Obamacare is just plain stupid. It rests on obliging a private insurer to insure an already sick or old person. Insurance only works for a pool of people, not individuals, mandated or otherwise. The perfect pool is the population of the U.S.; the best insurer is the U.S. Government, not profit seeking insurance companies, and the Democrats will go down again while insisting that this is unrealistic.
5
Not to lessen the impact this could have on our society as a whole but rather to speak to the Root Cause of this and a host of other Trump Administration ills such as selling-off our National Parks, ending the Clean Water Act, and in fact selling government to the highest bidder by the entire Trump Administration...to speak to all these things is to speak to human nature.>>>>>
The inhabitants of this planet are ruled by their nature which is to "Lie, Cheat, Steal, Kill"....in greater or lessor degree in every person who has ever lived, is living or will live. Deniers are liars.>>>>
Trump et al. are simply exhibiting this natural nature to a greater and more public degree than we are generally accustomed to in our Presidential Administrations....BUT, remember "Y'all 'lected the sombich".
2
This is at least a better platform than Hate America! and Hate Trump! but your hoping the entire middle class has forgotten the giant raid on family incomes Obamacare amounted to for far too long.
People tend to remember who tripled their medical expenses, took away most of the cafeteria-plan tax savings, and doubled deductible costs - not to mention causing many people to see their coverages cancelled every 2 or 3 years.
In the campaign, I would NOT bring up those pictures of Mr. Obama bowing his head over low enough to tie the Saudi king's shoelaces, even though you thought that they made him look really cool. jus' sayin'
3
Republicans like Newt Gingrich have told their deplorables they don’t need health insurance, they just show up at the er and get treated for free. Let them eat cake.
3
The Republicans hate us, positively hate us. They think most of us are useless drags on the rich, the only worthy citizens. They think we should just die and decrease the surplus population.
5
TRUMP'S & GOPpers' Message on Healthcare:
If you're not a member of the 1%,
GO DROP DEAD!
Gee, that's gonna win them lots of votes in the midterm elections!
7
The GOP supports suffering and dying, which is a crime against humanity.
Vote Republican if this pleases you. Be proud.
3
Clearly this is being done because it was an Obama accomplishment. As we all know the Fake POTUS has a list of things Obama did during his tenure, all of which are being dismantled one by one. This vindictive monster doesn’t care what he does to this country or its people as long as he can undo everything his hated predecessor did.
4
We have loonies running this country.
3
Dear God, my fellow citizens! This is pure, greed-driven madness! Universal health care is the ONLY WAY TO GO!
6
Obamacare is a disaster for those who pay because our costs have skyrocketed without addressing what is really important:
1. What we pay for.... waste. Useless treatment of terminal conditions because medicare is a blank check.
2. We pay for illegals because they ARE here and do get medical care without paying a dime. Deport them all, and stop the flow. Then....
3. Force the welfare recipients in the US to go to work and contribute. We are tired of paying for people to have babies and not contribute.
See how much we have left over then. And people wonder why Trump was elected.
4
Never again Republican.
5
I get it that the ACA is the liberal’s darling, but let’s just look at the FACTS: 1) it was suppose to decrease costs, but the average insurance premium increases over the last 8 years exceed the increases before the law took effect (averaging 25% increase each of the last 6 years) 2) it was suppose to increase the insured; granted on paper more people have a Medicaid card (75% of the “newly insured” have been new Medicaid enrollees), but less than half the nation’s physicians accept Medicaid so these folks still have no where to go but emergency rooms, driving up costs further 3) the physician suicide rate is now the highest amongst any white collar worker, essentially robbing a million patients a year of their doctor, and most published literature in my universe points the finger at the immmense needless regulations in the ACA.
So, Obamacare was a product of the Democratic Party, and on most fronts it is a failure, so maybe it isn’t a bad idea to throw it out and try something different. In the time it takes for the NYTs to write another article on the GOP trying to repeal the ACA....another doctor in this country will commit suicide.
4
Romney was the "polite" version when he was caught out implying that 47% of all Americans--some 150 million fellow citizens, were somehow "life unworthy of life" to vanish at little or no cost.
Trump is the unfiltered version. We are talking about a genocide by cheap means: disease and earlier death to the poor, the elderly, people of color, LGBTQ people, Muslims, and anyone else who isn't the political donor class to the GOP. The numbers dwarf Hitler (six million) and Stalin (over 50 million).
Cutting off people from "life, liberty, and the pursuit of happiness" is NOT "christian." There's a four-letter name for it, and it should be the new symbol of the GOP rather than the poor, endangered elephant.
5
What kind of nation does this to it’s citizens? In the richest country in the world?
Belligerent sociopaths.
5
Republican politicians really don't care if you die as long as they get theirs. Bottom line Republican politicians are heartless and unchristian and they are masquerading as caring people. Vote them out or suffer the consequences.
6
health care reform is being derailed by a failure of both parties to understand the true nature of the health care market. the debate is based on the premise that the markets for health care are characterized by free market capitalist principles. this is absolutely not the case. instead the markets are based on 4 interlocking govt sanctioned monopolies. Doctors enjoy a govt protected monopoly to practice medicine, and a govt protected monopoly to decide who can obtain a medical license.Doctors also enjoy a govt protected monopoly on access to prescription medicine, and pharmacists a govt protected monopoly to dispense it. Insurance companies enjoy a government protected monopoly to sell insurance. US Pharmaceutical companies enjoy a govt protected monopoly to sell drugs in the US. to say that these govt granted monopolies exist is not advocating that they be removed. however it is essential to recognize them for what they are if the two main purposes of health care reform, cost containment and guaranteed access, are to be achieved. usually when govt provides an industry a protected monopoly as in the case of utilities it creates a commission to control prices and ensure quality of service. the government has long been given the power to regulate monopolies. its time to label the health care market as such and regulate it accordingly.
2
If I had not been so ill 25 years ago that I was almost instantly granted Social Security Disability Insurance payments and eventually Medicare, my illness and inability to work would have wiped out everything I owned, basically a home, car and modest savings.
At that time, there was no guarantee of coverage for pre-existing conditions. I had been fortunate to work for large non-profits with whom I negotiated "first day" health insurance coverage without revealing my illness.
As I became sicker, it became clear that I could not work because it was impossible to determine when I might be well enough to do so. At the time, I had worked for an insurance company with its own health insurance division, so I was covered by their disability and health insurance for a while before receiving Social Security.
But, most people with disabilities are able to continue working and, just like me, want to work. They can do so as long as their preexisting conditions are covered.
Mr. Sessions has done America a grave disservice by filing this complaint to try to undo the ACA. One wonders if he is doing so to get back into Mr. Trump's good graces. Regardless of his motive, he is pushing the United States backwards, even as her former allies take increasing responsibility for the health of their citizens.
9
This is a mean bunch.
6
The Republican Party is the most destructive force in America.
9
And the GOP hollered loud and long about death panels.
7
To paraphrase, "It's healthcare stupid"! Americans liked the ACA despite some of its faults.They will not accept being denied for pre-existing conditions and high fees.They have seen a better way and their votes will reflect that.
6
Life long liberal, over 60, believer in single payer, and I'm thrilled Trump killed the mandate for the junk insurance I was forced to buy. You can have your neoliberal sucker identity politics, I'll take not being jammed for $2500 for nothing but to subsidize people who don't take care of themselves.
Neoliberals are just Republicans who play bleeding hearts for suckers, I'm not voting again at any level for a Democrat who won't support a national healthcare system. Yes health care is a concern, but I'm not going to be frightened into taking a lousy deal. I don't want prescriptions for heartburn because I overeat and I don't need constant tending for discomfort and strains, I give my healthcare $$ to the gym and dentist for real gain, not Anthem for supposed peace of mind.
5
Will Republicans finally be happy when millions are begging in the streets and dying in the gutters? Inquiring minds want to know.
7
No.
Republicans will be happy when liberals stop telling us to pay for everything.....
We need to stop illegal immigration, cut legal immigration to those who can afford to support themselves, and force responsibility on everyone who lives here. Don't have kids when you are already on public assistance. Don't smoke, don't engage in risky behaviors and don't start taking drugs (it is not a disease, it is a choice).
The safety net is something to fall into and bounce out of, not somewhere to exist and procreate and continue.....
3
The entire American healthcare system is one big scam with Republicans leading the charge to make it even worse. Deplorable, fix it!
4
Obamacare is unsustainable and needs to be repealed. Premiums have skyrocketed to the point of complete unaffordability, unless you are getting a subsidy from the government. Here in NY we have just received notification from our insurance carrier that they are requesting a 50% increase in premiums! This company already pays nothing towards our healthcare costs because of the extremely high deductible. Now, we are looking at a payment that is equal to what the average person would consider a mortgage payment, and still getting no coverage for expenses. If this isn't the most disastrous piece of legislation ever, I don't know what is.
3
What we need is a clear-cut definition of “insurance.”
Many people say that we have to stand united behind patriotic ideals and concepts. Unfortunately we get united by war or terrorist attack, but that is not enough to make a truly civilized society. If we do not stand united behind ideas of equal civil rights, social security, healthcare and childcare for all, clean air and water, then we are just doing a poor job in standing for each other.
If we are trying to deprive some of our own from dignity and decent life, then we are cruel to each other and it is only a matter of time before we get deprived of everything while going down the ladder to a bottomless hole.
4
Here's a novel idea:
Get the Democrats to grow a spine and back single-payer healthcare. You know--the same single-payer plan Ted Kennedy argued passionately for 50 years ago.
The continued interest in noodling and tweaking the system is getting us nowhere and leaving the problem of greedy private insurers and high drug costs front and center. How much more can one tweak? Democrats continue to bamboozle with talks of "Medicare Extra," "Medicare 55+,"Medicaid Expansion," "Healthcare Reinsurance," "Universal Healthcare" et al. None of these get at the core of the problem.
It is getting increasingly frustrating seeing Dems shoot themselves in the foot with this thinking and a continued reliance on market-based solutions. Market-based solutions are what got us into this mess.
Be bold and commit to legitimate systemic change--make Medicare for All the healthcare platform for the party!
11
I write this from the viewpoint of a 30+ year physician.
The implementation of Obamacare was our start of a nationalized health care system, something all western countries had implemented years ago. In fact, the last Western country to implement such a system was Israel in the mid-nineties...25 years ago!!
The GOP has had a history of fighting this since it was first suggested post WW2. It's still being fought tooth and nail.
Why? Simply the following, pharmaceutical and Health Insurance companies/HMO's/PPO's are cash cows totaling billions of dollars in net profits per year. You need to just look at their balance sheets or better yet the yearly compensation of the CEO's.
Consequently, these companies have their hands in the pockets of just about everybody sitting in the congress. The Congress relies on these donation/payments for their campaigns and wealth. Thus are you surprised at our state of health care and the expenses involved?
As a side note, Trump touted the horrors of Obamacare and his so called wonderful plan to his base, though he had no plan nor intention of creating a plan. His goal simply is to allow the above companies to continue to grow their wealth at our expense. This is no different than his friendship with the NRA, his joke of a Tax cut or his friendships in Asia and Russia.
People can write of the complicated issues surrounding health care, however, the issue is really quite simple: a bottom line of money and profits.
10
Reflecting the breathtaking and alarming venality of the GOP in its appointment and confirmation of Neil Gorsuch, the court should no longer be referred to as the Supreme Court since there is nothing supreme about it. It should instead be called the GOP-Packed Highest Federal Court.
6
Liberals talk about providing incentives to doctors for better results. How about providing incentives to patients to take care of themselves? If a person chooses a healthy lifestyle, they should pay less for health insurance.
2
This assumes that simply living a “healthy lifestyle” (whatever that means — the commenter doesn’t even make a stab at it, typical of fuzzy right wing economic thinking) will completely prevent cancer, heart conditions, diabetes, kidney failure etc. This is certainly not true. Also, he assumes no one will have an accident.
And how would my “healthy lifestyle” be proven? A company or the government playing “1984” and surveilling me 24/7 for a year?
I do however think that a good way to implement an incentive for lowering disease are special taxes. Support that sugary soda tax in your city. Taxes from cigarettes should be used for their health-related fallout, not for schools or highways - that is a perverse incentive. Put taxes on fast foods. This tax revenue should then be directed into healthcare.
This way, the person who isn’t living a healthy lifestyle has to pony up for their “unhealthy lifestyle” and pay into the healthcare system for it.
Unfortunately small government conservatives will find this solution intrusive into their daily life choices. So the vast right-wing political apparatus wants to have it both ways — tell people how to live but not do the necessary things to encourage them to do so.
8
Each of us could pay the full cost of our own healthcare. How’s that for an incentive?
2
Nice idea until one of these freedom lovers gets a heart attack, walks into an emergency room, and all taxpayers and insurance holders get to pay for it, while freedom child goes bankrupt.
5
Perhaps the best outcome is that the courts kill the GOP-designed ACA. Without the ACA, much of the rest of the patch-quilt non-system for delivery of health care will collapse. Hopefully, then our leaders will sit down honestly and put in place a real system for health care. Most Europeans pay 1/3 to 1/2 per person less than what the average American pays (adding up Medicare, Medicaid, Employer group, individual, and uninsured payments and then dividing by the adult population). No one in Europe files for bankruptcy protection from medical debts, they live longer and have much lower infant and maternal mortality rates. Pick a system, the French have an excellent system, and use it. Not hard at all. Of course, the folks who would lose that $500 billion in unnecessary costs will spend a few $million in bribes to keep their puppets in Congress in line.
10
I have lived with type 1 diabetes for 46 years. Through this journey, mostly self employed, yet able to afford something; I never was able to purchase any kind of health coverage because of my preexisting medical condition. Obamacare changed this. For the first time in my life I am able to have some coverage and to feel some limited security. Limited because I don’t know when and if the nasty republican politicians will be able to take it away from me and others. It is a HUGE difference to have the physical help and peace of mind of access to health care without the fear of not having enough money to pay for what one needs. So, warts and all, I am really thankful for Obamacare. I feel only dread and anger towards those who would take it away. I will surely vote for my interests.
