Why not let states opt into or out of the ACA, now? Why would congressional republicans balk? If they're right, those benighted blue states retaining the ACA should see dreaded insurance death spirals and rising mortality rates, while enlightened red states that opt out could implement the glorious republican "free" market replacement thereby experiencing lower costs and healthier populations.
5
Honestly, all this debate is moot. The ACA will be gone by Jan. 27. There's no repeal and replace. Just repeal.
1
"Keep costs down and patients healthy": What a sensible goal! It's surely what most every American wants. The Republicans appear to favor market forces and tax incentives, but market forces favor increasing revenue via higher prices and more treatments.
I heard it asserted this morning that Republicans have a "mandate" from the American people to repeal the ACA. This is where it's important to consider two things: (1) Hillary Clinton received more votes than Trump; (2) Many who voted for Republicans are looking for changes that will help them lead better and less precarious lives. I believe any mandate from the people is one to make health care more affordable, available, and successful in improving the overall health of Americans.
I encourage our Republican and Democratic senators and representatives to work together to build on the progress that has been made in terms of cost containment, quality, and accessibility of health care.
I heard it asserted this morning that Republicans have a "mandate" from the American people to repeal the ACA. This is where it's important to consider two things: (1) Hillary Clinton received more votes than Trump; (2) Many who voted for Republicans are looking for changes that will help them lead better and less precarious lives. I believe any mandate from the people is one to make health care more affordable, available, and successful in improving the overall health of Americans.
I encourage our Republican and Democratic senators and representatives to work together to build on the progress that has been made in terms of cost containment, quality, and accessibility of health care.
9
Why don't we just stop messing around and have single-payer for all now? All these articles you publish are about minor issues.
11
I know what a "bipartisan" bill is, or would be, if it existed, but what in the world is a "bipartisan reason"? A reason, an argument, that Republicans would listen to, and support, at least in part, if only they consented to listen to reason? And then in the title, the term "Obamacare" which is the label Republican strategists slapped on the law, so that the inevitable repeal, when their turn in power arrived, could be made to look like the undoing of the actions of a rogue president. By all means, lets continue to talk about good reasons or bad reasons for system changes, but the appeals to reason will fail when an opponent is more concerned with winning. And what is it they hate so much about the Affordable Care Act exactly?
5
Facts, facts, facts....la la la I can't hear you.
Every object analysis of the ACA, with all its flaws, shows that it has been a substantial success. The problem is you have to look at the facts to see that.
Last year my wife had an emergency room visit, and the bill was $3000, below our deductible. People would cry (as I did) about that bill, but if they looked at what the hospital would have charged without our insurance managing their billing rates, they would likely have had the heart attack she avoided - > $10,000.
Look at the health status of the working poor in states which refused the Medicaid expansion under the ACA. Thousands die per year, untold others are forced out of work and into dire poverty due to treatable illnesses. All to adhere to Republican orthodoxy - even though the facts prove them wrong.
Every object analysis of the ACA, with all its flaws, shows that it has been a substantial success. The problem is you have to look at the facts to see that.
Last year my wife had an emergency room visit, and the bill was $3000, below our deductible. People would cry (as I did) about that bill, but if they looked at what the hospital would have charged without our insurance managing their billing rates, they would likely have had the heart attack she avoided - > $10,000.
Look at the health status of the working poor in states which refused the Medicaid expansion under the ACA. Thousands die per year, untold others are forced out of work and into dire poverty due to treatable illnesses. All to adhere to Republican orthodoxy - even though the facts prove them wrong.
65
The truth is there was no foundation before for health care outside of medicare and medicaid. Most of the same guarantees are now in private care form the ACA. So get rid of the penalties and mandates if you want, as they are whipped cream and the cherry on top. The structure is the important part.
2
Anything can be improved upon if there is a desire, but the GOP would rather grant gratuitous tax cuts to billionaires, endorse an endless blank checks to the pentagon, and endow corporate welfare.
Expect millions to lose their health.
Expect millions to lose their health.
54
It would have been nice to see stories like this before the election instead of continuous Hillary email fake scandal news. It's not as helpful to see what we lost after it's gone.
72
No, don't fight to save the ACA for any reason. The people who voted Republican for Congress and president have spoken loud and clear. They want it gone. However, they have no idea of what they want to replace it. This is a huge opening for Medicare for All or a public option or some other iteration of a single-payer system, which is the only sensible remedy for the mess we call our healthcare "system," which remains a patchwork with gaping holes, inequities, and obscene profits. Republicans have no workable solutions themselves. They will not force every employer to subsidize group insurance for every employee, including part-time and contract workers. They have nothing to offer the self-employed and family farmers and small business owners or the laid-off workers between jobs who are the ones complaining the loudest about the too-expensive Obamacare exchange. plans. Now is the time for progressives to make the case for single-payer. Simplify, simplify. Everybody covered, all the time, everybody paying something affordable according to their incomes. No more confusion. Get on with your life with some peace of mind.
33
Why isn't the media underscoring the ACA successes? I am sick to death of seeing so-called "ordinary citizens" who are denouncing the ACA. One seen recently on television in Gettysburg, PA was a financial analyst, self employed, who clearly exceeded the income levels that would qualify for a subsidy. These wealthy self-employed people are the loudest voices denouncing the ACA. They are a tiny sliver of the millions of ordinary wage earners who have benefited tremendously from the Act. A few loud voices from people who can absolutely afford the premiums should not be the measure of the success of the act. Moreover, if the ACA is eliminated, even the wealthy are going to get a tremendous sticker shock. The insurance industry is rapacious. No one will escape their gaping maw.
37
The Affordable Care Act is not anything the Republicans like, after having demonized it as the handiwork of Lucifer since 2010. Their hateful spite has very little to do with the provisions of the law itself. It has everything to do the the "Obama" moniker that they, themselves, slapped on this entirely fixable measure in the total absence of any idea remotely resembling an alternative.
To all those self-indulgent seniors who voted for the GOP, Say "good-bye doughnut hole" while you chomp on the morbidly unhealthy sweet junk around it. Wash it down with a high fructose corn syrup-laden Pepsi. Now, for the Trump voters who'll be kicked off Medicaid. As Nobel Laureate Bob Dylan crooned, "You're on your own" now. Hope you like it. Stay well, if you can.
www.endthemadnessnow.org
To all those self-indulgent seniors who voted for the GOP, Say "good-bye doughnut hole" while you chomp on the morbidly unhealthy sweet junk around it. Wash it down with a high fructose corn syrup-laden Pepsi. Now, for the Trump voters who'll be kicked off Medicaid. As Nobel Laureate Bob Dylan crooned, "You're on your own" now. Hope you like it. Stay well, if you can.
www.endthemadnessnow.org
33
Republicans are quick to repeal instead of repair. These are unconscionable people who care nothing about the sick or less fortunate. They are also some of the most vindictive people . Attacking the ACA is attacking President Obama and this soothes their corrosive spirits. Those of us with any moral integrity know the difference between right and wrong and President Obama will be remembered for all the good he has done as President of the USA. They can repeal as much as they want. President Obama's legacy will not be tainted.
49
It's just little me. The lady in the neighborhood who babysits your children, housesits your homes and who cares for your pets when you travel. I love this work. It is deeply satisfying and fun and full of variety.
The reason I get to do these things is called Obamacare. Without it, I would be uninsurable or insurable with inadequate coverage and rates I cannot afford.
I think about what will happen to me and to my affordable healthcare. My stomach lurches and my heart hurts.
The one thing I know for sure is that no Republican cares about me. Their biggest urge is to dismantle my health and security.
So, due to unfortunate circumstances, I definitely qualify for disability. So far I have been able to work and I stay very busy. I'd like to keep working as much as I can and keep the insurance that has covered me.
If the Republicans ruin what has so tremendously helped me, I will be forced to go on disability. I won't find insurance any other way and I will need money to survive. Just think how much the government will save as all I need is affordable insurance.
Just think of all the children and dogs and cats and neighbors who will lose my help. But to Republicans, no one American matters in their rush to get rid of guaranteed care.
The reason I get to do these things is called Obamacare. Without it, I would be uninsurable or insurable with inadequate coverage and rates I cannot afford.
I think about what will happen to me and to my affordable healthcare. My stomach lurches and my heart hurts.
The one thing I know for sure is that no Republican cares about me. Their biggest urge is to dismantle my health and security.
So, due to unfortunate circumstances, I definitely qualify for disability. So far I have been able to work and I stay very busy. I'd like to keep working as much as I can and keep the insurance that has covered me.
If the Republicans ruin what has so tremendously helped me, I will be forced to go on disability. I won't find insurance any other way and I will need money to survive. Just think how much the government will save as all I need is affordable insurance.
Just think of all the children and dogs and cats and neighbors who will lose my help. But to Republicans, no one American matters in their rush to get rid of guaranteed care.
72
We should remember that Medicare was unpopular at first and there were some tweaks made to it. Now, I think it has proven it's value and popularity.
27
Trump said, while on the campaign trail, that he would replace Obamacare with something cheaper and better. Let's see it. Or do we have to wait for a reveal next week? Maybe Julian Assange can fill us in where he's hiding from the law in an embassy in London.
25
Many if not all poor rural Americans have 36 hour/ week community health clinics with Family Physicians and mid-level providers under the Affordable Health Care Act. When they acutely become ill outside these hours, these patients run to the Emergency Room, because they do not have to pay for the massive invoice they receive in the mail.
A family with parents in their fifties or older, and those who live in small towns under 100,000 population carry a burden of staggering health insurance premiums to pay for general medicine 36 hours a week in community centers.
The day that the senators and congressmen and presidents, who voted to create this horrid health care, actually take their family to one of these clinics and wait 3 hours to see a mid level caretaker. This is the day that the unaffordable health care system will fold.
A family with parents in their fifties or older, and those who live in small towns under 100,000 population carry a burden of staggering health insurance premiums to pay for general medicine 36 hours a week in community centers.
The day that the senators and congressmen and presidents, who voted to create this horrid health care, actually take their family to one of these clinics and wait 3 hours to see a mid level caretaker. This is the day that the unaffordable health care system will fold.
2
We obviously need to find ways to reduce the cost of health care in general before it bankrupts us. I'm no expert or even that well informed on the pros and cons of Obama care but I suspect we need a lot more than Obama Care as it is to reduce costs in a meaningful way (as costs keep going up- in some cases dramatically) The really interesting thing is that Republicans are absolutely obsessed with replacing it before having a better solution. Really - how can this possibly be justified to rational people - of either party?
10
Trump has promised a "better" program -- one that allows more people living in the US to get more and better health care for less money.
That's the "better mousetrap" the Republicans have vowed to provide.
It's high time time the Republicans put up or shut up.
That's the "better mousetrap" the Republicans have vowed to provide.
It's high time time the Republicans put up or shut up.
24
Obamacare is a threat to the national security, transferring billions of dollars from working middle-class Americans who don't qualify for taxpayer subsidies to the health care/insurance industrial complex, thus suppressing productive spending and labor particpation. Obamacare is the opposite of what the country needs, which is to rein in the exorbitant costs of medical tests and procedures. Instead, Obamacare perpetuates the central problem of costs, previously identified in NYT articles as our main problem, but largely ignored. Obamacare is unsustainable, and needs to be replaced by a system similar to those in other developed countries with far lower costs for the same services.
3
"Obamacare is a threat to the national security......"
Down the rabbit hole we go......
Down the rabbit hole we go......
21
The GOP's fight against Obama Care was never about what's best for the American citizen, it has always been all about their battle with anything President Obama did. Remember their "death panel" lies. Do not make the mistake of using reason in trying to understand or work with this GOP. Hopefully, when voters start to realize that the GOP has never had their interests in mind and that the real death panel is the GOP with its attempts to destroy the ACA. Maybe, just maybe things may start to change when the voter finally experiences the real costs of the GOP's policies. Sadly, it may take thousands of unnecessary deaths.
26
It seems that HSAs have been successful in controlling costs, and will surely factor into a GOP replacement plan. But, I assume there will still be those whose HSA balances do not cover their needed care, or those who do not have funds to cover their deductibles, or even their premiums. Denying them care, or forcing providers to absorb the cost of their care is not sustainable. Given that, I wonder about a national HSA system with annual contributions funded much like Social Security. The key feature of these accounts is that they can overdraft. The account will bear the full cost of care (or perhaps even a premium for preventable care). At the account holder's death, any negative balance will be subject to probate, and the debt forgiven if the estate cannot pay it off. Any positive balance will be added to the value of the estate.
This solution seems to address the "endless buffet" argument against the single-payer and third-party payer model. And, it addresses the arguments against the individual mandate. It ensures the provision of care to those in need, regardless of ability to pay. Mandates are irrelevant, pre-existing conditions are always "covered," and care is accessible regardless of age or employment status. It recognizes the simple fact that most people begin life healthy, and eventually decline. It will change the economics of end-of-life decisions.
I am curious to know what others think of this concept, and what the downsides might be.
This solution seems to address the "endless buffet" argument against the single-payer and third-party payer model. And, it addresses the arguments against the individual mandate. It ensures the provision of care to those in need, regardless of ability to pay. Mandates are irrelevant, pre-existing conditions are always "covered," and care is accessible regardless of age or employment status. It recognizes the simple fact that most people begin life healthy, and eventually decline. It will change the economics of end-of-life decisions.
I am curious to know what others think of this concept, and what the downsides might be.
4
The author's only solution is a government run and backed healthcare system. This is antithetical to how America operates, we want less government not more. And government that is there must be efficient, responsive and streamlined.
4
President Obama suggested today that we call the soon to be adopted no health care plan of the GOP Trumpcare.
I beg to disagree with my President. Let's call it TrumpDon'tCare
I beg to disagree with my President. Let's call it TrumpDon'tCare
24
Republicans in Congress hate Obama because of the color of his skin, his intelligence, his dignity and decency. They are are fixated on the ACA because it is one of the biggest achievements of his presidency. The fact that the ACA helps millions of people and saves the taxpayer money means nothing to them as long as they can continue to insult the president they hate even as he is leaving office by annihilating his accomplishment. I cannot even begin to describe the revulsion I feel toward these people and the voters -- many of them on the ACA -- who put them in office.
28
I can't believe you actually believe this.
Most Americans are not at all racist.
Who do you think voted Obama into office?
I'd bet cash you are retired and not in the working world, seeing how people of all races are fed up with the ridiculous costs of mandated insurance.
Deductibles are so high people cannot afford healthcare because they've spent all of their money on premiums.
We feel revulsion for the wealthy or retired whose ignorance makes them call other people names like racist.
Most Americans are not at all racist.
Who do you think voted Obama into office?
I'd bet cash you are retired and not in the working world, seeing how people of all races are fed up with the ridiculous costs of mandated insurance.
Deductibles are so high people cannot afford healthcare because they've spent all of their money on premiums.
We feel revulsion for the wealthy or retired whose ignorance makes them call other people names like racist.
3
The GOP-Trump coordinated effort to gut Obamacare is on shaky constitutional grounds. Equal Protection, Due Process, Separation of Powers Issues, and congressional and presidential overreach plague every step they are taking. I look forward to SCOTUS's nullification of their bogus "repeal" efforts later this year.
2
The Affordable Care Act has been devastating to hospitals that care for the undocumented uninsured. By slashing disproportionate share payments (DSH) and eliminating the upper payment limit (UPL), the ACA is directly causing the financial problems of NYC public hospitals:
https://www.bloomberg.com/politics/articles/2016-08-22/new-york-city-hos...
The problem is that democrats have dismissed any criticism of the ACA, and how they are being punished for their arrogance.
If the democrats actually addressed the limitations of the ACA, they could have acted to solve some of these glaring problems. Instead, they played politics and are now regretting it.
And don't you dare say that patients will be harmed by Trump, because those patients were already harmed by Obama and the ACA.
To make a medical analogy: Trump may make people DNR, but Obama created the injuries that put them in critical condition to begin with!
https://www.bloomberg.com/politics/articles/2016-08-22/new-york-city-hos...
The problem is that democrats have dismissed any criticism of the ACA, and how they are being punished for their arrogance.
