is flawed and needs a head to toe makeover at the very least.
Yes, he is right, insurance companies will charge those with pre-existing conditions substantially more if not controlled by regulation. They are no one's friends.
But, right now insurance companies are charging the 8-10 million who don't get subsidies and were previously insured hefty rates and those promise to become increasingly unaffordable. Previously insured healthy adults, are paying two, three - even four times what they previously paid.
Tthe excuse is these plans are so much better because they cover so much more - childbirth for men or those too old to have children, newborn and well child visits for childless adults. No more $2 million cap, but if you are healthy whether it's $2 million or unlimited is irrelevant.
What will happen is that healthy people of all ages who are not eligible for subsidies will drop insurance and join the ranks of the uninsured, leaving insurers with an ever sicker pool of enrollees and causing more to bolt the individual market. You can't ask 61 year olds to shell out 22% of income in healthcare premiums.
The Republicans could just sit back and let it happen. They may well choose to do so, thereby demonstrating that the ACA will implode on its own. Maybe then we'll have one national option for the individual market and that will be far better than this crazy construct.
Yes, he is right, insurance companies will charge those with pre-existing conditions substantially more if not controlled by regulation. They are no one's friends.
But, right now insurance companies are charging the 8-10 million who don't get subsidies and were previously insured hefty rates and those promise to become increasingly unaffordable. Previously insured healthy adults, are paying two, three - even four times what they previously paid.
Tthe excuse is these plans are so much better because they cover so much more - childbirth for men or those too old to have children, newborn and well child visits for childless adults. No more $2 million cap, but if you are healthy whether it's $2 million or unlimited is irrelevant.
What will happen is that healthy people of all ages who are not eligible for subsidies will drop insurance and join the ranks of the uninsured, leaving insurers with an ever sicker pool of enrollees and causing more to bolt the individual market. You can't ask 61 year olds to shell out 22% of income in healthcare premiums.
The Republicans could just sit back and let it happen. They may well choose to do so, thereby demonstrating that the ACA will implode on its own. Maybe then we'll have one national option for the individual market and that will be far better than this crazy construct.
5
"Medicare for all" is a frequent refrain in the posted comments. How's that going to work when Ryan & our Republican Senate and House force through a privatization of Medicare and replaces it with vouchers for the elderly to use to purchase coverage in the for-profit health insurance marketplace just as he proposed in 2011. A proposal that was forecast in 2011 to result in fully 50% of an average 65 year olds retirement income to go to health insurance premiums, co-pays and deductibles by 2022.
7
More snake oil from Trump and the GOP. As he has always done, the Donald blurts out something because it's what people want to hear, and has no idea of the complexities involved, and doesn't care if in 6 weeks or 6 months he has to say, well, we're doing something else instead because his original "plan" was a vague clump of hopes. I think we're in line for a whole series of "really great" plans like this.
8
I believe Bill Clinton was correct, and being honest, when he recently described "Obamacare" as a crazy system. Hillary was certainly correct in 2008 when she too spoke honestly about universal health care and said that For any kind of universal healthcare to work EVERYONE must be a participant.
There was not enough acknowledgment that, for far too many people, healthcare has deteriorated radically since Obamacare went in to effect. That's because it is such a bizarre patchwork. We needed universal health care and got high price insurance instead.
People don't seem to realize how much premiums have risen over the past couple of years. I've spoken with HR and the average rise was 15% a year. Meanwhile coverage declined, with insurance companies calling the shots about what they would and would not pay for. And those new $6,000 deductibles which meant that people who used to have good coverage were now going without doctor visits when it wasn't absolutely necessary. This meant that diagnoses were being made later in many cases - when illnesses had spread and were harder to treat.
People don't seem to understand that people who have employer based insurance are still paying for those policies themselves. They EARN their insurance. It's part of their pay. They also contribute from their salary to cover the cost of coverage. The rise in insurance contributions is one reason that wages have stagnated, or even decreased for many people.
There was not enough acknowledgment that, for far too many people, healthcare has deteriorated radically since Obamacare went in to effect. That's because it is such a bizarre patchwork. We needed universal health care and got high price insurance instead.
People don't seem to realize how much premiums have risen over the past couple of years. I've spoken with HR and the average rise was 15% a year. Meanwhile coverage declined, with insurance companies calling the shots about what they would and would not pay for. And those new $6,000 deductibles which meant that people who used to have good coverage were now going without doctor visits when it wasn't absolutely necessary. This meant that diagnoses were being made later in many cases - when illnesses had spread and were harder to treat.
People don't seem to understand that people who have employer based insurance are still paying for those policies themselves. They EARN their insurance. It's part of their pay. They also contribute from their salary to cover the cost of coverage. The rise in insurance contributions is one reason that wages have stagnated, or even decreased for many people.
11
Hmmm, maybe we should pay for subsidized health care by taxing the companies that produce high fructose corn syrup, processed foods, tobacco, and other junk...
11
There is a very easy solution to this mess. Just rename ObamaCare as TrumpCare. (It was after all a Republican program to begin with.)
His supporters will love it, and everyone can continue to get healthcare coverage.
His supporters will love it, and everyone can continue to get healthcare coverage.
9
If Republicans take a stance of "we're gonna screw those elite liberals" and give a hatchet job to the ACA, it won't be those elite liberals that are getting screwed. They already had insurance, and weren't relying on the ACA.
It'll be the base that voted for the Republicans who, once again, would be taking the schtupping.
Ready..... aim..... hey, where'd that foot come from ?!?
It'll be the base that voted for the Republicans who, once again, would be taking the schtupping.
Ready..... aim..... hey, where'd that foot come from ?!?
14
Especially after this election, why is the Times giving a platform to a guy who called the American people "stupid" and claimed that a lack of transparency was required to get the ACA passed? Remember that scandal? It's outrageous that he is given this opportunity.
3
Okay, let's give the young people marching in the streets something to really protest over: the absurd way that insurance companies and pharmaceutical companies make so much money under the lie of "health care". Let's start the fight for concrete change now!
8
The only thing worse than repealing Obamacare is keeping it.
The notion that this would ever work is ridiculous. We are either going to have socialized medicine in this country or we are not. The notion that we can split the baby by having Obamacare only leaves us with a baby torn in half.
Medicare for everyone is the only real solution. Anything else is simply a pretend smoke-and-mirrors way to expand Medicaid enrollment, which is fine, but let's call it what it is.
The notion that this would ever work is ridiculous. We are either going to have socialized medicine in this country or we are not. The notion that we can split the baby by having Obamacare only leaves us with a baby torn in half.
Medicare for everyone is the only real solution. Anything else is simply a pretend smoke-and-mirrors way to expand Medicaid enrollment, which is fine, but let's call it what it is.
5
I am self-employed and on ACA. It really angers me that Congress cares more about their ideology of "free markets are always best" than about people. If they took more than the most basic econ class they would realize that the free market cannot efficiently provide insurance, and insurance can't work without healthy people paying in. I have paid for insurance all my life and barely used it as I was healthy, but this year I was hit with a major condition that will required continued check ups and lifelong medication to keep me from disability. Now the GOP wants to roll it back. How cynical. Angry at the voters who are not even on ACA and self-righteously want to repeal it because Fox news and Breitbart told them so, but they love their Medicare - well now the GOP wants to destroy Medicare too.
13
I'm still trying to figure out the reasoning behind the selection of Trump as President. Please bring me up to speed
5
The bluff hand the Republicans have been holding for years has been called. And those who voted for them believing that they had something better to show have been played.
6
It is remarkable that corporate America has never seen the advantage of universal health insurance. Companies could reduce their HR departments by at least half, not have the yearly worry of rising premiums, or shifting insurance plans. The Obama administrations mistake was dealing with the health insurance companies, instead of the employers.
Eliminating 22 million people for the health care pool will only drive health premiums higher and eliminate needed care for many.
Here in Louisiana, , our public hospital system which has already been devastated by former Gov. Jindal, is dependent on the Medicaid expansion
of the ACA. The new University Hospital in New Orleans is dependent on these funds. Without these funds, Louisiana tax payers will see a rise in state taxes or the hospital will be shuttered. Short sightedness has won out again.
Eliminating 22 million people for the health care pool will only drive health premiums higher and eliminate needed care for many.
Here in Louisiana, , our public hospital system which has already been devastated by former Gov. Jindal, is dependent on the Medicaid expansion
of the ACA. The new University Hospital in New Orleans is dependent on these funds. Without these funds, Louisiana tax payers will see a rise in state taxes or the hospital will be shuttered. Short sightedness has won out again.
7
The Republicans have no health care plan. Why is that? Because they are captive to the lobbyists for insurers, hospitals, and big pharma. And because such a plan would look like Obamacare or single-payer.
8
If full pre-existing condition coverage is provided there is a bigger issue created. Without requiring mandatory insurance, people, particularly young healthy people, will simply wait until they get sick before purchasing insurance. This will have the effect of driving up the cost of insurance. The underwriters will have to factor in the costs of people currently uninsured who will buy insurance when they become ill.
3
Gruber? The Dems said they barely knew who he was and he had little to do with Obamacare. Better get the real story from a true "architect" of this disaster
3
Solve Mr. Gruber's concern by requiring insurance companies to provide coverage for those with pre existing conditions AND not allowing insurance companies to base their individual premiums on whether or not a person has a pre existing condition.
If insurance companies do not want to write policies with this limitation then good riddance to them.
profit making insurance companies do not belong in health care.
Extend Medicare ton all.
If insurance companies do not want to write policies with this limitation then good riddance to them.
profit making insurance companies do not belong in health care.
Extend Medicare ton all.
4
Why is this considered an Op-Ed piece? I always thought the Op-Ed page was the place for opinions and editorials, not for factual articles. My understanding is that it is factual that health care cannot keep the requirement to insure people with pre-existing illnesses at no financial penalty without premiums sky rocketing. Therefore this should be a front-page article, and in summary should be mentioned every time you print a "news article" mentioning President-elect Trump's desire to keep the popular aspects of the ACA and replace the rest. This entire issue of journalism's responsibility to identify erroneous statements, rather than just printing "everything that fits" has been raised due to the election results, and the Times should not continue with its status quo.
14
Exactly. Think Americans hate ObamaCare? Just wait til they get a taste of TrumpCare! And they control the entire government, so no way to shift the blame to the Democrats or the Media.
Trump and the Republicans can't fulfill their promises to their voters if they do nothing, but almost any action they take is pretty much guaranteed to make things worse for many Americans.
They made their bed. Too bad we all have to sleep in it.
Trump and the Republicans can't fulfill their promises to their voters if they do nothing, but almost any action they take is pretty much guaranteed to make things worse for many Americans.
They made their bed. Too bad we all have to sleep in it.
12
Why don't we go to the nearest elementary school and ask a random eight year old what they think is the best course for the nation to take on health care.
After a puzzled look, whatever uniformed, magical thinking nonsense that comes out of the kid's mouth will be on par with congressional Republicans and the new President.
We wouldn't spend a wasted second giving credibility or analysis to that kid. Why do it for them?
Just "reject and replace" anything they say with normal, adult, intelligent, reality-based policy based on everything we know about continuing our private based insurance industry.
(cause that's reality for now in America)
Everyone cool with that?
After a puzzled look, whatever uniformed, magical thinking nonsense that comes out of the kid's mouth will be on par with congressional Republicans and the new President.
We wouldn't spend a wasted second giving credibility or analysis to that kid. Why do it for them?
Just "reject and replace" anything they say with normal, adult, intelligent, reality-based policy based on everything we know about continuing our private based insurance industry.
(cause that's reality for now in America)
Everyone cool with that?
5
First, to those that have declared Obamacare a 'failure', I would suggest that to the folks who are alive today because they were able to get medical care because of the ACA, it is nothing short of a lifesaver. Second, some of the provisions in the ACA which are not the most popular (i.e., individual mandate), are absolutely necessary for the ACA to exist. Finally, while I appreciate that well-constructed arguments show the lack of forethought to many of Trump's policies, the simple fact is that most (if not all) of his policies were just campaign rhetoric that have no chance for being enacted because they were never meant to be implemented, plain and simple.
5
Trump lacks the experience, knowledge and creativity to devise any reasonable replacement for Obamacare. He never had a well-thought out plan for how to reform the health care system, he doesn't now, and he won't be able to come up with one when he is inaugurated. His campaign promise to get rid of Obamacare was nothing more than an effort to win votes from disgruntled voters. He understood that the very word "Obamacare" had come to be used as an epithet used to describe the Affordable Care Act by those Americans (mostly Republicans) who hated Obama. He never intended to fully follow through with gutting Obamacare, as is indicated by his qualifying his remarks already, less than one week after the election. Once in office, he'll probably dither around and refer things to committees for further studies, make some preposterous proposals he knows won't fly, and then when he fails, blame it on Congress, saying that the whole reform process was "rigged" by the Democrats. This leopard won't change his spots.
11
The author'scenario has already come to pass with the ACA still in force. Insurance premiums and deductibles are hideously high and not affordable at all. Why else are the majority of people getting insurance through the exchanges the ones who receive massive subsidies? No one can afford it otherwise. We do need to replace the ACA with a single payor option (Medicare for all) for all those unable to get subsidized health insurance through their employers. Even lowering the Medicare age to 50 would eliminate one valid cause of age discrimination too. And we need to start working on the core causes of runaway health care costs, starting with the physician pipeline and the drug development and approval processes.
6
Maybe they should ask Mitt Romney what to do.
3
Well Professor, you've already told us how to ram healthcare legislation down America's throat.
"lack of transparency is a huge political advantage"
"Gruber said Obamacare was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money". He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage.
I doubt that you'll be getting a call from the Republicans to fix the healthcare mess you helped Obama create.
"lack of transparency is a huge political advantage"
"Gruber said Obamacare was deliberately written "in a tortured way" to disguise the fact that it creates a system by which "healthy people pay in and sick people get money". He said this obfuscation was needed due to "the stupidity of the American voter" in ensuring the bill's passage.
I doubt that you'll be getting a call from the Republicans to fix the healthcare mess you helped Obama create.
1
"I doubt that you'll be getting a call from the Republicans to fix the healthcare mess."
Of course not, Mookie. They don't want a workable solution now any more than they did then.
Of course not, Mookie. They don't want a workable solution now any more than they did then.
3
Interesting that no one talks about a key reason that many small business owners and investors (likely Trump voters, I think) don't like the ACA: a 2.9% Medicare tax and a 3.8% investment income tax that were both created to support the ACA. For people who are self-employed and/or invest, particularly those in real estate, these large tax burdens are basically seen as fines for being successful.
1
And when somebody who doesn't have healthcare insurance goes to the emergency room and ends up in the hospital; who do you think pays their uncollectable bills, the tooth fairy? Most people just don't get it. You are going to pay for the uninsured, poor indigent healthcare, one way or another. You can do it in an organized fashion or a disorganized fashion, but the concept that you won't have to pay if Obamacare or something else doesn't exist, lacks serious thought.
6
"A 2.9% Medicare tax and a 3.8% investment income tax" are not "large tax burdens" nor are they "fines for being successful."
Unless you believe that greed is good.
Unless you believe that greed is good.
3
"The stupidity of the American voter."
The first thing Donald Trump should do is direct the various agency heads to cut off all Federal grant and research funds to the Department of Economics at MIT. When they ask why, just show over and over again to the voters Mr Grubers arrogant, smirking remarks.
The first thing Donald Trump should do is direct the various agency heads to cut off all Federal grant and research funds to the Department of Economics at MIT. When they ask why, just show over and over again to the voters Mr Grubers arrogant, smirking remarks.
3
"arrogant, smirking remarks"
such as
"[Republicans] can’t hide the fact that repealing the fundamental insurance protections that are central to [Obamacare] would be a cruel backward step,"
jmr?
such as
"[Republicans] can’t hide the fact that repealing the fundamental insurance protections that are central to [Obamacare] would be a cruel backward step,"
jmr?
3
Let's be real here. Trump's differences from his European extreme right counterparts is similar only on the immigration question. You have not heard any of the European politicians even mention of doing away with their national health insurance coverage. Why, because voters would reject them immediately. Only Americans are naive enough to vote someone such as Trump that promises to take their health insurance away, allow the proliferation of guns and cut taxes for the rich.
9
Thank you. Please dig deep on this, Mr. Gruber. What is the healthcare insurance coverage of the members of Congress? How is theirs different from our non-Congressional insurance options?
Everyone is subject to the chance of one-bad gene or one-bad traffic accident. But can Congressional members avoid bankruptcy from a health related matter - are they generally that financially well off? Or are they an unusually healthy group of folks that just cant conceive of the consequences of their actions on this? Or do they have a premiere insurance package that is not subject to these issues (pre-existing conditions,etc.) Are they generally that well off that, even if that one bad gene crops up in their kids, they can afford to pay whatever?
If they were a classroom or a group of employees or a willing group of unrelated adults with vastly different views and tasked with coming up with a solution, i'd love to see them go through a serious role-playing exercise with life roles randomly assigned (health, health insurance, age, jobs, family, income, etc.) And then a straw poll on their proposed changes to health care insurance.
Everyone is subject to the chance of one-bad gene or one-bad traffic accident. But can Congressional members avoid bankruptcy from a health related matter - are they generally that financially well off? Or are they an unusually healthy group of folks that just cant conceive of the consequences of their actions on this? Or do they have a premiere insurance package that is not subject to these issues (pre-existing conditions,etc.) Are they generally that well off that, even if that one bad gene crops up in their kids, they can afford to pay whatever?
If they were a classroom or a group of employees or a willing group of unrelated adults with vastly different views and tasked with coming up with a solution, i'd love to see them go through a serious role-playing exercise with life roles randomly assigned (health, health insurance, age, jobs, family, income, etc.) And then a straw poll on their proposed changes to health care insurance.
4
Republican are the dog that caught the car. While Trump is a hopeless liar and can literally backtrack in the following sentence (and somehow not be held accountable as the ultimate flip-flopper), I think the GOP is going to have a hard time after they "repealed" the ACA like 100 times in Congress and then decide they want to keep parts of it. Right? I mean the thing that was going to destroy America has absolutely to be pulled up by root and branch.
As Obama has said repeatedly, when the GOP uses extreme language they do not give themselves room to maneuver. Nobody disputes, Obama included, that because the GOP forced policy makers to come up with this Rhub Goldberg plan that it wouldn't have to be reformed. But now the GOP can't reform.
And while they would be content to not replace, the fact is that healthcare has to be fixed. Health savings accounts? Works great if you are a billionaire. But most of the country have 0 to less than $1000 a month in disposable income. Yes, that is the money that is supposed to go for education and retirement. It isn't clear to me that an HSA with $0 in it is going to be a big benefit to most Americans.
But again. Who is suprised? Donald Trump never offered a serious healthcare plan alternative. He is just an agitater. Nor has the GOP offered a serious alternative.
Donald Trump has been quoted as saying that he is surprised by all of the positions he has to fill to actually govern. But I am not suprised that he is surprise
As Obama has said repeatedly, when the GOP uses extreme language they do not give themselves room to maneuver. Nobody disputes, Obama included, that because the GOP forced policy makers to come up with this Rhub Goldberg plan that it wouldn't have to be reformed. But now the GOP can't reform.
And while they would be content to not replace, the fact is that healthcare has to be fixed. Health savings accounts? Works great if you are a billionaire. But most of the country have 0 to less than $1000 a month in disposable income. Yes, that is the money that is supposed to go for education and retirement. It isn't clear to me that an HSA with $0 in it is going to be a big benefit to most Americans.
But again. Who is suprised? Donald Trump never offered a serious healthcare plan alternative. He is just an agitater. Nor has the GOP offered a serious alternative.
Donald Trump has been quoted as saying that he is surprised by all of the positions he has to fill to actually govern. But I am not suprised that he is surprise
7
What I don't get (and would love the NY Times to print an analysis of) is why nobody brings up the indirect economic costs of the United States' current approach to healthcare. We hear a lot about how we pay more for less quality care than other countries -- both costs and outcomes are easy to quantify.
But what about the person who wants to be an entrepreneur but doesn't dare start their own business because health insurance costs would be too high? Do we not realize that one of the main reasons people over 50 are disproportionately represented among the long-term unemployed and the underemployed is that employers fear such employees will be more expensive to insure? Is the "gig economy" really about flexibility, or is it really about avoiding having to offer benefits? Health insurance is an enormous burden on employers that offer it, and creates significant uncertainty because premiums rise at unpredictable rates. How many employers are holding off on hiring, or hiring only part-time, on-call workers, because of the burden of health insurance? How many people are staying stalled in their careers, or choosing less challenging paths, in order to have employer-provided health insurance? How many startups just aren't happening? How many would-be doctors are going into other fields because they know medicine involves more fighting with insurers than helping patients?
The costs of our current "system" are not just the obvious doctor bills.
But what about the person who wants to be an entrepreneur but doesn't dare start their own business because health insurance costs would be too high? Do we not realize that one of the main reasons people over 50 are disproportionately represented among the long-term unemployed and the underemployed is that employers fear such employees will be more expensive to insure? Is the "gig economy" really about flexibility, or is it really about avoiding having to offer benefits? Health insurance is an enormous burden on employers that offer it, and creates significant uncertainty because premiums rise at unpredictable rates. How many employers are holding off on hiring, or hiring only part-time, on-call workers, because of the burden of health insurance? How many people are staying stalled in their careers, or choosing less challenging paths, in order to have employer-provided health insurance? How many startups just aren't happening? How many would-be doctors are going into other fields because they know medicine involves more fighting with insurers than helping patients?
The costs of our current "system" are not just the obvious doctor bills.
17
Sorry, Obamacare is in a death spiral because the actuarial experience was so very, very wrong. In fact, the sick signed up and got lots and lots of care and the healthy and probably unsubsidized stayed away. If all this insurance negotiation is such a success story why did health insurance for my husband and me for the exact same plan go from $12,200 in 2016 to $21,550 in 2017? We use no more than $2000 of healthcare annually. We are subsidizing the sicker to the tune of $$19,550 in after tax dollars. You got it wrong and you need to apologize to the American people.
Answer: insurance does not negotiate, our healthcare remains cost plus and I'm getting gouged badly we all are and nothing, nothing is done to rein in the crooks in healthcare.
Answer: insurance does not negotiate, our healthcare remains cost plus and I'm getting gouged badly we all are and nothing, nothing is done to rein in the crooks in healthcare.
6
"In fact, the sick signed up and got lots and lots of care"....Which somebody in the country was going to pay for one way or another anyway. Healthcare is not some new cost that just suddenly arrived, and given that prompt and preventative healthcare is cheaper than delayed and emergency healthcare; the country collectively can pay some up front or they will end up paying more later - one way or another they will pay. So what is the smart choice?
3
A death spiral is when the costs of providing healthcare rise faster than the premium to cover it. Many, especially the healthy young, have already exited. Of course those who are really sick stay in the system to save their lives and to get what amounts to subsidy by those who have much lower healthcare costs. People like me.
The smart choice is single payer. I am not going to sell my home, incur debt or anything else that might gravely damage my financial well being to the tune of $19,550 for other people and you wouldn't either. I could manage $5,000 but this is too much.
The smart choice is single payer. I am not going to sell my home, incur debt or anything else that might gravely damage my financial well being to the tune of $19,550 for other people and you wouldn't either. I could manage $5,000 but this is too much.
2
Gruber completely misunderstand, the nature of insurance. No one gives life insurance to dying people and those with poorer health pay more. Try getting auto insurance if you have had several DUIs. Nobody insures burning houses. It is not insurance to cover events that have already happened or are in the process of happening.
For awhile, insurance companies tried to make health insurance into "insurance" by imposing lifetime caps and limiting certain kinds of coverage on things like substance abuse and mental health care. With limits, insurance companies could act like insurance companies, estimate risk, and price accordingly.
Obamacare turned this on its head. Limits are off. Insurers can't charge rates that reflect underlying cost because of "community rating". So how many non burning houses must we insure to cover one house that is burning down and might take the entire neighborhood?
One possible solution might be to go back to insurers being able to sell true insurance policies to those who are insurable and put in the "progressives'" nirvana of a single payer "FEMA" for the uninsurable.
Gruber is right about one thing -- Trump hasn't thought any of this through yet. Paying for the chronically ill is a serious problem. And it is essentially "communistic". We would never argue that any poor person should be able to get a low cost Mercedes 500 SL, but, when it comes to health care, we believe any poor person should be able to get the equivalent of three at low cost.
For awhile, insurance companies tried to make health insurance into "insurance" by imposing lifetime caps and limiting certain kinds of coverage on things like substance abuse and mental health care. With limits, insurance companies could act like insurance companies, estimate risk, and price accordingly.
Obamacare turned this on its head. Limits are off. Insurers can't charge rates that reflect underlying cost because of "community rating". So how many non burning houses must we insure to cover one house that is burning down and might take the entire neighborhood?
One possible solution might be to go back to insurers being able to sell true insurance policies to those who are insurable and put in the "progressives'" nirvana of a single payer "FEMA" for the uninsurable.
Gruber is right about one thing -- Trump hasn't thought any of this through yet. Paying for the chronically ill is a serious problem. And it is essentially "communistic". We would never argue that any poor person should be able to get a low cost Mercedes 500 SL, but, when it comes to health care, we believe any poor person should be able to get the equivalent of three at low cost.
3
There is no profit in the cure (of an illness).
Until everyone realizes this, no substantive change in America's health system will occur.
The profit motive for everyone from insurers, hospitals, drug companies on down to the Q-Tips must be mitigated against the right of all Americans to BE healthy and have access to affordable health care.
Until everyone realizes this, no substantive change in America's health system will occur.
The profit motive for everyone from insurers, hospitals, drug companies on down to the Q-Tips must be mitigated against the right of all Americans to BE healthy and have access to affordable health care.
7
Oh puhleeze. Ok. You wanna talk about the ACA? Gone. All of it. Quickly.
Trump is dangling out a "keep some stuff" as a DISTRACTION. And see? once again, he WINS, because here we are: DISTRACTED from the very real evisceration of the country as we know it. If this man is not stopped we will not be talking about health care in my lifetime eve again. Maybe if you are 5 years old and younger you might hope to see a resurrected "USA" have a chance of trying to get national healthcare care when they are 50 if they are lucky.
But now? Let's get real: We need to preserve the republic.
Trump is dangling out a "keep some stuff" as a DISTRACTION. And see? once again, he WINS, because here we are: DISTRACTED from the very real evisceration of the country as we know it. If this man is not stopped we will not be talking about health care in my lifetime eve again. Maybe if you are 5 years old and younger you might hope to see a resurrected "USA" have a chance of trying to get national healthcare care when they are 50 if they are lucky.
But now? Let's get real: We need to preserve the republic.
3
"continuing the ban on the exclusion of pre-existing conditions by insurers."....You can't continue the insurance company ban on denying coverage to people with pre-existing conditions unless you also retain the insurance mandate. Why would anyone ever buy health insurance in advance if there was a guarantee that they could always buy the necessary coverage after they broke their arm?
5
Do Trump and the Republicans care? That remains to be seen.
3
As long as so called "insurance" companies are generating billions of dollars in profits from America's health care system, it will remain broken. The problems with the ACA are all attributable to a single fact: Our elected officials did not have the guts or integrity to demand a proper single payer system for all, without allowing unnecessary middle men to generate obscene profits while providing absolutely zero health care for anybody.
10
"The problem these patients faced was one of the most pernicious flaws of the individual insurance market pre-Obamacare; their exclusion essentially undercut the entire notion of insurance. "
You're kidding, right? Insurance is designed to cover costs associated with UNKNOWN risks. If you know that you have a risk or condition, you should not be allowed to wait until you actually experience the risk or condition, then opt in at that time. You need to be paying all along.
You're kidding, right? Insurance is designed to cover costs associated with UNKNOWN risks. If you know that you have a risk or condition, you should not be allowed to wait until you actually experience the risk or condition, then opt in at that time. You need to be paying all along.
4
I think that's we call single payer.
2
Normally that would be true, but we're not talking about insuring a car here, we're talking about access to medical care that could be lifesaving. Too, medical costs are so out of reach that paying out of pocket is not an option.
2
You sound as if you think healthy people don't need health insurance. When I was still relatively healthy, I had insurance through my employer. I got food poisoning and ended up in the ER.
My insurance company bounced the claim because I hadn't had an "accident." I called and said that I certainly hadn't gotten food poisoning on purpose, and they paid part.
Pre-existing conditions? It's not an issue of waiting until you're sick to get insurance. It's often an inability to change jobs or relocate, and there are many serious conditions that are not cancer. The pre-existing condition exclusion was 10 months, a time selected by insurance companies to avoid covering pregnancy. Only women get pregnant but it takes two; the father's insurance generally isn't involved. I wasn't pregnant but couldn't afford 10 months uninsured.
Many people have chronic conditions that allow them to work full time or more if they are treated by a doctor. What about that offends you?
Should I have stopped working so I could go on welfare, TANF, and Medicaid?
My insurance company bounced the claim because I hadn't had an "accident." I called and said that I certainly hadn't gotten food poisoning on purpose, and they paid part.
Pre-existing conditions? It's not an issue of waiting until you're sick to get insurance. It's often an inability to change jobs or relocate, and there are many serious conditions that are not cancer. The pre-existing condition exclusion was 10 months, a time selected by insurance companies to avoid covering pregnancy. Only women get pregnant but it takes two; the father's insurance generally isn't involved. I wasn't pregnant but couldn't afford 10 months uninsured.
Many people have chronic conditions that allow them to work full time or more if they are treated by a doctor. What about that offends you?
Should I have stopped working so I could go on welfare, TANF, and Medicaid?
3
What we need is affordable healthcare. The people in healthcare and medical industry aren't helping that. Why would more technology advances and research lead to more expensive care? We need to realize that healthcare is a need, not a luxury. Medical schools' high costs also don't help either. Because there are so many people in healthcare industry, there are some costs associated with it, but simple procedures shouldn't bankrupt anyone with or without insurance. Life saving drugs shouldn't cost that much if we really want everyone to live long happy lives. If we can lower the cost of healthcare and the cost of entering the field for those professionals, then we'll really have affordable healthcare. Maybe break up the healthcare industry so there is a lot more competition for patients' money, since hospitals charge them so much after providing simple care? If I can see ads for hospitals, please don't tell me they are nonprofit and caring for all. They only provide care for people with money.
2
The problem for Gruber is the premise to make the young (and financially strapped) pay for the old and unhealthy. In general, the old have more financial capacity than the young. So the model to share the costs would only increase in the future. Also, the tax penalty on the young for not buying into this Ponzi scheme was absurd. I do appreciate your honesty when you described anyone who actually supported Obamacare as stupid.
A good reminder how the current administration reads the hardworking taxpayers foolish enough to vote for Obama. "Cruel backward step" for the taxpayer? I think not. Its not your money is it Gruber?
A good reminder how the current administration reads the hardworking taxpayers foolish enough to vote for Obama. "Cruel backward step" for the taxpayer? I think not. Its not your money is it Gruber?
1
"The problem for Gruber is the premise to make the young (and financially strapped) pay for the old and unhealthy."....Well Duh. The answer is that with any luck everyone who is young and healthy today will eventually live long enough to become old and unhealthy. Do you even understand what a Ponzi scheme is? And as for the taxpayers - here is the real joke. According to the Congressional Budget Office, whose job it is to cost out every bill before Congress; repealing Obamacare would cost (note the word cost) the budget $10 billion dollars over the next ten years..... As in repealing Obamacare is $10 billion dollars more expensive than keeping it. So who is stupid?
5
Health care in this country would be a lot cheaper if people took care of themselves better. Diet here is terrible. The food industry has created a lot of the illnesses we the taxpayers are paying for. Imagine how much we'd all save if we were a healthier lot. Nope, keep eating all that fake food, sugar, and fast food garbage America. We look at healthcare in the wrong light. We are all about fixing, not preventing.
5
Never heard the old saying, "Eat right, exercise, die anyway"?
We will all get sick someday, no matter how good our diet.
We will all get sick someday, no matter how good our diet.
9
It is humorous when a NYT Op-Ed contributor takes a comment from the President elect and turns it into a detailed new law which of course in their minds would be terrible for everyone.
8
It will be very humorous when hundreds of thousands lose their health insurance and are not able to replace it. IT will be a laugh riot.