11
The lawsuit is not absurd. Seeking healthcare services is widely discretionary as is the patient’s choice of healthcare provider. And in some cases involving pre-existing conditions, such as lung cancer or a serious sports injury, the patient may be culpable for their health condition. They assumed risks. Why should these people not be expected to pay more for their health insurance? Would it be fair for all drivers to share the cost of accidents caused by drunk drivers? I don’t think so.
2
We do. Learn something, anything about insurance. And don’t EVER get sick or have an accident.
8
Yet again the Trump administration cannot keep their story straight. On the one hand they say that we have to enforce all the laws passed by Congress, and use that as the basis for separating parents and their children at the border, and on the other hand they tell Congress, we cannot support the remaining portions of the ACA as written, as the basis for talking away healthcare form millions of Americans. Either all the laws passed by Congress must be enforced or not. The only consistency to be found in these two positions is the impact on the vulnerable, those struggling to get by.
I will be the first to admit that ACA needed to be tweaked, but if it fails, if the millions of people who suddenly were able to get access to coverage through either Medicare expansion or even though they had preexisting conditions find they can no longer obtain affordable coverage, it won't be because ACA wasn't tweaked, it will be because ACA was systematically dismantled by the Republicans.
And the reason will be because the Republicans have decided that the average American should not be allowed to have nice things.
5
I have been working at least one (and up to 3) jobs at a time since I was 13 years old. For most of those 38 years, I have made enough to pay my share of income taxes. In 2005 I was diagnosed with severe Rheumatoid Arthritis and Fibromyalgia, in 2007 Degenerative Disc disease and 2013, Rheumatoid Lung Disease. Despite living with pain every single day of my life, I still work full-time, seasonally more than full-time and gladly pay for my health insurance. I would like Paul Ryan and Jeff Sessions and their ilk to look me in the eye and explain why I (and the many others who live with at least one of my illnesses) am not worth fighting the insurance companies over pre-existing conditions.
I was labeled disabled over 10 years ago. Would they prefer that I stop working, stop doing more damage to my body, and apply for disability? Would they prefer that the government pay for my health insurance and extremely expensive medications? I have kept working far beyond where I could have stopped because I have always pushed through the adversity as much as possible -but if our "leaders" don't think I deserve their protection- it seems to me that they don't deserve my income tax dollars at the expense of my health.
11
The unfortunate reality is that this is how insurance works: if you are at higher risk for using your car insurance (younger, previous accidents, etc.), your rates will be higher. Likewise, sicker and older people pay more for life and disability insurance...
...which is why it makes NO sense to run a healthcare system based on insurance. The goals of wide coverage and a robust safety net are AT ODDS with a free market, even a free insurance market. It’s time for the government to step in as the single payer, or to just admit that we don’t care about coverage or public health. I’d expect the latter from this administration except I have no expectation of honesty from them.
10
Our problem is money in politics. Were it not for the part-time congress working full-time to raise money, the donor class would have no influence over our national scheme.
Clearly, we spend three times as much on health care than comparable nations. If we eliminate insurance profits and administrative costs, negotiate drug prices and offset medical education tuition with national service, we could cut spending by two-thirds.
But we don't. We don't even discuss a national health system without first speaking of the inflated costs to taxpayers -- while duplicitously avoiding any discussion of the savings.
If we raise taxes, it still won't cost us as much as we now pay for health premiums. And if employers shift their health care costs to the payroll, the average worker may not even notice the hit.
But as long as elected officials pander for cash, they will work for the money and not for the people.
It is Citizens United and not the ACA that should be repealed.
9
Nothing will change until people stop believing that Trump or republicans are the only ones stopping universal care and opening Medicare for all.
You are being hoodwinked if you think the democrats care one bit. I have seen the democrats play this game for decades. They just throw up their hands and pretend they tried but the big bad republicans stopped them.
Democrats put up a bigger fight for DACA than for true healthcare reform. If that didn't open your eyes then nothing will. Obamacare has just enough of a few good points to keep us from seeing the trick played on us.
I do believe President Obama wanted to open Medicare for all but democrats, not just Lieberman, helped republicans shut it down. Wake up and clean house at both parties or continue being a so called first world country with a subhuman health care system.
The irony is that if democrats truly fought as hard for healthcare reform as they did for DACA they might regain some voters and win. Trump is egotistical enough that he would go along with democrats just to have the history books
view him as the true reformer of health care.
It won't happen because democrats are just as corrupt and in bed with the healthcare profiteers.
3
Nope. Sorry. Don't believe it.
Too many of my fellow brethren are too comfortable and hate to rock the boat. Facts and obvious advantages, fall aside to the hard work that change is. Too risky. Too complicated. People wont like it so don't try.
Remember incrementalism? Baby steps? Pie in the sky. Fix what we have, don't try for something better that will change everything.
Nope. In our Duopoly, the same side of the coin, are paid by the same masters. They won't risk their money. No one wants to put in the hard work. And our citizens are scared, meek and fat 'n comfortable. With a big-gulp at hand and a phone in the other.
Calif. had a chance. Co. had a chance. Vermont even looked.
Nope. Our own party has repeatedly backed out and or blocked it. Even our Mr. Krugman refuses to talk about it, unless to bad mouth it.
Universal/SinglePayer/Medicare4All.
Who knew Health Care was soo hard?!
3
Getting rid of Obamacare isn't theoretically bad. But the Republicans don't seem to have the foggiest idea of how to bring down costs except to return reflexively to a "free market" as the stock answer. They either have no imagination...or simply don't care. You can slam progressives all you want, but at least they try to solve problems. Sometimes those ideas don't work...then you try something else. But conservatives just don't see able to imagine new solutions to anything. Back to coal!
Here are a couple of ideas:
1. break up the mega-hospitals that are buying up all the smaller ones and reducing competition.
2. get rid of the networks ("Notworks?") that all the doctors have to be on. These seem to be nothing but cartels; if you have "A" insurance company, you're limited in many areas to the "A" network. Go out of network, like being unlucky enough to get sick in another city? Too bad, you may not be covered. And what if your doctor changes networks because one of the 2 mega hospitals in your area bought her practice?
Too bad.
3. Prohibit hospitals from usurious charges. My local ER charged me $80 for a "pulmonary function test." They simply stuck a cheap pulse oximeter on my finger. The list goes on, from $20 aspirin to ludicrous charges for every bandaid.
7
I guess you could say, accurately, the Republicans are enemies of the people. Keep that in mind on November 6. You can save yourselves, or you can cooperate in your own demise, as well as your fellow Americans.
6
Americans pay over 50 cents of every tax dollar into our military industrial state. We protect countries around the world but refuse via Republicans to protect Americans through decent healthcare.
We CAN afford healthcare for all. VOTE for healthcare over war in 2018, 2020, forever.
7
Healthcare as a profit driven model is an abomination. So is capitalism run amok which is what we now have. The wealth of America was built by slavery and the ruling class is doing their best to bring it back with perpetual debt.
9
Actually, even before any of this is take place and because of the disruption in the health insurance marketplace, it was reported earlier this year that in the first year of the Trump administration, the number of people with health insurance in America was reduced by over 3 MILLION from the year before and it is expected to rise by another 9 Million in 2018.
One can only surmise what will happen to these numbers if the "pre-existing condition" mandate is eliminated.
2
Terminology matters. Insurance is for things that can be replaced: cars, jewelry, homes. Even life insurance protects a “thing”, a stream of income, not a person. You don’t go out and buy another spouse with a life insurance benefit if they die.
Every person needs and deserves health COVERAGE. Healthy and young people support older and less healthy people in a health coverage pool. And they should be grateful they are young and healthy because someday they might be unhealthy and hopefully someday they will be old. Our health coverage system used to be based on large employer pools. That system no longer works for many reasons, but largely because employers are not mandated to offer health care coverage.
As many comments have noted our government is failing abysmally to provide for this basic human need for everyone. Oh except for our elected representatives in Washington. They have wonderful health care coverage.
8
Re "And even if the current law prevails in court, at least some damage will already have been done; uncertainty created by the Justice Department’s stance will almost certainly lead to higher premiums for Americans."
We've been here before and we know what will happen: Much of those higher premiums will be paid by the federal government as Premium Tax Credits (direct Obamacare subsidies to lower-income individuals). Yes, once again Republicans are taking their political frustration out on the federal deficit -- on all American taxpayers.
No, you can't make stuff like this up. It would be funny if it weren't so hurting to so many.
2
More to the point: Until we recognize that the insurance companies are NOT NEEDED for healthcare the healthcare debate is missing an integral piece of the puzzle. Until we recognized that the only reason insurance companies offer health insurance is to make money by adding a layer of bureaucracy to obtaining healthcare the debate is never going to benefit the people who pay for insurance and healthcare.
5
The American Healthcare system is so rotten it is not possible to fix. It needs to be pulled down and start with a clean sheet of paper.
Employers pay insurance companies and have no idea what is driving their premiums. Insurance companies usually have a monopoly in their state / market
Employees go for medical treatment with no idea how much anything costs and a small co pay or deductible. They have no knowledge of the cost and no incentive to (and remember a high deductible is a small part of the total cost usually).
The hospital providers have bought up the doctors to steer patients into their high fee for service model.
Hospitals charge made up prices and give insurance companies phoney baloney discounts that create an illusion of value. Drug companies charge telephone number prices and everyone adds a margin to cover admin costs and profits.
Its a shell game
5
John Boehner famously predicted the ACA would be a "train wreck." He was right, but not for the reasons he thought -- that it would collapse of its own weight. It is collapsing because our oh so compassionate Republican president and Congress have decided to slash at its foundations while jumping up and down on its structure. Fix it? Pshaw say the Republicans. Take a wrecking to it instead so the country can go back to those halcyon years when people died for lack and medical care and others lost their everything through bankruptcy caused by medical care.
4
I really don't understand the argument that people can't be required to purchase health insurance. What about auto insurance? What about seatbelts, motorcycle helmets? Are these not all infringements on our individual freedoms?
Uninsured citizen's just transfers the financial burden to the rest of us through unfunded 'taxes' in the form of unpaid Emergency Room expenses that become a taxpayer liability.
Providing affordable insurance not only is less expensive at large, but it also reduces the overall cost of healthcare by improving the health outcomes of sick people, which is not only humane, but also fiscally smart.
Why is this so difficult for some people to comprehend?
16
Jim, the difference is that driving is a choice. Being required to purchase a product from a private company ONLY on the basis of being a U.S. citizen is very different.
In addition, the purpose behind purchasing auto insurance to ensure that if you cause harm to another or their property while driving, there will be at least some minimal amount of money available to the person you harmed to pay for the damage done.
1
I understand that the Affordable Care Act was of real, tangible benefit to a certain number of Americans. However, it concerns me greatly to see the number of commenters who seem to think that it's Republicans alone who are responsible for our health care woes
The Affordable Care Act was never, ever an adequate response to the catastrophe that is the American health care system. When Obama was elected in 2008, he did so on a remarkable groundswell of enthusiasm, energy, and momentum. But instead of addressing what was REALLY the most pressing issue of our time, and replacing our current private insurance system with a single-payer model, he bailed out the banks. And then he bailed out the car makers. When he finally got around to health insurance, he never even bothered to put forth a single-payer, universal health care plan - instead, he proposed what was essentially a bailout for the health insurance companies.
The Democrats had an opening to fix this problem, and they chose not to take it. Really, they chose not to even try. So let's not fool ourselves into thinking that getting Trump out of office or voting the Dems into control of the House and Senate is going to result in the change we need. By and large, the Democrats have no more interest in eliminating private health insurance than the Republicans do.
All of our partisan finger-pointing only makes it easier for the TPTB on both sides of the aisle to maintain the status quo.
2
In many ways you are corect, When many democratic representatives, including Diane Feinstein and Nancy Pelosi have received hundreds of thousands of dollars in campaign finance funds from the healthcare industry, they are not really interested in doing anything about it either.
1
Of course, should the Supreme Court strike down the protections for pre-existing conditions, health insurers will do what those aftermarket auto repair warranty companies do -- claim that anything that goes wrong had its origin in a pre-existing condition. It will be up to the patient to prove otherwise, a very tall order.
5
If you go to any country in Europe, west or east, north or south, you will find that almost all human beings there are covered by health insurance from the day they are born, until they die. Of course, they are not perfect institutions but you can live with the certainty that all your health needs are covered. If you have friends here working, say as executives with Nestlé, a Swiss multinational, you can ask them for a more detailed information. Regarding healthcare we are like an underdeveloped third world country. And if you think, for a minute, any insurance in the world needs many subscribers -such as car insurance- or the costs will go up, and up, and up. Ah, as you may know, diseases still abound in this world. No?
5
This article does nothing to address the central problem in health care financing: the costs of medical tests and procedures. Obamacare failed for the same reason; it just rearranged how exorbitant US health care costs were paid for, to the detriment of working middle-class Americans. We can either follow the models of other countries with much lower costs but comparable health care outcomes, or we can maintain our path to separate systems based on income and status.
7
As mrfreeze6 so eloquently notes, residents of civilized countries abroad are perpetually mystified why "American exceptionalism" puts up with a health care system that doesn't cover everyone, costs more than anywhere else in the world and produces poorer results in key health measures such as infant mortality, life expectancy and the prevalence of chronic conditions. And the only reason why our health insurance premiums continue to rise is repeated assaults by the GOP on various aspects of the ACA, such as the individual mandate and, more recently, the requirement to insure those with pre-existing conditions.
9
We are reaching the point when, with or without Obamacare, fewer and fewer people are able to afford the costs of health insurance. This includes those who receive it through their employer and those who don’t. It also includes employers who carry heavier and heavier insurance costs. It is also one of the main culprits in the lack of improvement in wages, as employers’ costs for the health insurance of their workers consumes most of any annual increase they might be able to offer.