If the democrats actually addressed the limitations of the ACA, they could have acted to solve some of these glaring problems. Instead, they played politics and are now regretting it.
And don't you dare say that patients will be harmed by Trump, because those patients were already harmed by Obama and the ACA.
To make a medical analogy: Trump may make people DNR, but Obama created the injuries that put them in critical condition to begin with!
4
"This frees up providers to do things fee for service doesn't pay for: talk to patients about how they can take care of themselves, hire community health workers to promote behavior change, see patients by video or phone, or take on extra staff to coordinate care to avoid duplication and medical errors."
Fantastic! So we can pay somebody to lecture me about how I shouldn't smoke.
Fantastic! So we can pay somebody to lecture me about how I shouldn't smoke.
2
It would be interesting to hear an actual rational argument from any informed Republican for the repeal of the ACA. If that argument was ever actually made, it's apparently been lost in the mists of time.
The idea of repeal has taken on its own inertia. The GOP could just as well operate blind. There are no reasons anymore. It is simply a thing to do.
Why?
The black president pushed for and signed the law.
Please, Republicans, maybe Richard Luettgen, or other frequently appearing apologists for repeal, can you, in good faith, without obfuscation, actually make your argument for repeal, in simple, plain, short English?
Try.
The idea of repeal has taken on its own inertia. The GOP could just as well operate blind. There are no reasons anymore. It is simply a thing to do.
Why?
The black president pushed for and signed the law.
Please, Republicans, maybe Richard Luettgen, or other frequently appearing apologists for repeal, can you, in good faith, without obfuscation, actually make your argument for repeal, in simple, plain, short English?
Try.
15
It's costing those of us who aren't subsidized too much.
Our family pays $23K (!!!) a year in premiums for 3 people, then we each have a deductible of $2K. And beginning Jan 1, our premiums went up $2500 a year. We were promised a credit of $2500 a year by Obama himself.
Our teenager had to have a cyst removed right below her eyebrow. $23,000 for premiums, and we still had to pay the first $2,000 for that needed surgery and the pathology report.
Is that plain enough for you?
Our family pays $23K (!!!) a year in premiums for 3 people, then we each have a deductible of $2K. And beginning Jan 1, our premiums went up $2500 a year. We were promised a credit of $2500 a year by Obama himself.
Our teenager had to have a cyst removed right below her eyebrow. $23,000 for premiums, and we still had to pay the first $2,000 for that needed surgery and the pathology report.
Is that plain enough for you?
1
At its outset the ACA was anticipated to take a full decade before all the kinks and flaws were ironed out. Since health insurance for all had never been done before in our 240 year history, only after it had been in place for a time would what works and not could be analyzed and fixed.
This, of course, would have been more successful if Congress had spent their time working on solutions and repair as time went on instead of sabotaging it from the beginning, refusing to do absolutely anything but vote to repeal.
If we want our country to be a leader, to prosper, and to have a healthy and productive society Congress needs to face the facts that it must make the ACA better, to build on what President Obama has achieved, and to stop playing with citizens lives.
This, of course, would have been more successful if Congress had spent their time working on solutions and repair as time went on instead of sabotaging it from the beginning, refusing to do absolutely anything but vote to repeal.
If we want our country to be a leader, to prosper, and to have a healthy and productive society Congress needs to face the facts that it must make the ACA better, to build on what President Obama has achieved, and to stop playing with citizens lives.
5
We have "health" insurance, but not "sickness" insurance. I don't need to go to the doctor umpteen times for them to agree I'm well. But as soon as I'm sick it pays NOTHING. I want insurance that when I don't feel well and go to the doctor, my insurance covers it. I don't need insurance that only pays when I'm not sick! duh....
3
"It’s (ACA) a change that nearly everyone, Republicans and Democrats, agrees is desperately needed..."
No matter. ACA has Obama's name and his imprimatur. There need be no other reason for Republicans' desire and determination to kill ACA.
No matter. ACA has Obama's name and his imprimatur. There need be no other reason for Republicans' desire and determination to kill ACA.
4
Paul Ryan needs to understand that we see through him. If he'd been able to present a better alternative at any point in the past 8 years, he could have easily repealed the ACA and replaced it with this alternative. But he can't, because he has nothing. Not a single viable idea.
Why do people keep voting for this vicious, mean-spirited clown?
Why do people keep voting for this vicious, mean-spirited clown?
16
The political difficulty in controlling healthcare costs is shown (yet again) by doctors' recent rejection of Obama's effort to recruit them to help control drug costs.
http://www.nytimes.com/2016/12/16/us/politics/plan-to-reduce-medicare-dr...
As a professional in a field with lower stakes, I sympathize somewhat with doctors' reluctance: the public would blame doctors for lack of access to drugs.
But as a member of the public I am very disappointed with doctors unwillingness even to try to control drug costs. If doctors are unwilling, then responsibility falls to the healthcare system and to society as a whole. That's why the sort of systemic change promoted by Obamacare is necessary.
http://www.nytimes.com/2016/12/16/us/politics/plan-to-reduce-medicare-dr...
As a professional in a field with lower stakes, I sympathize somewhat with doctors' reluctance: the public would blame doctors for lack of access to drugs.
But as a member of the public I am very disappointed with doctors unwillingness even to try to control drug costs. If doctors are unwilling, then responsibility falls to the healthcare system and to society as a whole. That's why the sort of systemic change promoted by Obamacare is necessary.
1
I came from another country. Single payer works like a magic. So is education. Just need a country with not so many greedy people, more social. When 50 percent of this country thinks that a weak poor person deserves to die is a problem. What is even more funny that most of them are religious. Go figure.
37
Your last country was so awesome that you came here because...???
6
Welcome to the US, a place that has never really been a good one for poor and working people. (And truly religious people have rarely had a problem expressed loudly enough with other people dying over deadly beliefs. Look no further than the religious expansion wars with which history is pregnant.)
7
Yes, @Amir, I understand that it must indeed seem like 'magic' when one gets free healthcare and education, while allowing the poor suckers of the working middle class to foot the bill.
Psst: better hurry back home and take advantage of all those freebies! Especially since you judge America and Americans as clearly not up to your moral standards.
Psst: better hurry back home and take advantage of all those freebies! Especially since you judge America and Americans as clearly not up to your moral standards.
5
How can you expect a man who's warm to understand a man who's cold? (Solzhenitsyn)?
I'm angry at the politicians – whose families will have health care for the rest of their lives – that refuse to fix the problem of health care funding, but instead, cripple the very delivery system that could serve all Americans.
Notwithstanding that health care costs do need to come down, the age old debate still exists: The only way for health care to funded, affordable and available to all, regardless of income level, is charge EVERYONE whether they use health care or not - that is, through taxes, from DAY 1. No one should be able to "opt-out" and some sort of premium should be collected for [from] every person, starting at birth.
In many areas, health carriers pull out because the healthy don't participate (pay premiums) in significant enough numbers to offset increasing utilization by those who pay the least and use health care the most. Consequently, MY premiums are inflated to cover when Mr. X or Ms. Y use the emergency room as their primary care physician. The other way I pay for other's health care is through my taxes that pay for local health programs. Either way, I pay twice and they don't pay.
The answer is staring us in the face. Health care should be paid for by everyone for their lifetime. For example, imagine if 172 million people 65 year olds paid $25 a month for the past 65 years (of premiums)....do the math, that’s $,$$$,$$$,$$$.$$. I'm just sayin'
I'm angry at the politicians – whose families will have health care for the rest of their lives – that refuse to fix the problem of health care funding, but instead, cripple the very delivery system that could serve all Americans.
Notwithstanding that health care costs do need to come down, the age old debate still exists: The only way for health care to funded, affordable and available to all, regardless of income level, is charge EVERYONE whether they use health care or not - that is, through taxes, from DAY 1. No one should be able to "opt-out" and some sort of premium should be collected for [from] every person, starting at birth.
In many areas, health carriers pull out because the healthy don't participate (pay premiums) in significant enough numbers to offset increasing utilization by those who pay the least and use health care the most. Consequently, MY premiums are inflated to cover when Mr. X or Ms. Y use the emergency room as their primary care physician. The other way I pay for other's health care is through my taxes that pay for local health programs. Either way, I pay twice and they don't pay.
The answer is staring us in the face. Health care should be paid for by everyone for their lifetime. For example, imagine if 172 million people 65 year olds paid $25 a month for the past 65 years (of premiums)....do the math, that’s $,$$$,$$$,$$$.$$. I'm just sayin'
16
[Paul Ryan]..."We want to make sure that there’s an orderly transition so that the rug is not pulled out from under the families who are currently struggling under Obamacare while we bring relief.”
This- in response to the fact there is no Republican Replacement; which begs the question: "If" Obamacare is so bad- and we are "struggling under [it]"- then that Rug MUST be pulled up immediately- right? The kids who cried wolf too many times- now the wolf is at the door and...
This- in response to the fact there is no Republican Replacement; which begs the question: "If" Obamacare is so bad- and we are "struggling under [it]"- then that Rug MUST be pulled up immediately- right? The kids who cried wolf too many times- now the wolf is at the door and...
14
Now that we've moved to a situation where the Republicans can carry out their goal of repealing the ACA, shouldn't ALL Americans be interested in knowing what they'd like to have in its place? Do Republicans in the electorate not care how health care is going to work? Or is there an unstated assumption here that an unregulated free market approach is going to produce the best result? Because I haven't seen a word of discussion from the GOP about what they intend as a replacement for the ACA, and I think whether you are on the left or right that before you destroy what you have, a thoughtful person should want to know what the new system is.
18
One stark omission of this piece is- the tens of thousands of jobs (and more) around the country that will be lost upon Repeal. Allied health care workers, auxiliary health services employees-brought on board with expanded Medicaid and new entrants into the subsidized ACA. Schools offering diverse training from LVN & CNA's; Medical billing and Coding, Medical Equipment Techs; Medical Technologists...All will be upended. These are but a few of the expanded Employment offerings resulting from the Affordable Care Act- no one has focused on- soon to be gone.
13
Frankly, most such healthcare “reforms” have been about saving money, not providing patients the highest level of care. People don’t like it when insurers do it; they like it less when government does it.
3
if you look at the article, nearly every point was about money, not health.
2
Not so fast . The GOP majority in Congress would not succeed again in selling the old snake oil in new bottle with packaging , any time soon ! The Affordable Care Act of 2010 with a few new provisions , is an improved version of Romney Care. A GOP Health Care plan designed in 1980 's , and was success story in Massachusetts . The ACA provides Health insurance : A ) with pre existing conditions . b) Children up to 26 years of age, included with parents . Donald Trump , president - elect also endorsed these items after meeting President Obama . The GOP 's partisan strategy without an alternative Health Care plan to replace the Affordable Care Act . In frustration made 62 failed attempts to repeal the ACA ! The alternative should be to focus on required appropriate amendments on bipartisan basis , to improve the ACA for cost cutting, and operational efficiency measures particularly in the : " framework for the individual mandate and pieces of the state exchanges " the ACA has created . The precedence was set by GWB administration 's Social Security Part D , for Drugs . This Law was improved with quite a number of required amendments over many years .That is the yet to be followed on a bipartisan basis for the ACA . Rather than GOP in Congress wastes more time in 63rd attempt , to repeal the Affordable Care Act. of 2010 ,with new problems for 20- 25 million already enrolled in the plan .i. e. , the Law of the Land .
3
What Ms. Rosenberg simply misses is that the rush to yank the plug on the ACA has nothing to so with reasoned thought about the efficacy of part or all of the act. The ACA was a symbol of everything so-called free market Republicans are so vehemently against.
Obamacare was the first tenuous step to creating a method of getting decent health care to all Americans, regardless of their station in life. More importantly, the guts of the ACA involved all of us, mostly, contributing to the needs less fortunate Americans. The very success of the ACA is the reason the GOP will try to kill it, yet again. They don't want the dirty little secret out that, by God, the thing is working.
Obamacare was the first tenuous step to creating a method of getting decent health care to all Americans, regardless of their station in life. More importantly, the guts of the ACA involved all of us, mostly, contributing to the needs less fortunate Americans. The very success of the ACA is the reason the GOP will try to kill it, yet again. They don't want the dirty little secret out that, by God, the thing is working.
11
Nothing mentioned here about the skyrocketing premiums for the self-employed who do not receive government subsidization of their premiums, or the huge deductibles and co-pays which make it difficult to proceed with a costly surgery or treatment. I know, I know, just a coincidence Obamacare passed and rates shot up.
9
ACA does not work for those of us who are self employed. I have the same experience you do. Our family was better off under the high-risk pooled insurance that was available in our state before the ACA was passed. Not that this pool would be re-established under our Republican governor if ACA goes down.
The only real fix will be to have Medicare available to all. Nobel Economics Laureate Kenneth Arrow showed in his famous 1962 paper, why market based solutions don't work all that well in the healthcare space. Despite common knowledge in the economics profession, Obama tried to fix health care while preserving a "free" market for health services. The result was a half-baked, bastardized mix of government mandates and free market incentives that is already coming apart at the seams.
The only real fix will be to have Medicare available to all. Nobel Economics Laureate Kenneth Arrow showed in his famous 1962 paper, why market based solutions don't work all that well in the healthcare space. Despite common knowledge in the economics profession, Obama tried to fix health care while preserving a "free" market for health services. The result was a half-baked, bastardized mix of government mandates and free market incentives that is already coming apart at the seams.
5
more that that: rates had been going up for years before the ACA... sometimes at an even more alarming rate.
this is because the US model for medical care is that it is a money making business, it is not about health... or care.
this is because the US model for medical care is that it is a money making business, it is not about health... or care.
9
While the concept of ACOs sounds good, the question is how will value be determined? In my career as a Quality Assurance professional, we always based our efforts on customer satisfaction with our products.
I currently receive healthcare from an organization that emphasizes wellness and bills itself as a model for the future. Unfortunately, no one has yet asked me to rate the services received.
Will the customer have any input to the future of healthcare?
I currently receive healthcare from an organization that emphasizes wellness and bills itself as a model for the future. Unfortunately, no one has yet asked me to rate the services received.
Will the customer have any input to the future of healthcare?
4
If history is prelude, the GOP will destroy any proven good idea. It's in the party's DNA.
11
Hospitals make money from readmissions and complications. There is no financial incentive for the hospital to reduce care for patients. An income statement doesn't distinguish between appropriate care versus care that comes as a result of medical errors or other avoidable incidents such as hospital acquired infections. A procedure that rectifies a problem the hospital causes is reimbursed at the same rate as a procedure that the patient needs the first time he enters the hospital. Obamacare penalties financially incentivize hospitals to reduce readmissions and complications by withdrawing the reward for these actions. Taking the precautions on their own to reduce medical errors and hospital acquired infections raises expenses. Patient care is revenue. Raising the expense side while reducing the revenue side decreases profitability for a business, and a hospital is a business.
An analogy is the government asking companies that "hurt" us with their environmental impact to voluntarily reduce the pollution they produce. Government steps in and penalizes companies for polluting to improve our health and lives. Most of us see the value of this.
Profitability is what capitalism is all about. There is a constant struggle between the profitability of the capitalist model and governmental regulation.
It is not just hospitals in less affluent areas that provide care that brings the patient back in within 30 days. Many hospitals that serve affluent areas have that problem as well.
An analogy is the government asking companies that "hurt" us with their environmental impact to voluntarily reduce the pollution they produce. Government steps in and penalizes companies for polluting to improve our health and lives. Most of us see the value of this.
Profitability is what capitalism is all about. There is a constant struggle between the profitability of the capitalist model and governmental regulation.
It is not just hospitals in less affluent areas that provide care that brings the patient back in within 30 days. Many hospitals that serve affluent areas have that problem as well.
2
Republicans never liked Obama so no matter what he did they wouldn't like it. Had he cured cancer they would be spending their time trying to eliminate the cure. Had he brought about world peace they would start a war. Before the ACA was passed Republicans didn't care if you died bankrupt in the gutter. They are trapped now by having to come up with a replacement because instead of the ACA falling apart and costing jobs like they claimed it would it is working (though it need some tweaking). 20 million more people are insured, over 15 million jobs have been created, wages are rising and the economy is gaining strength all in spite of total obstruction by the right. They've had 6 years to cobble a plan together and they have nothing. Should they repeal the ACA democrats should present a bill stripping all benefits from present and former members of congress including themselves until a replacement is in place. It's time to put pressure on the inmates who are now running the asylum.
