All this talk about ACA (Obamacare) and no one ever says how they would change it - UNTIL Friday's interview by New Yorker editor David Remnick with Dr. Atul Gawande. The GOP never has come up with a plan nor has the NYTs or anyone else. Gawande's ideas made a lot of sense to me and at least with him you have something to think/argue about. Give it a listen http://www.wnyc.org/story/episode-68-politics-oscars-and-doctors-eye-vie...
20
This analysis failed to address a huge advantage of the ACA: It provides -- especially for those who suffer from a chronic condition -- the freedom to switch jobs or try starting a business.
Before the ACA, and maybe again after the Trump Administration and Congress get through repealing or changing the law, many people felt trapped in their jobs, holding onto them only because they offered group health insurance that they absolutely couldn't afford to give up.
Before the ACA, and maybe again after the Trump Administration and Congress get through repealing or changing the law, many people felt trapped in their jobs, holding onto them only because they offered group health insurance that they absolutely couldn't afford to give up.
91
So two of the most visible failures -- you can't always keep your plan or your doctor -- are because of the actions of INSURERS.
And Obama should be held responsible for their actions because -- why? Because he trusted them? OK, that was stupid to ever trust an insurer.
But what could he have done? Nationalized the insurance industry?
Threatened them with a gun?
I mean that was the tradeoff that was made to get any legislation -- to make it private insurance based. (Of course hundreds of GOP legislators still call it a "government health plan," which is 100% wrong but they love the sound of it.)
And Obama should be held responsible for their actions because -- why? Because he trusted them? OK, that was stupid to ever trust an insurer.
But what could he have done? Nationalized the insurance industry?
Threatened them with a gun?
I mean that was the tradeoff that was made to get any legislation -- to make it private insurance based. (Of course hundreds of GOP legislators still call it a "government health plan," which is 100% wrong but they love the sound of it.)
114
Lots of incorrect statements in this article, but presented as if they were facts. And lots of important missing information.
First of all, that 20M figure is so bogus. A "huge" percentage of those 20M were people who just enrolled in Medicaid...and 70% of them enrolled under the traditional income limits, not the expanded Medicaid limit...and did so to avoid the penalty.
Income to the govt because of Obamacare comes from penalties on people who did not enroll...effectively something for absolutely nothing. Then there is the medical device tax. And tax on sold homes. Etc.
With "narrow networks," people don't easily find a doctor in all locations. That surely cuts down expenses to the govt. Medicaid reimbursement by the govt to doctors is so bad (often below office overhead) that 51% of doctors see no Medicaid patients, and others limit the number.
No mention was made of the high deductibles...often mentioned when validly criticizing the Obamacare bronze and silver plans..$6-12,000 a year, so that the family is really without medical insurance, except for catastrophic events.
Millions had to change their doctor. Millions saw their premiums increase...even 40-300% at first, with more yearly increases.
Businesses in huge numbers cut full time employees down to under 30 hours/wk so that they could avoid providing the health insurance, and created new part time positions to make up for the employee loss.
And Congress got around the law for themselves.
Obamacare is a disaster.
First of all, that 20M figure is so bogus. A "huge" percentage of those 20M were people who just enrolled in Medicaid...and 70% of them enrolled under the traditional income limits, not the expanded Medicaid limit...and did so to avoid the penalty.
Income to the govt because of Obamacare comes from penalties on people who did not enroll...effectively something for absolutely nothing. Then there is the medical device tax. And tax on sold homes. Etc.
With "narrow networks," people don't easily find a doctor in all locations. That surely cuts down expenses to the govt. Medicaid reimbursement by the govt to doctors is so bad (often below office overhead) that 51% of doctors see no Medicaid patients, and others limit the number.
No mention was made of the high deductibles...often mentioned when validly criticizing the Obamacare bronze and silver plans..$6-12,000 a year, so that the family is really without medical insurance, except for catastrophic events.
Millions had to change their doctor. Millions saw their premiums increase...even 40-300% at first, with more yearly increases.
Businesses in huge numbers cut full time employees down to under 30 hours/wk so that they could avoid providing the health insurance, and created new part time positions to make up for the employee loss.
And Congress got around the law for themselves.
Obamacare is a disaster.
28
Obamacare made healthcare what it should be for all and if it goes away it would be a defeat for those who got Obamacare and also those who had fegular insurance through their work place as well as those on Medicare. Healtcare is an univresal need. Anyone who thinks that they don't need it don't understand what that means. Unless they have an income over $10,000/day they will find themselves in grave trouble when the hospital and doctor bills come due. That is what an average cost per day in the hospital will cost you. Even for those with insurance, they better get a good look at their deductibles and overall coverage and copays to see if it is adequate. Moreover, they have to be sure that if their health status changes that they are insurable and won't be kicked off the insurance roll, particularly if it is not a group insurance. Our overall healthinsurance has been bolstered by Obamacare, it would be to no one's interest to be without the ACA. No one is immune to sickness or accidents!
27
The statement that in 2009 many Americans could not get health care is incorrect. Since 1986, when EMTALA was enacted, hospitals have been obligated to provide emergency and active labor treatment, regardless of the patient's ability to pay. Ask an executive of any large urban hospital about the amount of uncompensated care the hospital provided in 2009 or any other year since 1986, and you will see that Americans indeed have had access to health care.
4
Access to emergency health care, not regular or non-routine but non-emergency health care. This was where Romney looked totally defenseless in the 2012 debates: "just go to the emergency room." "But what if I have a condition that is not an emergency and can't and shouldn't be treated at an ER?" *crickets*
54
Media has done a poor job comparing plans on the exchange to those that employees of small to medium size businesses have. It is not correct to compare a big corporate employer with lots of white collar and tech jobs. Those are more generous.
Instead please look at small to midsize companies or
Corporations in service industry. These employ 80% of the workforce. They have similar high individual and family deductibles and high out of pocket. Coinsurance of 70 to 80% until high out of pocket reached. Exchange plans are priced by actuaries to have costs and coverage similar to smaller employer plans.
People should not criticize the exchange plans in isolation. A majority of workers have similar plans through their work and most often have only one plan offered
I see so much criticism of exchange plans that suggests that they should (by inference) should cost less and have lower premiums than the comparable plans offered by most employers.
In addition exchange coverage comes with premium reductions for most of the people who buy it. Similarly, employed have substantial (pretax) dollars taken out of pay to cover premium.
I am recently retired but was a top managed care executive for a major non profit hospital system. I can confidently say that this important perspective is missed by almost all media and commenters.
Those of us inside hospital managed care know that single payer like Medicare is lowest cost, highest measured quality, and biggest networks of providers.
Instead please look at small to midsize companies or
Corporations in service industry. These employ 80% of the workforce. They have similar high individual and family deductibles and high out of pocket. Coinsurance of 70 to 80% until high out of pocket reached. Exchange plans are priced by actuaries to have costs and coverage similar to smaller employer plans.
People should not criticize the exchange plans in isolation. A majority of workers have similar plans through their work and most often have only one plan offered
I see so much criticism of exchange plans that suggests that they should (by inference) should cost less and have lower premiums than the comparable plans offered by most employers.
In addition exchange coverage comes with premium reductions for most of the people who buy it. Similarly, employed have substantial (pretax) dollars taken out of pay to cover premium.
I am recently retired but was a top managed care executive for a major non profit hospital system. I can confidently say that this important perspective is missed by almost all media and commenters.
Those of us inside hospital managed care know that single payer like Medicare is lowest cost, highest measured quality, and biggest networks of providers.
43
What it didn't do is make it easier for Americans to receive the care they need rather than the care they can afford. It didn't simplify things for patients. We still have to worry about the bait and switch techniques being used by the health insurance companies when it comes to formularies, doctors, hospitals, and other health care providers. It's an outright lie to tell us that a long term relation with our primary physician is important and then drop the physician from the plan or drive him to drop out of it.
If the plans were set up logically we'd have coverage no matter where we were when we needed to get health care. We'd pay premiums, not premiums, deductibles, co-pays, out of network costs, etc. And every health care provider would be in network, all of them. They could have their concierge practice on the side but they'd still accept insurance. We'd also do away with employer based health insurance. No one should have to go without health care because they don't have a job and cannot afford the premiums. Better yet, we could have a system where the government deducts the money based upon our income, all our income not just the first 115K or whatever the current Social Security limit is.
Will this happen? No. Why? Because all our politicians are too dependent upon the good will of big business to bother drawing up a logical, reasonable, and feasible health care system that would serve ALL Americans.
If the plans were set up logically we'd have coverage no matter where we were when we needed to get health care. We'd pay premiums, not premiums, deductibles, co-pays, out of network costs, etc. And every health care provider would be in network, all of them. They could have their concierge practice on the side but they'd still accept insurance. We'd also do away with employer based health insurance. No one should have to go without health care because they don't have a job and cannot afford the premiums. Better yet, we could have a system where the government deducts the money based upon our income, all our income not just the first 115K or whatever the current Social Security limit is.
Will this happen? No. Why? Because all our politicians are too dependent upon the good will of big business to bother drawing up a logical, reasonable, and feasible health care system that would serve ALL Americans.
34
"But prices shot up this year, causing financial shocks for buyers who don't receive government help in paying their premiums."
That must have pushed more than a few Obama voters into the Trump camp (some by way of the Sanders camp?) in time for this election.
That must have pushed more than a few Obama voters into the Trump camp (some by way of the Sanders camp?) in time for this election.
11
My employer does not offer health insurance, so I'm forced to buy it on my own. As someone who has a medical history, I'd be toast without the ACA. I'd also pay more because I'm a woman since pre-ACA, insurers charged women more.
I agree that the law isn't perfect, particularly with the difficulty in finding a plan since the insurance companies have increasingly dropped out or limited their plans. I used to be able to find a PPO. This year, there are no PPOs in my area. I bought an HMO plan with considerably higher premiums than I paid last year for the PPO, as well as greater cost-sharing and higher deductibles. It isn't great, but at least I can still be covered for an ongoing medical history. If Trump has his way, that will no longer be the case.
The people who criticize the ACA the most are lucky. They seem to have no medical history; get group plans through their workplaces, which are historically more generous and less expensive than plans on the individual market; and they don't have loved ones or family members who have had a serious illness that requires ongoing monitoring. Their employers also often contribute to their health insurance costs as a workplace benefit.
Before you tramp all over the ACA, please consider others who aren't so lucky. Walk a mile in their shoes and then talk to me about repealing/repairing the ACA.
I agree that the law isn't perfect, particularly with the difficulty in finding a plan since the insurance companies have increasingly dropped out or limited their plans. I used to be able to find a PPO. This year, there are no PPOs in my area. I bought an HMO plan with considerably higher premiums than I paid last year for the PPO, as well as greater cost-sharing and higher deductibles. It isn't great, but at least I can still be covered for an ongoing medical history. If Trump has his way, that will no longer be the case.
The people who criticize the ACA the most are lucky. They seem to have no medical history; get group plans through their workplaces, which are historically more generous and less expensive than plans on the individual market; and they don't have loved ones or family members who have had a serious illness that requires ongoing monitoring. Their employers also often contribute to their health insurance costs as a workplace benefit.
Before you tramp all over the ACA, please consider others who aren't so lucky. Walk a mile in their shoes and then talk to me about repealing/repairing the ACA.
63
I am surprised by the comment regarding national spending on health care. The vast majority of states are struggling with large budget deficits driven in large part by the surge in medicaid costs. Hardly the promise of helping to reduce health care costs that was central to the argument to pass the Affordable Care Act.
5
Those are states that refused to be part of the Medicaid program in the ACA. Their GOP governors said they'd rather suffer and have their citizens suffer than be part of the Obama program.
Sorry cn't feel too sorry for them.
Sorry cn't feel too sorry for them.
53
At this point in time, when so many pieces are moving, it makes sense to grade programs that are already in place like Obamacare. But I'm not seeing a great deal of coverage of the grades that America's education system is getting and, in light of the most recent election, I think that's problematic. If people are so uninformed, so lacking in critical thinking skills, that they believe propaganda without questioning it, then you're in real trouble. And that issue rests squarely on the education, which consistently scores far below those in other industrialized countries. I think this is where you need to start placing an emphasis; an ignorant electorate and, worse yet, Executive spell disaster for a "democracy".
7
I really would like to see these costs broken out in terms of insurance costs, deductibles, co- payments,out of pocket amounts and then actual care cost amounts charged, amounts negotiated...
that would give us apples to apples comparisons.
Simply showing covered bodies or saying re-admissions are reduced isn't enough to perform critical analysis that shows what the result is.
that would give us apples to apples comparisons.
Simply showing covered bodies or saying re-admissions are reduced isn't enough to perform critical analysis that shows what the result is.
8
America does not have a health care problem. It has a values problem. As long as health care system is viewed as an after-thought to life, it will remain an employment category that allows the already super-rich medical industrial complex to continue to be super-rich. If we ran our roads, electricity and sewer and water systems like we run our "health care" system, we'd all be walking home after work on goat paths to dark houses with a privy in the back yard. America has a values problem. We put money over EVERYTHING. Unless and until we admit that we have an addiction to money, rehabilitation of our core values will elude us. Winston Churchill once said that "America can always be trusted to do the right thing - but not before trying EVERYTHING ELSE." However, due to the increasing severity to our money addiction, it is harder and harder for Americans to recognize the obvious. We have regulations that make certain vital services affordable - roads, sewer, water, police, fire and national defense. But today it seems that our "national minimums" exist only in so far as it makes it possible to make the already obscenely rich even richer.
50
I owned a small business for many years. We always covered our employees with private medical insurance. However, before the ACHA our carrier, Aetna, pulled out of the small market business in Michigan, leaving us with a carrier of last resort, Blue Cross, due to a medical condition with one employee. Our rates went up over 60% that year.
The ACHA was nothing but positive for our business and employees - our rate initially came down significantly, increases moderated (in one year the rate actually went down), one employee could still be covered by his parents' plan and we frequently received rebates since Blue Cross was not spending 80% of premiums on health care.
The ACHA
The ACHA was nothing but positive for our business and employees - our rate initially came down significantly, increases moderated (in one year the rate actually went down), one employee could still be covered by his parents' plan and we frequently received rebates since Blue Cross was not spending 80% of premiums on health care.
The ACHA
27
FRED: "Real personal consumption expenditures: Services: Health care" Chart shows real costs decelerating from 2001 to 2013. Then real costs accelerating through October 2016. Today inflation adjusted costs are about $1.984 Trillion/year and increasing at an annual rate of 3.74%. For cost to be affordable the rate of health cost should be less than GDP which is about 2% annually. We must work together to reduce costs.
https://fred.stlouisfed.org/graph/?g=cCj6
https://fred.stlouisfed.org/graph/?g=cCj6
On balance, Obamacare has achieved more positive than negative results. The problems seem to reside in the program elements that political compromise in 2010 or obstruction since then have short-circuited. Administration, from the national to the individual levels, remain a nightmare. The only way to resolve the impasse would seem to be a single payer system or at least a robust public option.
At no time, however, was a GOP ever going to work constructively on behalf of constituent health to improve the cost and provision of care across the population. Partisan tactics were consistently more important than this. No opportunity to whittle away at the ACA's viability was ever missed.
The notion that Republicans were deliberately blocked out of participation in the program's original design is pure myth. The GOP played a shell game with consultation solely to allow time to gin up public outrage over the ACA. With its super-loud, well, oiled and heavily financed megaphone of doom, combined with the Obama Administration's tepid defense of its own creation, the GOP now owns the levers to undo the imperfect progress made since 2010.
www.endthemadnessnow.org
At no time, however, was a GOP ever going to work constructively on behalf of constituent health to improve the cost and provision of care across the population. Partisan tactics were consistently more important than this. No opportunity to whittle away at the ACA's viability was ever missed.
The notion that Republicans were deliberately blocked out of participation in the program's original design is pure myth. The GOP played a shell game with consultation solely to allow time to gin up public outrage over the ACA. With its super-loud, well, oiled and heavily financed megaphone of doom, combined with the Obama Administration's tepid defense of its own creation, the GOP now owns the levers to undo the imperfect progress made since 2010.
www.endthemadnessnow.org
20
Two factors that the critics seem to overlook: 1) Prior to the ACA those without insurance either did without timely medical care, or obtained it from the far more costly Emergency Room route, and 2) so many of the ACA's shortcomings were due to costly compromises the bill had to make to win approval.
Improve rather than Replace is much the better course.
Improve rather than Replace is much the better course.
28
What compromises? Every Democrat in the House and Senate voted for it. Every Republican voted against it. When Obama did his dog and pony show for TV and John McCain tried to present the Republican side, Obama snottily said, "The election's over, John." Further, the bill was stuffed down our throats by Democrat lawmakers who did not listen to the objections of those citizens whom they were elected to represent. And there was no meaningful discussion, as Nancy Pelosi (in)famously said they had to pass the bill to see what was in it.
7
Helping more people pay for outrageously priced health care is a success. Failing to make an attempt at changing outrageously priced health care to value-added health care is a failure.
16
The ACA doesn't mean you can afford to see a DR. unless you are poor. As Individual insured have to meet ridiculous co-pays while maintaining premiums. So You spend $7,265.00 out of pocket for premiums (year). You get a sore throat, $250.00 to see a primary care Dr and pay until you meet the $2,500 deductible, then you get 80% coverage. Trying to stay healthy in this country costs are unattainable. Trump wants to make it worse. Individual insurance is a low priority.
8
I live in a very wealthy part of the country,I got to an internist who takes NO insurance. She charges $145 for an office visit. If you are really paying $250 (and not making this up) you are nuts.
5
Very weak article, I felt. Necessary, however, to wipe away all the shouting about Obamacare / Affordable Care Act's efficacy, or for some its governmental subversion of a) individual choice b) unfettered marketplace finding the "best" solution c) states' own rights trumping federal overpowering of 'proper' Constitutional powers stipulation.
To sum it up, according to me — NOT ENOUGH INFORMATION YET TO ANSWER THE BIG QUESTIONS. I mean, “Duh”. How could a sweeping change, despite the comparatively minor degree of wholistic universal healthcare insurance PLUS solving America’s runaway costs of providing health care versus other nations’ far better outcomes – of national health, increased PERSONALIZED care, more freedoms of some choice & standardized framework of choices, etc.
AND NOTE: I never seem to see Obamacare haters mention the fact that, for the moderately to obscenely rich, as before AND during AND after repeal/replacement they can spend what they want & where they want anyplace in the world of commerce.
To sum it up, according to me — NOT ENOUGH INFORMATION YET TO ANSWER THE BIG QUESTIONS. I mean, “Duh”. How could a sweeping change, despite the comparatively minor degree of wholistic universal healthcare insurance PLUS solving America’s runaway costs of providing health care versus other nations’ far better outcomes – of national health, increased PERSONALIZED care, more freedoms of some choice & standardized framework of choices, etc.
AND NOTE: I never seem to see Obamacare haters mention the fact that, for the moderately to obscenely rich, as before AND during AND after repeal/replacement they can spend what they want & where they want anyplace in the world of commerce.
4
I have to say that I was puzzled by the Obamacare failures - until very recently, when I finally managed to dig through the medical spending numbers.
Truth is, prior to Obamacare introduction US health system was very unequal in terms of total healthcare spending: prior to Obamacare's introduction, on average US spent a lot more on adults on Medicaid than total spending (not just government) on adults on Medicare or for adults in private insurance.
As a result, the biggest problem with Obamacare was that it created a common pool between heavily subsidized adults and unsubsidized adults; as a result, the premiums for unsubsidized adults shot up far more than their own spending would imply.
Romneycare did a substantially different maneuver, where it essentially provided subsidized insurance for people up to 300% of poverty line through Medicaid channels, and provided regulated insurance for people who didn't qualify. But it didn't try to cram in stealth subsidy for people on already subsidized insurance plans by putting them in the common pool with self-purchased individuals - which is what poisoned Obamacare pools in the first place, and caused Obamacare premiums with already sky high deductables to get more expensive than group insurance plans.
Truth is, prior to Obamacare introduction US health system was very unequal in terms of total healthcare spending: prior to Obamacare's introduction, on average US spent a lot more on adults on Medicaid than total spending (not just government) on adults on Medicare or for adults in private insurance.
As a result, the biggest problem with Obamacare was that it created a common pool between heavily subsidized adults and unsubsidized adults; as a result, the premiums for unsubsidized adults shot up far more than their own spending would imply.
Romneycare did a substantially different maneuver, where it essentially provided subsidized insurance for people up to 300% of poverty line through Medicaid channels, and provided regulated insurance for people who didn't qualify. But it didn't try to cram in stealth subsidy for people on already subsidized insurance plans by putting them in the common pool with self-purchased individuals - which is what poisoned Obamacare pools in the first place, and caused Obamacare premiums with already sky high deductables to get more expensive than group insurance plans.
9
The Europeans, with simple and comprehensive health insurance, just shake their heads, laugh at us, and thank their lucky stars that they don't have to deal with Republicans when it comes to something as minor and insignificant as healthcare insurance.
One dismal note.
If Obama had not allowed Rahm Emanuel, Jim Messina, Max Baucus, and a couple other Whiz Kids to talk him out of the Public Option -- which he always had the voting muscle to put through -- Obamacare would now be the leading edge of Medicare for All, and even the Republicans could not trash it.
Even the Republicans' weaponized base of ignorant voters would be screaming:
"Keep the gummint's hands off my Obamacare!"
By the way, this article doesn't touch at all the positive effects PPACA had for Medicare, Medicaid, and even Employer Sponsored Insurance.
If Obamacare were repealed lock stock and barrel, as TOTUS would have it,
Granny Sarah would have to fork over $300-$400 or so for her Shingles shot, Prevenar-13 pneumonia shot, and flu shot; you and your kids would be paying more for you flu shots; and many women would still be disadvantaged monetarily relative to birth control.
While the Viagra for their Congressman was still covered under his taxpayer supported insurance.
And when you start charging for something, fewer people get it - in this case millions of people - and the health of the population as a whole suffers.
The medical industry, of course, makes more money treating unnecessary illnesses.
One dismal note.
If Obama had not allowed Rahm Emanuel, Jim Messina, Max Baucus, and a couple other Whiz Kids to talk him out of the Public Option -- which he always had the voting muscle to put through -- Obamacare would now be the leading edge of Medicare for All, and even the Republicans could not trash it.
Even the Republicans' weaponized base of ignorant voters would be screaming:
"Keep the gummint's hands off my Obamacare!"
By the way, this article doesn't touch at all the positive effects PPACA had for Medicare, Medicaid, and even Employer Sponsored Insurance.
If Obamacare were repealed lock stock and barrel, as TOTUS would have it,
Granny Sarah would have to fork over $300-$400 or so for her Shingles shot, Prevenar-13 pneumonia shot, and flu shot; you and your kids would be paying more for you flu shots; and many women would still be disadvantaged monetarily relative to birth control.
While the Viagra for their Congressman was still covered under his taxpayer supported insurance.
And when you start charging for something, fewer people get it - in this case millions of people - and the health of the population as a whole suffers.
The medical industry, of course, makes more money treating unnecessary illnesses.
12
Great article. Thank you.
It is a certainty that the ACA is not perfect. It is to be expected that there will be unintended consequences and pluses and minuses. Health care premiums seem to be a challenge for many people. The American health system is still too expensive, without sufficient emphasis on health maintenance and illness prevention, there remains a lot of inequity in the system. But, for the first time in history, there is a universal health care plan, accessible to the majority of citizens, in which there is the opportunity at least to study and learn how the 'system' affects the health of populations. For goodness, sake, let's work together to improve the existing system. Let's learn from what is working and fix what is not working.
Why repeal and replace?
Why not keep and improve?
This is how systems improve and evolve, and become more efficient over time.
It is a certainty that the ACA is not perfect. It is to be expected that there will be unintended consequences and pluses and minuses. Health care premiums seem to be a challenge for many people. The American health system is still too expensive, without sufficient emphasis on health maintenance and illness prevention, there remains a lot of inequity in the system. But, for the first time in history, there is a universal health care plan, accessible to the majority of citizens, in which there is the opportunity at least to study and learn how the 'system' affects the health of populations. For goodness, sake, let's work together to improve the existing system. Let's learn from what is working and fix what is not working.
Why repeal and replace?
Why not keep and improve?
This is how systems improve and evolve, and become more efficient over time.
12
I have a little secret to tell you, for those of you who don't work in healthcare: we cannot afford to provide everyone, of every income level, and every age, and every level of health, with healthcare from cradle to grave. We just can't. Not with a single payer, not with EMBI, not with Obamacare.
If we had completely free market healthcare, as in pay cash, we would likely be better off all around. We would have $50 doctor's visits. Not $500. We would have $10 epipens, not $800. We would have $1000 knee surgeries, not $40,000.
Nothing else will work. And there is no one, even Trump, who is going to ration healthcare for grannies. So we will continue to spend more on MDC, more on MDD, more for Obamacare subsidies. We will rocket past 20% GDP spending on healthcare. Salaries will remain stagnant, or will drop - since more of your salary and benefits will go towards HC premiums.
In my free market solution, the $10,000 per year your employer put into HC is yours to keep. Don't use it for 40 years of employment, and you have $400,000 to spend on a new hip when you're 70. Which would cost about $5,000 total. I work in HC, and I know what surgeries could be done for, and what implants cost.
If we had completely free market healthcare, as in pay cash, we would likely be better off all around. We would have $50 doctor's visits. Not $500. We would have $10 epipens, not $800. We would have $1000 knee surgeries, not $40,000.
Nothing else will work. And there is no one, even Trump, who is going to ration healthcare for grannies. So we will continue to spend more on MDC, more on MDD, more for Obamacare subsidies. We will rocket past 20% GDP spending on healthcare. Salaries will remain stagnant, or will drop - since more of your salary and benefits will go towards HC premiums.
In my free market solution, the $10,000 per year your employer put into HC is yours to keep. Don't use it for 40 years of employment, and you have $400,000 to spend on a new hip when you're 70. Which would cost about $5,000 total. I work in HC, and I know what surgeries could be done for, and what implants cost.
10
Do you mean to say that every other industrialized nation on earth can provide health care for all its citizens - but the United States of America, the richest nation ever known, cannot? Is that because Americans are "exceptional"?
28
Writing from Europe, I would argue that yes you can, like we do in all the European countries.
Your free market idea puts an extremely high risk on anybody who happens to have a grave accident, a severe diagnosis like cancer etc. That is the idea of any insurance: To pool the risks and cover those who are unfortunate.
Your free market idea puts an extremely high risk on anybody who happens to have a grave accident, a severe diagnosis like cancer etc. That is the idea of any insurance: To pool the risks and cover those who are unfortunate.
24
The sticking point is that single payer essentially makes every physician, PA, RN, etc. a government employee. Think about that.
5
If 20 million more people have health insurance, that's the end of discussion: IT WORKED!!
Another good discussion should be how to improve it after the experience of these years, not to destroy it and start from a vacuum again.
It is clear that the system was not working before the ACA as US was the country with the biggest expend on Health Care and still with 50 million uninsured. That was a shame.
Another good discussion should be how to improve it after the experience of these years, not to destroy it and start from a vacuum again.
It is clear that the system was not working before the ACA as US was the country with the biggest expend on Health Care and still with 50 million uninsured. That was a shame.
6
USA still spends more money on health care than any other nation. I know very few people who are not squeezed by the cost of for-profit healthcare. I can no longer afford my prescription meds, which have tripled!
1
The law has failed to meet any of the objectives that were set for it:
At best there are 12 million fewer insured then projected (20 million vs. 32 million)
It was to save $136 billion over 10 years but instead will cost close to $1.3 trillion.
Young people have not signed up as required to make the law economically sound.
The Accountable Care Organization (ACOs) concept has failed as 18 of the 23 Pioneers are out of business and several others are on the verge of closure.
Premiums are dramatically higher and deductibles and max-out-pocket are much higher.
Networks are narrower.
Plan choices are now very limited.
Yes it has decreased the uninsured rate, but at what cost to the country and the individual? Best estimate are 21 million have been insured. Of these almost 11 million are Medicaid based. Of the remaining 10 million who are paying, 4.5 million had insurance prior to ACA but their plans were non-compliant with the ACA (e.g. males needed pregnancy benefits). So the true newly insured is only about 5.5 million. And of the 10 or 11 million (depending on how you count) insured thru the exchange, 10 million get subsidies. If they didn’t; they won’t subscribe.
At best there are 12 million fewer insured then projected (20 million vs. 32 million)
It was to save $136 billion over 10 years but instead will cost close to $1.3 trillion.
Young people have not signed up as required to make the law economically sound.
The Accountable Care Organization (ACOs) concept has failed as 18 of the 23 Pioneers are out of business and several others are on the verge of closure.
Premiums are dramatically higher and deductibles and max-out-pocket are much higher.
Networks are narrower.
Plan choices are now very limited.
Yes it has decreased the uninsured rate, but at what cost to the country and the individual? Best estimate are 21 million have been insured. Of these almost 11 million are Medicaid based. Of the remaining 10 million who are paying, 4.5 million had insurance prior to ACA but their plans were non-compliant with the ACA (e.g. males needed pregnancy benefits). So the true newly insured is only about 5.5 million. And of the 10 or 11 million (depending on how you count) insured thru the exchange, 10 million get subsidies. If they didn’t; they won’t subscribe.