As less and less people are able to afford their health insurance cost, even when offered by their employers, more of them will opt to go without it. The consequences do not require a PhD in economics to foresee. Insurance companies, with less customers, will have to increase their rates even more, a self defeating act, or close their doors. The doctors and hospitals with less insured patients will have to either lower their prices substantially or also close their doors. Care to guess what will happen when it gets bad enough that people start dying in the streets? Everyone will clamor for it and we will pass Medicare for all. And oTrump will sign it. His ego will demand no less. He will have delivered on his promise for better and cheaper healthcare. He may demand that we call it Trumpcare, but who cares? We will have decent and affordable healthcare for all, from birth to the grave.
7
This is an easy problem to solve. Universal health insurance. Full stop.
Don't like that idea? Fine. There is another alternative that would result in drastically reduced health care costs - eliminate health insurance altogether. Health care providers would have no choice but to roll back costs to a level that people could afford to pay out of pocket.
Our health care woes are self-inflicted misery. We know the current model of relying on private insurance companies to cover health care costs doesn't work (ACA or no). We have to be brave enough to do something else.
9
In simplest terms, the right of Americans to health care (life an liberty) needs to supersede the right of health providers and drug companies to profit off of our citizen's morbidity and mortality. This balance has tipped too far in favor of drug companies, hospital corporations, medical device producers, physicians, etc. Yet, the corruption in our political system allows the profiteers to dominate, like so many other issues (e.g. school shootings). Clean up the sewer in Washington and then health care reform will happen.
7
The NYT should compel the Editorial Board to purchase insurance on the individual market so that they can know how expensive premiums have become and how large deductibles have come have become for those who do not have insurance paid for by employers. The ACA was bad legislation that caused this dramatic increase in costs.
By far the greatest cost in healthcare is unhealthy eating and overeating which creates obesity. Our obesity rate (Body Mass Index 30 and above) is 38% with 8% morbidly obese (BMI 40 and above). By comparison, Italy's obesity rate is less than 10%.
One 20 oz vending machine size bottle of Coke consumed per year is like consuming over 50 lbs of sugar per year.
Tobacco use is also a major contributor to high healthcare costs. Warning labels have been on cigarettes for over 50 years, yet still about 15% of adults smoke with rates as high as 25% in some states.
To lower healthcare costs we need nationwide public health interventions that lower obesity and tobacco use rates.
For example, the ACA wanted to help provide universal care like Canada, UK, and France, but refused to raise tobacco tax rates to levels in those countries. Public health officials also suggest taxing sugar-sweetened beverages (SSBs) such as Coke.
To lower healthcare costs and to help cover everyone with healthcare, we much focus our priorities on policy and public health to make our obesity rates more like that of Europe and we should tax tobacco more like that of Europe.
6
And doctors could charge less, right?
2
Obesity rates in Europe are rising dramatically each year, while in the US they have plateaued for 15 years (and fallen quite a bit for children).
The obesity rate in Italy is 21% anyways, not 10%. And the rate amongst CHILDREN is 42% -- much higher than in the US -- so in 20 years, Italy will have a HIGHER obesity rate than the US does now.
We already tax tobacco and we have lower rates of smoking than almost any European nation TODAY.
3
Dr. David, I live in rural Montana and most of my friends are thin, in shape and late middle age. A healthy life style has not prevented pancreatic cancer, breast cancer, MS or a heart attack among my friends. While obesity can and does cause health problems, there are many other causes, and a healthy life style is no guarantee of health. My farmer and rancher friends were not even able to buy anything more than catastrophic health insurance before the ACA. At the moment, they are covered, but that may change compliments of Republicans.
9
Imagine what it must be like, being a member of a political party whose raison d'etre is making it harder for people to obtain health insurance and health care. That and putting more money in the pockets of their already obscenely wealthy 1% campaign contributors. How do these people sleep at night?
9
The right of all citizen to health care should be added to the Bill of Rights. Remember, the incredible lies, Trump would give us better health care for fraction of the cost and the GOP would let the free market reduce prices and provide better coverage for everyone? Never mind we had free market for health care before the ACA, and Trump could care less about the American people, specially the vulnerable and less fortunate. Why would anyone should expect anything less from the morally corrupt GOP and most vacuous human elected as a president? In the words of Peter Navarro, there is a special place in hell for those who take away health care from the vulnerable and less fortunate or those who do not provide something better for less.
8
It has been said in jest but it seems more and more true, Republicans would bring Bin Laden back to life if they could just to smite Obama.
6
The Democratic party needs to shout this to the heavens before November. This is your message for the midterms, folks. Get loud and get bold!
The sadism of the Republican party is truly shocking. This perennial desire by Republicans to kick and stomp the most vulnerable Americans, all while trying to siphon every penny out of their pockets they can. It's unconscionable. The GOP disgusts me and they need to go- starting in November.
10
The fundamental problem with this divisive issue of government subsidized, regulated, or provided healthcare is simply stated: white Americans, particularly republicans (i.e., a the latter being a subset of the former) want the best, free healthcare and every other goodie from the government, while at the same time do not want the benefits to go to anyone they do not like (a rather long list of people, that likely amount to about 40% of all Americans).
If republicans had the power to choose who got free healthcare, and who was denied healthcare entirely - they would vote for it unanimously tomorrow. The concern that blacks, Hispanics, some women, immigrants would receive the same benefits as them - is what ties up their undergarments in knots, and brings out the worst in them.
They will agree with this privately; they want your grandmother to die, but their grandfather to get free hip replacements following regimen of free Viagra. In public, it is a mix of nut arguments about bureaucracy (which they love when it favors them), entitlements (which they are for as long as it is only them), and socialism (which they want for themselves, and rugged individualism for everyone else).
As a result, about the only people who are laughing all the way to the bank are health insurance companies, the new robber barons. I guess we pay taxes and fees because we are stupid, and when it comes to healthcare, we definitely exhibit high levels of stupidity.
14
Viagara is not free, and it is not covered by most private insurance, and not covered by Medicare or Medicaid and not covered by the VA plan for veterans (but IS covered by Tricare for current enlistees -- no idea why).
2
Repeal and replace! With the bestest plan ever!
My guess is that Kim knows this approach
3
As the evidence piles up that Republicans hate America and its inhabitants, who can possibly rationalize this nonsense. There is simply no justification for a return to the mess that pre-dated ACA. Republicans do not care about insurers. They don't care about medical professionals, and they certainly don't care about patients. They only care that they can keep bludgeoning us all with their divisiveness. They lie about those who try to fix the mess that is the American health care system, and win elections. To fix things, or even to allow others to do the hard work of fixing our system, denies them in their quest for absolute power. They are truly disgusting.
6
While I agree that health care should be a top priority for all Americans, I have to question the basic assumptions of this article. If Americans really view health care as their chief concern, then why did they elect Trump? He spent his entire campaign telling anyone and everyone that his first act would be to do away with the ACA.
This kind of weak analysis of faulty data is what led most reputable media outlets to predict an easy victory for Hillary Clinton. I think we may be in for a similar 'surprise' during the midterm elections when once again the idiot plebes will support a poorly-understood political platform that has no impact on their own personal and financial situation.
5
Exactly, I have said it a million times, if Americans are not going to elect those that will actually do something about healthcare in America, I have absolutely no sympathy for them whatsoever.
1
Trump promised better and cheaper health care - could someone convince Fox and Friends to ask him when that's going to happen??
Trump can goad Sessions all he wants on the Mueller issue, but he is still Trump's lackey.
The problem with this article is the Trump voters don't know about it and probably won't. It is outside of their bubble.
2
And yet mindless Republicans will vote for Trump's minions against their self interest.
4
Obamacare was intentionally designed to fail and get us to single payer which is not affordable. Only a scant amount of the population did not/does not have health care. All social entitlement programs are going bust so the socialist democrats want another. Let it go; we cannot afford it. Or better yet let every registered democrat pay for it out of their pay.
2
You get what you vote for. That simple.
6
America has entered the post truth world. Truth, facts and reason are an absurdity designed to mislead the people.
The only reality is the reality given to us by the Great Leader; regardless whether named Kim, Trump, Putin, Erdogan Maduro or many others.
The simple fact is that we deserve this. We created it and allowed it to fester. We can change, and the determination of our will is 5 months away.
6
GOP philosophy has been pretty consistent over the decades: people are all lazy & dishonest and unless forced to live with the 'wolf at the door' and in perpetual fear of poverty, will refuse to work and will freeload. Ironically, GOP voters revere the laziest presidents: Reagan, W and Trump who spent most of their time on the golf course or the ranch chopping wood (and who rarely - if ever - read a book). They also love their own 'entitlements' - as long as nobody of the wrong skin color get any.
5
When people tell me they are surprised by Trump's casual cruelty, sociopathic lack of empathy, outright racism and deadly dismissal of the poor, I wonder where they were during the ACA fight. Donald Trump took all of those horrendous aspects of Republican ideology and, like a Transformer, embodies them all on a grand scale. If you followed the lies, the fear and the hate spread about the ACA you wouldn't be surprised by Trump, you would think him inevitable.
1
The GOP: Make guns easy to get, and make healthcare impossible.
See y'all in November.
6
Republicans think healthcare is a privilege not a right.
1
The ACA, ("ObamaCare"), stinks. The Republican pseudo-plan stinks even worse.
Here is MikeCare, it almost doesn't stink:
You know how the government pays to provide us with universal necessities like cops, education, libraries, road construction and repair, fire departments, snow removal, defense, garbage removal and the like? That's what we need in regard to medical care to make sure that everyone in the country, regardless of wealth or income, is covered. Just like with the other services it should be paid for using the taxes which we pay.
Go to whatever doctor you want, you pay a deductible to discourage frivolous medical visits, and the medical providers get paid according to a reasonable government schedule that is tailored to region. Medical providers who do not want to accept what the government is paying can do so by posting a notice in their offices to that effect. You either pay the difference or go elsewhere.
And that's the end of it. Welcome to the 21st Century!
If it makes the prez feel any better we can call it "Trumpcare".
Representatives, get this through your heads, THIS is what We the People want. Anything less than this is no good and antiquated, if not criminal. We need and expect better from our elected representatives who work for us and get paid by us.
6
Because it's called Obamacare. That's what we've come to.
1
So when a Democrat White House decides not to enforce laws, it's a courageous study in federalism.
But when a man you despise does it, a "constitutional crisis" must be on the horizon.
Here's a lesson I learned in my first year of law school:
No matter how much you hate a man, you can't destroy him on that basis alone.
And if you continue to try, you often just make him stronger.
2
Trump and his administration aim at destroying healthcare and increasing the cost of healthcare for the sick and vulnerable and those with preexisting conditions. They do this against the interests of the majority of American and against their politically expressed desire in public opinion polls out of pure spite and derangement.
They offer nothing in return except a tax cut for the elite and extreme wealthy which in the future will devastate the security net of Medicare, Medicaid, and Social Security. It is obvious that they have no compunction to take from the poor to give back to the fortunate and rich.
How they get way with this is beyond me!
They are truly deplorable and need to be thrown out of office in the next election and sent to the political graveyard they so richly deserve.
2
I pay my premiums diligently every month for years. My insurance company in NYS want s 21% increase for 2019. My wages are stagnant and I am middle class and getting crushed. Where is the NY Times concern for the middle class I would like to know? I cannot sustain many more double digit increases in my premiums or you know what? In 10 years as I approach Medicare age I will be paying $3000 a month for just me in health insurance premiums! The middle class is the new uninsured in America.
P.S. Many Americans are selfish and do not want to pay any premiums if they can get away with it. Everyone has to contribute or the system will not work. If you do not pay you should get no coverage.
5
The arguments for the ACA made on the left are as unhinged from the reality on the ground as the arguments against it on the right. I often wish I could shake some sense into its defenders.
The benefits of the ACA accrue primarily to those who receive subsidies. For those of us with a bit more income than that (me, for example), it has been a terrific financial blow. My carefully-planned early retirement on a bit of a shoestring foresaw increases of 10 percent a year, or FIVE TIMES what I projected the general rate of inflation to be. I thought that was the safest conclusion. That would have amounted to an increase to date of 46 percent, compounded since the ACA's implementation.
The actual number has been 167 percent!!! Including the increases projected for 2019, my "insurance" will have more the TRIPLED in five years!!! Ponder that!
I have, and the numbers say that I have to go back to work, possibly abandoning the goals I had for personal accomplishment while I was still young enough to pursue them.
Progressives have walked right into a dead-end canyon in continuing to defend the Rube Goldberg contraption that is the ACA. Its effects are wildly uneven depending on the individual's finances and therefore unfair, and has done nothing to solve the core problem, which is to rein in grotesquely inflated medical costs which are the inevitable result of the moral hazard in for-profit, corporatized health care.
Address that core problem, and stop defending the indefensible!
4
You need (many, many people need) Medicare for all, along with the necessary cost controls in place.
2
My goodness, are we still calling Pelosi's Insurance Handout "affordable"? We're going to lose another election that way. The working class knows it's a lie.
3
How else can one conclude that the Trump administration's continuing attacks upon the Affordable Care Act have no basis in law--or people's health--than the malicious and viciously racist determination to destroy the President Obama's greatest domestic achievement?
It would seem a definite game-changer for Democrats to defend the A.C.A. as the mid-terms creep closer. But enough Republicans are stuck in a pro-Trump quicksand and remain fearful that any vote against the administration--for any policy or for any reason, whatever good it may augur for the ordinary citizen--would be put down to treason. Any politician opposing Donald Trump would bring down the wrath of the harpies upon his or head.
Republicans have sawed away at Obamacare and have been helped along by the willing ignorance of a population base that has benefited from it for years but has been bewitched into thinking that an un-American, Socialist plot to destroy the healthcare system as we know it, would hasten the downfall of "conservative" values. These benighted folks don't understand that their seeming defenders have the finest healthcare in the world, courtesy of their political office. The last thing Republicans would give away would be their (and their families') gold-plated lifetime "socialist" healthcare; but let's not allow facts to rudely intrude upon a good story.