3
Gruber, you were part of the lie factory that pushed this sausage through the grinder. And you are still lying to try to preserve what is in essence a complete disaster. You say more people are "covered," but what does that even mean with such astronomical deductibles, with the loss of the doctors and hospitals we used to be able to visit, not to mention the mutant-growth of premiums. People WITH "coverage" can't afford to get medical help. So net, they are being milked of thousands in premiums for "coverage" they can't afford to use.
Just eliminating the mandate alone, even if the "coverage" went away, would give people back enough money to pay out of pocket to see the doctor they want to see.
For people suffering from previously existing conditions, it would have made a LOT more sense to just address that issue. Don't destroy the entire healthcare system just to include this expensive subset. Create a pool, even a subsidized one, to help such people get covered. But instead you've destroyed the system that most people were happy with before you mucked it up.
But you did it of course to clear the way for single-payer, which you've admitted already. And single-payer is done for one reason: a power grab by centralized executive power.
You did say at one point that you relied on the stupidity of voters to get this thing passed. Well, I do hope, having tasted your socialist paradise for 4 years, that voters are, if not less stupid, at least a bit more educated.
Just eliminating the mandate alone, even if the "coverage" went away, would give people back enough money to pay out of pocket to see the doctor they want to see.
For people suffering from previously existing conditions, it would have made a LOT more sense to just address that issue. Don't destroy the entire healthcare system just to include this expensive subset. Create a pool, even a subsidized one, to help such people get covered. But instead you've destroyed the system that most people were happy with before you mucked it up.
But you did it of course to clear the way for single-payer, which you've admitted already. And single-payer is done for one reason: a power grab by centralized executive power.
You did say at one point that you relied on the stupidity of voters to get this thing passed. Well, I do hope, having tasted your socialist paradise for 4 years, that voters are, if not less stupid, at least a bit more educated.
9
Pay out of pocket?
Seriously, when was the last time you got a surprise injury or illness? Kidney stones? Gall stones? Traumatic brain or other injury from an auto accident? Being hit by falling masonry or a building during an earthquake? Terrorist attack?
A simple visit to a doctor can make buying food nearly impossible for many folks who don't have insurance. Then there are prescriptions.
Get a grip.
Seriously, when was the last time you got a surprise injury or illness? Kidney stones? Gall stones? Traumatic brain or other injury from an auto accident? Being hit by falling masonry or a building during an earthquake? Terrorist attack?
A simple visit to a doctor can make buying food nearly impossible for many folks who don't have insurance. Then there are prescriptions.
Get a grip.
4
I am afraid most people were not happy with the previous system. Working as I do in a physicians office, I can assure you that people went bankrupt, died, suffered and lost most of what they had, if they had an unexpected but severe diagnosis. Do you know any twenty-something type one diabetics (this is the kind that is developed as a child). Most of them didn't have insurance and couldn't afford their insulin. This is a very serious matter, not solved by pretend insurance (pay us a hundred a month and we will pay out eighty dollars in claims...).
8
The art of the deal may require compromise when opposing views are considered. But not always. An automobile requires four wheels, period. And case in point, Obamacare; republican governors have been, out of spite but also ignorance, torpedoing this program from its inception, making it so much more difficult to share risk and cost. The only way an obstructionist Congress could redeem itself may be replacing the Affordable Care Act with Single Payer Universal Health Care, as any civilized country (other than the U.S.) has already accomplished; it works well, all get quality care, no questions asked; and it is cheaper than our for-profit Health Insurance monster, seeking profit (greed) first, and health care as a necessary obligation for decency-sake. We can do better than that, if we can mount the will, then the courage to face the status quo...and the G.O.P. A long shot, granted, but not impossible if we can put our imagination to work.
4
Why is fact that the number of auto accident injuries, roofing falls, cancer cases, heart attacks and pregnancies that occur in any year not affected by the debate about health care payments. The medical world will provide the same number of doctor, nurse, technician and hospital cook hours to respond to those conditions regardless of whether we have some insurance program or just expect the hospitals and doctors to do their thing gratis.
If we just bite the bullet and extend Medicare to everyone there will be some problems that must be fixed. Example- how do we make the fees pay the value of the service. But I suspect the difficulty of solving those problems will be far easier than figuring out how to pay for the required coverage via privater insurers that must add a 50% profit fee onto the process of passing money from the real payers to the real providers.
If we just bite the bullet and extend Medicare to everyone there will be some problems that must be fixed. Example- how do we make the fees pay the value of the service. But I suspect the difficulty of solving those problems will be far easier than figuring out how to pay for the required coverage via privater insurers that must add a 50% profit fee onto the process of passing money from the real payers to the real providers.
5
Look at the VA health disaster. People put on secret waiting lists. Heartless bureaucrats perpetrating fraud and depriving vets of their "right to healthcare" so that the bureaucrats can look like they're ahead of schedule. People died waiting for care. Some killed themselves. But the VA paper pushers got BONUSES for this. Nobody was fired. They got promoted! Not one person held accountable. And it was not a single occurrence. It is systemic.
Did you know that the Dems have forced the VA to hire more and more union employees who can't be fired? And did you know that this prevents them from hiring doctors? So instead of doctors, they hire more and more unionized bureaucrats. This is how the government deals with backlogs of dying vets: hire more paper pushers!
This is what you wish upon every American when you opine for single-payer. Because without single payer, the private providers are still ACCOUNTABLE. As soon as the government takes over, accountability goes out the window. And then so do we.
Did you know that the Dems have forced the VA to hire more and more union employees who can't be fired? And did you know that this prevents them from hiring doctors? So instead of doctors, they hire more and more unionized bureaucrats. This is how the government deals with backlogs of dying vets: hire more paper pushers!
This is what you wish upon every American when you opine for single-payer. Because without single payer, the private providers are still ACCOUNTABLE. As soon as the government takes over, accountability goes out the window. And then so do we.
2
The current problem is that mostly sick people are buying from the exchanges and the insurance companies have set prices accordingly. The product for sale is "insurance for sick people." Healthy people have rationally chosen not to enter the market and pay the penalty instead. Bad equilibrium.
If the current law can work at all, the key is getting more healthy people on the exchanges. As long as people have an option not to, this means increasing the penalty, possibly dramatically. The result is forcing many lower income people to buy an expensive product (even if less expensive than before) which will eventually translate into more subsidies.
If the current law can work at all, the key is getting more healthy people on the exchanges. As long as people have an option not to, this means increasing the penalty, possibly dramatically. The result is forcing many lower income people to buy an expensive product (even if less expensive than before) which will eventually translate into more subsidies.
6
You poor Americans. Sometimes we take the security of our National Health Service for granted but I'll be telling people to thank their lucky stars over here they won't be living in Trump's America.
9
Enjoy Brexit, Mark. You have your work cut out for you.
1
The view that any repeal won't work is based on the belief that a mandate is the only way to continue such a health program and w/o it no plan could be viable. It seems like Trump wants to engage in something like what Dish TV is doing with their "Skinny Bundle" plan. You pick the individual channels and avoid the channels you don't want or need. Thus, you avoid paying for channels you don't watch. Applying this to the ACA revision, individuals would pick what insurance they want and companies would sell these policies in or out of state. So someone could buy a policy that includes a pre existing problem or wellness care, etc. The problem is the health problem you have today may become obsolete tomorrow and you may need insurance for an illness you never anticipated having. We could allow people to sell their own health care on a secondary market like we do on stubhub for tickets we don't want or can't use.
1
Let's face it, the ACA is deeply flawed because even under the current system, it does nothing to restrain costs of coverage. For those who were able to get Medicaid under the ACA, Obamacare has been a godsend, but for those who make too much to qualify for subsidies but not enough to afford thousand-dollar premiums, it does little or nothing. The ban on refusing to cover pre-existing conditions, even in the absence of cost control, does benefit the millions who get insurance through their employers, since the costs and benefits are spread (yes, there was a time when even employer-provided health insurance denied coverage for pre-existing conditions).
The ACA is an overall failure because it wasn't health care reform, it was health insurance reform, and tepid at that. If we truly wanted to reform health care in the USA, there would have to be a lot of other aspects considered, some of which would be right up Trump's populist alley. Tort reform, for example (all the little guys hate lawyers). Or making other countries pay a larger share of the costs of pharmaceuticals -- right now, the US consumers subsidize the rest of the world, because in Europe and Asia the governments tell the drug companies what they are willing to pay, and the companies charge the American market more to make the profit national health systems elsewhere don't let them. Trump's supporters are all for taking a harder line in foreign trade, so that approach might find a lot of support,
The ACA is an overall failure because it wasn't health care reform, it was health insurance reform, and tepid at that. If we truly wanted to reform health care in the USA, there would have to be a lot of other aspects considered, some of which would be right up Trump's populist alley. Tort reform, for example (all the little guys hate lawyers). Or making other countries pay a larger share of the costs of pharmaceuticals -- right now, the US consumers subsidize the rest of the world, because in Europe and Asia the governments tell the drug companies what they are willing to pay, and the companies charge the American market more to make the profit national health systems elsewhere don't let them. Trump's supporters are all for taking a harder line in foreign trade, so that approach might find a lot of support,
5
We have often by told lately that Mr Trump is a businessman, pragmatic, will get things done at less cost. Well if that is true he should turn to a single payer system. It is the most efficient method of providing health care for the nation at large. It is a business practise that works for nations. If Trump is truly pragmatic, he will see that. A progressive could never push it through our Congress, but a conservative might.
4
Pretty difficult to repeal any welfare program in America.I think Obama did his job by increasing govt dependency to record levels.Huge increase in food stamps.Huge increase in partially subsidized(Obamacare) and 100% subsidized(Medicaid) health care.I've read that when Obama was elected,there were 55% of the population paying more in taxes than received in govt benefits and 45% receiving more from govt programs than paid in.Now that has reversed,with 55% receiving more than paid in taxes.With this increase in govt dependency,the future should be bright for the Democrat party,the party of govt.Watch the value of the Dollar.It is the common stock of our bankrupt govt.It will take the hit,in the long run.
1
How about this:
The government either runs a or contracts out to states or insurance companies, major medical coverage for all. We all get HSA accounts, We all pay in, none can be denied, and your deductible is based on your total income (not just wage).
Nondeductible Coverage would include: vaccines for kids, one wellness visit, and child-birth.
Deductibles (again based on income —and I'm just shooting out concept numbers)—so someone making $20,000 has a deductible less than a hundred; while someone making $200,000 has a deductible in the thousands.
This would still let companies offer complete package coverage as incentives to employees, while providing what even the healthiest may need when they crack their heads open.
The government either runs a or contracts out to states or insurance companies, major medical coverage for all. We all get HSA accounts, We all pay in, none can be denied, and your deductible is based on your total income (not just wage).
Nondeductible Coverage would include: vaccines for kids, one wellness visit, and child-birth.
Deductibles (again based on income —and I'm just shooting out concept numbers)—so someone making $20,000 has a deductible less than a hundred; while someone making $200,000 has a deductible in the thousands.
This would still let companies offer complete package coverage as incentives to employees, while providing what even the healthiest may need when they crack their heads open.
2
It would be interesting to get Mr. Gruber's account of how the Public Option got deep-sixed by the Obama administration back in 2009. Crocodile tears in public, but most likely a sacrificial lamb to placate PhRMA and Big Insurance, with Max Baucus and the Senate Finance Committee being the willing Kabuki executioner.
Big Insurance's interest in not having to compete with what would have effectively been an extension of Medicare to the 64 Rx market but was prevented from using because of the Bush Administration's market ueberalles ideology on the matter.
And if the Public Option had had this sort of Rx option, there is no way that PhRMA could have kept the obscene lock it had, and has, on Part D.
Again, it would be interesting to hear from John Gruber, whether this is what went down. He was much more than a fly on the wall in the process.
Big Insurance's interest in not having to compete with what would have effectively been an extension of Medicare to the 64 Rx market but was prevented from using because of the Bush Administration's market ueberalles ideology on the matter.
And if the Public Option had had this sort of Rx option, there is no way that PhRMA could have kept the obscene lock it had, and has, on Part D.
Again, it would be interesting to hear from John Gruber, whether this is what went down. He was much more than a fly on the wall in the process.
8
Jonathan Gruber is the self-congratulatory liar who played a major role in creating the mess called Obamacare. Thus everything he has to say on the subject should be viewed with that information in mind. He has bragged about mis-representing the facts of Obamacare so that it would be accepted and passed into law. You can keep your doctor if you like your doctor. The average family will save money on health care under the ironically named "Affordable Care Act". All lies.
7
One of the major lies in this article is the absurd idea of adults staying their parents policies until ages 26, they were fully able to obtain health insurance on their own at a more than reasonable cost prior to Obamacare. The idea that an adult should be on mommy and daddy's insurance is ridiculous, this was done because the dems knew a lot of parents would pay for it when their adult offspring didn't really want it. Also, 20 million people did not get healthcare, more baloney, they got substandard, unusable health insurance at astronomical prices with massive deductibles and "benefits" they don't want or need. Obamacare must go in total and the "replacement" should have minimal government involvement. The VA debacle should end any discussion of single payer healthcare in the US. The worst possible healthcare on the planet is single payer, no wonder leftist want it.
5
Is the author of this piece the same Jonathan Gruber who lied to Americans about Obamacare? And said most Americans are too stupid to understand health care insurance in the first place? If so, why should we believe what he has to say now? Thank you.
8
Prior to ACA, I purchased a high deductible policy from BCBS. There was no drug coverage. The one condition I had was high BP which was totally regulated with the minimum dosage of a generic. For that, my premium was uplifted 25%. When I filled out the application, I had no other illness, surgeries, or conditions to disclose. But BCBS got my records from my doctor and his patient notes. I had mentioned to him glaucoma was in my mother and an older sister and that another sibling had had prostate cancer. BCBS issued me a policy excluding any condition with my eyes. The words went on for about a page. And of course they also excluded prostate cancer. These conditions were excluded for 3 years at which time I could request a waver which may or may not be allowed. I imagined the same will happen with ACA's replacement.
5
Wasn't this the same guy caught on tape saying how gullible and stupid the American people were for buying into ObamaCare? Only the Times would consider him a man of high integrity and erudition instead of the con man he really is. So what else is new?
5
I don't think most people writing about health insurance don't realize that insurance is little more than "socialism for profit." And that health care insurers actually encourage health care costs to go up because health care insurers make their profits off of the cash flow. (The premiums paid by the insured basically are skimmed off the top by insurance companies to provide (deductible) salaries to executive and to pay for such (deductible) items as lobbying, trick accounting and controlling the state insurance commissioners. Twenty to thirty percent of health care insurance premiums are skimmed; Medicare skims only 5%. The "Private health insurance" has not worked and will not work because its a monopolistic scam. The insurance industry is doing everything it can to kill the ACA because they know that Obamacare is little more than an advance death knell to their "business".
3
The Republicans have had eight years to come up with a useful alternative and they have FAILED. They have nothing.
6
Why would anyone care what Mr. (Americans are gullible) Gruber has to say?
It astonishes me that so few commenters recall that Republicans offered many provisions for the ACA, which were summarily dismissed by the then democrat majority and the then President.
Just as Nancy said when passing the ACA "we have to pass the bill to know what's in the bill", Republicans might now say the same. Would they be wrong to do so? Mr. Obama famously says "elections have consequences". Perhaps many of the NYT commenters did not yet come to the realization that an election just created a political environment that does not align itself with their desires.
Laws and Presidential edicts will now be implemented based on the results of those elections. Your perspectives on health care and global warming and America's place in the world are no longer as relevant as you would like.
Instead of seeking consensus democrats instead used parliamentary procedures and the President's pen and phone to enact their agenda. But now that they are out of power they want the opposition to adhere to their doctrines and allow for their input.
I believe I am describing a group that believes they have exclusive ownership of what is right and good. That's not my United States, where the Constitution limits the powers of the federal government to only those enumerated in that document.
Go back and read the NYT of 11/9 to see the news that changed the world.
It astonishes me that so few commenters recall that Republicans offered many provisions for the ACA, which were summarily dismissed by the then democrat majority and the then President.
Just as Nancy said when passing the ACA "we have to pass the bill to know what's in the bill", Republicans might now say the same. Would they be wrong to do so? Mr. Obama famously says "elections have consequences". Perhaps many of the NYT commenters did not yet come to the realization that an election just created a political environment that does not align itself with their desires.
Laws and Presidential edicts will now be implemented based on the results of those elections. Your perspectives on health care and global warming and America's place in the world are no longer as relevant as you would like.
Instead of seeking consensus democrats instead used parliamentary procedures and the President's pen and phone to enact their agenda. But now that they are out of power they want the opposition to adhere to their doctrines and allow for their input.
I believe I am describing a group that believes they have exclusive ownership of what is right and good. That's not my United States, where the Constitution limits the powers of the federal government to only those enumerated in that document.
Go back and read the NYT of 11/9 to see the news that changed the world.
2
I had a conversation with someone over the weekend about the demise of the ACA. Her husband had a serious episode of colon cancer but is deemed cancer free. We were talking about his pre-existing condition. She said "thankfully we already have good insurance." She didn't understand that health insurance, unlike life insurance, can be discontinued. They would then be shopping for new coverage with his pre-existing condition very likely to be excluded or coverage denied entirely.
I think a lot of people are going to be surprised by the good parts of the ACA when they are gone.
I think a lot of people are going to be surprised by the good parts of the ACA when they are gone.
6
So now the architect of the ACA - who infamously stated the only reason the Obama Administration was able to get the act passed was the "stupidity of the American voter" wants to tell us (again) what MUST be done. The irony is just too rich. Professor, can you hear us now?
2
THAT Mr. Jonathan Gruber! The one caught on tape saying they were able to pass Obamacare because of the "stupidity of the American people." Wow! Sounds pretty desperate to me!!!
4
Either many of the 50 million people who voted for trump are perfectly healthy and don't need insurance, or they will soon realize voting for Trump was not a good idea after all.
4
Billboards urging you to pre-donate your heart-organ
so that medical chop-shops could resell it for a ton.
Just a snapshot of what is wrong with US healthcare.
Huge cost effort to become a doctor.
Huge charge at the hospital for a simple injection.
Healthcare should be structured the same way as car maintenance/repair industry- plenty of competition, plenty of mechanics, plenty of shops.
There is no reason to pay so much to an insurance company for something so trivial as a human health and life.
so that medical chop-shops could resell it for a ton.
Just a snapshot of what is wrong with US healthcare.
Huge cost effort to become a doctor.
Huge charge at the hospital for a simple injection.
Healthcare should be structured the same way as car maintenance/repair industry- plenty of competition, plenty of mechanics, plenty of shops.
There is no reason to pay so much to an insurance company for something so trivial as a human health and life.
1
Is "repeal" possible without a supermajority in the senate? Why would a bill aimed at changing the existing healthcare law be allowed to pass without a filibuster? I know that there are a bunch of procedural tricks, but not sure if anything can apply here
Allow me to educate you. Repeal is a simple majority vote. Just like passing Obamacare was a simple majority vote. You are not changing the Constitution or convicting an impeached President (alas). It is a law like any other law.
The question you should have asked was "How is it the President is able to change the law passed by Congress and signed by himself without Congress passing such changes?" You see, that is a violation of the Constitution. It is illegal.
Now the filibuster could have been used to keep Obamacare from passing, but the Dem Congress used budget reconciliation to push it through, instead of putting it up for an actual vote after the Senate made some changes to the House version. Where was the filibuster allowed here? It wasn't. Where were the GOP amendments to the law? They were disallowed. The GOP was totally shut out from any involvement in this monster. It's all on the backs of the Democrats. That is a large part of why Trump won. He is there to dismantle it.
The question you should have asked was "How is it the President is able to change the law passed by Congress and signed by himself without Congress passing such changes?" You see, that is a violation of the Constitution. It is illegal.
Now the filibuster could have been used to keep Obamacare from passing, but the Dem Congress used budget reconciliation to push it through, instead of putting it up for an actual vote after the Senate made some changes to the House version. Where was the filibuster allowed here? It wasn't. Where were the GOP amendments to the law? They were disallowed. The GOP was totally shut out from any involvement in this monster. It's all on the backs of the Democrats. That is a large part of why Trump won. He is there to dismantle it.
Given Gruber's acknowledged propensity for not telling the truth about this subject, shouldn't this little piece be written off as more lies? That is the problem with liars, one never knows when they are telling the truth and when they are lying.
4
Republicans are about to discover how difficult healthcare politics is.
Many people are eager to help them learn this.
Many people are eager to help them learn this.
6
This is a level of detail that is entirely beyond Trump's ability to comprehend. But it's a very interesting point. Unfortunately, the Republicans will not have their own plan to replace the ACA when they meet on Inauguration Day to repeal it, so your arguments are moot as nothing from it will be preserved. It will remain to be seen how these two rules are implemented in the new GOP plan, if they actually are. IF the GOP actually comes up with a replacement plan, and THAT is highly unlikely.
3
What is this, some lame attempt at reputation rehabilitation? Gruber should stick to making off the cuff offensive statements and own up to them rather than trying to take the weasel word exit ramp. We remember Jonny even if you are pretending we don't.
2
As a cancer survivor, I have no idea what to expect. I'm in otherwise excellent health and always have been: never overweight, don't smoke, exercise regularly, avoid junk food. If it hadn't been for the cancer, I would be an insurer's dream.
As it is, my insurance is already unaffordable and essentially useless, unless I'm hospitalized. It's basically insurance against catastrophe. But Trump's plan will likely prevent me from getting any kind of insurance whatsoever.
Since I will probably never have a reocurrence, as my oncologist assured me after my operation, I'm not particularly concerned about a reoccurence - but an insurance company isn't going to look at my overall state of health and rate of probable reoccurence: it's going to ask, "Have you ever had cancer," and my answer will have to be "yes," and they will be able to say, "well, then, if you want insurance, cough up (insert insane amount of money) a month!"
If the ACA is repealed, I won't be getting any more subsidies, which I had been eligible for as a single-income, self-employed parent. So the most likely scenario is that I'll be uninsured again. Thanks, Trump!
As it is, my insurance is already unaffordable and essentially useless, unless I'm hospitalized. It's basically insurance against catastrophe. But Trump's plan will likely prevent me from getting any kind of insurance whatsoever.
Since I will probably never have a reocurrence, as my oncologist assured me after my operation, I'm not particularly concerned about a reoccurence - but an insurance company isn't going to look at my overall state of health and rate of probable reoccurence: it's going to ask, "Have you ever had cancer," and my answer will have to be "yes," and they will be able to say, "well, then, if you want insurance, cough up (insert insane amount of money) a month!"
If the ACA is repealed, I won't be getting any more subsidies, which I had been eligible for as a single-income, self-employed parent. So the most likely scenario is that I'll be uninsured again. Thanks, Trump!
6
Obamacare was one small step toward the giant leap of single payer. The election threw a wrench into those heretofore inevitable machinations. Therefore, Obamacare as we know it can’t survive the current Congress.
It behooves the GOP to recognize that absent an explicit Constitutional healthcare right, the nation feels moral obligation to provide basic healthcare access to all. Americans don't let people starve or bleed to death in the streets. Integrating current national, state, and local public health provision and payment will deliver basic healthcare accessible to all regardless of means. A model is the charity hospital system that served those with limited means prior to the enactment of Medicare and Medicaid, remnants of which still exist. Expansion of this provider network and VA integration will ensure sufficient supply. Access to higher echelons of quality would be funded largely by extant private funding.
Alternatively, Trump should negotiate with health insurers and self-insured corporations to spread individual insurance risk across all 300 million covered lives, vs. the status quo segregated individual pool, which lays the massive costs of heavy utilizers on their healthier fellow individually insureds; the former grateful for coverage at any cost, the latter outraged by skyrocketing premiums.
It behooves the GOP to recognize that absent an explicit Constitutional healthcare right, the nation feels moral obligation to provide basic healthcare access to all. Americans don't let people starve or bleed to death in the streets. Integrating current national, state, and local public health provision and payment will deliver basic healthcare accessible to all regardless of means. A model is the charity hospital system that served those with limited means prior to the enactment of Medicare and Medicaid, remnants of which still exist. Expansion of this provider network and VA integration will ensure sufficient supply. Access to higher echelons of quality would be funded largely by extant private funding.
Alternatively, Trump should negotiate with health insurers and self-insured corporations to spread individual insurance risk across all 300 million covered lives, vs. the status quo segregated individual pool, which lays the massive costs of heavy utilizers on their healthier fellow individually insureds; the former grateful for coverage at any cost, the latter outraged by skyrocketing premiums.
2
Never underestimate the power of hubris in a newly formed majority. The forces for repeal are strong enough to carry the day and the replacement will likely be a "let them eat cake" sham that extends the fortunes of the Republican elite, while preserving the profits of the healthcare industry. Remember, one of the major objections to the ACA is that it subsidizes the wrong sort of people, the lazy takers, the chronic do nothing poor people, feckless minority communities and illegal immigrants. We would rather have no insurance at all than see our tax dollars go to helping those kinds of people. Nobody is in this to establish or preserve the common weal, because we wouldn't accept it if they did. Capitalism is, after all, about maximizing profits at the expense of the other guy regardless of the consequences.
2
Most Americans, probably including Trump, don't understand the ACA. They don' t know why an individual mandate is necessary to finance covering pre-occurring conditions. All they know about the black box of insurance policy is that the government is forcing them to do something and it costs money.
I've seen few public attempts made to explain in understandable terms why it has to be the way it is. I believe much of the Trump revolution occurs because of the complexity of our world: "It hurts and I don't understand why it even has to exist."
We need to find ways to meet people at their level of understanding and keep them rationally informed. This is the basis of democracy.
I've seen few public attempts made to explain in understandable terms why it has to be the way it is. I believe much of the Trump revolution occurs because of the complexity of our world: "It hurts and I don't understand why it even has to exist."
We need to find ways to meet people at their level of understanding and keep them rationally informed. This is the basis of democracy.
4
Google's doodle yesterday celebrated the birthday of Sir Frederick Banting, the Canadian that discovered insulin. This drug helps manage the symptoms of Type 2 diabetes, and literally saves the lives of Type 1 diabetics. He gave away the formula in order to get a badly needed drug, the first of its kind, to market, to save the lives of the latter. In doing so, we turned Type 1 diabetes from a 100% fatal disease, whose victims were overwhelmingly children and teenagers, to what we now call a chronic illness, or as the insurance companies call it, a pre-existing condition. Insulin used to be cheap, until the 1980s, when pharmaceutical companies figured out how to obtain the hormone from engineered bacteria (a biologic) and slapped patents all over every step in the manufacturing process. The result has been a string of obscenities: pharmaceutical companies charging obscene amounts for a drug children need to stay alive, obscene profits raked into those companies at the expense of the American taxpayers and patients, who have no generic alternatives and the obscene posturing of politicians who seem to care more for the money donated to their reelection funds than they do for the people dying because they lost their insurance, or cannot get new insurance at any price. That was the case before the ACA and it looks as if things are going back to the bad old days. As someone with Type 1, I feel voters have sealed my fate, telling me I have no value as a fellow citizen.
3
I am very afraid for all Americans. Even the Trump supporters. They haven't a clue what they have perpetrated onto us. Most of the people in my retirement community have voted against their best interests again and will probably continue to do so. My only hope is that some people will wake up and do what happened when President Bush tried to privatize Social Security. Say NO. We must stand up and stop Paul Ryan and his misguided idea of block grants for Medicare. Write your congressman.
5
Coverage for those with pre-existing conditions under the ACA is covered by a 3.8% tax (fee) on those making over a pre-defined annual salary ($250k for a household or $160K for an individual) as well as a fine on employers that offer insurance ($65/employee) and the Cadillac tax (a 40% tax on employer's contributions over the median contribution across the country - about $10k).
The law also tried to pull monies from those fees and the 'newly young and healthy insured' to cover the expansion in Medicaid and those eligible for subsidies. However, the young mostly decided to opt out when they realized the fine they had to pay was minuscule compared to the premiums for the insurance they were mandated to buy - covering things like maternity leave and neonatal care for unmarried men.
So, while we continue to be misled by lack of facts in the media, the ACA isn't working, isn't cutting costs (except for the Federal government as CMS continues to cut payments to those that actually provide care vs. the myriad of companies and industries that have sprung up to serve as middle men), and it hasn't increased access as most providers are not willing to accept decreased payments and 1000-fold increase in red tape forms and mandatory data submissions to CMS.
No, we can't repeal the ACA as hundreds of billions have been spent trying to meet it's mandates. We can make changes, and should, but they must be small, well-thought out changes that will not have unintended consequences.
The law also tried to pull monies from those fees and the 'newly young and healthy insured' to cover the expansion in Medicaid and those eligible for subsidies. However, the young mostly decided to opt out when they realized the fine they had to pay was minuscule compared to the premiums for the insurance they were mandated to buy - covering things like maternity leave and neonatal care for unmarried men.
So, while we continue to be misled by lack of facts in the media, the ACA isn't working, isn't cutting costs (except for the Federal government as CMS continues to cut payments to those that actually provide care vs. the myriad of companies and industries that have sprung up to serve as middle men), and it hasn't increased access as most providers are not willing to accept decreased payments and 1000-fold increase in red tape forms and mandatory data submissions to CMS.
No, we can't repeal the ACA as hundreds of billions have been spent trying to meet it's mandates. We can make changes, and should, but they must be small, well-thought out changes that will not have unintended consequences.
2
How about allowing people over 55 to buy medicare and keeping the provision that children can keep parent's insurance (which could be medicare) to 26. This leaves a hole for the age groups of 26-54. Insurers only want to insure this group anyways.
5
Perhaps our President-Elect, Donald Trump, will do the math and notice that, as a shrewd businessman, we would all be better off with the health insurance industry out of the mix, regulated prices on BigPharma, with a Medicare for all system. Just think, employers would no longer turn full time jobs into part time jobs so as to avoid the onerous costs of paying for their employees' health insurance.
One can dream.
One can dream.
14
The Affordable Care Act is really not affordable and needs to go. President Elect Trump is correct it has helped decrease the quality of our health care system and is costing all Americans much more than any benefits derived from the act. The old saying there is no free lunch applies to this act as well. Had the Affordable Care Act not been rushed through congress but had bipartisan support Americans would likely seen a much better program.
If you really desire a better universal health care system, you need the input from qualified health care providers which have some business training. All insurance sold in America in the past has been sold on the expectation of a profit for the insurance company as well as coverage for the insured. Take away the profit part of the equation and the system no longer works.
If Americans wish total coverage without any rate adjustments, you will have to have universal government coverage like many other nations have today. While this sound good for the consumer, it tends to produce a mediocre health care system and many of these countries have a secondary private system used by many of the upper class. I do not think that is what Americans really desire.
It far past the time that we drop this Affordable Care Act and develop a sound health insurance program that covers all Americans and keeps the for profit incentive for the insurance companies.
If you really desire a better universal health care system, you need the input from qualified health care providers which have some business training. All insurance sold in America in the past has been sold on the expectation of a profit for the insurance company as well as coverage for the insured. Take away the profit part of the equation and the system no longer works.
If Americans wish total coverage without any rate adjustments, you will have to have universal government coverage like many other nations have today. While this sound good for the consumer, it tends to produce a mediocre health care system and many of these countries have a secondary private system used by many of the upper class. I do not think that is what Americans really desire.
It far past the time that we drop this Affordable Care Act and develop a sound health insurance program that covers all Americans and keeps the for profit incentive for the insurance companies.
4
The ACA was based on the current profit-driven health care market with considerable input from "qualified health care providers which have some business training". Which is why premiums keep getting driven upward.
Where is the evidence that universal government coverage tends to produce a mediocre health care system? According to statistics from the World Health Organization, the USA currently ranks #37 behind such luminaries as Costa Rica and Colombia. http://thepatientfactor.com/canadian-health-care-information/world-healt...
Sounds pretty mediocre to me, and expensive to boot.
Where is the evidence that universal government coverage tends to produce a mediocre health care system? According to statistics from the World Health Organization, the USA currently ranks #37 behind such luminaries as Costa Rica and Colombia. http://thepatientfactor.com/canadian-health-care-information/world-healt...
Sounds pretty mediocre to me, and expensive to boot.
3
Mr. Gruber, I know you were instrumental in shaping the ACA, even though your unguarded comment that it was based on unreality was not very helpful. As you well know, the problem with the ACA was retaining insurance companies, well known as for-profit entities with no desire to advance insurance for the uninsured. To wit, when the perverse incentives of the law (eg, the small penalties for not obtaining coverage) led to healthy people not joining the patient pool, the big insurers simply dropped out of the ACA.