10
Ron, very well stated. Touting 20 million covered is ludicrous. Many in that 20M already had coverage as you said and almost all who had it now pay more. Critical point missed is that those who were already insured by their employer are now paying much more. My own out of pocket deductible has risen by $2000 since ACA. Now have to pay for every Dr. visit too where company insurance paid in the past. Cost me $6000 yearly plus the deductible vs. $4500.
3
Deliberately misleading. The rate of uninsured was cut in half by the ACA, and the 20 million are those who did not have insurance previously. The lower number who got insurance compared with initial projections come from two factors: 1) a greater number of individuals than forecast remained with their employer insurance policies, and 2) the original forecast did not foresee that cruel Republican legislators and governors would opt out of expanded medicaid for the people of their states.
So take those factors into account, and the ACA has been tremendous. Got a problem with it? Express your outrage to all of those governors who refused to give health care to their poorest residents.
So take those factors into account, and the ACA has been tremendous. Got a problem with it? Express your outrage to all of those governors who refused to give health care to their poorest residents.
15
Unfortunately, the Affordable Care Act (known colloquially as Obamacare) has not provided anything resembling affordable health care since it has failed to curtail or roll back the ridiculously high cost of medical care. It is still not uncommon to be billed $350 for a two minute consultation with a dermatologist or $11,000 for a CAT scan. Although, I applaud the fact that as a result of the ACA 20 million additional individuals have some sort of health care, America cannot afford to continually pay 17% of GDP (three trillion dollars last year) without dire economic and social consequences.
8
It is difficult to evaluate a system which the majority party spent all its time sabotaging. Clearly, a single payer plan would have been better, but the Repubs wouldn't even agree to the public option. The fact that 20 million people benefit from it is a huge plus. Even more would benefit from it if Repub governors expanded Medicaid as the law intended them to, but were exempted from it by the SC (with Kagan and Breyer joining the conservative justices in allowing them to do so). Additionally, let's not forget all these people who had health insurance, but suffered from pre-existing condition rules and lifetime caps and exclusion of children over a certain age. The ACA improved lots of people's lives, but is not given enough credit for it. All social welfare programs need to be tweaked after passage -- certainly Social Security was. We're back to Repub intransigence which denigrated the program and the president and refused to improve it in any way, hoping it would fail.
10
The limit on lifetime and annual caps on medical expense payment by insurers has saved people from medical bankruptcy. This is a very big change from previous experience and offers serious protection to the middle class.
The requirement that insurers must pay out at least 80% of premiums in benefits or pay a rebate to consumers has increased insurance companies' efficiency.
The requirement that insurers must pay out at least 80% of premiums in benefits or pay a rebate to consumers has increased insurance companies' efficiency.
5
Unfortunately, health care is very much about money. The basic function of Obamacare was to throw barrels of money - our money - at all segments of the health care system. It would have been far more efficient and cost-effective to give the money directly to the people without insurance (and some with inadequate plans) and let them figure it out on their own. This, of course, glosses over the opaque and wildly distorted economics of the health care system. Some day someone will figure out how to make the health care industry like other industries, with real competition, some relationship between costs and prices, and real measures of quality. Until then the system will continue to be dysfunctional.
5
two points 1) there are subsidies in the ACA, and money is given "directly to people without insurance" to help them purchase insurance on the marketplace. and 2) we are the only western country where healthcare is an industry, and asking for "real competition" means that the most expensive to insure will not have access to insurance or healthcare.
9
great article
1
One could argue that it is not so much a question of many of the solutions lying in a Single Payer System...which they would,
Whilst continuing rising costs, coverage limitations and millions uninsured continue to be a direct consequence and result of the many problems caused by Multi Taker System.
Single Payer or Many Taker?
The answer is obvious as shown by the many countries that do so well for all their Citizens on their Single Payer Systems that costs them less.
Just as an answer of some sort is given by the fact that only one Country employs a Many Taker System which continues to fail so many Citizens that costs them more.
As often and consistently seen and proven unequivocally for decades:
http://www.commonwealthfund.org/publications/fund- . reports/2014/jun/mirror-mirror
To continue to avoid and deny the facts and evidence and refuse to acknowledge that a Many Taker System hurts and denies so many by not Giving enough to all those who in so many ways and by such means, Pay too high a price at too much of a cost to what's taken.
Whilst continuing rising costs, coverage limitations and millions uninsured continue to be a direct consequence and result of the many problems caused by Multi Taker System.
Single Payer or Many Taker?
The answer is obvious as shown by the many countries that do so well for all their Citizens on their Single Payer Systems that costs them less.
Just as an answer of some sort is given by the fact that only one Country employs a Many Taker System which continues to fail so many Citizens that costs them more.
As often and consistently seen and proven unequivocally for decades:
http://www.commonwealthfund.org/publications/fund- . reports/2014/jun/mirror-mirror
To continue to avoid and deny the facts and evidence and refuse to acknowledge that a Many Taker System hurts and denies so many by not Giving enough to all those who in so many ways and by such means, Pay too high a price at too much of a cost to what's taken.
6
Just did my tax return, had to change jobs mid-year. Live in high cost city and have debts to pay off. Put in obamacare 1095-A and I went from getting money to owing $455.
Nice! Maybe I should go out there and just get sick on purpose so I can use my insurance, because it doesn't sure as hell seem like the high premiums I'm paying is for me. Or maybe I should just work 1-2 shifts and be below the poverty line, because lord help you if you want to step up earnings little by little and getting slotted into a bracket.
Nice! Maybe I should go out there and just get sick on purpose so I can use my insurance, because it doesn't sure as hell seem like the high premiums I'm paying is for me. Or maybe I should just work 1-2 shifts and be below the poverty line, because lord help you if you want to step up earnings little by little and getting slotted into a bracket.
8
I see it as a bailout to the healthcare industry, not as a solution. It gave hospitals and large healthcare groups a second breath going into the 2008 Great Recession. Without this, hospitals would have to shut down, lay-offs would be rampant. This is more particularly so for the white-collar, management and administrative jobs, because going into the 2008 the healthcare industry was heavily organized as managed care groups that were so contingent on the economy doing well. Healthcare under managed care was not organized as a social safety net when the economy failed.
There is an ethical issue here. Yes, the administration also bailed out Wall Streets. However, if you loose your house, you can still go live with your brothers or sisters, eventually work your way back whenever the economic regain its growth.
With healthcare, you don't have that luxury. You can die. You can't just say, "oops, my bad, let's start over." You can permanent ruin the pillars for others if you don't get it right, and you don't have a choice here. Elizabeth Warren was wrong during the hearing - no, healthcare is not "about money." It is very much a black or white, either you do it or you don't.
The risk of not succeeding in healthcare policy is too high, a political suicide if so. Everyone already had their hands in the cookie jar on this one, but two things won't go away soon: 1) diseases, 2) people living longer with more chronic conditions. It's an ethical decision, not a financial one.
There is an ethical issue here. Yes, the administration also bailed out Wall Streets. However, if you loose your house, you can still go live with your brothers or sisters, eventually work your way back whenever the economic regain its growth.
With healthcare, you don't have that luxury. You can die. You can't just say, "oops, my bad, let's start over." You can permanent ruin the pillars for others if you don't get it right, and you don't have a choice here. Elizabeth Warren was wrong during the hearing - no, healthcare is not "about money." It is very much a black or white, either you do it or you don't.
The risk of not succeeding in healthcare policy is too high, a political suicide if so. Everyone already had their hands in the cookie jar on this one, but two things won't go away soon: 1) diseases, 2) people living longer with more chronic conditions. It's an ethical decision, not a financial one.
7
Insurance is not health care; the cost of insurance is not the cost of health care.
The cost of health care is redistributed by insurance, across persons and over time. The ACA also had provisions meant to affect the total cost of health care, which the article mentions in a paragraph.
The cost of insurance is the insurers' overheads and profit, and the time and hassle costs for the providers and the insured. Possibly the time and hassle costs are the bigger number: does anyone measure them and how they are changing?
Obamacare as passed has been sabotaged in implementation and in any case is still in transition to what it will be with full information about pools, procedures, and so forth. Evaluating it is hard: are you evaluating the impact of the law or of the sabotage? Of the bridge when half built or of the whole bridge?
The cost of health care is redistributed by insurance, across persons and over time. The ACA also had provisions meant to affect the total cost of health care, which the article mentions in a paragraph.
The cost of insurance is the insurers' overheads and profit, and the time and hassle costs for the providers and the insured. Possibly the time and hassle costs are the bigger number: does anyone measure them and how they are changing?
Obamacare as passed has been sabotaged in implementation and in any case is still in transition to what it will be with full information about pools, procedures, and so forth. Evaluating it is hard: are you evaluating the impact of the law or of the sabotage? Of the bridge when half built or of the whole bridge?
8
As Dean Baker points out, the Affordable Care Act "allowed millions of people to work part-time rather than full-time . . . .Margot Katz-Sanger left this point out of her scorecard on Obamacare. Since people are now able to get inursance through the exchanges, they are no longer dependent on getting it from their employer, which usually means working a full-time job. As a result, the number of people choosing to work part-time has risen by more than 2 million since the law went into effect. The people benefiiting have disproportionately been young parents and elder workers who are too young to qualify for Medicare."
http://cepr.net/blogs/beat-the-press/affordable-care-act-allowed-million...
5
And what of the increase in part time positions in an attempt to evade the requirement to provide coverage for full time work? "Choosing to work part-time" is nor the same thing, many want the full time work and can't get it.
4
We need single payer, universal healthcare. Cut out the Insurance companies. Reduce drug prices.
14
As I understood it, the increased costs of healthcare forced companies to drop full-time positions thereby saving them the expense of healthcare benefits.
5
The Insane Clown Posse of "Don the Con", "Flakey Flynn", "Bonehead Bannon", "Crackpot Conway" and the other self dealing and self aggrandizing members of the inner circle are well on their way to destroying America, our great institutions and values, and fleecing the public-all under the patriotic guise of making us safe and prosperous.
In just 2 weeks "Don the Con" has managed to introduce the worst cabinet selections, transition, policy promulgation, relations with allies and enemies, military excursions, public distrust, and approval ratings in our Nations great history. With all the chaos and anxiety it's hard to believe it's been just 2 weeks since the "Insane Clown Posse" took over. If this is an example of his forte, "business acumen", we're in for a long 4 years.
The public must be encouraged and educated on the issues so they can rise up with consistent and sustained actions: contacting government representatives, boycotting products and services from companies and states aligned with the "Insane Clown Posse", effectively and actively protesting, and organizing votes against Republicans at all levels of government beginning in 2018.
Our democracy and freedom are durable but not unbreakable.
In just 2 weeks "Don the Con" has managed to introduce the worst cabinet selections, transition, policy promulgation, relations with allies and enemies, military excursions, public distrust, and approval ratings in our Nations great history. With all the chaos and anxiety it's hard to believe it's been just 2 weeks since the "Insane Clown Posse" took over. If this is an example of his forte, "business acumen", we're in for a long 4 years.
The public must be encouraged and educated on the issues so they can rise up with consistent and sustained actions: contacting government representatives, boycotting products and services from companies and states aligned with the "Insane Clown Posse", effectively and actively protesting, and organizing votes against Republicans at all levels of government beginning in 2018.
Our democracy and freedom are durable but not unbreakable.
11
For America there is no question that it's Healthcare Insurance system hasn't been rewarding and profitable for many. The ACA, despite some bumps on the road, has broadly been seen by many to continue the process that many in America have continued to benefit and ensuring that they have continued to profit from the system and that for some, in many new areas of opportunity provided even more success than they could have hope for.
Despite such positive gains and better outcomes for those who continue to benefit from the Healthcare System, there remains just a single downside that few talk about given the overall positive results they continue to enjoy.
Until those who have and continue to profit so much and so well from the current successful system decide to change things for...
The Majority of Citizens who are Uninsured, Overcharged, Bankrupted, Held to Ransom, Unfairly Treated, Not Treated, Forgotten, Avoided, Die from Conditions that were Preventable , Left to Chance, Unhelped, Not seen, Not Heard, Not Cared For...
But it seems Today is never the day for such things...and Tomorrow never comes, perhaps some other Time...
Despite such positive gains and better outcomes for those who continue to benefit from the Healthcare System, there remains just a single downside that few talk about given the overall positive results they continue to enjoy.
Until those who have and continue to profit so much and so well from the current successful system decide to change things for...
The Majority of Citizens who are Uninsured, Overcharged, Bankrupted, Held to Ransom, Unfairly Treated, Not Treated, Forgotten, Avoided, Die from Conditions that were Preventable , Left to Chance, Unhelped, Not seen, Not Heard, Not Cared For...
But it seems Today is never the day for such things...and Tomorrow never comes, perhaps some other Time...
5
Most of the Failures are described relative to an ideal health system as opposed to the status quo before the law. The pre-law status quo is actually the relevant comparison.
14
The biggest problems were that drug price should be negotiated, especially with Medicare and Medicaid. The out of control prices of drugs, and medical devices is a major problem. We should include language that we will pay no more than the 5 top countries with Healthcare; Canada, Norway, German, Great Britain, Swiss or a similar configuration.)
The narrow networks do not work! They are absurd. While you can offer a true HMO like Kaiser. These made up Narrow networks that doctor friends of mine tell me they don't have any control whether they are in the network or not. They have applied, they never get a response, never get an opportunity to submit or respond to fees they would accept. Others are shocked to hear they are in the network they never applied.
Then the deductibles even for a family that makes $100,000 per year any deductible over $1000 per year for the entire family is too much it doesn't fit, in the budget. Most people want to be able to choose whether or not to have $0 deductible platinum, $250 deductible Gold, $500 deductible Silver or $1,000 deductible Bronze. If you have a $5,000 deductible then you need to have mandatory HSA's of at least 75% of that amount. Those large deductible plans really only work for about 1% of the population.
Then the biggest problem was the mandate wasn't large enough. Only $795 this year or 2% of your income when plans cost over 10% of income. Then there were too many exceptions.
The narrow networks do not work! They are absurd. While you can offer a true HMO like Kaiser. These made up Narrow networks that doctor friends of mine tell me they don't have any control whether they are in the network or not. They have applied, they never get a response, never get an opportunity to submit or respond to fees they would accept. Others are shocked to hear they are in the network they never applied.
Then the deductibles even for a family that makes $100,000 per year any deductible over $1000 per year for the entire family is too much it doesn't fit, in the budget. Most people want to be able to choose whether or not to have $0 deductible platinum, $250 deductible Gold, $500 deductible Silver or $1,000 deductible Bronze. If you have a $5,000 deductible then you need to have mandatory HSA's of at least 75% of that amount. Those large deductible plans really only work for about 1% of the population.
Then the biggest problem was the mandate wasn't large enough. Only $795 this year or 2% of your income when plans cost over 10% of income. Then there were too many exceptions.
12
It's really irrelevant whether Obamacare worked or not. It will go down in history as a failure. Obama's deciding not to work with Republicans in crafting a law that had more broad based support ensured it's fall and, thus, the destruction of the main part of Obama's legacy. Arrogance and incompetence combined to bring on nemesis.
5
The republicans wanted Obama to fail and they refused to work with him under any circumstances. You are wrong to blame Obama
24
first, rhetoric isn't analysis. second recall that the Affordable Care Act was modeled on the same principles that the conservative Heritage Foundation developed and was widely promoted by Republicans in the 1990s in response to the Clinton administration's proposed Health Care reform. Coincidentally is the same plan adopted by Massachusetts when Mitt Romney was the governor. by all reports it is functioning just fine there.
15
There's a saying in business that applies here. Low cost, broad access or high quality - pick 2. You can't have all 3. The ACA tackled quality in an attempt to improve cost and outcomes. It enriched coverage for those who have it. Made coverage more affordable for the bottom 2 quintiles. But anyone who had to buy their own insurance and made too much for a subsidy took it in the shorts. For them, the ACA was a huge problem. They couldn't buy the coverage they wanted and they had to pay too much. Healthy people could game the system and stay out of the risk pool. That jacked up rates for others. That could have been fixed with tax credits too, if the parties could have worked together. But costs will continue up to sabotage further efforts because of rampant capitalism. To get European drug prices, we'll have to regulate.
7
The New York State Health Care Exchange worked very well for those who make slightly more money than would make them eligible for expanded Medicaid, and put them on subsidized plans. My niece, who is single and makes $22,000 annually, pays $20 per month on a subsidized plan. She is 35 years old and has several serious pre-existing conditions. The plan she has is solid; she pays a co-pay when she visits a doctor and a small co-pay when she has to get a prescription. Even the $20 monthly fee is sometimes a stretch, because she has to maintain a car in order to maintain a job, and that's not cheap. But she's been plugging away. Without the ACA, she would be going to the emergency room and receiving uncompensated care, or she would essentially be indebted to the hospitals for the rest of her life. At least with this she has a chance. New York's exchange could be a role model for other states, especially those Republican states that decided not to establish their own exchanges because their governors disliked "Obamacare" so much. Good for Governor John Kasich of Ohio for bucking that trend and setting up an exchange for the citizens of Ohio. Does the ACA need improvement? Of course. The insurance companies and their lobbyists had way too much input into writing the law. "Repealing" the law to punish President Obama because Republicans hate him so much punishes the nation at large. Is governing for the people our goal? Or is self-aggrandizement for Republicans what we're after?
16
Yeah, but what if she were making $55K a year, and had to pay $1200 a month with a $7000 deductible? I guess she'd be riding a bike to work....
10
It would be a miracle for her to make that kind of money. She has learning disabilities and several physical problems (she needs a knee and hip replacement at the age of 35). Care has been a godsend for her through the New York State exchange. Otherwise, she would be in the ER every other week at complete taxpayer expense and might be on full-blown welfare, food stamps and other public support. She's able to work because she has health care. We are thankful for thank.
5
PPACA had three tenets. Accessibility, Cost and Quality. How can anyone believe that any of these have been met effectively. Sure, there are millions who are insured that weren't. And there are those great stories of those who would have lost everything had they not had insurance. But for everyone who has been "saved" there is someone who lost their insurance (the great lie) because indeed you couldn't keep your insurance or your doctor. And because of the non preexisting and other costs the plans that are left are all high deductible catastrophic plans. Maybe in some ways thats the best thing we can have. Consumers then have to use their medical savings accounts or out of pocket and that restores the physician patient relationship and eliminates the middleman insurance policy. Moreover, preventive health care at least in the uninsured cohort is a farce, it doesn't do anything of real value - the Oregon Medicaid experiment pretty well demonstrated that even when identified treatment was not successful in helping blood pressure or diabetic blood sugar control. That's pretty damning - it did however make people feel better perhaps because they knew they were covered in the event of a serious illness. Indeed the author cites an article that suggests eliminating the routine physical makes the most sense. All we need is to establish a point of service has available when we do have health care needs. One positive, it is a feel good for social justice.
1
If Republicans had allowed a single payer system, required all to purchase health insurance (rather than pay a modest penalty) and allowed Medicare to negotiate drug prices we might be having a very different discussion. As previously noted, the system needs revision and not repeal. It is lovely that the party which never did much to implement a national plan is now, because of a non-traditional Republican President, pressured to provide healthcare access for everyone, to a better healthcare system, for less money and with lower deductibles. Good luck. It will happen when Mexico pays for the wall and President Trump releases his tax returns.
9
Had allowed? democrats own every word of it.
7
How do they own a single payer system which was rejected? How do they own the paltry penalty which was a negotiated amount? Do you remember who cried about the government interfering with private enterprise when the Dems wanted to negotiate with the drug companies for price? What the Dems own is getting the conversation about providing healthcare universally to new level that seemed to elude Republican administrations.
5
Nice article. I would call the presentation very balanced.
When we compare the U.S. to the rest of the developed world, we're still a basket case. In the rest of the developed world: universal access everywhere, low cost or free to individuals, similar life expectancy to ours, about half the total cost in terms of GDP. (We were substantially more of a basket case pre ObamaCare, due to worse access problems, in my opinion. We'd be a bit less of a basket case if 19 Republican states extended Medicaid.)
Compared to say the UK: one in eleven people in the economy works to support the EXCESS resource we use over the UK (about 9% vs 18% of GDP) for similar life expectancies. That's about $5000 per person per year ($12,500 for an average household of 2.5) for the EXCESS. And they have 0 medical bankruptcies, and people don't have to second guess going to an emergency room, if symptoms of a possible stroke or heart attack appear, for fear of going bankrupt, or fear of the whole thing turning into a pre-existing-condition. (Pre-existing condition screening returns in the recently announced by Paul Ryan Republican "replace".)
(Credit to Bill Gates on Charlie Rose, as I've copied much of his description the performance of our health care system.)
OK, Republicans. Ball's in your court. If Ryan's version of the coming plan is your replace, then I think we're sunk.
But otherwise: focus, focus, focus. Maybe you can do it.
When we compare the U.S. to the rest of the developed world, we're still a basket case. In the rest of the developed world: universal access everywhere, low cost or free to individuals, similar life expectancy to ours, about half the total cost in terms of GDP. (We were substantially more of a basket case pre ObamaCare, due to worse access problems, in my opinion. We'd be a bit less of a basket case if 19 Republican states extended Medicaid.)
Compared to say the UK: one in eleven people in the economy works to support the EXCESS resource we use over the UK (about 9% vs 18% of GDP) for similar life expectancies. That's about $5000 per person per year ($12,500 for an average household of 2.5) for the EXCESS. And they have 0 medical bankruptcies, and people don't have to second guess going to an emergency room, if symptoms of a possible stroke or heart attack appear, for fear of going bankrupt, or fear of the whole thing turning into a pre-existing-condition. (Pre-existing condition screening returns in the recently announced by Paul Ryan Republican "replace".)
(Credit to Bill Gates on Charlie Rose, as I've copied much of his description the performance of our health care system.)
OK, Republicans. Ball's in your court. If Ryan's version of the coming plan is your replace, then I think we're sunk.
But otherwise: focus, focus, focus. Maybe you can do it.
6
OK, but why do we spend twice as much as the UK? Where does this money go? The insurance companies are just passing the money through....to whom?
2
Back in 2009 when the debate over ACA was happening, Howard Dean said that healthcare reform without a public option is not healthcare reform. He was absolutely right. Had public option existed, the insurance exchange death spiral would never have happened. Obama betrayed the working class Americans who voted him in, and once they realized that they got screwed, they took revenge on the Democratic Party in 2016. Asking Republicans to reform healthcare is like asking the fox to guard the hen house. Medicaid will be slashed and turned into a block grant. Next time when recession rolls around, not only will millions of Americans be out of jobs, they will also have no Medicaid to count on because Trump took it away from them.
11
Well, when ObamaCare was being constructed, but I recollect that ObamaCare with a public option was set to go, except that 60 votes were needed in the Senate which Democrats just had by a margin of 0, and MA Senator Edward Kennedy -- one of the 60 -- died on us.
At that time, I recollect the people of Massachusetts voted for Republican Senator Scott Brown, as I understand it, because the Democratic candidate didn't know who some football or baseball player was, and this made enough of the people of MA feel like the Democratic candidate wasn't "one of us". (Neither would I know who that football or baseball player was. As I type this, I do NOT have the Super Bowl on!)
I kind of accept the explanation that it was Senator Brown being against ACA entirely, that caused the public option to go away. (The additional needed Democrat thought the public option was too socialistic or something.)
And I also tend to accept that anything less Byzantine and market-oriented than what we got -- essentially MA RomneyCare -- would not have had enough votes. I.e., less Byzantine single-payer, save 15% of medical costs that are now administrative, etc.)
(Of course, I admit I don't really know all the details of the ObamaCare passage and what was possible. I yield to people more knowledgeable on the details.)
At that time, I recollect the people of Massachusetts voted for Republican Senator Scott Brown, as I understand it, because the Democratic candidate didn't know who some football or baseball player was, and this made enough of the people of MA feel like the Democratic candidate wasn't "one of us". (Neither would I know who that football or baseball player was. As I type this, I do NOT have the Super Bowl on!)
I kind of accept the explanation that it was Senator Brown being against ACA entirely, that caused the public option to go away. (The additional needed Democrat thought the public option was too socialistic or something.)
And I also tend to accept that anything less Byzantine and market-oriented than what we got -- essentially MA RomneyCare -- would not have had enough votes. I.e., less Byzantine single-payer, save 15% of medical costs that are now administrative, etc.)
(Of course, I admit I don't really know all the details of the ObamaCare passage and what was possible. I yield to people more knowledgeable on the details.)
10
Death of Senator Kennedy was a major blow. The words of Joe Lieberman was another factor. He promised to filibuster anything that resembled public option. As Shakespeare once wrote: "There is a tide in the affairs of men. Which, taken at the flood, leads on to fortune; Omitted, all the voyage of their life Is bound in shallows and in miseries." A huge opportunity lost for Obama and a generation of Americans.
9
In fact, it was the execrable Connecticut senator Joe Lieberman who joined with the Republicans to kill the Public Option: the vote was 59 Democrats for and 40 Republicans plus one "Democrat" against.
After Lieberman killed the Public Option, Democrats proposed reducing the eligibility age for Medicare from 65 to 55, a move that Lieberman had previously publicly supported. Once again, however, Lieberman sided with the Republicans to filibuster even that reform.
That is why we don't have a public option. And it was the fury of the people of Connecticut at Lieberman that led him to retire rather than face the voters when he came up for re-election.
After Lieberman killed the Public Option, Democrats proposed reducing the eligibility age for Medicare from 65 to 55, a move that Lieberman had previously publicly supported. Once again, however, Lieberman sided with the Republicans to filibuster even that reform.
That is why we don't have a public option. And it was the fury of the people of Connecticut at Lieberman that led him to retire rather than face the voters when he came up for re-election.
6
The ACA abolished pre-existing conditions and expanded Medicaid enrollees but was very poorly presented and explained to the public. With high copay sand deductibles the doctors offices were propulsed to the forefront and had the burden of explaining all this to the public. Doctors offices were sadly changed into collection agencies.
1
Being in healthcare, I can clearly see the pros and cons. Two plans here in Utah closed their doors and patients were left scrambling to find new plans. That was bad. Then I see patients who have these plans with limited benefit coverage, high premiums and high deductibles and out of pocket expenses. Others have fared better. Depends on what plan you purchased.
The best part is ridding us all of that stupid pre-existing clause. No more adverse selection either. The bad? Too expensive for many.
I pray they just make tweaks to it, fund it better to relieve the cost, open statewide competition and move forward. We cannot go back now. It would be chaos.
The best part is ridding us all of that stupid pre-existing clause. No more adverse selection either. The bad? Too expensive for many.
I pray they just make tweaks to it, fund it better to relieve the cost, open statewide competition and move forward. We cannot go back now. It would be chaos.
6
Why does the author choose to start off referring to Obamacare in the past tense? Despite a profound misreporting of GOP intent to repeal Obamacare, they are nowhere close to doing anything of the sort. An article in the Times yesterday made that clear. Too many people believe it is already gone when that is not in any way true. There is no need to contribute to this general confusion among the public. At least read the other articles written by your colleagues before charging ahead with something as false as this article's premise.
5
What doesn't get remembered is that the ACA included a public option that was supposed to help competition in less attractive markets. The fact is that health insurance providers still take money off the top and don't bring any value to the table. Single payer would have solved that, not that there was a chance it would have passed, given all the outright lies about the ACA.
4
Not true. Public option was deleted from the final bill. Insurance industry would not allow it, and Obama didn't want to fight for it.
3
Can you imagine what success the ACA would be if only stubborn and hateful Republicans had not done everything it could to demolish it. Obamacare rocks!
12
I have two thoughts. The first, I am weary of the conversation about whether healthcare is to be provided to all or to be denied to some or many. To me this is a basic moral and ethical question. I cannot understand how we can be debating this issue still.
Second, family insurance costs between $18,000 and $25,000 per family per year. The mean income in the US this year is $53,000. Thus it is plain that healthcare is not affordable to most Americans. That is the fact at the center of this debate.
Of note: during the 3 years that Obamacare was in full force, the actual costs for healthcare for my company went down or remained flat every year. Thus, for me and my employees, healthcare cost less under Obamacare. I suspect that this was, in part, due to the fact that hospitals could reduce their costs because the previously uninsured were now paying something. In the past, those costs were passed forward in the rates to the insured.
Second, family insurance costs between $18,000 and $25,000 per family per year. The mean income in the US this year is $53,000. Thus it is plain that healthcare is not affordable to most Americans. That is the fact at the center of this debate.
Of note: during the 3 years that Obamacare was in full force, the actual costs for healthcare for my company went down or remained flat every year. Thus, for me and my employees, healthcare cost less under Obamacare. I suspect that this was, in part, due to the fact that hospitals could reduce their costs because the previously uninsured were now paying something. In the past, those costs were passed forward in the rates to the insured.
20
The numbers you cite are, at best, for a solid platinum plan, both the employer and employee contribution combined at a company with a terrible insurance broker. No person earning $53,000 pays half of that for health insurance. Within a company with a bad insurance broker again and the best plan, you might pay $9,000 per year in some unfortunate parts of the country. If you are self-paying for a platinum plan (in which case you are neither in the ACA nor earning 50K per year), you could pay that much. But that would be your choice.