Ignorance and fear will defeat the A.C.A. Democrats must see that it doesn't happen. And, given their lethargy, what else do they have?
1
Your problem peddling this line is America remembers full well what a rip-off of the entire middle class the PPACA was.
People were FORCED to pay double and triple for coverage and THEN charged way too much in deductibles. Good, hadworking people were robbed so that LESS than 5% of the country could get free services.
Remember how people remembered Roosevelt for the supposedly good things he did while the depression was going on?
People will think of Democrats for a century when they hear of any gov't health care scheme. For the good of the country, Bernie, keep bringing this up while Auntie Waters screams for impeachment.
Is the hate I feel (as I have never felt hate before) for 45, his administration and the GOP a pre-existing condition?
3
Trump thinks he deserves a Nobel Prize. I think the Nobel Commission should give him one. And they should hire the eloquent Robert DeNiro to award it to him. I suspect Mr DeNiro might volunteer his services pro bono.
2
It is not just for the "sake of doing so". It is Trump and his followers hatred of Obama. Trump's racist origins make it impossible for him to ever accept a "black" president. So he challenged Obama from the start with the birther claim. His thin skin resulted in further Obama hatred for the perceived insults during the Corespondent's Dinner. He will never let any of this go. The courts and the Justice department will also support Trump's Obama hatred as will the GOP. So the Affordable Care Act is Obama's work and they will continue to try to kill it. But this single Obama gift may sink all of them because they insist on destroying what everyone needs, Health Care.
2
The lives of Americans are on the line. All hands on deck !
Need to take the Senate back and stop the potential wreck.
GOP to America:
You can keep your doctor. You can keep your insurance company. You can get your medications from those big pharmaceutical companies that have all the money in the world to tell you on television what drugs you should be taking, instead of your doctor taking 5 minutes to tell you what you need and what side effects it may have. Your employer can decide whether you can have contraception or not. But, you and the government which just gave away trillions to billionaires, can't afford any of it and bankruptcy is in your future if you get pretty sick.
Health Care Stalkers is far too kind a title for this group.
6
again, the American system is not doing what it needs to do-what other civilized countries have been doing for years -
ensuring health care for their citizenry.
all ideological differences aside, that kind of treatment of the masses by their government barely qualifies the US as a 3-rd world country.
what a shame and a sham.
6
It feels like we are approaching an either/or moment. Either we dismantle all social programs associated with health care or we go all-in on a socialist health care system. The middle ground has been taken off the table. After a full term of Trump and his sycophantic henchmen raping and pillaging America, the people will face the biggest decision of their political lives. Follow the Social Darwinists or go Socialist with a universal system based on people not employment.
3
Single payer. Poof. All the problems go away.
4
It breaks my heart to see that politicians are willing to allow fellow Americans to suffer and die to win political leverage.
As the world looks on, the former leader of the free world is displaying a desperate lack of its ethics, morals and compassion.
1
Trump and his Republican Party sabotaged Medicaid, Obamacare, even Medicare to satisfy their murder greed and free the tax money for their corporations at the death expenses of 52 to 80 millions of Americans. These Republicans have no plans except stealing tax money and let Americans kids "murdered" at school by free gun sales.
4
For this administration we are sheep to be fleeced.
Trump ran as a populist but is governing as an oligarch with the full support of a complicit republican congress.
3
Democrats must make the Republicans wear this like the badge of betrayal it represents. Make no mistake, this is not about healthcare, or even insurance. This is about giving more and more and more to the rich and powerful, less and less and less to the rest. They wanted chaos, now they'll get it, in spades.
3
This won't hurt the GOP at the polls one bit. NYT can't seem to get it through its head: ACA is enormously unpopular, and with good reason. It's pretend healthcare reform that does nothing to reduce skyrocketing costs that are hurting everybody
Medicare for everyone.
2
Is it possible that if the ACA implodes that Medicaid will expand? Or would a "survival of the fittest" rule the land?
Remember when the GOP said the ACA was about "death panels"?
What's the difference between not funding pre-existing conditions and "death panels"?
7
Death panels don’t exist but this decision means they don’t need to. Twelve major accomplishments of the ACA that are positive are 1-10 covering preexisting conditions. 11 that more people can be insured without killing economy and arguably why job growth has been more steady even though not spectacular and 12 noncompliance is now a medical problem that we are considering, the causes, pathogenesis, symptoms, signs, assessment, prevention and treatment as well as the societal costs.
1
There is another half to what the Republicans are doing.
Catering to big business. That's the health care industrial complex which includes Big Pharma.
The official unofficial GOP motto is in play here, as well.
"No one deserves anything they can't pay for themselves."
For being what we think is the leader among the free world when it comes to lifestyle, the US is far behind when it comes to two things.
Every civilized country in the western world has what amounts to a single payer system for health care. The government controls the costs. (We all know the evil "chargemaster" system hospitals use from Steven Brill's book. Such a thing should not be allowed to exist.) We all get gouged and the government allows it.
The other thing we are behind in—and one in which we should also followed the rest of civilized world—is guns.
7
I live because twenty years ago and eighteen years ago I had good insurance, a very supportive family, a job that let me take leave knowing I would go back to it when well and the ability because of the insurance to access the best doctors at the James and at Stanford. The insurance came from my job and meant when I was well that I could not leave as I had preexisting conditions that made me extremely expensive to cover. Luckily, I basically liked my job and my bosses. Many people are not so fortunate. This is why health care easily available and affordable to people is a necessity. Frankly, being able to access such care could spur innovation, because a person could take a chance at developing a new business and would be relieved of the possibility of total bankruptcy because of a health care issue.
The opposite case was well presented in Charley Fish's book, Insuring Death. Fish imagined a world where health care funding was limited and people without financial resources to pay for health care were put to sleep, "assisted suicide" with a "consent form" signed by them, a form they did not understand.
I saw my father's suffering during the last few weeks of his life. Such suffering without any hope of recovery costs society; it is not good. On the other hand, cost saving measures that end the life of someone who could have had more years possibly contributing in some way or another to society is not a good alternative to a strong affordable health care system.
1
Meanwhile, health care costs are starting to accelerate, driven mostly by prices. We are likely to return to the days of double digit premium increases everywhere. Combined with these attacks on the ACA, the rate of uninsured is rising. Insurance companies are boosting deductibles and coinsurance features to the point where the total costs of an insurance plan is more than twice the premium payments. My wife for example, pays almost $700 a month for a $6500 deductible for a network where it is almost impossible to find a primary care doctor. So between the premium, deductible, coinsurance, out of pocket maximum her plan costs her almost $20,000 a year. And we are glad to have the insurance. Next year she goes on Medicare and our costs will drop by almost 80%.
Why? Let me tell you why. Insurance companies pay anywhere from 75% to over 400% of Medicare for the same services and administrative costs are about a third of a commercial insurer.
My it took my wife to medical group owned surgicenter yesterday for a minor outpatient procedure. In the parking lot: two Ferrari's, a Lamborghini, and Aston Martin Vantage, and a McClaren. You would not see that in Europe.
We pay too much for health care. Physicians, particularly specialists, make way too much money, hospitals are grossly over reimbursed and are bloated institutions who care not a bit about affordability.
Time for a change.
14
As a physician who you think makes too much money driving a dented Prius and staying up nights either caring for patients and doing the massive documentation requirements imposed by emergency and insurance networks and generating mostly useless data to them, tell me why you do the insurance companies’ bidding for them by ignorantly blaming the doctors. The doctors driving the Ferrari’s may be the administrators coming to tell them what to do. The doctors may have been paid heavily by the insurance networks to come work for them while they(ins cos) are trying to narrow where you can get your care. When your child is sick do you want an insurance company answer your calls instead of your doctors office because they are nickel and diming your doctor to do their paperwork instead of seeing patient and reading about medicine instead of coding and Emrs and how to deal with the government and insurance companies. I doubt it.
2
Hint to the next democratic presidential candidate and also democrats running for congress in 2018,
Don't run as an identity obsessed, east coast liberal, never met a Wall Street banker, war, trade agreement I did not like campaign like Hillary ran.
Address some of the issues of concern to mainstream America, #1 being health care like your article states.
7
The USA is an oligarchy. Democracies have healthcare systems which serve the people.
We have a political system based on money, and the world's best healthcare for the rich. No coincidence
24
"Being stalked" is the right analogy. American citizens are being stalked by the insurance companies and by our own government. And we have nowhere to hide.
As a person with a pre-existing condition who is 5 years away from Medicare (the holy grail, if ever there was one), I am worried sick.
But I have decided to take a zen approach. I have told my loved ones that if I get sick again, no extreme measures should be taken to save me or prolong my life. Just keep me comfortable and painfree until I go.
Is this anyway for a 59 year old to be forced to live?
19
Age 60 and sharing the exact same sentiments.
6
Elections have consequences and Americans voted to repeal ObamaCare. The Republicans are just try to do what they promised to do. If Americans wanted a more fair, equal, and less expensive health system, they won't have voted for Republicans. Americans liked what they had before ObamaCare, why not let them have it back?
3
Some Americans. Some Americans voted for Trump. Three million more voted for Clinton. Yes, elections have consequences. One consequence of a close election is lack of a popular mandate.
Republicans didn't repeal Obamacare because they couldn't agree on how. Every proposal was worse than the prior one, and each met with fierce public and political resistance.
No, Americans were not satisfied with the status quo ante. Obamacare was passed for a reason, with lots of Republican input, albeit no support in the end. Huge majorities support the major consumer protections in the law. A majority of states adopted the Medicaid expansions.
Republicans became The Party of No under Obama, and still are. Trump's wrecking ball reaches from Paris to Toronto, undoing anything Obama did, once he finds out. Some Americans think that's a good thing. But not a majority.
10
More people voted for Mrs. Clinton in our last presidential election. Where did you get your election figures? There is no extant evidence that people voted for Donald Trump because they were against the Affordable Health Care Act,
3
Are you on drugs? I did not vote to end Obamacare - not because I need it, but because so many people I know need it. 3 million more Americans did not want this president or this administration. have you not been paying attention?
2
Let's stop allowing the issue of healthcare to be defined as an insurance issue. Insurance is a financial tool to insulate one from the risks of financial loss. Healthcare is a human right & need. Insurance companies have been acting as gatekeepers between patients and doctors, and in the process they've made us poorer, rationed healthcare & driven up costs far beyond what other industrialized nations pay, and for lower quality, less comprehensive care. The central flaw of Obamacare isn't the individual mandate. The central flaw is that it cut insurance companies into the healthcare pie and gave them a bigger slice than anyone else. If my business is destroyed by flood & I have no insurance, I may suffer financial ruin. If I suffer from heart disease, MS, cancer, etc. and can't get healthcare, I die. Insurance can't fix that. Universal healthcare coverage paid for by taxes levied on ALL of us, can. Kick out the insurance companies and their exorbitant costs and watch costs drop dramatically. Stop engaging with trolls who complain that healthy people are being victimized by being required to have health insurance. Everyone is healthy until they aren't. We don't allow people to opt out of paying the portion of their taxes that fund things they think they'll never use. Childless people help fund schools, young people help fund social security, etc. It's how civilized society functions. Let's be more civilized. How's that for a campaign slogan?
33
Thank you, thank you. I have never seen the paradox of health care for Americans described so perfectly. I have long believed exactly what you described without being able to say it in words.
5
Trump promised a wall. We're still waiting. He promised better healthcare plans for all. The only time his administration mentions anything about healthcare is when it takes steps to dismantle it. Most Americans want affordable healthcare. Trump's actions, helped with the complicity of the GOP, are mean and heartless. The ACA will fail as this administration's actions continue to drive up costs for the average family. In other words, those voted into office are driven by greed and meanness--they ignore the will of their constituencies, while they enjoy government healthcare and line their own pockets.
15
Recently I was shocked to find out that a wonderful writer whose books I thoroughly enjoy has had a terrible accident which resulted in extensive burns on his body. What horrified me was the fact that his friends had to open a GoFundMe page to pay for his medical treatment because as a freelancer he cannot afford insurance. I won’t name his name but you can find the page easily enough. What kind of country allows its artists, musicians, and entrepreneurs to go without health coverage? What kind of country betrays the best of the best? We are not talking about some welfare mom/opioid addict but about a man whose work has brought joy and entertainment to hundreds of thousands of people. I lived in countries with a single-payer healthcare (Israel, Italy, the UK, which all have different systems to ensure universal coverage) and compared to them, the American system is a Kafkaesque nightmare of inefficiency, red tape and waste. Tax everybody on a sliding scale, pool all the money, and give writers and artists the chance to improve our world without asking for handouts.
18
Most of us find that health insurance does not equate optimal health care even after paying the premiums and the deductible. So the more truthful title should be The health insurance industry stalkers.
I am for universal health healthcare but with freedom of choice to reject carrying any private health insurance that is not affordable to that individual without being penalized but provided emergency care for free should one be needed as is currently done for all residents of the USA. No one should die in our streets for the lack of health care. The penalty on those who could hardly make ends meet after spending on essentials like food clothing and shelter was draconian.
The profits of current health insurance companies since the passage of Obamacare mandate has increased significantly. Just find out the price of stocks of these companies today and what it was just after the passage of Obamacare. Also find out the premiums increases and coverage decreases.
So Obamacare is not perfect , not sustainable and for many it is a broken system that needs to be fixed or replaced with a better one. These are my kind words. Bill Clinton has called Obamacare the craziest system in the world and there are very few left who disagree with Bill on this one. Obama should have forced a passage of public -private hybrid health care where Govt could have leveraged the billion dollars it spend every day on medic aid and another trillion it spend on medicare and care of government personnel.
3
The entire US healthcare system is the craziest system in the world.
1
Scott D from Toronto. The US healthcare delivery system is the most advanced and most up-to-date in the world. That is why many Canadians come down to the US or go elsewhere to get timely and optimal treatment for many medical conditions. The problem for many Americans is affordability in terms of insurance premiums and deductibles.