21
This is just plain silly - if the Repubs could admit they were only propagandizing the hatred of the Affordable Care Act ("Obamacare" is and was always a pejorative term) they would be free to just agree with it. Does substance matter at all, or are we just schoolchildren engaged in name-calling?
8
The ACA is helping reduce the cost and suffering of millions of citizens and this is the very reason the republicans are against it. It interferes with their plans to destroy effective and good governance.
8
I would like to refute Trump's fear mongering regarding Canada's universal health care system. It differs from Obamacare in that it has been in effect since 1965 and is funded entirely by governments. There is no private insurance in the mix, although no one is prevented from holding private insurance. However, although not perfect, it works, because it provides equal access to the best medical care, clinics, doctors, and hospitals, regardless of income. I recently spent six days in a hospital receiving orthopaedic surgery due to an accident. I never received a bill for the stay, the treatment, the physiotherapy, the x-rays, the medications, nothing! I was in a semi-private room with another professional, and we were on a floor with people of all ages and incomes.
In short, Mr. Trump, universal medicare is an expression of fundamental equality in a society, and the idea that health care resides outside of the for-profit economy.
In short, Mr. Trump, universal medicare is an expression of fundamental equality in a society, and the idea that health care resides outside of the for-profit economy.
23
They should have asked for Republican input WHEN they passed ACA.
2
Rohit, they did and they asked for GOP participation. However the GOP in its infinite state of temper tantrum refused to work with the Democrats, President Obama, or anyone but themselves. And they refused to work with Obama period on anything because he wasn't a valid president in their opinion. However, don't confuse your fantasy with the facts on account of reality.
25
Rohit, the Dems most certainly did ask for Republican input, and right from the start. The Republicans chose obstruction instead. There are many sources for that fact. But for a comprehensive recounting please read The Atlantic magazine story "The Real Story of Obamacare's Birth." https://www.theatlantic.com/politics/archive/2015/07/the-real-story-of-O...
17
Lets call republicans in congress, rigid ideologues as they portend to be, the greatest hypocrites in town. How is it even possible, to repeal the Affordable Care Act, however important to safeguard health insurance for the poor, without having anything to replace it? This is pure nasty spite towards Obama, and a clear injustice to the millions benefiting from it. Why are they discriminating the folks that can't afford things, when the millionaire club in congress takes health care for granted? It is as bad as those denying a living wage to workers, when they themselves are impossibly distanced socially to understand the poor's predicament? Shameful all around. And despicable.
5
The problem is that this plan will not work in small rural communities. Also you might end up having to see a doctor you don't like or who has bad reputation. I prefer fee for service so I CAN CHOOSE the doctor and not have him chosen for me. The Dems are leaning towards the Soviet model and not the free enterprise model.
2
You could choose a doctor. Narrow networks are what the insurance companies are forcing down our throats. There was nothing in the ACA that said they had to limit who we saw or in what state we got our treatment. There was nothing that said they needed to set deductibles as high as they did or exclude community hospitals. They decided to continue business as usual using the ACA as an excuse to continue what they'd started: the complete evisceration of effective quality health care for all but the very rich. And they do it with cooperation from Congress.
9
look into it: besides the fact that rural ares are typically undeserved in health care because there's not enough money to be made... your complaints can be laid directly at the feet of insurance. companies, who basically forced themselves to the table when they have no business there.
but, of course, without the "participation" of the insurance industry, it would be socialist/communist single payer, ergo a non-starter.
who says medical care has outgrown the use of leaches?
but, of course, without the "participation" of the insurance industry, it would be socialist/communist single payer, ergo a non-starter.
who says medical care has outgrown the use of leaches?
3
ACA is too expensive, keeping up corporate profits while leaving out millions of citizens. Our politicians and liberal pundits have to use examples of dozens of nations who have had h/c for all for generations. Show working examples how average people pay for it and use it. That it's either single payer, or uses non profit insurance co's, Their govt negotiates insurance and medical costs on behalf of the citizens who elect it. What a radical idea?
Our politicians stay away from these comparisons. Without positive role models, citizens can't challenge the powers that be who are beholden to corporate campaign donors.
ACA shows how US politics does not work to represent the people and hold it's elected lawmakers and leaders to account. Our system's 1st priority is corporate profits for ins/drug co's. We the people take whatever's left over and use it for our medical care.
The media never transmits the practical info we need to fight for our rights. But it's always ready to transmit the dirty word 'socialism' for the universal health care plans that dozens of other capitalist countries have long operated for their citizens.
Our politicians stay away from these comparisons. Without positive role models, citizens can't challenge the powers that be who are beholden to corporate campaign donors.
ACA shows how US politics does not work to represent the people and hold it's elected lawmakers and leaders to account. Our system's 1st priority is corporate profits for ins/drug co's. We the people take whatever's left over and use it for our medical care.
The media never transmits the practical info we need to fight for our rights. But it's always ready to transmit the dirty word 'socialism' for the universal health care plans that dozens of other capitalist countries have long operated for their citizens.
2
There is no reason to keep the ACA, it is a massive failure and is basically just insurance, not care, not patient protection, and not improvements in the process. I really don't see the alternatives being very good either but have limited ability to educate our representatives.
1
OK. I hear this message repeated almost as if it was delivered from Heaven. It is a massive failure you say. How? Any details? Trump repeated this ad infinitum, but of course never specified the problems. Too expensive: meaning what? This country has the highest medical care costs on the planet with outcomes that are mediocre. If any of those who felt that the ACA was so horrible had ventured to propose constructive ways to deal with the problem (other than single payer, which seems even further out of reach than ever and of course would be anathema to "conservatives"), I would have some understanding. But the preferred alternative was no alternative: Just say no.
5
This 'repeal and replace' gambit is echoing the results of 'the sequester', which is still with us.
The Sequester involved passing a budget so onerous to all parties that it would surly be fixed before going into effect.
How did that work out?
Now, the GOP wants to kill Obamacare with the clock ticking, assuring us that a replacement will be implemented before the ACA expires.
Why does this sound like failure?
In another time and place with other parties and politicians and other voters and other systems this might be doable, but here?
You gotta be kidding!
The Sequester involved passing a budget so onerous to all parties that it would surly be fixed before going into effect.
How did that work out?
Now, the GOP wants to kill Obamacare with the clock ticking, assuring us that a replacement will be implemented before the ACA expires.
Why does this sound like failure?
In another time and place with other parties and politicians and other voters and other systems this might be doable, but here?
You gotta be kidding!
5
Sadly, I have to disagree with with Ms. Rosenberg, for as Wilde said, "...the worst slave-owners were those who were kind to their slaves, and so prevented the horror of the system being realised by those who suffered from it, and understood by those who contemplated it.." To compromise with Republicans on their draconian agenda to rob healthcare safety from Americans is to obfuscate the horrors of what Republicans plan to do.
Instead, the best way to save Obamacare is to let Republicans repeal it completely, set the clock back, and let the electorate suffer the consequences their vote, so that they will realize the horror of the horror of the Republican agenda they chose, and change their minds in subsequent elections.
The age of compromise is as much gone as Camelot is. Eight years of Obama is testament of that. The Democrats lost state legislature after state legislature during his presidency, a presidency in which Obama repeatedly tried to compromise with intransigent Republicans instead of staying true to the Liberals who bestowed the Presidency on him. Though History may note his many other achievements, She will note he has been a failed political strategist. And political strategy is important, for say what you will, but you cannot help people if you do not hold the reigns of power.
Instead, the best way to save Obamacare is to let Republicans repeal it completely, set the clock back, and let the electorate suffer the consequences their vote, so that they will realize the horror of the horror of the Republican agenda they chose, and change their minds in subsequent elections.
The age of compromise is as much gone as Camelot is. Eight years of Obama is testament of that. The Democrats lost state legislature after state legislature during his presidency, a presidency in which Obama repeatedly tried to compromise with intransigent Republicans instead of staying true to the Liberals who bestowed the Presidency on him. Though History may note his many other achievements, She will note he has been a failed political strategist. And political strategy is important, for say what you will, but you cannot help people if you do not hold the reigns of power.
5
It is clear that the GOP regards the health of Americans as nothing other than a cash cow. Here's an idea: pull all congressional health care, issue vouchers, and make sure members of congress no longer enjoy the tax-funded (socialized!) health care they receive.
14
How is it possible that after 8 years and 70 votes to repeal the ACA by root and branch that the republicans do not have a replacement?
Why do people vote for these frauds whose only contribution is tax breaks to the wealthy and punitive fines for everyone else?
Republicans are working overtime to be the new fascist party.
Why do people vote for these frauds whose only contribution is tax breaks to the wealthy and punitive fines for everyone else?
Republicans are working overtime to be the new fascist party.
292
RM,
You and I know they don't have a replacement. There is no improvement to the right of the ACA, only to the left, in form of a public option or single payer. To the right is the old system.
It seems everyone, Dems, GOPers, talking heads, people, forget that the ACA was in fact the plan of the Heritage Foundation, pitched by Newt Gingrich in the late 90s, and implemented by Mitts in Mass.
You and I know they don't have a replacement. There is no improvement to the right of the ACA, only to the left, in form of a public option or single payer. To the right is the old system.
It seems everyone, Dems, GOPers, talking heads, people, forget that the ACA was in fact the plan of the Heritage Foundation, pitched by Newt Gingrich in the late 90s, and implemented by Mitts in Mass.
8
While I agree with this, it is not a good argument.
IMO, the arguments that work best are simple arguments.
The free market rules do not apply to healthcare. No one wants to bargain for their health or their life.
Not many people want the cheapest health care.
You cannot trade dollars with an insurance company and win.
IMO, the arguments that work best are simple arguments.
The free market rules do not apply to healthcare. No one wants to bargain for their health or their life.
Not many people want the cheapest health care.
You cannot trade dollars with an insurance company and win.
13
The moral high humane humble empathetic road to single payer can be found when every American has access to the same level and kind of quality affordable healthcare that Speaker of the House of Representatives Paul Davis Ryan has enjoyed on the government benefits welfare dole since his father died when he was a teenager.
Amoral taker Ryan believes that no one else has the moral fortitude nor intelligence nor work ethic to benefit from this blessed healthcare government benefit.
Ryancare for everyone every where all of the time to replace Obamacare.
Amoral taker Ryan believes that no one else has the moral fortitude nor intelligence nor work ethic to benefit from this blessed healthcare government benefit.
Ryancare for everyone every where all of the time to replace Obamacare.
18
A very illuminating piece. I wish Some of the Republican lawmakers read this.
I wasn't aware of the far-reaching benefits of ACA. We hear only about the negative news about it, like the initial enrollment problems & the premium-hike for this year - even Bill Clinton blurted out that premiums are skyrocketing while coverage is reduced by half!
I was with the public option/single-payer camp. Republicans wanted ACA to fail, especially when they are trying to privatize social security, etc. Then they were determined to prevent president Obama's second term - any success with Obama's policies would be a loss for them.
I wasn't aware of the far-reaching benefits of ACA. We hear only about the negative news about it, like the initial enrollment problems & the premium-hike for this year - even Bill Clinton blurted out that premiums are skyrocketing while coverage is reduced by half!
I was with the public option/single-payer camp. Republicans wanted ACA to fail, especially when they are trying to privatize social security, etc. Then they were determined to prevent president Obama's second term - any success with Obama's policies would be a loss for them.
12
One of the strangest things about the Republicans' current repeal plan, so far as anyone knows what it is, is that it might entail a vote to repeal -- but not actually to take effect until the good things in the ACA can be replaced by ...some... other system. So, in other words, pass an ineffectual repeal. But the Republicans have already taken 60 ineffectual repeal votes. How is this different? It means that they can say to their conservative ACA-haters, "See, we repealed it," but then, sotto voce: "we don't really dare to take health insurance away from 20 million people. We'll just undermine it, and when it falls apart, say that it collapsed of its own fault."
10
Paying for better outcomes is laudable in theory. But this piece has no practical situational awareness. My office is hiring more administrators to ensure we document nonsense metrics that have nothing to do with actual health care quality. They do not measure patient quality of life, if a diagnosis was made, if a real discussion was had, or if I came in at 2 AM to treat someone's stroke. Out of my 8 partners, one spends about 1/2 day a week making sure we game the system in the proper way to avoid penalties. This is the absolute reverse of something that "frees up providers."
All of this wouldn't be objectionable if it did help. But not only are the metrics obscure, they change from year to year. ACO to PQRS to MACRA - they are all terrible, and give physicians no confidence in the system. I know I've lost what little faith I had. And because the Big Brother metrics are captured on hated electronic medical records (it is hard to capture the depth of this hatred among doctors), they suffer further loathing and scorn: a toxic mindset follows.
In short, the experience with governmental interference, including the incompetence among Medicare's 'leadership,' is turning many of us into libertarians.
While there appears to be a very real upside with home visits and same day appointments, this hardly merits the word innovative, and ignores the downsides.
All of this wouldn't be objectionable if it did help. But not only are the metrics obscure, they change from year to year. ACO to PQRS to MACRA - they are all terrible, and give physicians no confidence in the system. I know I've lost what little faith I had. And because the Big Brother metrics are captured on hated electronic medical records (it is hard to capture the depth of this hatred among doctors), they suffer further loathing and scorn: a toxic mindset follows.
In short, the experience with governmental interference, including the incompetence among Medicare's 'leadership,' is turning many of us into libertarians.
While there appears to be a very real upside with home visits and same day appointments, this hardly merits the word innovative, and ignores the downsides.
5
If the medical profession spent more time working to improve the system instead of opposing every attempt to provide affordable care to all Americans maybe your office would not have to spend so much time on administrative matters. Simply stated -- the U.S. is the ONLY developed nation that does not provide affordable medical care to all its citizens. Full stop. If others can do it, why can't the U.S. This is THE glaring failure of the U.S. medical profession and U.S. society.
14
I'm literally telling you that I come in at 2 AM to help a patient with a stroke, and you accuse me of not spending time trying to improve things. What have you done lately?
I'm also telling you that on the ground, regulations have increased my overhead, slowed me down (EMR), made me jump through hoops, turned my good faith efforts into a toxic stew of discontent, and haven't helped patients one bit.
But wait, there's a utopian system in Europe. Sounds too good to be true.
I'm also telling you that on the ground, regulations have increased my overhead, slowed me down (EMR), made me jump through hoops, turned my good faith efforts into a toxic stew of discontent, and haven't helped patients one bit.
But wait, there's a utopian system in Europe. Sounds too good to be true.
3
In a 2011 GOP primary debate, Wolf Blitzer asked Ron Paul: What should be done for a seriously ill, but uninsured, patient? Should we just let him die? Members of the audience loudly responded: "Yes!"
Perhaps the GOP, in its drive to repeal Obamacare, is merely bowing to the sentiments of its base and reverting to its regressive roots in the economic fatalism of Thomas Robert Malthus:
"To act consistently [in accord with the laws of population increase, of scarcity and of the market], we should facilitate, instead of foolishly and vainly . . .[attempting to] impede, the operation of nature in producing . . .mortality . . . . [W]e should . . . court the return of the plague. . . . But above all, we should reprobate specific remedies for ravaging diseases . . . ." An Essay on the Principle of Population (New York: Dutton, 1960), vol. 2, pp. 179-80; originally published in 1803.
Why should politicians like Speaker Ryan look to Ayn Rand, an atheist, for guidance concerning healthcare issues, when the Reverend Thomas Robert Malthus, a Christian clergyman, is so much more directly on point?