I am fully onboard with what Obamacare did to our company insurance premiums (kept them low after years of 20% per year increases), but when you introduce patently false information in your first paragraph, you support those who would beat it down. I don't think that was your intent. As a consumer, if you are paying that much, you are rich.
I am fully onboard with what Obamacare did to our company insurance premiums (kept them low after years of 20% per year increases), but when you introduce patently false information in your first paragraph, you support those who would beat it down. I don't think that was your intent. As a consumer, if you are paying that much, you are rich.
5
The price I quoted was for a family plan with no more than $2000 per year deductible. It is true that, if you have a $5000 or $10000 deductible, you can get a less expensive plan. However, if you make $40,000 and you get a $4000 bill, your family is in deep trouble.
These are the actual numbers for insurance plans. This is how much MAJOR corporations are paying. Smaller companies often pay far more. I just hired a small consulting firm with 10 employees. Their benefit costs are $17,000 /year per family with a $10,000 deductible. I know that one of the largest companies in my city has a benefit plan that costs more than $18,000 per family. Sadly, my numbers are right for most of America.
These are the actual numbers for insurance plans. This is how much MAJOR corporations are paying. Smaller companies often pay far more. I just hired a small consulting firm with 10 employees. Their benefit costs are $17,000 /year per family with a $10,000 deductible. I know that one of the largest companies in my city has a benefit plan that costs more than $18,000 per family. Sadly, my numbers are right for most of America.
7
Look it up the average Fortune 100 firm pay $18000 to 22000 per family plan. Some pay 100% some have employees paying 10-25% of the cost. With deductibles ranging from $250-$1000 per person.
Even the Federal Employee Blue Cross and Blue Shield Plans are 15,000 to 17,000 per year for family coverage and they are part of the largest group in the country. Also very far from a Platinum plan offered by Fortune 100 firms, especially since Congress left the group.
Even the Federal Employee Blue Cross and Blue Shield Plans are 15,000 to 17,000 per year for family coverage and they are part of the largest group in the country. Also very far from a Platinum plan offered by Fortune 100 firms, especially since Congress left the group.
4
One more unfortunate outcome of the ACA and its flawed implementation was the failure to increase competition in the individual, non-group health insurance markets. Major consumer subsidies combined with online exchanges, standardized plan designs and even carefully regulated policy language were all intended to encourage more insurers to enter the markets and compete for more paying customers. This in fact did not happen. Established carriers, concerned about unknown health conditions among new consumers, only fitfully joined the exchanges. New carriers including the undercapitalized CO-OPs faced massive risk shifts thanks to the "you can keep your policy if you want to" decision from Washington. This had the effect of allowing younger/healthier/low cost customers to keep their old policies and motivating older/sicker/costlier customers to abandon their pre-ACA policies and enter the exchanges in search of a better deal. The result was disastrous underwriting for those who did enter the exchanges and failure for many new carriers. Overall competition for individual market customers has if anything declined compared with 2013 and before. Any new program from Washington should have as one objective the increase in competition in insurance markets, especially for non-group individual customers.
4
The US health care system is a maze but there are maxims
1. Individuals look forward to getting on Medicare.
2. Big Pharma and Device Makers yearn to be approved by the Center for Medicare and Medicaid and in turn use it to reach "covered event" under private insurance; the out patient providers and the hospitals yearn for the same.
3. The medical code for a "covered event" is negotiated as to price between each provider and insurer. The insurers then go out and price the insurance premium, deductibles, co pays and maximum out of pocket based on expectations of the population. Insurers reprice based on experience.
4. The patient is not at the table for the medical code negotiation and has little certainty what medical events they will have.
The result is an MRI can price at a range of $1,200 to $3,000; a colonoscopy , CAT Scan, X Ray, Mammogram can also have a price range that will vary by the negotiations. it overwhelms to forsee the combination of things the patient may need and whether they are covered by the premium, require a co pay and when the maximum out of pocket will be reached to transfer the risk to the insurance company.
The patient is one of the cattle on a long drive and the fact there is no single payer for the whole 300,000,000 people subjects each patient to the risk the system will leave them on the trail. The 300,000,000 need to spread risk, however, that is too logical and paradoxically quite humane.
1. Individuals look forward to getting on Medicare.
2. Big Pharma and Device Makers yearn to be approved by the Center for Medicare and Medicaid and in turn use it to reach "covered event" under private insurance; the out patient providers and the hospitals yearn for the same.
3. The medical code for a "covered event" is negotiated as to price between each provider and insurer. The insurers then go out and price the insurance premium, deductibles, co pays and maximum out of pocket based on expectations of the population. Insurers reprice based on experience.
4. The patient is not at the table for the medical code negotiation and has little certainty what medical events they will have.
The result is an MRI can price at a range of $1,200 to $3,000; a colonoscopy , CAT Scan, X Ray, Mammogram can also have a price range that will vary by the negotiations. it overwhelms to forsee the combination of things the patient may need and whether they are covered by the premium, require a co pay and when the maximum out of pocket will be reached to transfer the risk to the insurance company.
The patient is one of the cattle on a long drive and the fact there is no single payer for the whole 300,000,000 people subjects each patient to the risk the system will leave them on the trail. The 300,000,000 need to spread risk, however, that is too logical and paradoxically quite humane.
12
It was a failure for me and for many others, but at least it exposed some of the problems caused by the assumptions we make. Our healthcare system is too expensive to begin with and creating pools from those who were uninsured almost naturally creates very expensive policies. All throughout the Obama administration I heard numbers of people who had policies, I have never seen one bit of evidence that people were able to buy more healthcare. Insurance isn't healthcare. Until the Democrats realize it was a failure we cannot fix it.
10
Shorten patents and copyrights down to 5 years. Legalize all drugs. I should be able to buy ambien over the counter. But if I want it cheaper without the tax then I need to get a prescription. Meanwhile universal healthcare for two-four decades to bring down health costs to reasonable level. Then abolish all universal healthcare. Have everything at cost. By abolishing it, and having costs cut down to reasonable level as per se aspirin..you create essentially a universal healthcare on its own as anyone can afford treatment; its cheaper too as there are no programs running it. But the key is to keep patents down to 5 years along with copyrights and to end prohibition on drugs so you can buy anything without a prescription but you need to pay a tax. Money saved on inmate reduction and raised through taxes could go to drug treatment, and perhaps free education for nurse practitioners etc. Also with the implementation and after it's decommissioning of universal healthcare, insurance companies should be banned along with PBMs.
1
Obamacare was a good start but needs lots of fixing. I would like to start another company but I and my potential partners would have to pay 1500.00 a month in healthcare. That's a lot of money on a startup that needs to conserve cash. Why didn't Obama create a national group policy for small businesses just like employees at large companies? This was a huge miss in the plan. Last year BCBS had three programs and now only one. The monthly premium has gone from 900 to 1500 per month. How is that fair? They want me to pay for people that are not healthy and pay next to nothing for their coverage.
4
This elderly pre-retirement couple would have to pay $2000 for two/month plus $12,ooo deductible. Mind you there's no help with the huge monthly cost. Why is it that the elderly are asked to pay up to three times as much as for, let's say someone with a pre-existing condition.
We need a basic policy. Then, if you want to pay for pregnancy, please do. Don't expect everyone in the country to pay for a fat policy that covers every eventuality. Such a bloated policy is what got us into trouble in the first place.
We need a basic policy. Then, if you want to pay for pregnancy, please do. Don't expect everyone in the country to pay for a fat policy that covers every eventuality. Such a bloated policy is what got us into trouble in the first place.
6
Does you state have a health care exchange, or did your governor decide not to have one? That may be part of the problem.
2
My wife and I have both been on disability in the past and have pre-existing chronic conditions. Without the ACA we would have been bankrupt in 2016 (for the second time because of medical bills). But we weren't and instead, after receiving government help for years, we are realatively healthy, are employable and pay taxes. I have paid much more in taxes over the the last 15 years than the disability benefits that we have received over the years, not including what our Medicare coverage paid during those years when we were on disability because I was hospitalized over 10 times. I can't say if me or my wife would have died without this help but our health would have certainly suffered more and life has been less stressful because of it. I have started thinking of what I should do in the future without the ACA because the odds are I will eventually be bankrupt again if I can't get health insurance.
12
While you had fat subsidies complememts of taxpayers people like us were uninsured for years now. It's a very unfair system!
3
Part of the stigma of being mentally ill comes from the fact that by receiving $493 per month from the government so that I could barely *survive*, people think I was receiving
"fat" subsidies and presumably I don't deserve it. I would have most certainly been homeless without it. Stigma is a very unfair thing.
"fat" subsidies and presumably I don't deserve it. I would have most certainly been homeless without it. Stigma is a very unfair thing.
1
We are in the subset of folks who have been burdened by the ACA by now paying over twice as much for a plan that offers not much more than catastrophic coverage and having had to switch from our established docs. Friends we know who are thrilled by Obamacare have made a series of decisions - not to attend college (we paid for our own higher educations, working hard to make that happen), working as yoga teachers, massage therapists. We've both worked in jobs that were not exactly passions, but allowed us to be self-sufficient.
All plans now cover mental health, substance abuse, fertility . . . which all of us must supplement with our premiums. Also, there is never any monetary reward for healthy choices such as diet or exercise. We feel we've been penalized for a lifetime of good choices by being forced to subsidize people who have not. Enjoy the Super Bowl - we're heading out for a hike.
All plans now cover mental health, substance abuse, fertility . . . which all of us must supplement with our premiums. Also, there is never any monetary reward for healthy choices such as diet or exercise. We feel we've been penalized for a lifetime of good choices by being forced to subsidize people who have not. Enjoy the Super Bowl - we're heading out for a hike.
10
Your assumption that people with medical conditions brought these problems on themselves through poor choices is inherently flawed and reeks of higher-than-thou attitude. One of my friends who was at the gym nearly every day, never smoked or drank, was a vegan and never had an ounce of fat on her had not one but two episodes of breast cancer and died. Did she make poor choices? Of course, not! Many medical conditions are outside our control (ergo, genes and the environment). So you can come down off your high horse and have a little compassion for people whose circumstance are uncontrollable.
2
Nice photo of Obama rototilling America, good thing my president also has a pen and a phone.
3
How can there be any debate on Obamacare. It is a Left Leaning, Ideologically Driven, Socialist Eperiment, a complete disaster shoved down America's throat. Obama and the Democrats knowingly, willfully and repeatedly lied to pass this Socialist Agenda.
It is a job and economy killer and MUST be completely repealed. Any thing in it's place can NOT be so eggrigious but only be an improvement.
It is a job and economy killer and MUST be completely repealed. Any thing in it's place can NOT be so eggrigious but only be an improvement.
7
Good point about the jobs aspect.
My neighbor owns her own small business and will not hire another employee because it will put her over the limit for Obamacare regs.
My neighbor owns her own small business and will not hire another employee because it will put her over the limit for Obamacare regs.
4
Actually the law created hundreds of thousands of health care jobs, and during the great recession when we needed them. But there were millions of people who were worse off because of ACA. Their experience was bad, but the GOP allowed no fixes. That doesn't invalidate the 20 million for whom the ACA worked. Somehow, we have to make cost and coverage work for everyone.
1
Good article. Balanced, comprehensive. The only thing it is missing is trajectory: Obamacare is imploding. The systematic undercharging of the sick and trying to make up for it by grossly overcharging the healthy is leading to adverse selection -- greater enrollment by the sick than the healthy. The death spiral has begun. The Republicans are acting like they have time to address this, but they don't. It's getting ready to fall apart on their watch.
9
We may argue about how much profit the pharmaceutical industry should make, but we all agree they supply a product that saves lives. We can argue about how much money doctors make, but we agree they provide a service that saves lives. They are necessary.
But WHY are we shoveling untold millions of dollars into the insurance industry? They don't provide ANYTHING of value and yet we keep paying them. Are we CRAZY?? Single-payer simply means remove the useless middle man.
But WHY are we shoveling untold millions of dollars into the insurance industry? They don't provide ANYTHING of value and yet we keep paying them. Are we CRAZY?? Single-payer simply means remove the useless middle man.
13
EXACTLY!
Obama could have done anything, but he enriched the insurance industry even more!
We pay $1900 a month in premiums! If we could just have a catastrophic policy that kicks in after we meet a $10K deductible, we wouldn't burden anyone and we wouldn't be on the verge of going broke (despite being 2 college graduates who work full time).
Even the poor can afford $15 a month into a catastrophic fund; free clinics could provide them basic care. Solve the problem of preexisting conditions completely separately. You don't sell insurance to someone whose house has already burned down.
Obama could have done anything, but he enriched the insurance industry even more!
We pay $1900 a month in premiums! If we could just have a catastrophic policy that kicks in after we meet a $10K deductible, we wouldn't burden anyone and we wouldn't be on the verge of going broke (despite being 2 college graduates who work full time).
Even the poor can afford $15 a month into a catastrophic fund; free clinics could provide them basic care. Solve the problem of preexisting conditions completely separately. You don't sell insurance to someone whose house has already burned down.
3
When I picked a Medicare advantage plan, I researched the annual pay of each insurance company's CEO. I immediately eliminated those companies whose CEOs earned huge multi-million-dollar salaries, including the one endorsed by AARP (United Healthcare). The salaries range from $12-25 million annually, and that's just salary, without perks! Why does ANYONE need that kind of money? What does anyone do to earn that kind of money? The president of the United States doesn't earn that kind of money (well, maybe the current one does, but the taxpayers don't pay that salary to the president or vice present), and that's a much tougher job than running an insurance company.
So the insurance companies are laughing all the way to the bank, and STILL telling Congress that they're not making enough money. Poor babies...All this, while people are struggling to pay health insurance premiums.
So the insurance companies are laughing all the way to the bank, and STILL telling Congress that they're not making enough money. Poor babies...All this, while people are struggling to pay health insurance premiums.
3
If your idea is of single payer is that the government will just write checks to cover whatever bills hospitals and doctors care to send in, then the taxpayers would soon find out what the insurance companies do....because the government would have to do pretty much the same thing. It might be cheaper, ir might be more expensive. But without someone to keep the medical-industrial complex in check, it would grow until it consumed 100% of the GDP.
1
We know what Bill Clinton thinks of Obamacare: "It's the craziest thing in the world..:
http://www.cnn.com/2016/10/04/politics/bill-clinton-obamacare-craziest-t...
http://www.cnn.com/2016/10/04/politics/bill-clinton-obamacare-craziest-t...
9
Margot, in your list of the ACA's Successes, why don't you mention lives saved?
For the ACA saves Americans' lives. Just one example: one provision of the law requires greater accountability from hospitals to prevent infections and medical errors, contributing to some 87,000 lives saved -- and that's just counting through the end of 2015. The ACA also has led to early detection of cervical cancer for more women.
These are real people, real Americans, who are alive and healthy because of this law, who are here to contribute to our commonwealth and our economy right now.
I do not understand why the Obama adminstration, the allies of the ACA, and the press have focused so much on the 20 million insured number. Sure, that's an impressive number, but insurance is after all just a contract.
American lives saved -- more than the population of the city I live in. Now that's real. Maybe if the ACA dialogue had emphasized this success more, it would be at least a partial response to the self-employed, the small business owners, and the too-much-income to qualify for Medicaid expansion people who have found the ACA so frustrating: "Your contribution, your sacrifice, isn't about insurance. It's about your fellow citizens who would not be alive right now without this law and without your help. Thank you! Demand expansion and reform of this powerful and imperfect law, and help for you too will be on the way."
For the ACA saves Americans' lives. Just one example: one provision of the law requires greater accountability from hospitals to prevent infections and medical errors, contributing to some 87,000 lives saved -- and that's just counting through the end of 2015. The ACA also has led to early detection of cervical cancer for more women.
These are real people, real Americans, who are alive and healthy because of this law, who are here to contribute to our commonwealth and our economy right now.
I do not understand why the Obama adminstration, the allies of the ACA, and the press have focused so much on the 20 million insured number. Sure, that's an impressive number, but insurance is after all just a contract.
American lives saved -- more than the population of the city I live in. Now that's real. Maybe if the ACA dialogue had emphasized this success more, it would be at least a partial response to the self-employed, the small business owners, and the too-much-income to qualify for Medicaid expansion people who have found the ACA so frustrating: "Your contribution, your sacrifice, isn't about insurance. It's about your fellow citizens who would not be alive right now without this law and without your help. Thank you! Demand expansion and reform of this powerful and imperfect law, and help for you too will be on the way."
6
The most egregious problem with America's healthcare system is not that insurance companies milked the system for too much profit, but rather that providers and suppliers ran roughshod over the consumers to achieve their outsized profit motives. I get that many of these are publicly traded corporations and on the hook to shareholders to continually increase their profits. I get it that the profit motive is central to America's system of innovation. Even so, the country faces a critical juncture in which we either decide to regulate the profit motives of the suppliers and providers or we decide that it is ok with us that not all Americans will be able to afford healthcare. To date, Congress has rigged the marketplace in favor of suppliers and providers with the result that America has the most expensive healthcare system among the developed nations. All the hoopla over repeal/replace the ACA is just a diversionary tactic to keep us from addressing the real problem, and that is a bought and paid for Congress that continues to act in favor of large corporations at the expense of individual citizens.
7
I think when the auto industry and TBTF banks were given their bailouts, Americans took their first steps toward realizing that socialism isn't a dirty word, and began to feel that the financial class shouldn't be its only recipients. Now we are moving toward the majority realization that the only solution to our health care crisis is that previously demonized ideal: "Socialized medicine." It's becoming more obvious daily that most developed countries (and some less developed ones) have nationalized health care that provides demonstrably better results than ours, and that their people are not shy about praising. It's really time to wake up to this reality and make it a rallying cry for all Americans: Medicare for all.
6
In most of these systems, doctor's incomes are far lower than in the US. For example, senior doctors in public hospitals in Germany are paid 80,000 Euros, while the average salary for all doctors in the US is $207K.
You seem to feel this is a convincing argument, There is no compelling reason to think that doctors' salaries will go down under a single payer system, only that the cost of running the system will be significantly reduced, and the pool of payers will increase. I remember, at he time of their merger the CEO of Daimler Benz being appalled at how high the Chrysler CEO's salary was. Most doctors I know are passionately in favor of a single payer system, though I admit its a small sample, and none of them went into medicine for the money. Lowering the cost of Med school would be another worthy goal, as would raising the salaries of aid workers.
1
Dear Ms. Sanger-Katz: Obama had the conceit to call it "The Affordable Care Act". No one, not even the NYT has tried to make the case that it is affordable, because we have all learned the hard way that it is not. It is therefore by definition an abject failure. Try to be honest for once.
15
At a minimum, he law changed the way every politician looks at national health care, and for that matter health care in general. We had been waiting for a Republican national health care plan since 1993, when Senator Dole promised we would have one within one year! Twenty years was long enough. Obama changed the rules of the game. There now has to be national health care, not just "access" (what ever that means). And now the Republicans are talking about "fixing" Obama care, since they have no truly innovative ideas of their own. They had 6 years to think of improvements, why should ANYONE believe they will come up with anything substantial in another 6 months. And the health insurance industry won't give them 3 months!
6
Those who wish to kill Obamacare will rue the day. They will be coming for you next. Price wants to destroy employer based insurance, and Medicare.
11
Move to Cuba if you want free healthcare David.
5
The absence of generally available and affordable healthcare directly impinges on the rights of life, liberty, and the pursuit of happiness for American citizens.
5
Trump has been for single payer for decades. His continued support for universal healthcare and the fact that he could win a Republican primary espousing that has more to do with the epic failure of Obamneycare, not any of its minor successes.
3
Most people have no idea how expensive US healthcare is.
They pay a small fraction via their employer and complain about that small amount.
If you buy it outright, its hideously expensive, so those people, if they are generally healthy, think they're getting a raw deal.
Insurers cherry pick so they make money.
Since the US pays more as a % of GDP , we should expect more, but we're never going to get economies of scale or help the poor until the market is truely one market. The only way for that to happen is single payer.
It works, and works better than what we have now, in all of the other industrialized countries.
We're fooling ourselves if we think going free market would solve our prolbems.
They pay a small fraction via their employer and complain about that small amount.
If you buy it outright, its hideously expensive, so those people, if they are generally healthy, think they're getting a raw deal.
Insurers cherry pick so they make money.
Since the US pays more as a % of GDP , we should expect more, but we're never going to get economies of scale or help the poor until the market is truely one market. The only way for that to happen is single payer.
It works, and works better than what we have now, in all of the other industrialized countries.
We're fooling ourselves if we think going free market would solve our prolbems.
7
This reads like word soup. There is no "market" if the government has a monopoly.
1
How exactly would 'single payer' persuade doctors and hospitals to do the job for half of what they're now making?
2
So what is the grade, man?
3
Yet another example of click bait from the NYT,
1
The one overwhelming success of the ACA is that it has brought health care to America's people. It could have and should have been improved over the past 6 years, but the fact that we have it will still stand even if it's changed or renamed.
7
Not surprisingly, many of the people unhappy with the ACA and their insurance options through it are not in fact unhappy with the ACA. They are unhappy with insurance in general. They don't value the "peace of mind" that having coverage brings, so they feel they are not getting anything from the cost. They also don't understand that they are not paying other people's subsidies, but participating in a system that collects more from some people than they will collect back, so there are funds available to cover the costs of the hopefully fewer people who have expensive medical needs.
I have had cancer and have a number of autoimmune diseases. I am lucky that even at my age, I can afford the high premiums and deductibles. Anticipating high costs last year, I bought a platinum plan for $600 per month (I am single so the coverage was just for me). My total bill for health care last year before insurance payments was about $3,000. So I contributed about $4,200 to the communal pool and that was put toward the care of others. I am thrilled I was healthy enough in 2016 to be able to pay into this system.
That $4,200 was the cost for me for the knowledge that if I had a recurrence of cancer or a hospitalization, I would not be bankrupted or have to accept less-than-good care. It was and is well worth it. I hope to continue to be healthy enough to pay more into the system than I get back, and am grateful that I can get coverage, and peace of mind, in case something happens.
I have had cancer and have a number of autoimmune diseases. I am lucky that even at my age, I can afford the high premiums and deductibles. Anticipating high costs last year, I bought a platinum plan for $600 per month (I am single so the coverage was just for me). My total bill for health care last year before insurance payments was about $3,000. So I contributed about $4,200 to the communal pool and that was put toward the care of others. I am thrilled I was healthy enough in 2016 to be able to pay into this system.
That $4,200 was the cost for me for the knowledge that if I had a recurrence of cancer or a hospitalization, I would not be bankrupted or have to accept less-than-good care. It was and is well worth it. I hope to continue to be healthy enough to pay more into the system than I get back, and am grateful that I can get coverage, and peace of mind, in case something happens.
16
Agreed. I feel so lucky when I "don't use" my health insurance!
4
That is all very well - but what if paying the premiums is so burdensome you have to live like a pauper? If you have little left for food, shelter, and clothing, you are likely to be pretty discontent. What good is being healthy, and being insured, if you can't afford to live decently?
1
Affordable health insurance coverage is but one element of an effective health care system. Health insurance does not address affordable healthy foods - like fresh vegetables and fruit grown in living soil without untested herbicides or pesticides; or grass-fed meats free of hormones and antibiotics. Even our popular former first lady Michelle Obama hit a wall promoting healthy foods. When her message was perceived as a threat to corporate profits she retreated to the safer "Let's Move" exercise program. Pilot programs that promote healthy, safe environments for exercise and regenerative agriculture for a healthy diet in our poorer urban and rural areas are encouraging and go a long way toward producing long term health and reducing health expenditures. Unfortunately poverty and polluted, unsafe environments go hand-in-hand. If a comprehensive national health plan is out of our reach in today's political environment, at least we could invest in the foundations of good health - access to healthy foods and exercise for all.
We already have a lot of healthy choices and a lot of people know what's good nutrition is. However, people would rather eat what they feel like. That's fine - I won't force them about what to eat - but don't make me pay their medical bills. Same about unsafe sex and smoking.
4
Admittedly, a broad swath of America - those unemployed or underemployed - don't wake up each morning thinking about or having access to healthy choices. Paths to good paying jobs (e.g., tech schools) may be the best way to encourage better choices (not to mention health insurance).
The Affordable Care Act has had a positive benefit for so many people in my life, and though it is not perfect, it still offers some degree of security to many more. My son, for example, was unable to find a job that provided health insurrance after graduating with a Master's Degree from LSE. He also has a pre-existing condition, and we were grateful that he could, at least, buy on the exchange. We live in a gig economy. Many young people are in this same position. People in congress (and people with employer based insurrance) have no idea what a problem this is. My nephew was in the same position. A diabetic, he taught English in Japan for several years after he graduated from college. Whe he came home, he worked at a grocery store until he ended up going back to school. Same problem. No health insurrance in many of those minimum wage jobs. People who have always had access to healthcare cannot possibly appreciate this.
45
The ACA was written by the insurance industry- Obama walked it through mainly because he knew government subsidies would pick up the tab. What we were left with was a "Cadillac Plan" for welfare recipients and undocumented workers and an over priced, unusable plan for families who earn more than $30,000 a year. ACA is unfair and penalizes the middle class. The only thing left is a single payer system - but that will ultimately evolve into a multi tiered system with privatized medicine catering to the wealthy and community-social welfare type medicine "rationed off" to everyone else.
11
It is wonderful to finally have health insurance--at any price--and not be excluded by my pre-existing health conditions. $840 a month was a small price to pay when I got cancer and was able to get treatment. The ACA certainly has its faults, but the GOP wanted it (and President Obama) to fail rather than work to make it better.
16
I appreciate your comment. I've had similar experiences. The ACA was a lifesaver for me.
9
The main thing wrong with Obamacare? The insurance companies. They do not contribute health, they do not contribute medical expertise. Most doctors' offices have to hire somebody just to deal with the insurance companies, jacking up prices for everyone. And people can't, as they do in the market for pizza and cars and football tickets, choose whether to get sick or get hurt or, if they do get sick or hurt, whether their medical problems are cheap or expensive to treat.
The idea of universal insurance means that everyone pays into the pool, and the few who need expensive care every year can afford it. For political reasons -- mostly insurance company clout -- Obama tried out the Republican idea of the individual mandate and private profit-making insurance companies. But caring for the sick and injured and ensuring that everyone has access also to preventive care doesn't seem to be a profit-making activity. Take the insurance companies out of the equation and keep the other features of Obamacare. There's a replacement we can believe in.
The idea of universal insurance means that everyone pays into the pool, and the few who need expensive care every year can afford it. For political reasons -- mostly insurance company clout -- Obama tried out the Republican idea of the individual mandate and private profit-making insurance companies. But caring for the sick and injured and ensuring that everyone has access also to preventive care doesn't seem to be a profit-making activity. Take the insurance companies out of the equation and keep the other features of Obamacare. There's a replacement we can believe in.
23
As a 50-something New York City resident I paid $995/month for a comprehensive health insurance plan in 2013, the last year before Obamacare. The premiums escalated rapidly each year (sometimes 24%) getting me to that $995 amount.
In 2014 I purchased a Platinum Plan under the Affordable Care Act (same thing as Obamacare) for $495/month with no subsidy as my income is "too high." That's a 50% reduction in one year for comparable coverage. In 2017 I now have a Gold Plan from a different company and pay $634/month. My out-of-pocket costs since 2014 have been minimal and my generic prescriptions have been provided at no additional cost.
For me Obamacare has been a huge success. It has saved me many thousands of dollars and provided me excellent access to healthcare.
In 2014 I purchased a Platinum Plan under the Affordable Care Act (same thing as Obamacare) for $495/month with no subsidy as my income is "too high." That's a 50% reduction in one year for comparable coverage. In 2017 I now have a Gold Plan from a different company and pay $634/month. My out-of-pocket costs since 2014 have been minimal and my generic prescriptions have been provided at no additional cost.
For me Obamacare has been a huge success. It has saved me many thousands of dollars and provided me excellent access to healthcare.
8
Only because New York has the worst market in the nation.
So you're saying that I am happy with Obamacare even though I'm in the worst market in the nation? That would mean that Obamacare is doing exceedingly well.
You really need to check your facts because the Affordable Care Act is doing well in states where their leaders want it to work -- like New York and California. My Los Angeles brother's premiums with Kaiser also dropped dramatically from 2013 to 2014 when he joined the Affordable Care Act plans.
You really need to check your facts because the Affordable Care Act is doing well in states where their leaders want it to work -- like New York and California. My Los Angeles brother's premiums with Kaiser also dropped dramatically from 2013 to 2014 when he joined the Affordable Care Act plans.
2
I was on Kaiser in those same years and my premiums almost doubled.
"Obamacare isn't perfect, but it's a start – and it's better than nothing."
That's the title of an article that appeared in the Guardian that caught my eye. And it basically expresses President Obama's thoughtful response when questioned once about how he would feel if the Trump administration repealed his namesake healthcare program about which he felt much satisfaction and pride. "It's at least a start" he said. Not "I would be heartbroken" like most of us would feel if something helpful that we were proud of were suddenly taken away. So, regardless what might be other varying assessments of it, it's a start--and so it is.
That's the title of an article that appeared in the Guardian that caught my eye. And it basically expresses President Obama's thoughtful response when questioned once about how he would feel if the Trump administration repealed his namesake healthcare program about which he felt much satisfaction and pride. "It's at least a start" he said. Not "I would be heartbroken" like most of us would feel if something helpful that we were proud of were suddenly taken away. So, regardless what might be other varying assessments of it, it's a start--and so it is.