Healthcare costs have run amok. It is a big money-making business. Many physicians here in Idaho Falls used to accept Medicare as payment in full - most now do not. Doctors offices here in this town are the most expensive buildings in town. Most of my adult working life was spent in hospital administration, and the changes since Medicare was started (1965) have been enormous. The U.S. stands alone among the nations of the world in spending on healthcare and the results are nothing to brag about. Most of us want Single Payer or Medicare For All. VOTE!
19
If the Corporate Dems didn't rig the primaries we would be implementing Medicare for all right now.
The are rigging the 2020 race as we speak. I guess they would rather have Trump than a progressive .
4
The irony is that both threats as well as actions to undermine health coverage serves to strengthen Trump’s hand by instilling fear in voters. For it is this fear which triggers instinctual tribalism in which following your leader unquestionably is the only perceived path to survival.
For millions of years animals were instinctually wired to survive by staying with the herd. For the past 300,000 years Homo Sapiens survived by forming tribal groupings in which the leader instilled a common belief system to bring cohesion in action where other tribes were considered life-threatening and were treated as an enemy.
We saw these fear-triggered instincts emerge in the 1950’s when the threat of nuclear annihilation from Russia gave us bomb shelters, Joe McCarthy and career-ending black lists. Today we see it in our increased partisanship and rejection of “others” where we are blinded by economic fear from recognizing each other’s humanity or forming opinions based upon fact and reason, which have given us guns, Donald Trump and democracy-destroying mistrust of the other party.
The present Kabuki dance in Singapore is just another manifestation of our being led around by our nose through fear. We have two sociopathic leaders who have concluded that they can best further their aims for self-aggrandizement and autocratic control by creating a perceived nuclear threat and then pretending to make peace together.
10
Dear American patient, do you really want the right to sue for not only actual but also huge punitive damages and "mental anguish" for any poor outcome (provider fault or not). Because then your health care system is charging you for defensive medicine, for lawyers salaries, and for windfall judgements to patients. You can have all this, but it will cost you dearly. Rather, if you just were allowed to sue for the cost of fixing the medical problem and for cost of work lost, then your health care premiums would be less. Just sayin. PS brought to you by the country that gives a billion dollars for talcum powder causing cancer in one person. Johnson's baby powder. And you wonder why your healthcare and medicine is expensive?
2
No I don't wonder. Malpractice insurance constitutes 0.5% of medical expenditures. Not nothing, but next to nothing compared with 22% for insurance profits.
Do a little research. Healthcare in this country costs 50-100% more than elsewhere, with no better outcomes. Defensive medicine is not the main culprit. A full third, $1 trillion, is wasted in profits, overhead, and — literally — price gouging. An X-ray can cost $500 or $5000, depending entirely on who sets the price.
5
Sure buddy, those prices are entirely due to litigation. It's not for a healthy profit margin. SMH
I fully expect any more real damage to healthcare to happen after the midterms. The GOP will pull out another prop, and blame the collapse on Democrats. The base will buy it, because they buy it all.
But they will put their faith in Trump to get them back their factory job, and benefits, and to sell themselves the fantasy that the only people who need help with healthcare are lazy poor people and illegal immigrants.
We cannot go on with three basic markets, with three cost structures. Government, which subsidizes high cost elderly; business, which mandates all be part of the system, healthy or otherwise, but can lay off the older and less healthy; and the individual market which penalizes the sick, because the healthy don't have to participate, and the pool is small because nearly everyone healthy is in the business pool.
Part of me wonders if all of this is really just philosophy - no government in the business sector - or if it is just another voter suppression scheme. In Ohio, they purged the voter rolls. A few more moves on healthcare, and they will succeed at just purging voters.
13
Do Trump supporters from the middle class and the working class support Trump's dismantling of Obamacare? If they do, then they should get what they wish for. For the folks who would have voted Democratic but did not show up for the election, they will have to accept whatever is decided for them, because they did not claim their right to have input. Hey folks, you made your choices, now you take the consequences. It is especially fascinating to see Trump supporters lose their health care coverage, after having gotten fooled by his media circus. Next time, follow the money!
7
The "they made a bad decision let them suffer" trope seems to be an easy way to abdicate doing anything. The healthcare "system" in the US has been setup to be as confusing as possible so nothing can change. YOur solution is to blame the victims.
2
The working class is sick of paying for yachts and champagne. We've figured out that Obamacare was a huge fraud.
Last chance Democrats: let the GOP do to the ACA what they said they would: repeal, destroy, maim. There's got to be real world consequences for voters to LEARN. Don't treat them like overprotective parents. The economy is humming... the Donald might get reelected.
5
This will backfire and make single payer a more realistic option. Wonder why health insurers support Obama care? It keeps lining their pockets. I don't want trump to burn it down, because of the human suffering that will follow, but perhaps real change will rise out of the ashes.
3
If you want single payer or universal coverage...Trump is doing you a huge favor by burning down the system. Obamacare GUARANTEED Big Insurance that there would never, ever be single payer. But if Obamacare collapses....we can make a fresh start and insist that EVERYONE is treated the same .... no group is shut out or forced to pay higher costs....nobody gets health care "free" while others pay high deductibles....EVERYONE TREATED THE SAME, just like Medicare or Canadian single payer.
1
All of the good that was created in America's healthcare world by the Affordable Care Act is being stripped out, slowly but surely, by a single political party: the Republicans. It may be that the A.C.A. was poorly constructed, and poorly enacted, but those provisions that gave Americans good healthcare options even if they had preconditions; even if they were poor; even if they were young; even if they worked at a low paying jobs were loved by all of the millions of Americans who benefitted. And even if your family did not gain from the law, you knew someone who did, or still does. Soon, if the Republican Party is successful, all of the law will be gone. Millions of Americans will be left with insane medical cost burdens, or bankruptcy, or even death as their option, when a medical emergency, or simply a high medical cost arises in their lives. We need to vote against Republicans. They hate Americans who are not healthy enough to carry their own weight. They want us to be gone. They are creating a world where we will be.
3
"But the two aren’t equivalent. Challenges to the marriage law raised fundamental questions about who we are as a people, and what we want the Constitution to stand for." Au contraire Times Editorial Board. The 50+ GOP attempts to repeal the ACA, the refusal of currently about 1/3 of states to expand Medicaid and our rapacious, capitalistic system of funding and providing healthcare show all too well what kind of country "We the people of the United States" is. We continue to refuse to regard healthcare as a fundamental human right as recognized by every other civilized nation in the world. The ACA was a necessarily practical compromise first step toward universal healthcare. Nearing age 70, I had hoped that we would at long last achieve universal healthcare in my lifetime. Now I'm not so sure.
3
Repeal Obamacare, a gift to the private insurance companies who take tax payer money to provide (or not) extremely expensive, complicated and faulty financing, and replace it with expanded and improved Medicare for all. There's a bill for that in both the House and the Senate. It's cheaper by far, simpler, and allows the freedom to pick our own hospitals and providers. It frees business to take care of business. It's the first rational step in providing affordable and accessible health care to the people of this country. We know it works because it already exists, and Americans who have it like it better than private insurance. Everybody in, nobody out!
14
If the pre-existing condition requirement is found to be un-constitutional, and that applies "across the board", millions of Americans who get their health insurance from their employer might be excluded, if they must go thru underwriting. Currently, insurance companies are not able to discriminate when offering group insurance.
10
I think if the court dumps the equal protections for people with pre-existing conditions, we should march at the White House in protest, so profoundly unfair a ruling that would be. However, insurance companies have been price gouging their way around this provision for diabetics since 2016. Blood sugar test strips, at the major pharmacies, went up 30% in 2018 in the last 3 months from $104 to $154 per box of 100 strips (about a 10 day supply.) The price of insulin has gone up by about $150 per bottle since 2016 as well.
Diabetics are dying every day because they can’t afford care without insurance. Which is already too expensive for those in the wage gap, low-to-middle income earners can’t afford it. Insurance companies bargain with pharma manufacturers to negotiate discounts which are not great and also drive up retail pricing to force the necessity of coverage and maximize profits.
We must demand regulation for pharmaceutical and hospital care pricing.... as well as keep insurance intact. The racketeering of healthcare is a national crisis.
30
Thank you for mentioning that. I have some friends who are diabetic, plus I have (of all things!) a diabetic cat, so I have to buy diabetic supplies with no insurance coverage at all. The costs have gone up 3-5 times for NO REASON -- diabetic supplies are simple and low tech. They have been around for decades. The cost should have gone DOWN, but Big Insurance decided they had a captive audience of desperate people they could gouge....and OBAMACARE offered no protections against this exploitation whatsoever. NONE! ZIP! that's your holy "Obamacare", letting diabetics be ripped off by Big Pharma!
1
GOP PR does not match reality. The new tax bill is already costing me money given elimination of my deductions. All medical and insurance covered costs are totally out of control. Now the GOP is threatening Social Security, Medicare, and Medicaid. Any flow of tax monies to local infrastructure so local taxes are going up. They took an oath to serve, not to destroy. They cannot serve if they do not allow facts and solutions into governance rather than ideologies and a propaganda news station run by Australians.
20
The mandate surely is severable from the rest of the law, meaning that, should the mandate fall, the ACA should not. A court will strike down a law only if the invalidation of one or more key provisions would prevent the law from operating as Congress intended. Last year's tax bill complicates this new challenge: when Congress eliminated only the mandate penalty, electing not to repeal related insurance provisions, it tacitly acknowledged that a mandate-less ACA is acceptable. This is the latest expression of congressional intent, something that a court cannot--at least, should not--ignore.
1
Has an employer ever had worse health care coverage then it’s employees?
So why would any citizen willingly permit Federal employees to have better health care coverage then they have?
Congress should be forced to have healthcare coverage that is not one bit more robust that what every citizen is entitled to. If we don’t have coverage for pre existing conditions, neither should any federal employee.
35
Excellent point.
And coverage for lawmakers should end 18 months after they leave office, just like COBRA does for everyone else.
3
Trump and his cabal are about erasing Obama, not about helping the American people. It is plain that the GOP really has no problem with leaving millions of Americans without access to what the call "the greatest healthcare system in the world." They live with a world view that those who have more money, access, position etc., have earned it and deserve it; those who are lacking such things are getting what they deserve. Look at their policies from immigration to education to tax cuts. Compassion, community concern, and human need are not on their radar.
31
One might look back to Lincoln for wisdom on difficult, complex issues, of which universal medical care is one.
Lincoln was dead before his ideas on the difficult, complex issues of reconstruction were implemented. On one of the imperfect ideas, he remarked, "Concede that the new government of Louisiana is only ...as the egg is to the fowl, we shall sooner have the fowl by hatching the egg than by smashing it."
[Quoted in The Civil War and Reconstruction by J. G. Randall and David Donald, Second Edition, page 556]
4
The ACA needs to be fixed not scraped. Yes, the funding does not work nor the assumption that the influx of the young and healthy would offset the cost to others. Even if the funding issues were resolved, the key problem to the ACA is the cost of healthcare in the US. What we are seeing are double digit rate increase for coverage and insurers exiting the market. There is no simple or single solution to the problem. Doing nothing however is definitely not the answer.
5
I think there is a consensus among most:
1. pre-ex shouldn't affect coverage in terms of availability and price;
2. health care premiums and out-of-pocket costs are unaffordable or higher than what they need to be, especially if the system were better organized, more efficient and focused as much on better health outcomes as its does on collections; and,
3. a shift toward the use of prescription drugs to maintain (or prevent bad) health status, i.e. so-called disease management, has added even more pressure to the financing challenge facing government, consumer and employer payers/sponsors of health coverage alike.
The ACA poorly addressed each of these key challenges. But there remains overwhelming support against excluding or charging more for pre-ex conditions. Also, most of the ACA individual market players (there are only a few now) like BCBS plans and HMOs have been very vocal in their support for providing coverage for those with pre-ex. So it is doubtful that any regression to the past where pre-ex means no coverage isn't likely to stick.
On the other hand, addressing affordability, especially drug costs, and the health care system's overall high costs will and should remain our focus. If you solve these challenges, then the marginal costs of those with pre-ex too is solved.
4
Insurance wouldn't cover nutrition counseling, mental health counseling, physical therapy etc. so pills and surgery came to the fore.
Also, before the affordable care act, we had mandated insurance states, like New York and New Jersey (where insurance coverage had to be available, not necessarily affordable) and non- mandated insurance states, like Florida and California, where you could be denied coverage for pre- existing conditions....without the ACA, this is what we'd go back to.
7
AMM:
Space here is too short to get to all that might or should be done to improve the ACA--all of which would face ongoing obstruction from Republicans who are not inclined to social contracts to help the majority of US citizens. They'd be thrilled to cut almost all these benefits, including Medicare and Social Security, if they could get away with it.
We've known for a long time that our health system is too expensive (and not as good as other developed nations): burdensome administrative costs, overpriced tests/procedures/meds, over-sale of anything linked to health care.
It is far from clear how we get out of this with our current two-party warfare (and that is what this is). The Republicans are most concerned with the upper economic quintile (and arguably even more restrictive than that).
As this editorial notes, Mr. Sessions is more than happy to push for his notion of the law and its enforcement at the expense of the vast majority of our citizens. Given what is happening to the federal judiciary (large numbers of conservative judges appointed to lower courts), who knows what will happen during the ensuing decade.
2
We need Medicare for all paid for by the corporations. It will save them money and cut red tape for their employees. Everybody wins, a novel idea in the age of Trump.
12
Stop blaming Trump. All politicians are part of the problem. The more you just blame Trump the more nothing will get done. How is that for a novel idea? The health insurance problem did not start with Trump.
A minor qualm. It is not just the Trump Administration but all the Republicans, including those who have benefitted like Ohio Gov John Kasich.
You don't know which ones are worse, those Republican governors who took advantage of ACA to help their state citizens but chose to stay quiet or those who rejected ACA for their own state citizens out of spite.