What good is covering pre-existing conditions if patients are priced out of the market with steep premiums based on their illness? The whole point of this poor attempt to achieve near-universal coverage was doomed to failure from the start because of the size of the pool.
Hey, it's easy to insure patients who are young or who aren't sick. That way profits stay high. But those pesky little sick people--they really affect the bottom line?
Trump will keep the "popular" provisions of the ACA, but the sickest patients will still be excluded due to the cost of their insurance. And for those with pre-existing conditions, the good news is 'hey you can't be excluded for your cancer" coupled with the bad news, which is, we'll cover that but because of your age, your other health issues, we won't cover you at all in the first place.
Back to square one with Trump. You write this is a "cruel backward step." Since when has Trump been responsive to "cruel"?
What good is covering pre-existing conditions if patients are priced out of the market with steep premiums based on their illness? The whole point of this poor attempt to achieve near-universal coverage was doomed to failure from the start because of the size of the pool.
Hey, it's easy to insure patients who are young or who aren't sick. That way profits stay high. But those pesky little sick people--they really affect the bottom line?
Trump will keep the "popular" provisions of the ACA, but the sickest patients will still be excluded due to the cost of their insurance. And for those with pre-existing conditions, the good news is 'hey you can't be excluded for your cancer" coupled with the bad news, which is, we'll cover that but because of your age, your other health issues, we won't cover you at all in the first place.
Back to square one with Trump. You write this is a "cruel backward step." Since when has Trump been responsive to "cruel"?
8
Forcing policy holders to pay for other policy holders dental costs and pregnancy costs and laying significant fines on those without health insurance doomed ACA. Pre-existing conditions coverage can be delayed by one year after joining as was done in some states prior to ACA. This prevented someone from signing up for health care when they got sick only. A larger deductible for pre-existing conditions can be assessed. Keeping a child on a parents health care policy until 26 years of age is not really a cost increaser because a family policy costs more that a couple policy. Offering a large number of types of coverages, rather than mandating them would open up a wide array of pricing and policy choices. There are many things wrong with the ACA and many things right. The largest number of increased insured came from the expansion of Medicaid. At least this cost is shared by all taxpayers. One hopes that Congress will address this issue quickly and come up with a solution that is better than the original ACA.
2
If you have medical insurance then you are paying for others in your pool. If you get sick than the others in your pool are paying for you. That is the basic structure of insurance.
3
The answer might be not replacing it and allowing the markets to work without regulation. Nobody has even suggested this, and nobody will.
2
We should simply allow insurance companies to sell no-frills catastrophe insurance policies. I'll pay for my physical every year, and use insurance only when I really need it, which is hopefully never.
5
That's a big gamble. What if you get a chronic condition requiring expensive repeated treatment and expensive drugs? It's not catastrophic, but it will be expensive. What if you do have a catastrophe and the insurance has a cap, and your care will cost more than the cap?
3
If you listen to Trump during his flame fanning rallies, he always promised to repeal Obamacare completely. This was met with cheers by his fans because of one trait shared by all of them: they don't want to be told what to do.
That's it. They are a bunch of selfish, small-minded, short-sighted fools.
They don't want any healthcare, they don't want to spend any money, they don't want to have to think, they do not want to be told that anything they do or not do will have any consequences.
Just like their leader, the talking Cheeto.
That's it. They are a bunch of selfish, small-minded, short-sighted fools.
They don't want any healthcare, they don't want to spend any money, they don't want to have to think, they do not want to be told that anything they do or not do will have any consequences.
Just like their leader, the talking Cheeto.
18
Without specifics on republican plans, other than the two items cited, much of this article is mere fear mongering... I don't see the author describing what should be, only harping on what could happen if.....
I would much rather see a constructive article talking about what SHOULD be in a republican replacement for the ACA.... rather than talking all gloom and doom... Maybe the republicans would listen to good suggestions. At least we should try to offer them!!!!!!
I would much rather see a constructive article talking about what SHOULD be in a republican replacement for the ACA.... rather than talking all gloom and doom... Maybe the republicans would listen to good suggestions. At least we should try to offer them!!!!!!
3
Republicans had 6 years to suggest replacements or amendments to ACA but only tried to repeal it. Now they are on the line for what they are finally forced to propose. I relish the idea that the American people will see Republican policy in action. I am very sad for all the people who will be harmed in the process.
6
Experts in climate have a maxim in how we must deal with the negative effects of CO2: "Manage the unavoidable and avoid the unmanageable." With Trump, we will be doing a lot of the former and none of the latter.
4
The correct replacement for Obamacare is to make health CARE, keeping people healthy and helping them avoid unhealthy behavior, a government program. That allows health INSURANCE to be what it's supposed to be - the spreading out of the financial cost of unpredictable catastrophe across a large population of which only the unlucky experience disaster.
Getting your teeth cleaned regularly is a predictable maintenance issue falling under CARE. Fixing broken teeth after an accident is an unpredictable calamity, an expense covered by INSURANCE.
Getting your teeth cleaned regularly is a predictable maintenance issue falling under CARE. Fixing broken teeth after an accident is an unpredictable calamity, an expense covered by INSURANCE.
9
We've gone from Obamacare to DonaldDon'tCare.
25
Professor Gruber
Why not repeal EMTALA ?
Emergency Medicine and Active Labor Act of 1986, that guarantees FREE healthcare in ER’s across the country to anything from sprained ankles to FREE emergency open heart surgery. It was signed by Reagan, I called it Reagancare!!. I doubt it was a republican idea.
Why not repeal it. I am serious
This act “MANDATES” doctors/hospitals to give free care to the un-insured.
May be just may be after EMTALA repeal, Republicans will come to their senses. “May be” then, they will think it more important to insure ALL citizens than to insure ALL vehicles.
I can be the lead plaintiff; I can show to courts, I perform uncompensated care because of a Reagan “MANDATE”.
HELP
Why not repeal EMTALA ?
Emergency Medicine and Active Labor Act of 1986, that guarantees FREE healthcare in ER’s across the country to anything from sprained ankles to FREE emergency open heart surgery. It was signed by Reagan, I called it Reagancare!!. I doubt it was a republican idea.
Why not repeal it. I am serious
This act “MANDATES” doctors/hospitals to give free care to the un-insured.
May be just may be after EMTALA repeal, Republicans will come to their senses. “May be” then, they will think it more important to insure ALL citizens than to insure ALL vehicles.
I can be the lead plaintiff; I can show to courts, I perform uncompensated care because of a Reagan “MANDATE”.
HELP
7
Dro, I am not sure where you are going with this. Are suggesting that it will be a good thing if repealing EMTALA brings about a crisis, with people turned away at the hospital door and left to die on the sidewalk, because then everyone will see the need for single payer or some other system that insures everyone? Maybe that works, or maybe those implacably opposed to universal health care won't care about the bodies. Just the free market at work. Nothing to see here, folks. Move on.
2
Maybe this one part of the anti-American Republican attempt to destroy America will finally wake up voters. I doubt it, but it might.
6
The real tragedy is that we don't have a nationalized health care system. Health insurance companies that make profits are middle men that make money on this and they do nothing useful at all. The answer to lowering costs is to get rid of the companies. It is unethical for companies to make profits on health care.
16
Omg - don't fall for this little dangling out of a shiny promise of keeping anything. It's just distraction. ACA is 1000% dead. All of it. They do not care.
3
Yeah, go ahead, throw them all off and then see what happens when you have millions on the streets against the myopic sadistic masochistic unAmerican unpatriotic tyrannical Republican'ts and deplorables. Stupid Americans! We did this before with illegal war criminal Bushie family and it didn't turn out well and now we are doing it again because of your stupidity with Trumpet and theologian Pence and bigot McConnell and fascist Ryan and Toomey. We are no different from 1930s Germany and Italy. Only question? Which one is Himmler and Goebbels and Mussolini?! Definitely won't turn out well. How stupid can you get?! Guess not stupid enough?! Don't you ever learn?!
Gumbmint not the problem but the deplorables and unAmerican unpatriotic masochistic sadistic myopic tyrannical Republican'ts most definitely are. Wake up. They don't care about you as they ONLY care about themselves, the rich, the whites, and the corporations. You and yours have been had by these treasonous fascist Republican'ts and Trumpet. Fine, want to ruin your own life, okay, but just don't drag the rest of us down with you because you aren't capable of making intelligent decisions and believing lies. Stop watching Fixed Noise propaganda coolaid.
If they can be replaced prior to January 2017, it would stop the destruction immediately that they are plotting as we speak. Resist and block all they want and do! No exception. No excuse. No compromise.
Gumbmint not the problem but the deplorables and unAmerican unpatriotic masochistic sadistic myopic tyrannical Republican'ts most definitely are. Wake up. They don't care about you as they ONLY care about themselves, the rich, the whites, and the corporations. You and yours have been had by these treasonous fascist Republican'ts and Trumpet. Fine, want to ruin your own life, okay, but just don't drag the rest of us down with you because you aren't capable of making intelligent decisions and believing lies. Stop watching Fixed Noise propaganda coolaid.
If they can be replaced prior to January 2017, it would stop the destruction immediately that they are plotting as we speak. Resist and block all they want and do! No exception. No excuse. No compromise.
7
Trump should keep the popular parts of the ACA, the name Obamacare, is not helping us.
2
For those of you who raised Johnathan Gruber as the poster boy saint in the bashing of Obamacare, this should be a good read. Clearly the time for compromise is gone: Let the hurt, maim and death of Republicare begin.
3
No one posting realizes that ACA made changes to all parts of health care system including Medicare.
Repeal ALL of the law ands there arw enough provisions that Medicare would have to cease operations for months while things werechanged back.
Trump and team are ignorant of this and do not seek facts.
Chaos
Repeal ALL of the law ands there arw enough provisions that Medicare would have to cease operations for months while things werechanged back.
Trump and team are ignorant of this and do not seek facts.
Chaos
6
Jonathan Gruber fairly describes the policy choices that led him to recommend the Obamacare solution for pre-existing conditions. In this Democratic scheme, young healthy workers and small businesses must pay more than their fair share in an act of forced charity for the chronically ill. This design causes a strain on the economically vulnerable that should be paid by the economically strong (i.e. the wealthy).
Mandatory health insurance is just another form of taxation but, like payroll taxation, it tends to disproportionately harm those struggling to get ahead. A better system would tax wealth and income inversely and require people to pay what they can afford for health care and let the government pay the rest. Consider the effect of a taxpayer choice of an income tax rate between 8% and 28% paired with a wealth tax rate of 2% decreasing to zero. Each taxpayer would also be able to save up to $500,000 wealth tax free for retirement, health care and education. The job killing combined payroll taxes (now fixed at 15.7%) would be eliminated. Social Security would be funded by a 4% VAT and 8% C corporation tax with no tax expenditures. Cumulative wealth taxes could be used to offset estate and gift taxes (set at 28%) – finally making the Estate Tax fair to all.
With fair tax reform the government would have accurate wealth and income data for families and individuals. Those with significant assets would have the incentive to purchase private health insurance.
Mandatory health insurance is just another form of taxation but, like payroll taxation, it tends to disproportionately harm those struggling to get ahead. A better system would tax wealth and income inversely and require people to pay what they can afford for health care and let the government pay the rest. Consider the effect of a taxpayer choice of an income tax rate between 8% and 28% paired with a wealth tax rate of 2% decreasing to zero. Each taxpayer would also be able to save up to $500,000 wealth tax free for retirement, health care and education. The job killing combined payroll taxes (now fixed at 15.7%) would be eliminated. Social Security would be funded by a 4% VAT and 8% C corporation tax with no tax expenditures. Cumulative wealth taxes could be used to offset estate and gift taxes (set at 28%) – finally making the Estate Tax fair to all.
With fair tax reform the government would have accurate wealth and income data for families and individuals. Those with significant assets would have the incentive to purchase private health insurance.
3
Obamacare socks the wealthy -- that is why Republicans hate it (though they are never honest about it). As for the "injustice" to the young: yes, they overpay, but they will take their turn being subsidized as they age.
3
Gruber again? Notice he doesn't try to quantify the issue. He just uses the same old hysteria. In fact this was an issue SOLELY for people without coverage applying for insurance in the individual market (a tiny number of people), and even most of these could get coverage through high-risk pools in 30+ states. And for this we turned the entire insurance market on its head?
5
As a healthy 62 year old at the time, I was denied any health insurance by Blue Cross/Blue Shield, because I properly disclosed on my application that I had once discussed the possibility of surgery on a knuckle of my left forefinger related to an injury. I challenged the denial and for two years, until I went on Medicare, I had a BCBS policy that covered all of me except one knuckle on my left forefinger.
While Mr. Gruber is a health care expert and I am only a health care consumer, this (seemingly ludicrous) example shows that his comment that insurers would provide coverage for all but a pre-existing condition might only be accurate for those willing to fight the initial denial. But it does support his comments that without the current rules of the ACA in place, insurers will be motivated once again to take advantage of all but the healthiest applicants.
While Mr. Gruber is a health care expert and I am only a health care consumer, this (seemingly ludicrous) example shows that his comment that insurers would provide coverage for all but a pre-existing condition might only be accurate for those willing to fight the initial denial. But it does support his comments that without the current rules of the ACA in place, insurers will be motivated once again to take advantage of all but the healthiest applicants.
8
Who are we kidding. Republicans really don't care about Americans' health. If they did, they would have worked with the Obama administration to improve the ACA, optimize it, and tailor it with the right compromises to suit the thinking of both parties. On top of it, they have no ideas except to give it all to private parties. Paul Ryan wants to privatize Medicare! I fear we are in for a very rough time. Liberals need to put aside their differences and unite behind a Democratic president, even if he/she is flawed; the stakes are too high for us not to make a few compromises in the qualities of a Democratic presidential nominee. How I wish Hillary had won!
103
Unfortunately, the Obama Administration stonewalled the Congress and would not have anything to do with changing anything in the ACA. Paul Ryan's power is over-stated and his ideas in regards medicare and social security are so radical as to be un-recognizable to most of America. Furthermore, now that the baby boomer generation is moving into the medicare ranks, well, thats a voting block to be reckoned with.
2
I might have some sympathy for "poor" insurance companies if I did not see the returns on their stock in the form of dividends. How many people does it take to process an insurance form that is already on line? Well, that depends on how much work each actually does in a day. Do they arrive on time and get to work right away? Or do they need to stop on arrival greet everyone, get coffee and breakfast, eat breakfast and drink coffee while chatting for 30-60 minutes? A coffee break is how long? To watch some one would think it is 30 minutes, not 10. Lunch break is how long? Is it an hour to exercise, then 20 minutes to shower plus 30 minutes to eat lunch? A day's work is how many hours? Is it 8 or only 5 hours from when you arrive?
No wonder Insurance companies charge so much and deliver so little.
No wonder Insurance companies charge so much and deliver so little.
2
An interesting solution (which I just read a few days ago, maybe in NYT?) is to keep the mandate, but increase both the tax penalty for those who don't buy insurance and the tax subsidy for those who do buy it. This will force more people into the system while keeping their costs down. Having more healthy people in the system should keep premiums from rising.
That said, I'd prefer a single-payer, tax-funded system.
Looking forward to watching the Repubs try to figure this one out ...
That said, I'd prefer a single-payer, tax-funded system.
Looking forward to watching the Repubs try to figure this one out ...
3
Article is simplistic, in that nobody suggests to do away with ACA w/o providing alt that wd deal with all scenarios raised. Yes, will take time and deep thought to devel.
Main flaw in ACA is requires employers to provide cov. Makes about as much sense as requiring to provide car to all. Health ins was always a perk that cos could use to entice best ppl. Was win-win situation that was gd for employees and also gd for employers who could negotiate grp rate less than aggregate individ cov. Also ensured cov of pre-existing cond, as insurers were told either cover us all, or we'll shop elsewhere. But one can't force employer, it is his choice. If he opts not, then presumably employees wd seek better terms elsewhere. Free mkt at work.
But deeper prob w healthcare is inelastic demand. Price has nothing to do with decision to get treatment. We take it as given that every1 will seek and deserve no matter cost. For this reason, a co like Epi-pen can chrg astronom fees if they are only maker. How to get free mkt to operate and still gtee cov to all is diff and may be impos.
Bernie may be crct, that only logical sys is univ. In effect, vry lrg grp plan. Wd elim much admin cost, too, and provide US with strong buying pwr to negot gd rates. Downside is whether wd stifle innov and lead to rationing if providers and drugmakers decide effort not worth low income.
So all considerations need to be on table. It is a vexing challenge.
Main flaw in ACA is requires employers to provide cov. Makes about as much sense as requiring to provide car to all. Health ins was always a perk that cos could use to entice best ppl. Was win-win situation that was gd for employees and also gd for employers who could negotiate grp rate less than aggregate individ cov. Also ensured cov of pre-existing cond, as insurers were told either cover us all, or we'll shop elsewhere. But one can't force employer, it is his choice. If he opts not, then presumably employees wd seek better terms elsewhere. Free mkt at work.
But deeper prob w healthcare is inelastic demand. Price has nothing to do with decision to get treatment. We take it as given that every1 will seek and deserve no matter cost. For this reason, a co like Epi-pen can chrg astronom fees if they are only maker. How to get free mkt to operate and still gtee cov to all is diff and may be impos.
Bernie may be crct, that only logical sys is univ. In effect, vry lrg grp plan. Wd elim much admin cost, too, and provide US with strong buying pwr to negot gd rates. Downside is whether wd stifle innov and lead to rationing if providers and drugmakers decide effort not worth low income.
So all considerations need to be on table. It is a vexing challenge.
I voted for Obama twice... and I supported Obama Care, until I tried to use it to help a low-income couple in my community. I was shocked and appalled that the price for a couple (2 years ago) was $1400/month... more than half of their income. Mind you, they have to advance this money (which they do not have), with a nebulous promise that they will get some back when they file taxes. Obama wanted the Affordable Care Act so much he was unable to walk away from a lousy deal. In that regard, he can learn from Bill Clinton or Donald Trump.
Trump questioned the premise that drugs costs more in the US than anywhere else in the world. My Blood Pressure Medication costs $2640/year at CVS, but the same name brand costs $480 at a Canadian pharmacy. That is over $2000 that my insurance pays and passes the cost to my employer.
Another premise that Trump questioned is dividing the country into 50 pools. Imagine if we had 50 stock markets... That would be crazy. Similarly, the current system is idiotic. The price would go down if companies are forced into putting everyone into the same pool.
Trump is not the Devil, he is a person with good and bad. Obama/Hilary are not angels either. THE NYT would do well evaluating Trump's proposals on their own merits rather than spreading hysteria and then apologizing with a second letter to subscribers like the one that arrived last week.
Trump questioned the premise that drugs costs more in the US than anywhere else in the world. My Blood Pressure Medication costs $2640/year at CVS, but the same name brand costs $480 at a Canadian pharmacy. That is over $2000 that my insurance pays and passes the cost to my employer.
Another premise that Trump questioned is dividing the country into 50 pools. Imagine if we had 50 stock markets... That would be crazy. Similarly, the current system is idiotic. The price would go down if companies are forced into putting everyone into the same pool.
Trump is not the Devil, he is a person with good and bad. Obama/Hilary are not angels either. THE NYT would do well evaluating Trump's proposals on their own merits rather than spreading hysteria and then apologizing with a second letter to subscribers like the one that arrived last week.
2
Good law was disparaged by Republicans so badly that people were against it. If fiddling of law doesn't work, blame will be passed to Obama and original law. Republicans know how to control the media. Sadly, the good work done by Obama is gone.
People choose fiction over facts, and choices have consequences.
People choose fiction over facts, and choices have consequences.
5
The Republicans have never cared much about healthcare so it has rarely been on its agenda. It's been six years since ACA was passed, and despite a promise to repeal and replace, the GOP has failed to offer even one workable replacement.
The GOP knows that the best market-based solution to cover everyone with the cheapest prices is embodied in ACA. Any tweaking will drive prices through the roof.
I can only assume Trump wil tinker with the edges and the GOP will pass something that looks very much like ACA, but with a different name, and call it a day.
The risk the GOP runs is that, when the Dems are in power again, the Dems won't return to Obamacare but will move to single-payer.
The GOP knows that the best market-based solution to cover everyone with the cheapest prices is embodied in ACA. Any tweaking will drive prices through the roof.
I can only assume Trump wil tinker with the edges and the GOP will pass something that looks very much like ACA, but with a different name, and call it a day.
The risk the GOP runs is that, when the Dems are in power again, the Dems won't return to Obamacare but will move to single-payer.
1
Sadly, once the future Democrats move to single payer, the Trump SCOTUS will declare it illegal.
2
News to Trump and all of your uninformed, unereducated Republicans. Why do you think Obama HAD to include penalties etc? There is no way to insure the sickest highest users of medical care if you don't make the young and healthy join in!!! No way. Do you think we are stupid? And frankly I agree it's not fair to those of us who are healthy AND conscientious. I'm 66 and use no medical care, not even Medicare, just a high-deductible HSA from work. Why do I put so much time and effort into staying healthy? Oh well, my company subsidizes all the fat slobs I work with who are sick all the time -- cancer, HBP, statins.
Regardless, enough about me, I'm so sick of repeal Obama Care from the morons (those who were in the dumb classes who I did not speak to in high school). Lets get rid of the mandate and watch all the unpopular insurance companies fail. Then each State will vote in single-payer, and this is a much better solution. Or maybe have an early buy in for Medicare for those few unlucky sick souls and their obese friends. The silver lining in all this is not listening to the know-nothing Republican gripers. NO more email, repeal Obamacare, crooked HIllary and so forth. Go forth, you dumb Republicans -- show us your stuff.
Regardless, enough about me, I'm so sick of repeal Obama Care from the morons (those who were in the dumb classes who I did not speak to in high school). Lets get rid of the mandate and watch all the unpopular insurance companies fail. Then each State will vote in single-payer, and this is a much better solution. Or maybe have an early buy in for Medicare for those few unlucky sick souls and their obese friends. The silver lining in all this is not listening to the know-nothing Republican gripers. NO more email, repeal Obamacare, crooked HIllary and so forth. Go forth, you dumb Republicans -- show us your stuff.
6
Children that are still on their parents' health insurance at the age of 26 should not be allowed to vote.
2
Right back at you: People on Medicare should stop voting the minute they get more than they paid out.
Why?
The entire issue of what we wrongly call 'health insurance' needs to be rethought from the basic premises up.
We might begin by calling it, properly, 'medical insurance'. We might then discuss why provider costs have been allowed to ratchet up to the point where you presumably need insurance to cover a simple check-up, and whether it might make more sense to bring down those costs to the point where they can normally be covered out of pocket, and insurance kicks in only for catastrophic or chronic problems.
Then we might also discuss the issue of moral hazard - the unfortunate fact that people do take more risks when they figure 'insurance' will cover any damage they do.
We might also have the hard discussions about what a Medicare For All system - which I support - would cover as basic care, or not. (E.g., the recent book 'Avalanche' chronicles an Australian woman's fruitless quest to conceive a child, with none of her mounting costs covered by the National Health. Is infertility a condition to be covered, and fertility a 'right'? We already consider childbirth a 'right', and abortion a 'right' although Medicaid will cover the former but not the latter.)
We might also ... but what's the use. We won't have any of these discussions.
We might begin by calling it, properly, 'medical insurance'. We might then discuss why provider costs have been allowed to ratchet up to the point where you presumably need insurance to cover a simple check-up, and whether it might make more sense to bring down those costs to the point where they can normally be covered out of pocket, and insurance kicks in only for catastrophic or chronic problems.
Then we might also discuss the issue of moral hazard - the unfortunate fact that people do take more risks when they figure 'insurance' will cover any damage they do.
We might also have the hard discussions about what a Medicare For All system - which I support - would cover as basic care, or not. (E.g., the recent book 'Avalanche' chronicles an Australian woman's fruitless quest to conceive a child, with none of her mounting costs covered by the National Health. Is infertility a condition to be covered, and fertility a 'right'? We already consider childbirth a 'right', and abortion a 'right' although Medicaid will cover the former but not the latter.)
We might also ... but what's the use. We won't have any of these discussions.
5
Trump can't wait to repeal Obamacare. But the narcissist may be seduced by a workable system, provided it's called Trumpcare.
3
The provision most likely to be removed - mandatory coverage or tax penalty - is also the deal breaker for private insurers.
So long as Medicare-eligible American hospitals are bound by the Reagan requirement to treat all comers, there will be a free rider problem that only a coverage mandate can address.
Republicans have never proposed or passed comprehensive health care reform because hard cold math conflicts with their individualist principles. It will be refreshing to see them struggle and fail at this again.
So long as Medicare-eligible American hospitals are bound by the Reagan requirement to treat all comers, there will be a free rider problem that only a coverage mandate can address.
Republicans have never proposed or passed comprehensive health care reform because hard cold math conflicts with their individualist principles. It will be refreshing to see them struggle and fail at this again.
3
What could be worse? Compromising or losing our Democracy. Elected by a minority whose majority is ignorant gives us an emperor without clothes or standing and is undemocratic and unAmerican. Resist.
3
The US has already committed the worse atrocity against the PPACA and the nation. A bucket of deplorable disciples electorally put a demagogue into the most powerful position in the world. We will pay dearly for their mistake. Maybe next time we will learn the consequences of what happens when Dems stay away from the polls. But we have hope. Don't bet Rump will still be with us come 2020.
DD
Manhattan
DD
Manhattan
2
Isn't this author the guy who boasted about how he structured the ACA to take advantage of stupid people?
If he was duplicitous then, why wouldn't he be duplicitous now?
If he was duplicitous then, why wouldn't he be duplicitous now?
1
When I spoke to my realtor after the election, she laughed and said some people like Trump. Then she told me that health insurance premiums for herself, her husband and her daughter had just been increased from $1200 per month to $2000 per month and her deductible went up. Her family voted for Trump. What we really need is single payer health insurance but we will not get that under Trump.
3
Mr. Trump is going to try to play 3 card monte. Mr. Gruber just explained why the card he picks will not be a winner.
4
I am always amazed to see that the critics of the ACA do not even understand (or deny understanding) "Insurance 101". Insurance is about spreading the risk and can only work, if there is a mix in customers, this is why car insurance works and affordable.
And thinking that the professional deniers of the insurance basics are ruing this country for the next for years is scary. Another reason that confirms what a lousy business man Mr Trump is.
And thinking that the professional deniers of the insurance basics are ruing this country for the next for years is scary. Another reason that confirms what a lousy business man Mr Trump is.
3
As I understand Paul Ryan's plans, he basically wants to do the same thing to Medicare, gradually, giving people "premium support" and eventually moving wealthier seniors into private insurance. Although I don't think Republicans would go this route, would not the result be the absence of affordable coverage just like this, and was this not the whole reason Medicare was brought into existence?
I was not a Bernie supporter, but single payer seems eminently more sensible than this mess.
I was not a Bernie supporter, but single payer seems eminently more sensible than this mess.
5
If you don't like your health insurance choices, move to Massachusetts. If NY and CA like Romneycare they can enact Cuomocare and Browncare.
It's not like there aren't actual States within the United States that have the power to address this within their borders, and even create cross-border arrangements by State Compacts.
When did liberals decide to give up on the available tools provided by the federal system of government?
In an age of GOP control of all branches of the Federal government, the Dems better figure out how to get competitive at the State level and use the significant powers available to State governments, starting with the populous States where Dems are in charge.
It's not like there aren't actual States within the United States that have the power to address this within their borders, and even create cross-border arrangements by State Compacts.
When did liberals decide to give up on the available tools provided by the federal system of government?
In an age of GOP control of all branches of the Federal government, the Dems better figure out how to get competitive at the State level and use the significant powers available to State governments, starting with the populous States where Dems are in charge.
Romneycare was not possible without a significant federal subsidy for Mass medicare. Nor will Cuomocare or Browncare. Obamacare simply nationalized Romney. The opposition to Obamacare is pure demagoguery in the worse sense. The only "good news" is that it will cure Democrats of their foolish belief in compromise (these days, anyway) and lead to serious advocacy of and action on single payer.
6
I am an old man who remembers a time when LBJ was so ashamed of the poverty that he saw in the richest country in the world that he wanted to eliminate it. There is much about this election and the comments that I have read that have troubled me but nothing has disturbed me more than that of maggieast a Clinton supporter who blames the loss because of an
“Electoral College reaches into the swamplands and gives bigger voice to those living in the muck than to those who live on dry land”
It has many who recommend it. It oozes with contempt for those who live in the muck. Why over 50 years after the “War on Poverty” does the richest country in the world still have people living in the muck? The people living in the muck were the ones whose only hope was the Democratic Party and they voted Republican because they were abandoned by the Democratic Party.
You people have no shame. You deserve Donald Trump.
“Electoral College reaches into the swamplands and gives bigger voice to those living in the muck than to those who live on dry land”
It has many who recommend it. It oozes with contempt for those who live in the muck. Why over 50 years after the “War on Poverty” does the richest country in the world still have people living in the muck? The people living in the muck were the ones whose only hope was the Democratic Party and they voted Republican because they were abandoned by the Democratic Party.
You people have no shame. You deserve Donald Trump.
Saying insurance companies prior to ACA denied coverage to sick people is not the whole story. I moved to Texas before ACA kicked in. I was denied coverage because I had one remaining appointment to close the file on a minor and successful surgery. I appealed with my doctor's letter saying I was healthy, the surgery was successful and would never need to be repeated. Still denied. An insurance broker told me then that Blue Cross never writes a policy on anyone over 60. They always find something. Their web page at the time asked three questions on the home page. Have you ever smoked? Have you ever had cancer? Are you overweight? A yes answer meant the application page would be locked. A lie meant they would retroactively cancel your coverage and sue to be reimbursed. Also, premiums for women were higher than for men.
7
Besides the whole "pre-existing condition" predicament is the mandate aspect of the the ACA. Letting anyone pay a relatively small fine instead of joining the "pool" so that healthy, the sick, and the in-between were all going to even out premiums so that the universal health plan was affordable and profitable to be an incentive for companies to participate.
Everything dies on the vine without the mandate. The every person for themselves scramble was a nightmare in non-coverage of life threatening diseases, as well as the astronomical prices. The way around was to crowd the ER's in every instance, which was also the most expensive way to cover the "universal" coverage. This was Mitt Romney's take on how repealing the ACA wouldn't be such a big deal. How wrong. How stupid. How corrupt. It meant that sick people who weren't insured got dumped at street corners and substandard nursing facilities.
Any change to Obamacare will be a huge fight with medicare for all, single payer style of coverage.
Everything dies on the vine without the mandate. The every person for themselves scramble was a nightmare in non-coverage of life threatening diseases, as well as the astronomical prices. The way around was to crowd the ER's in every instance, which was also the most expensive way to cover the "universal" coverage. This was Mitt Romney's take on how repealing the ACA wouldn't be such a big deal. How wrong. How stupid. How corrupt. It meant that sick people who weren't insured got dumped at street corners and substandard nursing facilities.
Any change to Obamacare will be a huge fight with medicare for all, single payer style of coverage.
2
Certainly is DT's MO, isn't it? Promise the moon and don't get caught up with those silly details - except the details are, as they say, where the devil resides.
We have a fundamental conflict here: how to continue to allow insurers and medical care providers to milk the system for maximum profits while still offering citizens the illusion of being protected from catastrophic financial loss in the event of illness. The ACA represents a byzantine effort to merge profits with protection, but it is clear that it has major failings. It is also abundantly clear how vacuous the "repeal!" promise is: cutting out major components, such as the individual mandate, essentially nullifies any positive aspects of the law that we wish to maintain - which is pretty much why the individual mandate is there.
We're all in for a rude awakening, I'm afraid. The fact is, the ACA might be salvageable but until & unless we are willing to curtail the obscene profits of health care providers, there isn't much we can do to protect ourselves from financial ruin. It's a simple mathematical equation - someone has to pay for the ads, the executive bonuses, and the shareholders' interests.
We have a fundamental conflict here: how to continue to allow insurers and medical care providers to milk the system for maximum profits while still offering citizens the illusion of being protected from catastrophic financial loss in the event of illness. The ACA represents a byzantine effort to merge profits with protection, but it is clear that it has major failings. It is also abundantly clear how vacuous the "repeal!" promise is: cutting out major components, such as the individual mandate, essentially nullifies any positive aspects of the law that we wish to maintain - which is pretty much why the individual mandate is there.