6
Translation: It's welfare.
Welfare "is good" if you are getting the deal and it's not if you are not. It's as simple as that. The insurers were getting the deal, so it was good or they could quit participating. Super low income people were getting the deal so they could . People with certain tough circumstances were getting the deal. In this respect the setup was too unfair and that's why it is unpopular.
Interesting to me is that 1. while citizens were forced to buy in, insurers were not, a rather much an insulting display of who wears the pants in the healthcare family. 2. The sell was bait & switch; great coverage for cheap the first year and I defended it, now it's a millstone and I wish I had opposed it to start. 3. While American companies have recorded record profits, they have not been taxed to prevent ACA premium increases.
I'm a liberal, and I was happy when Trump signed the order telling agencies not to punish people who don't buy a plan. Sorry I am not going to overlook what this costs me just because it helps some certain few.
Welfare "is good" if you are getting the deal and it's not if you are not. It's as simple as that. The insurers were getting the deal, so it was good or they could quit participating. Super low income people were getting the deal so they could . People with certain tough circumstances were getting the deal. In this respect the setup was too unfair and that's why it is unpopular.
Interesting to me is that 1. while citizens were forced to buy in, insurers were not, a rather much an insulting display of who wears the pants in the healthcare family. 2. The sell was bait & switch; great coverage for cheap the first year and I defended it, now it's a millstone and I wish I had opposed it to start. 3. While American companies have recorded record profits, they have not been taxed to prevent ACA premium increases.
I'm a liberal, and I was happy when Trump signed the order telling agencies not to punish people who don't buy a plan. Sorry I am not going to overlook what this costs me just because it helps some certain few.
12
I'm self employed and a high earner. I've been on ACA plans for the last 2 years, and my premium went up 40% this year for a much less compressive plan with a $6700 deductible. (Last year my deductible was $1000)
Do I like it? No way. Does the ACA need tweaks? Yes. (And I absolutely agree with your point that the insurance companies need to come to the table. I'd also add that pharmaceutical companies should, too.)
However, I disagree with your point that you shouldn't pay more. I strongly believe that because I am privileged, it is my duty to give back. I got lucky in a lot of ways. Yes, I have worked extremely hard, but like many others, I have been fortunate in my life. I don't love paying a huge premium, but I can afford it. If it means that less fortunate people get access to healthcare, well, so be it. After all, healthy, happy society *DOES* benefit me. (and it benefits you, too.)
Do I like it? No way. Does the ACA need tweaks? Yes. (And I absolutely agree with your point that the insurance companies need to come to the table. I'd also add that pharmaceutical companies should, too.)
However, I disagree with your point that you shouldn't pay more. I strongly believe that because I am privileged, it is my duty to give back. I got lucky in a lot of ways. Yes, I have worked extremely hard, but like many others, I have been fortunate in my life. I don't love paying a huge premium, but I can afford it. If it means that less fortunate people get access to healthcare, well, so be it. After all, healthy, happy society *DOES* benefit me. (and it benefits you, too.)
13
It may helps millions, but not you. Just thinking of number one?
6
I have no idea why you are insinuating I am a high earner. I barely cover living costs and have zero retirement. I am perfectly healthy, and I don't appreciate being penalized for it. You pay, be my guest, enjoy the nobility.
2
The ACA did many significant things especially by changing the pre-existing condition rejection by insurance companies and covering well visits. The biggest mistake it did was catering (caving in) to insurance company lobbyists. The purpose of health care should be to cover sickness as well as prevention not put million dollar salaries and bonuses into insurance company pockets. Calling it "Obama Care" was another mistake as it turned many republicans against it even though it was based on the model Mitt Romney put into place in MA. Until we have a civil united party system that can explain to the lay person why we should always be covered, that eventually our bodies do break down and we do have accidents, we are going to see policy prices continue to go up. A far more fair system would be to allocate a portion of our taxes toward a national nonprofit system that would cover and provide good basic coverage. If one wanted more then, and only then, should insurance companies be allowed to enter the market. I sincerely hope we don't go back to a system that once rejected my 3 year old daughter who was perfectly healthy but was born with only 1 kidney. I hope to not have to donate money to cover a friend's cancer medication because the insurance company won't. Until our elected officials have their cadillac lifetime health plans taken away and are treated as regular citizens who have to purchase insurance year to year, they will never understand.
9
The ACA is a wonderful example of damned if you do and damned if you don't. The intent of the law, as championed by the Obama Administration, was noble. How the law was crafted and finalized in the Congress, left much to be desired. It became unwieldy, fraught with overly complicated language and messy implementation. Instead of both sides cooperating to make the best possible, it became a political wasteland. Toss in state by state implementation that was and is a miss-mash of complexity and it isn't too hard to understand the love-hate feelings that abound.
As best I can tell it helped many and cost some. Signing the law had to be a tough choice as it wasn't everything it could have been, but fixing something was thought to be easier than not having anything at all.
I hope I am never in the position to need ACA and it is hard to turn away from my fellow citizens who are not as fortunate as I. I think it can be salvaged, but too many seem intent on destruction.
As best I can tell it helped many and cost some. Signing the law had to be a tough choice as it wasn't everything it could have been, but fixing something was thought to be easier than not having anything at all.
I hope I am never in the position to need ACA and it is hard to turn away from my fellow citizens who are not as fortunate as I. I think it can be salvaged, but too many seem intent on destruction.
4
#1. "both sides cooperating to make the best possible," Really. Obama was never open to cooperating with the folks across the aisle. He was quick to remind everyone that, "We won." In other words the winning team got the bounty. Imagine some people had actually believed his campaign promises.
#2. How do you expect congress to review a complicated document placed on the table the evening before the vote would be called the following day?
#3. How can Obama and the Democrats justify allowing insurance companies, corporations, medical device providers etc. to craft a future health care program - while visions of $$$$ drove their input?
#4. Last but not least - to this day I believe the support of the Kennedy family for Obama versus HRC sat firmly on Obama's promise to Teddy to pass a universal health care plan - but, truth be told - Obama had no clue of the complexity of such a program, and he and 'handlers' foolishly went ahead with the arrogance that they could pull anything off. It didn't work.
#2. How do you expect congress to review a complicated document placed on the table the evening before the vote would be called the following day?
#3. How can Obama and the Democrats justify allowing insurance companies, corporations, medical device providers etc. to craft a future health care program - while visions of $$$$ drove their input?
#4. Last but not least - to this day I believe the support of the Kennedy family for Obama versus HRC sat firmly on Obama's promise to Teddy to pass a universal health care plan - but, truth be told - Obama had no clue of the complexity of such a program, and he and 'handlers' foolishly went ahead with the arrogance that they could pull anything off. It didn't work.
3
Really. The offer was on the table both before, actually well before, as the basis was the GOP plan from the 90s, as well as after it passed. The answer was a resounding NO.
Congress wrote the document. The president can only make recommendations. Congress writes the Bills, which become the laws. Basic US civics.
Please cite your sources for comment 3.
Number 4 is an opinion, and is treated as such.
Congress wrote the document. The president can only make recommendations. Congress writes the Bills, which become the laws. Basic US civics.
Please cite your sources for comment 3.
Number 4 is an opinion, and is treated as such.
Here is another failure of Obamacare. I used to be a heroin addict, and when I quit I was put on suboxone. Suboxone literally saved my life. While on heroin, I had almost died, I had been kicked out of MIT my senior year, and I was suicidal. While on suboxone, I finished college at CU, I transitioned to become a transgender woman, and I started a company that made me part of the middle class. For 4 years I paid $300 a month for the medications, as I did not have insurance.
Last year, 50% of my tax refund was taken in Obamacare fines. My partner and I decided to get insurance. We bought a Gold level Obamacare plan for $800 a month for both of us.
I was so excited to have what I thought was good insurance. However, when I tried to fill my suboxone script, they denied me! After paying the $300 cash, I called them. They told me that suboxone was too expensive, and they wanted me to take a different drug called zubsolv that had a different formulation but that they said was the same thing.
The next month I got zubsolv. After a week of taking it, I had horrible cravings for heroin for the first time in 4 years. I got very ill. started throwing up, couldnt work, and eventually ended up in the emergency room with a panic attack. I felt like a huge chunk of my recovery had just been thrown out of the door.
My insurance would still not cover the Suboxone. So today, we pay $800 a month for insurance, and I pay $300 extra for suboxone that the insurance doesnt cover.
Last year, 50% of my tax refund was taken in Obamacare fines. My partner and I decided to get insurance. We bought a Gold level Obamacare plan for $800 a month for both of us.
I was so excited to have what I thought was good insurance. However, when I tried to fill my suboxone script, they denied me! After paying the $300 cash, I called them. They told me that suboxone was too expensive, and they wanted me to take a different drug called zubsolv that had a different formulation but that they said was the same thing.
The next month I got zubsolv. After a week of taking it, I had horrible cravings for heroin for the first time in 4 years. I got very ill. started throwing up, couldnt work, and eventually ended up in the emergency room with a panic attack. I felt like a huge chunk of my recovery had just been thrown out of the door.
My insurance would still not cover the Suboxone. So today, we pay $800 a month for insurance, and I pay $300 extra for suboxone that the insurance doesnt cover.
6
Bear with me on this rant; it really does pertain to your situation:
Bill Gates involved himself in public education. One of his missions seemed to be firing "bad" teachers who taught poor kids because if poor kids are failing, it's not poverty, right? it's the teachers... Google "stack ranking at Microsoft."
So he barged in, with no experience attending or teaching in an urban public school (or any public school) and the firings, harassment, pay freezes, constant testing, and misery began. A decade later, after his involvement, things are even worse for the students in urban districts (he also had this fetish with "small schools" that cost districts millions, only to flop).
Bill Gates is a bad person because he is willing to ignorantly harm people to reach his ends. He could afford to fund free Suboxone for every American in need of it. Only good would come of that. Only good for good people trying to reclaim their lives.
Our insurance just stopped covering a gastro drug my daughter took. It's $300 a month. So on top of the $26,000 we will pay by December in premiums, we now have to add that $300. And as an urban teacher, my pay has been frozen for years despite my students' outstanding results bc I'm at the top of the scale.
Bill Gates involved himself in public education. One of his missions seemed to be firing "bad" teachers who taught poor kids because if poor kids are failing, it's not poverty, right? it's the teachers... Google "stack ranking at Microsoft."
So he barged in, with no experience attending or teaching in an urban public school (or any public school) and the firings, harassment, pay freezes, constant testing, and misery began. A decade later, after his involvement, things are even worse for the students in urban districts (he also had this fetish with "small schools" that cost districts millions, only to flop).
Bill Gates is a bad person because he is willing to ignorantly harm people to reach his ends. He could afford to fund free Suboxone for every American in need of it. Only good would come of that. Only good for good people trying to reclaim their lives.
Our insurance just stopped covering a gastro drug my daughter took. It's $300 a month. So on top of the $26,000 we will pay by December in premiums, we now have to add that $300. And as an urban teacher, my pay has been frozen for years despite my students' outstanding results bc I'm at the top of the scale.
4
Many people forget that Barak Obama was a community organizer before he was a senator and President. In many ways, he approached problems with that perspective. I believe he sees things as a process towards a goal and almost always that his view is more about the long term rather than the short term effects. I firmly believe his indubitable success in moving the debate towards healthcare versus a debate about the mechanics of health insurance may eventually be looked upon as one of the great achievements in US History.
8
Obamacare did nothing to subsidize the premiums of the middle class. I am right smack in the middle of the middle class, and my premium is over $400 a month! My partner also pays $400 per month. We get NO subsidies.
In effect, the middle class is the one subsidizing the poor. The rich get off scott free under Obamacare, while premiums for people like me have gone up by leaps and bounds.
That to me is why Obamacare failed. It is not redistributative. It is not reducing inequality. It is dragging middle class people down into the ranks of the poor. Ive had several friends lose so much money on deductibles and emergency care that they have been dragged down into the poor and have then qualified for subsidies or even medicaide. Also, of you currently are on medicaide, that is a big motivator to not try to make more money. I have a friend who refuses to work full time because all the extra money he would make would get taken away because he would lose his medicaide. As a result, he only works 25 hours a week so that he can stay just poor enough to get all these benefits. That is a horrible way to live in my opinion.
If you are rich or poor, Obamacare works for you. If you are middle class, Obamacare is much worse than before. My entire tax refund last year got sucked into Obamacare fines, and now this year I pay $400 a month for insurance I cant even use to cover the one mediciation I take, while insurance executives take home million dollar bonuses. Its maddening.
In effect, the middle class is the one subsidizing the poor. The rich get off scott free under Obamacare, while premiums for people like me have gone up by leaps and bounds.
That to me is why Obamacare failed. It is not redistributative. It is not reducing inequality. It is dragging middle class people down into the ranks of the poor. Ive had several friends lose so much money on deductibles and emergency care that they have been dragged down into the poor and have then qualified for subsidies or even medicaide. Also, of you currently are on medicaide, that is a big motivator to not try to make more money. I have a friend who refuses to work full time because all the extra money he would make would get taken away because he would lose his medicaide. As a result, he only works 25 hours a week so that he can stay just poor enough to get all these benefits. That is a horrible way to live in my opinion.
If you are rich or poor, Obamacare works for you. If you are middle class, Obamacare is much worse than before. My entire tax refund last year got sucked into Obamacare fines, and now this year I pay $400 a month for insurance I cant even use to cover the one mediciation I take, while insurance executives take home million dollar bonuses. Its maddening.
10
"In effect, the middle class is the one subsidizing the poor. "
And the democrats are using obamacare to buy the votes of the poor with middle class money.
And the democrats are using obamacare to buy the votes of the poor with middle class money.
8
The rich don't get off 'scot free'. They probably pay $800 a month or $1200 a month, but that is much less burdensome if you make $25K a month. But, on the other hand, it is still real after-tax money that they could have used to spend on something else.
1
I am in a govt. defined pension plan (just like all the HYPOCRITES in congress that want to kill ACA) and once I vested,I will have decent health care until I die. Lucky me. My premiums and co-pays have gone way, way up over the years. But I am OK with that. Why ? Because my friend's son was diagnosed with rare incurable Stage 4 cancer at 21. That was 2 years ago. He is responding very well to treatment now, and he can stay on his Mom's insurance for a few more years and then not be denied coverage after that. I shudder to think of what this great kid would have been faced with if not for ACA.
14
As a nurse, when I hear Paul Ryan talk about "patient centered care" I would love to ask him what he means.
He knows nothing about patient care plans. He knows nothing about specific patient procedures. He knows nothing about costs of routine patient diagnostics, preventative or otherwise.
So then throw in healthcare to be overseen by a wealthy doctor, Tom Price. He has been a legislator for twelve years and despises the Affordable Care Act.
He doesn't really know anything about patient centered care these days either, like going in to talk to real patients who may have to lose their homes to receive chemotherapy. What he knows about patient care is buying stocks for products that he knows may somehow legally or not put money in his own pocket. And he should be Secretary of Health and Human Services?
Fact is, the naysayers know nothing about patient centered care. They can't even describe it, let alone uphold it. And if they are willing to repeal the ACA and allow the predicted 43,000+ patients die per year because they have the ACA taken away, they don't care about patient centered care, either.
He knows nothing about patient care plans. He knows nothing about specific patient procedures. He knows nothing about costs of routine patient diagnostics, preventative or otherwise.
So then throw in healthcare to be overseen by a wealthy doctor, Tom Price. He has been a legislator for twelve years and despises the Affordable Care Act.
He doesn't really know anything about patient centered care these days either, like going in to talk to real patients who may have to lose their homes to receive chemotherapy. What he knows about patient care is buying stocks for products that he knows may somehow legally or not put money in his own pocket. And he should be Secretary of Health and Human Services?
Fact is, the naysayers know nothing about patient centered care. They can't even describe it, let alone uphold it. And if they are willing to repeal the ACA and allow the predicted 43,000+ patients die per year because they have the ACA taken away, they don't care about patient centered care, either.
24
We need to separate the words Health and Insurance. It needs to be called Health Coverage and the idea that this basic right should be some kind of gamble put to rest. Calculate how much it would cost to provide reasonable health coverage for everyone in the nation and obtain the funds to implement it by applying a tiered tax to everyone. The very wealthy should be taxed at higher percentages because they benefit proportionally more from the workforce and have a responsibility to fulfill the social contract between employers and employees.
8
And on that point the rich should pay the full boat cost of the defense department, because it is the rich, and their business interests, that are "defended" when we go to war. No communist ever threatened me during the Cold War, no Vietnamese ever did, nor any Iraqi. What gets threatened is business activity, and I don't own stock.
2
It is obvious what the Republicans really detest about ObamaCare is that it raised taxes on the high income people in this country, which are their primary constituency.
I pay a little less than $300 per month and I have just found out that I do not have to pay for routine prescriptions. So yeah! I have a little less than two years to go until MediCare kicks in, something I have been paying into and looking forward to for the 40 years of working life. Soooooo, I want 'government hands IN my Medicare.'
I pay a little less than $300 per month and I have just found out that I do not have to pay for routine prescriptions. So yeah! I have a little less than two years to go until MediCare kicks in, something I have been paying into and looking forward to for the 40 years of working life. Soooooo, I want 'government hands IN my Medicare.'
7
Conservatives legitimately dislike the mandate too. And the threat to insurer's bottom lines, and the forced competition. There's plenty to dislike. If you pay $300 a month for drugs you are a cash cow for those people.
i have been with kaiser since the mid 70's. before there was the ACA my yearly cost went up rather rapidly some years. since this national system has been in place my yearly cost has barely budged. now i have been buying it on my own for many years. in 18 months i get medicare. yippee. hope it is still there in 18 months.
4
I was unable to get private insurance because of a pre-existing condition. I signed up under the Affordable Care Act and not only have my medical costs significantly lowered, I now receive preventative care and regular physical exams, which I had not received for years. There is no doubt in my mind that the ACA has been a positive contribution to my life.
15
The lesson from Obamacare is that single payer healthcare is the only system that works.
If you are middle class, Obamacare was a complete failure. My partner and I pay $800 a month in premiums with no subsidies. The insurance also doesnt even cover the medication that I take. They tried to push me into a generic knockoff with a different formulation, and it made me so sick I had to go to the emergency room. Now, I pay another $300 a month for the medication I take. Our $800 a month premiums, in effect, cover nothing because it still costs me the full price for the medication I take.
Obamacare is only a good thing if you are poor. Everyone in the middle class is subsidizing the incredible cost of healthcare for the poor, while rich people dont have to pay an extra dime. Insurance companies still make huge profits, and they still refuse to cover things like my medicine, even though we have a Gold level plan. Its just such a huge waste of money.
If you are middle class, Obamacare was a complete failure. My partner and I pay $800 a month in premiums with no subsidies. The insurance also doesnt even cover the medication that I take. They tried to push me into a generic knockoff with a different formulation, and it made me so sick I had to go to the emergency room. Now, I pay another $300 a month for the medication I take. Our $800 a month premiums, in effect, cover nothing because it still costs me the full price for the medication I take.
Obamacare is only a good thing if you are poor. Everyone in the middle class is subsidizing the incredible cost of healthcare for the poor, while rich people dont have to pay an extra dime. Insurance companies still make huge profits, and they still refuse to cover things like my medicine, even though we have a Gold level plan. Its just such a huge waste of money.
7
Medicare provisions introduced as part of Obamacare:
Provide free coverage for some preventive benefits, such as screenings for breast and colorectal cancer, cardiovascular disease, and diabetes and flu and pneumonia shots.
Closing the coverage gap (or “doughnut hole”) in the Part D drug benefit by 2020. During the coverage gap before Obamacare you paid 100% out-of-pocket while in the donut hole. After Obamacare in 2017, you pay 40% for brand-name drugs and 51% for generics while in the donut hole.
Reduced the cost of drugs.
Made Medicare solvent:
By reforms in the payment and delivery systems of doctors, hospitals and health care providers.
Established new sources of revenue dedicated to the Medicare program, including an increase in the Medicare payroll tax on earnings of higher-income workers.
Higher income beneficiaries pay income related premiums for coverage.
Don’t let Congress repeal Obamacare and with it these provisions that make Medicare affordable and solvent for 57 million seniors.
Provide free coverage for some preventive benefits, such as screenings for breast and colorectal cancer, cardiovascular disease, and diabetes and flu and pneumonia shots.
Closing the coverage gap (or “doughnut hole”) in the Part D drug benefit by 2020. During the coverage gap before Obamacare you paid 100% out-of-pocket while in the donut hole. After Obamacare in 2017, you pay 40% for brand-name drugs and 51% for generics while in the donut hole.
Reduced the cost of drugs.
Made Medicare solvent:
By reforms in the payment and delivery systems of doctors, hospitals and health care providers.
Established new sources of revenue dedicated to the Medicare program, including an increase in the Medicare payroll tax on earnings of higher-income workers.
Higher income beneficiaries pay income related premiums for coverage.
Don’t let Congress repeal Obamacare and with it these provisions that make Medicare affordable and solvent for 57 million seniors.
7
I think we can all agree that everyone needs health care. The debate is over how we pay for it. Fostering the responsibility off on the employers of America makes it very difficult for American businesses to compete in the global marketplace. It also leaves out the self employed and the unemployed. It seems to me it would be far more fair and inclusive to pay for our health care system with a value added tax. Everyone contributes and everyone receives health care. We also need to look at why health care in America costs so much more than the rest of the world.
9
The lesson from this and related articles is clear. Those at the lower end of the income scale (250% or less of poverty) have reported much higher rates of satisfaction with Obamacare because the costs to them, as a percentage of income, remain affordable. Those at or above 300% of poverty have generally reported much less satisfaction with Obamacare due to too high premiums ($5,000 to $7,000 per year) and sometimes completely unrealistice deductables of around $12,000.00 per year. The choice is do we want to spend the extra hundreds of billions of dollars (over a 10 year period) and tax ourselves accordingly to provide affordable insurance to substantially everyone or does the status quo or something less suffice? Because I believe that access to heath care is a right, I would vote for higher taxes and better insurance.
5
I appreciate your willingness to pay higher taxes for a public good but I don't think we need to make so severe a choice. In this country the administrative costs of private health insurance absorb 17% of all money spent in that system on health care. The corresponding costs in Medicare are 5-6% of total spending. By offering employers currently ensuring employees through private insurers, a chance to do so through Medicare we could, as a nation, save vast sums on health care expenditures both by reducing administrative costs and through the leverage that Medicare could exert on providers to reduce costs.
3
If you are afraid of higher taxes, consider how that would be offset by the reduction in health care spending. I doubt that those who have suffered from high premiums and tax penalties would complain if that spending was significantly reduced by universal medicare coverage.
1
Logically, I agree with you. Unfortunately, given the realistic political constraints for the foreseeable future coming from the Republican Party, the best that we can hope for is some version of Obamacare with substantial private insurance company participation. The primary issue will be the amount of subsidies and/ or credits to a health savings account.
Romney/Baucus care would be more fair. One might add Roberts care because of the Supreme Court's interference in the law. Since the US manifestly rejects the notion that the state through taxation take care of health care, consumers are left with self interested businesses that allow profitability to be a major factor in health insurance policy.
2
Republicans are beginning to realize: the horse is out of the barn. America demands universal health care, like all the other advanced nations on earth. The ACA is deeply flawed, but we know what the flaws are. It's too late to go back. Let's just fix the thing, and move on. Trying to fight it now will be more expensive than repairing it.
9
Margot, you identify three areas where Obamacare failed. Remember, the main purpose of the ACA was to improve the individual health insurance market, not to create a market to rival employer provided health insurance. Employer provided insurance covers a much more stable and healthy group. Your "failures" of Obamacare are actually clear improvements over the pre ACA individual health insurance marketplace:
"Health insurance remains very expensive." Health insurance, pre ACA, was not even available in the individual market to those with serious health problems. Anyone of average means who developed a serious health problem was one job away from losing everything. If avoiding this seems expensive, consider the pre ACA alternative.
"The health care system remains complex and confusing." Navigating the healthcare system without insurance, pre ACA, was complex, confusing and financially devastating.
"If you like your plan, you can’t always keep your plan." Pre ACA, you had to keep your job to keep guaranteed coverage. In the financial crises, many lost both. If Congress would support the ACA, you would ar least be able to keep "a"plan, if not "your" plan.
The primary flaw with Obamacare is that it depends on a Congress full of saboteurs. Let's fix it and stop trying to kill it before we pass judgement.
"Health insurance remains very expensive." Health insurance, pre ACA, was not even available in the individual market to those with serious health problems. Anyone of average means who developed a serious health problem was one job away from losing everything. If avoiding this seems expensive, consider the pre ACA alternative.
"The health care system remains complex and confusing." Navigating the healthcare system without insurance, pre ACA, was complex, confusing and financially devastating.
"If you like your plan, you can’t always keep your plan." Pre ACA, you had to keep your job to keep guaranteed coverage. In the financial crises, many lost both. If Congress would support the ACA, you would ar least be able to keep "a"plan, if not "your" plan.
The primary flaw with Obamacare is that it depends on a Congress full of saboteurs. Let's fix it and stop trying to kill it before we pass judgement.
19
Single-payer or bust.
8
My premiums tripled and my choices are severely limited. For me, huge fail. Unless someone does something to get the costs of care down(take on big pharma for example) , insurance will become more and more unaffordable.
9
The (literal) elephant in the room is the American obesity epidemic.
No health insurance program is viable if a third of the population has a pre-existing condition.
No health insurance program is viable if a third of the population has a pre-existing condition.
5
Actually, studies have shown that the US and Europe have about the same number of medical procedures per capita. Americans do not seem to be any less healthy than Europeans living where medical costs are half as much.
The real problem is that each medical procedure in the US costs 2 to 3 times as much as the same procedure in Europe.
The real problem is that each medical procedure in the US costs 2 to 3 times as much as the same procedure in Europe.
What this article leaves out is the notion that the ACA has helped a lot of the working poor and lower middle class along with the chronically ill self employed, and that this group tends to vote for Democrats if they vote at all. On the flip side the ACA has caused a lot of upper middle class small business people to loose insurance they liked and forced them to replace it with an alternative that costs more and doesn't work as well for them, and that outside of major metropolitan areas this group is reliably Republican and always votes.
6
The choice need not be one of keeping ACA or replacing it. We could do both. If you like your ACA insurance, keep it. If you do not like the ACA, you can opt to buy health insurance better tailored and priced to your needs, such as covering only catastrophic events. Or if you are comfortable with the risk, no insurance at all.
2
The ACA when enacted was a new law. Overtime all new laws require fixes. At one point Obama was asked how he rated the ACA after it had been in place for awhile. He responded on a scale of 1 to 10 it rated an 8.
The Republicans were/are only interested in repeal not fix.
The only fix in our healthcare system is single payer.
The Republicans were/are only interested in repeal not fix.
The only fix in our healthcare system is single payer.
4
Eliminating the layers of profit from the system would do wonders to reducing the cost of healthcare. Pharma, insurance, doctors all getting rich off of patients.
2
Without profit there would be no Pharma or doctors and no profits for the government to tax.
1
A bit of history might be in order to put President Obama's accomplishment into perspective.
Teddy Roosevelt wanted a government health insurance program, but his term ran out, and he had already pledged not to run for another term
Franklin Roosevelt promised a health insurance program after the War, but died before its end
Truman wanted a health insurance program, but was stymied by the "do nothing" Congress, postwar recession and McCarthyite hysteria about government aid programs
The Clintons attempted a government health program, but were stymied by insurance and drug lobbies and professional organizations, and cooking up a complicated plan in the dark
George W. Bush got Medicare Part D passed, but only after failing to properly fund it and placing constraints on the program's ability to negotiate prices
President Obama got it done, warts and all, despite a unanimous wall of opposition from Republicans. Its shortcomings are largely due to having to capitulate to pressures from lobbyists and conservative Democrats.
The main problem was it, like most government programs, it over-promised and under-delivered - just like aircraft carriers and jets. It counted on two impossible conditions: 1) that sufficient numbers of healthy people will create a balanced insurance pool and 2) that the newly enrolled would have more or less the same healthy status as their age/sex matched cohorts. Neither was true, and so the programs ran into financial trouble.
Teddy Roosevelt wanted a government health insurance program, but his term ran out, and he had already pledged not to run for another term
Franklin Roosevelt promised a health insurance program after the War, but died before its end
Truman wanted a health insurance program, but was stymied by the "do nothing" Congress, postwar recession and McCarthyite hysteria about government aid programs
The Clintons attempted a government health program, but were stymied by insurance and drug lobbies and professional organizations, and cooking up a complicated plan in the dark
George W. Bush got Medicare Part D passed, but only after failing to properly fund it and placing constraints on the program's ability to negotiate prices
President Obama got it done, warts and all, despite a unanimous wall of opposition from Republicans. Its shortcomings are largely due to having to capitulate to pressures from lobbyists and conservative Democrats.
The main problem was it, like most government programs, it over-promised and under-delivered - just like aircraft carriers and jets. It counted on two impossible conditions: 1) that sufficient numbers of healthy people will create a balanced insurance pool and 2) that the newly enrolled would have more or less the same healthy status as their age/sex matched cohorts. Neither was true, and so the programs ran into financial trouble.