Perhaps the GOP, in its drive to repeal Obamacare, is merely bowing to the sentiments of its base and reverting to its regressive roots in the economic fatalism of Thomas Robert Malthus:
"To act consistently [in accord with the laws of population increase, of scarcity and of the market], we should facilitate, instead of foolishly and vainly . . .[attempting to] impede, the operation of nature in producing . . .mortality . . . . [W]e should . . . court the return of the plague. . . . But above all, we should reprobate specific remedies for ravaging diseases . . . ." An Essay on the Principle of Population (New York: Dutton, 1960), vol. 2, pp. 179-80; originally published in 1803.
Why should politicians like Speaker Ryan look to Ayn Rand, an atheist, for guidance concerning healthcare issues, when the Reverend Thomas Robert Malthus, a Christian clergyman, is so much more directly on point?
3
Speaker Paul Ryan claim devotion to a very different Jesus Christ. His true devotion is making the rich richer so they keep funding his mean spirited extortion of the most fail.
3
It is unfortunate that an issue that is as important as health care has become a political football. The problem is enormous and needs to be solved from multiple disciplines. Healthcare professionals, business administrators, lawyers and, yes a few politicians, should all work together. I don't care if a republican or democrat comes up with the solution, we need a solution now. The time has past for playing politics with health and lives of Americans.
10
We have an imperfect solution in the ACA. Rather than work to improve the law, Republicans have mindlessly fought to destroy it. For them, it is all about politics and ideology.
11
Caring for people, costs. The ACA costs.
The only argument put forth by the Republicans is that it now costs people who felt, previously, that their existing taxes should cover everything - including caring for the indigent sick. The fact it didn't was tacitly understood - but who wants to speak the unspeakable?
Frankly, the Republicans have given voice to that part of America who feels they spend enough of their earnings paying for things that don't directly improve their standing, but rather, affect the common good.
The brilliance of the Democrats plan is that once millions of previously uninsured people experience actual health care - that going back to the previous situation will have consequences. Sure, 20 million previously uninsurables now are insured - but those 20 million have families and relatives who will similarly dislike having their loved one uncared for. Multiply 20 million by two, or three, or four, and you get the true effect.
The brilliance of the Democrats is that there is no way to go back to being uncaring without penalty.
I, for one, do not want to live in a class-driven leper colony where death is the only alternative for the weakest of us. And I hear plenty of politicians dancing around that truth with "repeal, but replace..." and having no solution. The solution they hint at is for the uninsured to go uninsured and leave the rest of us to live long lives in security.
And so, as many of us have concluded, we must pay to remain moral.
The only argument put forth by the Republicans is that it now costs people who felt, previously, that their existing taxes should cover everything - including caring for the indigent sick. The fact it didn't was tacitly understood - but who wants to speak the unspeakable?
Frankly, the Republicans have given voice to that part of America who feels they spend enough of their earnings paying for things that don't directly improve their standing, but rather, affect the common good.
The brilliance of the Democrats plan is that once millions of previously uninsured people experience actual health care - that going back to the previous situation will have consequences. Sure, 20 million previously uninsurables now are insured - but those 20 million have families and relatives who will similarly dislike having their loved one uncared for. Multiply 20 million by two, or three, or four, and you get the true effect.
The brilliance of the Democrats is that there is no way to go back to being uncaring without penalty.
I, for one, do not want to live in a class-driven leper colony where death is the only alternative for the weakest of us. And I hear plenty of politicians dancing around that truth with "repeal, but replace..." and having no solution. The solution they hint at is for the uninsured to go uninsured and leave the rest of us to live long lives in security.
And so, as many of us have concluded, we must pay to remain moral.
15
I support the ACA as long as it strives to actually be affordable. Some of the commenters here are guzzling the Kool-Aid. And appear to not know any lower income people.
Fact; People earning in the low $20k zone pay for care they cannot uses as the deducible is between 5K to 7.5K. So they are forced to throw away several hundred dollars each month for care that would only benefit them in the event of catastrophic illness.
Fact; People earning in the low $20k zone pay for care they cannot uses as the deducible is between 5K to 7.5K. So they are forced to throw away several hundred dollars each month for care that would only benefit them in the event of catastrophic illness.
4
Fact: People earning in the low $20K's are either on Medicaid or receive subsidies for almost all of their policy.
The places with the highest costs are the ones that did not expand Medicaid. Your ire should be aimed at those republican governors and their legislatures. those are the real death panels.
The places with the highest costs are the ones that did not expand Medicaid. Your ire should be aimed at those republican governors and their legislatures. those are the real death panels.
19
Furthermore, insuring oneself in the event of catastrophic illness is not throwing money away.
6
Exactly. I need a knee replacement and can't afford the deductible. Walk a mile in my shoes, or rather, limp a mile. For the healthcare I've actually received over the last two years (three office visits, an x-ray, and one bottle of pills) my monthly payments added up to over $5,000, plus the ACA sent them a subsidy on my behalf. I'm grateful for the ACA, as otherwise I'd have no catastrophic illness insurance, but that's all it is. I've paid well above retail for all the healthcare I've received. The ACA could certainly be replaced with something better, but In America, better is defined as "more profitable". The Republicans haven't come up with a replacement simply because there isn't a more profitable system they can come up with.
2
My experience as a medical social worker some years ago led me to the conclusion that prevention is always better than treatment. It improves quality of life and costs less in the long run. Medicare in its efforts to contain costs, has been slow to come to this table. The ACA has helped enormously. It should not be gutted but fixed to provide what is missing--economic stability for insurance.
16
I have been a middle of the road cautious Democrat. But when it comes to preserving the gains made by the Affordable Care Act I think Democrats have to go for the jugular. There certainly has been a lot of naivete about ACA and what it does and does not do. It is definitely complicated. But now Democrats have an opportunity. Republicans during the Obama administration used this complexity to their advantage. Now it is the Democrats' turn. As is very well known, Obamacare is an old Republican plan with a few more regulations that Republicans do not like. Democrats can make the Republicans pay for not compromising when they had the opportunity. That seems implausible now. But a recent survey published in CNBC says most Americans do not believe they should have to pay more $100 a month for comprehensive health insurance. Democrats should go on the offensive, take this idea, and direct this message to the very Trump voters who have benefited from Obamacare and yet still blame Obamacare. It is very risky but some Democrats should go for repeal too in favor of $100 a month for everyone insurance. The risk is worth it in my opinion because there are many Republicans who are hell bent on demolition and I fear they will succeed if Democrats do not start playing the same game. But whatever Democrats propose, do NOT call any plan single payer health insurance!
13
"Jugular"?
Democrats need to go for the testicular and the ovarian so that their cold hearts and tiny minds will follow.
Democrats need to go for the testicular and the ovarian so that their cold hearts and tiny minds will follow.
4
Affordable healthcare access for all isn't some grand luxury, it's a matter of national security. We caught our first glimpse of what a pandemic can do during the Ebola outbreak. Then, we began to see it again last year with Zika.
Statistically speaking, when persons don't have access to care (i.e., they are uninsured or underinsured and feel they can't afford treatment), they wait until their condition becomes unbearable before they seek out medical attention. Further, if they do not get tested for infection, they can and will spend disease without even knowing it.
When the Zika vaccine becomes a reality, will we offer it for free or charge $1000 per dose? My guess is will be giving it away on every street corner to avoid the costs of treating children born permanently impaired by the disease. Imagine what the cost of their care, and the care of all those infected, might do to our healthcare system.
If we want to protect our country from dangers foreign and domestic, we need to get real about the current and potential costs of patient healthcare outcomes. It begins with putting patients before politics.
Statistically speaking, when persons don't have access to care (i.e., they are uninsured or underinsured and feel they can't afford treatment), they wait until their condition becomes unbearable before they seek out medical attention. Further, if they do not get tested for infection, they can and will spend disease without even knowing it.
When the Zika vaccine becomes a reality, will we offer it for free or charge $1000 per dose? My guess is will be giving it away on every street corner to avoid the costs of treating children born permanently impaired by the disease. Imagine what the cost of their care, and the care of all those infected, might do to our healthcare system.
If we want to protect our country from dangers foreign and domestic, we need to get real about the current and potential costs of patient healthcare outcomes. It begins with putting patients before politics.
35
You make a very good point given that, in this country, arguments of efficiency trump those for equity any time. I find that sad, but we might as well act on reality.
5
I say let the Republicans go ahead and repeal the ACA, thereby digging their own political grave.
I also think this can serve as an abject lesson for anyone who actually still buys the lie that Republicans want solutions that benefit ALL Americans; that they care about the environment; that they care about ethics; that they care about the truth. The Swamp is in no danger of being drained.
I also think this can serve as an abject lesson for anyone who actually still buys the lie that Republicans want solutions that benefit ALL Americans; that they care about the environment; that they care about ethics; that they care about the truth. The Swamp is in no danger of being drained.
15
Adam, do you mean object lesson or abject lesson? The two have different meanings although abject is quite apt given how little most people understand about health, health care, and how things work in other parts of the world.
There's no mystery here, or experiment--Kaiser has been doing this forever, integrated care, nurse treatment, constant communication and information, easy access and of course cost savings. Our Kaiser Medicare pays the entire cost of gym membership of our choosing--talk about prevention! So yes, continue the innovation but don't ignore what is working. I have for many years wondered why the Kaiser model, studied even by countries with good health coverage, is not apparently replicable. It should be.
14
The most short-sighted, vindictive and harmful part of the whole Republican tantrum over ACA was their flat refusal to pass any of the tweaks and corrections that everyone agreed were needed as the program was implemented. They were determined to make it fail. Think where we could be if we could have spent this time making it work.
24
Aside from throwing 20 million people to the wolves, ending Obamacare makes no sense for the reasons outlined in this article, but also because it forms a conceptual model for how we can treat the people who make up this great nation in the future. Ending it erodes an important way of defining citizens as worthy people - not just in terms of health care treatment, but in regards to other areas such as taxation policy and educational opportunity as well.
The Republicans' new spiritual leader, Donald Trump, has said he doesn't respect people because they don't deserve respect. Trump wasn't elected *despite* saying this, but because of it. Republicans - the party of so-called "faith and family" - don't respect people as having inherent value.
Until Americans - including politicans AND voters - see all humans as "real people" worthy of care and consideration, this wealthiest nation on Earth will not have health care for all - health care that would enable them to work, defend the nation, and grow the economy. Until then, health care, tax policy, educational opportunity, and more will unfairly favor the rich, who do not need the help and special consideration they are given.
Obamacare isn't just health care, it represents a blueprint for the humanity and dignity of all people, and that is why Republicans hate it.
Don't believe for a moment they care; they haven't devised an alternative for decades, but they sure have heaped tax cut upon tax cut for the rich, haven't they!
The Republicans' new spiritual leader, Donald Trump, has said he doesn't respect people because they don't deserve respect. Trump wasn't elected *despite* saying this, but because of it. Republicans - the party of so-called "faith and family" - don't respect people as having inherent value.
Until Americans - including politicans AND voters - see all humans as "real people" worthy of care and consideration, this wealthiest nation on Earth will not have health care for all - health care that would enable them to work, defend the nation, and grow the economy. Until then, health care, tax policy, educational opportunity, and more will unfairly favor the rich, who do not need the help and special consideration they are given.
Obamacare isn't just health care, it represents a blueprint for the humanity and dignity of all people, and that is why Republicans hate it.
Don't believe for a moment they care; they haven't devised an alternative for decades, but they sure have heaped tax cut upon tax cut for the rich, haven't they!
182
Republican definition of value: What can you do (especially economically) for me.
4
"Aside from throwing 20 million people to the wolves"
I did not know that being eaten by wolves was a major cause of death in the US.
But seriously, health and health insurance are not the same thing.
And being forced to pay for something that you think you do not need comes very close to being unconstitutional. ACA was upheld, but by just ONE vote.
I did not know that being eaten by wolves was a major cause of death in the US.
But seriously, health and health insurance are not the same thing.
And being forced to pay for something that you think you do not need comes very close to being unconstitutional. ACA was upheld, but by just ONE vote.
If you think you don't need health insurance, and you don't buy it, and you get hit by a car and have surgery and maybe a month in the hospital...how much do you think it will cost you in medical bills lasting for decades, lost pay, perhaps losing your job because you're not there to do it, lasting disability, pain, and suffering?
As far as "being forced to pay for something that you think you do not need", anybody who thinks they don't need health insurance must be superhuman...not one of us gets out alive...and even children get cancer, are killed in accidents, or come down with serious infections or diseases.
Neither you nor I know when we may become seriously ill, when we may be involved in a terrible accident, or when our time has come. To believe that health insurance is something you will never need is to deny the nature of our existance as humans on this planet.
By not having insurance, you force those of us who do to pay for you when YOU get sick or injured...something you would probably not like others to inflict upon you, whenever THEY get sick or injured.
And finally...being "close" to unconstitutional is not "unconstitutional" - it's "close" - many things are upheld by just ONE vote, that's the way the court works...whether something is upheld by 9 votes or 1 vote, that's the court's ruling, and that means it's upheld, whether we like it or not. I personally think the Citizens United decision is catastrophic, but because I respect our system, I abide by it.
As far as "being forced to pay for something that you think you do not need", anybody who thinks they don't need health insurance must be superhuman...not one of us gets out alive...and even children get cancer, are killed in accidents, or come down with serious infections or diseases.
Neither you nor I know when we may become seriously ill, when we may be involved in a terrible accident, or when our time has come. To believe that health insurance is something you will never need is to deny the nature of our existance as humans on this planet.
By not having insurance, you force those of us who do to pay for you when YOU get sick or injured...something you would probably not like others to inflict upon you, whenever THEY get sick or injured.
And finally...being "close" to unconstitutional is not "unconstitutional" - it's "close" - many things are upheld by just ONE vote, that's the way the court works...whether something is upheld by 9 votes or 1 vote, that's the court's ruling, and that means it's upheld, whether we like it or not. I personally think the Citizens United decision is catastrophic, but because I respect our system, I abide by it.
5
My wife and I are both retired and are on a fixed income. We do not have any company health insurance nor do we qualify for any subsidy. Our health care premiums have gone up over 48% in the last three years...and this is with dropping to a Bronze level for 2017. Our individual deductible is $6,500 and our family deductible is $13,000.
How are we being helped by Obamacare?!!!!!
How are we being helped by Obamacare?!!!!!
9
Please provide your solution I am waiting
1
You live in a state that did not expand Medicaid
Therefore the insurance companies are punishing all residents that buy on the exchange
See the connection?
Therefore the insurance companies are punishing all residents that buy on the exchange
See the connection?
5
Before ridding 20-million 'poor' now covered by the AFA (Obama Care) because of oft-stated reasons the cost to USG, perhaps it is time to 'explore' the amounts of money it costs the USG to subsidize the costs of health insurance for 435 Congressmen/women and the 100 Senators and their Staffs. Exploration into these costs for State Governments might also be warranted.
26
I just need to point out that, as the Republican congress rushes to repeal the ACA before the electorate notices and protests the consequences of their spite, I am unable to contact my representatives, Todd Young and Trey Hollingsworth, to register my opposition, because apparently they have not set up their congressional websites. So much for listening to constituents.
I strongly suggest, not that they care, that since congress proposes to repeal health insurance, and essentially health care, for more than 20 million taxpayers, that they should at the same time repeal their own taxpayer provided health insurance. This is only fair and ethical.
I strongly suggest, not that they care, that since congress proposes to repeal health insurance, and essentially health care, for more than 20 million taxpayers, that they should at the same time repeal their own taxpayer provided health insurance. This is only fair and ethical.
30
The push for repeal has nothing to do with policy, it is all about destroying Obama and his legacy. After all, the original plan for what became the ACA was a plan produced by right wing think tanks in response to Hillarycare in the 90s. With Obama gone, watch as the GOP kills the taxes on the rich and the medical device tax and then simply rebrands what's left as Trumpcare. At the same time, they will roll Medicare into it as a way to make it impossible for the next Democratic wave (the one that comes in 2020) to implement single payer based on Medicare for all.
12
Republicans seem to be totally motivated to "Repeal Obamacare", rather than acknowledge haw sorely it is needed, and wanted by many of their constituents. They castigate any sort of Social Safety Net as making America "like Sweden"; but, why is "like Sweden" bad? It's better to treat illness and disease by preventative measures, rather than when the need is more acute--and necessary.