We're all in for a rude awakening, I'm afraid. The fact is, the ACA might be salvageable but until & unless we are willing to curtail the obscene profits of health care providers, there isn't much we can do to protect ourselves from financial ruin. It's a simple mathematical equation - someone has to pay for the ads, the executive bonuses, and the shareholders' interests.
89
Trump's lack of understanding of the ACA is typical of his willful ignorance. He now plans to replace the ACA because it's "a disaster" but he wants to keep the pre-existing conditions allowance and keep the age limit for children at 26. Is Trump truly unaware that those two benefits are part and parcel of a large and sweeping healthcare overhaul, and woven into Obamacare? We are in for a difficult and painful ride with Trump, as we all witness aghast how his unwillingness to learn and his resistance to tradition doom his misbegotten and hopefully short presidency.
83
Those two items mentioned can easily be unwoven from the ACA and continued in a different plan, however my real fear is that there exists Republicans who, like many Democratic legislators, have their heads so far up the b..ts of lobbyists that they will damage even the very good provisions of the ACA. I can imagine a time when Trump vetoes legislation coming from a Republican Congress. A mistake you make is to push Trump into a corner that is now his. My hope is that Trump will resist this.
The "bad" parts are in the program to help pay for the "good" parts. Eliminating the "bad" parts will explode the costs. People don't have to "like" every aspect of the plan. Such a plan wouldn't be sustainable.
2
Let the Republicans own this problem. That may be the only way out. Let them be fully responsible and see how all the people, not just brainwashed red staters, feel about losing healthcare benefits.
Democrats need to keep the pressure on.
Democrats need to keep the pressure on.
2
Am I reading the Onion? Jonathan Gruber is writing about Obamacare and a critique of Trump's initial comments about it's overhaul? The same guy who said, and I paraphrase, it passed because Americans are so stupid? I know. Mr. Gruber was taken out of context, right?
So the left came-up with the phrase "climate change deniers" for those people who deny climate change research, studies, evidence. Let me propose a similar phrase for those who deny the law was entirely unilateral, congressional election results of 2010 and 2012 were an overwhelming response to Obamacare, premiums and deductibles have done nothing but increase significantly, major insurers are leaving the exchanges, employers (small and large) state they cut-back hours and staffing, and people who say they'd rather pay the fine than the deductible; which the deductible is higher than the fine: "Obamacare failed deniers." To anyone with more than two operational brain cells, the only tangible elements of Obamacare worth perpetuating are the pre-existing conditions provisions and dependent coverage (although a 26 year old isn't really a kid; after all you can vote at the age of 18. If 26 year olds are considered dependents/kids then perhaps we should make 26 the age to vote? Sounds reasonable. But in a country where definitions are anything but definitions... I digress.) How those two provisions of Obamacare are perpetuated, I believe, is up to Congress and the President. That's how it worked the first time around.
So the left came-up with the phrase "climate change deniers" for those people who deny climate change research, studies, evidence. Let me propose a similar phrase for those who deny the law was entirely unilateral, congressional election results of 2010 and 2012 were an overwhelming response to Obamacare, premiums and deductibles have done nothing but increase significantly, major insurers are leaving the exchanges, employers (small and large) state they cut-back hours and staffing, and people who say they'd rather pay the fine than the deductible; which the deductible is higher than the fine: "Obamacare failed deniers." To anyone with more than two operational brain cells, the only tangible elements of Obamacare worth perpetuating are the pre-existing conditions provisions and dependent coverage (although a 26 year old isn't really a kid; after all you can vote at the age of 18. If 26 year olds are considered dependents/kids then perhaps we should make 26 the age to vote? Sounds reasonable. But in a country where definitions are anything but definitions... I digress.) How those two provisions of Obamacare are perpetuated, I believe, is up to Congress and the President. That's how it worked the first time around.
This is exactly the same reason why we need to have a trayectory towards a national health care syste: the free market cannot efficiently serve the public. At the end of the day, the idea of having a one payer system covering all Americans is the only solution to this problem. I hope to live to see the day when, against all odds, such system is implemented, but I am not holding my breath.
3
Repealing Obamacare is the fastest way to single payor healthcare that I can think of. How does this happen?
The biggest problem in healthcare over the past 30 years has been medical inflation and the resulting "insurance death spiral." When health costs go up, healthy people stop purchasing insurance, leaving only sick people in the insurance market. One of Obamacare's goals was to stop this by the mandate which made it more difficult to opt out of insurance so that everyone was in the insurance pools. This divided the cost among more people. In the early times of Obamacare, this did slow the rate of premium increases.
However, this year, premium increases are back with a vengeance, and healthcare inflation is still unchecked. When republicans repeal Obamacare, if they do not have a plan to effectively address the death spiral, then the death spiral will accelerate. This has the potential to crash the insurance markets entirely. If there is no viable market for insurance, then either a large percentage of the country goes without insurance, or the government will have no choice to step in and fill the void with single payor.
Trump's campaign promise to allow insurance companies to sell across state lines is not adequate to stop medical inflation and the death spiral. It will only lead to a race to the bottom for insurance, (think Mississippi regulates insurance) leading to greater dissatisfaction in the insurance market, and more fertile ground for single payor.
The biggest problem in healthcare over the past 30 years has been medical inflation and the resulting "insurance death spiral." When health costs go up, healthy people stop purchasing insurance, leaving only sick people in the insurance market. One of Obamacare's goals was to stop this by the mandate which made it more difficult to opt out of insurance so that everyone was in the insurance pools. This divided the cost among more people. In the early times of Obamacare, this did slow the rate of premium increases.
However, this year, premium increases are back with a vengeance, and healthcare inflation is still unchecked. When republicans repeal Obamacare, if they do not have a plan to effectively address the death spiral, then the death spiral will accelerate. This has the potential to crash the insurance markets entirely. If there is no viable market for insurance, then either a large percentage of the country goes without insurance, or the government will have no choice to step in and fill the void with single payor.
Trump's campaign promise to allow insurance companies to sell across state lines is not adequate to stop medical inflation and the death spiral. It will only lead to a race to the bottom for insurance, (think Mississippi regulates insurance) leading to greater dissatisfaction in the insurance market, and more fertile ground for single payor.
4
There is no need to get rid of Obamacare. We only need to change its name to the Trump Corrective and all is well. Trump just prints the same huge set of volumes for his bill, nobody reads them just like the original and voila! The important thing is to wipe away Obama's legacy, isn't it, for these Obama haters.
2
Single payer health care. Period.
5
Though supposedly a businessman, it becomes obvious that Trump knows less than nothing about the insurance business if he thinks keeping only parts of Obamacare is feasible. What is the purpose of proposing such an impossible idea, other than to expose his complete ignorance regarding all matters health insurance related?? Oh I forgot- the real reason was to obtain votes from those most likely to end up with either unaffordable or no insurance at all once Obamacare is repealed.
1
Thank you Prof. Gruber for reminding us, as unintentional as that may have been, of the utter immorality of the American healthcare system, ACA or no. Only in "Amerika," of nearly all "advanced" societies, is healthcare held hostage by the capitalist vultures for whom others' misery is an invitation to pillage. So what to do about it? Move to a civilized country with true universal healthcare at a reasonable price. Check it out. You'll be amazed at how many of them there are.
3
A health "insurance" plan that only covers healthy people while they are healthy isn't really insurance at all, now is it? It's more of a "support your local insurance executive" plan.
The fundamental issue is that the "free economy" doesn't really like the concept of insurance, and constantly innovates in the absence of tight regulation to squirm out of actually insuring anyone. We've seen it in health care insurance in the US and in homeowners' insurance after major disasters like hurricanes.
Of course it's sacrilege to suggest that there's anything the free market couldn't do better if only left to its own devices.
The fundamental issue is that the "free economy" doesn't really like the concept of insurance, and constantly innovates in the absence of tight regulation to squirm out of actually insuring anyone. We've seen it in health care insurance in the US and in homeowners' insurance after major disasters like hurricanes.
Of course it's sacrilege to suggest that there's anything the free market couldn't do better if only left to its own devices.
4
Having dealt with private insurance for the past two years thru two family illnesses I am now an advocate of s single payer system. The amount of money wasted in the billing process is ridiculous. Private insurance has administrative costs of 24% while Medicare is about 3%.
4
This column must be part of Mr. Gruber's rehabilitation, but somehow, anyone with such professorial arrogance who calls the American voter stupid has nothing to say that I wish to hear.
1
Here we go back to the republican death panels. These folks are truly dastardly.
Family values? Supposedly christian values? Go figure. Unbeleivable that such a large segment of the population thought trump was their saviour. They will have their days of crushing dissapointment from their choice soon enough. They've been had.
Family values? Supposedly christian values? Go figure. Unbeleivable that such a large segment of the population thought trump was their saviour. They will have their days of crushing dissapointment from their choice soon enough. They've been had.
3
My daughter has a genetic disorder that affects the connective tissues of her body (basically problems can potentially develop in any organ system). While she does not require expensive care now, there is the specter of expensive care for people with her illness. If Obamacare is repealed, she may well find herself uninsurable at any reasonable price. She is considering this as she applies to PhD programs in chemistry and makes plans for her adult life. Access to affordable health care is a political football that directly impacts a young person's career path by essentially forcing them to work for a large employer to avoid individual underwriting for health insurance if they have a pre-existing condition. For an educated young adult, the world is full of opportunity. I would not fault her for becoming a health care expatriate and settling somewhere where health care affordability is a given and a non-issue.
69
My thoughts are with you and your daughter. Hopefully, with a strong chemistry background, she will find an exceptional job and a warm welcome in another country (i.e. Canada, Sweden, Norway) that appreciates young bright women and will provide full healthcare coverage to your daughter. It's just sad that she'll have to move so far away.
1
Fool me once, shame on Gruber, fool me twice, "call it the stupidity of the American voter or whatever…"
The Ds lost their Senate supermajority in 2010 w/ the election of Scott Brown IN MA SPECIFICALLY TO STOP OBAMACARE.
With only 59 votes, the Senate Ds could no longer close out the bill, so they circumvented the will of the people by reverse engineering the closeout as a reconciliation bill that would require only a simple majority.
What goes around comes around. (Ditto for the insane Obama-Clinton Iran nuke deal that defeats the grim logic of MAD.) A president who lives by lies, diktats, and extraconstitutional maneuvers deserves to die by them.
The Ds lost their Senate supermajority in 2010 w/ the election of Scott Brown IN MA SPECIFICALLY TO STOP OBAMACARE.
With only 59 votes, the Senate Ds could no longer close out the bill, so they circumvented the will of the people by reverse engineering the closeout as a reconciliation bill that would require only a simple majority.
What goes around comes around. (Ditto for the insane Obama-Clinton Iran nuke deal that defeats the grim logic of MAD.) A president who lives by lies, diktats, and extraconstitutional maneuvers deserves to die by them.
Get rid of it!
As a business owner, my costs have skyrocketed. If you nee healthcare, find a provider and pay for it like many of us do.
Unfair to make a portion of society subsidize those who can't seem to get it together.
Plus, it's not very efficient.
As a business owner, my costs have skyrocketed. If you nee healthcare, find a provider and pay for it like many of us do.
Unfair to make a portion of society subsidize those who can't seem to get it together.
Plus, it's not very efficient.
1
So you want those death panels do you?
Since the tax penalty for refusing to buy insurance seems to be the feature of Obamacare that most outrages the working poor, why not reword the mandate as a tax credit for everyone who does buy insurance?
2
We are a wealthy country. There is no good reason w hy we cannot provide health coverage to every one.
Right now under the ACA, we are limited to shopping for health coverage to the marketplaces in our respective home states. Does that make sense? What other product or service do we have to buy solely in our home states? Why are we prohibited from shopping around?
One of the promises of the ACA was that medical expenses for all would be coming down because sick people are not turned away from medical providers and allowed to die. They do get treated for no money and the fees that we pay subsidize those free services. How has that worked out?
Right now under the ACA, we are limited to shopping for health coverage to the marketplaces in our respective home states. Does that make sense? What other product or service do we have to buy solely in our home states? Why are we prohibited from shopping around?
One of the promises of the ACA was that medical expenses for all would be coming down because sick people are not turned away from medical providers and allowed to die. They do get treated for no money and the fees that we pay subsidize those free services. How has that worked out?
Millions of people ending up on the street because social security was lost in the stock market for one. Two those same people who cannot pay the bills they religiously paid with their social security check. Then watch to see how fast we reach the worst depression in the history of mankind.
All other industrialized countries have some form of universal government run health care, mostly single payor. They get better care as measured by all 16 of the bottom line public health statistics, and they do it at 40% of the cost per person. If our system were as efficient, we would save over $1.5 TRILLION each year.
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Some data:
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Let;s compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
If you want to bring up the VA, let me point out that any program no matter how well thought out can be ruined by lack of funding and incompetence. (One can combine these two by regarding lack of funding as incompetence on the part of Congress.) As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
www.pnhp.org & www.oecd.org, especially
http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequ...
Some data:
Here are the per capita figures for health care costs in 2013 in PPP dollars (which take cost of living into consideration) from the OECD:
OECD average - 3463
US - 8713
UK - 3235
France - 4124
Australia (similar obesity) - 3966
Germany - 4919
Denmark - 4553
The Netherlands - 5131
Canada - 4361
Israel - 2128
Let;s compare some bottom line statistics between the US and the UK which has real socialized medicine.
Life expectancy at birth:
UK - 81.1
US - 78.8
Infant Mortality (Deaths per 1,000):
UK - 3.8
US - 6.0
Maternal Mortality (WHO):
UK - 9
US - 14
If you want to bring up the VA, let me point out that any program no matter how well thought out can be ruined by lack of funding and incompetence. (One can combine these two by regarding lack of funding as incompetence on the part of Congress.) As Einstein said,
"The difference between genius and stupidity is that genius has its limits."
5
Come on House Republicans. This is no time to be shy. Surely you have a replacement plan since you tried to repeal the ACA dozens of times. Put it out for all of us to see and marvel at.
3
The verdict of this election seems clear. The Democrats, when they had the chance, should have enacted their preference (including Obama's): single payer. That should be their goal going forward. The repeal of Obamacare will eventually produce a backlash sufficient to do it.
1
But it only gets worse. Ryan is insisting on Medicare reform, turning it into private insurance with a voucher, a voucher that will not cover the cost of insurance. But the Republicans won't care. They simply want to get healthcare of the back of the tax base so they can permanently ensconce low tax rates for themselves. They really won't care what the public reaction is. This is a scorched earth administration that will undue everything possible in four years. It will take generations to return to the conditions they are about to destroy.
2
But Mr. Gruber, you are applying mathematics and logic to this problem! Where is your magical thinking?
Leave it to the Times to pull discredited Gruber out of their hat to make the argument for the ACA.
https://www.washingtonpost.com/opinions/marc-thiessen-thanks-to-jonathan...
Find someone who still has credibility to make this argument - is it really that hard?
The Times demonstrates once again how sad and disconnected from reality its opinion writers, on staff and otherwise, are.
https://www.washingtonpost.com/opinions/marc-thiessen-thanks-to-jonathan...
Find someone who still has credibility to make this argument - is it really that hard?
The Times demonstrates once again how sad and disconnected from reality its opinion writers, on staff and otherwise, are.
I am a physician. I also have type 1 diabetes. I love the fact that people such as myself can get coverage under the ACA. I am niether a Republican or a Democrat. But here is the problem with the ACA that the average well educated NY Times reader with good employer based coverage does not get. Here is a text from someone I know in Arizona, with permission.
"There is only one silver level ACA plan available in my county for 2017. The premium is $1,354 per month for me. For a couple that are my age whose income is roughly $64,100 , the monthly premium is $2,709 per month or $32,508 per year yep, that is over 50% of their income
" The two bronze level plans in my County are not that much cheaper. There is also one gold level plan. That's it. Four amma floor plans total. One insurer.
"In case you are challenged concerning your health insurance post you can verify at the healthcare.gov website. Look at the 2017 plans for a 64 year old couple with an income of approximately $64,100. They will ask you your ZIP code and County. The ZIP code is 85142 and the county is Pinal
Thus its clear the ACA needs fixing. I don't know what the answer is, but clearly there are major issues that wealthy Americans don't realize. I see individual contractors who must buy their own insurance, and low income people who can't afford it. I treat a lot of type 2 diabetes. The cost rise of drugs and insulin in particular is heartbreaking. Unaffordable care is nearly as bad as no care at all.
"There is only one silver level ACA plan available in my county for 2017. The premium is $1,354 per month for me. For a couple that are my age whose income is roughly $64,100 , the monthly premium is $2,709 per month or $32,508 per year yep, that is over 50% of their income
" The two bronze level plans in my County are not that much cheaper. There is also one gold level plan. That's it. Four amma floor plans total. One insurer.
"In case you are challenged concerning your health insurance post you can verify at the healthcare.gov website. Look at the 2017 plans for a 64 year old couple with an income of approximately $64,100. They will ask you your ZIP code and County. The ZIP code is 85142 and the county is Pinal
Thus its clear the ACA needs fixing. I don't know what the answer is, but clearly there are major issues that wealthy Americans don't realize. I see individual contractors who must buy their own insurance, and low income people who can't afford it. I treat a lot of type 2 diabetes. The cost rise of drugs and insulin in particular is heartbreaking. Unaffordable care is nearly as bad as no care at all.
1
The fundamental flaw in our healthcare system is on display again: for-profit healthcare is an oxymoron, because if the goal is profit, it cannot also be optimal healthcare, but more often than not is merely a tip of the hat to patient care. Similarly, for-profit incarceration is another example, where retraining for a life beyond prison does not take precedence if the motive is profit. The problem is the corporate state. There are certain areas in the social arena that cannot be optimized if the profit motive interferes. Single payer was and still is the answer in this realm, but the time for that solution has apparently passed for a while. I hope I live to see its implementation attempted at some point in the future.
116
You hit the nail on the head!! Healthcare MUST NOT BE A BUSINESS!! period!. The whole World has realized this except for "Greedy" American Medical Industry which with its sister industry, the Military Industrial Complex are destroying this country. If a Government run system can not work then how do you explain Medicare? There are people in this country that oppose Government run healthcare but want to keep their Medicare!!
1
Good concise statement of the problem.
1
I might add education to your list. The proliferation of charter schools, owned by people trying to get rich off of them, is terrible. Education is not for profit, the same as health care, incarceration, vitally necessary utilities such as heat and water...
1
If the ban on a denial of coverage for pre-existing conditions is maintained the insurers have one of two choices. Charge the market price (which means it's unaffordable and therefore coverage has effectively been denied) or go bankrupt as millions of people with cancer, emphysema, diabetes, etc. etc. show up wanting to purchase insurance at an affordable price. This is why you need the mandate because it's a fundamental component of the insurance business model which Trump doesn't appear to understand. RISK SPREADING. The insurer's jargon description for all this is guaranteed issue (of coverage) and community rating (affordable prices). It's inescapable!
50
You state the truth. Neither Trump nor his kids or any of his other crack advisers have any knowledge of how the ACA regs are intertwined.
1
@Kathyinct
Fairfield County CT
Exactly so. Obamacare is a hybrid of a private insurance model where risk is spread both by the mandate and as a natural process of enrolling a diverse number of users; and subsidies for low income enrollees. If you don't want a single payer system this is the only option as every president from Nixon onwards who has tried to address the issue has found. It's this or back to the pre 2008 situation of ever increasing costs and premiums, and ever more employers dropping coverage and adding to the ranks of the uninsured. This is not rocket science. This is why it's going to very entertaining watching Republicans take health insurance off 22 million people. Remember when they screamed (falsely) that Obamacare was taking coverage off 2-3 million people.
Fairfield County CT
Exactly so. Obamacare is a hybrid of a private insurance model where risk is spread both by the mandate and as a natural process of enrolling a diverse number of users; and subsidies for low income enrollees. If you don't want a single payer system this is the only option as every president from Nixon onwards who has tried to address the issue has found. It's this or back to the pre 2008 situation of ever increasing costs and premiums, and ever more employers dropping coverage and adding to the ranks of the uninsured. This is not rocket science. This is why it's going to very entertaining watching Republicans take health insurance off 22 million people. Remember when they screamed (falsely) that Obamacare was taking coverage off 2-3 million people.
3
Pre-existing coverage was mandatory with HMO coverage in Texas. It sort of worked because HMO coverage was group coverage and the costs of treating sick people was offset by getting premiums from healthy people. Even so, most group coverage in Texas moved to PPOs because there was no requirement to cover anyone with pre-existing conditions for those conditions and insurers made contracts with providers to pay less than fair market value for doctor visits and hospital stays among other costs. Just getting pre-x coverage does not mean that it will be affordable and I expect the subsidies will go away. We will be left with the GOP genocide plan where the sick who have money will get very expensive coverage and the rest will die for lack of treatment. Lets start counting the Trump promises which will not happen.
33
(Not Mark) You know there are other things we can do, don't you? It's not all or nothing. That's a big problem in this country, it's either 'my way or the highway' whether you're left or right. I say this as neither.
Every year my employer-based heath insurance provider changes "to save you money" and it's a new round of doctors. Furthermore I detest this in-network/out-of-network model.
But these problems, and the high but still affordable premiums we face, pale in concern compared to the problems the uninsured faced, pre-Obamacare.
There are no easy and no inexpensive answers here.
We cannot ethically return to a system where sickness resulted in bankruptcy and premature death as was the case for millions pre-Obamacare.
All I have ever heard from the right is remove restrictions to crossing state lines. What, so we can all ride the elevator to the bottom? This is not what I want.
Well we could save on single payer, by capturing all the profit and salaries now going to the insurance companies. Great, that puts a whole sector of people out of work and that card can only be played once. Meanwhile, people expect more and more out of healthcare and costs only go up. Maybe moving away from the fee for service model could help.
Oh, and Somehow they've figured it all out in Europe, but we can't look there for solutions! Tell me again, why is that??
But these problems, and the high but still affordable premiums we face, pale in concern compared to the problems the uninsured faced, pre-Obamacare.
There are no easy and no inexpensive answers here.
We cannot ethically return to a system where sickness resulted in bankruptcy and premature death as was the case for millions pre-Obamacare.
All I have ever heard from the right is remove restrictions to crossing state lines. What, so we can all ride the elevator to the bottom? This is not what I want.
Well we could save on single payer, by capturing all the profit and salaries now going to the insurance companies. Great, that puts a whole sector of people out of work and that card can only be played once. Meanwhile, people expect more and more out of healthcare and costs only go up. Maybe moving away from the fee for service model could help.
Oh, and Somehow they've figured it all out in Europe, but we can't look there for solutions! Tell me again, why is that??
62
(Not Mark) Many countries in Europe use the insurance model that we have now. However, you should look into the idea of crossing state lines. It was more complex than you realize. Also, many places with government health care restrict access to medicine and different therapies, not always with the patient in mind. I have lived in Europe and seen it up close and personal, so to speak. Many Americans think they will be getting cadillac service at chevy prices.
1
It works in Europe because they have chosen to spread the risk over the entire population, as to basic (not fancy, not cutting edge) health care. In the U.S., Republicans especially like the idea of not forcing you to buy something you might not need. Collectively, until we are willing to pay the higher taxes required, it cannot happen here. The ACA only got us part of the way there, and now the Republicans want to walk that back. Not wealthy? Too bad.
Never from the Right have we heard serious solutions or serious willingness to work towards improvements.
And now Trump is going to wave a magic wand and make it all better? Trump Nation is seriously deluded here.
And now Trump is going to wave a magic wand and make it all better? Trump Nation is seriously deluded here.
35
(Not Mark) That is simply untrue. I'm an independent, but I remember quite a few republican ideas that were out there. The dems wanted it their way and they got it.
Of all the discretionary things to cut in the national budget, why not instead reduce or scrap the billions of $ subsidizing foreign governments so they go without and we dont? We have a serious deficit to overcome the interest on which is also flowing abroad.
5
A minuscule fraction of the budget that would not even put a dent in healthcare
The tenets of the Republican replacement for "replace" has already been tried and have essentially abandoned because they have been abject failures!
First, some states have tried preexisting conditions "insurance" pools, on for those needing them found themselves essentially uninsured as waiting lists and exponentially grown, premiums rates rapidly grown and initial deductibles rose!
Second, what happened when credit card companies were freed to sell across state lines, the companies fled to little regulations friendly states like South Dakota and Delaware, with the result that interest rates skyrocketed. Without any checks on company behavior, there will be yet another ugly race to the bottom!
First, some states have tried preexisting conditions "insurance" pools, on for those needing them found themselves essentially uninsured as waiting lists and exponentially grown, premiums rates rapidly grown and initial deductibles rose!
Second, what happened when credit card companies were freed to sell across state lines, the companies fled to little regulations friendly states like South Dakota and Delaware, with the result that interest rates skyrocketed. Without any checks on company behavior, there will be yet another ugly race to the bottom!
26
(Not Mark) If you let people pick insurance from any state while keeping a basic national policy (such as catastrophic care that is the ACA now), then people will have more to choose from and perhaps, find something they both like and can afford. States have many mandates that drive up the prices of insurance policies and also create monopolies. This helps the insurance companies, they don't have to worry about customers, they have no where to go.
Take away the mandate and keep the existing condition requirement, and see how many insurers want to be in the market. And if they do, watch what they charge for premiums so they can make any money.
27
"This car is lousy so we're getting rid of it!
But the tires are great so we're going to keep them (and say we fixed the car)!"
Whoopie.
But the tires are great so we're going to keep them (and say we fixed the car)!"
Whoopie.
25
Now that the Republicans are running the show they're going to have to quit their whining: they bought the jalopy saying they could fix it and now it's all on them. Let the infighting begin in 3, 2, 1 as Paul Ryan et al. try to repeal it altogether or do as Dr. Gruber outlines here. What's worse, once you give people a benefit it's much harder to take it away than never give it to begin with. Trump is going to be forced to placate the working class that elected him while running afoul of the millionaires running the healthcare system, or run afoul of the working class to placate the corporations and their lobbyists who own our senate and congress. Hoo-boy, it's perverse but I'm looking forward to the dogfight. What are the Trump voters in states that have adopted the ACA going to do when they're told that the whole lot of "terrific" that is replacing their healthcare turns out to be a whole lotta nothin'? The corporations are in it for profit, the lobbyists doing their darndest for the corporations, the politicians who spend half their time dialling for dollars are going to have to determine who comes first: the people who fund their campaign or the people who vote them into office. They'll choose The Money, you can count on it.
No excuses left now. They own this. Yee-ha!
No excuses left now. They own this. Yee-ha!
65
(Not Mark) So tell me, what did the dem's choose?
Trump's stated plan is to replace ACA with better insurance at a lower premium. Who doesn't want that?
Just wondering if Trump will be including the cure for cancer in his plan as well.
Just wondering if Trump will be including the cure for cancer in his plan as well.
23
Well, Yes. His plan will allow then to Die
All he needs to do is start up his perpetual motion machine
No, but each of us will get our very own unicorn.
Fool me once, shame on Gruber, fool me twice, "call it the stupidity of the American voter or whatever…"
(The full Gruber quote caught on video: "Lack of transparency is a huge political advantage. Call it the stupidity of the American voter or whatever, but basically, that was really, really critical for the thing to pass.")
(The full Gruber quote caught on video: "Lack of transparency is a huge political advantage. Call it the stupidity of the American voter or whatever, but basically, that was really, really critical for the thing to pass.")
19
@Marian
New York, NY
Lack of transparency and the accompanying lack of voter knowledge and interest (how much do you really know about the ACA or the TPP?) are a fundamental part of the process of representative government. That's why it's called sausage making. How naïve are you?
New York, NY
Lack of transparency and the accompanying lack of voter knowledge and interest (how much do you really know about the ACA or the TPP?) are a fundamental part of the process of representative government. That's why it's called sausage making. How naïve are you?
13
If only we were all as worldly as John. He is wise enough to accept Gruber's designation as stupid.
2
(Not Mark) Lying to the electorate is not part of the 'sausage making'. I'm up to snuff on both programs and knew how bad the ACA would be before it was passed. A little economics knowledge is not a bad thing either.
2
Regarding children up to age 26, the goal should be to have a vibrant economy and children should be full time students or on their own at 21. At this time, there are too few good jobs, but the goal is the same.
15
Isn't Gruber the one that said 'just lie' to ignorant people? And we're suppose to take anything he says serious? BTW 'you reap what you sow'.
9
Or just not tie health insurance to employment, like the rest of the industrialized world.
The writer of this piece has an absurd opinion. His example of the breast cancer survivor actually had two options under the prior system before Obamacare: no insurance, or exorbitantly expensive insurance in a high-risk pool. This is not a real option for many who must scrape to pay their food, lodging and other bills. The Obamacare provision that bans insurance discrimination due to pre-existing conditions is a proverbial Godsend.
The fatal flaw of Obamacare is that it remains a huge giveaway to for-profit insurance companies and enormous sums that could be spent on actual care go to the whole intermediary bureaucracy, insane amounts of paperwork and salaries--truly obscene in the case of executives.
Obamacare is not a cousin of the type of universal coverage = true universal CARE that every other affluent, civilized country enjoys. It is a different creature entirely.
What the US needs is Medicare for all as Bernie Sanders advocated. In doing its best to defeat Bernie (who would have won the general election against Trump) and pushing Hillary Clinton who could not win the NYT has helped to create the looming healthcare crisis and many more.
Obamacare is not a cousin of the type of universal coverage = true universal CARE that every other affluent, civilized country enjoys. It is a different creature entirely.
What the US needs is Medicare for all as Bernie Sanders advocated. In doing its best to defeat Bernie (who would have won the general election against Trump) and pushing Hillary Clinton who could not win the NYT has helped to create the looming healthcare crisis and many more.
90
To Judy in Vermont
I can not tell you how happy I am to see that someone over there who has finally figured things out. Bernie wanted to do great things for America. He wanted the country to stop castrating its youth by making it so hard and expensive to go to college. The idea that Hillary Clinton should have been the Democratic candidate was appalling to me. I say that as someone who voted for Obama with enormous enthusiasm. Hillary is the darling of Wall Street. Wall Street wanted Hillary and not Trump. Hillary had about as much appeal to the working class as Marie Antoinette had for the peasants of France.
My mind has been in a spin since this election and considering the outcome the only reasonable conclusion I can come to is that Hillary Clinton was a Republican mole who has successfully brought destruction to the Democratic Party, has enabled the Republicans to obliterate everything Obama has done, forced Obama to humiliate himself by having to invite a man who he said was mentally unfit to be President to the White House and now has to go to Europe to defend Trump. Years from now historians simply looking at the numerical results of this election would conclude that either the current President was awful or the Democratic candidate was awful. Now the conservatives will be able to appoint at least one and maybe more justices to the Supreme Court.
Maybe in 2020 she will try again and she can complete her work of destruction.
I can not tell you how happy I am to see that someone over there who has finally figured things out. Bernie wanted to do great things for America. He wanted the country to stop castrating its youth by making it so hard and expensive to go to college. The idea that Hillary Clinton should have been the Democratic candidate was appalling to me. I say that as someone who voted for Obama with enormous enthusiasm. Hillary is the darling of Wall Street. Wall Street wanted Hillary and not Trump. Hillary had about as much appeal to the working class as Marie Antoinette had for the peasants of France.
My mind has been in a spin since this election and considering the outcome the only reasonable conclusion I can come to is that Hillary Clinton was a Republican mole who has successfully brought destruction to the Democratic Party, has enabled the Republicans to obliterate everything Obama has done, forced Obama to humiliate himself by having to invite a man who he said was mentally unfit to be President to the White House and now has to go to Europe to defend Trump. Years from now historians simply looking at the numerical results of this election would conclude that either the current President was awful or the Democratic candidate was awful. Now the conservatives will be able to appoint at least one and maybe more justices to the Supreme Court.
Maybe in 2020 she will try again and she can complete her work of destruction.
Holy mackerel. If it were such a big giveaway to insurance companies, why have so many abandoned the exchanges? I see, they want to skip the giveaway.
The GOP plan is Medicare for none, not Medicare for all...."Paul Ryan sees an opening to gut Medicare, Obamacare — and it’s all thanks to Donald Trump"
www.salon.com/2016/11/14/paul-ryan-sees-an-opening-to-gut-medicare-obama...
www.salon.com/2016/11/14/paul-ryan-sees-an-opening-to-gut-medicare-obama...