14
I think you are skirting around the main issue, namely the high cost of anything related to health care in this country.
I have been on good employer provided insurance for over 40 years. At least every other year costs would go up a lot more than inflation.
Currently, I am on a high deductible plan, where I pay around $100 a month, but my deductible is about $6000 and the out of pocket is $12000. It is a good plan for us only because we are really healthy.
This is on a employer plan, where everybody joins and people are relatively healthier than the poor people on the street.
Health insurance costs will keep going up forever, given that we have to pay the highest doctor's salaries in the world; the highest hospital costs, the highest drug prices, and the fanciest medical equipment.
How can you run an efficient system when you pay $500,000 to a hospital CEO?
The Aetna CEO earned 36 million in 2012, including options and stuff like that.
I have been on good employer provided insurance for over 40 years. At least every other year costs would go up a lot more than inflation.
Currently, I am on a high deductible plan, where I pay around $100 a month, but my deductible is about $6000 and the out of pocket is $12000. It is a good plan for us only because we are really healthy.
This is on a employer plan, where everybody joins and people are relatively healthier than the poor people on the street.
Health insurance costs will keep going up forever, given that we have to pay the highest doctor's salaries in the world; the highest hospital costs, the highest drug prices, and the fanciest medical equipment.
How can you run an efficient system when you pay $500,000 to a hospital CEO?
The Aetna CEO earned 36 million in 2012, including options and stuff like that.
14
Until every American embraces the concept that their healthcare is a basic human right and not a commodity to be bought and sold, nothing will change. What other first world country thinks that it is only acceptable for someone to be entitled to good healthcare just because of where they are employed? That person's family might even be covered, (whether their spouse works or not), well that's just fine. However, the guy who works full-time hours holding down multiple part-time jobs--well he is not considered worthy of affordable healthcare. At least Obamacare tried to address some of those issues.
Many people have complained about their premiums increasing because of Obamacare. What members of Congress did anything to address this? How were insurance companies held accountable regarding costs and profits? Instead of working on solutions, their only concern was about trying to repeal the ACA sixty times. Before Obamacare, for years the only insurance I could buy was a major medical policy called "ValueMed". It was not accepted by most doctors. It did not cover office visits, prescriptions, lab tests. Only catastrophic hospital care. By 2006, my premiums were so expensive (compared to my income) that I cancelled my insurance. I had no insurance, no doctor, no care for 8 years until Obamacare started in 2014. It is a terrible feeling to have to live this way. I am not looking forward to losing access to a doctor again.
Many people have complained about their premiums increasing because of Obamacare. What members of Congress did anything to address this? How were insurance companies held accountable regarding costs and profits? Instead of working on solutions, their only concern was about trying to repeal the ACA sixty times. Before Obamacare, for years the only insurance I could buy was a major medical policy called "ValueMed". It was not accepted by most doctors. It did not cover office visits, prescriptions, lab tests. Only catastrophic hospital care. By 2006, my premiums were so expensive (compared to my income) that I cancelled my insurance. I had no insurance, no doctor, no care for 8 years until Obamacare started in 2014. It is a terrible feeling to have to live this way. I am not looking forward to losing access to a doctor again.
9
I don't want anyone going without care, but I don't want to have to sell my house to subsidize others, either--especially if they smoke or are obese or use drugs or have more than 2 children.
If costs were lower, we could all forgo insurance except for catastrophic coverage. I see one doctor who doesn't take insurance; he charges around $45 for an exam, for example. So it's a possible scenario if doctors are incentivized (this particular doctor is 90 and works half days a few days a week, so money isn't his big concern).
Obama could have attacked costs, but he decided instead to redistribute thousands upon thousands of dollars from anyone with a job to insurance companies. Bad call, and it cost the Dems the Supreme Court.
If costs were lower, we could all forgo insurance except for catastrophic coverage. I see one doctor who doesn't take insurance; he charges around $45 for an exam, for example. So it's a possible scenario if doctors are incentivized (this particular doctor is 90 and works half days a few days a week, so money isn't his big concern).
Obama could have attacked costs, but he decided instead to redistribute thousands upon thousands of dollars from anyone with a job to insurance companies. Bad call, and it cost the Dems the Supreme Court.
4
" I don't want to have to sell my house to subsidize others, either--especially if they smoke or are obese or use drugs or have more than 2 children."
We should also not have to subsidize "free" health care for parasitic illegal aliens and "refugees".
We should also not have to subsidize "free" health care for parasitic illegal aliens and "refugees".
4
It can't just be a basic human right. You are in charge of your health, try live a healthy life instead of others pay huge bills when you got yourself sick!
1
Obamacare was bold and needed. But it failed in part because we still allow companies and government to compete with the single payer system. To work we need to level the playing field for all and remove the option for these institutions to pay for these services. Only then can you create a marketplace that works and where local governments can choose what is and is not covered and how to cover the cost for those that need it.
The ACA has certainly worked for me. I found a plan with a premium within my budget and I kept the same doctor I've had for 15 years. The only change I encountered between 2016 and 2017 was a slight increase in both premium and deductible, but not enough to force me to change plans. My prescriptions are only $10 (generic price) and I pay a co-pay of $25 for my primary doctor and $35 for a specialist. I am retired, too young for Medicare and work part-time. I live on my social security and part-time salary, so I'm certainly not rich.
I don't really understand why the ACA seems to be ok for me, but so many others hate it. It must be the difference state to state, which is not the fault of Obama, but is the fault of various state legislatures, which wanted the ACA to fail and so limited the offerings their citizens had access to. My state wanted the ACA to succeed and our legislature made sure we had choices.
I don't really understand why the ACA seems to be ok for me, but so many others hate it. It must be the difference state to state, which is not the fault of Obama, but is the fault of various state legislatures, which wanted the ACA to fail and so limited the offerings their citizens had access to. My state wanted the ACA to succeed and our legislature made sure we had choices.
15
Congratulations on living in a state that values affordable health care for its residents. State boundaries seem to be the critical 'walls' between reasonable health care insurance and deplorable health care insurance.
I would like to see a state-by-state comparison. Perhaps it already exists?
I would like to see a state-by-state comparison. Perhaps it already exists?
3
Possibly you get a subsidy, meaning taxpayers and middle class earners who are paying huge premiums for individual policies are paying for people paying cheap premiums.
4
People who get subsidies either conveniently forget that the money comes out of their neighbor's pocket or simply don't care.
I'm not saying this is true of MsPea.
I'm not saying this is true of MsPea.
6
The cost of health insurance is always going to be the cost to pay claims plus the cost to administer the system, including profits for health insurers, adjusted for whatever investment income is earned while cash is held before it is disbursed to pay claims, operating expenses and returns to investors. What Warren Buffet calls float. The only way to lower premiums is to reduce claim payments, operating expenses or returns to shareholders. The basic math of this seems to get very little attention in discussions of the cost to consumers. It should be obvious that the 25%(minimum) operating expense factor which includes multi-million $$ executive compensation is the low hanging fruit. It also seems obvious that single payer would be the least cost way to administer the system. Once that reality is faced the out of pocket cost to consumers (deductibles) can be considered. Why not a % of adjusted gross income such as currently required to take medical deductions when filing income tax? Things such as medical savings accounts or high deductible plans should be available for those with personal financial resources to afford it. The only things we seem to lack are political will and the ability to face reality.
2
Why not worry about reducing the cost of actual health care, instead of trying to cut insurance costs? Under the ACA, at least 80% of the costs must be coming from actual care, so that's where the bulk of the savings would be.
1
One thing is for sure, healthcare is much better than it was before the law went into effect, especially for self employed individuals, it as a life saver.
7
The main failure of Obamacare that is rarely mentioned is the failure to provide for additional doctors to take care of the 20 million newly insured. There are many foreign-trained doctors who are ready to pick the slack (more like try to bridge the gulf), but the bottleneck is the residency training programs, which are funded by the government. We had a shortage of primary care doctors before 20 million were given insurance. So, 20 million people were not given insurance, only an insurance card since they cannot find a doctor to take care of them and still end up in emergency rooms. This makes Obamacare a cynical ploy by the politicians who famously proclaimed, "we need to pass this bill to find out what's in it".
6
I give ObamaCare a "C". Doing nothing would have been a D, and a Republican plan of further tax cuts for the wealthy and social service cuts for the poor would be an F. ObamaCare gets credit for extending health care to some of the poorest Americans. It used a very progressive tax scheme. However, it did not lower health care costs for Americans overall, it left many, many Americans uninsured and it lined the pockets of doctors and health care administrators, arguably the richest of Americans. In other words it tended to comfort the comfortable while allowing them to continue to afflict the afflicted. It also did relatively little for the middle class.
2
In terms of covering citizens who previous to Obamacare had no healthcare coverage; bravo. But for those of us who carried the weight, sorry but in my personal experience the answer if no.
I am an extremely healthy 63 year old. My health insurance premium went from $400 per month to $1200+ per month. Repeat, $1200 per month. And I am healthy. Over the years that the law went into effect I have been to the doctor ONCE.
I am an extremely healthy 63 year old. My health insurance premium went from $400 per month to $1200+ per month. Repeat, $1200 per month. And I am healthy. Over the years that the law went into effect I have been to the doctor ONCE.
6
Because Obama and ACA defenders can say 75 percent of folks got affordable care. Because you are in the minority, you are merely a casualty, and nobody cares you are paying through the nose for a bad plan.
6
I too, am a healthy So. Calif. 63 yr old female but my (quite good) Anthem Ins. went down with Obamacare -- not significantly but from $954 to $922 a month. I have no idea why, neither did the Anthem agent.
I'm happy with my insurance (while acknowledging its very high), but it would be nice to know why you had your rate increase Debbie & I didn't.
That's why Universal health would make more sense, wouldn't have these huge discrepancies?
I'm happy with my insurance (while acknowledging its very high), but it would be nice to know why you had your rate increase Debbie & I didn't.
That's why Universal health would make more sense, wouldn't have these huge discrepancies?
3
I am also 63, and I'm paying $715 for my corporate retiree plan.
Corporate pink: "I see you qualify for the subsidized rate, so your cost as a single will only be $715 for medical, dental, and vision."
Me: "Hmmmm.....how much do the unsubsidized people haf to pay?"
Corporate pink: "Oh, they're paying about $1400...."
It's good insurance, with a large network of top doctors- I have been seen by doctors who are full professors at major medical schools. The annual deductible is $2750, so I could do worse.
Corporate pink: "I see you qualify for the subsidized rate, so your cost as a single will only be $715 for medical, dental, and vision."
Me: "Hmmmm.....how much do the unsubsidized people haf to pay?"
Corporate pink: "Oh, they're paying about $1400...."
It's good insurance, with a large network of top doctors- I have been seen by doctors who are full professors at major medical schools. The annual deductible is $2750, so I could do worse.
One failure of the Affordable Care Act became apparent when Massachusetts had to replace their highly functioning online health exchange with one that met the federal law's requirements that did not work and cost taxpayers millions to replace. Healthcare is local, and onerous one size fits all federal policies always have unintended consequences. Give power back to the states and cities where the people can decide how they want to pay for and deliver health care. San Francisco can decide that universal coverage is the way to go while Texas can decide its own fate. This would be democracy in action, with local elected officials creating policies that their constituents demand. Constituents, on the other hand, have the responsibility to know the facts and understand the issues they are voting on, something sorely lacking in the era of 'alternative facts.'
2
Well I don't live in Massachusetts & don't know didly about their health insurance situation. Do you actually know anything? You certainly haven't given us any specifics, just generalities about federalism. Are you talking about the rocky roll-out of the ACA? We are past that now & you'll need something that's still active.
Should Social Security & Medicare be abolished so the states can each design their own structures?
Should Social Security & Medicare be abolished so the states can each design their own structures?
2
Until recently, the countries that provided services (such as day care, paid maternity leave, and health care) to their residents were very careful to limit who could become residents. Social services and health care are too expensive to provide for every migrant who wanted to move in.
Canada and some Western European countries have offered universal services and health care. Now that they have been admitting thousands of poorly educated refugees, it will be harder for them to sustain these services.
President Obama was called “liar” on the Senate floor for saying his health insurance plan would not be available to illegal immigrants. But now, the governor of California has signed a bill making illegal immigrants eligible for Obamacare.
Illegal immigrants have displaced many American workers and legal immigrants from the work force. Thanks to our Free Trade bills and automation, we have fewer low and unskilled jobs. Illegal immigrants have scooped up many of the remaining jobs. The idea that illegal immigrants should also be able to enroll in Obamacare is unethical. Mexico has plenty of resources, but most of them are controlled by the Mexican wealthy. The illegal immigrants should return to their own countries and demand that the economies be liberalized so it would be easier for them to make a living there. Americans should not have to subsidize the Mexican oligarchs by letting poor, uneducated Mexicans take our jobs and use our government services.
Canada and some Western European countries have offered universal services and health care. Now that they have been admitting thousands of poorly educated refugees, it will be harder for them to sustain these services.
President Obama was called “liar” on the Senate floor for saying his health insurance plan would not be available to illegal immigrants. But now, the governor of California has signed a bill making illegal immigrants eligible for Obamacare.
Illegal immigrants have displaced many American workers and legal immigrants from the work force. Thanks to our Free Trade bills and automation, we have fewer low and unskilled jobs. Illegal immigrants have scooped up many of the remaining jobs. The idea that illegal immigrants should also be able to enroll in Obamacare is unethical. Mexico has plenty of resources, but most of them are controlled by the Mexican wealthy. The illegal immigrants should return to their own countries and demand that the economies be liberalized so it would be easier for them to make a living there. Americans should not have to subsidize the Mexican oligarchs by letting poor, uneducated Mexicans take our jobs and use our government services.
6
I wouldn't worry about it if I were you. The Republicans will soon put an end to taxpayer-funded medical treatment, not only for illegal immigrants, but for many American citizens, as well. Republicans believe that, as Trump has made clear, only those who contribute and can pay their own way are entitled to anything, including medical care. Hospitals and doctors will be free to turn away those without insurance or the means to pay the bills, so your precious tax dollars will be put to much better use, like paying for Trump's sons' business trips abroad.
7
Funny that I live in California & haven't heard a peep about this supposed new law that Jerry supposedly signed. What's the name of this "law" which I suspect doesn't exist in any form whatsoever? My understanding is that Federal law prohibits any ACA spending on folks who ain't here legally & Federal law, of course, takes precedence over stater law.
But do you even care if what you're saying is true? Or are you happy with your alternative facts?
But do you even care if what you're saying is true? Or are you happy with your alternative facts?
7
A year and a half ago, Governor Brown signed a bill extending Medi-Cal to illegal immigrants under the age of 19. Medi-Cal is California’s version of Medicaid. The federal government pays half of Medi-Cal’s costs.
This past June, Brown signed another bill. This one requests a waiver from the federal government to let illegal immigrants buy insurance on the health exchange. Obamacare allows for such waivers. While the Ca. waiver would not offer either federal or state subsidies to illegal immigrants, at this time, according to an article in U.S.News and Report , titled “California Moves Toward Extending Obamacare to Illegal Immigrants”, written by Kimberly Leonard, on 6/3/16, the spokesman for the Ca. state senator Ricardo Lara, who sponsored the bill, said whether or not the state would subsidize low-income illegal immigrants would be part of on-going discussions.
This past June, Brown signed another bill. This one requests a waiver from the federal government to let illegal immigrants buy insurance on the health exchange. Obamacare allows for such waivers. While the Ca. waiver would not offer either federal or state subsidies to illegal immigrants, at this time, according to an article in U.S.News and Report , titled “California Moves Toward Extending Obamacare to Illegal Immigrants”, written by Kimberly Leonard, on 6/3/16, the spokesman for the Ca. state senator Ricardo Lara, who sponsored the bill, said whether or not the state would subsidize low-income illegal immigrants would be part of on-going discussions.
1
The cost of healthcare should be in the "Too soon to tell" category. Insurers knew that their costs would rise for the first few years as people who had been sick but unable to afford care entered the system. Over time, the number of people in that category is bound to shrink along with the percentage of people needing costly care. I think that the increased premiums still reflect the first part of this transition not the second.
2
Of the 20 million or more people with Obamacare, how many receive insurance through expanded Medicaid? How many receive substantial subsidies and help with deductibles? How many actually must pay the high premiums and/or deductibles out of pocket? The last category is painful or unaffordable for those within it, but a relatively low percentage of Obamacare consumers, I think. Rather than dump Obamacare, we need to tweak it. Add a public option in states that don't have enough competition. Raise the income levels to include more people to receive subsidies. Simplify the system so that it is easier to use. Raise taxes on our wealthiest citizens to pay for the improvements. The only other good option for our nation is a single-payer system, basically Medicare for all.
5
It's a mixed bag.
It helps those who had no hope of coverage either because of poverty or pre-exisiting conditions.
But the expanded coverage brought more sick people into the pools and that raised premiums. As it happens, ignoring the people who need the most care is cost effective for people who don't need care.
The question those who hate the ACA have to ask themselves is this: can the old system still work?
If fewer people have corporate and manufacturing jobs, more people have service jobs, jobs with small business, part time jobs, independent contract jobs, can we still have an individual market that will not provide care to people who are sick, have been sick in the past, are older, are any kind of risk? In other words, if more and more people start to fall outside of the coverage provided by job- based insurance, so that the number grows from the pre-ACA 50 million to say 60M or 100M, can the old system work?
The ACA was a reaction to a new reality, a new type of economy. We can repeal the ACA, but we cannot repeal reality. And that is where the argument should start.
It helps those who had no hope of coverage either because of poverty or pre-exisiting conditions.
But the expanded coverage brought more sick people into the pools and that raised premiums. As it happens, ignoring the people who need the most care is cost effective for people who don't need care.
The question those who hate the ACA have to ask themselves is this: can the old system still work?
If fewer people have corporate and manufacturing jobs, more people have service jobs, jobs with small business, part time jobs, independent contract jobs, can we still have an individual market that will not provide care to people who are sick, have been sick in the past, are older, are any kind of risk? In other words, if more and more people start to fall outside of the coverage provided by job- based insurance, so that the number grows from the pre-ACA 50 million to say 60M or 100M, can the old system work?
The ACA was a reaction to a new reality, a new type of economy. We can repeal the ACA, but we cannot repeal reality. And that is where the argument should start.
8
1- Single payer -easier administration less cost. Insurance forms simple. Medicare 50% cheaper to administer then private already. 60% of the health care in this country paid by government without Obama care.
2- Health care costs due to the unregulated charges of Drugs and providers, no controls, no reasons for charges. In Europe the same drugs 6X cheaper due to controls. Our drug companies spend more on advertising then research.
3- We can afford single payer and it will save most thousands of dollars. See letusbeawarefolks.blogspot.com-Can we afford single payer health care?
2- Health care costs due to the unregulated charges of Drugs and providers, no controls, no reasons for charges. In Europe the same drugs 6X cheaper due to controls. Our drug companies spend more on advertising then research.
3- We can afford single payer and it will save most thousands of dollars. See letusbeawarefolks.blogspot.com-Can we afford single payer health care?
2
I have been a physician in practice for 50 years. I believe I am as well-credentialed and as experienced as one can be. I understand most political and social points of view. I love science, medical practice, people, and America. So I am allowed to voice this opinion: the only rational and potentially enduring means of financing health care is a "single-payer"system. Unfortunately, in order to get the ACA into law it was politically necessary in include private insurance companies (very much for their profit!) in the mix. Those companies benefit from extremely high deductibles, premiums, co-payments etc. Not the public. It's private enterprise with some government involvement. They are profiting while those who cannot afford insurance become worse off. Getting heath care finances out of the private sector is the only way to make our system work better.
20
In most countries with so-called single payer, including Germany and Switzerland which really have compulsary insurance plans, doctors make much lower incomes than they do in the US. For example, in Switzerland, a very wealthy country, the average income of a specialist MD is $135K, compared to $245K in the US.
Would American doctors really be willing to accept much lower pay in a single-payer system in the US?
Would American doctors really be willing to accept much lower pay in a single-payer system in the US?
If you want cheaper health care, you're going to half to take money out of one or more of the many pockets that have been built into the current system over the past 90 years, ACA or not, and they are likely to raise a bit of a fuss over it. Volunteers?
2
Everyone will say they are fairly paid, it is the other guys who are robbing the country blind.
All doctors must be induced to take all insurance plans. Then we might see some real free marketplace competition. Republicans want people to "shop around," but when you live in a city of one million and there is only one gastroenterologist that takes your plan, there is no shopping to be done. And what if that one gastroenterologist is the worst doctor you've ever encountered in your life, and you'd rather be examined by a rabid racoon than have him touch you again? This whole baloney about "shopping around" and "choice" is exactly that, if you have no power to induce doctors to accept insurance that they think underpays them. Single-payer for all, with no exceptions! Either that, or no options for doctors to turn patients away because they don't have the "right" insurance!
7
Doctors could game that fairly easily. "Oh, the next available appointment is on September 7, shall we put you down for it?" In the meantime, cash payers can be seen on the same day.
1
All the more reason why single-payer for ALL is the only real answer.
1
Candidate Obama was opposed to the individual and employer mandate and favored a robust public option.
President Obama was for both mandates and opposed to any public option.
Obamacare began as the conservative Republican Party Heritage Foundation's free market capitalist response to the failed Clinton Administration's era failed health care reform. Mitt Romney used it in Massachusetts. And Republicans favored it until the Kenyan Luo Muslim Arab socialist usurper infected it.
Obamacare puts private profit bureaucrats between the people and their medical health care provider personal medical care health decisions. Limited options, high premiums and deductibles make this catastrophic care.
Single payer today! Single payer tomorrow!
President Obama was for both mandates and opposed to any public option.
Obamacare began as the conservative Republican Party Heritage Foundation's free market capitalist response to the failed Clinton Administration's era failed health care reform. Mitt Romney used it in Massachusetts. And Republicans favored it until the Kenyan Luo Muslim Arab socialist usurper infected it.
Obamacare puts private profit bureaucrats between the people and their medical health care provider personal medical care health decisions. Limited options, high premiums and deductibles make this catastrophic care.
Single payer today! Single payer tomorrow!
7
How can reality be so misunderstood.
Obama care is a pure giveaway. Even f the goal were to just provide free health insurance to 20 million people, it is a failure. It could have been done far more cheaply and efficiently by just giving a subsidy to needy individuals and letting them make insurers compete for the money.
The reasons that it is an unmitigated failure is that it is unsustainable financially, it is inequitable to the bulk of society, it is unwanted in its present form by both insurers and most users who are not receiving it entirely free. It is a very poorly designed system which would collapse under its own weight. There is no success in keeping such a system alive. And, it is destructive of the (admittedly insufficient) insurance coverages previously available.
It is a success in revealing the insanity of putting a bunch of college professors, inexperienced freshly graduated aides and politicos in charge of designing a practical system.
Obama care is a pure giveaway. Even f the goal were to just provide free health insurance to 20 million people, it is a failure. It could have been done far more cheaply and efficiently by just giving a subsidy to needy individuals and letting them make insurers compete for the money.
The reasons that it is an unmitigated failure is that it is unsustainable financially, it is inequitable to the bulk of society, it is unwanted in its present form by both insurers and most users who are not receiving it entirely free. It is a very poorly designed system which would collapse under its own weight. There is no success in keeping such a system alive. And, it is destructive of the (admittedly insufficient) insurance coverages previously available.
It is a success in revealing the insanity of putting a bunch of college professors, inexperienced freshly graduated aides and politicos in charge of designing a practical system.
11
I would rather think it reveals the insanity of putting a gaggle of businesspeople in charge of deciding who gets care, and how much care, and for how long. Medicare is an extremely practical and successful system, and not expanding it to cover everyone is the real insanity.
3
The debate about Obamacare always has been a partisan debate, not a factual debate over pros and cons. Those who are opposed - for whatever reasons - may never support it. But they might support an alternative.
The majority of Americans do not support repeal without replacement. So let's replace the ACA with a law that maintains benefits of the winners and improves benefits of the losers under Obamacare.
Employer sponsored plans subsidize 50%-75% of premiums. Government sponsored plans subsidize more. The average enrollee in ACA that qualified for a subsidy in 2016 got 73%. So, let's give such subsidies to those who don't get them under the ACA.
Start with people up to age 34. They are the cheapest to subsidize. Subsidies are only given on the exchanges, so that would lower the risk profile of the exchanges and increase it outside the exchanges. Insurers would have to sell via the exchanges, which would reduce premiums and deductibles. Then expand the subsidies to the rest of adults who need private insurance.
re-draft the Medicaid expansion provision of the ACA to withstand Supreme Court challenge.
Cap the administrative costs + profits if drug companies like we do insurers today. Also use government purchasing power to negotiate lower drug prices. Healthcare costs would decrease for a lot of Americans.
Maintain the supplemental taxes upon insurers, drug companies, device makers (re-instate) and the wealthy to pay for it.
Fewer losers who can't afford it!
The majority of Americans do not support repeal without replacement. So let's replace the ACA with a law that maintains benefits of the winners and improves benefits of the losers under Obamacare.
Employer sponsored plans subsidize 50%-75% of premiums. Government sponsored plans subsidize more. The average enrollee in ACA that qualified for a subsidy in 2016 got 73%. So, let's give such subsidies to those who don't get them under the ACA.
Start with people up to age 34. They are the cheapest to subsidize. Subsidies are only given on the exchanges, so that would lower the risk profile of the exchanges and increase it outside the exchanges. Insurers would have to sell via the exchanges, which would reduce premiums and deductibles. Then expand the subsidies to the rest of adults who need private insurance.
re-draft the Medicaid expansion provision of the ACA to withstand Supreme Court challenge.
Cap the administrative costs + profits if drug companies like we do insurers today. Also use government purchasing power to negotiate lower drug prices. Healthcare costs would decrease for a lot of Americans.
Maintain the supplemental taxes upon insurers, drug companies, device makers (re-instate) and the wealthy to pay for it.
Fewer losers who can't afford it!
2
The high deductibles ought to have had means-based subsidies, the way the premiums did. A one percent income tax could have covered that.
1
I would add one more item to your list: prevention. Imagine how much lower our health care bills would be if everyone watched their diet, exercised regularly, and got enough sleep?
2
Even Mr Obama opined that the ACA was a work in progress and needed to be refined and improved. But, it has helped millions of people, and could be a lifesaver for millions more if Congress could get over its animus for anything Obama, and set aside its devotion to the service of the private sector.
15
Eighty percent of Obama Care is free money from the US taxpayers. If we want this health care program, then we must raise taxes to pay for it. Europeans and the Canadians have higher taxes to pay for their socialized health care. Next up, free food, free legal services, free tickets to the superbowl?
5
We Europeans have free health care and we do pay higher taxes. My husband recently had a long catastrophic illness, that was very expensive to treat. I think we would have lost our home in the United States. Here, now that he is back on his feet our life is nearly back to normal. France does not give out food stamps but families that need it are given help to cover food and school expenses. We actually do have free legal services for those who need it but I think that also exists in the US. No free tickets to sports events here as far as I know.
6
Let's think about what those "Europeans" who are alleged to pay higher taxes get for their money: excellent comprehensive health care at little to no further out-of-pocket cost, quality public education, good infrastructure including useable public transportation and modern airports, etc. People don't mind paying because they see the benefits they get.
10
Europeans also get a free ride on defense by not living up to their NATO commitments and letting the US pick up the slack. If the US did not do this Europeans would have to raise their taxes even higher to pay their "fair share" of NATO.
1
Let's see 20 million more Americans with medical insurance.
Before ACA Republican plan of be rich, don't get sick and/or don't have a bad event and put billionaire big phrama and HMO execs. over the public.
Any questions.
Before ACA Republican plan of be rich, don't get sick and/or don't have a bad event and put billionaire big phrama and HMO execs. over the public.
Any questions.
5
Missing in this article - as in most all others - is the fact that Democrats failed to stand up to the for-profit health insurance industry and big pharma when the law was passed - leaving a giant, gapping hole in the law's intention and omitting a PUBLIC OPTION (also known as Medicare-For-All). The A.C.A. - as a law - has never been complete without it. This is why "Obamacare" has "failed" and most everyone knows it regardless of whether or not the NYT is willing to print the fact.
The infrastructure for a Public Option or Medicare-For-All is already in place and the healthcare.gov site could have been easily piggy-backed onto existing government sites. But, no. As has been the case for the past few decades, Democrats have sided with their corporate benefactors in the health insurance industry AND NOT WITH THIER CONSTITUENTS! The result is healthcare for corporations, not people.
If the suffering of those who need it most didn't make me want to cry, I'd say that watching the industry melt down in the event of repeal may be the silver lining of this entire exercise. Those - however - will be tears of joy instead. A reminder to capitalists and health insurance executives/owners, where in the definition of medicine do you find the word profit?!?
You don't.
And until Democrats have the honesty to admit that they have failed their constituents and the country on this issue, perhaps the better their chances at becoming a viable national political party again someday.
The infrastructure for a Public Option or Medicare-For-All is already in place and the healthcare.gov site could have been easily piggy-backed onto existing government sites. But, no. As has been the case for the past few decades, Democrats have sided with their corporate benefactors in the health insurance industry AND NOT WITH THIER CONSTITUENTS! The result is healthcare for corporations, not people.