Among the twenty most-industrialized nations in the OECD, America is the only member nation that does not have a Universal Health Care System. Some sort of "Health Care for All" system, with the necessary Mandate, has been a bipartisan goal since the mid-20th Century. So, why not now?
As Income-Inequality has become more and more obscene in America, the High-Income "Class" are more resentful of those who need a little help in getting health care. The theme seems to be, We got ours, you get your own!. A healthy America provides for more efficient workers, less prone to spread diseases by working while sick, and, frankly: How many Americans must become homeless, and possibly dying on the street, before the Republican Party decides to join the Human Race?
https://thetruthoncommonsense.com
Among the twenty most-industrialized nations in the OECD, America is the only member nation that does not have a Universal Health Care System. Some sort of "Health Care for All" system, with the necessary Mandate, has been a bipartisan goal since the mid-20th Century. So, why not now?
As Income-Inequality has become more and more obscene in America, the High-Income "Class" are more resentful of those who need a little help in getting health care. The theme seems to be, We got ours, you get your own!. A healthy America provides for more efficient workers, less prone to spread diseases by working while sick, and, frankly: How many Americans must become homeless, and possibly dying on the street, before the Republican Party decides to join the Human Race?
https://thetruthoncommonsense.com
35
People who use the "like Sweden" or "like Denmark" criticism have obviously never been to either country! I have close friends in Denmark and have spent much time there. If I were younger, I would move there.
14
As far as I can tell, the main criticism against Sweden and Denmark are the taxes. People are penny wise and pound foolish in the US. Another unfortunate side effect of the ever decreasing educational standards. Citizens of countries with better quality of life, healthcare, education, and an equitable social safety net realize that they get a lot in return for higher tax rates. In the US any suggestion of a modest increase in taxes is vilified. But I surmise that many people, myself included, paying high premiums for health insurance with a pretty sizable deduction and no subsidy would rather pay a few dollars more in taxes for a national healthcare system.
12
Another way of phrasing "penny-wise, and pound-foolish" is to just consider: the many GOP ideologically dumb-headed ideas, which are formed without considering the adverse implications!
2
We should keep the ACA or go to universal health care for all. I imagine a future where there is intelligent prenatal care where the parents and later the individual partners with health professionals to live a healthy life. Many health problems are preventable. Medical research can find the answers to diseases like cancer and dementia. We desperately need better protocols to prevent infections. Instead of hating medical care and healthy living we should embrace it.
9
The hospitals in my state are very concerned that the system will be thrown into chaos by pulling the plug on funding of the ACA. That will leave hospitals scrambling to make up for shortfalls, they will have to raise prices and it is likely that all health insurance premiums will rise, not just those on the exchanges.
I have already written my state representatives to demand they reintroduce a bill for statewide single payer which has been floating around the legislature for sometime. Now is the time to do it. Enough with the GoP in Washington. We have to insulate ourselves from their chaos.
I have already written my state representatives to demand they reintroduce a bill for statewide single payer which has been floating around the legislature for sometime. Now is the time to do it. Enough with the GoP in Washington. We have to insulate ourselves from their chaos.
24
Affordable Care Act (ACA) is working but it certainly needs some tweaking and improvement in many areas. ACA is a huge program and the roll out has been a bit rocky. Like any major undertaking it needs to be studied and fixed.
The Republicans are not just a bunch of fools to ignore all the good that this program is doing to stem the tide of personal medical bankruptcy, uncontrolled medical inflation, and improving the quality of care in the US. Governor Pence of Indiana did use the expansion of Medicaid to help his constituency get affordable health care and so did another 10 Republican Governors.
The republican governors know that it is working and is resisting the inflationary pressure that was pushing the States to make a choice of denying healthcare to the indigent/low income households, or to cut other much needed expenses in social sectors.
Just because President-elect Trump used his electioneering speeches to decry ACA (Obama care) to get what he wanted (win) we should be worried about it; yes we should be worried about his speeches but also give him the credit to pull it off by winning. He is a smart man and is using his clout to get the best possible deal. I foresee a change of label but no wholesale repeal/dumping of a wonderful program like ACA similar to Medicare and Social Security.
Healthcare for all has been a need whose time has come and both the Republicans and the Democrats needs to work together to improve ACA.
The Republicans are not just a bunch of fools to ignore all the good that this program is doing to stem the tide of personal medical bankruptcy, uncontrolled medical inflation, and improving the quality of care in the US. Governor Pence of Indiana did use the expansion of Medicaid to help his constituency get affordable health care and so did another 10 Republican Governors.
The republican governors know that it is working and is resisting the inflationary pressure that was pushing the States to make a choice of denying healthcare to the indigent/low income households, or to cut other much needed expenses in social sectors.
Just because President-elect Trump used his electioneering speeches to decry ACA (Obama care) to get what he wanted (win) we should be worried about it; yes we should be worried about his speeches but also give him the credit to pull it off by winning. He is a smart man and is using his clout to get the best possible deal. I foresee a change of label but no wholesale repeal/dumping of a wonderful program like ACA similar to Medicare and Social Security.
Healthcare for all has been a need whose time has come and both the Republicans and the Democrats needs to work together to improve ACA.
3
Sorry, Wizarat, but Pence came out and spoke today about how important he feels it is to get the ACA overturned. No explanation of any replacement plans. Do you really think Trump wants "the best deal" to help Americans. If he did, he would have had his people work out a plan and state what it is. But he doesn't.
5
What am I missing? Obamacare ought to be dropped and Medicare for all implemented. Am I wrong?
11
Ms. Rosenberg is completely absorbed in a paradigm that is no longer valid.
If anything, our recent experiment with National Insurance proves that National Insurance is an unavoidable, unreasonably expensive, un-necessary Disaster.
#1....National Insurance, Federally subsidized or not, simply is NOT National Health Care. Insurance does NOTHING to solve the insane rise in Health CARE costs......it isnt designed to control costs, Insurance is a important method to "reduce risk", whatever the cost of that risk is..
#2....National Health Care, still not achieved, is itself an un-necessary goal. it is revealed to be an over-reach of Bureaucratic power and control. Centralized control is counter=productive in the Electronic, Peer-to-Peer, FLAT society of the 21st Century.
#3...There is no way to avoid Health Care. Nor should we even try to avoid health care. Health Care is inevitable, as anyone who has ever required immediate medical attention can testify!! Ad campaigns urging us to "stay healthy" are simply propaganda messages intended to make us feel guilty about actually seeking professional medical care.....its embarrassing that we allow this nonsense to continue.
....
Attempting to rope 350+ million Americans into one universal medical system is a futile attempt to avoid the 21st Century.......
Would it not make more sense to create a Simple National Standard for Health Care and allow 50+ local jurisdictions to come up with their own way of meeting it???
If anything, our recent experiment with National Insurance proves that National Insurance is an unavoidable, unreasonably expensive, un-necessary Disaster.
#1....National Insurance, Federally subsidized or not, simply is NOT National Health Care. Insurance does NOTHING to solve the insane rise in Health CARE costs......it isnt designed to control costs, Insurance is a important method to "reduce risk", whatever the cost of that risk is..
#2....National Health Care, still not achieved, is itself an un-necessary goal. it is revealed to be an over-reach of Bureaucratic power and control. Centralized control is counter=productive in the Electronic, Peer-to-Peer, FLAT society of the 21st Century.
#3...There is no way to avoid Health Care. Nor should we even try to avoid health care. Health Care is inevitable, as anyone who has ever required immediate medical attention can testify!! Ad campaigns urging us to "stay healthy" are simply propaganda messages intended to make us feel guilty about actually seeking professional medical care.....its embarrassing that we allow this nonsense to continue.
....
Attempting to rope 350+ million Americans into one universal medical system is a futile attempt to avoid the 21st Century.......
Would it not make more sense to create a Simple National Standard for Health Care and allow 50+ local jurisdictions to come up with their own way of meeting it???
2
No.
9
No.
4
The GOP opposition to the ACA is the reaction of thwarted toddlers--spite and not rationality. Then again, their desire to completely gut the safety net of Medicare, Medicaid, ACA, etc, to provide tax cuts for the wealthy and corporations also shows their allegiance to their donors rather than their electors.
10
I disagree, their donors make millions off of the ACA, Medicare Part D (remember, not negotiation on drug prices) and even Medicare. This is about destroying Obama and his legacy. Nothing more, nothing less.
And the GOP will pay more of a price for killing the donor's revenue stream than for killing the citizens who will lose access to healthcare because they can no longer afford it.
And the GOP will pay more of a price for killing the donor's revenue stream than for killing the citizens who will lose access to healthcare because they can no longer afford it.
1
Some of those who comment below are wrong (e.g., Luettgen) in claiming that value-based purchasing was in place before the ACA and can continue without the ACA.
The ACA appropriated $10 billion dollars to pay-for-performance. And, the ACA changed Medicare reimbursement rules that allowed CMS to pay hospitals, doctors, nursing homes, etc. billions more for quality rather than quantity.
Prior to the ACA Medicare had only let grants in the 1990s and early 2000s to develop measures of quality. In the early 2000s Medicare planned many and funded a few small scale demonstration projects. But it did not have the authority or funding to pay many hospitals, doctors or nursing homes based upon performance rather than fee-for-service (except for end-stage renal disease).
Here is a summary published by Medicare just before the ACA was passed of what it had done to that point. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst... Here is Medicare's summary statement:
"To restructure payment systems, CMS and the Congress would need to develop incentives ... Additional statutory authority is required in order to allow for performance-based payments in all Medicare FFS payment systems"
Republicans will use Budget Reconciliation as a deceitful ploy to remove funding for the ACA and claim they are leaving the popular parts. But pay-for-performance, pre-existing conditions, etc will end also
The ACA appropriated $10 billion dollars to pay-for-performance. And, the ACA changed Medicare reimbursement rules that allowed CMS to pay hospitals, doctors, nursing homes, etc. billions more for quality rather than quantity.
Prior to the ACA Medicare had only let grants in the 1990s and early 2000s to develop measures of quality. In the early 2000s Medicare planned many and funded a few small scale demonstration projects. But it did not have the authority or funding to pay many hospitals, doctors or nursing homes based upon performance rather than fee-for-service (except for end-stage renal disease).
Here is a summary published by Medicare just before the ACA was passed of what it had done to that point. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst... Here is Medicare's summary statement:
"To restructure payment systems, CMS and the Congress would need to develop incentives ... Additional statutory authority is required in order to allow for performance-based payments in all Medicare FFS payment systems"
Republicans will use Budget Reconciliation as a deceitful ploy to remove funding for the ACA and claim they are leaving the popular parts. But pay-for-performance, pre-existing conditions, etc will end also
12
If your "market" can only avoid "collapse" by forcing people via a gun (or the IRS) to purchase something they choose to not purchase freely, then you're no longer operating on the basis of the rights to life, liberty, and pursuit of happiness. You are operating as a master over slaves. Congratulations, President Obama - you have enslaved all Americans, as others were once enslaved.
5
Here is a chance for the Republicans, to become Human, they should take the ACA and make it better, they would own it, God would smile on them again and 24 million people would still have insurance. It's a win win for them!!
1
The Democrats problem is that when they rammed this thing through they said some really big lies:
"If you like your healthcare plan, you can keep it."
"The average family can expect to see their premiums go down by $2,500."
Consequently, the public finds it hard to believe anything good reported about Obamacare. Plus when you give some people a benefit that others pay for and use fuzzy accounting (saving Medicare $700 billion, without a death panel, then double counting this make believe savings to both extend Medicare's life AND to pay for subsidies for the non-elderly), you have a recipe to insure that any positive results can be safely ignored and thrown out.
"If you like your healthcare plan, you can keep it."
"The average family can expect to see their premiums go down by $2,500."
Consequently, the public finds it hard to believe anything good reported about Obamacare. Plus when you give some people a benefit that others pay for and use fuzzy accounting (saving Medicare $700 billion, without a death panel, then double counting this make believe savings to both extend Medicare's life AND to pay for subsidies for the non-elderly), you have a recipe to insure that any positive results can be safely ignored and thrown out.
5
Yesterday the press reported that one reason automobile manufacturers like building cars in Canada .. Is that employee health care is paid for by the state vs. in US where employer pays for h/c costs
So instead of killing ACA .. Why not transform it into a single payer medicare for all type program .. That would reduce manufacturing costs .. Costs for towns and cities as well .. And pension health care costs too (big issue for towns/cities as well as companies)
Just saying...
So instead of killing ACA .. Why not transform it into a single payer medicare for all type program .. That would reduce manufacturing costs .. Costs for towns and cities as well .. And pension health care costs too (big issue for towns/cities as well as companies)
Just saying...
16
Why Obamacare is just such rent-seeking garbage...
To quote...
...The transformation moves health care away from a fee-for-service model, which pays doctors and hospitals according to the number of procedures they do, toward value-based care, which pays based on what helps patients get better...
Sounds good - but...
1. If doctors and hospitals are taking on the role of insurance companies by assuming risk - then why are insurance companies still in the middle of things...And taking a financial cut...
Further, by this dumb measure of things, our most accomplished surgeons and hospitals would be nuts to take on the most challenging cases - because their success percentages will suffer...
Further still, low percentages would all-but-invite predatory litigation - which of course makes eminent sense to our Lawyer-in-Chief...
2. If this is such a great idea - then there should be no payment for any cancer phrarmaceuticals till patients have survived for five years, with a good prognosis...
See...All progressives look to do is hammer the working middle class, while pandering to the rich...This is why most economists are progressives - that's what they do, reflexively...
To quote...
...The transformation moves health care away from a fee-for-service model, which pays doctors and hospitals according to the number of procedures they do, toward value-based care, which pays based on what helps patients get better...
Sounds good - but...
1. If doctors and hospitals are taking on the role of insurance companies by assuming risk - then why are insurance companies still in the middle of things...And taking a financial cut...
Further, by this dumb measure of things, our most accomplished surgeons and hospitals would be nuts to take on the most challenging cases - because their success percentages will suffer...
Further still, low percentages would all-but-invite predatory litigation - which of course makes eminent sense to our Lawyer-in-Chief...
2. If this is such a great idea - then there should be no payment for any cancer phrarmaceuticals till patients have survived for five years, with a good prognosis...
See...All progressives look to do is hammer the working middle class, while pandering to the rich...This is why most economists are progressives - that's what they do, reflexively...
7
Bottom line a version of ACA or even something better will eventually come out of it. Republicans said themselves that even if they go back to (imo their de facto criminal policy of be rich, don't get sick or don't have a bad life event), it will take yrs to implement and by that time they will most likely be voted out of office since a major of Americans want health care fixed like the rest of the civilized world and not revert back to the rep. de facto criminal health care policy..
1
Note to Republicans. Your dog whistle campaign against Obama worked, even though he wasnt running for office anymore. Now just take a break and take the credit for helping millions of Americans have access to healthcare, like the rest of the civilized world. Even Trump is now calling it the ACA, with Obamacare in parentheses.
p.s. the problem with affordable healthcare in the US is pricing. Follow the money.
p.s. the problem with affordable healthcare in the US is pricing. Follow the money.
4
Get rid of the individual mandate, and I'm on board. Till then, I'll continue to oppose it, as will many who still believe in the constitution.
2
The program falls apart without the mandate. And guess who pays? You! If people without insurance go to the ER and can't afford the bill, it gets passed on to everyone else. How? The hospital needs to be paid, so it raises its rates. Insurers must pay higher rates, and pass them on to you in higher premiums and copays. Everyone loses - the patient who may have waited to long for treatment, and YOU who will pay for it. That's freedom?
17
You can forgo the mandate when you no longer have a body. Since every body consumes medical care simply by being born and every body gets sick from time to time it is only right that you carry coverage for your body rather than foisting the bill on the rest of us when you do get sick.
3
A viable medical insurance program works best when it has the maximum number of subscribers - people - in its risk pool. A system in which the apparently health choose to opt out weakens the whole problem. The issue: how to incentivize the maximum number of people to join the program. The ACA designers chose to introduce mandates to provide such incentives. Could they have come up with a better plan than mandates? Who knows? Of course people resist being forced to pay for something they think they don't need. But everybody is mortal and will find they need medical attention some day, and then those who opted out of the medical insurance program might come to have some regrets over their choices.