1
I see many of the woe-is-me, anti-Obamacare types are out in force with their non-evidentiary claims of high healthcare insurance premiums caused. Conversely, you see nothing of the increased costs of capitalist provided group healthcare insurance.
I can tell you that in the 2001, the monthly cost of an affordable group life insurance plan (Healthcare Savings Account plan with $5,000 deductible) for employees of a small business (45 employees) I managed was over $400 per family. Based on the typical increase of six percent annually, that premium equates to a monthly premium of $958 in today's dollars.
Keep in mind that a healthcare savings account program, with its very large deduction, is what Trump and his fellow Republicans are proposing.
Obamacare should be improved, not repealed.
I can tell you that in the 2001, the monthly cost of an affordable group life insurance plan (Healthcare Savings Account plan with $5,000 deductible) for employees of a small business (45 employees) I managed was over $400 per family. Based on the typical increase of six percent annually, that premium equates to a monthly premium of $958 in today's dollars.
Keep in mind that a healthcare savings account program, with its very large deduction, is what Trump and his fellow Republicans are proposing.
Obamacare should be improved, not repealed.
43
Who can save up enough in a health savings account, even over say 10 years, to cover a major surgery and days in a hospital?
Tell you one thing - if Dr. Ben Carson is giving advice, we'll be lucky if anyone has a path to any likable and workable insurance.
Seems he's the only medical pal Trump has and has been rumored to assist Trump.
As an RN Case Manager whose job it was for decades to help patients both inpatient/outpatient insurance issues, Ben Carson's mumbling were very difficult to decipher, in fact, impossible. It is hideous to see comments from obviously people who know nothing about insurance to praise the "highly intelligent" Dr. Ben Carson and look to him to set healthcare straight in America!
True, the Affordable Care Act may not have proven to be perfect, but without it, many would have endured not only untoward pain and suffering, but economic demise. Donald Trump knows nothing about healthcare law, healthcare policies, and healthcare period. But to think a neurosurgeon, whose job it was to operate on people's brains, would be a guru in the insurance policy world is very far fetched.
Trump's biggest personal take on "getting rid of Obamacare on Day 1" was to get rid of anything connected with Barack Obama - and Obamacare, the Republican namesake version of healthcare insurance would certainly be just one way in Trump's false promises to make his America Great. Such fibs!
Seems he's the only medical pal Trump has and has been rumored to assist Trump.
As an RN Case Manager whose job it was for decades to help patients both inpatient/outpatient insurance issues, Ben Carson's mumbling were very difficult to decipher, in fact, impossible. It is hideous to see comments from obviously people who know nothing about insurance to praise the "highly intelligent" Dr. Ben Carson and look to him to set healthcare straight in America!
True, the Affordable Care Act may not have proven to be perfect, but without it, many would have endured not only untoward pain and suffering, but economic demise. Donald Trump knows nothing about healthcare law, healthcare policies, and healthcare period. But to think a neurosurgeon, whose job it was to operate on people's brains, would be a guru in the insurance policy world is very far fetched.
Trump's biggest personal take on "getting rid of Obamacare on Day 1" was to get rid of anything connected with Barack Obama - and Obamacare, the Republican namesake version of healthcare insurance would certainly be just one way in Trump's false promises to make his America Great. Such fibs!
79
If he's actually appointed to Trump's team and assigned a health care policy role, you can be sure that Dr. Carson will not be the one developing the policies and rules. Staffers further down the line will be doing the hard work. Dr. Carson's life experience as an excellent physician does not equate to understanding the intricacies of the various health insurance markets.
Trump has the possibility to truly become a working class hero (like FDR) if he fixes ObamaCare and transforms it into something that works for everyone.
11
Did you not read the article you commented on?
46
The article doesn't describe a fix. It describes a moral hazard.
9
FDR created Social Security, so senior citizens would no longer starve to death. Trump wants to make healthcare available only to very rich, which will kill a lot of people. "Trump" and "FDR" should never appear in the same sentence, unless it is to show how diametrically opposed they are.
2
Problem is everyone wants to have free healthcare. Problem is life isn't free. Free healthcare = taxes. Raise taxes = complainers complain. Lower taxes = no free healthcare = complainers complain. See. It's a darned if you do, darned if you don't world. Healthcare shouldn't be profit oriented because a health work force = productive workforce. I am in favor of single payor (and before you say RATIONING, don't think rationing isn't done already). I'm in favor of preexisting conditions not being a reason insurance companies use to deny care and having the college age children on parent's health care policies. Personally I am on a college student health plan and it stinks.
13
I would not mind paying taxes if, 1. I could be assured that Trump and others of his ilk were paying at the same rate on all their income as I do; and 2. If we cut out the waste on things such as too many days off for and high pay for members of the government and their various aides and eliminate all lobyists.
The way to solve the insurance problem in the US is to adopt a more European solution--your insurance premium is deducted from your income regardless of the source of that income.
No more free rides for people like Trump.
The way to solve the insurance problem in the US is to adopt a more European solution--your insurance premium is deducted from your income regardless of the source of that income.
No more free rides for people like Trump.
1
Everyone wants it free?
Or affordable, non-bankrupting?
Or affordable, non-bankrupting?
2
(Not Mark) Why do you think your government plan would be any better than the one you're on now?
The central question in health insurance is whether healthy people will help pay the costs of sicker people or not. The public is never asked this question or forced to answer it. Instead, we try to get healthy people to pay the costs of sicker people, but in indirect or subtle or dishonest ways. If health care is supplied by employers, then healthy people will indirectly help sicker people but the employer may be discouraged from hiring people with a known likelihood of being expensive to insure because doing so would get him higher insurance premiums.
On the individual marketplace, it makes economic sense for insurers to discriminate against people it may cost them more to serve. That is the way markets work. They will discriminate any way they can (and will be discreet if it is illegal). They all want to get clients that are cheap to insure, and will offer these clients lower rates if they are allowed to do so.
So the free market gives a clear answer to the question of whether healthy people will subsidize sicker ones, and that answer is that they will not. To get this subsidy to happen, markets must be induced to behave unnaturally. The convolutions of our health insurance is partially explained by political need to make subsidies happen without seeming to do so and thereby violate free enterprise principles.
If we the people decided for full or partial subsidies, implementation would be a geeky technical question rather than an object of confused debate.
On the individual marketplace, it makes economic sense for insurers to discriminate against people it may cost them more to serve. That is the way markets work. They will discriminate any way they can (and will be discreet if it is illegal). They all want to get clients that are cheap to insure, and will offer these clients lower rates if they are allowed to do so.
So the free market gives a clear answer to the question of whether healthy people will subsidize sicker ones, and that answer is that they will not. To get this subsidy to happen, markets must be induced to behave unnaturally. The convolutions of our health insurance is partially explained by political need to make subsidies happen without seeming to do so and thereby violate free enterprise principles.
If we the people decided for full or partial subsidies, implementation would be a geeky technical question rather than an object of confused debate.
10
And yet it is normal to require everyone to have car insurance, and a common complaint when hit by an uninsured motorist, to the point that many carry uninsured motorist insurance. But do you hear many people rail against home owners' insurance or car insurance? No. Yet they ALL work by spreading the risk around and those who don't use it, subsidizing those who do.
80
@sdavidc9
And that is how insurance works, car insurance, homeowners insurance, flood insurance, you name it. Some have claims and some have no claims. In the case of group health insurance coverage, i.e. employer coverage, the sick have claims and the healthy subsidize those claims with their premiums. Premiums are based on the experience of the group. But if you are a group of one, because you are buying a "one off by yourself policy," your experience sucks. Other fallout of course is that employers will not have to provide coverage. So group coverage will drop in numbers as well. My guess is that with the plan Congress allows Trump to have, if any, the number of uninsured's will skyrocket. Then we are back to ER coverage for the uninsured which is the most expensive health care in the world. This by the way is paid for by taxpayers as local taxes.
And that is how insurance works, car insurance, homeowners insurance, flood insurance, you name it. Some have claims and some have no claims. In the case of group health insurance coverage, i.e. employer coverage, the sick have claims and the healthy subsidize those claims with their premiums. Premiums are based on the experience of the group. But if you are a group of one, because you are buying a "one off by yourself policy," your experience sucks. Other fallout of course is that employers will not have to provide coverage. So group coverage will drop in numbers as well. My guess is that with the plan Congress allows Trump to have, if any, the number of uninsured's will skyrocket. Then we are back to ER coverage for the uninsured which is the most expensive health care in the world. This by the way is paid for by taxpayers as local taxes.
11
@Raindrop: Perhaps the reason people do not rail against home owner's insurance or car insurance is that nobody expects to be able wait to buy coverage AFTER his/her car or home is damaged and then receive a payout far in excess of the premium paid. In order to receive full, unrestricted Medicare insurance coverage, I had to provide evidence that I was already insured. My wife, who is not eligible for Medicare was informed by BC&BS that her monthly premium would be doubled from $700/month to $1,400/month as a direct result of Obamacare. Much of the additional coverage obviously came from increasing premiums for those who were already paying and even that proved to not be sufficient.
1
Please, each person who writes a reply, use the @ sign followed by the name of the person to whom you are replying. One might think that the Times could add this instruction to the word reply.
Only-NeverInSweden.blogspot.com
Only-NeverInSweden.blogspot.com
2
GOP loves EMTALA or Reagancare for the uninsured and illegals. It is an unfunded mandate placed on hospitals to care for anyone who struggles into the ER. Of course there is the small issue of paying for this socialist endeavor. Most hospitals go bankrupt if they rely just on the insured to sustain themselves. Federal funding to most hospitals dried up with Obamacare and without expanded Medicaid, and hospitals closed up in poorer rural areas like down here in backwards Georgia.The only other hope is expanded medical clinics for the poor which decreased due to Obamacare's mandates placing requirements on the employer and the uninsured who were above the poverty line. GOP will continue to play football with US health care so that only the healthy and wealthy get adequate and affordable care.
19
Considering my premium before Obama came into office was $120 a month and my premium for 2017 is $440 a month..I gotta say..if Trump want's to blow this thing up to make it worse then at the very least it's a start in the right direction towards creative destruction. Maybe single payer emerges after the plans get to $5000 a month before Trump leaves office..at least there will be a significant increase in demand to totally reform the system - this comes from an Hayek style capitalist! That said I think single payer would be what pre-ops needed to bringing costs down so we can eventually eliminate all insurances and government involvement and have people pay the full price upfront - again, only after single payer works to bring down prices and reforms are made in regards to patent reform (5 years protection max!) and increase in shifts of responsibilities from doctors to NPs. So if Trump leads to complete chaos in healthcare plans..at this point I don't even care as with the continuation of the current set up I'm bound to be paying above $500 a month in 2018.
3
Given that the average cost of health care in the US is $6K/yr per person, your current premium is about right. If you think that is too much, you have to attack the cost of health care itself , not the cost of insurance.
Just imagine a USA in which the vote of each individual could be recorded in a database like that of the US Census Bureau.
In this database every person covered by ACA would also be registered.
Donald Trump succeeds in ending ACA and, of course, provides nothing in its place.
An automated system instantly gives the New York Times a graph showing the following.
Number of voters for Trump covered by ACA
Percentage of voters for Trump who no longer have any health insurance.
The Times then interviews Trump voters to learn how happy they are.
In other words, dream graphics that show how less well off Americans vote against their own interests.
Cannot happen. I was led to this line of thought because Sweden, a country whose medical researchers know that "race" is a meaningless non-scientific variable, is a country with databases that are gold mines for epidemiologists not only in Sweden but in the USA. These databases contain the complete medical histories of all of us covered by Universal Health Care and much more. Thus epidemiologists can carry out studies that, I believe, cannot be carried out in the USA. The Times reported on one such study within the past week.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
In this database every person covered by ACA would also be registered.
Donald Trump succeeds in ending ACA and, of course, provides nothing in its place.
An automated system instantly gives the New York Times a graph showing the following.
Number of voters for Trump covered by ACA
Percentage of voters for Trump who no longer have any health insurance.
The Times then interviews Trump voters to learn how happy they are.
In other words, dream graphics that show how less well off Americans vote against their own interests.
Cannot happen. I was led to this line of thought because Sweden, a country whose medical researchers know that "race" is a meaningless non-scientific variable, is a country with databases that are gold mines for epidemiologists not only in Sweden but in the USA. These databases contain the complete medical histories of all of us covered by Universal Health Care and much more. Thus epidemiologists can carry out studies that, I believe, cannot be carried out in the USA. The Times reported on one such study within the past week.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
10
Dear Swedish citizen Larry,
Are you single? I gotta get out of this cesspool here. (Just joking ... well maybe)
Are you single? I gotta get out of this cesspool here. (Just joking ... well maybe)
(Not Mark) A vote against the ACA is not a vote against insurance. It's a vote against this plan. The idea of the government have a database with everything about me and mine gives me the heebie jeebies, but to each his own.
@ Moira San Antonio Texas - Moira to do many kinds of epidemiological research requires those kinds of databases. My familiarity with that kind of research led me to present an Orwellian scenario that I would not want implemented. I just want a few people to imagine what may happen when Donald Trump's extreme promises cannot be realized. I have no idea about the demographic groups covered by the ACA but just suggesting, if there are large groups of out-of-work people who are now covered and one day discover they are not, what then.
No even in Sweden we do not want my Orwellian example. Thanks for the reply
Larry
No even in Sweden we do not want my Orwellian example. Thanks for the reply
Larry
This whole issue makes me want to bang my head against my desk.
Look folks, the wheel has already been invented here.
Just look at what every other functioning country is doing.
There are basically three ways of doing this:
1. Single payer (medicare for all),
2. A two tiered system (universal coverage for basic care, and private insurance for better, quicker care),
3. Insurance mandate (basically Obamacare)
Every other functioning country is using one of these three systems.
Listening to Republicans is like listening to children saying they like the fact that the wheel moves you forward. So they want to keep that aspect of the wheel. But they want to get rid of the round shape of the wheel.
You can't. That's what makes the whole thing work.
If it were possible to keep private insurance without a mandate, we would have done it. It doesn't work.
Even their own Heritage Foundation, who came up with the plan in the first place, knew that.
It is going to be fun watching Republicans tie themselves in knots trying to keep the good aspects of Obamacare without the Insurance mandate.
Good luck with that guys.
Look folks, the wheel has already been invented here.
Just look at what every other functioning country is doing.
There are basically three ways of doing this:
1. Single payer (medicare for all),
2. A two tiered system (universal coverage for basic care, and private insurance for better, quicker care),
3. Insurance mandate (basically Obamacare)
Every other functioning country is using one of these three systems.
Listening to Republicans is like listening to children saying they like the fact that the wheel moves you forward. So they want to keep that aspect of the wheel. But they want to get rid of the round shape of the wheel.
You can't. That's what makes the whole thing work.
If it were possible to keep private insurance without a mandate, we would have done it. It doesn't work.
Even their own Heritage Foundation, who came up with the plan in the first place, knew that.
It is going to be fun watching Republicans tie themselves in knots trying to keep the good aspects of Obamacare without the Insurance mandate.
Good luck with that guys.
223
And the subsidies. If people, especially those with pre-existing conditions, can't afford the mandated insurance, it all falls apart.
18
Here's hoping you have good insurance to take care of the head trauma from banging it on the desk.
Oh good lord. Republicans don't care. At all. You get nothing. Nada.
Your new plan, effective Jan 22 is essentially: "you're on your own squirt".
That's also their plan for Social Security and Medicare. And pretty much any other stuff that falls under the rubric of "social compact". Dept of Education? Gone. EPA? Gone.
The only thing that will continue to be socialized is the Defense Department: they will get everything they want and them some.
Your new plan, effective Jan 22 is essentially: "you're on your own squirt".
That's also their plan for Social Security and Medicare. And pretty much any other stuff that falls under the rubric of "social compact". Dept of Education? Gone. EPA? Gone.
The only thing that will continue to be socialized is the Defense Department: they will get everything they want and them some.
1
Now there's a country we haven't heard from, Dr. Gruber. He knows what you do, create a high risk pool and force the insurance companies to participate across state lines.
Any government subsidies should come from the phase out of the ESI tax exclusion. In fact, Mr. Gruber testified before Congress to do exactly that but was apparently overruled by Zeke. Although the hearing room was mostly empty that day, and Gruber was basically talking to himself.
The phase out would have a floor, so that employer paid premiums continue to be excluded from taxable income. And for those with higher AGI, out of pocket expense becomes deductible at a much lower rate, it was 7% of gross, Ocare changed it to 10%. The ratios should also go back to 5-1, instead of 3-1 to encourage younger healthier people into the exchanges. And most of all, get rid of the mandates, they are not constitutional anyway.
It is refreshing to see someone who does know what they are talking about, stating that these conditions only existed in the individual market prior to the AHCA.
The only thing now is, what do we call it? Ocare?
Or maybe, Grubercare.
Any government subsidies should come from the phase out of the ESI tax exclusion. In fact, Mr. Gruber testified before Congress to do exactly that but was apparently overruled by Zeke. Although the hearing room was mostly empty that day, and Gruber was basically talking to himself.
The phase out would have a floor, so that employer paid premiums continue to be excluded from taxable income. And for those with higher AGI, out of pocket expense becomes deductible at a much lower rate, it was 7% of gross, Ocare changed it to 10%. The ratios should also go back to 5-1, instead of 3-1 to encourage younger healthier people into the exchanges. And most of all, get rid of the mandates, they are not constitutional anyway.
It is refreshing to see someone who does know what they are talking about, stating that these conditions only existed in the individual market prior to the AHCA.
The only thing now is, what do we call it? Ocare?
Or maybe, Grubercare.
3
If insurance mandates are not constitutional then we should get rid of car insurance too.
14
Where are the stories of people who have been runined by ACA, as we used to see so many stories of those ruined by lack of options and unaffordable treatment before it? Yes, it was to an extent railroaded and there are problems to worked out. But scrapping something that has made life better for the millions who had nothing before and starting from scratch while those people are cast back into limbo makes no sense. Clinton was working out ways to bring down costs and streamline administration etc and it would be foolish, wasteful and risky for Trump to continue playing this game of chicken with a repeal. Repeal is the selfish way to go--for those unwilling to consider how it has helped and how it can be made better, and for Republicans and Trump who just want to tear down something else Obama accomplished and replace it with their big signature, which would very likely turn out to be exactly what a fix on ACA would look like.
26
(Not Mark) Please, the media loves the ACA, they would never have a story about a bad outcome.
I can't believe that anyone thinks that Trump has any plan to replace ObamaCare. He has a bunch of political slogans pretending to be policy. And he doesn't care. If you are not wealthy you are a loser. 'Nuff said.
The horror. The absolute, avoidable, horror.
The horror. The absolute, avoidable, horror.
120
I actually was genuinely touched when Trump said people wouldn't be dying in the streets. It was such an embrace of compassion when the loudest Republican voices had previously been screaming to let people die.
6
Is there already a website where every single person covered by the ACA can join others to tell President-to-be Trump what they face the day he and the Congress act on the ACA?
Then when and if all these people lose coverage can they become collectively an effective force that can send Trump and Co. a lesson during the next mid-term election.
I can easily imagine what Trump's actions will mean. Right now if I needed care at any level I could walk to my neighborhood Vårdcentral (Clinic) and get help immediately at no cost Or if I faced an acute problem then ambulance or taxi to akuten (Emergency room). Suppose that were all to be taken away from me tomorrow. Then what?
Perhaps Trump will give us our first chance to make him and those who voted understand that his goal is to make life much worse for exactly those people who most need help from the government.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
Then when and if all these people lose coverage can they become collectively an effective force that can send Trump and Co. a lesson during the next mid-term election.
I can easily imagine what Trump's actions will mean. Right now if I needed care at any level I could walk to my neighborhood Vårdcentral (Clinic) and get help immediately at no cost Or if I faced an acute problem then ambulance or taxi to akuten (Emergency room). Suppose that were all to be taken away from me tomorrow. Then what?
Perhaps Trump will give us our first chance to make him and those who voted understand that his goal is to make life much worse for exactly those people who most need help from the government.
Only-NeverInSweden.blogspot.com
Dual citizen US SE
17
Have you people figured it out yet?
If the Republicans are in the position to obliterate everything that Obama did making it seem as though his admininistration never existed then whose fault is that-Donald Trump or Hillary Clinton?
If the Republicans are in the position to obliterate everything that Obama did making it seem as though his admininistration never existed then whose fault is that-Donald Trump or Hillary Clinton?
6
Why must everything be Hilary's fault? She introduced single payer health care in 1993. She just won one million more votes that Donald Trump but she didn't really win because the Electoral College reaches into the swamplands and gives bigger voice to those living in the muck than to those who live on dry land. Hilary isn't running now. Why not blame yourself?
48
to maggieast
Having reread your comment I must add that the part about the "the Electoral College reaches into the swamplands and gives bigger voice to those living in the muck" speaks volumes about the people who support Hillary and their utter contempt for those who live in the muck. Why does the richest country in the world have people living in the muck? These are the kind of people that FDR, LBJ wanted to help and the Democrats are supposed to want to help.
Indeed why do you not blame yourself?
Having reread your comment I must add that the part about the "the Electoral College reaches into the swamplands and gives bigger voice to those living in the muck" speaks volumes about the people who support Hillary and their utter contempt for those who live in the muck. Why does the richest country in the world have people living in the muck? These are the kind of people that FDR, LBJ wanted to help and the Democrats are supposed to want to help.
Indeed why do you not blame yourself?
1
Some of those out there who voted for Trump to "shake things up" are also clueless as to what may happen to their health care. Obamacare is no panacea. In fact, there is an argument to be made for it being the result of a bad compromise. In getting "Obamacare", people still have high out of pocket costs, just not as high as prior to it, or (apparently) after it. It was never a good compromise. Republicans don't care about the law, and they certainly don't care about yours or anyone's high medical costs. Get used to this fact over the next 4 years, at least.
32
My out of pocket costs were $2500 under my previous healthcare plan, no that I got thrown into Obamacare my out of pocket costs are $6000. Want to try again on the affordable part !
7
If you lived in California you wouldn't have that high cost. Because very state can regulate prices and they did. Maybe you should move to a more progressive state.
37
Of course, you also live in a state whose governor refused to expand Medicaid, making health care more expensive than in states that did. So maybe your beef should be with your own state government, not the federal ACA program.
28
Trump will destroy the ACA gradually. I predict Congressional Republicans will repeal the entire act at the beginning of Trump's term with no defined replacement . But the act will be in place for 2017, probably with no penalty for not getting insurance. Then they'll pretend to work diligently on the replacement, passing individual portions of their alternative to great fanfare. Things like the aforementioned popular provisions, health savings accounts, deductibility of expenses, insurance companies across state lines, and scaled down block grants for Medicaid indexed to general but not medical inflation (the poor don't vote, nor, apparently do petulant Dems and millennials).
The magic of the insurance marketplace (and kind Republican state governments) will then take over until we're essentially back to where we started. A population that is largely uninsured, mostly priced out of the market, or dependent on increasingly stingy employers.
When/if this gets pointed out years later, they'll throw up their hands and say it's too complicated, and people really need to be responsible for their own lives and stop relying on government to fix things like health care.
They'll end up proving government can't do anything right and people who were poorly served by the ACA , mostly in red states, will just believe them.
No one will be held accountable except, perversely, maybe the Democrats for several more generations.
Rinse and repeat for Medicare and Social Security.
The magic of the insurance marketplace (and kind Republican state governments) will then take over until we're essentially back to where we started. A population that is largely uninsured, mostly priced out of the market, or dependent on increasingly stingy employers.
When/if this gets pointed out years later, they'll throw up their hands and say it's too complicated, and people really need to be responsible for their own lives and stop relying on government to fix things like health care.
They'll end up proving government can't do anything right and people who were poorly served by the ACA , mostly in red states, will just believe them.
No one will be held accountable except, perversely, maybe the Democrats for several more generations.
Rinse and repeat for Medicare and Social Security.
75
Red state governments did this to their people. They could have controlled costs but didn't. Don't blame o care for that.
How very humorous.
Mr Gruber works for an American university that undoubtedly provides him with excellent health care insurance singing the praises of Obamacare. Would he be so generous with his analysis if he and his family had Obamacare of the bronze level with its high deductible?
Mr Gruber works for an American university that undoubtedly provides him with excellent health care insurance singing the praises of Obamacare. Would he be so generous with his analysis if he and his family had Obamacare of the bronze level with its high deductible?
6
John-cc:
Your ad hominem attacks on Mr. Gruber does nothing to undermine his argument that Trump's proposed changes to Obamacare will make life miserable for millions of Americans. Conversely, it fully undermines your position.
Your ad hominem attacks on Mr. Gruber does nothing to undermine his argument that Trump's proposed changes to Obamacare will make life miserable for millions of Americans. Conversely, it fully undermines your position.
21
My daughter in the US and has Obamacare. It is worth nothing. She did not even want it but only has it because she would be penalized if she did not take it. I had to help her figure out what to chose because it was so complicated What a wonderful system. It was bad enough not having insurance and now you would even have to pay a fine if you did not have it. If her experience is even a slight measure of others then your statement that the changes will make millions miserable is not true because millions with Obamacare are miserable.
As for my attacks on Mr Gruber you did not answer my question. Indeed you have attacked me for asking it. Would he be so generous with his analysis if he and his family had Obamacare of the bronze level with its high deductible?
As for my attacks on Mr Gruber you did not answer my question. Indeed you have attacked me for asking it. Would he be so generous with his analysis if he and his family had Obamacare of the bronze level with its high deductible?
2
John-cc. By your argument it would seem because Donald Trump is very wealthy and does not depend on Obamacare he has no right either to propose policy. Of course he can and the right to express ideas and opinions is enshrined in the first amendment.
Republicans "can’t hide the fact that repealing the ... protections ...central to the act would be a cruel backward step?" Well, I'm not so sure. They've thrown an 8 year temper tantrum about the ACA without any of them ever giving an explanation of how they would solve the problems the ACA addresses. I can recall no reporter calling them on this fraud (though during campaigns quite a few citizens have exposed them with hard questions before small audiences).
57
A curious piece of the agonizing efforts to get health care to US citizens is that when the gone but not forgotten Hillary Clinton as First Lady presented her plan, it was savagely rejected. But Hillary persistent as always no matter what the level of insult, went humbly to Chuck Grassley who controlled the republicans in the committee that would have to give any health care bill a chance. Senator Chuck gave it some thought and came up with something that looked like the current ACA, then the word came down from Bob Dole: no health care for the uninsured EVER! Then Romney stole Chuck's plan and established it in Massachusetts and Chuck's republican plan WORKED for Mitt in Mass. Soo.. when Obama, Nancy, and Harry decided to give the effort one more try, the template was Chuck-Mitt. Since it was a republican template, the foolish democrats thought they might get some Republican support. But no, the Bob Dole rule held--no affordable insurance for the desperate, not if the Republicans could help it. And so here we are. Now to be sure there are lots of subsidized health care in the US, let's see: Medicare, medicaid, free care for the actvive duty warriors in the Armed Services, the VA for the discharged warriors, free care for Native Americans on reservations, even Medicare if under 65 with renal failure, company plans, union plans and more. But for the many left out of all that, there is the despised ACA or the best Republican plan: die young! So it goes.
47
Give the recent results of the election among the working class it's worth pointing out that health insurance is essentially a horribly regressive tax that hits the working class especially hard as they make just enough to get little if any subsidies but have to pay more or less the same amount as someone making $1 million/year or more. And anyone lucky enough to have his or her employer pick up the tab pays for it in lost wages, hence the wage stagnation we've been seeing the last few decades.
If someone really wanted to help the working class they'd be pushing for single-payer national health care funded by a mix of payroll and income tax. People making less than some number (say $100,000) would pay significantly less than they do now (perhaps hidden because their employers pay for it now) and not have to live in fear of losing their insurance if they lose or change their job. None of the tweaks to ACA and certainly not its repeal will help the working class. National health care is the answer.
If someone really wanted to help the working class they'd be pushing for single-payer national health care funded by a mix of payroll and income tax. People making less than some number (say $100,000) would pay significantly less than they do now (perhaps hidden because their employers pay for it now) and not have to live in fear of losing their insurance if they lose or change their job. None of the tweaks to ACA and certainly not its repeal will help the working class. National health care is the answer.
38
Well, yes. But presumably National Health care would never pass. I.e., it is politically impossible. I believe Obama asserted as much. Recall, the ACA as it is--a very market program, just passed by a hair.
3
Someone WAS pushing for single-payer national health care.
His name is Bernie Sanders.
BTW--he's STILL pushing for single-payer national health care.
His name is Bernie Sanders.
BTW--he's STILL pushing for single-payer national health care.
1
You know the drill: universal health care!
The only way for healthcare to really work, and be affordable, is to cover everyone. Every. Last. Person.
Enroll people at birth. Use the Medicare system with the VA thrown in. And public health as well. Everything. Together.
From Senators to Bricklayers. Farmers to Teachers. Soldiers. Sailors. Pilots. All of us with the SAME coverage. If the wealthy want to feather the nests of insurance companies and get concierge care, even for preexisting conditions, by all means pay away.
But instead, under some new name, a brand he'll get paid for, our Congress will betray the American people one more time - to enrich the insurance companies (for the insurance) and the financial folk (for the "healthcare savings accounts" - which eat you alive with account fees and fund fees).
This country has insane ways of getting "healthcare." If you're not mad to start with (and will mental health really be covered?), you'll be driven mad by the insane system.
Protest! Exercise your Right to Dissent, your Right to Assemble, your Rightbto Free Speech. Use it or lose it!
The only way for healthcare to really work, and be affordable, is to cover everyone. Every. Last. Person.
Enroll people at birth. Use the Medicare system with the VA thrown in. And public health as well. Everything. Together.
From Senators to Bricklayers. Farmers to Teachers. Soldiers. Sailors. Pilots. All of us with the SAME coverage. If the wealthy want to feather the nests of insurance companies and get concierge care, even for preexisting conditions, by all means pay away.
But instead, under some new name, a brand he'll get paid for, our Congress will betray the American people one more time - to enrich the insurance companies (for the insurance) and the financial folk (for the "healthcare savings accounts" - which eat you alive with account fees and fund fees).
This country has insane ways of getting "healthcare." If you're not mad to start with (and will mental health really be covered?), you'll be driven mad by the insane system.
Protest! Exercise your Right to Dissent, your Right to Assemble, your Rightbto Free Speech. Use it or lose it!
32
Where is the motivation to achieve in life if a bricklayer and a Fortune 500 CEO get the same benefits?
1
Um, maybe satisfaction in a job well done? Who's the elitist here?
4
Unbelievable! So getting treatment for illnesses should be determined by whether you're a bricklayer or CEO? What a monstrous, cruel idea.
4
I live in New York State. Under the pre-Obamacare iteration of health insurance, insurers were required to take all comers. Sounds great until you realize that what you were shoved into was a so-called "high-risk pool" that effectively forced the relatively healthy, who need insurance like the rest of us but who do not have it through an employer to pay exorbitant premiums to cover those with chronic and very expensive conditions. Since this pool of insureds was small, and got smaller every time the insurers jacked the premiums up (every year), this made premiums exorbitantly expensive, forcing a few relatively healthy people to pay for the really sick. This was a patently unfair price to charge for the privilege of obtaining any health insurance at all. Under Obamacare, or better yet a national health insurance system, everyone would be required to pay in, and the very very sick could be covered at a relatively low cost to all of us. The rest of us had coverage, including those who are now healthy and think disaster could not possibly happen to them.
11
New York state pre-ObamaCare did not have a mandate to carry coverage, which is why the "death spiral" happened to the insurance pool as you describe--very high cost. (It actually happened to me just before the ACA, when I lived in Binghamton, NY, and the premium for the lowest cost plan for a person of any age went up to $1100 a month for a person of any age from $600. just two years earlier.)
RomneyCare, in MA pre-ObamaCare, and ObamaCare, both have a "mandate" to carry coverage, in the sense that you pay a penalty for not having coverage. This is designed to avoid the adverse-selection (sicker people buying the insurance) that you experienced in New York. However, under ObamaCare, the penalty is kind of small, so, around the country, there is still a good bit of adverse selection.
In Massachusetts, under RomneyCare and now under ObamaCare, unlike the rest of the country, the people have more of a sense of social solidarity, and the mandate works better, and most people pick up coverage, and do not game the system and pick up coverage just when they get sick.