If the suffering of those who need it most didn't make me want to cry, I'd say that watching the industry melt down in the event of repeal may be the silver lining of this entire exercise. Those - however - will be tears of joy instead. A reminder to capitalists and health insurance executives/owners, where in the definition of medicine do you find the word profit?!?
You don't.
And until Democrats have the honesty to admit that they have failed their constituents and the country on this issue, perhaps the better their chances at becoming a viable national political party again someday.
11
Let's look at the record: The public option for ACA was removed due to good 'ol Joe Lieberman threatening a filibuster.
Trying to blame it's omission on the Dems is trumpian.
Trying to blame it's omission on the Dems is trumpian.
3
Democrats have lost hundreds upon hundreds of elected seats across the country since the truths of Obamacare were revealed.
There's your grade.
Pre-Obama care, we had good policies that covered the 4 of us for around $14,000. Like chumps, we responsibly paid our premiums instead of rolling up the ER and freeloading off of society. We didn't like it, but we did it.
Since Obamacare, our costs have jumped up $10K in premiums, approximately $2K in deductibles--and that's not counting the premium hike of $250 a month we were hit with on Jan 1. We are not rich. We know people who voted for Trump to stave off having to sell their house over insurance costs.
Obamacare cost the Democrats the Supreme Court, which is exactly what they deserve for pillaging the finances of anyone who works but isn't a millionaire.
There's your grade.
Pre-Obama care, we had good policies that covered the 4 of us for around $14,000. Like chumps, we responsibly paid our premiums instead of rolling up the ER and freeloading off of society. We didn't like it, but we did it.
Since Obamacare, our costs have jumped up $10K in premiums, approximately $2K in deductibles--and that's not counting the premium hike of $250 a month we were hit with on Jan 1. We are not rich. We know people who voted for Trump to stave off having to sell their house over insurance costs.
Obamacare cost the Democrats the Supreme Court, which is exactly what they deserve for pillaging the finances of anyone who works but isn't a millionaire.
11
Here in France everyone has health care. It is equal for everyone. We can choose our doctor, public or private hospitals and there is no upper limit as is so often is imposed by US insurance companies. Nor is there any refusal of coverage for people with pre-existing conditions. We may pay more in social charges but it is worth it. I think Obamacare was a start in the right direction. It now looks like universal health care in the States will be taking a big step backwards.
14
Christine, yes you have much higher taxes. Must we all have higher taxes for social programs. The US revolted from England because of high taxes.
2
"Higher taxes for social programs" are otherwise known as civilization. At least in France the people get something for their money.
5
France can afford healthcare because unlike the US, they don't finance a quarter of the UN budget.
4
"they have found the pool of Obamacare enrollees to be sicker"
The big question is then, what would happen to these people without health insurance?
I think this is a cost that is not being included in the analysis. Maybe these people would have got sicker and ended up in the emergency room, greatly increasing the cost.
In any case, the ACA failed in lowering costs so that health insurance would become accessible to the middle class.
We the people are condemned to have the most expensive system in the world regardless.
This is because everybody has to get their bite off the health pie in a for profit system.
We have the most expensive doctors, hospitals, drugs and medical equipment in the World. They are all protected by armies of lobbyists.
To those arguing for single payer, I say: you need to change the politicians first.
The big question is then, what would happen to these people without health insurance?
I think this is a cost that is not being included in the analysis. Maybe these people would have got sicker and ended up in the emergency room, greatly increasing the cost.
In any case, the ACA failed in lowering costs so that health insurance would become accessible to the middle class.
We the people are condemned to have the most expensive system in the world regardless.
This is because everybody has to get their bite off the health pie in a for profit system.
We have the most expensive doctors, hospitals, drugs and medical equipment in the World. They are all protected by armies of lobbyists.
To those arguing for single payer, I say: you need to change the politicians first.
10
No program as massive as the ACA is going to be perfect right out of the box. The ACA has desperately needed tweaking, but the Republicans, so intent on simply jettisoning the program, have refused to even consider making the necessary modifications to make the program work. So it's hard to judge the ACA because it was never really allowed to become what it might have been.
35
Just give up and have single payer government coverage. Will it be better? It will be expensive.
It was passed without a single Republican vote.
No trade-offs were made to get Republican votes because, as was obvious to anyone who could count, no Republican votes were needed.
Democrats 100% own Obamacare. It is what the Democrats made it. And it is a disaster that cost Democrats the Supreme Court.
No trade-offs were made to get Republican votes because, as was obvious to anyone who could count, no Republican votes were needed.
Democrats 100% own Obamacare. It is what the Democrats made it. And it is a disaster that cost Democrats the Supreme Court.
4
Well, Honeybee, you're very wrong again.
The Democrats made massive and damaging concessions to the Republicans in an effort to get them to wake up and serve the people who put them in office.
Most significantly, though, the Republicans crushed the program by refusing to allow it to develop a sufficiently large pool to preserve immoral insurance company profits, and by keeping entire states out of the program. Try reading a bit, it might help.
In fact though, after a pretty rocky implementation period, Obama Care is humming along rather well in states where there is even a modicum of cooperation.
So, again, you're wrong.
Also insanely angry.
The Democrats made massive and damaging concessions to the Republicans in an effort to get them to wake up and serve the people who put them in office.
Most significantly, though, the Republicans crushed the program by refusing to allow it to develop a sufficiently large pool to preserve immoral insurance company profits, and by keeping entire states out of the program. Try reading a bit, it might help.
In fact though, after a pretty rocky implementation period, Obama Care is humming along rather well in states where there is even a modicum of cooperation.
So, again, you're wrong.
Also insanely angry.
3
You have to consider "Congress" wrote the ACA - this means you had a large number of members influenced by lobbyist - like all major bills - full of compromises. Single-Payer or Medicare for all would have been the best solution - but with all the money from the medical industry complex - we got the best option possible - not perfect - but better than before.
Right now I sure wish we had a third Obama term - he will be missed.
Right now I sure wish we had a third Obama term - he will be missed.
5
On Obama care the mainstream Republicans and Trump are on the same page. If you can't "monetize" peoples illness and make a buck off it, then whats the point?
It's pretty easy to criticize Obama care, but then ask the Republicans what have they done to address the problem of affordable health care in this country? Oh, that's right, nothing.
It's pretty easy to criticize Obama care, but then ask the Republicans what have they done to address the problem of affordable health care in this country? Oh, that's right, nothing.
5
Never happen until we insist that Congress and all Congressional employees participate in the same health plan they consider good enough for their employers--us. Anything else is unconscionable and against public policy.
2
Individual health care or a precursor to privatization of health care is less than perfect. As an individual who self insures and am ineligible for any help paying my premiums I find health care necessary but likely to become unaffordable in the near future. The insurers such as Florida Blue bully the insured and present information that is so confusing making it impossible to make a choice. My out of pocket is so high that if I did require surgery I would go bankrupt. I face each new coverage selection year with fear as I know that each time I change plans I will pay more and loose benefits.
3
Stopped reading after this sentence: "For those who believe the primary goal of the law should have been to make health insurance affordable to all who want it, the rational answer is: No, Obamacare did not achieve uniform affordability. "
The name is the *Affordable* Care Act. If it isn't affordable it is a failure.
End of story.
The name is the *Affordable* Care Act. If it isn't affordable it is a failure.
End of story.
21
Spoken like a man who has insurance, has always had insurance, and wants it to be a little cheaper.
But, Johannes, this is not just about you. It's about controlling national health care costs.
It's about overcoming Republican idiocy like refusing to let the government negotiate prices on its own drug purchases.
It's about the legal corruption of, for example, allowing BigPharma to extend patents and copyrights, and massively increase prices, whenever they change the color of a capsule or the printing on a box.
It's about changing a political environment that has the insanely-pro-buisness standing up and cheering whenever some highly talented business person buys an old, almost generic drug and simply because he wants to increases the price 600% +. Yea, free markets!
Obama Care changed some and at least started a more balanced discussion of the rest.
And while, sure, you can't sort the effects of Obama Care from everything else happening on the planet, you can at least say with confidence that, after generations of destructive increases in health costs, the period when things finally began to level off coincided with the implementation of Obama Care.
As to your own issues of cost, do you in any way hold responsible the insurance companies who left your market, and the others who hiked their prices, because they weren't making as much profit as they wanted to?
But, Johannes, this is not just about you. It's about controlling national health care costs.
It's about overcoming Republican idiocy like refusing to let the government negotiate prices on its own drug purchases.
It's about the legal corruption of, for example, allowing BigPharma to extend patents and copyrights, and massively increase prices, whenever they change the color of a capsule or the printing on a box.
It's about changing a political environment that has the insanely-pro-buisness standing up and cheering whenever some highly talented business person buys an old, almost generic drug and simply because he wants to increases the price 600% +. Yea, free markets!
Obama Care changed some and at least started a more balanced discussion of the rest.
And while, sure, you can't sort the effects of Obama Care from everything else happening on the planet, you can at least say with confidence that, after generations of destructive increases in health costs, the period when things finally began to level off coincided with the implementation of Obama Care.
As to your own issues of cost, do you in any way hold responsible the insurance companies who left your market, and the others who hiked their prices, because they weren't making as much profit as they wanted to?
34
Agreed, it's a failure that improved the lives of millions of people and was a significant net improvement over the health system that existed before it.
1
Eliminate the overhead of health insurance and let people pay what they can afford for health care. Universal health care is the goal and figuring out a fair way to pay for it is the key. Income is less important than family wealth in the determination of how much government subsidy is needed. Those with significant assets to protect would be free to purchase any health insurance policy that is right for them. Health insurers would compete by providing coverage and options that consumers really want.
Health care providers should compete by listing their prices and prohibiting discounts that drive-up rates for the uninsured. Competition in health care delivery (independent of insurance) is necessary to keep costs down.
Obamacare achieved political objectives but health care for all at reasonable cost was never part of the plan.
Health care providers should compete by listing their prices and prohibiting discounts that drive-up rates for the uninsured. Competition in health care delivery (independent of insurance) is necessary to keep costs down.
Obamacare achieved political objectives but health care for all at reasonable cost was never part of the plan.
3
I'm an Australian married to a lovely American lady. My wife and I have lived in the United States for the last four years whilst she completes a PhD. At the end of her PhD we are moving back to Australia to start a family, and healthcare is perhaps the numbers one public policy issue affecting this decision.
I was unemployed for a chunk of time last year and we lived off my wife's PhD earnings of around $18k. In this case, Obamacare was an affordable catastrophic care plan. The plan I chose had a deductible of $5k, and so any serious illness or accident would have necessitated borrowing money from family, but not a crippling sum. But the key is that at this income level the subsidy was generous, close to 100% of the premium, or around $200 a month.
I am now working two part time jobs and went on the marketplace and declared a combined family income of $37k. The subsidy offered was $43 with the lowest plan -- a plan with a $6500 deductible -- $183 a month including the subsidy.
This is mentioned in the article, but I think the system's key failing was that it essentially put the burden of subsidising sick people on self or part time employed people not earning much money.
To me, the health system isn't something that can be tweaked or tinkered with. Those claiming that Obamacare's failings are the result of political skullduggery or sabotage are in my opinion, missing the point. Only a complete overhaul and the treating of healthcare like a public good will fix it.
I was unemployed for a chunk of time last year and we lived off my wife's PhD earnings of around $18k. In this case, Obamacare was an affordable catastrophic care plan. The plan I chose had a deductible of $5k, and so any serious illness or accident would have necessitated borrowing money from family, but not a crippling sum. But the key is that at this income level the subsidy was generous, close to 100% of the premium, or around $200 a month.
I am now working two part time jobs and went on the marketplace and declared a combined family income of $37k. The subsidy offered was $43 with the lowest plan -- a plan with a $6500 deductible -- $183 a month including the subsidy.
This is mentioned in the article, but I think the system's key failing was that it essentially put the burden of subsidising sick people on self or part time employed people not earning much money.
To me, the health system isn't something that can be tweaked or tinkered with. Those claiming that Obamacare's failings are the result of political skullduggery or sabotage are in my opinion, missing the point. Only a complete overhaul and the treating of healthcare like a public good will fix it.
11
The successes are unequivocal. The failures can be dealt with piecemeal. We need to increase the mandate, make certain of more competition by initiating a public option and make sure that patients can keep their doctors. If the public option is structured correctly, such as optional enrollment in Medicare, it should, in time, result in a single payer system. One more thing - Medicaid should be converted to a federal program, removing the states from the equation so that the petty politics that now denies Medicaid to people in 1/3 of the states cannot happen.
6
So James while I may agree with you in some respects, exactly how do you pay for this? Lets assume we increase the payroll tax to say 10% and remove the income caps. What happens in 5 years when the system like Medicare is in default? Do we raise the payroll tax to 14%, 16%, or 21%? The problem is the government. I am all for a single payer system with a payroll tax of 5% just for medical bringing the payroll tax to 12.65% matched by employers. This money must go into a private system where the government cannot raid the pot to pay for garbage. In addition, let those who want to purchase supplemental insurance do so without the whining of the left that they have better access to care. Because guess what, that is exactly what will happen.
2
How to pay for health care is a complicated process. The rest of the advanced world has better healthcare at a significantly lower price. This cannot be disputed. We is America have a strong aversion to learning from the experience of other countries. Income inequality is a major contributor to these problems, in ways that are not always intuitively obvious. Administrative costs for Medicare (a public option) are about 5 percent while commercial insurance administrative costs exceed 20 percent of total cost of healthcare.
3
I disagree that the rest of the advanced world has better healthcare. While they may have healthcare my impression is anything that requires specialization is just about non-existent. You also rant about income in-equality, well I am not equal to Bill Gates and until liberals get over the equal aspect of things, then maybe we can come to a conclusion. Medical care and medical insurance are two different animals.
There is so much baggage to "unpack" in this article, it would require too many characters for this minimal comment space. A few points: first, the "Obamacare" moniker was deliberately imposed by the GOTP - risible because this plan was theirs from the get go, though they voted en bloc to oppose because an African American Democrat had the temerity to proffer it. Second: whining insurance companies low-balled their initial premiums to gin up business: if they failed to anticipate sicker covered lives, they are failing to acknowledge their refusal to cover folks with pre-existing conditions, who, when insured, took full advantage of actually accessing vital health care. Third: insurance companies routinely dropped physician practices and other providers - long before the PPACA was enacted, and to blame the PPACA for that is simply a lie. Most provisions of the PPACA, when polled separately with the public, have strong support, e.g. the prohibition on denial of coverage for pre-existing conditions; the prohibition on charging women more than men for policies; the permission to retain adult children on parents' policies; and so on. Congress' failure to take on Big Pharma, which has gouged Americans with impunity, is disgraceful; ditto their refusal to permit Medicare to competitively negotiate drug prices. Ultimately, we need single payer covering all Americans - but don't count on the GOTP to offer that. 2/5, 11:04 AM
11
Obama's administration coined the term ObamaCare and Obama embraced it, has stated so many times. The way for ACA to have served the American public and received less enmity from the GOP and from even middle class Democrats, especially the self-employed and small business community, who are stuck ponying up for all those subsidies while losing their own health insurance or seeing the premiums double or triple: Obama admin advisers who wrote in toto the ACA ought have come from broad corners and the center, not just Big Pharma and Big Medicine and Jonathan Gruber. Then, Democrats in Congress ought have read the damned thing before voting and giving it a near unanimous pass, despite the 19 obvious and pedestrian flaws that the Obama admin rushed to fix in its first days. i.e. At least SOME due diligence would've been welcome and wholly preventive in fact and in preception.
7
Given that Obamacare (ACA) was never fully implemented thanks to republican hypocrisy and political opposition based on dissemination of lies and the general stupidity of Americans who bought into them it is almost impossible to judge its success or failures. What we know for sure, however, is that they had eight years to come up with something better and failed to come up with anything let alone something better.
10
many people also struggle to understand co-pay vs deductable,...and how they relate and overlap. Are they separate enitities or one and the same up to the expiration of the deductable? How is the out of pocket maximum calculated, and why should lower tier plans, which are essentially catastrophic, end up punishing lower income people for persuing rigorous preventative and midlevel care.
2
Here is what ACA did for me as the small business owner;
1. It ensured health insurance for my family and for my employees
2. It did not save money, except in the first year. Our premiums had increased 17% annually prior to ACA, but we had the skyrocketing of premium cost this year so it's a wash.
3. It made us feel safer. Period.
Let's repair ACA and I don't care if you rebrand it to make republicans look better. The end results only matter.
1. It ensured health insurance for my family and for my employees
2. It did not save money, except in the first year. Our premiums had increased 17% annually prior to ACA, but we had the skyrocketing of premium cost this year so it's a wash.
3. It made us feel safer. Period.
Let's repair ACA and I don't care if you rebrand it to make republicans look better. The end results only matter.
14
I consider tje ACA success not as a final product but as agent of change in Americans' attitudes toward universal healthcare. In my view a country as successful as ours should absolutely have universal healthcare and now that Americans have had a taste it will be extremely difficult to go backwards even with a conservative power base. I believe that over time we will end up with a system that works and is more affordable.
2
What happens if/when most insurance companies withdraw and only ONE remains? Would that not mean, given the "mandate" to sign up or pay a fine, that the "pool" would be so big that, at last, the insurance concept would work, for the insured and the insurance company alike? (We might even be able to raise the salary for the CEO.)
Perhaps we should simply pay for health insurance with our taxes as it is done in a number of countries? (In Denmark, my birth country, medical doctors became so concerned about the private, old-fashioned system that THEY organized the health insurance plan, which ultimately turned into national health. Not perfect, but pretty good; certainly less messy than what we have here.)
Perhaps we should simply pay for health insurance with our taxes as it is done in a number of countries? (In Denmark, my birth country, medical doctors became so concerned about the private, old-fashioned system that THEY organized the health insurance plan, which ultimately turned into national health. Not perfect, but pretty good; certainly less messy than what we have here.)
2
Obamacare needs to be upgraded. To single payer. And we need to end networks. Americans (and humans) have the right to health care and to choose their doctors.
41
"Americans (and humans) have the right to health care and to choose their doctors."
And of course somebody else, preferably the evil "rich", should have to pay for it.
And of course somebody else, preferably the evil "rich", should have to pay for it.
2
So how exactly would this work, if you chose a top specialist who makes $800K a year and bills $2500 an hour?
The ACA is flawed. No one is arguing against that. It's flawed mainly because there were changes made to it from the original version. It has expanded care to more people that were previously uninsured. Premium has increased but premium would have increased anyways, with or without the ACA. It has increased preventive care , improved coverage for women , reduced unfair practices , improved coordination or care. If you are a physician who doesn't want to adopt to the system and are not ready to make changes, may be you shouldn't be practicing any more (mind you , you don't even have to spend any money , there is a federal fund to pay for a new electronic system).
Has it reduced health care spending ?- it depends how you look at it. It has reduced uncompensated care and added quality assurance steps that has reduced spending. I think the article is correct in saying it is all about values. the 20 millions who now have coverage are only 20 percent of the population. The rest get their coverage from employers or buy their own insurance. If you value that health care is a collective responsibility and lack of coverage for all endangers public health and finances , ACA is your answer. If you think ppl are living off of your tax dollars and ACA is not your cup of cake. Regardless , health care policy is in the US is incremental. There are positive changes that has shaped the health care system as a result of the ACA. President Obama deserves credit for these.
Has it reduced health care spending ?- it depends how you look at it. It has reduced uncompensated care and added quality assurance steps that has reduced spending. I think the article is correct in saying it is all about values. the 20 millions who now have coverage are only 20 percent of the population. The rest get their coverage from employers or buy their own insurance. If you value that health care is a collective responsibility and lack of coverage for all endangers public health and finances , ACA is your answer. If you think ppl are living off of your tax dollars and ACA is not your cup of cake. Regardless , health care policy is in the US is incremental. There are positive changes that has shaped the health care system as a result of the ACA. President Obama deserves credit for these.
5
Doctors who don't want to change can always work for cash in the cash register, and practice solo. In the current environment, they might find their services are in high demand if their prices are at all reasonable.
Question? Why do some people repeatedly blame President Obama for the high cost of their health insurance? The health insurance companies make the decisions about what to charge for their services. Just like the pharmaceutical companies. THEY ARE RAISING PRICES. Why are we not out in the streets demanding a single payer system like what they have in Germany, Singapore, Japan or Norway? The only person in Congress fighting for a single payer system is Sanders. I think President Obama would have preferred a single payer system but fought for what he could get. The Affordable Care Act is not perfect by any means but its better than nothing and for that I'm grateful.
16
People rightly blame Obama because Obama came up with a long list of things that every policy must cover--including maternity care for men and women almost at Medicare age.
All of those add-ons increased cost.
Obama very, very clearly told everyone we'd save $2500 dollars a year (my healthy family's costs have skyrocketed $10K) and he very, very clearly said that if we liked our plan, we could keep our plan. He lied.
All of those add-ons increased cost.
Obama very, very clearly told everyone we'd save $2500 dollars a year (my healthy family's costs have skyrocketed $10K) and he very, very clearly said that if we liked our plan, we could keep our plan. He lied.
5
Honeybee, you live in this little fantasy world of blame. We all know what happened, when and why. It's insurance, it sucks, we get it, but you seem to think it's Obama's fault.
4
@Chuck, I only blame Obama when someone like Regina--the original poster--asked why everyone blames Obama. In fact, the first word of her post is "Question."
So I answered her question. Sorry if you dislike my factual response.
I also "blame" Obama in response to the accusation that Republicans are somehow responsible for this mess by pointing out that not one Republican voted for Obamacare, which proves that Obama didn't need even 1 Republican vote to pass whatever he wanted. He obviously wanted Obamacare.
I "seem to think it's Obama's fault" only because it actually is.
So I answered her question. Sorry if you dislike my factual response.
I also "blame" Obama in response to the accusation that Republicans are somehow responsible for this mess by pointing out that not one Republican voted for Obamacare, which proves that Obama didn't need even 1 Republican vote to pass whatever he wanted. He obviously wanted Obamacare.
I "seem to think it's Obama's fault" only because it actually is.
2
If Obamacare goes away, say hello to a future America as sick as its current president and then some. Don't forget to thank the GOP for your sickness with your vote. They deserve all the credit for making America sick again. All of this is possible only if America survives the current internal attack against its civility and humanity.
6
It is 5% of the American public that are responsible for more than 50% of all spending on health care - most of it at taxpayer expense, one way or another and generally several ways, since the overwhelming sick are middle aged and elderly. But it is only s certain segment of those over 45 in bad health.
We've needed better PREVENTIVE health care systems in the U.S., but we also need some means of not penalizing the diligent and responsible who are not obese, alcoholic, smokers, sugar and drug addicts, creating almost all their long term health issues with their own toxic decisions and bad habits. Much of that is an accumulation of poor lifestyle issues from childhood that are preventable and become lifetime chronic once middle age kicks in. Health and health care are not treatment of the sick, that is critical care after the fact. Health and health care is preventive by its very nature.
We've needed better PREVENTIVE health care systems in the U.S., but we also need some means of not penalizing the diligent and responsible who are not obese, alcoholic, smokers, sugar and drug addicts, creating almost all their long term health issues with their own toxic decisions and bad habits. Much of that is an accumulation of poor lifestyle issues from childhood that are preventable and become lifetime chronic once middle age kicks in. Health and health care are not treatment of the sick, that is critical care after the fact. Health and health care is preventive by its very nature.
2
Like everything he touches, Mr. Trump has turned the ACA into the enemy and used its flaws as a tool to get attention for himself. Good government and good governing (I know I'm asking too much here) would have taken the ACA/Obamacare and improved on it, but that, of course, would have to mean you cared one iota about the people you serve. Mr. Trump, Mr. Ryan and Mr. McConnell only care about themselves so why am I surprised that they are willing to throw it all away -- the good and the bad -- to try to make themselves look like geniuses rather than the petulant, unethical people they really are. One question: What did the American people (most who did not vote for Mr. Trump) do to deserve this? I have searched and searched and cannot find the answer and remain filled with overwhelming sadness.
5
>17% of US GNP goes to medical costs. Without government imposed controls on drug prices and payments to doctors the cost will continue to soar. When one is ill, you have a choice of death and pain, or to pay whatever the hospital wants. A relatively small health crisis over a few weeks can run half a million dollars. Insurance was cheaper in the past because there were caps on the lifetime payout. If you had a major health crisis you went bankrupt. I wish the republicans the best of luck in crafting a better health care law, but see no chance of success,
2
You are right, but....the recipients of these huge sums of money are well able to use the political system to defend their income streams. If you think they will easily be subdued, you are living in a fantasy world. The doctors could very well form a union, go on strike, and let everybody die unless their pay demands are met. What would we do then?
I grade the Affordable Care Act an ( A+ ) for concept.
( Even though it was\is a republican idea to require all to have health insurance )
The problem being, that it was President Obama ( a black man and a Democrat ) that implemented it, therefore at all possible turns it was necessary to destroy the law via any means necessary. republicans have been successful in essentially keeping the insurance pool small ( via nixing it in almost half of the states ) that have kept costs high.
It is has helped millions of Americans achieve some semblance of health care and has kept untold people alive, but that is of little concession.
SIngle Payer is the only option going forward. Anything else in an ( F )
( Even though it was\is a republican idea to require all to have health insurance )
The problem being, that it was President Obama ( a black man and a Democrat ) that implemented it, therefore at all possible turns it was necessary to destroy the law via any means necessary. republicans have been successful in essentially keeping the insurance pool small ( via nixing it in almost half of the states ) that have kept costs high.
It is has helped millions of Americans achieve some semblance of health care and has kept untold people alive, but that is of little concession.
SIngle Payer is the only option going forward. Anything else in an ( F )
7
The ACA plans here in New York have cut the premium cost in half when compared with the old NYS system of direct purchase or as they like to call it "guaranteed issue". In addition to the very high cost the old NYS system required a 12 month wait for pre-existing conditions if the member went beyond the 63 days between coverage plans.
I hope New York have a back up plan to cover the states residents should the need arise.
I hope New York have a back up plan to cover the states residents should the need arise.
3
It would be fairer to address whether ACA worked on a comparative basis: ACA versus what preceded it and ACA versus the world envisioned by its Republican critics. On that basis, the chief failure here - health insurance remains expensive - disappears.
2
Perhaps if the plan was born in truth is may have reached adulthood. Can you imagine Attorney Pelosi bragging that she did not read the plan?.
5
Singlehandedly killed healthcare for anyone earning up to 200,000 a year. .
4
It gave the Republicans a majority in both the House and Senate and the Presidency. They are about to shift the Supreme Court to the right for the next couple of decades.
It was an amazing success for the Republican Party and I now fear for our countries short term future.
It was an amazing success for the Republican Party and I now fear for our countries short term future.
2
A question facing the country: Is healthcare a right or is it a privilege? We seemed to have answered the question some 7 years ago. In November it appears we changed our mind and answered differently.
While I disagree with what the voters in seemingly decided November 8, the health care consequences to me are insignificant. For others, there is a range of possibilities beginning with 'not much' and ending at 'deadly.'
It is incomprehensible that voters and so many politicians have so little regard for the health and wellbeing of our neighbors. And it is equally incomprehensible that the media -- including the NYT -- never demanded an answer and explanations to the right v. privilege question. Equally, the media allowed soundbites to pass for serious discussion.
There is plenty of fault to find and much to fix with healthcare delivery in the United States. I blame media for allowing unchallenged vilification of the ACA and ignoring congress's moral abdication. The fourth estate is dead.
The same fate seeming awaits the poor and those with serious preexisting conditions if the GOP/Trump deliver on their promises.
While I disagree with what the voters in seemingly decided November 8, the health care consequences to me are insignificant. For others, there is a range of possibilities beginning with 'not much' and ending at 'deadly.'
It is incomprehensible that voters and so many politicians have so little regard for the health and wellbeing of our neighbors. And it is equally incomprehensible that the media -- including the NYT -- never demanded an answer and explanations to the right v. privilege question. Equally, the media allowed soundbites to pass for serious discussion.
There is plenty of fault to find and much to fix with healthcare delivery in the United States. I blame media for allowing unchallenged vilification of the ACA and ignoring congress's moral abdication. The fourth estate is dead.
The same fate seeming awaits the poor and those with serious preexisting conditions if the GOP/Trump deliver on their promises.
4
A recent NYT article pointed out that 5% of participants in Obamacare are receiving 75% of the benefits. This is the poor health, high-cost group.
This means that 95% of the participants are receiving 25% of the benefits. This is a very low pay-out for the vast majority of participants.
This means that 95% of the participants are receiving 25% of the benefits. This is a very low pay-out for the vast majority of participants.
7
That would be true of any sort of insurance. If you buy fire insurance, and your house doesn't burn down, you pay the premium and receive nothing.
But health care is different. That's why the insurance model does not really apply, and should not be used.
But health care is different. That's why the insurance model does not really apply, and should not be used.
3
It's a start point. Universal health is the way to go and would save millions of dollars and lives. Those who want their private insurance should be able to have it and those who want an affordable one, should have theirs but with everyone paying something into the system. It is time for people to realize how important good health is and avoiding epidemics. So happy to live in France, the health care is always the top rated and having gone through it, it is but we all pay into it which is fair and we get to chose our doctors - no groups to chose from.