But both groups, including those in Congress, are conspirators with the Trump Administration to deny the U.S. citizens for reasonable healthcare for no decent reasons. It is a shame; it is a disgrace.
Even after President Obama, they just couldn't stomach his accomplishments and sought to undermine it. Their ego and racism are at display, nothing more
22
How can anything positive happen with American healthcare while we continue to pay almost twice as much for the basic product? We pay over three hundred billion dollars a year for prescription drugs alone. If we paid just the average amount that all the other advanced countries do, we would save over a hundred billion dollars a year. Until Americans stop voting for candidates who take money from the healthcare industry, nothing will change. The Times has reported these basic numbers sporadically. Until you begin reporting them like a drumbeat, daily, Americans will go on sleeping our lives away.
22
Hey! how about the NYT hitting hard on this issue (HEALTH CARE) 5 times daily -- instead of wasting paper and ink on mocking Trump every day?
While I am not a supporter of Donald Trump, I feel strongly that the healthcare cost scandal is far more important to America and Americans than whatever new tweets come from the White house.
How a political party can unravel a health care program when each of us, including all members of their party, will have health issues now or in the future defies understanding.
"Because Obama did it" is an insufficient reason to harm honest and hard-working Americans.
It is as if we did not like our shoe maker, so we cut off our feet.
35
It's another example of the 1% who get the best of health care such as Mr. Kudlow, while the rest of us can either forgo unaffordable vital care or go bankrupt in the process. Trump and his Republican party have imposed their vision and values to facilitate a society of Social Darwinism.
24
The American economy is built mainly on the consumption of goods and services. The amount of consumption is limited by how much disposable income is available to consumers. Disposable income is generally what is left over AFTER paying for essentials such as taxes, food, clothing and shelter. That amount has been in decline in real dollars since the 1950s and mostly under Republican administrations.
When people pay more of their disposable income for health insurance, there is less left over for everything else. This multi-decade trend disfavors the impoverished and low and middle-income families the most. Meanwhile, the wealthy can still afford market-driven health care. But reduce disposable income enough times for enough people and a cornerstone of our economy, consumption, collapses.
Forcing a basic human need such as health care to be provided through a for-profit system, which is essentially what Republicans are insisting be done, is immoral as it enriches the investor class at the expense of the less well off and deprives many of even the most basic level of care.
34
The U.S. is in a race against time. The question is very simple:
Will the suffering and chaos from Trump's misdeeds affect a sufficient number of people BEFORE November to overturn the GOP House majority? Or will he be able to demonstrate sufficient 'success' (the stock market, unemployment) and grandiose posturing (with the world's dictators) to carry his stumbling body across the finish line?
Trump's actions on Health care alone, affecting 52 million Americans, should be sufficient to turn the tide in November. The fact that the outcome is still in doubt is both illogical and frightening.
39
Once again please remember that gutting Obamacare does not save the average citizen any money.
Whether the care is paid for through private insurance by Obamacare or not, the money is still spent, because our ERs are required to provide care regardless of insurance coverage.
If Obamacare is repealed, taxes will go up to fund the uninsured care in ERs and hospitals, or taxes will stay the same, but insurance premiums will skyrocket to allow ERs and hospitals to charge insured patients more, subsidizing the uninsured.
And of course, the care delivered to the uninsured under such circumstances is the most expensive because it is emergent and it is in the hospital.
All eliminating Obamacare guarantees is that private insurance companies will be allowed to charge more and make more because they can deny coverage to the money losers. And that young health people without insurance who are suddenly ill - like gunshot victims, automobile accident victims, and the like - will go bankrupt while trying to survive.
Why do we make drivers get insurance?
32
The FEDERAL government does not make drivers get insurance.
There are lots of reasons to criticize Republican opposition to Obamacare. But I sure don't agree that their challenge is trivial and based on a technicality. The Republicans claim that the government can't make people buy health insurance--that's what the mandate is all about. Health costs amount to 12% of family income. The government charges middle class families the same in taxes. I don't think taxes are a trivial matter. And I don't think health care costs are trivial. I am not saying that it isn't justifiable but that kind of expenditure for a young family is anything but trivial.
1
Tax based health care systems in most of the industrialised world provide better, lower-cost care than in the US. This has been the case for decades. Tax-phobia in the US has been a hammer with which post-Reagan so-called 'conservatives' have been trying to smash anything which does not enrich the already obscenely wealthy for forty-plus years. Universal health care is always better for pretty much everyone than a profit based system. That The Kochs and the Trumps may have to pay a little more in taxes is not a bad thing.
64
Your false concern over health costs for a "young family" ring hollow. At least be honest. You don't want to pay taxes that may subsidize others' health care.
Well, I don't want to pay taxes to subsidize billionaires' tax cuts or finance fatuous GOP wars like Iraq.
We're even.
6
Are you saying, then that 12% of a family's income is trivial? Because if you are you could give it to me. BTW, I'm not sure what the Koch brothers, taxphobia, and post-Regan conservatives have to do with the health care mandate. Maybe you meant to reply to somebody else's comment.
The problem is that in America, the disadvantaged always think that somebody is getting more than they are by gaming the system and end up voting against their own self-interests.
And all those people who want to have the freedom not to have insurance sure expect to get emergency care when they need it as the law requires hospitals to provide without thinking that they are freeloading on the backs of others.
50
It is clear the current executive and legislative branches have no interest in protecting American's health. The judicial branch has thankfully taken a step to make it easier for ACA to survive. The individual mandate is the lifeline for ACA. Without the individual mandate, ACA will slowly sink into oblivion as premiums rise without a mixed insurance pool.
The fact of the matter is for many policy makers, the ACA is a debate of 'unlawfully' penalizing taxpayers vs. public funds supporting public good. But, the watershed moment embodied by McCain's vote sheds light on the actual debate. A Harvard trained health policy professor who spent his whole career in health policy told us that he did not really understand health policy until he got sick. McCain could have easily and blindly voted along with his colleagues, but he saw his mortality as the vote approached him. He wanted to make his last vote count to be helpful to many mortal lives like his, rather than further pitting ethereal principles.
21
“…dismantling what some political opponents built, just for the sake of doing so”? No. The only pre-existing conditions that the GOP cares about are being Black, Hispanic, or poor, and these are the people who will be disproportionately affected by what the Trump administration is trying to do. Restricting their access to health care is one of the things Trump campaigned for and was elected for. If they care enough, maybe next time more of them will turn up to vote against him.
18
Most poor people -- by far -- are white.
Most people on welfare and Medicaid -- by far -- are white.
Hmmm. The young people striving to pay off student debt, buy a home, and raise a family should pay a large subsidy to older Americans who have had years to accumulate savings? This article assumes young people should be held captive to support all others, rather than be equitably rated for medical insurance. Why not cheat the young, maybe they won't notice ... is that the best approach for the Democrat party?
1
Universal coverage or individual mandate is not cheating the young. No healthy young person knows whether they or their children, or their parents, will need major bankrupting medical care from one day to the next. That's why it's called insurance. It's less likely for them than for older people, but I've seen too many accidents, cancers and other unplanned for illnesses to let young people believe they don't need insurance.
7
Insurance, yes of course. Drivers with a multiple accident record pay higher premium rates, for good reason; they are greater risks. Older people pay higher premiums for life insurance; they are at greater risk to die. That's insurance.
Forcing young people to subsidize older people's medical insurance is redistribution, plain and simple, not insurance.
So you are against Medicare. Either you do not plan to get older or you are independently wealthy...or may be just a Republican.
Voters who say healthcare is their top concern and then vote GOP or not at all (2010, 2014, 2016) are irrelevant to the conversation. Voters "say" all the time they want better healthcare, protection for the environment, security in their old age, etc. etc., but if we have learned anything these past many election cycles, talk is cheap. We have to stop blaming the GOP, stop blaming Dems (who at least try to solve those problems), and simply acknowledge that most - MOST - Americans simply do not care.
21
You say "stop blaming the GOP" but acknowledge that Democrats are trying to solve the problems (and have solved several that Trump & Friends are in the process of reversing). Republican politicians really are the ones to blame--along with the voters who don't pay attention to what their party's candidates are really doing.
21
Democrats only help their "base" the poor and could care less about the middle class.
Outside the republican effort to discard everything associated with Obama, why are republicans so anti-ACA? There are some similarities between it and car insurance. In both cases everyone is charged to cover the losses of the few who get into accidents.
21
My theory: People need cars, and are willing to pay for insurance because another car might hit them. But too many people seem to believe that they'll never need medical insurance--they're youthful and healthy and virtuous and careful, and if an accident does happen, there's always the ER.
12
52 million people with pre-existing conditions is obviously way more than the approximately 12 million who purchase health insurance through the ACA. This evil elimination of benefits to people who need benefits most must also impact employer-sponsored health insurance plans. It’s not just ACA enrollees who are threatened, it’s you too!
29
...and the list of "pre-existing conditions" includes almost anything. I had trouble getting insurance before the ACA for a mere hypo-thyroid condition. It is treatable with synthroid, but it was considered a pre-existing condition, even though it is rather minor. Untreated, it can kill you.
4
It boggles the mind that state governments and the U.S. justice department would effectively take the position that insurance companies have the right to deny coverage to those with preexisting conditions. Even the insurance industry is (officially) opposed to a situation wherein people can be so easily pauperized by disease, often leaving hospitals and the rest of us footing the bill. One doesn't need a wild imagination to come to a Marxist conclusion that the state appears to be in favor of creating the largest possible pool of desperate workers willing to serve the ruling class for crumbs. This is American plantation politics at its worst.
35
Expecting insurers to cover pre-existing conditions is poor business but then the government is the same “business” that thinks postage should be the same from Atlantic Ave, Brooklyn to Chambers St, Manhattan.
2
Right. So let people with pre-existing conditions die right after their families go bankrupt. That's the American Way! Profits over people! Good business practice over saving lives!
Maybe we should just get rid of insurers and have a single payer system.
1
Covering the sick is the whole point of health insurance. That point being health care. Health insurance is not a business for a few to get rich on, it is a concept of allocating the risk. That is the point. Please, try, try, try to think for yourself. It might even feel good.
3
Just when I was beginning to cotton to Sessions for bringing the hammer down on the drug dealers from Mexico and central America, here he goes, bringing the hammer down on my kids' health insurance.
In the end we all suffer from a pre-existing condition. In Jeff's case it is a politically fatal case of Trump Hubris.
16
Republicans/Conservatives on the topic of health care: still heartless after all these years. I think being heartless might qualify as a pre-existing condition, so they should be careful in in their attempts to deny access to their fellow Americans, particularly the sick and older people. One of the children in our family was diagnosed with a very aggressive cancer one year ago. Perhaps these soulless legislators should spend some time in a cancer hospital and witness the suffering as patients and families navigate catastrophic illness that has been thrust upon them. Patients do not need to have the fear of losing insurance compounding the uncertainties they already confront from cancer. The flaws in Obamacare have been well identified over the years, but at least patients and families knew they would not be denied coverage. To have live with the uncertainty of losing coverage while battling illness is absurd in a just and humane society. Republicans have yet to provide a plausible alternative, only laughable ones and yet push blindly forward against the will of the electorate. Democrats would do well to remind voters on election day that the current administration and Congress cannot be trusted on the topic of their health care.
38
Health care: destroy it because it's there. It's there because it was somebody else's idea. What a constructive way to govern a nation!
57
If Republicans were serious about repealing Obamacare and replacing it with something better, I would be all for that. Obamacare is a terrible system and it effectively functions as a redistributive program from have-nots to have-nots, which is the worst kind of redistributive program you can possibly contrive.
For all the protestations that Obamacare's redistribution scheme is "how insurance works" it actually does not function like an insurance pool at all due to the restrictions on denial of coverage for pre-existing conditions and the fact that everyone who buys into the Obamacare market pays the same price for coverage. In private insurance pools, your individual premiums are largely tailored to your individual risk factors. Obamacare does not do this, which makes it a redistributive program rather than an insurance pool.
A redistributive system for healthcare might be a good idea, but this particular one is not because it effectively redistributes from low wage young workers to low wage old workers by forcing young people to buy insurance at much higher cost than they otherwise would have to through the combination of the individual mandate and the pooled coverage costs. A better redistributive scheme (indeed, the only such scheme that would actually work) would be redistributing from people with actual money to low wage workers.
However, the Republican party is not at all serious about replacing this with something better in any kind of meaningful way.
3
Pete:
One flaw in your otherwise persuasive argument: Old people pay higher premiums than young people. Therefore the redistribution is not from the young to the old, but from those who don't have claims to those who do.
My life insurance premiums for the past half century have been redistributed to those who died in that period.
But my time will come!
2
NOT TRUE. I am over 60, and therefore, my lousy worthless Obamacare with HIGH DEDUCTIBLE costs 300-400% MORE than if I was under 40.
My own ACA facilitator told me this -- she showed me my exact policy for a person under 40 would cost only $75 a month. I have to pay $359 a month!
Of course, both policies have an unsustainable, unworkable $7900 deductible each year, to make sure you cannot access ANY health care whatsoever.
1
THIS is the winning issue for the Midterms, and beyond. Nothing like focusing the mind when a sick child or other family member can't afford, or even get necessary treatment. I suggest that Trump supporters take their sick to their GOP Congressperson, local office. Demand treatment, demand answers, demand results. Let's see what happens.
43
Yet Nancy Pelosi and Chuck Schumer remain silent. Vote Democratic in November, but vote Democratic with the goal of sweeping out ALL of the do-nothing politicians in both parties who are currently wasting air in Washington.
11
They were not silent. they were cut out of the discussion. read the news, Laura, I think national news reaches Kitsap county too.
2
Actually, they haven't been silent. Just because you ignore what someone says doesn't mean they aren't speaking.
2
They don't remain silent!!! They have been fighting on every front.
Nancy Pelosi has been demonized by the Fox/Republican disinformation machine.
You are only contributing to it.
2
What will his voters believe, Trump, or their eyes?
That is the question.