RomneyCare, in MA pre-ObamaCare, and ObamaCare, both have a "mandate" to carry coverage, in the sense that you pay a penalty for not having coverage. This is designed to avoid the adverse-selection (sicker people buying the insurance) that you experienced in New York. However, under ObamaCare, the penalty is kind of small, so, around the country, there is still a good bit of adverse selection.
In Massachusetts, under RomneyCare and now under ObamaCare, unlike the rest of the country, the people have more of a sense of social solidarity, and the mandate works better, and most people pick up coverage, and do not game the system and pick up coverage just when they get sick.
12
Fight for a form of ACA that benefits the people and not the
huge profits of the Corporate Hospitals and Insurance Companies.
huge profits of the Corporate Hospitals and Insurance Companies.
4
My boss has often said that if something can't be done at a profit, it isn't worth doing. In a capitalist economy, he's right.
This is is all about those with pre-existing conditions. What about all the young people who have chosen the bronze category for whom Obamacare is worse than worthless because it has such a high deductible but they are still required to have the insurance?
Any European who looks at the Obamacare and the rest of American health care system can only shake their head in amazement and will stumble for the right description. I live in one of the poorest countries in Europe. If I woke up sick this morning I simply go to the local health center where I can see my assigned doctor for about $5. He will prescribe for drugs that will be mostly generic and all my expenses are tax deductible. We spend more money on the health care of our dog than we spend on our own health care because it costs $35 to see a vet and if he needs a drug it is often not generic and sadly those expenses are not tax deductible.
My daughter is working in the US and if she gets seriously ill she will come back to Europe. Yes what a wonderful thing the merciful Democrats have done in making Obamacare.
Mr Gruber, Professor of a great American university, you give some hard serious thought to what I wrote.
PEOPLE IN OTHER COUNTRIES HAVE TO SPEND MORE MONEY ON THE HEALTH OF THEIR DOGS THAN THEY HAVE TO DO ON THE OWN HEALTH CARE.
Any European who looks at the Obamacare and the rest of American health care system can only shake their head in amazement and will stumble for the right description. I live in one of the poorest countries in Europe. If I woke up sick this morning I simply go to the local health center where I can see my assigned doctor for about $5. He will prescribe for drugs that will be mostly generic and all my expenses are tax deductible. We spend more money on the health care of our dog than we spend on our own health care because it costs $35 to see a vet and if he needs a drug it is often not generic and sadly those expenses are not tax deductible.
My daughter is working in the US and if she gets seriously ill she will come back to Europe. Yes what a wonderful thing the merciful Democrats have done in making Obamacare.
Mr Gruber, Professor of a great American university, you give some hard serious thought to what I wrote.
PEOPLE IN OTHER COUNTRIES HAVE TO SPEND MORE MONEY ON THE HEALTH OF THEIR DOGS THAN THEY HAVE TO DO ON THE OWN HEALTH CARE.
16
Yes, yes.
The thing is, here in America, a large proportion of the people have been brainwashed by Republican elites, and the political support for something like you have in Portugal would be considered too "socialistic". ObamaCare is considered more of a market solution. And that barely passed in our Senate (by a margin of 0 votes).
The thing is, here in America, a large proportion of the people have been brainwashed by Republican elites, and the political support for something like you have in Portugal would be considered too "socialistic". ObamaCare is considered more of a market solution. And that barely passed in our Senate (by a margin of 0 votes).
14
Maybe, just maybe, excessive taxation and expensive medical spending are the reason that it's among the poorest European nations. How many cutting edge tech firms have their roots in Portugal? How many billionaires call it home? How many soldiers do you have protecting your interests abroad?
Another great lie perpetrated by the Republican party and Trump is the repeal of all or some of the ACA and replacing it with TBD will reduce health care costs. It would seem that those blaming Obamacare for their rising health premiums, might yearn for its return. When Trump and a Republican Congress remove drug company regulations and private insurance industry uncertainty leads to higher health care costs and premiums, this will create a vicious cycle of individuals and businesses dropping health insurance while the insurers respond by driving premiums even higher. But of course, it will be all Obama's fault, even when he is out of office.
13
Let's re-wind this tape. How can any thinking human believe that if Obamacare had not come into existence that premiums would have plateaued and that people with pre-existing conditions would be insured at an affordable rate? Our population is aging, the technology and treatments to keep us alive are expanding (and people feel entitled to receive them), and our health care system continues to be fee-for-service and profit-driven, among other things. Trumpcare will not be better. Different, but not better.
32
It would have been better, of course, for Gruber to have made known his opinion before November 8; but perhaps he assumed Hillary was going to be president. Now that Trump has won the election, there are states, which have implemented the ACA, like California, that will have to choose whether it is preferable to try to salvage the ACA (even if federal subsidies are ended) or replace it with real health care reform -- as advocated by Bernie Sanders (but denounced by Clinton) -- namely, single payer, Medicare for All. Given Clinton's defeat, she won't be in a position to discourage/block single payer from being enacted in any states. Given Trump's threat to the ACA, there are states, like, California, that can do the right thing for its residents by abandoning the ACA and legislating a single payer program.
10
That is rather lengthy explanation of the obvious... Well, it should be obvious to anyone with half a brain. So either the Republicans who are promoting this disaster either are on drugs, incredibly stupid or do not care if people die because they cannot afford private health insurance. Now imagine what will happen to the elderly if Medicare is privatized in 2017 as Ryan claims, and every individual must find their own private insurance. What kind of premiums will be available to those on a fixed income, when the insurance company's pool of covered individuals is predominately the sick and elderly? to pay to an insurance company whose pool of insured is the sick and elderly?
This country is beginning to feel more and more Kafaesque.
This country is beginning to feel more and more Kafaesque.
15
I tried to point this out to my friends in Martin County and North Palm Beach County. Martin County's over 65 population is 28 percent. That the most important issue outside of SS and Medicare were fresh water releases from Lake Ockeechobee and that this would only be resolved by the replacement of the Corp managed Hoover Dike. They as usual got wrapped up in Gun's, God and Country and reelected Rubio instead of voting for their Congressman hoping to become a Senator Patrick Murphy. They voted in a Tea Party Congressman who's only real life experience was loosing his legs in Afghanistan and was moved into the district and funded by outside money. He will vote with the Tea Party Block and will never vote their interest. Stupid is as Stupid does. It is going to be a horrible 4 years. It will take a year or two to kick in. But the economic impact of this vote will be huge.
4
This is of course, a bit constrained by bias on what the President-elect might desire. He might want to, simply, open Medicare to all without restriction. Yes, perhaps the program might go bankrupt, increase the federal deficit, or be overwhelmed by new patients --but this might happen tomorrow and Mr. Trump's concerns might not extend that far.
Further, He could use the Swiss model, where each canton (state in the US) could offer a plan to its residents and choose deductibles. Of course, these solutions are not as pro-insurance industry as Obamacare, or Romneycare, and some GOP purists might object. Yet, if there are some checks and balances on an autocrat owning both Houses of Congress, it is unlikely that those will be engaged by something as unexciting as insurance when the deportation of millions, the defenestrating the Supreme Court, and the obliteration of climate change legislation is coming up.
Further, He could use the Swiss model, where each canton (state in the US) could offer a plan to its residents and choose deductibles. Of course, these solutions are not as pro-insurance industry as Obamacare, or Romneycare, and some GOP purists might object. Yet, if there are some checks and balances on an autocrat owning both Houses of Congress, it is unlikely that those will be engaged by something as unexciting as insurance when the deportation of millions, the defenestrating the Supreme Court, and the obliteration of climate change legislation is coming up.
2
Dear Donald Trump,
The Affordable Care Act (Obamacare) desperately needs TWO major improvements OVER ANY OTHERS:
1. Grant EQUAL INCOME TAX TREATMENT to all health insurance purchases .
2. "TEAR DOWN THIS WALL" which segregates America's health insurance risk pools between the employed and the unemployed. (Thanks to Ronald Reagan for the inspiring quote!)
Under Obamacare, businesses and congress continue to buy health insurance with BEFORE-TAX-DOLLARS (a significant income tax ADVANTAGE), while individuals must buy health insurance with AFTER-TAX-DOLLARS (a significant income tax PENALTY).
Individual policyholders continue to pay so much more in income taxes and premiums than businesses and congress do for the exact same health insurance coverage.
Granting "Equal Income Tax Treatment" to Individual Mandate Health Insurance Purchases will give ALL Americans the same tax treatment enjoyed by businesses and congress when purchasing private health insurance.
In the long run, granting Equal Income Tax Treatment to all health insurance purchases will help consolidate health insurance risk pools nationwide. Larger risk pools, when combined with fewer, more standardized comprehensive health plans, will lead to better health insurance coverage at lower rates for all Americans.
The Affordable Care Act (Obamacare) desperately needs TWO major improvements OVER ANY OTHERS:
1. Grant EQUAL INCOME TAX TREATMENT to all health insurance purchases .
2. "TEAR DOWN THIS WALL" which segregates America's health insurance risk pools between the employed and the unemployed. (Thanks to Ronald Reagan for the inspiring quote!)
Under Obamacare, businesses and congress continue to buy health insurance with BEFORE-TAX-DOLLARS (a significant income tax ADVANTAGE), while individuals must buy health insurance with AFTER-TAX-DOLLARS (a significant income tax PENALTY).
Individual policyholders continue to pay so much more in income taxes and premiums than businesses and congress do for the exact same health insurance coverage.
Granting "Equal Income Tax Treatment" to Individual Mandate Health Insurance Purchases will give ALL Americans the same tax treatment enjoyed by businesses and congress when purchasing private health insurance.
In the long run, granting Equal Income Tax Treatment to all health insurance purchases will help consolidate health insurance risk pools nationwide. Larger risk pools, when combined with fewer, more standardized comprehensive health plans, will lead to better health insurance coverage at lower rates for all Americans.
3
It is a fallacy to believe that corporate premiums are cheap. My company is self insured and our premiums with one dependent (spouse) are $670/month with an individual deductible of 3000 per person max. The only plan that will contain costs are single payer. But al long as health care in America is profit motivated fees will continue to escalate until our economy is crushed by them and more people die.
114
James Benning, You are exactly wrong. If private companies could provide health insurance cheaper than the government, Medicare Advantage would cost less than traditional Medicare.
3
My wife has "retiree" coverage through her previous employer (a health insurance company, ironically, and now a client of hers). We can see any doctor(s) we want without referrals, but it costs us nearly $700 each per month with a very high deductible - and it will go up to $800/month in 2017. Hardly 'affordable' for retirees. Looking forward to some savings soon with Medicare, if it's still around....
2
The bottom line is Trump has no properly informed idea about any aspect of being president, as we are seeing this past week. He has no clue on personnel, ethics, health care, foreign policy, money management, or any of the other basic roles he will have to play.
I predict he will either be impeached and removed or have an MI and resign in the first 2 years.
I predict he will either be impeached and removed or have an MI and resign in the first 2 years.
6
As a cancer survivor, I was denied health coverage a dozen years ago. I even proposed to several insurance companies that they cover me for all medical needs unrelated to cancer. They said no. Then I discovered that New Mexico had a high risk insurance pool which guaranteed me the right to insurance at a rate only somewhat higher than the policies which were denied to me. It seemed quite reasonable.
If the ACA is gutted, there are ways of insuring that those with preexisting conditions aren't totally screwed. We just have to be creative.
If the ACA is gutted, there are ways of insuring that those with preexisting conditions aren't totally screwed. We just have to be creative.
1
The pre-ObamaCare high-risk pools could be quite expensive. Each state had its own rules and premiums, I recall in CT, just prior to ObamaCare, a male 60-64 had to pay $23,000 a year in premiums, plus had to allow an additional stop-loss of $7500 a year, for a total of $30,000 a year just for one person. (Double that for a couple.)
Also, I actually did some research on this a while back, and the high-risk pools across the states had all kinds of flaws where you could be ineligible even if you had responsible maintained health insurance all of your life prior, and did not try to game the system. About half of states had such problems if you didn't move beteween states, and, if you dared move with a pre-existing condition, there was a problem in 3/4 of states.
This links are now dead, but, if interested, what I found is on my old page here: http://nasmusicsoft.com/HealthInsuranceUSATable.html
Also, I actually did some research on this a while back, and the high-risk pools across the states had all kinds of flaws where you could be ineligible even if you had responsible maintained health insurance all of your life prior, and did not try to game the system. About half of states had such problems if you didn't move beteween states, and, if you dared move with a pre-existing condition, there was a problem in 3/4 of states.
This links are now dead, but, if interested, what I found is on my old page here: http://nasmusicsoft.com/HealthInsuranceUSATable.html
5
I bet you a hundred to one that Mr. Gruber does not get his health insurance through Obamacare. I do and it is a living hell. I have been cancelled twice in two years. I live in Houston and there is not one PPO in the market. There are only three insurers and they only offer HMOs. I am facing the loss of access to my doctor of 20 years and the hospital he is a part of. The insurance plans are expensive and have very high deductibles. As far as I can tell, doctors are avoiding these plans like the plague. I will have the "privilege" of paying hundreds of dollars a month for no care. Thanks, Obama. I am happy that Trump won. At least maybe someone will clean up this garbage.
4
I don't understand why this fact-based, experiential comment from Houston is not a Times pick. Is it because it doesn't agree with Times editorial policy?
2
If Trump repeals Obamacare, he on track for the stupidest decision he'll make as president.
3
Mr. Trump and other Republicans can discuss kind-sounding alternatives as much as they like, but they can’t hide the fact that repealing the fundamental insurance protections that are central to the act would be a cruel backward step.
----------------------------------------------
What if the fundamental insurance protections that are 'central' to the act are also forcing insurers to increase the premiums by as much as 160% in come markets and others to just bail out of market place? The fourth scenario is what we are experiencing now: insurers are simply not participating in the marketplace.
The ACA relied on the government reimbursing insurers for losses they incurred but the Republican congress is not going to let that happen, having let that not happen in the recent past.
There is no easy fix, absent taxpayers subsidizing cost of providing coverage to those with preexisting medical issues. And, having promised to lower taxes, Trump administration and this new Congress will not be able to make this law work.
You famously said that the stupidity of American voters will let you pass and implement this boondoggle, and you are back to your mischievous arguments. You should probably explain how the insurance companies can be forced to operate in the market place and suffer losses year after year. Maybe, you are just counting on the stupidity of insurers to pretend profits do not matter to them.
Stupidity, alright.
----------------------------------------------
What if the fundamental insurance protections that are 'central' to the act are also forcing insurers to increase the premiums by as much as 160% in come markets and others to just bail out of market place? The fourth scenario is what we are experiencing now: insurers are simply not participating in the marketplace.
The ACA relied on the government reimbursing insurers for losses they incurred but the Republican congress is not going to let that happen, having let that not happen in the recent past.
There is no easy fix, absent taxpayers subsidizing cost of providing coverage to those with preexisting medical issues. And, having promised to lower taxes, Trump administration and this new Congress will not be able to make this law work.
You famously said that the stupidity of American voters will let you pass and implement this boondoggle, and you are back to your mischievous arguments. You should probably explain how the insurance companies can be forced to operate in the market place and suffer losses year after year. Maybe, you are just counting on the stupidity of insurers to pretend profits do not matter to them.
Stupidity, alright.
1
Once we start looking at the ACA replacement and accept the concept that no one can be denied treatment for preexisting conditions and that no one should be thrown off insurance, and that, indeed, everyone should be included, we get back to the practicalities. In order to do this, we must have the individual mandate. When we have the mandate, then we must have a way of helping those who can't afford it to pay for it. Thus the subsidies. I don't know any way to preserve the good things about the ACA and not have the rest. In fact, more subsidies are needed to help people at the higher end of the income thresholds, and government-imposed cost controls on prescription drugs and other costs are essential to holding costs down. All this goes against Republican ideology; will they change to accommodate what is necessary to cover every American or will they adopt a mere shell of a plan that leaves millions out?
154
Republicans do not have as a goal to cover every American. They have as a goal to protect and enrich white men. They don't even think every American should be allowed to vote. Do you think they care if we can all get prenatal care and insulin?
1
People have been against the law, why won't Republicans implement a popular opinion?
Will republicans "change to accommodate what is necessary to cover every American or will they adopt a mere shell of a plan that leaves millions out?"
You know the answer to that.
You know the answer to that.
"Cruel backward step"? Donald Trump is the Leona Helmsley of DC now. Where only the "little people" worry about things like healthcare. Of course cutting or gutting the ACA is just that. But, who would do such a thing without a viable, humane and comparable alternative? Donald Trump of course. He doesn't care. He cared about winning. He'll leave these changes to the Ryan's and the McConnell's to take the heat on.
The ER's will soon be filled again with Rust Belt folks wearing their Make America Great Again red hats....
The ER's will soon be filled again with Rust Belt folks wearing their Make America Great Again red hats....
17
I suspect Trump will adopt much of Ryan's proposal to health insurance (http://www.hatch.senate.gov/public/_cache/files/bf0c9823-29c7-4078-b8af-...
Note the key provision is to put all those with chronic conditions into a high risk pool. My guess is these pools would be administered by the states and subsidized with a Federal block grant.
If I were a conservative Republican who favored limited government, my position would be for NOT replacing Obamacare, just repeal it. Turn control back over to the states making Federal block grants available for Medicaid expansion and for high risk pools.
I prefer a national health care system, but that's not going to happen.
Historically, state run high risk pool premiums, deductibles, and coinsurance were astronomically higher than those of existing Obamacare plans.
Note the key provision is to put all those with chronic conditions into a high risk pool. My guess is these pools would be administered by the states and subsidized with a Federal block grant.
If I were a conservative Republican who favored limited government, my position would be for NOT replacing Obamacare, just repeal it. Turn control back over to the states making Federal block grants available for Medicaid expansion and for high risk pools.
I prefer a national health care system, but that's not going to happen.
Historically, state run high risk pool premiums, deductibles, and coinsurance were astronomically higher than those of existing Obamacare plans.
3
Not only were the state high-risk pools often very expensive, but the eligibility rules were generally not well-crafted and actually had eligibility holes so that people who responsibly had maintained health insurance for their entire lives prior to having a pre-existing condition and did not try to game the system still could not pick up the high risk pool and have pre-existing conditions covered.
I researched this about 8 years ago, and about 50% of states had such a problem for people not moving between states, and, for people moving between states, about 75% of states had such a problem. (The links are now dead, but, if interested, my results are here: http://nasmusicsoft.com/HealthInsuranceUSATable.html )
I researched this about 8 years ago, and about 50% of states had such a problem for people not moving between states, and, for people moving between states, about 75% of states had such a problem. (The links are now dead, but, if interested, my results are here: http://nasmusicsoft.com/HealthInsuranceUSATable.html )
1
Anybody with even the most rudimentary understanding of insurance must realize that the only way that health insurance companies can be compelled to offer guaranteed insurance at reasonable premiums without the option of exclusion is by spreading the risk to the entire population - i.e. individual mandate. Otherwise one would simply buy coverage the day one becomes ill. Likewise a basic public option offers the best incentive for insurance companies to keep costs down. I am astounded by Republican naivete repeatedly demonstrated by their plans to keep only some (good and popular) parts of the ACA. In the words of your president elect, stop it !
19
This is what happens when you lie to the American public for 8 years:
-You lose elections
-Your programs get gutted
-You get fired
-You don't get a second chance, because no one trusts you
-You lose elections
-Your programs get gutted
-You get fired
-You don't get a second chance, because no one trusts you
1
Seriously? What is YOUR replacement plan?
7
Unfortunately, the author omits the one fact that should frighten the bejabbers out of all the Republicans who are thinking of gutting Obamacare while totally oblivious to the huge ticking time bomb that lies waiting for them if they repeal it . . . or if they throw it totally out of balance.
Namely, the fact that the whole original idea of Obamacare was a desperate, uphill effort to find some feasible way to adapt the private insurance market to bring affordable care to people with pre-existing conditions.
Yes, Obamacare obviously needs some fine-tuning to tamp down soaring premium prices. But if Republicans throw the whole thing out of balance, then the only alternative would be a Canadian-style single-payer system, which Republicans hate. It took America almost 70 years (beginning with President Harry Truman) to finally come up with a universal health insurance plan that retained the private market. If Republicans now destroy Obamacare, then they will have absolutely no one to blame but themselves if Americans in the next election -- desperate to restore universal, affordable health insurance -- opt instead for the Canadian system that Republicans hate.
Be very, very careful what you wish for.
Namely, the fact that the whole original idea of Obamacare was a desperate, uphill effort to find some feasible way to adapt the private insurance market to bring affordable care to people with pre-existing conditions.
Yes, Obamacare obviously needs some fine-tuning to tamp down soaring premium prices. But if Republicans throw the whole thing out of balance, then the only alternative would be a Canadian-style single-payer system, which Republicans hate. It took America almost 70 years (beginning with President Harry Truman) to finally come up with a universal health insurance plan that retained the private market. If Republicans now destroy Obamacare, then they will have absolutely no one to blame but themselves if Americans in the next election -- desperate to restore universal, affordable health insurance -- opt instead for the Canadian system that Republicans hate.
Be very, very careful what you wish for.
7
The best news of this election is that the republican party has to govern. They are skilled at attacking an opponent or party while manipulating public opinion, but that is politics. Confronted with legislating, the GOP are exposed, having no one to blame but themselves. Very curious to see how they tackle real problems. More so to see if the country holds them accountable.
Not that this will help, but stay healthy if you can. The GOP has wasted the last 8 years resisting and did not spend the time wisely developing a plan to replace the ACA.
Not that this will help, but stay healthy if you can. The GOP has wasted the last 8 years resisting and did not spend the time wisely developing a plan to replace the ACA.
13
The ACA was the Republican health care plan. Private insurance set in state exchanges. At least it was their plan until a black man was president.
The ACA helped people who were uninsured, but if you look at the stock prices of health insurance skyrocketed since the passage of the ACA, you'll understand why the GOP will not dare to repeal it.
The insurance companies would nail the Republican heads to the floor.
With price of insurance rising, the solution continues to be The Public Option.
The Public Option would be non-profit insurance co-op, a mutual insurance company, backstopped by federal dollars until it becomes self-sustaining. This will at last start the removal of the vampire health insurance companies from the health care system. Companies that take 30% off the top and provide less than zero value.
As for now, there is nothing Trump and the GOP congress can repeal with it all tumbling down on their heads. But in some strange way...I wish it would.
The ACA helped people who were uninsured, but if you look at the stock prices of health insurance skyrocketed since the passage of the ACA, you'll understand why the GOP will not dare to repeal it.
The insurance companies would nail the Republican heads to the floor.
With price of insurance rising, the solution continues to be The Public Option.
The Public Option would be non-profit insurance co-op, a mutual insurance company, backstopped by federal dollars until it becomes self-sustaining. This will at last start the removal of the vampire health insurance companies from the health care system. Companies that take 30% off the top and provide less than zero value.
As for now, there is nothing Trump and the GOP congress can repeal with it all tumbling down on their heads. But in some strange way...I wish it would.
6
Gotta love all the mental gymnastics everyone is doing to justify the failure of Romney Care...I mean...Obama Care...in charging patients through the nose. A field day for health insurance companies, but a nightmare for those insured.
I'd love to see the free press push for medicare for all. That would be the day.
I'd love to see the free press push for medicare for all. That would be the day.
8
Dear Soc (I hope you don't mind if I call you by the familiar). I had this argument with a Republican recently (I'm from MA living in Stockholm right now) and pointing out that people here are happy and protected with a very strong social safety net (plus education, etc etc etc). The response was that all of these countries (that you list) are not a "dual-sovereign" state. That is, because the US is made up of 50 "sovereign" states, we can't have a federal program of health care. The assumption must be that health care is not a right, but a market and sick people are profit. While there is explicit debate about that (e.g., health care is a right but not health insurance), it seems both disingenuous and cruel for not bringing the debate to the human level.
But my debate with my Republican friend brought into focus the "State vs Fed" philosophy and explains perhaps why the Republican party is the party of "No". Specifically, that the Federal govt has a very limited role: to wage war and protect industry. (Actually, they don't protect industry, they protect the current market share of those who pay to play, which is very different.)
We are heading for dark days.
But my debate with my Republican friend brought into focus the "State vs Fed" philosophy and explains perhaps why the Republican party is the party of "No". Specifically, that the Federal govt has a very limited role: to wage war and protect industry. (Actually, they don't protect industry, they protect the current market share of those who pay to play, which is very different.)
We are heading for dark days.
3
The Achilles heel of all non-governmental, non-single payer approaches to universal health care is the interposition of for-profit entities between the insured and medical providers. Just as murder will out, greed will out. To paraphrase a line from Jurassic Park: "Profit will find a way.
8
> How do you define "basic health care?" ... it's catastrophic health care that's needed most of all.
Exactly. The problem with Obamacare was piling on this, that and the kitchen sink. Insurance is for the unexpected, the broadly unpredictable. Things of dubious value or lifestyle treatments aren't the stuff of insurance. Let's cover catastrophe in one way or another and for everyone but then get out of the way.
Exactly. The problem with Obamacare was piling on this, that and the kitchen sink. Insurance is for the unexpected, the broadly unpredictable. Things of dubious value or lifestyle treatments aren't the stuff of insurance. Let's cover catastrophe in one way or another and for everyone but then get out of the way.
Sadly, insurance will need to get much worse before insurance gets much better. It's like cleaning your garage: you have to make a mess and throw out the trash before you can organize a better system.
Let's just hope and pray that the garage is still standing when we're done.
Let's just hope and pray that the garage is still standing when we're done.
Oh, jeez, professor Gruber is right.
When I read in the paper that Trump might keep the ACA provision "that forces insurers to cover people with pre-existing health conditions", I was intellectually sloppy, and assumed he meant keeping age-modified community rating (everyone in the same location the same age pays the same) without exclusion of pre-existing conditions.
Keeping that without the critical ObamaCare/RomneyCare provisions would be bad enough: without the mandate to carry coverage there would be very high premiums and insurance pool death spirals, and without the subsidies and Medicaid extension, a load of people just wouldn't be able to afford insurance.
But, alas, prof Gruber has made me realize that I didn't parse Trump's statement carefully enough: as Trump worded it, insurance companies have to cover everyone's pre-existing conditions, but can charge a very sick person say $300,000 a year. Thus, a vacuous protection, leaving life, even for those who have relatively high incomes, risky and dangerous.
Is it, that Trump, a guy who claims he wants to help the working class, would do such a thing to them and the rest of us? Is it ignorance: a failure to call in honest experts (such as prof. Gruber)? Or is it some kind of perverted acting in self-interest under a cover of trying to help the working class? Or perhaps Trump has good intentions, but his Republican colleagues will take us, knowingly, backwards to a life of health coverage misery and danger.
When I read in the paper that Trump might keep the ACA provision "that forces insurers to cover people with pre-existing health conditions", I was intellectually sloppy, and assumed he meant keeping age-modified community rating (everyone in the same location the same age pays the same) without exclusion of pre-existing conditions.
Keeping that without the critical ObamaCare/RomneyCare provisions would be bad enough: without the mandate to carry coverage there would be very high premiums and insurance pool death spirals, and without the subsidies and Medicaid extension, a load of people just wouldn't be able to afford insurance.
But, alas, prof Gruber has made me realize that I didn't parse Trump's statement carefully enough: as Trump worded it, insurance companies have to cover everyone's pre-existing conditions, but can charge a very sick person say $300,000 a year. Thus, a vacuous protection, leaving life, even for those who have relatively high incomes, risky and dangerous.
Is it, that Trump, a guy who claims he wants to help the working class, would do such a thing to them and the rest of us? Is it ignorance: a failure to call in honest experts (such as prof. Gruber)? Or is it some kind of perverted acting in self-interest under a cover of trying to help the working class? Or perhaps Trump has good intentions, but his Republican colleagues will take us, knowingly, backwards to a life of health coverage misery and danger.
5
I am wondering why this very, very important issue about health care was not discussed more or explained in depth BEFORE the election. This issue that directly affects every American in a big way was marginally mentioned in the debates and on the campaign trail. Now here we are waiting and wondering what Trump plans to do about the ACA-- and I am really, really worried. Great article, but wish it had been published a little sooner.
5
Regretting your Trump vote already?
Nancy----
I proudly voted for Hillary and even volunteered for her campaign. I was a very staunch supporter of her. My comment was made in regret that many people who voted for Trump may not have done so if they would have had a better understanding of the ACA.
I proudly voted for Hillary and even volunteered for her campaign. I was a very staunch supporter of her. My comment was made in regret that many people who voted for Trump may not have done so if they would have had a better understanding of the ACA.
Another part of ObamaCare that rarely is mentioned is the ending of lifetime limits on insurance payments. With the price of care rapidly increasing and cancer treatments and some forms of surgery easily costing hundreds of thousands of dollars, more and more people would be quickly bumping up against the limits.
I do hope Trump does one thing. Let him end the requirement that hospitals can't turn people away seeking emergency care even if they have no insurance or money to pay. If people don't want to have insurance under ObamaCare, fine. Just don't freeload on the rest of us. I wonder how they would feel if they had an accident and came to an ER and were told if you don't have insurance you have to pay cash up front or we'll show you the door.
I do hope Trump does one thing. Let him end the requirement that hospitals can't turn people away seeking emergency care even if they have no insurance or money to pay. If people don't want to have insurance under ObamaCare, fine. Just don't freeload on the rest of us. I wonder how they would feel if they had an accident and came to an ER and were told if you don't have insurance you have to pay cash up front or we'll show you the door.
2
None of the cultural elites such as Jonathan Gruber (of MIT) seem to care at all about the most obviously immoral aspect of the story he just told - that medical treatment of breast cancer runs into the hundreds of thousands.
Gruber points the finger at the evil Republicans while his fellow professional elites (in medicine, the media, academia, Silicon Valley, etc.) enrich themselves at the expense of everyone else in the country.
Anyone who questions this incestuous, cliquish arrangement is told they are a "conspiracy theorist." Call it what you like; this time the people had the last laugh.
Gruber points the finger at the evil Republicans while his fellow professional elites (in medicine, the media, academia, Silicon Valley, etc.) enrich themselves at the expense of everyone else in the country.
Anyone who questions this incestuous, cliquish arrangement is told they are a "conspiracy theorist." Call it what you like; this time the people had the last laugh.
1
Of course we've got to repeal all of it. Have you forgotten the massive number of bribes that were paid to various states to obtain passage? Throw them away. We must come up with a better solution for people who were very ill. I favor an assigned risk pool for those who are seriously ill. That is, they would pay more for insurance but the cost would be capped at perhaps 2 or 3 times what most people pay. Add to that money from a small tax on normal priced policies. Just a guess, but perhaps a tax of 3-5% on policies for healthy people added to the increase cost of polices in the assigned risk pool would do it.
Certainly we should not attempt to force people to purchase insurance. It is unconstitutional to tax someone for breathing. Allow insurance companies to charge different prices for different age groups. In this way the premiums for the young and healthy would go down and they would be more likely to purchase insurance.
Make the patients more aware of their medical expenses and give them incentives to decline unnecessary treatments. I would favor ending the tax deduction for business to provide health insurance and have people purchase their own insurance. Then the insurance companies would have to satisfy their customers or be fired. And the patients would be more aware of the costs and could pick and choose coverage, dedcutables, etc. that meet their own needs. Certainly the medial savings accounts that Ben Carson has proposed should be included.
Certainly we should not attempt to force people to purchase insurance. It is unconstitutional to tax someone for breathing. Allow insurance companies to charge different prices for different age groups. In this way the premiums for the young and healthy would go down and they would be more likely to purchase insurance.
Make the patients more aware of their medical expenses and give them incentives to decline unnecessary treatments. I would favor ending the tax deduction for business to provide health insurance and have people purchase their own insurance. Then the insurance companies would have to satisfy their customers or be fired. And the patients would be more aware of the costs and could pick and choose coverage, dedcutables, etc. that meet their own needs. Certainly the medial savings accounts that Ben Carson has proposed should be included.
It isn't insurance if sick people must pay three times more. It's cruelty.
3
When the person who takes out a policy is already sick and the insurance company is supposed to pay all of their bills THAT is not insurance. Insurance works because the policy holders pool their money and spread the risk of paying for a major illness. When the payment is a certainty, that is not insurance. That is why the insurance companies are dropping like files. The democrats knew this would happen from day one. They could not sell socialized medicine and tried to trick us into this plan which will lead to socialized medicine if unchecked. Thank God we were able to stop them.