5
All of the so-called "failures" you cite here are baked in to the absurd U.S. healthcare system and would exist with or without the Affordable Care Act. The question is whether the cost, complexity and confusion of this system have been made better or worse by the ACA.
2
The GOP, and some faux Democrats worked hard to undermine the ACA because it was the same as undermining Obama.
Yes, access to health care was improved, affordability not so much, but this could have been had easily: build a few less bombs, avoid senseless war, cut back subsidies to profitable companies.
But people don't value their health enough, or they would have voted for representatives who cared about the issue of affordability/access.
The repeal of Obamacare will cause suffering and death, as will the GOP plans to destroy Social Security and Medicare.
You know if you voted for this. What's it like to look in the mirror?
Yes, access to health care was improved, affordability not so much, but this could have been had easily: build a few less bombs, avoid senseless war, cut back subsidies to profitable companies.
But people don't value their health enough, or they would have voted for representatives who cared about the issue of affordability/access.
The repeal of Obamacare will cause suffering and death, as will the GOP plans to destroy Social Security and Medicare.
You know if you voted for this. What's it like to look in the mirror?
3
Improving "health" is a somewhat amorphous metric. How about deaths? Is there any evidence that Obamacare has saved lives, and conversely, how many might die if it were to be repealed?
2
Mr. Obama sold us out to pharma and the insurance industry. He did not have to do that. Democrats controlled the House and Senate and they could have created universal health care (medicare for all). Medicare is an efficient system that does well for retired persons and it could have worked for everyone. So, despite the small improvements the ACA created there are still 30 million without insurance and those who get subsidies and those who are forced to purchase it are paying much more than people living in Germany, France, Great Britain and Canada. And we know that whatever Republicans have up their sleeve (if anything) it will destroy what ACA has created.
6
Medicare works because everyone pays in 2.9% of their income, or 3.8% of income over $250K, but only those over 65 are eligible for the benefits. There is no 'someone else' who would foot the bill for 'Medicare for All', unless we could figure out a way to tax people living in foreign countries.
I was and am against the system called 'Obamacare'. If a universal - one payor- plan is not put into effect, it overburdens middle class payees and small to medium businesses.
That said, my family has benefitted from Obamacare.
That said, my family has benefitted from Obamacare.
4
In 2009, TR Reid wrote an excellent book examining the American health care system entitled "The Healing of America." I had the pleasure of attending a NPR forum featuring him in Seattle that year which was a lively and serious discussion about the difficulties of the American health care delivery system. I highly recommend everyone read the book; however, my biggest takeaway from the talk was/is this:
There will never be real healthcare reform in the U.S. until and unless American values change and access to the HC system is considered a human right rather than a commodity. Opponents of a universal system claim that all Americans already have "access" to the best system in the world. Sadly, we all have access to a Ferrari as well, but this doesn't mean we can afford one (or even get behind the wheel).
I currently live in a country where everyone pays into a system (on a sliding scale) that ensures that almost everyone can see a doctor and receive health care. My Italian friends and colleagues simply cannot fathom what the problem is in a country as well-off as the U.S.
Personally, the greatest success of the ACA is that it has brought the HC system under greater scrutiny and many now understand what better options might exist in the future. It has also brought to light just how little politicians care about people and how much they love insurance companies and other powerful beneficiaries of an overpriced, out-of-control industry.
There will never be real healthcare reform in the U.S. until and unless American values change and access to the HC system is considered a human right rather than a commodity. Opponents of a universal system claim that all Americans already have "access" to the best system in the world. Sadly, we all have access to a Ferrari as well, but this doesn't mean we can afford one (or even get behind the wheel).
I currently live in a country where everyone pays into a system (on a sliding scale) that ensures that almost everyone can see a doctor and receive health care. My Italian friends and colleagues simply cannot fathom what the problem is in a country as well-off as the U.S.
Personally, the greatest success of the ACA is that it has brought the HC system under greater scrutiny and many now understand what better options might exist in the future. It has also brought to light just how little politicians care about people and how much they love insurance companies and other powerful beneficiaries of an overpriced, out-of-control industry.
5
Well, at least the doctors in the US have access to Ferraris....maybe that's the problem!
1
Obamacare made medical insurance available, which is good. But the insurance is more expensive than many can afford, and the taxes and regulations that fund the subsidies the law provides are a substantial burden not just on the wealthy, but also the middle class.
The law provides too many mandates, and does too little to reign in medical costs. The contraceptive mandate has received the most press, but the mandate for unlimited mental health coverage is the more expensive. Whether the latter is a good thing is controversial, and depends to some extent on one’s philosophy. Is addiction a disease or is it making the wrong personal choice? Are depression and stress diseases or are they often simply part of life? The unlimited mental health coverage required by the ACA has virtues, but it also contributes the high costs of ACA insurance.
The law should do more to control costs. Providers should be required to disclose what medical care will cost in advance. Pharmaceutical firms that raise the price of many drugs, especially established off-patent medicines, to extortionate levels should be penalized. FDA regulation may need to be reformed. Malpractice law should be reformed at the Federal level; defensive medicine contributes greatly to the high cost of care. We must close loopholes in the ACA which allow the abuse of special enrollment periods.
There is much left to be done. The goal of increasing the number of insured is vital, but it must be affordable insurance.
The law provides too many mandates, and does too little to reign in medical costs. The contraceptive mandate has received the most press, but the mandate for unlimited mental health coverage is the more expensive. Whether the latter is a good thing is controversial, and depends to some extent on one’s philosophy. Is addiction a disease or is it making the wrong personal choice? Are depression and stress diseases or are they often simply part of life? The unlimited mental health coverage required by the ACA has virtues, but it also contributes the high costs of ACA insurance.
The law should do more to control costs. Providers should be required to disclose what medical care will cost in advance. Pharmaceutical firms that raise the price of many drugs, especially established off-patent medicines, to extortionate levels should be penalized. FDA regulation may need to be reformed. Malpractice law should be reformed at the Federal level; defensive medicine contributes greatly to the high cost of care. We must close loopholes in the ACA which allow the abuse of special enrollment periods.
There is much left to be done. The goal of increasing the number of insured is vital, but it must be affordable insurance.
7
The whole notion of short-term grades for the ACA creates problems--as if the short term can be termed a valid assessment, enough to trash the whole process that has take over 50 years to begin to implement. A couple of points:
1. The whole discussion of "values" is problematic. Popularity polls are not based on understanding, but on political winds and slogans. So many people approve of individual components of the ACA--they just don't want to pay for it.
2. Many of us understand that the law was never perfect, that it was unrealistic to think that the law would not need fixing.
3. Some of the swings favoring amending the law have been quite dramatic. It is now clear that 75% of US primary care physicians favor fixing the law. Only a tiny fraction currently favors outright repeal: http://www.nejm.org/doi/full/10.1056/NEJMp1700144?query=TOC .
4. This nonsense of a "death spiral" for insurance companies involved with coverage is a partisan contrivance: http://www.nejm.org/doi/full/10.1056/NEJMp1614545?query=TOC . What we are be seeing is more akin to early market adjustments.
5. Making decisions based on so many personal testimonials is unnecessarily fraught. Why should we not expect good and bad individual outcomes--that will never change?
6. Why devolve to 50 state plans? Do we want Medicare run under 50 separate sets of state regulations?
I think any notion that the choice is "column A or column B" is a false one. We need adjustments, not legislative chaos.
1. The whole discussion of "values" is problematic. Popularity polls are not based on understanding, but on political winds and slogans. So many people approve of individual components of the ACA--they just don't want to pay for it.
2. Many of us understand that the law was never perfect, that it was unrealistic to think that the law would not need fixing.
3. Some of the swings favoring amending the law have been quite dramatic. It is now clear that 75% of US primary care physicians favor fixing the law. Only a tiny fraction currently favors outright repeal: http://www.nejm.org/doi/full/10.1056/NEJMp1700144?query=TOC .
4. This nonsense of a "death spiral" for insurance companies involved with coverage is a partisan contrivance: http://www.nejm.org/doi/full/10.1056/NEJMp1614545?query=TOC . What we are be seeing is more akin to early market adjustments.
5. Making decisions based on so many personal testimonials is unnecessarily fraught. Why should we not expect good and bad individual outcomes--that will never change?
6. Why devolve to 50 state plans? Do we want Medicare run under 50 separate sets of state regulations?
I think any notion that the choice is "column A or column B" is a false one. We need adjustments, not legislative chaos.
5
I am old enough to know that the GOP is only concerned about helping corporations make more money and restricting the rights of the majority under the heel of social conservatives. Period. Obamacare, in their view, is evil because is neither focuses upon profits nor advances the cause of theocratic control. If you have any other evidence, produce it.
29
Silly to try to grade the ACA.
We had a notable increase in insurance coverage since (and due to) the passage of this act.
Now, we have an opportunity to progress to a (more) rational system of disease care or regress to the nonsystem we had, or worse.
We had a notable increase in insurance coverage since (and due to) the passage of this act.
Now, we have an opportunity to progress to a (more) rational system of disease care or regress to the nonsystem we had, or worse.
3
It is amazing the amount of alternative facts from the Anti-Obama crew. Pre-ACA health insurance was denied to people with pre-existing conditions or the even more laughable situation - people were paying for insurance that would cover everything but a pre-existing condition. People were told that they had maxed out of coverage. Children were denied healthcare either because of pre-exisiting conditions or because they had reached their parent's policy max.
Employers were already offering 70%/30% plans and high copays. Companies like Wal-mart were not offering health insurance to their employees instead referring them to Medicaid.
Pre-ACA, Americans who were self-employed or had employers who did not provide health insurance had very few and very bad options. Premiums were astronomical for many people and businesses. Insurance companies regularly raised premiums so high as to force the policy holder to cancel. Othertimes, the insurance company would simply cancel. President Obama and ACA saved my family from bankruptcy and I credit it with making my son healthy again. Does ACA need an Upgrade? Yes. Open Medicare to people starting at 50 and for people with serious chronic health issues - this would make 50 years able to complete in the work force with younger workers. Medicare is already a high-risk pool. I object strongly to Republicans so-called Repair of ACA. Republicans Rand Paul, Phil Gramm, Paul Ryan believe rationing of healthcare, via block grants repairs ACA.
Employers were already offering 70%/30% plans and high copays. Companies like Wal-mart were not offering health insurance to their employees instead referring them to Medicaid.
Pre-ACA, Americans who were self-employed or had employers who did not provide health insurance had very few and very bad options. Premiums were astronomical for many people and businesses. Insurance companies regularly raised premiums so high as to force the policy holder to cancel. Othertimes, the insurance company would simply cancel. President Obama and ACA saved my family from bankruptcy and I credit it with making my son healthy again. Does ACA need an Upgrade? Yes. Open Medicare to people starting at 50 and for people with serious chronic health issues - this would make 50 years able to complete in the work force with younger workers. Medicare is already a high-risk pool. I object strongly to Republicans so-called Repair of ACA. Republicans Rand Paul, Phil Gramm, Paul Ryan believe rationing of healthcare, via block grants repairs ACA.
62
I agree, Alex. Pre-ACA my sister, who had expensive, private insurance, was diagnosed with cancer and needed immediate life-saving treatment. Her insurance co. denied coverage, including the procedure that provided her diagnosis! Said it was a pre-existing condition.
5
Margot Sanger-Katz tries to tell us that the success or failure of the ACA "may vary with your own experience, but it ultimately depends on what you value."
Nothing could be further from the truth. The Affordable Care Act is a tremendous success, cutting in a short time the rate of uninsured Americans in half, and doing so while more than half of the states, those controlled by Republicans, refused to implement the key Medicaid portion of the law. The Congressional Budget Office has determined that the ACA will reduce the federal deficit on a net basis by $143 billion from 2010-2019, and far more as time goes on. According to Kaiser, health care costs have risen lower over the past five years than during any five year period in the past half century.
And all of these successes have come despite the unrelenting opposition of the Republican Party.
Yet corporate journalists like Sanger-Katz keep pretending that the ACA was either a failure, or a partial failure, without acknowledging the destructive effects of Republican opposition.
No, Ms Sanger-Katz, it's a fact that the ACA has improved health care and health coverage immensely. And it doesn't depend on "values." It depends on the truth.
Nothing could be further from the truth. The Affordable Care Act is a tremendous success, cutting in a short time the rate of uninsured Americans in half, and doing so while more than half of the states, those controlled by Republicans, refused to implement the key Medicaid portion of the law. The Congressional Budget Office has determined that the ACA will reduce the federal deficit on a net basis by $143 billion from 2010-2019, and far more as time goes on. According to Kaiser, health care costs have risen lower over the past five years than during any five year period in the past half century.
And all of these successes have come despite the unrelenting opposition of the Republican Party.
Yet corporate journalists like Sanger-Katz keep pretending that the ACA was either a failure, or a partial failure, without acknowledging the destructive effects of Republican opposition.
No, Ms Sanger-Katz, it's a fact that the ACA has improved health care and health coverage immensely. And it doesn't depend on "values." It depends on the truth.
38
Obamacare flattened the curve to the lowest annual cost increase in decades, but it was unable to actually lower costs for many reasons, including (1) special interest lobbying to protect industry revenues & profit, (2) misaligned incentives, and (3) an insurance middleman that adds more cost than value. Any "repeal & replace" plan will face these same obstacles. (See http://www.mhealthtalk.com/influencing-healthcare-policy/)
12
Pre-the ACA, we paid for private health insurance (my husband is self-employed). My family's basic health plan premiums, which were subject to steep increases every year, exceeded our mortgage payments. Each year, we changed insurance companies, signing up for the least expensive plans, changing networks and doctors. The ACA has been a tremendous improvement for us. Because of the comprehensive benefits and affordability, we have felt protected, especially because one of my children has a chronic illness. The ACA should be improved, not "repealed and replaced." Affordable, quality healthcare is a right for all people.
66
Yes! Had the exact same experience. For a family of 4 where we are, premiums were $4000-8000/mo (!!!!!!) and are now $1000/mo max, much less if you take a Silver plan which is more than sufficient IMO.
2
From the beginning, Obamacare faced challenges because of the profit motive of insurance companies and hospitals (even so-called non-profits want to see positive numbers on the bottom line). The US regulates insurance companies more lightly than many other countries. The lack of meaningful competition and asymmetric information mitigate against protection by market forces.
An honest survey would show that most Americans are ready for universal health care. The insurance, pharmaceutical and hospital lobbyists have denied us that option.
Health care costs are inflated by unnecessary care, including end-of-life coverage that many don't want; ideally, hospitals could consult a database in the cloud to find out a patient's wishes without waiting for a live advocate.
And despite enormous evidence to the contrary, many people believe that costs will be reduced by "preventative" services. Study after study shows that "wellness exams" have little value and may actually do harm, yet people (and doctors) continue to believe in them with religious fervor. The prestigious New England Journal of Medicine makes a strong case against annual physicals which cost an estimated $10 billion a year and take up 10% of physician time - which means people with symptoms often wait weeks for an appointment that *could* make a difference. http://www.nejm.org/doi/full/10.1056/NEJMp1507485?
An honest survey would show that most Americans are ready for universal health care. The insurance, pharmaceutical and hospital lobbyists have denied us that option.
Health care costs are inflated by unnecessary care, including end-of-life coverage that many don't want; ideally, hospitals could consult a database in the cloud to find out a patient's wishes without waiting for a live advocate.
And despite enormous evidence to the contrary, many people believe that costs will be reduced by "preventative" services. Study after study shows that "wellness exams" have little value and may actually do harm, yet people (and doctors) continue to believe in them with religious fervor. The prestigious New England Journal of Medicine makes a strong case against annual physicals which cost an estimated $10 billion a year and take up 10% of physician time - which means people with symptoms often wait weeks for an appointment that *could* make a difference. http://www.nejm.org/doi/full/10.1056/NEJMp1507485?
5
I am a big fan of the Cochrane Collaboration, and Peter Gøtzsche, which that NEJM article cites. However, these studies are notoriously difficult, and they are not able to find a small difference in outcomes. There's a difference between "wellness exams," which are a marketing gimmick, and annual physicals, or "general health checks," which the Cochrane article studied. If you really want to find out whether annual physicals have beneficial effects, you must do a large randomized, controlled trial, and Cochrane only found 9 that recorded mortality. The latest was published in 1970, and treatment of heart disease and cancer has changed dramatically since then. So the entire NEJM article is based on obsolete data.
$10 billion for annual physicals sounds like a lot, but it's only 0.3% of all health care costs ($3 trillion). So even a 1% improvement in mortality would be cost-efficient.
Paul Krugman had a column about this (which I can't easily find). Krugman said that the major costs (and potential savings) of health care are not from elective services like visiting the doctor for sniffles (or annual exams). The big costs come from big-ticket items like treating heart disease or cancer (with $100,000 drugs).
The annual physical exam has been a part of medicine for a long time. If it doesn't do any good, and it's expensive, then the health system shouldn't pay for it. But advocates for abolishing it have to prove it, with more than 2 meta-analyses of 1970 data.
$10 billion for annual physicals sounds like a lot, but it's only 0.3% of all health care costs ($3 trillion). So even a 1% improvement in mortality would be cost-efficient.
Paul Krugman had a column about this (which I can't easily find). Krugman said that the major costs (and potential savings) of health care are not from elective services like visiting the doctor for sniffles (or annual exams). The big costs come from big-ticket items like treating heart disease or cancer (with $100,000 drugs).
The annual physical exam has been a part of medicine for a long time. If it doesn't do any good, and it's expensive, then the health system shouldn't pay for it. But advocates for abolishing it have to prove it, with more than 2 meta-analyses of 1970 data.
2
@Norman - The average income of a cardiologist in the US is $362K. If a patient has a major heart problem, he is going to chew up many billable hours with his cardiologist. So it's not just the drugs.
Jonathan, I was adressing the argument in the NEJM article that annual well-patient exams have no benefit. I said that it may be true, but I would want more evidence before giving up a widely-practiced custom.
If someone is seeing a cardiologist, then he's not a well patient. He's being managed for a cardiac disease. I think the most common diagnosis is high blood pressure, and the most common drug to start with is a diuretic, to lower blood pressure. Somebody, either a cardiologist or a primary care practitioner, has to monitor the blood pressure (among other things). As a cardiologist told me, if the blood pressure is too high, the patient can get heart failure or a stroke. If the blood pressure is too low, the patient can get dizzy or faint and fall, which is a major cause of disability and death among the elderly. So a doctor should be monitoring heart patients for blood pressure and the (many potential) adverse effects of blood pressure medication. They should be monitoring the heart disease for signs of progression. Medicare reimburses doctors by about $85 for a simple visit. That's not a lot of money, compared to, say, a hospital admission for a fall with a broken bone.
But for a well patient, $85 a year for an annual "checkup" isn't a lot of money, and eliminating it won't save a lot of money. If you want to save money, concentrate on the big-ticket items, like advanced imaging and vascular surgery for asymptomatic patients.
If someone is seeing a cardiologist, then he's not a well patient. He's being managed for a cardiac disease. I think the most common diagnosis is high blood pressure, and the most common drug to start with is a diuretic, to lower blood pressure. Somebody, either a cardiologist or a primary care practitioner, has to monitor the blood pressure (among other things). As a cardiologist told me, if the blood pressure is too high, the patient can get heart failure or a stroke. If the blood pressure is too low, the patient can get dizzy or faint and fall, which is a major cause of disability and death among the elderly. So a doctor should be monitoring heart patients for blood pressure and the (many potential) adverse effects of blood pressure medication. They should be monitoring the heart disease for signs of progression. Medicare reimburses doctors by about $85 for a simple visit. That's not a lot of money, compared to, say, a hospital admission for a fall with a broken bone.
But for a well patient, $85 a year for an annual "checkup" isn't a lot of money, and eliminating it won't save a lot of money. If you want to save money, concentrate on the big-ticket items, like advanced imaging and vascular surgery for asymptomatic patients.
1
Let's be accurate. 20 million gained health insurance. Gaining health care is more elusive due to high deductibles, unwillingness to take on Medicaid patients, etc. Would like to see how many millions people are now in my boat: have health insurance but avoid seeing a doctor. Days of the $20 copay are gone, my health insurance costs have climbed by thousands in the past 3 years. Thanks Obama.
9
The one undeniable truth and for this I appreciate Obama, this preening alt-left elitist delivered the House, Senate, State Houses and governorships to the party of the people-Republican. Thanks Barry!!!!!
3
" Twenty million more people have health insurance.
Providing health coverage to the uninsured was Obamacare’s principal goal, and on that measure, it has succeeded. The gain of 20 million insured, based on an Obama administration estimate last year, is probably now even higher."
This is misleading, if you breakdown the 20 million. How many people /households obtained healthcare coverage through the expansion of "Medicaid" which is much different than health care insurance?
Expanding Medicaid is not the issue, but the mechanism used to expand this coverage is unless funding from the federal government was offset somehow.
Now getting back to the 20 million number, how many people/ households already had coverage and lost that coverage due to the AHA?
Furthermore of the 20 million number, is there any "double" counting? What I mean is were 20 million new policies issued or for example in one household with 4 people, were all 4 people under one policy being counted as 1 additional or 4 new people getting coverage?
Also within that 20 million count were people who turned 26 from the state of NJ added in to this number because NJ already coverage children to the age of 26 prior to the AHA.
Providing health coverage to the uninsured was Obamacare’s principal goal, and on that measure, it has succeeded. The gain of 20 million insured, based on an Obama administration estimate last year, is probably now even higher."
This is misleading, if you breakdown the 20 million. How many people /households obtained healthcare coverage through the expansion of "Medicaid" which is much different than health care insurance?
Expanding Medicaid is not the issue, but the mechanism used to expand this coverage is unless funding from the federal government was offset somehow.
Now getting back to the 20 million number, how many people/ households already had coverage and lost that coverage due to the AHA?
Furthermore of the 20 million number, is there any "double" counting? What I mean is were 20 million new policies issued or for example in one household with 4 people, were all 4 people under one policy being counted as 1 additional or 4 new people getting coverage?
Also within that 20 million count were people who turned 26 from the state of NJ added in to this number because NJ already coverage children to the age of 26 prior to the AHA.
1
If 20 M, then we should all know 5-10 people.
I work with governments and know many middle to lower income people.
I know "0" people on Obama-care.
I work with governments and know many middle to lower income people.
I know "0" people on Obama-care.
Obamacare will be considered a success for those previously uninsured with all its failures and incompleteness until there is a better way for universal healthcare and if the Republicans get their act together if they succeed in repealing Obamacare and replacing it with a better one. Any healthcare that does not have essential elements of Obamacare viz No medical precondition and healthcare coverage for all unemployed below the age of 26 and essential immunizations will fall short of an acceptable replacement for Obamacare. If on;y the Republicans in Congress had allowed for a public option and personal savings for those who take care of their health by following healthy living guidelines of the CDC, Obamacare would have been a greater success.
5
You know how the government pays to provide us with universal necessities like cops, education, fire departments, roads, snow removal, defense, garbage removal and the like? That's what we need to make sure that everyone in the country is covered for medical care. Not just this silly, convoluted ACA. Just like with the other services it should be paid for by the government using the taxes which we pay.
The ACA is deficient in that not everyone is covered because people are permitted to opt out by paying a fine. What sense does that make?
The ACA is deficient in that not everyone is covered because people are permitted to opt out by paying a fine. What sense does that make?
33
That is certainly true. However, if taxpayers found out that the police patrolmen were driving new Porsches, and the garbage men were living in giant mansions, then certain questions would start to be asked. It is only because these sorts of services are not chewing up huge amounts of the GDP that the taxpayers are wiling to cough up.
I get it, that the intention motivating the implementation of the ACA, "ObamaCare", was laudable, health insurance coverage for all.
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. The company complies with New York law. When I need a covered repair I can take it to anyone I please. That's the way it should be with health insurance.
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. The company complies with New York law. When I need a covered repair I can take it to anyone I please. That's the way it should be with health insurance.
6
The AHA aka "Obamacarelessiness" was a form of taxation that the Democrats in Congress and President Obama forced on the American taxpayer in a multitude of ways...
Rather improve healthcare coverage and tackle the rising costs of medical care, address Medicare and Medicaid fraud, their law undermines the very essence of the US Constitution, that of "freedom".
Rather improve healthcare coverage and tackle the rising costs of medical care, address Medicare and Medicaid fraud, their law undermines the very essence of the US Constitution, that of "freedom".
1
You speak as if the insurance companies are providing medical care. But it is really doctors and hospitals. Insurance companies still have to charge enough to cover their huge bills, and shifting costs around from one insurance company to another is no sort of solution.
1
To evaluate the ACA, alternatives, not absolutes, should be used.
The main failure of the ACA was the concept that by enlarging the patient pool, insurance companies and healthcare providers would compete and lower prices. This did not work. Health care does not work as other traditional markets.
The ACA should be evaluated compared to the market preceding the ACA or to the proposals currently on the table. I am not aware of any Republican proposals that are ready to be considered in spite of 60 votes to repeal and replace.
The main failure of the ACA was the concept that by enlarging the patient pool, insurance companies and healthcare providers would compete and lower prices. This did not work. Health care does not work as other traditional markets.
The ACA should be evaluated compared to the market preceding the ACA or to the proposals currently on the table. I am not aware of any Republican proposals that are ready to be considered in spite of 60 votes to repeal and replace.
4
The ACA might have been better if the Republicans had tried to help instead of sabotage any and all of the President's efforts. There are people today who are alive because of this law, it has had an overall positive effect, but does need serious adjustment. Perhaps it is time to lower the age for Medicare to remove the greater risk of older citizens from the private marketplace for their primary insurance. We should not put senior citizens at risk by reinstating the "donut hole" for prescriptions. Furthermore, many require Medicaid and Republican plans to reduce that program will force states to choose between helping sick children and providing nursing home services to our elders. I prefer Obamacares to Trumpdoesn'tcare.
52
The suc3ess is the insurance companies, drug com[anies, hospitals clinics and doctors can charge as much as the market can bear and gouge the average American in doing so.
The incomplete is that state insurance boards allow for smaller and smaller groups, and rating zones, to continue to raise premiums. Also, no cost containment, no set fees fro procedures, no control on the price of medication. And force people to buy insurance or pay a fine. And, in teh process try to wreck Medicare and Medicaid, to potential make them unstable enough, so they fail.
The failures. The United States devotes 20% of its economy to health care. It is the most expensive place to receive health care. However, it ha`s worse out comes that much of the industrial world. As derided the NHS is in the UK, or public health insurance in Canada; both countries have better health care outcomes than the US. The ACA is proving it is unsustainable and is collapsing under its 1100 page weight.
The "ACA was President Obama's great "bait and switch". He pro9mised Medicare for All and gave us the Heritage Foundation, GOP centric, Romney implemented health care. And the, in the pocket of the health care industry Democrats, only obliged.
The incomplete is that state insurance boards allow for smaller and smaller groups, and rating zones, to continue to raise premiums. Also, no cost containment, no set fees fro procedures, no control on the price of medication. And force people to buy insurance or pay a fine. And, in teh process try to wreck Medicare and Medicaid, to potential make them unstable enough, so they fail.
The failures. The United States devotes 20% of its economy to health care. It is the most expensive place to receive health care. However, it ha`s worse out comes that much of the industrial world. As derided the NHS is in the UK, or public health insurance in Canada; both countries have better health care outcomes than the US. The ACA is proving it is unsustainable and is collapsing under its 1100 page weight.
The "ACA was President Obama's great "bait and switch". He pro9mised Medicare for All and gave us the Heritage Foundation, GOP centric, Romney implemented health care. And the, in the pocket of the health care industry Democrats, only obliged.
6
My daughter is among the numbers of people who suffer from chronic and sometimes life threatening diseases. Before Obamacare, health insurance companies refused to cover her "existing condition" or offered minimal coverage at extreme costs that only the wealthy could afford. When the Republicans do away with Obamacare, they will harm my daughter and thousands of others in the same situation. I hope the voting public remember that during the mid-term elections. The Republican Party has broken faith with America, and in the process has adopted the means and methods of a Russian strongman.
122
I am sorry for your daughter but she doesn't deserve to benefit at someone else's expense. Obamacare did not work. It took healthcare away from many other sick Americans.
4
Deborah, you obviously don't understand the principles of insurance. "There but for the grace of God, go I." We all in this life together. No one is exempt from health problems. You aren't paying for Ned's daughter, "society" is paying, as well it should.
3
No. I have had cancer three times and my doctors and hospitals were taken away from me due to Obamacare. Before it, I had decent care. As a private business owner, I must pay for my own insurance. Making too much to qualify for Obamacare, but not rich enough to keep my old plans, I lost everything!!!! Lucky to still be alive....
2
Only in America is health insurance a luxury not a right. The ACA is a good start but much more work is needed to ensure that it meets the intended goals. Something that might help would be to add a public option to the exchanges that provides affordable quality health insurance for those who only have a few options to choose from. Private insurance needs competition to motivate it to offer quality insurance at an affordable price.
17
The driving forces of health cost in the USA are doctors afraid of being sued so they very defensive when ordering tests etc, and end of life medical expense.
These are the two issues that need to be addressed however our politicians are not adult enough to work to resolve. Probably because most are lawyers and don't want to hurt their attorney friends financially and second no one wants to tell an 85 year old they can't get a pacemaker etc...