20
Oh, oh, oh!! I know the answer to that one!
Trump, of course.
The slam tennis between our imperious Executive and Congress showcases Justice trying a trick shot between the legs. The ball is too heavy to make it over the net; members of even the wobbly-legged Senate are already there ready to swat. A LIbertarian would have a hard time calling someone with pre-existing health problems some kind of deadbeat slacker. The work regulations for 'medicare for all' are impossible for some to meet, in the benighted states; and while jumping through all the hoops to prove their case payment is withheld, driving them deeper into the ditch. A sizable contingent of wealthy people despise this type of war on poverty in their name.
4
Not protecting pre-existing conditions is guaranteeing that Midterm town hall meetings will be flooded with citizens who will lose/have lost their coverage. Will it still be a partisan issue to the voters in those eleven states?
"In eleven states, at least three in ten non-elderly adults would have a declinable condition, according to the analysis: West Virginia (36%), Mississippi (34%), Kentucky (33%), Alabama (33%), Arkansas (32%), Tennessee (32%), Oklahoma (31%), Louisiana (30%), Missouri (30%), Indiana (30%) and Kansas (30%)." Kaiser Family Foundation Analysis
22
That would be good -- short term pain -- long term gain -- if those millions of people GOT MAD ENOUGH to march on Washington and DEMAND universal coverage.
I think Americans voted for this. And now they are getting it. Remember, in politics, the rule is Caveat Emptor. What else did you expect from Trump? Or the GOP for that matter?
4
The Republicans will keep control of the Senate and probably the House this year. Two of the Supreme Court justices are very, very old.
Once this election is past, they will get rid of the ACA entirely.
Then they will privatize social security.
Nobody actually wants any of this, but that's what will happen. Because 40-45% of our country wants to "win" and "own the libs" and doesn't much care what that means long term.
They won't like what they've "won," but they won't blame themselves. They will probably just double down on the hate for immigrants and Muslims and educated people and people of color. They will be granted some nice state-sanctioned sectarian violence as a distraction and a reward - which they will enjoy, because that's who they are - but at the end of it, they still won't have healthcare or even subsistence living in old age.
Oh well. Winning. MAGA. And so forth.
21
So health care is a priority for a majority of Americans of both parties. And yet Republicans keep voting for people who want to take away their health care. Sad comment on this country and the ignorance or just plain apathy of so many voters. And then their are the majority of people who don't even bother to vote. We are clearly in the last gasps of democracy in this country. Soon we will look like all the other democracies who have become autocratic.
8
The column says, "there’s no clear-cut definition of 'pre-existing condition.'"
Yes there is. If you have a chronic illness, if you've ever been seriously ill and required hospitalization, if you have heart disease, cancer, diabetes, asthma, obesity, kidney failure, or worst of all mental illness, you have a pre-existing condition and you will not get covered. Period.
There are over 128 million people with these kinds of pre-existing conditions, and the GOP are putting their lives at risk.
It's not hyperbolic to say, the Republicans will literally kill their fellow Americans to push for their radical ideology.
25
It’s a cold day when this president brags about his wife staying in a hospital for a week for a known outpatient procedure at taxpayer expense, and then encourage the demolition of pre-existing condition protection.
As an RN Case Manager who was forced to give patients the non approval news about their health insurance decisions I find this inhumane.
President Obama has never, ever looked so good. His kindness for America will always be appreciated by many a patient, healthcare provider, and youth who were able to have their parents have a better life as long as possible because of the provisions of The Affordable Care Act.
And may that youth remember Donald Trump’s inexcusable irresponsibility when they can vote.
When people with multiple sclerosis cannot change jobs because they suffer with their disease, or when an afflicted leukemia patient is writhing in emotional pain because they will not be able to ever change insurances, let them remember the cruelty of this Republican leadership. When a parent of a child with diabetes, cancer, any neuro disease cannot even sleep because they worry how that child will ever be able to get health insurance on their own, let them curse Donald Trump and his administration.
There is no excuse how elected officials can turn their back on the Americans they have the responsibility to protect, in sickness and in health.
153
You also have to appreciate the irony of Lawrence Kudlow going to taxpayer funded Walter Reed Medical Center with a heart attack at the same time we are having difficult funding adequate care for our veterans.
27
Steve
My sentiments exactly. We’ll see how long he gets to stay, also. Where are the insurance cops when it comes to these people?
MIMA
2
I don't know what it will take to get America to join the rest of the civilized world that has already figured out how to provide high-quality healthcare to all their citizens without bankrupting anybody or the government. All I know is that nothing good will happen until Democrats control both houses of Congress and the White House. If we didn't spend so much on high-tech weapons, maintaining military bases and waging wars in regions of the world we have no business being in, we could have what we need. But that's not going to happen either.
22
The Trump Administration cannot have their cake and eat it, too. They cannot provide "great mental health care", (the Trumpist solution to problems like gun violence) without great health care. Trumpists cannot "protect the unborn" or help childbearing women, without great health care. They cannot grow productive jobs without great health care. The elderly? They can obtain great health care through government insurance called Medicare. For everyone else without a generous employer, its the Affordable Care Act. Republican led states file suit against the ACA? Vote them out in November. Then, newly unemployed, ask those Trumpists how they will manage their own health care.
17
I think they are insured for life. Congress votes itself incredibly good health insurance, and exempts itself from the laws that apply to everyone else.
7
This op-ed ignores a growing problem -- what about those of us who are not subject to the "mandate tax penalty" because the IRS says (and we agree) that the only ACA policies available are already "unaffordable"? Our modest incomes put us over the "subsidy cliff" and, if we don't have employer provided coverage, we will spend 33% of our pre-tax income for medical insurance/care ... unless we go to the maligned short-term policies.
29
The subsidy cliff definitely needs to be fixed! But that will never happen with Republicans controlling all branches of government.
7
Support the efforts to "fix" the ACA rather than "break" it. Unfortunately, the Republican majority knows that any fix will strengthen the ACA and so will refuse to approve it.
6
Just skip it. Exercise, eat right, go to the dentist, and relax.
The truth is Obamacare has a few good points but was a horrible compromise. We should have Medicare for all and not some Obamacare that penalizes or overcharges certain segments of the population while giving free coverage to others. Everyone should have to pay something even if it is only a few dollars on a sliding scale. If premiums can be taken from senior citizens on social security then premiums can be taken from welfare checks.
We had a chance at opening Medicare when President Obama was first elected but it was actually the democrats who stopped it. So enough with pretending it's just the republicans blocking true healthcare reform. The democratic party stabbed President Obama in the back many times on many issues and healthcare was one. Then they have the nerve to wonder why President Obama isn't supportive of the DNC.
Scrap the whole thing and start over by opening Medicare to all with everyone paying a Premium.
17
Times were desperate as many conveniently forget. People with pre-existing conditions could not get insurance at all. Obamacare was a flawed compromise AND YET it ultimately brought 20 million into insurance who formerly didn't have it.
No, we didn't have a chance at Medicare. Any public option was under filibuster threat by Joe Lieberman and ultimately doomed. What passed was literally the best they could do under the circumstances.
20
Actually it was one Democrat who prevented people over age 50 from buy into Medicare as had been proposed: Joseph Lieberman, who, curiously enough, came from that land of insurance companies, Connecticut. But, of course, I'm sure that had nothing to do with his vote.
15
I've made this comment before, but it's still relevant. I came to the US in 1972, to Reagan's California. I don't know if it was his idea or Brown Sr's, but MediCal ran differently form Medicaid everywhere else.
If you met a (low) asset test every state resident was covered by MediCal. Your monthly deductible was the difference between your monthly income and the poverty level.
To make this into a universal system you'd need to use state poverty levels, and impute a monthly income from assets (requiring a declaration every year with your taxes).
The effect is that nobody should go broke from medical bills- the worst that can happen is you get to poverty level income.
1
Obama givith and the GOP taketh away.
Whose surprised? GOP, doing their best to destroy America.
67
Today, in an upscale portion of Atlanta zip 30342 just past some 2.4 million dollar houses and in front of new townhouses they are constructing for $900k up, my 18 year old daughter was driving my 11 year old Mercedes E350 East and a twenty something male was driving a Mustang of similar vintage west. It was approx 4:45. Their was a sudden downpour and it was evening rushour so traffic was slow bumper to bumper each way. The water began to rise and would not go down the storm sewer. Both my daughters car ( my car ) and the young man’s car in the lane next to my daughter flooded.
I own a house and have a pension. Georgia is a state that allows garnishment if you own anything. So I have always had the maximum limits and comprehensive insurance. Even on the 11 year old car. Today I am very glad I did. Even though I have been paying almost $800 per month, it dropped to $645 and I just received a notice to $600.
The guy in the next lane sadly has no compressive insurance. He told me he was only paying $180. He had someone come and they finally got his car running it was smoking black smoke.
My Mercedes was put on. Flat bed to The Mercedes dealer.
1
You make a good point and exactly the point regarding insurance and affordability. If the insurance company deems your old Mercedes as a total loss, they will write you a check for about $3500 or so. On the other hand, had your daughter or the other man been hurt in an accident, the hospital bills could easily exceed $50,000 -100,000, or more. Who knows? You see, replacing automobiles (and we know the value of a vehicle) is nothing compared to the expense of providing healthcare. Insurance companies know this and, and that's why your insurance has limits to how much they will pay for medical bills. Insuring against catastrophic health events requires an enormous pool of resources and premiums most individuals can't afford. When the insured reaches the limits of their insurance and the bills keep adding up, the hospital will not throw them out or let them die. We need a better system.
17
Seventy percent of the electorate want single payer, Medicare for all. The oligarchy has been trying to stop it. It's recent attempt with Obamacare bought it some time, but being a right-wing healthcare policy cooked up at the Heritage foundation, it was doomed to fail. When will they realize that healthcare is not a for-profit, money making, corporate endeavor, but a service for all citizens. This isn't some esoteric, abstract concept. It exists and has existed for decades in all the industrialized societies. The oligarchs and the media wing of their interests just can let go it seems and admit that they can't keep denying people a better and cheaper healthcare system with better outcomes.
74
If the 70% you say want single payer would vote that way, we would have it. Instead enough of them vote Republican to sabotage it. Doing the same thing over and over and expecting a different result - you know what that is.
2
Single payer would bankrupt this country and 1/2 to 2/3 of America has no money so again you would be crushing the middle class to pay for everyone else. No go.
1
I have a family member who had never had health insurance until the ACA was made available to him. His employer chose not to provide health insurance coverage and the cost of buying it himself was prohibitive. He and his wife are in their sixties and have pre-existing conditions, of course.
Last month he registered to vote for the first time and he plans to vote in upcoming elections. And NOT so that he can lose his health insurance coverage.
I hope there are many more like him.
84
We are in so much trouble trouble in part because of people like your relative - people so apathetic they don't bother to vote, in his case, for four decades. What possible excuse could there be? There are many more like him but I wish there weren't. If the majority of people educated themselves and did their civic duty by voting, we would have a representative government. It is well known that the Republicans lie, cheat and steal to win elections, often by disenfranchising voters. People like your relative, who don't vote, and others who brainwash THEMSELVES by only watching Fox, do the Republicans' dirty work for them. They have failed themselves but it is all of us who suffer.
1
Let us not forget, that it was Richard Nixon, who first suggested a single payer health care system. The powers that be at the time, the AMA(American Medical Association) put that idea down very quickly. Now, decades later, the idea that all Americans don't have health insurance, or the same coverage, we have 8 separate costly federal government programs, and bureaucracies associated with them, many receive free or almost free care, when a great majority of them, most seniors could pay a premium for (Part A hospital), most Veterans, all federal government employees current and former, most current military, etc. could pay their fair share, based on a sliding fee schedule, similar to Switzerland, but no, what we have in America, is an abomination. Congress has taken care of themselves, they don't deserve to even receive a pension for that alone. Former Presidents who are receiving a salary each year, staff, office expenses, security detail, etc., they are serving only themselves, so they can't be respected, any of them. They could lead by asking Congress to suspend all of their benefits. Medicaid will run out of money in 7 years to fully pay all the bills, so you, the American public has been had. My family has had more doctors in it over 3 generations than any other in America. My grandfather, a Mennonite, in the first generation, a graduate of Rush Medical College at the University of Chicago, would be ashamed at the state of healthcare in America.
16
Trump keeps doing things the voters don't like despite the coming mid-term election that could put the Democrats in power. But Trump doesn't seem concerned.
Maybe he knows something we don't?
16
Yes, of course. He and the Republicans in Congress have no intention of giving up power, elections or no elections. Do the thought experiment. Can you see them quietly handing over the House? "OK, Democrats, you won fair and square. Here are the committee chairmanships, the subpoena powers, etc. Investigate the President and his cronies all you want. That is your prerogative now." I don't think so.
3
The voters are with him even more now than they were in 2016. That's what he knows.
The Times will never admit it, but Trump is more popular now than Clinton or Obama were at this point in their presidencies. MORE, not less.
"Democrats hoping to make health care a centerpiece of midterm election campaigns just got a gift from the Trump administration. "
You would like to think that, but the Dems. don't seem to know a political advantage even when it runs up and hits them between the eyes.
28
The Editorial Board makes two mistakes.
1. Severability - It speaks volumes that the board just left the main argument to the referenced article. But the basic point is that the Roberts Court in NFIB v Sebelius only allows the mandate because of Congressional authority to tax. But if there is no tax any longer, then the mandate is arguably unconstitutional. And without the mandate, the Court needs to ask whether the ACA can stand with this essential piece carved out - severability. So far so good. But the liberals go too far when they somehow construe that Congress decision to eliminate the mandate tax somehow meant that they were affirming the remainder of the law. There is nothing in the Congressional record to suggest this, and much to suggest that this was contrary to their intent.