Using your logic, insurance companies should be required to sell homeowners insurance to people whose homes just burned down and car insurance after the car has been wrecked.
I am trying to come up with a way to spread the risk without trying to force people to buy insurance.
I am trying to come up with a way to spread the risk without trying to force people to buy insurance.
Professor Gruber depicts insurers as enemies of the people. I am an educator in the field of insurance and can explain why insurers, no matter how benevolent, cannot insure pre-existing conditions without being financially supported in some other way. I'll explain in terms simple enough for a reporter to understand, Imagine selling car insurance that covered pre-existing accidents. A man could have a wreck, walk to an insurer, insure the car he'd just demolished, and cash in the policy the same day. If you want insurers to cover pre-existing conditions, you need a mechanism such as the mandate to spread the risk over a person's lifetime (and the lifetimes of others). In order to have a mandate, you need subsidies or you'd be forcing people to buy a product they can't afford. [Car insurance is mandated ONLY if you own a car; health insurance is mandated if you own a body, so it's not a similar mandate.] And a easy as 1-2-3 you have Obamacare... Pre-existing conditions must be covered so we must have mandates so we must have subsidies. 1-2-3. Any reporter who writes that Trump is considering keeping coverage for pre-existing conditions without immediately writing, "but, of course, to do so is impossible," should look for a job at Breitbart News.
2
The reason for pre existing condition exclusion was mainly for pregnancies, where the outcome is unknown. The insurance companies know exactly how many car accidents they will be paying for.
1
Ladies and Gentlemen:
We are about to begin our descent. Please fasten your seatbelts and prepare for turbulence.
We are about to begin our descent. Please fasten your seatbelts and prepare for turbulence.
4
Just another half baked idea by Trump who obviously thinks nothing through. A big story before the election was that health care premiums would soar in 2017, a negative for Clinton with her tie in with Obamacare. Truly what sense does it make when Trump indicates insurance companies cannot deny coverage for individual with pre-existing conditions, but would allow insurance companies to charge premiums to pre existing condition applicants that financially are out of reach. If the government supplements these people the costs will be astronomical. Trump is a farce. All his vague generalities on policies will now have the light of reality shone on them as Obama stated. This will be the time that the country recognizes how badly they have been suckered. Too late. 4 more years of this confusion.
8
Republicans have been clamoring for a National Health Care Plan, with a Mandate, since President Nixon sent a letter to Congress in 1972--Dole (1996 Campaign), Gingrich (2008 book), Romney (Mass. Plan and 2009 USA Today Op-Ed), etc . but now, since President Obama raised the issue, and signed it into Law, their against it! At the both the National and State Level.
When you oppose a program purely for ideological reasons, refusing to call it by the right name (now, where have we heard that one before), misrepresenting it, and denying it to your poor (Extended Medicaid) residents, you are acting emotionally, rather than rational.
And, it sure is interesting that the GOP is rebelling against one of its own pet projects. Next, they'll be against Oxygen, Water and Motherhood!
https://thetruthoncommonsense.com
When you oppose a program purely for ideological reasons, refusing to call it by the right name (now, where have we heard that one before), misrepresenting it, and denying it to your poor (Extended Medicaid) residents, you are acting emotionally, rather than rational.
And, it sure is interesting that the GOP is rebelling against one of its own pet projects. Next, they'll be against Oxygen, Water and Motherhood!
https://thetruthoncommonsense.com
3
Every one of those plans you mentioned, including Nixon talked about the ESI tax exclusion, and how to phase it out.
Even Dr. Gruber advocated for that as a mechanism to bring competition back into the marketplace, and pay for government subsidies.
Even Dr. Gruber advocated for that as a mechanism to bring competition back into the marketplace, and pay for government subsidies.
The Republicans strategy on health care is already clearly laid out in their policy proposals. Gruber's analysis misses the mark. Repubs are not worried about making private insurance work for all; they are going to resurrect high risk pools and claim they cover pre-existing conditions. They similarly sweep suffering under the carpet by shifting medicaid policy to the states through block grants.
The beauty of these mechanisms from their perspective is they can drastically, gradually cut the social safety net while rhetorically claiming to care about the poor. It's politically smooth cruelty. For the end result just look at the fate of the poor in Republican controlled states like Texas. That will be the whole country, and the Dems now can't stop it.
The Republicans never claimed to be universal health care. 90% works for them, and the 10% left out mostly vote Democratic if at all.
The beauty of these mechanisms from their perspective is they can drastically, gradually cut the social safety net while rhetorically claiming to care about the poor. It's politically smooth cruelty. For the end result just look at the fate of the poor in Republican controlled states like Texas. That will be the whole country, and the Dems now can't stop it.
The Republicans never claimed to be universal health care. 90% works for them, and the 10% left out mostly vote Democratic if at all.
2
Actually, I believe the number was something like just 82% insured pre-ObamaCare (even worse than you have it), which is what the Republicans would seem to be dragging us back to.
I think now we have about 90% insured. (About 1.5% of this is from failure to extend Medicaid in 20 Republican states. The other 8.5% is people, lacking social solidarity, not responsibly picking up insurance or gaming the system, with also some cases of people -- incomes around 400% of poverty with low or no subsidies -- actually unable to afford plans. On the people unable to afford plans, recall it was generally acknowledged that higher subsidies are needed at certain income levels, and Congressional Republicans vowed to block the needed legislative changes.)
I think now we have about 90% insured. (About 1.5% of this is from failure to extend Medicaid in 20 Republican states. The other 8.5% is people, lacking social solidarity, not responsibly picking up insurance or gaming the system, with also some cases of people -- incomes around 400% of poverty with low or no subsidies -- actually unable to afford plans. On the people unable to afford plans, recall it was generally acknowledged that higher subsidies are needed at certain income levels, and Congressional Republicans vowed to block the needed legislative changes.)
1
Trump's election has already undermined the bond market and is well on its way to meeting Putin's requirement that the US be denied the benefit of being the world's reserve currency.
These actions alone are enough to shake up both out domestic economy and our position in the world at large............and, it's not even day one of his Presidency.
The repeal of health care, regressive tax cuts, and the deportation of so called "illegals will only weaken us more.
He is already making moves to install himself, his family, and his business at the core of our democracy, and appointing sycophants and psychophants to run the offices of the President in order to protect himself against democratic processes, including checks and balances.
That said, once Donald uses those powers and his populism to become the actual King of Republican small government dreams, America won't matter. It will just one more fallen empire ruled and taken over by a self righteous, self server, and his motly crew of religiously loyal wannabe heirs to the Kingdom.
These actions alone are enough to shake up both out domestic economy and our position in the world at large............and, it's not even day one of his Presidency.
The repeal of health care, regressive tax cuts, and the deportation of so called "illegals will only weaken us more.
He is already making moves to install himself, his family, and his business at the core of our democracy, and appointing sycophants and psychophants to run the offices of the President in order to protect himself against democratic processes, including checks and balances.
That said, once Donald uses those powers and his populism to become the actual King of Republican small government dreams, America won't matter. It will just one more fallen empire ruled and taken over by a self righteous, self server, and his motly crew of religiously loyal wannabe heirs to the Kingdom.
7
The problem with the ACA is that it continued for profit medicine and therefore guaranteed rising health care costs long into the future. That combined with the price controls placed on Medicare physician salaries, means that in order to pay back huge medical schools debts, physicians are enslaved to health care companies that derive profits from non-physician compensation and pressure their doctor employees to do more tests or lose their jobs.
That is not going to change for a long time, because with the price controls, the government continues their shady argument that health care costs are stable or going down when in reality they are going up dramatically and any patient with high premiums and high deductibles and high medication costs will tell you that.
The only saving grace is that insurance premiums are so high, and the net worth of individuals is declining so fast that is makes more economic sense for most of the population to just go without insurance, pay the small penalty and wait an illness out until the next sign up and then buy insurance. If they are unlucky enough to get sick, declare bankruptcy and leave the bills to someone else.
That is not going to change for a long time, because with the price controls, the government continues their shady argument that health care costs are stable or going down when in reality they are going up dramatically and any patient with high premiums and high deductibles and high medication costs will tell you that.
The only saving grace is that insurance premiums are so high, and the net worth of individuals is declining so fast that is makes more economic sense for most of the population to just go without insurance, pay the small penalty and wait an illness out until the next sign up and then buy insurance. If they are unlucky enough to get sick, declare bankruptcy and leave the bills to someone else.
2
It is my sincere hope that any changes in medical coverage will not make it more difficult for the mentally ill to receive the care they need in order to be contributing members of society. Mental illness often is forgotten in the discussion, as it is not as visible as some other conditions. Anyone living with depression, anxiety or other psychological conditions can attest to the cost of competent care.
3
Again, Trump is speaking off the top of his head, I believe. He hasn't a clue how to replace Obamacare. I doubt he even understands Obamacare. As Andy Borowitz joked on the New Yorker site, "Trump agrees to Google Obamacare."
4
This is the result of trying to ride two horses. One horse, that of making health care laws, owned by the government and the other , of implementing and giving effect to the laws, owned by the privately owned insurance companies. And proverbially it is extremely difficult - nay even impossible - to ride two horses, that too if each horse is prone to go its own way.
Many of the people who supported Trump are from areas of the country with high levels of ill health. If they are lucky they have employee sponsored healthcare, and feel they don't need to support a comprehensive affordable plan. But I think they will be in trouble if Trump does what you outlined. Prices overall will rise and we will go back to the days of the over use of emergency rooms and hospitals bankrupting patients.
1
Well, we have the quote:
"I mean, people have access to health care in America. After all, YOU JUST GO TO AN EMERGENCY ROOM."
--G.W. Bush, Cleveland, 7/10/07
Source: paragraph 16 in the official White House archive, here:https://georgewbush-whitehouse.archives.gov/news/releases/2007/07/200707...
"I mean, people have access to health care in America. After all, YOU JUST GO TO AN EMERGENCY ROOM."
--G.W. Bush, Cleveland, 7/10/07
Source: paragraph 16 in the official White House archive, here:https://georgewbush-whitehouse.archives.gov/news/releases/2007/07/200707...
2
Obamacare could be repealed and replaced with something better, which would be Medicare for All. It is cheaper, better coverage, covers more people... gets rid of Medicaid....
If Trump wants to quiet the masses, he might offer it. After Obamacare, there may be a demand for it.
If the masses twitter for it, Trump might listen. He is supposed to be a populist.
And if Trump wants a decisive win over Ryan and McConnell, this is one he could accomplish with huge poll numbers... if someone really pushes it...
If Trump wants to quiet the masses, he might offer it. After Obamacare, there may be a demand for it.
If the masses twitter for it, Trump might listen. He is supposed to be a populist.
And if Trump wants a decisive win over Ryan and McConnell, this is one he could accomplish with huge poll numbers... if someone really pushes it...
2
I used to work for a medical device manufacturer. Before the ACA, they could charge American patients much more than in other countries for the same products. The American market was so profitable, that their business plan relied on it. Once the ACA went into effect, some of the cost controls took effect, immediately reducing profitability and my former employer lost money. If I were in a position to ask questions, I would have asked why didn't they adjust their business plan once the law was passed. They had four years to do so. But I suspect they lobbied the Republican congress to repeal the ACA and were hopeful that they could go back to the old way of doing business. The Health Care industry is a gold mine for those who know how to take advantage of it, and the American tax payers and the patients are getting a bad deal. Follow the money. It will lead straight to the Republicans in congress.
341
Take your example and multiply it a hundred-fold, and you're describing the pharmaceutical industry.
1
Republicans see a human life as something that should generate a profit for Insurance Companies. Before Obamacare If the body was not profitable the Insurance Companies would deny the person coverage and find a more profitable body. The market will decide which bodies have profit potential. The Insurance Companies have no interest in the welfare of an unprofitable body. They don't care if unprofitable bodies can't afford healthcare for their illnesses. Let them die penniless without dignity ! The Affordable Care Act sough to protect human life from this inhuman situation. Now Republicans want to return us to the human body as a profit making machine for Insurance Companies.
7
Just wait until Paul Ryan gets done with Medicare.
4
That will be a nice challenge. Keeping a list of pre-existing conditions for your 89-year old parents. (Miss just one on the application, and they deny any claim they judge is related.)
5
This is a no-win for the GOP less one scenario.
If the GOP repeals Obamacare, 22 million lose coverage, including Republicans and right-leaning Independents with pre-existing conditions. The GOP is elected out.
If the GOP tries to sneak the cost of pre-existing care out of the system by promising that it will be covered, but it then proves far too expensive through risk pools or in the end it is not available at all, the GOP is elected out.
If the GOP tries to repair Obamacare, something that even many liberals like myself believe must occur if it is retained, their base will primary them out.
The one scenario with which the GOP can run (and potentially get away with) is to allow those with pre-existing conditions to buy into Medicare, which would cut insurance rates for those without pre-existing conditions and hide the obvious: that those same taxpayers are flipping the bill for this expensive care 1) as their taxes go to cover the high cost of Medicare and 2) as their insurance premiums rise to cover the cost of free riders.
Sadly, the one option that guarantees everybody good care and keeps prices lowest for everyone, universal coverage, offends the GOP and their voters.
If the GOP repeals Obamacare, 22 million lose coverage, including Republicans and right-leaning Independents with pre-existing conditions. The GOP is elected out.
If the GOP tries to sneak the cost of pre-existing care out of the system by promising that it will be covered, but it then proves far too expensive through risk pools or in the end it is not available at all, the GOP is elected out.
If the GOP tries to repair Obamacare, something that even many liberals like myself believe must occur if it is retained, their base will primary them out.
The one scenario with which the GOP can run (and potentially get away with) is to allow those with pre-existing conditions to buy into Medicare, which would cut insurance rates for those without pre-existing conditions and hide the obvious: that those same taxpayers are flipping the bill for this expensive care 1) as their taxes go to cover the high cost of Medicare and 2) as their insurance premiums rise to cover the cost of free riders.
Sadly, the one option that guarantees everybody good care and keeps prices lowest for everyone, universal coverage, offends the GOP and their voters.
6
Trump has pulled off the ultimate scam! He has sold to over 60 million people the belief that he is the savior for all of the ills, fears, and philosophical injustices felt by his supporters. It's the ultimate "reality TV show" with Trump as the host and the American public as the contestants. The difference here is that only the host wins and all the contestants lose.
I have disagreed with a good number of past presidential policies, Democrat and Republican but have never felt the dread, fear, and utter embarrassment that I now feel with Trump as president.
I have disagreed with a good number of past presidential policies, Democrat and Republican but have never felt the dread, fear, and utter embarrassment that I now feel with Trump as president.
11
'...After describing the Electoral College, Alexander Hamilton wrote in The Federalist Papers that the 'process of election affords a moral certainty, that the office of President will never fall to the lot of any man who is not in an eminent degree endowed with the requisite qualifications. Talents for low intrigue, and the little arts of popularity, may alone suffice to elevate a man to the first honors in a single State; but it will require other talents, and a different kind of merit, to establish him in the esteem and confidence of the whole Union, or of so considerable a portion of it as would be necessary to make him a successful candidate for the distinguished office of President of the United States.'
How is the Electoral College following the precepts of Alexander Hamilton in accepting the notion that Trump is, to an eminent degree, endowed with the requisite qualifications?
12
It may be a fanciful hope but at some point the Republicans are going to have to actually be specific on the actual replacement to Obamacare.
This article points out how difficult it will be to keep the carriers in check.
This article points out how difficult it will be to keep the carriers in check.
1
Every homeowner purchases fire insurance because the cost of replacement of a house exceeds the means of most people. The insurance may be high but it's affordable. Most everyone needs medical insurance for the same reason because a medical calamity would be well beyond all but the wealthy's reach. Yet the insurance is too costly for so many.
5
No more compromises, please. VA for all.
2
As our president-elect waffles over health insurance options, the only thing that's clear (to me) is that he wants to be liked by all Americans. I mean, why else offer to keep those with pre-existing conditions "safe" while allowing everyone else to pick and choose through whatever's left....if we can afford it.
Gee, what a deal. Most of us, with 12 years of schooling can understand that, without the mandate, this can't work.
Keep talkin' Boss. Your loyal followers believe you.
Gee, what a deal. Most of us, with 12 years of schooling can understand that, without the mandate, this can't work.
Keep talkin' Boss. Your loyal followers believe you.
2
"Mr. Trump and other Republicans can discuss kind-sounding alternatives as much as they like, but they can’t hide the fact that repealing the fundamental insurance protections that are central to the act would be a cruel backward step."
Unfortunately, cruel backward steps seems to be the standard Republican operating procedure.
Unfortunately, cruel backward steps seems to be the standard Republican operating procedure.
8
We continue to underestimate the narrow-mindedness of Donald Trump and the Republican party. Having never presented an alternative to Obamacare despite a seemingly unlimited number of votes calling for its repeal, it is unreasonable to expect a thoughtful analysis and strategic implementation of the healthcare now.
Rather, we can continue to expect these types of topical solutions which are designed to appease their followers and whose severe ramifications can be pushed off into the future and somehow, eventually, blamed on the democrats.
Rather, we can continue to expect these types of topical solutions which are designed to appease their followers and whose severe ramifications can be pushed off into the future and somehow, eventually, blamed on the democrats.
2
Why Hillary lost the small entrepreneur: small businesses are prohibited from offering health insurance coverage to new employees on a pre-tax basis.
1
Obamacare is a disaster.
Health Insurance for a family of 3 now costs $26,000 ($20,0000 with a 6,000 deductible).
This simply means we spend too much per person on health care.
A single payer system would not reduce how much we spend.
We need to make some hard decisions on what we cover in order to spend less!
Health Insurance for a family of 3 now costs $26,000 ($20,0000 with a 6,000 deductible).
This simply means we spend too much per person on health care.
A single payer system would not reduce how much we spend.
We need to make some hard decisions on what we cover in order to spend less!
1
The people who voted for DT and Republicans in general want the ACA repealed. Like other issues from this election (e.g., climate change, women's reproductive rights), they don't realize that they will be negatively affected by their choice. However, all that really matters was that DT made White Americans feel great again.
4
With Trump's unpredictability, it's hard to tell what he'll actually end up doing. Considering his willful ignorance about nearly everything... I'm sure it will be poorly thought out, unwieldy, and shareholder friendly. Or - as Trump will call it - a tremendously beautiful win for America.
3
Mr. Gruber gets print space to:
1) Criticize Pres.-elect Trump
2) Try to salvage a self-imploding program
The ACA didn't really make health insurance much more affordable. But it did transfer a whole lot of money from Medicare and other programs to subsidize insurance companies.
The ACA was a giveaway to Big Pharma and Big Insurance but the Insurance companies made out, and continue to make out like bandits.
Mr. Gruber's suggestions still don't solve the issue. Why can't we have an a la carte insurance set of plans and options where we can at least afford catastrophic insurance and maybe major prescription drug coverage?
Why does every policy have pediatric dental? That's not a recipe for a sustainable or fair policy. And the middle class has gotten the bill again.
Sorry Mr. Gruber. Your comments here aren't enough to save a poorly designed system that you created. Please let others try and get out of the way.
1) Criticize Pres.-elect Trump
2) Try to salvage a self-imploding program
The ACA didn't really make health insurance much more affordable. But it did transfer a whole lot of money from Medicare and other programs to subsidize insurance companies.
The ACA was a giveaway to Big Pharma and Big Insurance but the Insurance companies made out, and continue to make out like bandits.
Mr. Gruber's suggestions still don't solve the issue. Why can't we have an a la carte insurance set of plans and options where we can at least afford catastrophic insurance and maybe major prescription drug coverage?
Why does every policy have pediatric dental? That's not a recipe for a sustainable or fair policy. And the middle class has gotten the bill again.
Sorry Mr. Gruber. Your comments here aren't enough to save a poorly designed system that you created. Please let others try and get out of the way.
6
I'm glad the media is providing space for this thoughtful analysis. Too bad there was no focus on the issues that mattered before the election.
1
People also forget that the ACA sets limits on out-of-pocket costs--currently about $7,000 per person per year. While that is a lot, when I was diagnosed young with breast cancer, pre-ACA, my out-of-pocket max (with insurance) was $18,000 per year. And the insurer opted not to cover a necessary-and common- treatment drug, which cost about $6,000 *per dose. The diagnosis led to a 6-figure medical bill within a few months (and eventually, a meeting with a bankrupcy lawyer, even though I had never missed a credit card or student loan or any other payment in my life). How will the new president's approach avoid that?
4
The ACA, of course, will be an emblematic test of how Trump will govern in general post-campaign. Will he join the reality-based community of policymakers, wonks and healthcare experts, or will he cave in to fringe lunatics, his no-college base of voters and the opportunistic ideologues who are hellbent on commandeering the Trump train? Despite the rhetoric and the appearance that he is an impulsive demagogic bully, I'm willing to give Trump a chance on immigration, healthcare and foreign policy. We'll know soon enough how much to despair.
Professor Gruber, you and the NYT sold me on how great ACA was going to be. Listen, I'm progressive. Voted for Hillary.
But, I'm not buying your story this time. My wife and I can't really use our coverage, which a tax credit makes more affordable, because we can afford the more than $7K in deductibles.
So, you guys fooled me once. Not that I expect anything from the Republicans. But I didn't trust them. I trusted you. Not again.
But, I'm not buying your story this time. My wife and I can't really use our coverage, which a tax credit makes more affordable, because we can afford the more than $7K in deductibles.
So, you guys fooled me once. Not that I expect anything from the Republicans. But I didn't trust them. I trusted you. Not again.
3
There is no way to preserve insurance for those with preexisting conditions without price controls. It's great to say you'll preserve coverage but meaningless in operation. We always needed a public option and this makes it crystal clear. Too bad the GOP will never agree, and intend to dismantle our current most successful single payor plan, Medicare.
4
Trump simply does not care. He is quite happy to ransack and destroy whatever good work has gone before him. Truth, logic, and the welfare of ordinary people are things he has no concern or capacity for. Maybe if you could rephrase the argument in a way that appeals to his limitless insecurity, he might pay attention.
3
Just as you cannot keep only the parts you like of the ACA, you cannot judge its replacement until you see it in its entirety. When did Trump say he was simply going to keep these 2 components of the ACA and otherwise return to health insurance as it was? The answer is never, yet this is the central assumption of Gruber's article. And of course this is coming from the man who proudly proclaimed that the passing of the ACA relied on the stupidity of the American people. Surely the NYT can find someone more credible to critique the current state of health care insurance in the U.S.
1
Gruber is probably the best health economist of his generation. He has a big mouth and said some arrogant and snobbish things, but that does not diminish the fact that he understands health economics and has been toiling away for years to advance the subject. Would you prefer that he boast about sexually assaulting someone instead?
You’d think that Republicans, who are all about competition, would recognize and learn from a successful global competitor when they see one: Single Payer, which demonstrably produces superior healthcare outcomes than in the US at far lower cost than in the US in practically every single developed country where it has been implemented.
7
Prez Elect Trump, do what you do best, rip us all off. That way WE ALL will hate you.
1
And I thought I was bad, jumping to a conclusion and writing a snide comment based on only reading the headline. God this Op Ed makes me feel like less of a lowbrow, thanks. And it validates my long held belief that details are irrelevant anyway.
Trump's knowledge of insurance policy does not extend as far as this column. Do we think that Trump has ever read an analysis of the issue as lengthy as this one?
2
Regarding your example, you suggest a person shopping for insurance after a breast cancer diagnosis could be denied coverage. This is false. If she maintained continuous coverage up until and through the treatment, her policy is non-cancellable and guaranteed issue. If she didn't pay her premium, she'd be in trouble, but that would be her poor decision. You can't allow people to let their insurance lapse and jump back on when they get sick. That's why the program doesn't work now.
1
It's not a matter of letting it lapse. Suppose a person had insurance with a particular employer and lost that job. Now the person has a choice - continue that policy or choose another. Why should this person be locked into continuing insurance with the company that the former employer used? And if a person is not pleased with their insurer, they are stuck? Socialized medicine, like I have where I live, is the only decent solution. I can move jobs, retire early, be a freelancer, whatever I want, and I still can have the same HMO, which is paid for with a payroll tax (based on income). Freelancers pay social security and health tax, again, based on income. There is a minimum amount to pay (really small) for students or people who choose not work (like to stay home and care for children). The same public care for everyone. There are people who take private insurance on top of the public health care - there will always be premium services for those who have money, so the system is not perfect, but it far beats anything anyone in the US can dream of actually happening (what Bernie Sanders might have dreamed of never would have actually happened). Our life expectancy is higher than it is in the US, so it's working pretty well.
1
Isn't this the Obama healthcare adviser who stated, in an open forum, on videotape, that enactment of Obamacare depended on a lack of "transparency" and the "stupidity" of the American voter? Obviously, a rhetorical question.
The problem with the U.S. healthcare system is that it costs twice as much as other modern western nations and has grown to the point it eats up 20% of GDP. Obamacare has done nothing to slow or reduce the cost of the U.S. healthcare system. Those who make too much income to receive premium subsidies can't afford the hyper increases in premiums, and even those with well above average incomes are being squeezed. And even those who have health insurance cannot afford to use it because of the high deductibles and co-pays. There is a strong sense Obamacare is circling the drain regardless of what the Trump administration does or does not do--one can smell it.
Perhaps Professor Gruber and the other big heads who helped enact Obamacare can come up with a program which will cost half as much and cover everybody? That would be popular.
The problem with the U.S. healthcare system is that it costs twice as much as other modern western nations and has grown to the point it eats up 20% of GDP. Obamacare has done nothing to slow or reduce the cost of the U.S. healthcare system. Those who make too much income to receive premium subsidies can't afford the hyper increases in premiums, and even those with well above average incomes are being squeezed. And even those who have health insurance cannot afford to use it because of the high deductibles and co-pays. There is a strong sense Obamacare is circling the drain regardless of what the Trump administration does or does not do--one can smell it.
Perhaps Professor Gruber and the other big heads who helped enact Obamacare can come up with a program which will cost half as much and cover everybody? That would be popular.
2
I'd like to know why this article wasn't published by the Times in the weeks/months before the election. Kind of late now, isn't it?
1
Thank you for taking on one of Mr. Trump's many statements in which he makes a proposed change that seems so easy and obvious--but which in fact is anything but. It's good to read informed opinions during a time like this.
1
The clearest solution is the one the Republicans hate the most, but which would cost the least. Medicare for all.
Sadly, it would put a number of money-grubbing health care CEOs and their highly paid employees out of work. Their lobbyists will prevent the most practical solution from coming to pass until many, many more people have suffered the indignity and poverty of healthcare destitution.
Sadly, it would put a number of money-grubbing health care CEOs and their highly paid employees out of work. Their lobbyists will prevent the most practical solution from coming to pass until many, many more people have suffered the indignity and poverty of healthcare destitution.
8
the point being you can't have guaranteed issue without also having community rating. the whole point of insurance is to spread the risk across widest possible pool. which is why ultimately we will need single payer.
1
The problem is. You expect the republicans to be rational. No chance.
2
Aha. Mr. Gruber points out the flaw that will doom Trump's sketchily proposed revision of the ACA. If the Republican try to implement it or dispense with the ACA altogether, they will plunge a dagger into their promise to mitigate the inequality and suffering endured by so many ordinary people.
These and other of Trump's half-baked proposals and appointments do not augur well for his presidency. Much worse, they augur poorly for the United States in this, its time of trouble.
These and other of Trump's half-baked proposals and appointments do not augur well for his presidency. Much worse, they augur poorly for the United States in this, its time of trouble.
1
It beggars belief that America is still arguing in 2016 about the need for affordable and available health insurance for its citizens when Germany passed its own health insurance bill in 1883. And may I add that the possible future existance of Obamacare and Medicare under Trump and Ryan is as dark as the devil's pocket.
4
Trump fooled not quite 50% of the population so why wouldn't he think he could fool them about health insurance?
Remember his promise about the wall? He's sort of backing off on that one. Jobs for those people at the Carrier Factory? I hope they're not holding their breath. I do expect him to crush the emigrants since they're the most vulnerable and defenseless group around.
Remember his promise about the wall? He's sort of backing off on that one. Jobs for those people at the Carrier Factory? I hope they're not holding their breath. I do expect him to crush the emigrants since they're the most vulnerable and defenseless group around.
2
Many people with serious chronic illnesses can care for and at least partially support their families if they have ongoing medical care. To rip this away from them condemns them to misery and worse. It means children are removed from loving parents to become wards of the state. It means other relatives go bankrupt too, trying to pay astronomical costs charged to the uninsured loved ones. How can that be good for society? Are we to return to this nightmare?
3
It seems fundamentally that what really is going on with Republicans is that they hate it when someone else solves a problem - such as the insurance problems that existed pre-Obamacare. We need only look back at their bitter and prolonged opposition to Social Security and Medicare for more evidence. Paul Ryan's plan to make Medicare into a voucher system would be even worse as it would quickly collapse under the high cost of the supplemental plans the elderly would be forced to purchase to cover the costs not paid for by the vouchers. They demonize solutions but offer nothing practicable as replacements.
193
"It seems fundamentally that what really is going on with Republicans is that they hate it when someone else solves a problem - such as the insurance problems that existed pre-Obamacare."
Absolutely correct. The Affordable Care Act was originally proposed by the Heritage Foundation, and implemented successfully at the state level by none other than Mitt Romney.
The Republicans' main objection to the ACA was that it was proposed as a compromise plan by a centrist cosmopolitan Democrat. The could not abide with the reality that he had been successful where every other administration from both parties had failed.
Absolutely correct. The Affordable Care Act was originally proposed by the Heritage Foundation, and implemented successfully at the state level by none other than Mitt Romney.
The Republicans' main objection to the ACA was that it was proposed as a compromise plan by a centrist cosmopolitan Democrat. The could not abide with the reality that he had been successful where every other administration from both parties had failed.
"Obamacare "solved" nothing. It offers little coverage other than pet liberal solutions tied to exploding premiums and high out of pocket costs."
As a liberal, I am proud of my support for "pet liberal solutions" such as provision of health insurance coverage to all legal residents of the United States.
High premiums for some are indeed a flaw, but one that could be addressed if both parties were committed to actually addressing the needs of all Americans.
As a liberal, I am proud of my support for "pet liberal solutions" such as provision of health insurance coverage to all legal residents of the United States.
High premiums for some are indeed a flaw, but one that could be addressed if both parties were committed to actually addressing the needs of all Americans.
Both Social Security and Medicare were passed with broad bipartisan support.
The repeat of ObamaCare will produce social chaos in additional to poor health care for the lower 99%. All one needs to do is to poll New Yorker's to understand how many are covered and like the care they have, despite the programs imperfections. Repealing ObamaCare will be a great societal calamity. My private employer sponsored plan will increase to offset lost income. Insurers are bound to lay off employees. Who does the TrumpDon'tCare plan hurt? The lower 99%. President Obama is a true intellect and gentleman in calling for "calm" and "giving a chance", but I hope he understands how motivated people are to preserve their personal health, and how much they hate having something taken away from them.
1
Professor Gruber's astute analysis exposes the ugly reality behind the GOP claim that its alternative represents an improvement on the ACA. Ryan's plan to substitute health savings accounts for the current law's subsidies helps only those families with the financial ability to save. Nor would this approach ensure enough customers to enable the companies to comply with the requirement concerning people with prior conditions.
Ryan surely knows these facts, but Trump quite possibly does not. His notion that he can cherry pick which parts of the law he wishes to retain underscores the danger to the country of electing a president who lacks an elementary understanding of law or who knows so little about the problems facing the country. This ignorance exposes Trump to manipulation by politicians like Trump and Mike Pence, whose agendas may differ significantly from his.
Trump's own values and goals pose large enough risks for the country. Pence, however, seeks to roll back the progress we have made on LGBT rights, while Ryan aspires to incorporate into our tax and spending policies the discredited supply-side theory of the Reagan years. The lethal combination of Trump's prejudices and the ideology of Pence and Ryan give a whole new meaning to those lines from "Richard III,": "Now is the winter of our discontent...", to be followed by an equally bleak spring, summer, and fall.