2
How can the Republican party simultaneously fight tooth and nail to ensure that a fetus is not aborted, thus "saving" her life, while fighting equally hard to deny her the care she needs once she is born? A life, any life, is greatly diminished if it doesn't have the means and ability to stay healthy (above and beyond what one can do on her own).
As 91% of Congress is Christian, isn't helping to heal others mimicking Jesus' example in the best possible way?
Shouldn't access to quality healthcare for all be a Christian priority?
What am I missing?
As 91% of Congress is Christian, isn't helping to heal others mimicking Jesus' example in the best possible way?
Shouldn't access to quality healthcare for all be a Christian priority?
What am I missing?
10
Obamacare is an albatross around the economic neck of this nation. The sooner it is gone the sooner this economy can soar. Health-care cannot be run as if we're the post office.
3
The real reason for bipartisan support is because Obama Care is essentially a private insurance for profit system originally concocted by the Heritage Foundation and first implemented by the GOP Governor Romney in Massachusetts.
Obama added a few elements, but this is really a GOP program. Those in the GOP that oppose it usually do so for two reasons. One group doesn't like some of the regulations that put limits on what the insurance companies can or must do. So for them it's not 'free market enough.'
But a second group opposes it because they believe there shouldn't be any government involvement at all, especially in the generous subsidies that are provided.
This later group wants full free market. In other words you get what you can pay for. They're happy with the days when 30 million people had no insurance at all.
Yes Trump supporters, this is what you voted for.
Obama added a few elements, but this is really a GOP program. Those in the GOP that oppose it usually do so for two reasons. One group doesn't like some of the regulations that put limits on what the insurance companies can or must do. So for them it's not 'free market enough.'
But a second group opposes it because they believe there shouldn't be any government involvement at all, especially in the generous subsidies that are provided.
This later group wants full free market. In other words you get what you can pay for. They're happy with the days when 30 million people had no insurance at all.
Yes Trump supporters, this is what you voted for.
10
The trouble is, the medical market is not really a free market, because most people feel compelled to access medical services when they or their family members get sick. Shopping for medical services is not like shopping for iPhones or designer footwear. No, the medical market is a distorted market, largely monopolized by providers, and with vast asymmetries in information versus providers (the docs) and consumers (Joe Six Pack),Those who want to impose pure free-market thinking on the medical market are foolishly missing something very important here.
2
Can someone outside medical practices please notice that your doctor is drowning in bureaucracy. He or she has no time to really listen to you, because the latest management scheme to reduce costs demands endless uncompensated time for entering data into cumbersome computer programs, or for sitting on hold in a phone tree to talk to a rep just as you might for customer service at an airline. The prices of drugs and medical technology rise to the sky, the administrators' and insurance executive salaries soar, yet cost control focuses solely on harrying the providers. Doctors are burning out and it's not good for you.
13
The repeal of the ACA is about ideology and nothing else. The repubs will repeal the ACA by the end of the month and the consequences be damned. This is little more than a power play by the Tea Party faction of the party to ensure control of the future agenda of congress. Trump doesn't care, all he is interested in is gaining power, punishing opponents (past and present), and building his personal; wealth. One year from now Americans will wake up wondering what happened.
3
I get it, that the intention motivating the implementation of the ACA, "ObamaCare", was laudable. However, what's stupid about the ACA is that you should be able to shop around and buy health insurance coverage from any insurer in any state regardless of where you reside and you should be able to see the medical provider of your choice regardless of any so-called network or state requirements. Let the carriers compete. If there are no carriers who want to go into this business then the government will need to set up an insurance company, or set up a system like the Assigned Risk Pool where uninsureds can enroll and the government assigns the customer to a rotating list of carriers whether the carriers like it or not. Carriers who object can get out of the business.
I am in New York. My car insurance comes from an insurance company in Illinois and when I need to repair my car for an insured incident I can take it to anyone I please. That's the way it should be with health insurance.
I am in New York. My car insurance comes from an insurance company in Illinois and when I need to repair my car for an insured incident I can take it to anyone I please. That's the way it should be with health insurance.
7
The scenario envisioned in "A Bipartisan Reason to Save Obamacare" makes sense, but has a critical flaw: It assumes that Republican lawmakers actually give a flip about our health care, when in fact they are so focused on destroying anything linked to President Obama that they will sacrifice all of us in order to look anti-Obama. It's a shame that these lawmakers are so blinded with hatred and spite for the President that they are unable to do their jobs.
3
A story to illustrate the point of this piece:
A couple of years ago, I broke my wrist. Instead of going to the ER, I went to the orthopedist, who, naturally had to see me immediately, x- rayed, splinted and told me to take extra NSAIDs. A few days later, I felt increasingly faint and weak, and after ten days, I passed out. A trip to the ER by ambulance revealed nothing except a rapid heart rate, and they sent me home. Three days later, I was back. This time they admitted me, gave me a complete cardio work up, including taking blood samples every two hours, found nothing, released me and sent me to my gp even though I couldn't even stand. After a few seconds perusing my chart, he said, "I know what's wrong with you; you've lost a third of your blood. The extra NSAIDs caused an upper GI bleed." And this, after umpteen blood drawings in hospital. A few weeks on iron substitutes and I was fine.
To add extra cost to injury, the hospital had to eat the cost of my expensive tests because I returned within ten days with the same symptoms (a Medicare no-no).
I don't fault the orthopedist; not everyone would have been as sensitive to ibuprofen. But the hospital didn't even pay attention to the results of the least expensive, common sense test. When I complained to the hospital, of course, they couldn't admit fault because that might have caused me to sue for malpractice, but I could tell they listened as they transferred me through the chain of command to the head of Emergency.
A couple of years ago, I broke my wrist. Instead of going to the ER, I went to the orthopedist, who, naturally had to see me immediately, x- rayed, splinted and told me to take extra NSAIDs. A few days later, I felt increasingly faint and weak, and after ten days, I passed out. A trip to the ER by ambulance revealed nothing except a rapid heart rate, and they sent me home. Three days later, I was back. This time they admitted me, gave me a complete cardio work up, including taking blood samples every two hours, found nothing, released me and sent me to my gp even though I couldn't even stand. After a few seconds perusing my chart, he said, "I know what's wrong with you; you've lost a third of your blood. The extra NSAIDs caused an upper GI bleed." And this, after umpteen blood drawings in hospital. A few weeks on iron substitutes and I was fine.
To add extra cost to injury, the hospital had to eat the cost of my expensive tests because I returned within ten days with the same symptoms (a Medicare no-no).
I don't fault the orthopedist; not everyone would have been as sensitive to ibuprofen. But the hospital didn't even pay attention to the results of the least expensive, common sense test. When I complained to the hospital, of course, they couldn't admit fault because that might have caused me to sue for malpractice, but I could tell they listened as they transferred me through the chain of command to the head of Emergency.
5
Government:Bad. That's it in a nutshell for the GOP. It does not mean that the GOP does not desire some outcomes of government. Even they acknowledge the need for mail delivery. It's just that they want to turn every service into a profit center, for they see opportunity everywhere for the wealthy rent-seekers to have more. They are ideologues. Cruel. Wrong. Out of step with the citizenry. As a country, we have done a handful of great things for people: SS, medicare, medicaid, the Post Office, public schools, national parks. The GOP wants it all for private enterprise. The rubes in the confederacy and in a handful of counties of the upper midwest have now handed them the final chance. They will stop at nothing. Anyone notice Paul Ryan's crazed look in his eyes?
6
Once the decision is made that everyone must pay into the system to cover pre-existing conditions, a Value Added Tax becomes the most efficient means of raising the revenue to pay for it.
3
Several years ago when he still at times told the truth, our president elect said a single payer system was the only form of health insurance that made any sense. Obviously he now has amnesia about ever saying such a thing but he was right then and is right now.
It will be entertaining to see how the Republicans keep their promise to end ObamaCare while keeping most of its provisions. And when all those people whose insurance isn't through ObamaCare yet continue to see their premiums and deductions rise as they will especially as hospitals will need to raise rates to make up for the emergency care they need to those without insurance, I will be curious to see what they will now blame it on.
It will be entertaining to see how the Republicans keep their promise to end ObamaCare while keeping most of its provisions. And when all those people whose insurance isn't through ObamaCare yet continue to see their premiums and deductions rise as they will especially as hospitals will need to raise rates to make up for the emergency care they need to those without insurance, I will be curious to see what they will now blame it on.
2
Paying for prevention versus early detection and treatment is a profound cultural change here in the United States. I would love to see a day when healthcare professionals are paid just as much to protect our health when it is good, as they are to treat illness and disease.
1
The Affordable Care Act is much more than an insurance program. The are many regulations regarding patient safety, efficiencies to cut costs and protections for consumers. The insurance industry changed health care in the 1990's and patients and medical education were effected. The ACA changed that with regulations. The lobbyists who are pushing the Republicans to abolish the act are looking at profit and not people. Our Congress should act in our best interests or we can vote them out...
2
It is very clear that the Republicans don't care if Obamacare is helping or not. They are stubbornly willing to throw it out and forget the consequences, because that's what they've promised to do since 2010. And masses of people are on their side because all they see is that now they are 'forced' to buy insurance whereas before they could get away with being uninsured and put that money to 'better uses'. Try explaining to people who think this way that in reality, not having insurance costs society, including themselves, far more in the end. It will never convince them, because they are incapable of seeing beyond their next paycheck.
What we really need is to ditch the whole thing and abolish privatized insurance altogether. Private insurance companies are an amoral business that cannot turn a profit without either charging everyone a massive fee or cutting coverage for anybody who actually needs to use its services. Before the ACA, we had the version that cut or refused services when patients got too expensive. Now, with the ACA, we have the version that charges everyone a huge fee. Neither way is a good solution to the problem.
What we need is a publicly funded, universal healthcare policy that everyone pays into and everyone uses. Pair that with robust, competition driven private/public medical infrastructure to keep costs low, and we may finally have a winner.
Too bad such a policy would never gain traction with the GOP. I expect zero solutions from them.
What we really need is to ditch the whole thing and abolish privatized insurance altogether. Private insurance companies are an amoral business that cannot turn a profit without either charging everyone a massive fee or cutting coverage for anybody who actually needs to use its services. Before the ACA, we had the version that cut or refused services when patients got too expensive. Now, with the ACA, we have the version that charges everyone a huge fee. Neither way is a good solution to the problem.
What we need is a publicly funded, universal healthcare policy that everyone pays into and everyone uses. Pair that with robust, competition driven private/public medical infrastructure to keep costs low, and we may finally have a winner.
Too bad such a policy would never gain traction with the GOP. I expect zero solutions from them.
8
The GOP rationale for returning to some form of past health insurance (but only-unspecified--better) because Americans have the best health care in the world is a beginning fallacy. We pay more for medicine than the rest of the world, our paperwork is cumbersome, choosing a plan is bewildering (gaming your health and the system.) We see a doctor when we have to; not when it is prudent--because of cost. And this does not begin to describe the problems of anyone without insurance. Divorce, widowhood, job change, prior illness (or simply a period of no insurance)--these led to loss of insurance prior to the ACA.
The GOP in trying to redo health care should be made to have the same plans as they propose for our electorate--with the same restrictions, the same bewildering application process in choosing between apple/orange plans, and the same hassle --if they had their wish--women would have in having two different insurance plans to pay for health non pregnancy/pregnancy. (The men could have two separate plans relating to health non-reproductive organs vs reproductive organs.) Then, maybe, they could return to a sane discussion of good and reasonable options.
The GOP in trying to redo health care should be made to have the same plans as they propose for our electorate--with the same restrictions, the same bewildering application process in choosing between apple/orange plans, and the same hassle --if they had their wish--women would have in having two different insurance plans to pay for health non pregnancy/pregnancy. (The men could have two separate plans relating to health non-reproductive organs vs reproductive organs.) Then, maybe, they could return to a sane discussion of good and reasonable options.
3
The ACA, "ObamaCare", does not successfully address its objective of providing healthcare for everybody because those who opt not to obtain healthcare insurance are fined. Then, even though they don't have coverage they get treated anyway. We don't let the ill and injured die in the parking lots of the emergency rooms. Someone pays for this.
America is so afraid of the "s" word, "socialism" .
It's not socialism when the government collects our tax money to provide police, fire departments, schools, road building and repair, snow removal, traffic lights, aid to the poor and such.
It would not be socialism if the government covered our medical expenses using the tax money which they collect from us, (after the payment of a meaningful deductible to discourage frivolous medical visits). People who work for employers that provide medical care and do not use the government's plan would get tax credits.
It's 2017. We are the wealthiest nation on the earth. We can and should do something like this. I would imagine that 100+ years ago there were people who argued against government funded education.
The big losers here will be the medical providers who will probably be required to charge what the government permits them to charge within a certain range taking region into account. If a medical provider wants to charge more, that would need to be prominently displayed in the medical providers' facilities and the additional cost would be be the informed patient's responsibility.
America is so afraid of the "s" word, "socialism" .
It's not socialism when the government collects our tax money to provide police, fire departments, schools, road building and repair, snow removal, traffic lights, aid to the poor and such.
It would not be socialism if the government covered our medical expenses using the tax money which they collect from us, (after the payment of a meaningful deductible to discourage frivolous medical visits). People who work for employers that provide medical care and do not use the government's plan would get tax credits.
It's 2017. We are the wealthiest nation on the earth. We can and should do something like this. I would imagine that 100+ years ago there were people who argued against government funded education.
The big losers here will be the medical providers who will probably be required to charge what the government permits them to charge within a certain range taking region into account. If a medical provider wants to charge more, that would need to be prominently displayed in the medical providers' facilities and the additional cost would be be the informed patient's responsibility.
4
This is an important part of the discussion.
Underlying our health care crisis is waste. We spend compared with other advanced countries with universal care more than 8% of our GDP more than they do. That waste is twice our defense budget, which is officially about 4% and so twice everyone else's defense and considered a great burden.
There are advanced countries with universal care that spend half what we do on health care, 9% of GDP, and that a bit smaller GDP too. What we spend is not unavoidable. The extra is just plain waste.
Why? Fee for service is part of it. We pay for tests, so tests get done, extra ones.
But a lot of that extra is administration costs. Doctors hire people to do nothing but submit complex bills and complex reports requesting authorizations. Insurance companies then pay people to do nothing but say "no" and attempt to shift the bill to some other health care payer, which pays people to also say no. The doctor then pays someone to argue with them until someone finally pays up, or the patient goes without despite all the money spend on administering the non-care.
On top of all that, there is a very large profit margin. It used to be that 5% profit was acceptable and 10% was good. Now the standard in business schools is 20%. That compounds to massive expense very quickly as it moves through layers of profit centers.
There is more, like drugs costs.
All of this is what makes our insurance so "impossible."
Underlying our health care crisis is waste. We spend compared with other advanced countries with universal care more than 8% of our GDP more than they do. That waste is twice our defense budget, which is officially about 4% and so twice everyone else's defense and considered a great burden.
There are advanced countries with universal care that spend half what we do on health care, 9% of GDP, and that a bit smaller GDP too. What we spend is not unavoidable. The extra is just plain waste.
Why? Fee for service is part of it. We pay for tests, so tests get done, extra ones.
But a lot of that extra is administration costs. Doctors hire people to do nothing but submit complex bills and complex reports requesting authorizations. Insurance companies then pay people to do nothing but say "no" and attempt to shift the bill to some other health care payer, which pays people to also say no. The doctor then pays someone to argue with them until someone finally pays up, or the patient goes without despite all the money spend on administering the non-care.
On top of all that, there is a very large profit margin. It used to be that 5% profit was acceptable and 10% was good. Now the standard in business schools is 20%. That compounds to massive expense very quickly as it moves through layers of profit centers.
There is more, like drugs costs.
All of this is what makes our insurance so "impossible."
102
The issue of administration costs, doctors submitting and re-submitting bills to the committees of "no" is a big one. It's why my doctor wanted single payer and retired in frustration when it didn't happen. He spent half his day dealing with a pile of unpaid claims. This little circus needs to be eliminated.