These are the two issues that need to be addressed however our politicians are not adult enough to work to resolve. Probably because most are lawyers and don't want to hurt their attorney friends financially and second no one wants to tell an 85 year old they can't get a pacemaker etc...
7
There is no evidence to suggest that medical liability costs and "defensive medicine" are key drivers of the rising medical costs in the United States. Estimates over the last decade have generally concluded that medical malpractice and defensive medicine costs represent on the order of about 2-3% of overall health care spending in the United States. Here is one fairly comprehensive paper reviewing the evidence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
2
You have to be kidding? Obgyn are just about extinct due rising malpractice insurance rates.
3
Yes, health care remains the most expensive in the world, and the health outcomes in this country are no better, and often worse, than in advanced societies with National Health Care systems. This is a fact.
ObamaCare is the only program the American people could wrest from a dysfunctional Congress. At least it's something, but it's far from good. We need single-payer health care, a.k.a. "Medicare for All" in this country if we want to control costs and provide reasonable health care for our citizens.
Americans must stop thinking that providing health care for everyone is government coerced socialism. If you keep thinking this, and voting for politicians who advocate zero government, then you will get exactly what you deserve: no health care.
ObamaCare is the only program the American people could wrest from a dysfunctional Congress. At least it's something, but it's far from good. We need single-payer health care, a.k.a. "Medicare for All" in this country if we want to control costs and provide reasonable health care for our citizens.
Americans must stop thinking that providing health care for everyone is government coerced socialism. If you keep thinking this, and voting for politicians who advocate zero government, then you will get exactly what you deserve: no health care.
216
How would Medicare for All work? Do you think that those providing medical care would tamely allow their incomes to be cut in half, without violent protests and all sorts of trouble? Application of government coercion is exactly what would be required.
I think many doctors would welcome a system that rewards them generously, though not obscenely, and eliminates the frustrating waste of time and money spent on billing and arguing with insurers. They might be more receptive if the new system is coupled with gradual forgiveness of their medical school debts.
For those who want more, perhaps we should create an alternate system (let's call it "Fat Cat Tuesdays"). The wealthy get to 'jump the line' one day a week or month, provided they pay whatever fee the doctor asks, BUT they also pay a 100-200% surcharge for the privilege...which is applied directly to the national bill for health care, and for increasing the number of medical students.
As for the insurers, of course they will fight, and that won't change until there is meaningful campaign reform.
For those who want more, perhaps we should create an alternate system (let's call it "Fat Cat Tuesdays"). The wealthy get to 'jump the line' one day a week or month, provided they pay whatever fee the doctor asks, BUT they also pay a 100-200% surcharge for the privilege...which is applied directly to the national bill for health care, and for increasing the number of medical students.
As for the insurers, of course they will fight, and that won't change until there is meaningful campaign reform.
1
The ACA, like real estate, is all about location. It had a problem from the start, namely the insurance industry is still balkanized by states with states allowing or disallowing an insurance company from selling insurance within a state. The second problem was the back office workers in health insurance did not assess risk correctly and mispriced the premiums. The third problem was the ACA was supposed to foster competition in the insurance market, not realizing that there are wide swaths of the country where there was no real competition. Fourth, the ACA had no real provisions for cost containment outside of Medicare. Fifth, keeping my doctor went away before the ACA was even implemented. The decade leading up to the ACA, we have had two firms gobbling up clinics, doctors and hospitals and the two of them now have a virtual oligopoly for health care. What the ACA did do well in our area was greatly reduce the use of ER's by the uninsured and reduced unrecovered costs as well as get more patients using urgent care clinics and getting them scheduling appointments at regular clinic hours. Whether we will see a benefit from the large drop in unrecovered costs is still an open question.
6
From my perspective, there are a few things that could be done that would go a long way to improving healthcare.
1) Improve continuity of care by instituting a universal medical record so all the doctors caring for a patient knows what the other doctors are doing. This would reduce redundant testing and things such as over-prescribing opiates. Perhaps mental health could be excluded; up for debate.
2) Make the cost of non-emergency health care transparent so people can shop. I believe if people know the cost they will shop even if insurance is paying. America loves shopping and finding the best deals. How can we have free market health care when no one knows the price. Shopping becomes futile as does free market price control
3) Mandate emergency room price controls so that costs are in line with non-emergency health care. It can cost more but lets put a limit on that.
4) When the cost of a drug rises more than some figure above inflation, the drug company must go before a layman's board for approval.
5) Allow drugs from other countries into America after FDA approval.
Most of these changes cost little in the larger scheme of things but their impact on health care costs would be significant.
1) Improve continuity of care by instituting a universal medical record so all the doctors caring for a patient knows what the other doctors are doing. This would reduce redundant testing and things such as over-prescribing opiates. Perhaps mental health could be excluded; up for debate.
2) Make the cost of non-emergency health care transparent so people can shop. I believe if people know the cost they will shop even if insurance is paying. America loves shopping and finding the best deals. How can we have free market health care when no one knows the price. Shopping becomes futile as does free market price control
3) Mandate emergency room price controls so that costs are in line with non-emergency health care. It can cost more but lets put a limit on that.
4) When the cost of a drug rises more than some figure above inflation, the drug company must go before a layman's board for approval.
5) Allow drugs from other countries into America after FDA approval.
Most of these changes cost little in the larger scheme of things but their impact on health care costs would be significant.
6
I give it a big fat "F".
1-It expanded Medicaid which is minimal healthcare. Most doctors do not accept it.
2-It made healthcare unaffordable for middle class small businessmen who must purchase their own plans.
3-It gave less incentive for start-ups, particularly immigrants who start their own bodegas, barber shops etc. due to its increased expense and ineligibility once they begin to make some money but not be rich.
4-It destroyed solo primary care medical practices and forced early physician retirement by requiring undue regulations and expenses. (i.e. electronic medical records) creating a primary care doctor shortage.
5- It forced the conglomeration of hospitals to join forces for power against insurance companies including Medicare.
6-It led to WalMart medicine-incorporating small medical practices into mammoth entities.
7-It forced doctors to lose their independence and respect by having to yield to the decisions of insurance companies rather then their own expertise in care and decision making.
8-It took choice of doctor and hospital away from actual cancer patients who already had plans. (I am one such person).
9-It made many hard-working middle class Americans contribute from their paychecks to their once healthcare benefit.
1-It expanded Medicaid which is minimal healthcare. Most doctors do not accept it.
2-It made healthcare unaffordable for middle class small businessmen who must purchase their own plans.
3-It gave less incentive for start-ups, particularly immigrants who start their own bodegas, barber shops etc. due to its increased expense and ineligibility once they begin to make some money but not be rich.
4-It destroyed solo primary care medical practices and forced early physician retirement by requiring undue regulations and expenses. (i.e. electronic medical records) creating a primary care doctor shortage.
5- It forced the conglomeration of hospitals to join forces for power against insurance companies including Medicare.
6-It led to WalMart medicine-incorporating small medical practices into mammoth entities.
7-It forced doctors to lose their independence and respect by having to yield to the decisions of insurance companies rather then their own expertise in care and decision making.
8-It took choice of doctor and hospital away from actual cancer patients who already had plans. (I am one such person).
9-It made many hard-working middle class Americans contribute from their paychecks to their once healthcare benefit.
16
@Jane
New Jersey
I went through your list carefully. Some of them are completely incoherent (e.g. 9) but the rest are to a greater or lesser extent simply lies. For example the claims that electronic record keeping forced doctors to retire or that hospital systems haven't been consolidating for decades for reasons totally unconnected with Obamacare...in fact they're not dissimilar from the reasons cable TV operators have been consolidating.
New Jersey
I went through your list carefully. Some of them are completely incoherent (e.g. 9) but the rest are to a greater or lesser extent simply lies. For example the claims that electronic record keeping forced doctors to retire or that hospital systems haven't been consolidating for decades for reasons totally unconnected with Obamacare...in fact they're not dissimilar from the reasons cable TV operators have been consolidating.
10
Jane's comment is completely untethered from reality. None of what she wrote is true.
4
Most medical care is untethered from reality. It involves procedures costing thousands of dollars, to be paid by people barely getting by.
Preventive care, forget about it.
Preventive care, forget about it.
2
The law was as many have observed was something of a kludge as are most major new initiatives in America because of path dependence. It set out to expand health insurance using a insurance market model based upon the existing system. There is no other realistic route given the enormously complex current setup. Now if you use this model and want guaranteed issue (no one can be refused insurance) at community rated prices (i.e. affordable) without the insurance companies going bankrupt then you have to have mandates to swell the risk pools (which is how all insurance works) and subsidies to assist those on low incomes. This is math not politics. And of course this is why Republicans find themselves in a box because they know all this as well as I do. The alternatives they propose are either irrelevant or don't work. If selling insurance across borders worked why is insurance the same price in huge markets like CA as it is in smaller ones like VA? HSA'S? OK if you're a high earner but risky if you get really ill and very high deductibles. High risk pools are unaffordable even with subsidies, not surprisingly because all the super ill people are in them. So are Republicans going to take health insurance off 22 million people and risk destabilizing the private individual market (~ 7 million) and other collateral damage?
26
I am a consumer healthcare advocate, and have spent countless hours on this topic.
Without question, the most monumental mistake made by the Affordable Care Act political leadership was allowing it to be referred to as "Obamacare" in the first place. The moniker gave politicians the ammunition to (shock alert!) turn it into a political football, which endangered and continues to endanger the lives of millions of Americans for nothing more than political gain. Once it became that toxic hot potato, Congress could use it as a weapon against each other rather than fix its loopholes for 6 long years and counting. Who has benefited? The insurers and the healthcare providers who know that no one with power in government is at all interested in protecting citizens from improper/illegal claim denials, skyrocketing premiums/deductibles, price gouging prescription drugs and healthcare provider costs and illegal billing practices.
Our lives shouldn't be be treated like a poisonous game of politics, profit, power and ego played by Congressmen and the White House and Lobbyists and Insurers and Healthcare Corporations where we serve as the disposable pawns. They profit. We suffer emotionally, financially and physically. We are put in harm's way for no reason. We die for their greed.
Notice what's missing from all of the healthcare "reform" legislation on the table of recent? Any mention of the patient, and the improvement of his/her life.
Without question, the most monumental mistake made by the Affordable Care Act political leadership was allowing it to be referred to as "Obamacare" in the first place. The moniker gave politicians the ammunition to (shock alert!) turn it into a political football, which endangered and continues to endanger the lives of millions of Americans for nothing more than political gain. Once it became that toxic hot potato, Congress could use it as a weapon against each other rather than fix its loopholes for 6 long years and counting. Who has benefited? The insurers and the healthcare providers who know that no one with power in government is at all interested in protecting citizens from improper/illegal claim denials, skyrocketing premiums/deductibles, price gouging prescription drugs and healthcare provider costs and illegal billing practices.
Our lives shouldn't be be treated like a poisonous game of politics, profit, power and ego played by Congressmen and the White House and Lobbyists and Insurers and Healthcare Corporations where we serve as the disposable pawns. They profit. We suffer emotionally, financially and physically. We are put in harm's way for no reason. We die for their greed.
Notice what's missing from all of the healthcare "reform" legislation on the table of recent? Any mention of the patient, and the improvement of his/her life.
310
@Sarah O'Leary
Dallas, Texas
Er... Ms O'Leary the label "Obamacare" was pinned upon it not by the Democratic political leadership but by the Republicans for rather obvious reasons.
Dallas, Texas
Er... Ms O'Leary the label "Obamacare" was pinned upon it not by the Democratic political leadership but by the Republicans for rather obvious reasons.
15
It's simplistic and just plain wrong to assert that the "the most monumental mistake...was allowing it be called Obamacare. Once it became that toxic hot potato, Congress could use it as a weapon...rather than fix its loopholes."
Republican leadership declared their intention to obstruct every Obama iniative. The majority of people want single payer. The monumental mistake was electing a petty, incompetent Congress that obstructs sensible healthcare reform against the wishes of their constituents.
Republican leadership declared their intention to obstruct every Obama iniative. The majority of people want single payer. The monumental mistake was electing a petty, incompetent Congress that obstructs sensible healthcare reform against the wishes of their constituents.
19
A reminder that the original idea came out of the Heritage Foundation, a conservative think tank The first state to implement it was Massachusetts, governed at the time by a Republican, Mitt Romney. Universal healthcare is a good idea, but with the oppositional party vowing to obstruct anything Pres. Obama tried to do to make sure he was a one-term president, we now have a group of uninformed voters who vote against their own interests and a Republican party whose only interest is in keeping the rich richer. Pros. Obama may have compromised too much by taking the single-payer option off the table, but at least he got universal healthcare launched. Let's fix this "first draft" of healthcare reform, not destroy it. Since the current president has continued to assert his callousness and vindictiveness in his first weeks in office, it's up to someone in the GOP to care about their constituents and not just politics.
3
For heaven's sake. It is not about "law", it is about conscience. Saving lives is an exercise in the redistribution of wealth. Saving money is easy. It is simply that the people who think they are paying for all of it place greed ahead of decency.
70
Well, what is 'decency'? Will Congress appropriate ten billion dollars to save the life of one man? The answer, as everyone knows, is that they will let him die. That is reality.
The amount of money available is limited, and resources have to be allocated across various needs. If we spend 100% of money on health care, we'd have nothing left for food, shelter, and clothing, so we don't.
The amount of money available is limited, and resources have to be allocated across various needs. If we spend 100% of money on health care, we'd have nothing left for food, shelter, and clothing, so we don't.
2
Two thoughts-
First, Medicare must be allowed (nay, required) to negotiate drug prices, and negotiate hard.
Second, "narrow networks" are so narrow that they make seeing some specialists in a timely fashion nearly impossible. For example, in my area of nearly 2 million there are exactly 3 gastroenterologists on my plan and to be seen there is a wait of 6 months. This also drives up costs in ER visits.
First, Medicare must be allowed (nay, required) to negotiate drug prices, and negotiate hard.
Second, "narrow networks" are so narrow that they make seeing some specialists in a timely fashion nearly impossible. For example, in my area of nearly 2 million there are exactly 3 gastroenterologists on my plan and to be seen there is a wait of 6 months. This also drives up costs in ER visits.
63
as a recipient of "obama" care, i can see that the system is flawed. the lower echelon plans do not encourage users to take advantage of preventative medicine because you generally have to pay out of pocket for everything until you meet your $6000 or more deductible. i do not like the fact that my government has to subsidize my health insurance when i had a perfectly decent local HMO before that, once Obamacare was instituted, stopped providing coverage in Miami. I think the entire system is awful and shameful and I look at socialized medicine with envy.
8
I am covered by my wife's HMO plan from her employment at a local community college for which she pays a monthly contribution. Our maximum out of pocket is $4,500 per year. My point being that it's not just ACA policies that have high deductibles.
9
And at the age of 60, will her monthly contribution be triple that of her younger colleagues? One of those seldom mentioned things about the ACA.
1
Unfortunately, the ACA did not provide Americans with health insurance as that term is understood in normal parlance because most of the plans have extremely high deductibles, actively discouraging many citizens from all but the most urgent medical consultations. The country that has the most superior health care is, of course, France, with essentially 100% coverage of its citizenry, effectively no deductibles whatsoever, and lifespans that vastly exceed those of Americans. To follow their model, you would have to eliminate the private insurers, the absurd retail prices for drugs paid by the government, and most importantly the entire culture of rampant greed that pervades this "business" in the US. You would also have to start returning power to the physicians and send packing all the managers that have infested the systems. And you might want to stop requiring doctors to carry absurd patient loads and calling them "providers"--a term intended to mimimize their importance.
187
Physicians have little power you say and nasty corporate overlords oppress them. Then how do they average over 250,000 dollars a year in income and make up a large portion of the one percent?
3
Also take a look at Japan. I was speaking to a Japanese colleague who was telling me about going to the doctor and having several medical tests. I asked him how much it cost. He said it was the equivalent of about $30 US. Wow, you must have great health insurance! He replied, no, that's just what it costs.
1
Here is Obamacare's greatest failure. You can't insure everyone all the time with the insurance business model Obamacare is simply an ill conceived wealth transfer mechanism. For every one of the million that received money (insurance) there were a group, or 5 times as big or saw, that had to pay more. O'Care simply moved money from those that could "afford" to pay more, to those that did not. Anyone, foolishly believing this was about Healthcare is at best sophomoric and at worst, well, hate to say this on a Sunday, stupid.
3
The ACA's biggest achievement was it made America think deeply about what we should be offering each other collectively. It's biggest failure was that it was passed in a bipartisan way with a good dose of distortion and lies. Hopefully the lesson we will learn from this experiment is that we should confront important economic and social issues with candor and honesty. Final outcomes should be the product of thoughtful pragmatism and principle rather than parochialism and partisanship. Unfortunately it seems to me that is a lesson we are not prepared to learn.
7
I have the amazing ability to see typos after I hit 'enter'.
Sentence 2 above must start with Its, not It's., and bipartisan starts with two too many words - it should read partisan.
I may notice a typo in this note of correction after I hit enter. If eye do, my apologies. :-)
Sentence 2 above must start with Its, not It's., and bipartisan starts with two too many words - it should read partisan.
I may notice a typo in this note of correction after I hit enter. If eye do, my apologies. :-)
1
The cold hard truth is that per-capita health expenditure in the US will exceed $10,000 this year and that money has to come from some place. Having health insurance does not make that basic economic fact go away.
The only way to address the long term issue is to control cost by:
1. Reduce drug prices. Fund comparative trials, reject new "me too" drugs that do nothing more than older generics. Reject new formulations of old drugs that are re-branded and cost as much as a newly developed drug.
2. Address end of life issues. Medicare would be made solvent in the long term and billions of dollars saved in the short term if every primary care physician, after an appropriate training course, was paid well to explain end of life issues to patients and help them with advanced directives. Millions of people would be spared futile care at the end of life.
3. Provide safe harbors for physicians who follow guidelines in evaluating specific complaints to reduce unnecessary testing and imaging, making them immune from litigation in case of a "missed diagnosis".
And for good measure,
4. Mutualize insurance companies to align the fiduciary responsibility of the management of health insurance companies to benefit patients rather than shareholders.
The only way to address the long term issue is to control cost by:
1. Reduce drug prices. Fund comparative trials, reject new "me too" drugs that do nothing more than older generics. Reject new formulations of old drugs that are re-branded and cost as much as a newly developed drug.
2. Address end of life issues. Medicare would be made solvent in the long term and billions of dollars saved in the short term if every primary care physician, after an appropriate training course, was paid well to explain end of life issues to patients and help them with advanced directives. Millions of people would be spared futile care at the end of life.
3. Provide safe harbors for physicians who follow guidelines in evaluating specific complaints to reduce unnecessary testing and imaging, making them immune from litigation in case of a "missed diagnosis".
And for good measure,
4. Mutualize insurance companies to align the fiduciary responsibility of the management of health insurance companies to benefit patients rather than shareholders.
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These proposals do little to address fundamental costs. While the number of medical procedures per capita is about the same in the US and in Europe, each medical procedure costs 2 to 3 time as much. This is primarily because salaries in medicine are much higher than in Europe, and the capital expenditure on fancy building, machines, and facilities is much greater.
I was with you until number four. Insurance companies are the problem, unless you think that access to health care is not a fundamental human right, but is secondary to private profit. Take the insurance companies completely out of the picture and the cost factor is dramatically reduced. The shareholders will not become poor, only deprived of one stream of unearned income on which they pay reduced taxes.
2
Another major success of Obamacare was sharply improving the individual (non-group) insurance market, encouraging new business start-ups. Before Obamacare, the individual market was a disaster with coverage at best astronomical and at worse unattainable. Obamacare established rules of the road, lowered private market rates and made it possible to both be self-employed and to protect your family.
Repeal threatens millions of self-employed individuals and new business formation. Why Republicans would declare war on small business is unfashionable.
Repeal threatens millions of self-employed individuals and new business formation. Why Republicans would declare war on small business is unfashionable.
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Republicans see small business as a proving ground for corporate buyouts. Successful SB's are quickly gobbled up by the investor class, while those that struggle are left to drown in the "rising tide."
Obamacare may have helped those whose insurance and medical costs were subsidized and hurt those subsidizing others' costs. Health insurers scrambled for share of market and were generous in passing along their costs to those consumers who paid for insurance. All the rest, bureaucratic morass.
9
"Reduced inequality"? From my experience, the ACA insured some at the expense of others. Last year was the first year in twenty five that I went without health insurance. I did not qualify for a subsidy and the premium for a catastrophic deductible was absurd. This year in Montana the increase was another 42%. The ACA failed. Unfortunately, I have no faith that the other Party can do any better. Hope it doesn't get worse.
33
@smalldive- The decision to embrace Obamacare was done at the state level. I am curious, did Montana set up its own state marketplace? Were their any navigators available to help people sort out what was available? Did state representatives from Montana work in Congress to improve the problems of Obamacare? Were they interested in holding insurance companies responsible for costs and profits?
5
Although Montana has had Democrats as governor for the past 12 years, the state did not set up a state exchange. Probably for the best as this state is not known for any level of governing competence. Could it have been worse than the national marketplace? Maybe, although I work in a profession with many who qualify for subsidizes, and their experiences were without exception awful. From a selfish perspective, those of us millions who are individually insured and do not qualify for subsidizes have borne the brunt of astronomical increases, driving many like myself to give up insurance. This year, between excessive deductible and a premium 4 times what it was 5 years ago, I would pay about $18,500 before anything is covered. That's 30% of my net income and, I believe, not good legislation.
3
It can only get worse until we have National health care.
4
Here we see the sine qua non of both the feminist superstructure and family planning zealots - the singular ability to prevent and if not that, abort, pregnancies. It is not "health care" or even "women's health" that is championed. It is a culture of convenience and death. A perfect illustration of our times, this country and its politics. Nihilism is the guiding principle, coercion and hyperbolic mouthings its methods. Ignorance and hate are the products. Partisans of this have done a fine job desensitizing us, dividing us and demonizing. Never-ending war, consumerism, ignorance and death worship. Predicted long ago and soon to mark the advent of a long period of universal suffering, the bills will come due.
8
Sally, in case you were unaware, abortion is legal in the USA. Change the law if you can, but until then, it is illegal to block access to legal procedures. If an employer were Jehovah's Witness, should they be able to exclude blood transfusions as part of the health care package offered to their employees? We clearly have a president who thinks he's above the law - he isn't; thank you Alexander Hamilton for crafting a system of checks and balances.
Picking a fight with the Judicial Branch is not a very smart idea for a president in his second week of office. Like so many of Trump's ready-fire-aim EAs, it seems to be the standard approach and defines who president Trump really is. The Emperor is naked, may his reign be short.
Picking a fight with the Judicial Branch is not a very smart idea for a president in his second week of office. Like so many of Trump's ready-fire-aim EAs, it seems to be the standard approach and defines who president Trump really is. The Emperor is naked, may his reign be short.
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Spare me the argument that pregnancy, labor and delivery are mere "inconveniences" that have no relationship to women's health. During my first pregnancy, I was hospitalized with complications during the second trimester. I have three kids - all delivered by c-section. (One third of all deliveries in the US are now done by c-section). My best friend from childhood started spotting in the first trimester, and spent 15 weeks on bedrest to keep her from miscarrying. One co-worker developed gestational diabetes, another had a stroke while delivering. Another friend almost died during delivery, when the anesthesiologist accidentally gave her the wrong medication and she had an allergic reaction to it.
But no, there's no "women's health" issue here. It's all just "inconvenience" to people like you.
But no, there's no "women's health" issue here. It's all just "inconvenience" to people like you.
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Sally Round the Roses:
The issue isn't abortion, or death ('death worship' – where did you get that?!?). It's about guaranteeing every citizen – that includes females – autonomy over their bodies.
The issue isn't abortion, or death ('death worship' – where did you get that?!?). It's about guaranteeing every citizen – that includes females – autonomy over their bodies.
32
The Obama administration loves to tout all the people who got signed up for care at an affordable (and subsidized) price. But like this very rosy article, it mostly omitted mention the large number of people who are self-employed and make too much income--but who aren't necessarily rich--for a subsidy and who have seen rates and deductibles skyrocket to levels that mean they often are paying most or all of their healthcare costs out of pocket. They also face a maddening chase just to stay insured, as insurers keep dropping out of the market and downgrading options and excluding hospitals and doctors. These folks are dismissed as a small percentage but their numbers are still large, and the diminished healthcare they get under Obamacare is seen as a minor consequence because they are not poor. If the affluent people in the Obama administration faced the same expense and hassle to retain decent healthcare, they'd not be so cavalier about middle class people who have to buy individual policies on the open market. And the frank falsehood of "If you like your doctor/policy .." should not only be more plainly pointed out here but should be acknowledged as something that Obama either did or should have foreseen. It was, after all, a major selling point and turned out to be as counterfeit as Volkswagen's mileage claims for Diesel engines.
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The diesel engines got great mielage, but VW cheated on pollution.
25% of health costs are on management- paperwork and excess overhead, and 25% on overdiaganosis and overtreatment- to play it safe.
25% of health costs are on management- paperwork and excess overhead, and 25% on overdiaganosis and overtreatment- to play it safe.
2
You could go for a single payer system like Medicare or the single payer systems like every developed country and economy in the world. But if you want to continue with the most expensive but currently at number 11 for positive outcomes healthcare system, fill your boots.
7
@The Old Netminder - a few comments. I was a self-employed software contractor for a number of years prior to ACA and I can assure you that buying your own individual health care was 1. extremely expensive and the rates increased every year without fail, and 2. coverage was very difficult to get in the first place as there were very few companies that would offer individual policies. And, if you had a pre-existing condition, you could just forget about it. Thus, the implicit suggestion that pre-ACA things were more rosy for an individual is just not true.
As far as your statement "If the affluent people in the Obama administration faced the same expense and hassle to retain decent healthcare ..." I assume you really are talking about *all* the members of Congress and their coverage that the rest of us can only dream about. And as far as being "cavalier about middle class people who have to buy individual policies on the open market", folks like Paul Ryan have a corner on that market and send chills running up and down my spine with their disregard for the quality of life of the people they allegedly represent.
As far as your statement "If the affluent people in the Obama administration faced the same expense and hassle to retain decent healthcare ..." I assume you really are talking about *all* the members of Congress and their coverage that the rest of us can only dream about. And as far as being "cavalier about middle class people who have to buy individual policies on the open market", folks like Paul Ryan have a corner on that market and send chills running up and down my spine with their disregard for the quality of life of the people they allegedly represent.
14
The reported increase in the percentage of the insured (8.9%) is overstated by 0.5% to 1.5% because the census bureau changed the methodology for determining the count from the household survey in 2013, and did not follow the standard statistical practice collecting the data using both methods for two years so that the change from the methodology could be distinguished from change with other causes. It is horrifying that the census bureau was ordered by Obama to abandon scientific methods.
5
If Obamacare (aka Romneycare) is so bad then suggest a better system; if that is single payer or the ability to buy into Medicare - as Hillary suggested, I'll vote for it. What have you got?
10
One provision alone has significantly changed the health and functionality of U.S. residents for a long time: universally available and affordable contraception.
Our economy punishes individuals and families who experience unplanned pregnancies. An unplanned and perhaps unwanted child causes enormous economic and personal stress and even chaos for parents.. Planned babies are born into families that want them and have saved money and personal leave in order to care for them and have figured out some way to manage the stress of sleepless nights and daycare instability. Unplanned children face much more risk of abuse and neglect. NOW we know that neglect and abuse cause lifelong mental illness including addictions. We face huge challenges from a dysfunctional population of mentally ill persons with and without addiction.
A healthier and more productive population is an enormous advantage to our country. We save huge amounts of taxpayer dollars for every prevented unplanned pregnancy. Economics will have trouble calculating the dollars saved but it's big. And unplanned children often suffer greatly.
Our economy punishes individuals and families who experience unplanned pregnancies. An unplanned and perhaps unwanted child causes enormous economic and personal stress and even chaos for parents.. Planned babies are born into families that want them and have saved money and personal leave in order to care for them and have figured out some way to manage the stress of sleepless nights and daycare instability. Unplanned children face much more risk of abuse and neglect. NOW we know that neglect and abuse cause lifelong mental illness including addictions. We face huge challenges from a dysfunctional population of mentally ill persons with and without addiction.
A healthier and more productive population is an enormous advantage to our country. We save huge amounts of taxpayer dollars for every prevented unplanned pregnancy. Economics will have trouble calculating the dollars saved but it's big. And unplanned children often suffer greatly.
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There is no evidence to support any of your assertions regarding planned v. unplanned pregnancies. They sound logical, and intuitive, but the science doesn't back up your assertions. There are plenty of parents who plan pregnancies but when the child arrives are not able or willing to be competent parents.
We do know that poor parenting can cause lifelong problems, but we also know that mental illness can result from genetic issues, independent of whether a child resulted from a planned or unplanned pregnancy. Drug addiction is as prevalent among children who were planned as children who were unplanned.
We do know that poor parenting can cause lifelong problems, but we also know that mental illness can result from genetic issues, independent of whether a child resulted from a planned or unplanned pregnancy. Drug addiction is as prevalent among children who were planned as children who were unplanned.
8
Unfortunately, many poor, unmarried women in their 20s and 30s do want a baby. They can afford contraception, but if there is no one to love them, then they will create someone who will love them.
2