Ryan surely knows these facts, but Trump quite possibly does not. His notion that he can cherry pick which parts of the law he wishes to retain underscores the danger to the country of electing a president who lacks an elementary understanding of law or who knows so little about the problems facing the country. This ignorance exposes Trump to manipulation by politicians like Trump and Mike Pence, whose agendas may differ significantly from his.
Trump's own values and goals pose large enough risks for the country. Pence, however, seeks to roll back the progress we have made on LGBT rights, while Ryan aspires to incorporate into our tax and spending policies the discredited supply-side theory of the Reagan years. The lethal combination of Trump's prejudices and the ideology of Pence and Ryan give a whole new meaning to those lines from "Richard III,": "Now is the winter of our discontent...", to be followed by an equally bleak spring, summer, and fall.
1
The implication is that this is a policy decision by the Republicans. I believe it is purely political.
Let's look at Gruber's premise. "Alternatively, the insurer could offer coverage, but say that any breast-cancer survivor had to pay, say, five times more than everyone else."
OK. But let's say that because of the person's history of breast cancer, the expected costs are also "five times more than everyone else." Insurance companies are not charities. As the departure of three of the largest insurers from Obamacare attests, if you dictate a situation where insurers consistently lose money, they will exit the market. Almost 1000 counties in America will have only one insurer.
Insurance is not magic. Each person must pay the expected cost of their treatment. Sure, a large pool will lower the variance of cost - which is important. But a high expected cost will either mean higher premium or it means that someone else must bare the cost.
Obamacare tries to force the young and healthy to bare this cost by charging them more than their health would suggest. The problem is that when the government manipulates prices, people react. Far fewer young people have joined the Obamacare exchanges than needed.
The only alternative is to have the government provide coverage for a high risk pool. In reality, these consumers who are already sick aren't insurance customers. It's like shopping for car insurance after you've already had an accident.
But this doesn't alter the basic need to allow the free market to price each person's risk.
OK. But let's say that because of the person's history of breast cancer, the expected costs are also "five times more than everyone else." Insurance companies are not charities. As the departure of three of the largest insurers from Obamacare attests, if you dictate a situation where insurers consistently lose money, they will exit the market. Almost 1000 counties in America will have only one insurer.
Insurance is not magic. Each person must pay the expected cost of their treatment. Sure, a large pool will lower the variance of cost - which is important. But a high expected cost will either mean higher premium or it means that someone else must bare the cost.
Obamacare tries to force the young and healthy to bare this cost by charging them more than their health would suggest. The problem is that when the government manipulates prices, people react. Far fewer young people have joined the Obamacare exchanges than needed.
The only alternative is to have the government provide coverage for a high risk pool. In reality, these consumers who are already sick aren't insurance customers. It's like shopping for car insurance after you've already had an accident.
But this doesn't alter the basic need to allow the free market to price each person's risk.
2
"The only alternative is to have the government provide coverage for a high risk pool. In reality, these consumers who are already sick aren't insurance customers."
Yes, it's called Socialized Medicine, and the only method that works and is fair in a compassionate and caring society. If everyone pays into that system, then the government - who should not have a profit motive, unlike the insurance companies - would be able to cover everyone, no matter whether they are "high risk" or not.
Yes, it's called Socialized Medicine, and the only method that works and is fair in a compassionate and caring society. If everyone pays into that system, then the government - who should not have a profit motive, unlike the insurance companies - would be able to cover everyone, no matter whether they are "high risk" or not.
3
No, we do not want the world where "each person pays the expected cost of their treatment". It's too cruel, and it makes life is too unpredictable and risky. Think harder, please. (It's not this way in the rest of the developed world, it's not this way under RomneyCare or ObamaCare.)
3
Why is it that reform-minded legislators fail to address the workings of the private insurance market when they propose their reforms? Professor Gruber provides a simple and clear explanation of what happens in that market if the pre-existing condition provisions of the ACA stay but everything else goes. If the individual mandate goes, so goes any meaningful opportunity to address the importance of creating a diversified risk pool -- something any insurance market (whether it be for our homes, our automobiles, our lives or our health) requires to keep coverage affordable. That aspect of the ACA needs work and we can fix it. Any "reform" that fails to create good insurance risk, a foundational component of the insurance market that has defined health care coverage in the United States for dozens of decades, cannot be called meaningful reform. And any call to repeal certain provisions of the ACA without being honest about the impact this cherry-picking will have on the insurance market does a grave disservice to those individuals without access to affordable health care coverage and those who care for about them. Not only does it deny them needed care and support, it also makes having a civil, robust and productive dialogue about a critical public and personal need next to impossible.
1
This op-ed writer is picking apart a casual comment by Trump for precise meaning. Retaining the rule on benefits for pre-existing conditions implies that applicants cannot be excluded for pre-existing conditions; underwriting can be based on age, geography and behavior (smoking), but not on health. In fact, that is how most people interpret that part of the ACA. Congress will have to write the new law, and it is unlikely to make such an obvious omission.
1
Well, perhaps Gruber was being overly precise in his parse of the statement.
However, I recall when I lived in CT pre-ObamaCare, the state had a law stating that pre-existing conditions could not be excluded on individual policies, but, in fact, it was as Gruber now takes it. That is, (a)a company could charge based on pre-existing conditions without bound and (b)it could deny coverage entirely.
(CT did have a high-risk pool to cover people, provided they had maintained continuous prior coverage. It was expensive. Last time I checked, just before ObamaCare went into effect, a male 60-64 had to pay an annual premium of $23,000 a year, plus allow for a $7500 stop loss for that plan. Total $30,000 a year. And of course, with medical inflation, it would be higher now.)
However, I recall when I lived in CT pre-ObamaCare, the state had a law stating that pre-existing conditions could not be excluded on individual policies, but, in fact, it was as Gruber now takes it. That is, (a)a company could charge based on pre-existing conditions without bound and (b)it could deny coverage entirely.
(CT did have a high-risk pool to cover people, provided they had maintained continuous prior coverage. It was expensive. Last time I checked, just before ObamaCare went into effect, a male 60-64 had to pay an annual premium of $23,000 a year, plus allow for a $7500 stop loss for that plan. Total $30,000 a year. And of course, with medical inflation, it would be higher now.)
I've been benefiting from Obamacare in the individual insurance market for two years. It's better than nothing, but that's about the only thing good that can be said for it. Democrats were foolish to pass a Republican health plan without a single Republican vote, and the Trump victory last week was largely reaped from that foolishness. Care under the "Affordable Care Act" is anything but. I'm an exceptionally healthy 55 year old and I pay almost $400 a month for INDIVIDUAL coverage with a $7000 deductable! Max Baucus was in the bag for the insurors, Obama was dangerously naive, and Chuck Grassley if you can believe it played them both for fools. It was idiotic to create health care "reform" that INCREASED rather than decreased the burdens on employers. Let Trump repeal Obamacare; let the Republicans accomplish nothing with their attempts at free-market solutions; then maybe we'll have a shot at what the Democrats should have pushed for in the first place -- true single-payer health care such as Medicare for all, a la Bernie.
5
Trump said something that was not covered in this column.
He said “Cover children LIVING AT HOME until age 26!” That is YUGE! The point was to cover our kids until they finished school whether universities and post grad or tech schools while living ELSEWHERE! THEN cover them until they can find work (hopefully--maybe in those coal mines he wants to re-open or building a fence on the southern border--Wall? What wall?)
Trump looked shell-shocked after speaking with Obama then with Leslie Stahl.”Wow it’s a big job..bigger than I thought!”
The entire time Obama was speaking of “unity” with Trump you just knew he was thinking “Okay fool! Let’s see you REALLY screw this up!” The same way he told Mitt Romney in the debate on whether Obama had referred to Benghazi as a terrorist attack. “Please continue Governor!” As Obama sat back on his stool. Sucker!!
And now we have we have Breitbart’s Steve Bannon as Consigliere. Trump’s been watching the Godfather too many times.
He said “Cover children LIVING AT HOME until age 26!” That is YUGE! The point was to cover our kids until they finished school whether universities and post grad or tech schools while living ELSEWHERE! THEN cover them until they can find work (hopefully--maybe in those coal mines he wants to re-open or building a fence on the southern border--Wall? What wall?)
Trump looked shell-shocked after speaking with Obama then with Leslie Stahl.”Wow it’s a big job..bigger than I thought!”
The entire time Obama was speaking of “unity” with Trump you just knew he was thinking “Okay fool! Let’s see you REALLY screw this up!” The same way he told Mitt Romney in the debate on whether Obama had referred to Benghazi as a terrorist attack. “Please continue Governor!” As Obama sat back on his stool. Sucker!!
And now we have we have Breitbart’s Steve Bannon as Consigliere. Trump’s been watching the Godfather too many times.
1
Republicans have been crying "Repeal!" and "Repeal and replace!" since the ACA was passed. We still don't know what their 'replace' involves. They complained that the Act was passed without any Republican support, and they are correct; they never offered any constructive suggestions while it was being debated. We remember John Boehner saying something to the effect of 'let's slow down and start over.' Before they start their next move, I want to hear Republicans acknowledge two things: 1) that all citizens should have the right to basic health care, and the opportunity to get insurance coverage they can afford; and 2) that since our insurance, medical and pharmaceutical systems are made up largely of private corporations, and since Congress has the right to regulate interstate commerce, the government has every right (and responsibility) to regulate the systems to make 1) happen.
153
Try opening up state lines to all health insurance companies, it's called competition and will immediately allow people to shop for any healthcare plan they want which means lower costs and better opportunities for the consumer.
You forget that Dr. Ben Carson, who supported DT stated that medical caare is not a right. Reepublican governors refused to extend Medicaid within their states, which was also part of the ACA. One republican, and I do not remember his name, and here I paraphase, that everyone has to die sometime. Please tell me why anyone could believe that the appeal of the ACA will only result in more deaths, sorry and pain foisted upon the backs of those who can least afford it, the middle class and working 'poor'. Oh, an by the way, the working poor may probably be deined as those earning less than $18.00 per hour for thier labor.
One will be hard pressed to find a right to healthcare in the Constitution. However, it is fair to stipulate that in the 21st century there is consensus that we as a country have assumed a moral obligation to provide a basic baseline of healthcare to all in need. We don't let people starve to death in this country, nor do we metaphorically let them bleed to death.
1
should read " rising sea levels ' sweep us all away .
This should be required reading, and by the way, it doesn't matter. We have a largely intact House that has voted more than 50 times for an outright repeal of the ACA. They'll do this again and will get support from the Senate and from Trump, who will explain that he plans to replace Obamacare with a very terrific plan that will, of course, fail to materialize.
The ACA has been crippled by a failure to clamp down on exorbitant costs for routine care and procedures. This was a logical and necessary step, but Congress became enthralled with a quixotic effort to repeal the ACA instead of reducing high medical costs that form the basis for expensive premiums and co-pays.
Within a year we'll be back on the short list of countries that don't have a coherent approach to health care and insurance coverage, with the exception of Medicare for the elderly and Medicaid for the needy.
Oh, wait...
The ACA has been crippled by a failure to clamp down on exorbitant costs for routine care and procedures. This was a logical and necessary step, but Congress became enthralled with a quixotic effort to repeal the ACA instead of reducing high medical costs that form the basis for expensive premiums and co-pays.
Within a year we'll be back on the short list of countries that don't have a coherent approach to health care and insurance coverage, with the exception of Medicare for the elderly and Medicaid for the needy.
Oh, wait...
Maybe Trump's plan would force the insurance companies out of the health care business, opening the way to single payer. Our present system is broken; private insurance cannot take care of our health care needs.
There is only one insurance company with plans for me on the Colo. exchange, with premium increases of 33 to 50% for a plan that covers way less than my current plan. I am giving up on the insurance companies and am going to put the money I would have given them into my HSA to take care of my own health care.
I voted for single-payer in Colo, tho it didn't pass. Maybe we can someday join the rest of the world in a rational healthcare system.
There is only one insurance company with plans for me on the Colo. exchange, with premium increases of 33 to 50% for a plan that covers way less than my current plan. I am giving up on the insurance companies and am going to put the money I would have given them into my HSA to take care of my own health care.
I voted for single-payer in Colo, tho it didn't pass. Maybe we can someday join the rest of the world in a rational healthcare system.
2
A simple single payer and get rid of insurance companies all together. It is the insurance companies who make money on both the healthy and the ill.
5
Every time ( which is just about every week now ) someone writes an article about health care it just ends up being one long confusing piece, Just like Health Insurance in the U.S. today. Sure Trump should keep the two provisions, children allowed to stay till 26 years old and no denial for pre-existing conditions. But in the end it won't matter what he keeps or changes, because it will just keep getting worse and worse. At least if they scrap Obama Care the government ( IRS ) won't come after you, audit and fine you if your not signed up. Hopefully sometime in the next 100 years, before the rising levels sweep most of us away, we will come to single payer or medicare for all, Just like most of the civilized world. There is a reason they all do it that way, it is the only thing that will work.
Orange, NJ
Orange, NJ
3
I wonder if Trump understands this issue. Certainly Paul Ryan does. just as certain, the Trump voters who derided Obama care do not understand the protection ACA gave them, amd the attendant cost. Thise voters may have elected the president they deserve. unfortunately the rest of us must suffer the consequences of their pre-existing ignorance.
3
I know the dangers of trying to predict anything, much less what Donald Trump might do, are huuuge, but I've never let that stop me before. When his team actually studies Obamacare and sees that it was the most conservative of all the options considered when it was developed, we will get a Trumpcare that has the paragraphs rearranged but is essentially the same. When he says he will keep the two critical elements in this article and provide better coverage at lower cost, he is just stating what he would LIKE to be possible. Everyone would like that to be possible, including Mr. Obama and the people that helped design Obamacare in the first place. Couldn't be done then, can't be done now without cutting reimbursements to medical professionals so much that they won't accept the plan. Since that is unworkable, what we will have is, as Shakespeare might have said, a plan by any other name...
1
If he wanted, Mr. Trump can certainly provide a far better alternative to health care than either the ACA or what existed prior: Give us a single-payer system so that we are truly in line with the rest of the developed world.
Now who mentioned that before? I can't seem to remember...
Now who mentioned that before? I can't seem to remember...
1
The US by 2013 was 2.9 years of life expectancy behind the average for the other top 22 high income western nations. This is 928 million lost years of life for Americans compared to those living in other nations.
ACA will probably reduce this discrepancy by one a half to two years, given lack of implementation of all benefits. Eliminating ACA will cost about 1.5 to 2 years of life for average Americans. Destroying Medicare and Medicaid as Paul Ryan (but not others) propose to do would decrease American life expectancies by another 2 years.
The provision of full coverage with a public option, as all other countries do, would get us at least equal to the average for all others in life expectancy, if not above their average, and at much less cost than today. The differences between better coverage and the worst coverage few would be 5 years less life expectancy for Americans compared to other nations. This would be many more lost years of life than resulted from WWII in Europe. The decisions to be made now on health care have more impact on human life than would a decision to have another WWII. Choose wisely, America.
ACA will probably reduce this discrepancy by one a half to two years, given lack of implementation of all benefits. Eliminating ACA will cost about 1.5 to 2 years of life for average Americans. Destroying Medicare and Medicaid as Paul Ryan (but not others) propose to do would decrease American life expectancies by another 2 years.
The provision of full coverage with a public option, as all other countries do, would get us at least equal to the average for all others in life expectancy, if not above their average, and at much less cost than today. The differences between better coverage and the worst coverage few would be 5 years less life expectancy for Americans compared to other nations. This would be many more lost years of life than resulted from WWII in Europe. The decisions to be made now on health care have more impact on human life than would a decision to have another WWII. Choose wisely, America.
1
The longer term fix is to limit the exposure of private insurance to some reasonable annual and life-time maximum. Not stuck on the number but lets say $50K annually and $750 lifetime. Have the mandatory private insurance cover the routine and reasonable medical costs like broken legs, appendicitis, etc. Allow the private sector to sell optional catastrophic insurance to those that can afford it and want it. Make the government the provider (possibly through Medicare) for everyone with extremely expensive on-going health issues.
This keeps the private sector -- but claims are capped and more easily managed and premiums can actually be affordable. Those that can afford it can by optional additional coverage and rely on the private sector. Those unfortunate people with chronic expensive issues are covered through a govt program paid for through broad based taxes -- but don't overly burden the private insurance pool.
This keeps the private sector -- but claims are capped and more easily managed and premiums can actually be affordable. Those that can afford it can by optional additional coverage and rely on the private sector. Those unfortunate people with chronic expensive issues are covered through a govt program paid for through broad based taxes -- but don't overly burden the private insurance pool.
1
Trump and Congressional Republicans are oblivious to how institutionalized Obamacare already is. To name a few ways: ACA provisions are now built into employer and individual policy contracts; employees expect to be offered benefits when they perform full-time work (or its equivalent, if they are wrongly categorized); people expect to have comprehensive coverage with no exceptions; people expect a minimum of premium payments to go toward claims, not unlimited money for insurer advertising and salaries; young adults can count on being on parents' coverage until 26.
The way insurers and employers operate has already been changed, as have covered peoples' expectations. It all goes together and there's no regression from these achievements.
The way insurers and employers operate has already been changed, as have covered peoples' expectations. It all goes together and there's no regression from these achievements.
Dear Mr. Gruber,
Please explain to us why is our health insurance about twice as expensive as that of Canada. or Britain? Also, we pay a lot ourselves, there they pay nothing.
Please explain to us why is our health insurance about twice as expensive as that of Canada. or Britain? Also, we pay a lot ourselves, there they pay nothing.
4
Paul Ryan and co. were frothing at the mouth after Trump won.
Sorry to laugh but those same Republicans just hung Trump out to dry.
Trump, clueless as he is, repeated the Republican mantra, "Repeal Obamacare" during the campaign not realizing the acute hardship tossing people with a pre-existing condition off insurance would cause.
Now what? The smartest, healthiest President of our time is going to have a really big, no yuuge, dilemma.
His 60 Minutes interview was baffling since he walked back what he said on the campaign trail but clearly has no idea about the ramifications.
If he prohibits insurance companies from denying coverage for pre-existing conditions and does not require the healthy to buy insurance, is the government responsible for their losses when the only people who sign up have pre-existing conditions?
A bill repealing the ACA is going to land on Trump's desk in the first week of his presidency.
I guess if there is a test of Trump's deal making wizardry, this is it.
Sorry to laugh but those same Republicans just hung Trump out to dry.
Trump, clueless as he is, repeated the Republican mantra, "Repeal Obamacare" during the campaign not realizing the acute hardship tossing people with a pre-existing condition off insurance would cause.
Now what? The smartest, healthiest President of our time is going to have a really big, no yuuge, dilemma.
His 60 Minutes interview was baffling since he walked back what he said on the campaign trail but clearly has no idea about the ramifications.
If he prohibits insurance companies from denying coverage for pre-existing conditions and does not require the healthy to buy insurance, is the government responsible for their losses when the only people who sign up have pre-existing conditions?
A bill repealing the ACA is going to land on Trump's desk in the first week of his presidency.
I guess if there is a test of Trump's deal making wizardry, this is it.
If they keep the pre-existing conditions, they must keep the mandate. Otherwise, people would not sign up for insurance until they got sick. And if they keep the mandate, the PEC and the young adults on their parents care, what's left to repeal?
2
Obamacare was a Republican conceived plan. They opposed its passage unanimously because their number one objective was to insure that the black man in the White House would be a one term president. Maybe they will now remember where this private insurance plan came from and maybe start calling it Romneycare.
4
Bringing back the cherry-pickers and gatekeepers (i.e.death panels).
And this from the so-called pro-life party.
And this from the so-called pro-life party.
3
Let's not ever forget that Jonathan Gruber was recorded saying that "lack of transparency" & "the stupidity of the American voter" were critical in getting Obamacare passed. Why should anyone believe a word from one of the architects of the law who said these words? Thanks in large part to Mr. Gruber & ObamaCare, we have a majority of governors, state legislatures, the Senate, the House and the presidency in Republican hands.
2
President Elect Trump emphatically said (60 Minutes) he will keep the provisions you articulated and the health care would be better. He will do what he said he will do. Obamacare is not worth the paper it is written on. Your paper specifically had a specific article on more people being content with being fined than to pay the obscenely high premiums on Obamacare. Report fact not fiction.
Americans are coming to expect universal health care. Politicians won't be able to avoid it.
The real problem is cost of all US health care. We spend between half again as much and twice as much as other advanced modern countries. That is wasteful excess of between equal to our entire defense budget, or double it.
Somebody is making off with abusive waste in an amount equal to or double our entire defense budget. That is an astounding amount of money.
The real fight is to keep that money. We know the abuses that happen from efforts to leach off the defense budget. This is a lot more money.
We can't fix health care with any plan, so long as we allow the whole things to be looted like this.
The real problem is cost of all US health care. We spend between half again as much and twice as much as other advanced modern countries. That is wasteful excess of between equal to our entire defense budget, or double it.
Somebody is making off with abusive waste in an amount equal to or double our entire defense budget. That is an astounding amount of money.
The real fight is to keep that money. We know the abuses that happen from efforts to leach off the defense budget. This is a lot more money.
We can't fix health care with any plan, so long as we allow the whole things to be looted like this.
19
Only in the U.S. is health care considered an "industry." No one should be making huge profits off of the poor health of their fellow citizens. Physicians take an oath relating to this; insurers and prescription drug companies should be obligated to do the same.
4
In the days before the ACA was passed I wondered why it was that the citizens of Massachusetts had been gifted with universal health care, under a Republican governor no less, while the rest of us were made to do without. Now that all or most of the ACA has been placed on the fast track to the boneyard by the new hero of America's working class I have to go back to wondering why the health of our citizens is regarded as consequential only to the politicians of the Commonwealth. Where is Governor Cuomo and our legislators in Albany when it comes to universal health care? If The Donald proceeds to do his worst, what will it take for Cuomo and company to do right by their citizens and bring Romneycare here to New York?
221
A good question, thanks:
Where is Governor Cuomo and our legislators in Albany on
universal health care? What'll happen to NYState citizens with
no Affordable Care Act?
Where is Governor Cuomo and our legislators in Albany on
universal health care? What'll happen to NYState citizens with
no Affordable Care Act?
1
In his Solomonic wisdom, Donald Trump pledges to save the ACA baby by cutting it in half and presenting it to a horrified nation.
Save the good parts, but don't pay for them...in true Republican economically bankrupt fashion...thereby killing everything in the long-term.
32 of 33 developed nations have had universal health care or single-payer for eons before the USA and its merciful Democrats tried to join the civilized world with the ACA in 2014.
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
UK 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
UAE 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014 Insurance Mandate
Republican America, the greediest, dumbest, most selfish and unhealthiest student in the civilized world.
Save the good parts, but don't pay for them...in true Republican economically bankrupt fashion...thereby killing everything in the long-term.
32 of 33 developed nations have had universal health care or single-payer for eons before the USA and its merciful Democrats tried to join the civilized world with the ACA in 2014.
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
UK 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
UAE 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014 Insurance Mandate
Republican America, the greediest, dumbest, most selfish and unhealthiest student in the civilized world.
598
Thanks for the list, very instructive.
1
Well done, Socrates!
May I add that the protests of those naysayers who want to dismiss universal healthcare as a 'Socialist' scheme, conveniently forget that our established police and Fire Departments, FBI, FEMA, schools, social security system, National Park System, etc, etc, etc, are all socialist institutions, run by the local or federal governments.
May I add that the protests of those naysayers who want to dismiss universal healthcare as a 'Socialist' scheme, conveniently forget that our established police and Fire Departments, FBI, FEMA, schools, social security system, National Park System, etc, etc, etc, are all socialist institutions, run by the local or federal governments.
2
In Germany the original health insurance law, in particular for the poorest, goes back to 1883, Bismarck set that up. He was called socialist for that. He didn't care.
1
The Republican idea, from the Heritage Foundation, that underlies the Affordable Care Act, and which was implemented by Mitt Romney when he was governor of Massachusetts, included the "individual mandate" which charged people for not buying insurance. Its stated purpose was to discourage "free riders," namely people who postpone buying insurance, even at affordable rates, unless and until they get some expensive health problem. Discouraging "free riders" encourages everyone, sick or healthy, young or old, to buy health insurance. The whole point of insurance is to have a large pool of buyers, only a small fraction of whom need to cash in on the insurance at any given time. Otherwise people would buy collision insurance only after their car crashed.
Why the Republicans unanimously opposed what was a Republican idea -- unless it was their total refusal to accept President Obama's attempt to reach across the aisle to them -- is beyond me. After all, the only other way of achieving universal coverage at reasonable cost to the insured is a single-payer system.
Thanks for this clear explanation, Professor Gruber. I hope somebody explains it to the president-elect.
Why the Republicans unanimously opposed what was a Republican idea -- unless it was their total refusal to accept President Obama's attempt to reach across the aisle to them -- is beyond me. After all, the only other way of achieving universal coverage at reasonable cost to the insured is a single-payer system.
Thanks for this clear explanation, Professor Gruber. I hope somebody explains it to the president-elect.
465
Republicans opposed it because it was Obama's plan (even though it was Heritage's plan). They also opposed it because, if it worked, it would demonstrate that the government can be a force for good in the lives of the people. And if you are a modern Republican, you must not entertain such thinking.
There are many ways of achieving universal coverage other than single payer. Germany has a large number of insurance companies. The Netherlands has five insurance pools with risk adjustment across pool. The US could get to near universal coverage by lowering the eligibility age for Medicare to (say 55), expanding Medicaid eligibility, and letting employers use private insurance companies. Most of our excess costs comes from lack of purchaser market power over service providers, drug companies etc,, not from administrative costs of insurance companies (although billing costs are a big waste of money) If the federal government used its market power through Medicare, Medicaid and the VA to negotiate competitive prices, this would achieve much of the lower costs that single payer systems achieve through use of global budgets and salaried health care providers. Single payer is a slogan, not a solution likely to work in the US because of the existing insurance arrangements that would need to be disrupted.
I'm sure the Republicans refused it solely because it was proposed by Obama. It was part of their obstruction of his governance. In the process, they not only shot themselves in the foot, but are now wanting to bring the entire country down with them. Even their own constituents, whom they continually entrance to vote Republican against their own best interests. We've begun so tribal it's disgusting.
3
I'm sure glad the readers can now have the benefit of such a distinguished professor to generate an argument of this length to explain something so simple and obvious that anyone with an eighth grade education could figure it out on their own. Earth shattering problem solving of magnitude must be how the ACA was developed in the first place.
First of all, Trump has not presented any replacement for the ACA. All he has said is that he wants to retain these two components. Now I want Trump to be my president like I want brain cancer, but before his plan can be rejected, it has to be presented.
Secondly, your plan is a wreck and is collapsing under its own weaknesses. Sounds to me like you are trying to get out from under it by chucking the whole thing.
The only way to make something like this work is to spread all costs over the entire population. If everyone, everywhere was in the program, the costs borne by the very sick would be spread out over all premiums which raise them all only slightly. Your system concentrates many high cost patients into small groups so their costs are carried by few people. Result, premiums go through the roof.
That's why a single payer, Medicare for all, payroll tax financed system works best. Even a voucher system, paid for with tax receipts, could be used. That would be a more market based approach, but everyone must be included and all must participate, even employer based plans. Buy the plan you want. No underwriting.
First of all, Trump has not presented any replacement for the ACA. All he has said is that he wants to retain these two components. Now I want Trump to be my president like I want brain cancer, but before his plan can be rejected, it has to be presented.
Secondly, your plan is a wreck and is collapsing under its own weaknesses. Sounds to me like you are trying to get out from under it by chucking the whole thing.
The only way to make something like this work is to spread all costs over the entire population. If everyone, everywhere was in the program, the costs borne by the very sick would be spread out over all premiums which raise them all only slightly. Your system concentrates many high cost patients into small groups so their costs are carried by few people. Result, premiums go through the roof.
That's why a single payer, Medicare for all, payroll tax financed system works best. Even a voucher system, paid for with tax receipts, could be used. That would be a more market based approach, but everyone must be included and all must participate, even employer based plans. Buy the plan you want. No underwriting.
154
You are correct. A single payer program is the way to go. And as you know, Obama didn't fight for a public option that would have led to Medicare for all. He couldn't do it with the Congress he had, even with the Dems in the majority, let alone having any Republican support. Baucus and the blue dogs held him back a much as any R's would have, if they had been even involved.
The notion of healthcare "insurance" is inherently absurd. We know that everyone who is young and health is destined to become old and sick. The ACA was designed to buy off the Insurance industry to establish the principle of universal healthcare.
Now that that is established (i.e., millions of people will cry bloody murder if they lose medical care), the physics of healthcare economics will force Trump to put up or shut up.
Now that that is established (i.e., millions of people will cry bloody murder if they lose medical care), the physics of healthcare economics will force Trump to put up or shut up.
Ryan would like to privatize Medicare and make it a voucher system, HMOs -- I thought that voucher systems required lots of paper work?
Without getting into the weeds, as the author does, following up as he has on helping to concoct the lies by which the ACA was sold (barely) to a gullible Congress, Republicans will find that simply repealing ObamaCare is neither wise nor perhaps even actionable.
You cut loose 22 million people from their healthcare once having given it to them, you have a lot of ‘splainin’ to do to Americans – despite the overwhelming disapproval we register regularly of the program. This would be among the actions that undivided Republican government might do that would lose them their power almost as surely as Democratic hubris in concocting and ramming the ACA lost them theirs.
Funding for the ACA should be frozen. After 20 Jan., President Trump should name a blue-ribbon commission to work for two years (instead of the one year Nancy Pelosi gave the 111th Congress and HHS) to define, once and for all, how government is to participate in the provision of healthcare in America. The results, once passed by Congress on an up-or-down vote, not only should replace the ACA but EVERY other healthcare program we have – Medicare, Medicaid, Veterans’ Care, the HC components of Social Security, the state-accretions: EVERYTHING.
My own preference would have a single-payer component for very basic healthcare, available to ALL Americans, and availability of enhanced coverage on subsidized exchanges from nationally-chartered insurers.
High time to solve this and get on with our lives.
You cut loose 22 million people from their healthcare once having given it to them, you have a lot of ‘splainin’ to do to Americans – despite the overwhelming disapproval we register regularly of the program. This would be among the actions that undivided Republican government might do that would lose them their power almost as surely as Democratic hubris in concocting and ramming the ACA lost them theirs.
Funding for the ACA should be frozen. After 20 Jan., President Trump should name a blue-ribbon commission to work for two years (instead of the one year Nancy Pelosi gave the 111th Congress and HHS) to define, once and for all, how government is to participate in the provision of healthcare in America. The results, once passed by Congress on an up-or-down vote, not only should replace the ACA but EVERY other healthcare program we have – Medicare, Medicaid, Veterans’ Care, the HC components of Social Security, the state-accretions: EVERYTHING.
My own preference would have a single-payer component for very basic healthcare, available to ALL Americans, and availability of enhanced coverage on subsidized exchanges from nationally-chartered insurers.
High time to solve this and get on with our lives.
190
How do you define "basic health care?" For those of us who believe that you shouldn't have to lose your life savings in order to save your life, it's catastrophic health care that's needed most of all. That PLUS universal care for all minor children, whose health shouldn't be imperiled by their parents' income, or lack of it.
131
stu:
"Basic", to me, would include life-saving care. But you must have read the MANY descriptions I've offered of what I suggest would work over the last few years, right up to yesterday.
However, now and here are not the time and venue to negotiate "basic". THAT'S largely what the commission would do over two years -- and they'd need every day of it.
"Basic", to me, would include life-saving care. But you must have read the MANY descriptions I've offered of what I suggest would work over the last few years, right up to yesterday.
However, now and here are not the time and venue to negotiate "basic". THAT'S largely what the commission would do over two years -- and they'd need every day of it.
6
Was single-payer not what Obama initially intended on doing but was stopped by rabid Republicans who forced Obama to keep private insurance in the loop, thus resulting in the Frankenstein dysfunctional bland of services that was doomed from the onset!? You probably can trace everything that went wrong in Obama's programs in the 8 years of his terms to a Republican hand bent on making him fail.... now they reproach him executive orders....Under Trump, the tail will still be wagging the dog!
10
Trump campaigned on getting rid of Obamacare.
The easiest way to do that is to make some minor tweaks to the program and "replace" it with Trumpcare.
It's a win/win for Trump.
He fulfills a campaign pledge, makes some simply, obvious fixes to the program to make it more solvent, and then gets his ego polished by putting his name on the plan.
Everyone walks away happy.