25
But if we want to ensure that all Americans, regardless of what health insurance company's insurance they have are receiving high quality care we need to have national standards and insurance that covers us no matter where we are in America when we need treatment. This is not a luxury: it's a necessity. Just because a person lives in Wyoming and has their insurance through a company in Wyoming doesn't mean they can't fall ill or have a medical emergency in Illinois or Texas. And just because an insurance company's protocol for treatment says that all the drugs a patient gets are to be generic doesn't mean that all patients can be treated with generic drugs: some will need the brand name for whatever reason. One size fits all medicine or health care, especially when it ignores the realities of a patient's life or conditions, is not quality healthcare. It's wasteful. So too is the constant fighting and worrying patients and their families have to do whenever someone needs health care.
We need a single payor universal health CARE system. What we still have is a system where the patients lose, the doctors cannot always do what they know how to do, and a tremendous amount of confusion of who pays for what with the patient bearing the brunt of this confusion. That's not health care. That's a waste of time, harmful, and an obstacle to going for or giving good health care.
We need a single payor universal health CARE system. What we still have is a system where the patients lose, the doctors cannot always do what they know how to do, and a tremendous amount of confusion of who pays for what with the patient bearing the brunt of this confusion. That's not health care. That's a waste of time, harmful, and an obstacle to going for or giving good health care.
109
The GOP objections to the ACA are entirely ideological, and have nothing to do with the effectiveness or success vs failures of the law. They need to take a hard look on how the ACA has reduced emergency room as free clinic use, how it has stabilized and even reduced costs for employer plans, how it has rescued failing hospitals, especially in rural and under served areas--areas than cannot afford to lose their hospitals. A tax on medical equipment devices is appropriate, as these are beneficiaries of more insured people. A tax on the wealthier is appropriate as well, I certainly don't mind some of my tax dollars going towards health care for the less fortunate because I also benefit with lower premiums on my own health insurance due to my insurance not having to make up for all the uninsured that show up at the hospital emergency room. The mandate for insurance must be kept in place or coverage for the gravely ill (cancer, diabetes, heart disease,birth defects) will be out of reach for everyone. But the cost of individual plans need to also stabilize and come down to the level of large group plans. I would recommend grouping individuals into policies for say "the self-employed collective" or the "Small Business Group" or like the "Freelancers Union" of NYC that can bargain group rates for their members rather than individual risk pools that can cost way more than most will be willing to pay. Deductibles also should apply to the family, not for each member of it.
137
This type of experimentation has been going on since the 90s when quality of care and bundled services, e.g. a set price for each disease state, were en vogue in some commercial health plans. There were many quality institutes devoted to the premise that delivery of care could be made much more efficient.
Of course such programs begin to die when the costs were too high because health plans didn't have the patience to follow through on the learning curve. I am very glad that the ACA has continued this model, And it sounds like a lot has been learned already.
As as these articles by the Times show, healthcare quality initiatives take time, are cumbersome, and complex. Healthcare has always been a cottage industry: it can't be automated or robotized all the robots are being increasingly used in hospitals for routine bedside check ups.
It would be a shame if the Republicans throughout the baby with the bathwater by repealing the ACA just when its many innovations we're starting to pay dividends.
But shame is not probably the right word. Healthcare unfortunately has been treated as an ideological and political issue, not a product that can be delivered more easily cheaply and efficiently if systems are in place to study what works.
That healthcare now consumes 18% of GDP when only 20 years ago it consumed 11, is unacceptable. The GOP is right on one thing --The ACA need fixing. Not by Congress--but by providers who know what needs fixing.
Of course such programs begin to die when the costs were too high because health plans didn't have the patience to follow through on the learning curve. I am very glad that the ACA has continued this model, And it sounds like a lot has been learned already.
As as these articles by the Times show, healthcare quality initiatives take time, are cumbersome, and complex. Healthcare has always been a cottage industry: it can't be automated or robotized all the robots are being increasingly used in hospitals for routine bedside check ups.
It would be a shame if the Republicans throughout the baby with the bathwater by repealing the ACA just when its many innovations we're starting to pay dividends.
But shame is not probably the right word. Healthcare unfortunately has been treated as an ideological and political issue, not a product that can be delivered more easily cheaply and efficiently if systems are in place to study what works.
That healthcare now consumes 18% of GDP when only 20 years ago it consumed 11, is unacceptable. The GOP is right on one thing --The ACA need fixing. Not by Congress--but by providers who know what needs fixing.
60
It seems to be a win-win. Costs are kept down and folks stay healthier, thus improving their quality of life. It is sad to see the GOP so focused on repealing all of it. Their hatred of Mr. Obama driving their commitment to be sure that he is a "complete failure" is unreasonable, to say the least. Combine that drive with their knee-jerk belief that government involvement in our lives is always bad and they are driven to bad policy.
There have been noises from the GOP recently about keeping the "most popular" aspects of the ACA. What they amazingly do not get is that they cannot keep the requirement that companies cover folks with pre-existing conditions w/o making healthy folks buy insurance. If home insurance or auto insurance operated that way, people would be calling to sign up as their house burned or at the scene of a car crash expecting the company to pay them for the damage. As noted the system would collapse.
If I have any bright spots in the aftermath of the recent election, one will certainly be watching the GOP twisting in the wind on healthcare. They may come to regret getting what they hoped for.
There have been noises from the GOP recently about keeping the "most popular" aspects of the ACA. What they amazingly do not get is that they cannot keep the requirement that companies cover folks with pre-existing conditions w/o making healthy folks buy insurance. If home insurance or auto insurance operated that way, people would be calling to sign up as their house burned or at the scene of a car crash expecting the company to pay them for the damage. As noted the system would collapse.
If I have any bright spots in the aftermath of the recent election, one will certainly be watching the GOP twisting in the wind on healthcare. They may come to regret getting what they hoped for.
63
The ACA is and always has been a GOP plan, which began at the rightwing think tank, the Heritage Foundation, decades ago. Then it went to Romney in MA and then to the ACA.
The ACA was the GOP's concept for keeping some of their big donors (i.e., health insurance companies) afloat. Obama only went with it because that was all he could have gotten through at the time. Obama wanted single payer but he thought, probably correctly, that was doomed from the start.
This is a fact.
They'll change the name of it and that will be that. It served its purpose as a political weapon that the GOP used to get back into power.
The ACA was the GOP's concept for keeping some of their big donors (i.e., health insurance companies) afloat. Obama only went with it because that was all he could have gotten through at the time. Obama wanted single payer but he thought, probably correctly, that was doomed from the start.
This is a fact.
They'll change the name of it and that will be that. It served its purpose as a political weapon that the GOP used to get back into power.
171
That's really not correct. The heart of the ACA, which people keep failing to talk about, is something to which the Republican party is deeply opposed, the requirement that employers buy health insurance for their employees. The thing that gets all the attention, the "individual mandate" for the self-employed or workers in very small businesses, covering somewhere around 30% percent of the workforce, is less important.
The Heritage Foundation proposals to which you refer were meant to protect business owners from any requirement to insure their workers by applying an individual mandate to the whole population, essentially destroying the traditional of employer insurance. The Romney idea was to do the same, but the Massachusetts legislature (working under the advice of Ted Kennedy) passed an employer mandate over his veto. The ACA is not a Republican idea.
The Heritage Foundation proposals to which you refer were meant to protect business owners from any requirement to insure their workers by applying an individual mandate to the whole population, essentially destroying the traditional of employer insurance. The Romney idea was to do the same, but the Massachusetts legislature (working under the advice of Ted Kennedy) passed an employer mandate over his veto. The ACA is not a Republican idea.
1
@David
You're slicing rather thin here..... My overall point was that this was the GOP's idea from the start to avoid single payer (like the rest of the industrial west has) in some assorted formats.
When it is all said and done we'll virtually have the ACA under a new name, with very high deductibles, which is insurance for the rich or stupid people.
So when you little boy breaks his arm its $5000 out of pocket, which also keeps people from preventive care or early detection, leading to great costs down the road.
I know somebody that had one of these high deductible policies and their boy suddenly became ill with a stiff neck and headache....
Mom bet that it was just a bug or flu sending the boy to bed, because going to the ER would be >$1200 out of pocket which she didn't have. Turns out it was meningitis: Result dead kid.
Look at bottom with the facticity of the situation there are only a few choices:
1] The GOP theorem of sink or swim....bootstraps, baby! You are on your own.
2] Some form of the ACA.
3] Single payer
4] Die
The rest of the industrial west has figured this out why can we? The GOP?
You're slicing rather thin here..... My overall point was that this was the GOP's idea from the start to avoid single payer (like the rest of the industrial west has) in some assorted formats.
When it is all said and done we'll virtually have the ACA under a new name, with very high deductibles, which is insurance for the rich or stupid people.
So when you little boy breaks his arm its $5000 out of pocket, which also keeps people from preventive care or early detection, leading to great costs down the road.
I know somebody that had one of these high deductible policies and their boy suddenly became ill with a stiff neck and headache....
Mom bet that it was just a bug or flu sending the boy to bed, because going to the ER would be >$1200 out of pocket which she didn't have. Turns out it was meningitis: Result dead kid.
Look at bottom with the facticity of the situation there are only a few choices:
1] The GOP theorem of sink or swim....bootstraps, baby! You are on your own.
2] Some form of the ACA.
3] Single payer
4] Die
The rest of the industrial west has figured this out why can we? The GOP?
5
Maybe Obama did want 'single payer', or any other plant that would be truly universal and lower cost. But he should have gone around the country making speech after speech pushing it---despite Gop blocking. If leaders and politicians would do that, the public would understand it, and the Gop would be shown up for the frauds they are. But we just keep hearing how the Gop blocked Obama--end of story. We seem to be passive prisoners.
But ACA has no cost controls, makes our taxes prop up insurance profits, and lets the big campaign donor health industry exploit the majority of citizens.
Of course anything would be better than what the US had before ACA. But it's far inferior to most other modern countries---most of which don't turn their elections over to corporations for sponsorship as the US does.
Even Sanders who mentioned other advanced countries h/c in a sentence in every speech, never explained to Americans how the average citizens abroad pay for and use their h/c. So we don't get concrete role models, and are at the mercy of a Gop originated h/c system. Our politics is not giving us the ammunition we need to fight for even late 20th C standards of h/c that dozens of nations have.
And our liberal columnists at the NYT usually avoid the comparisons.
But ACA has no cost controls, makes our taxes prop up insurance profits, and lets the big campaign donor health industry exploit the majority of citizens.
Of course anything would be better than what the US had before ACA. But it's far inferior to most other modern countries---most of which don't turn their elections over to corporations for sponsorship as the US does.
Even Sanders who mentioned other advanced countries h/c in a sentence in every speech, never explained to Americans how the average citizens abroad pay for and use their h/c. So we don't get concrete role models, and are at the mercy of a Gop originated h/c system. Our politics is not giving us the ammunition we need to fight for even late 20th C standards of h/c that dozens of nations have.
And our liberal columnists at the NYT usually avoid the comparisons.
If corpoations paid all their employees fee for service instead of a salary they would go out of business.
1
They did that. It was called "piece work." It is now illegal in many situations.
Republican professionals like Gail Wilensky need to publicly address the point of the column- that the Affordable Care Act is reducing the overall cost of medical care by encouraging necessary innovation in treatment. The column should be read into the congressional record on the floor of the House. And President Obama should include its points in his going away speech to the nation on January 15th and challenge Mr. Trump to address it accurately when he speaks at his news conference a day later.
18
Healthcare will continue to challenge state and local governments especially within ten years when those already early aged 70's baby boomers hit their early 80's. That is when they become the cardiac patient, need stents, surgery and a minimal amount of the population after age 80 does not need a cardiologist. Healthcare will become increasingly expensive. We have not seen anything yet. So expect big necessary changes in healthcare, and Medicare to accommodate the masses.
1
There is no need for healthcare to be as expensive as it is, if we accept the fact that old people die. I hope enough boomers have watched their parents become useless burdens and will choose another path for themselves. People almost 90 who no longer contribute need a nice peaceful end of life, and then the chance to die with dignity. They do not need stents, pacemakers, new hips, colonoscopies, mammograms.
2
The generous assumption here is that the GOP machine honestly wants to create a good health care system. The evidence, however, is that the GOP wants to be sure the health care business is as profitable as possible, which is only tangentially related to providing good health care for all Americans.
90
An insurance industry acting in its best interests would charge the highest possible fees while having its client-patients live for as short a time as possible to reduce the risk they might be required to pay out claims.
4
And we have a HHS secretary nominee whose main goals seem to be increasing the amounts that doctors can charge and ending provision of prenatal care to the poor and not better the provision of healthcare.
6
Thanks Tina,
You've presented several sound reasons to save the Affordable Care Act. Your analysis is very cogent, knowledgeable, and balanced. Unfortunately, Republicans are pulling out all of the stops, bar none, to eliminate the Affordable Care Act - we can count on that.
At every stop along the way, President-elect Trump waxed poetic on how he would repeal Obamacare and rip health care off the backs of the millions. Rest assured, health care coverage under Obamacare for millions of Americans care will disappear - sooner or later – under President-elect Trump, Senate Majority Leader McConnell and Speaker Ryan. It's coming our way - full steam ahead.
And, rest assured, in a few weeks, President-elect Trump and Scott Pruitt over at EPA will aggressively put into motion the means to rip out federal controls on emissions from coal burning powerplants and other facilities that burn fossil fuels. Health care needs will grow exponentially under President-elect Trump, Mr. Pruitt and his buddies in the Senate and House after they get their hands on those pesky environmental rules.
God help us all in the days, months, and years ahead.
You've presented several sound reasons to save the Affordable Care Act. Your analysis is very cogent, knowledgeable, and balanced. Unfortunately, Republicans are pulling out all of the stops, bar none, to eliminate the Affordable Care Act - we can count on that.
At every stop along the way, President-elect Trump waxed poetic on how he would repeal Obamacare and rip health care off the backs of the millions. Rest assured, health care coverage under Obamacare for millions of Americans care will disappear - sooner or later – under President-elect Trump, Senate Majority Leader McConnell and Speaker Ryan. It's coming our way - full steam ahead.
And, rest assured, in a few weeks, President-elect Trump and Scott Pruitt over at EPA will aggressively put into motion the means to rip out federal controls on emissions from coal burning powerplants and other facilities that burn fossil fuels. Health care needs will grow exponentially under President-elect Trump, Mr. Pruitt and his buddies in the Senate and House after they get their hands on those pesky environmental rules.
God help us all in the days, months, and years ahead.
39
Obama shoved a policy down the Nation's throat and is fighting to prevent its regurgitation. His comment that elections have consequences was true and incredibly arrogant.
Instead of fighting, he owes the nation a sincere and contrite apology, followed by a credible offer to reform this disaster in a bi-partisan manner. The people's anger has to do as much with the manner this legislation came to be as well as disagreement with some of its policies. If Obama cares more about policy than ego, this is one way to disarm many of his critics. Such a shame. He had the potential to be an incredible unifier
Instead of fighting, he owes the nation a sincere and contrite apology, followed by a credible offer to reform this disaster in a bi-partisan manner. The people's anger has to do as much with the manner this legislation came to be as well as disagreement with some of its policies. If Obama cares more about policy than ego, this is one way to disarm many of his critics. Such a shame. He had the potential to be an incredible unifier
5
So basically your response to the data is a rant: "shoved down the nation's throat" (I thought Congress passed a law); "disaster" (please explain how 20M more with health insurance is a disaster; respond to the data in this op ed and in Mr. Rattner's today showing quantifiable improvement); "the people's anger" (agree the vote for DJT may have had anger as a reason, but I think immigration, jobs, etc. may have played a significant role too; it wasn't a referendum on the ACA); Obama's chance to be a 'unifier' (he adopted basically a GOP plan from MA! Also the comment on day 1 of Obama's 1st termby Senate minority leader: "My job is to make sure he doesn't win a second term"; as my mom used to say, "It takes two to tango.")
16
What a bunch of nonsense. President Obama, who was, along with his family, the target of incredibly ugly racism, is blamed for not being a "unifier" when the GOP and right wing media obstructed and disrespected him from day one?
24
Do you really believe that most people in this country are aware how the legislation came about?
There was an article in The Times yesterday that discussed a woman who was angry that her son will leave her insurance when he was 26 and blamed ObamaCare but was unaware that it was ObamaCare that required him to be on her policy to that age in the first place. I doubt anybody who is so ignorant about this was aware of the voting in Congress.
There was an article in The Times yesterday that discussed a woman who was angry that her son will leave her insurance when he was 26 and blamed ObamaCare but was unaware that it was ObamaCare that required him to be on her policy to that age in the first place. I doubt anybody who is so ignorant about this was aware of the voting in Congress.
17
My wife who died of Cancer but lived for 3.5 years with a stage 4 diagnosis was treated this way by Blue Cross prior to the ACA. What has happened since the ACA is both the insurance industry and the health care industry has consolidated. Every major health care provider pretends to offer integrated care. The reality isn't the same thing.
One of the things that has happened is hospitals get reimbursed less for each hospitalization. That's a big incentive to move patients to managed Oncology nurses. It's also a big incentive to move people who can still be treated to hospice.
One of the things that has happened is hospitals get reimbursed less for each hospitalization. That's a big incentive to move patients to managed Oncology nurses. It's also a big incentive to move people who can still be treated to hospice.
11
Why don't the republicans just call it the ACA, never mention "Obamacare (nee Romneycare)" again, and hijack credit for themselves for creating a terrific healthcare system. The greatest in the world.
Seriously, the only real public health care that will work is a basic level of government supported free health care. Make for-profit health providers work to earn their profits, by having to be better than the government supported health services.
The present system still allows every entity in the health delivery chain to grab as much money out of the system and pockets of the public as possible. Any changes the GOP make will no doubt just ensure the profit making is more efficient, not the service.
Seriously, the only real public health care that will work is a basic level of government supported free health care. Make for-profit health providers work to earn their profits, by having to be better than the government supported health services.
The present system still allows every entity in the health delivery chain to grab as much money out of the system and pockets of the public as possible. Any changes the GOP make will no doubt just ensure the profit making is more efficient, not the service.
6
The real objection to Obamacare is and has always been Obama. All of the claims about rates going up, about dissatisfaction by patients and physicians, losses by insurers, costs going up are fundamentally propaganda devoid of truth and without remedy. True, it implies that the ACA was a Heritage/Conservative program that became an important focal point from which Republicans could attack the Black Man in the White House. And they did attack the program to damage and distract Obama and to reduce Obama's support. Republicans were aided by the Democratic establishment that represents insurers, pharmaceutical/equipment manufacturers, Unions that wanted to protect privileged insurance policies, and quiet sophisticated racists, Religions that preach against gender equality, fetal person hood, and promote sexual repression and science regarding sexuality.
The Republican plans to destroy Medicare, Medicaid, Social Security and Public education are given cover under Republican hysteria over the ACA.
The outcome to the average American with Health Insurance will be resumption of escalating fees, cascading loss of employer based insurance, overwhelming ED costs and an explosion of "premature" deaths among the uninsured.
Bipartisanship has been and continues to be submission to Republican and oligarchic authority. When Republicans and their puppet masters can only perceive the bottom-line per quarter instead of long term growth we are condemned to cyclical depressions.
The Republican plans to destroy Medicare, Medicaid, Social Security and Public education are given cover under Republican hysteria over the ACA.
The outcome to the average American with Health Insurance will be resumption of escalating fees, cascading loss of employer based insurance, overwhelming ED costs and an explosion of "premature" deaths among the uninsured.
Bipartisanship has been and continues to be submission to Republican and oligarchic authority. When Republicans and their puppet masters can only perceive the bottom-line per quarter instead of long term growth we are condemned to cyclical depressions.
328
Obama didn't lose the midterm elections, Democrats did. Obama didn't lose the Senate, Democrats did. Obama didn't lose the Presidency, he was re-elected twice, Hillary did.
6
In just three years, my health care insurance premium has gone from $500/month to $1944 per month. And for that crazy high monthly premium, all my expenses are out of pocket as I am healthy enough (thankfully) not to reach the deductible. Furthermore, my physician charges have gone from $120 per visit to $240/visit.
Meanwhile at 62, my premium is paying for services I won't need. Given my current situation, I would prefer to have the choice, given my healthy state, to have kept the catastrophic health care plan I used to have instead of Obamacare I am required to have. My brother has this plan (he sucks it up and pays the penalty). He is just three years younger than me and pays $550 per month. Before Obamacare, he paid mid-$300's.
Faced with that astronomical premium, I stepped back to part time work so I could take advantage of the tax subsidies. That means I can pay little into my self-directed retirement (an annual contribution to a IRA). So, don't tell me that all objections to Obamacare are ideological. For many of us it'f financial. For those of us not yet Medicare age, without employer based insurance, it is especially painful. Yes, cancer or a heart attack would be worse but before Obamacare I was able to buy insurance for that AND work full time!!
Meanwhile at 62, my premium is paying for services I won't need. Given my current situation, I would prefer to have the choice, given my healthy state, to have kept the catastrophic health care plan I used to have instead of Obamacare I am required to have. My brother has this plan (he sucks it up and pays the penalty). He is just three years younger than me and pays $550 per month. Before Obamacare, he paid mid-$300's.
Faced with that astronomical premium, I stepped back to part time work so I could take advantage of the tax subsidies. That means I can pay little into my self-directed retirement (an annual contribution to a IRA). So, don't tell me that all objections to Obamacare are ideological. For many of us it'f financial. For those of us not yet Medicare age, without employer based insurance, it is especially painful. Yes, cancer or a heart attack would be worse but before Obamacare I was able to buy insurance for that AND work full time!!
3
The aforementioned is why "Not Hillary" won. Ignoring the serious financial problems of PPACA is not going to win elections.
Ms. Rosenberg makes a rational argument but reason has nothing to do with Republican antipathy to the ACA. This morning we were treated to a comment by Vice President Electoral Pence who claimed that the ACA stifled job growth, despite the fact that employment rose more under Obama than Reagan. If reason was favored by the GOP, they would have devoted some of the energy wasted during sixty attempts to repeal the ACA into developing an alternative.
47
But if you counted "employment" under the same guidelines that Obama uses and applied them under the Reagan administration, Obama would not even be close. The same with "deportations" under Obama compared to prior administrations. It would seem that Mr Obama paid close attention in "funny math" class at Harvard. If the numbers do not favor you then switch the formula until they do. All conservatives are not as gullible and dense as the left would assume. But nice try.
2
Real conservatives preserve what is working and revise what isn't. Repealing the ACA without a replacement is radical, not conservative.
113
The problem is that this crowd is not built on conservative principles or ideology. Rather they have a "philosophy" based on a few novels of Ayn Rand, a third rate novelist, who when the going in her personal life got tough jumped into the very programs she decried.
11
Now retired from the practice of medicine for 43 years, I would recommend just two changes from our current semi-system.
Medicare pays for an annual health check visit which, while not bad, misses the mark. Checking the status of immunizations, screening for dementia and depression and establishing guidelines are being followed is good but incomplete.
CHANGE #1: Use this visit to verify with the patient a complete and current list of that patient's problems.
CHANGE #2: Use this visit to verify and document measurable, attainable and patient-negotiated goals for each problem under active management.
If you aim at nothing, you will hit it.
A patient who is not involved with his care and engaged with the goals of his care cannot ever achieve them.
One example will suffice: ask yourself this--how much end of life care is rendered simply because no one has been asked ahead of time about goals? The imperative to "do everything possible" is greater than the directive to "do everything appropriate to ease suffering".
Even advance directives are insufficient. They should not focus on the last 15 months of care but the last 15 YEARS of care. We can do it better and we can do it cheaper. Just talk with the patient!
Medicare pays for an annual health check visit which, while not bad, misses the mark. Checking the status of immunizations, screening for dementia and depression and establishing guidelines are being followed is good but incomplete.
CHANGE #1: Use this visit to verify with the patient a complete and current list of that patient's problems.
CHANGE #2: Use this visit to verify and document measurable, attainable and patient-negotiated goals for each problem under active management.
If you aim at nothing, you will hit it.
A patient who is not involved with his care and engaged with the goals of his care cannot ever achieve them.
One example will suffice: ask yourself this--how much end of life care is rendered simply because no one has been asked ahead of time about goals? The imperative to "do everything possible" is greater than the directive to "do everything appropriate to ease suffering".
Even advance directives are insufficient. They should not focus on the last 15 months of care but the last 15 YEARS of care. We can do it better and we can do it cheaper. Just talk with the patient!
198
What an outstanding comment when the vast majority of other comments are whiny political partisan drivel.
1
Indeed, Mr. McNeill, communication solves all problems, even if the resulting outcomes are not the most desirable, at least one knows the deal. However, the provision in the ACA to have doctors consult with patients regarding end of life care in advance was labeled as "death panels." So, G.H. from Bryan Texas, there's your "whiny political partisan drivel."
3
The biggest and best changes to make would be to reduce the wait times for appointments when we're ill, to stop the narrow network nonsense, to stop the bait and switch games providers and insurance companies play, and to ensure that we're covered no matter how much we earn, where we are when we need the care, and end the balance billing. Then start to listen to the patients instead of talking at them. There may be some very good reasons why they aren't engaged in their own care or are refusing to go for care. The biggest reason I refuse to go is because I'm tired of worrying about what is or isn't covered under my insurance and the surprises I get when the bill comes. It's part of the provider and the insurance company game: see how much they can get before the patient complains or stops going.
Ohio voted rather convincingly for the people who want and plan to destroy the ACA which will throw 10's of millions of Americans off the insurance rolls leaving them with no alternative but charities and ERs which currently cannot turn anyone away (but watch, the GOP will change that, too).
Thousands, hundreds of thousands will suffer and die needlessly, and many, if not most, will do so in those states that voted to end the ACA by voting for Trump and re-electing their Republican Senators and Representatives. They have done it to themselves and I have little sympathy for them.
I had a doctor who had a sign in his office that read that a doctor cannot do anything that a patient cannot undo. The patient has chosen to abandon the ACA and throw tens of millions into the streets to die, and die they will.
Thousands, hundreds of thousands will suffer and die needlessly, and many, if not most, will do so in those states that voted to end the ACA by voting for Trump and re-electing their Republican Senators and Representatives. They have done it to themselves and I have little sympathy for them.
I had a doctor who had a sign in his office that read that a doctor cannot do anything that a patient cannot undo. The patient has chosen to abandon the ACA and throw tens of millions into the streets to die, and die they will.
47
This comment is the usual right wing nonsense, cue a cite to the washington times. Medicaid like public housing beats the hardship and suffering they replace. The racist underpinnings of opponents must be constantly exposed and condemned.
28
The US spends more on payments management than real national health plans pay in salaries to doctors.
18
The movement toward “value-based-care” rather than “fee-for-service” pre-dated the ACA. It definitely is something (among other “somethings”) that we should retain; but retaining it doesn’t require that the ACA survive.
As the Washington Times once noted in an editorial, Medicaid is “like forcing people into the medical equivalent of public housing." The effects of the ACA on evolution of the healthcare universe are one thing, but the expansion of a program that is very expensive and that delivers a quality of care that is highly dubious is quite another. States are strangling over the expense of this program, which may grow substantially if Congress block-grants Medicaid reimbursement to the states, as could very well happen. In combination with unfunded public employee retirement obligations, it already has vastly diminished traditional state expenditures for infrastructure and education – as it has at the federal level, as well.
What’s more, the mandates as well as new taxes to (at best partially) pay for the ACA impose hardships on those forced to enter the exchanges with little-to-no subsidies, in order to afford the fiscal elbow-room to provide coverage to those who are FULLY subsidized – usually though Medicaid. They are onerous and probably not strategically viable from a political perspective.
Instead of arguing for retention of the ACA, that appears to be a lost cause, it would make more sense to agree on ALL the “somethings” we should retain in its replacement.
As the Washington Times once noted in an editorial, Medicaid is “like forcing people into the medical equivalent of public housing." The effects of the ACA on evolution of the healthcare universe are one thing, but the expansion of a program that is very expensive and that delivers a quality of care that is highly dubious is quite another. States are strangling over the expense of this program, which may grow substantially if Congress block-grants Medicaid reimbursement to the states, as could very well happen. In combination with unfunded public employee retirement obligations, it already has vastly diminished traditional state expenditures for infrastructure and education – as it has at the federal level, as well.
What’s more, the mandates as well as new taxes to (at best partially) pay for the ACA impose hardships on those forced to enter the exchanges with little-to-no subsidies, in order to afford the fiscal elbow-room to provide coverage to those who are FULLY subsidized – usually though Medicaid. They are onerous and probably not strategically viable from a political perspective.
Instead of arguing for retention of the ACA, that appears to be a lost cause, it would make more sense to agree on ALL the “somethings” we should retain in its replacement.
25
R. Lueettgen: How dare you pontificate on Medicaid when you have not, obviously
experienced the need for it. My sister, who passed away this past July, a highly
ediucated music teacher, suffered from cancer and had colostomy surgery as
well, eventually losing the sight of one eye. She fought hard, though frail, and
continued to teach, and due to hospise care and private nursing went through her
money and some of mine. Eventually she was forced to go onto medicaid, fighting
to keep her home, an apartment in NYCity, and keep going. Once you go on
medicaid you find another world of denial poised to defeat you at every turn.
Medicaid officials are scarce, hard to find, to deal with, and paid poorly. It was an
experience I will never forget or forgive - the way my sister was treated was cruel
and inexcuseable. We need healthcare Richard that really cares for sick people
who deserve a lot better than my sister got. Try some compassion in your pronouncements - it will do your heart good.
experienced the need for it. My sister, who passed away this past July, a highly
ediucated music teacher, suffered from cancer and had colostomy surgery as
well, eventually losing the sight of one eye. She fought hard, though frail, and
continued to teach, and due to hospise care and private nursing went through her
money and some of mine. Eventually she was forced to go onto medicaid, fighting
to keep her home, an apartment in NYCity, and keep going. Once you go on
medicaid you find another world of denial poised to defeat you at every turn.
Medicaid officials are scarce, hard to find, to deal with, and paid poorly. It was an
experience I will never forget or forgive - the way my sister was treated was cruel
and inexcuseable. We need healthcare Richard that really cares for sick people
who deserve a lot better than my sister got. Try some compassion in your pronouncements - it will do your heart good.
89
It's mind-boggling how Richard can turn an extremely convincing article about the little-known innovations demanded by the ACA and build a smokescreen around the facts, hung on a quote from the Washington Times (take note, folks, that's not the Washington Post). To say that Medicaid is "like forcing people into the medical equivalent of public housing" is like saying that Doctors without Borders is like forcing people in tragic situations to accept life-saving treatment when they really should be left to die.
Ms. Rosenberg's article is another example of reporting that should be on the front page, not the opinion page or it should be made into a movie or a television special that interrupts your regular programming before the new Congress makes its next cowardly move to enrich the already rich.
Ms. Rosenberg's article is another example of reporting that should be on the front page, not the opinion page or it should be made into a movie or a television special that interrupts your regular programming before the new Congress makes its next cowardly move to enrich the already rich.
207
Those of us who support fundamental healthcare as a right for all citizens of the United States understand that those of you on the right don't like the ACA, Medicare or Medicare. It is indeed true that those programs are expensive, but conservatives continue to refuse to support the most cost effective, efficient healthcare system: single-payer universal healthcare. In the long run, that system would do more to bring costs down while providing healthcare for all. If you doubt that, just look at the healthcare costs of countries who have that system in some form compared to healthcare costs in the U.S. Your statement that the ACA "delivers a quality of care that is highly dubious" is not really supported by any facts that I'm aware of and ignores the major point that most people without the ACA would have no health insurance at all. If the Republican Congress is successful in repealing all or essential parts of the ACA, conservatives can declare victory and over 20 million people will again be without health insurance.
72