2. Role of the DOJ - Liberals want to criticize the Trump DOJ for filing a brief supporting the plaintiffs in Texas v US - even as the Obama DOJ did the same in the Defense of Marriage Act. Their rationalization ? "Challenges to the marriage law raised fundamental questions about who we are as a people, and what we want the Constitution to stand for." But the board misses that conservatives have just as fundamental an issue with Obamacare as they had with DAMA. We simply reject such an expansion of government - especially beyond the scope of the New Deal or the Great Society. The question is whether the Court will honor their commitment to defend the Constitution ?
2
The tax is still viable.
2
Conservatives get sick, too. They think they won't lose their savings if they get really sick; they are wrong. VW refused to open a plant in the South due to right to work laws, and no mandated health care. So, those States preferred unemployment and no health care, because. The Trump voters in the "heartland" are now facing unemployment and benefits which will end. They will not have travel expenses covered, as they would have with Clinton; they will not have education and job retraining benefits either. Perhaps they can go to the Mall for another protest when the Black Lung victims show up again.
2
If you can suggest a way to provide healthcare to all the citizens of the richest nation in the world without the dreaded expansion of the government, please do so. Otherwise, hold your peace.
1
Understanding how Trump operates reveals why this is happening. 1) First of all, Sessions would not have taken this position if Trump didn't tell him to. Trump probably didn't think it up, but he most assuredly gave the go ahead.
2) Trump wants more that anything to destroy everything President Obama accomplished. Trump wants to erase Obama.
3) Trump is not a negotiator or deal maker. He is a bully. He takes advantage of situations where he can push people around. He hits those who can't hit back.
4) Trump takes big gambles and here is the gamble he is willing to take. He knows that if this strategy wins, Obamacare will collapse. If that happens, he believes that he can convince his base that it fell apart on its own. He will shift the blame to Obama and the Democrats.
5) Trump knows that many of his base will be terribly hurt by the collapse of Obamacare. He will use their pain to attempt to force the Democrats to vote for some lousy plan that he will push which will be better than nothing. The Democrats will of course refuse and he will use that refusal to blame the Democrats for the pain of his base.
6) So long as Tump can convince his base that Obamacare collapsed on its own, and he probably can, he places the onus back on the Democrats for anything bad that happens in the aftermath.
7) Trump wins no matter how this plays out and no matter how much trouble he causes his base.
8) Obamacare dies which is ultimate goal.
101
Thank you for bringing healthcare back to the table. Please keep it there. I am hoping that enough voters now realize that Republicans don't have a plan, never did and never will because they simply don't care about ordinary working people who aren't rich enough to pay tens of thousands of dollars a year for insurance and then many thousands more if they get very sick or injured. They care about capitalism and corporate profits and shareholder dividends, not people who get cancer, heart disease, strokes, kidney disease, diabetes, and all the rest. If that is not clear to voters now, it never will be.
145
Recently an angry Trump supporter told me Trump tried to get his better, cheaper healthcare plan passed, but the Democrats wouldn't let him. I had no words...
12
'Democrats hoping to make health care a centerpiece of midterm election campaigns just got a gift from the Trump administration.'
I'd like to think that were true but I don't have a lot of confidence that many voters will actually comprehend the cause and effect here. Even before Trump was elected, the GOP Congress was sabotaging the ACA by cutting risk corridor payments by 88% (thank you, Mario Rubio).
Then Trump doubled down by cutting the cost sharing subsidies for lower income ACA policyholders, expanding the short term insurance coverage window and by eliminating the individual mandate. The result has been soaring premiums, especially for those older people who don't qualify for subsidies.
The Trump impact on middle income families who qualify for premium subsidies has been modest, in some cases Gold and Bronze premiums have actually been reduced to zero.
Eliminating the pre-existing conditions mandate will create many unhappy voters because such a large percentage of them would be impacted, more than 50% of the 50+ age group. But they won't figure it out until the open enrollment period, which conveniently (for the GOP) occurs after the Nov 2018 mid-terms.
The bad news will hit the Trump states hardest, causing closure of medical facilities and increased burdens on state and local budgets. If there is an electoral price to be paid by the GOP for their failure to have a replacement for the ACA, it won't happen until 2020.
Better late than never.
40
Very well stated. I would add, that the Democrats are lousy messengers.
The Trump Administrations attacks on the ACA are part of the Republican drive to deliver to wealthy donors (the Kochs, Mercers, etc.) a package of lower taxes for the rich and cuts in benefits for the poor and middle class, along with gutting environmental, financial, and health and safety protection. So the latest move is not simply to dismantle what the Obama presidency built for the sake of doing so. There is malice aforethought.
103
See also Reed Abelson's excellent NYT article of a year ago, namely 6/11/17 about the issues of flexibility for individuals and businesses that the ACA has brought to society. An intended consequence of the ACA is to allow many to retire earlier, to allow entrepreneurs to try start-ups, to allow individuals to take a gap year. All of these help to keep unemployment rates down as well as the tax dollars needed to pay for those on the unemployment rolls. We are healthier as a society for the arrival of the ACA. Yes, it can be improved, but we should keep it working for us.
142
I think this is a key benefit of universal health care that most people don't realize. We are so used to the status quo. But as an artist, I am aware of the many talented individuals doing work they are less suited for just so that they can get employer-based health care benefits. It was my hope with the ACA that our economy would shift to people using their talents and energy in jobs that they are best equipped to do and away from a system that tied them to employers because they needed to provide protection for themselves and their families.
54
I left a job recently that I was remarkably ill-suited for, and that didn't utilize a single one of my talents, in order to transition to a business where I could actually give what I could best offer. I had hoped to be able to continue insurance through COBRA, but at $700+ a month that was impossible. I'm extremely healthy overall, but there is one medication that is critical for my overall well-being, and without it my ability to do ANY job is compromised. It runs about $140 per month. Going in for the appointments with my doctor so he will keep prescribing the medication averages another $50 per month. That's doable - barely- for me now, so I'm able to stay on the meds I need, but I'm one broken bone or illness away from financial catastrophe. I looked at getting insurance through the ACA marketplace so I could get a subsidized policy, but even a conservative estimate of my total 2018 income means I would have to pay $300 or so a month out of pocket for a very modest plan, AND I'd still be stuck with huge co-pays for any care I needed. The policies available these days are for many people completely pointless- why pay hundreds of dollars a month only to end up still facing bankruptcy the first time you need any serious care?
Bottom line is that for most, the ACA has done nothing to eliminate health insurance from the equation when it comes to deciding how we earn a living. Universal health care is the only sensible solution.
The link is: https://www.nytimes.com/2017/06/11/health/health-insurance-transitional-...
Republicans aren’t stalking the ACA: they’ve given it a fatal dose of poison that simply will take a while to kill the victim. By repealing the individual mandate and refusing to fund the program to any extent required to make it function, it will die soon enough. The question is, what replaces it?
Democrats may eventually be recognized as having done Americans a favor by enacting SUCH a dysfunctional and fiscally unsustainable kludge that Congress will be forced to replace it with something that actually works and IS fiscally sustainable. Of course, the price they exacted to do that including destruction of the Democratic Party’s effective participation in our governance and dividing our people more vitriolically than at any time since our civil war … might cause a rational person to question whether Democrats KNOW how to grant favors.
Whatever happens, Republicans aren’t about to get rid of no-preexisting-conditions, certainly not before November and probably never – and Democrats could have had that from Republicans back in 2009-2010 WITHOUT the ACA.
My own druthers? If Republicans announced that it was high time that we defined a REAL healthcare system, that basic healthcare (NOT “Medicare for all”) needed to be provided on a single-payer basis, and that they wanted it to be a Republican solution, not a Democratic warmed-over ObamaCare, then November indeed would see a “wave election” – just not for Democrats.
1
Objection: assumes facts not in evidence. The GOP controls both houses of Congress and the Presidency - if they had a workable solution it would have already become law. They absolutely intend to kneecap the ACA by any means possible and if they succeed they will crow over their victory and continue to do nothing for those the law helped.
There will be no replacement protections for pre-existing conditions because you can’t have a part without the whole. Protections for pre-existing conditions were made possible by the mandate and the exchanges. The healthy and the sick have to all sign up in one pool for a workable marketplace.
And I swear to god, if you suggest high risk pools as a solution than I hope you become seriously ill, lose whatever insurance you have now, and have to turn to a high risk pool and see how you like it. They’re a joke - I know, I was on the waiting list for one when the ACA passed and changed my life.
39
The Republicans have had YEARS to come up with replacement heath coverage legislation but have not done so. They have declared quite often that government should not be in the business of health care or coverage. All they really want is to repeal the ACA (and probably Medicare too); the Republicans have no desire for a replacement.
24
Richard, you really show your ignorance of how health insurance works. The simple fact is you cannot have a private insurance system without community ratings which means a set of minimal coverage standards; a mandate of some form which means healthy people cannot free ride on the system and only buy insurance when they are sick; and no underwriting which means you cannot deny coverage to those with preexisting medical conditions.
The Republicans know this and eliminating the mandate and allowing what amounts to schlock insurance and not defending the outlawing of underwriting is sawing away at the 3 essential ingredients for a successful health insurance system. Republicans have no intention of replacing the ACA with anything. They mean to destroy it.
A single-payer system paid for with taxes would eliminate this problem, but I will sell you a nice historic bridge in NYC at a bargain basement price if you actually believe Republicans would support or propose such a replacement.
27
My physician recently ordered an MRI of my foot but when I tried to figure out how much it would cost me, it was impossible. Even though I have a so-called 'cadillac' health plan, there is a deductible and the insurance will only cover 80% after deductible. No one could tell me what that would come to. No one could assure me that the radiologist who reviewed the MRI would be 'in network.' And, the doctor could't even explain to me how having the MRI might affect care and treatment of my foot in a manner to justify the (unknown and unknowable) cost. So, I'm not going to have the MRI. The doctor also wants me to have a number of routine screenings --but If I do that and they find something, it means I will have a preexisting condition on my records. If Obamacare is overturned, I will be in a mess when I change insurance as planned within the next few years. Our entire healthcare system is a total mess. If I lived in any other developed (or many developing) nations, I could have the MRI and the screening tests done with no worry. Why don't politicians and Republican voters understand this? Could it be because many Trump voters are on medicare or medicaid and don't have to worry???
364
Yes to the first part of the last sentence - red states have higher medicaid population percentages - but they do need to worry, because nothing is assured for anyone.
7
If that is the case, they will need to worry anyway. The Republican attack on the ACA, combined with the tax bill, has shortened the life of Medicare by 3 years to 2026.
14
Do you know the difference between Medicaid and Medicare? Do you have people in your family who worked all their lives and have Medicare?
People on Medicaid may not have to worry but people on Medicare certainly do. After working for decades, people on Medicare have a monthly premium taken out of their social security and they are still responsible for 20% of their cost which can vary greatly. Even when purchasing a separate gap policy they still have to pay some costs out of pocket.
There is a huge difference between Medicaid and Medicare and I am always surprised that so many Americans don't know the difference.
10
Insurance must be able to charge related to risk, the foolish idea of community being related to risk destroys any idea of the ACA being insurance.
2
So, what happens to people who are high risk and can't afford the higher premiums? For example, a person diagnosed with MS in their 20s.
The reason health insurance cannot work like other insurance is that some people are simply uninsurable. No insurer would offer insurance to a person with MS, or a heart condition.
If someone can't afford car insurance, we as a society say, let them walk or take a bus. If they can't afford life insurance, we as a society say that's okay. If they have no homeowners insurance and their house burns down, we say, too bad, maybe we help them a bit maybe we don't. But if they can't afford health insurance and they are high risk and uninsurable....do we just let them be sick and suffer and maybe die? If they fall down a flight of stairs and end up with permanent impairment, what do we do?
And if they choose to self insure with a modest income, and then get an unpredicted weird disease or have an accident that costs tons of memory to treat... we just let them die? If not, how do we/they pay for it?
96
Community isn’t related to risk, it’s related to cost. The larger the pool of people paying into the plan, the lower the cost for all members.
70
"Health insurance" is an oxymoron. By now it should be obvious that we can't "insure" health as a means of providing healthcare to a population at a reasonable cost.
3
I think the Trump administration is just following the neoliberal agenda. This agenda is to attack health and education, and increase corporate welfare for defense contractors.
12
"Neoliberal" is another word for Republicans.
The word confuses rather than enlightens.
1
Where are out Democratic protectors--and Republicans who are increasingly from states adopting Medicaid/ACA for their constituents? Silent and reactive when they need to be out in front of the #1 issue for voters.
34
The Democrats aren't silent. They're loudly and joyfully using this issue against Trump and the Republicans. And this will only increase as November approaches.
12
JP,
I don't know about Democratic ones, but an Independent Democratic Socialist fellow has been debating on TV, holding rallies, and walking Picket Lines. Sadly the same dude has been saying and presciently warning, for 40+ yrs. now the need for Universal/SinglePayer/Medicare4All. And Democratic's accuse him of not getting anything done. All the while it is their own hubris that refuses to help pull an oar.
I agree with your comment JP. Where are they?!
2
I'm a middle class person. I'm a freelancer who's lucky enough to make a living and the only health insurance available to me is through the ACA. While I don't make a lot of money, I make too much to receive a subsidy. I just received a letter from my insurance company informing me that because the mandate will no longer be in place in 2019, my premiums will be going up 25%. As a result, for the first time in my life, I will not be able to afford health insurance. I'm a healthy person, but still. I'm furious at Trump and the GOP. They only care about protecting themselves and the very rich. They are destroying this country.
457
If you are healthy why do you need or want health insurance? Save the money you would spend on the insurance and self insure.
Sure, all of us can easily save hundreds of thousands of dollars for a cancer diagnosis and course of treatment, or pay for treatment after an accident requiring surgery and therapy.
1
You don't understand what insurance is. You can save all you want, but you can't self-insure - insurance is based on pooled risk.
1
And yet, everyone elected to Congress has their pre-existing health conditions covered.
327
I don’t think this is true. Healthcare wonks need to weigh in and clarify how far the PEC elimination will go.
I don’t know about this. If we loose our pre-existing condition coverage, I think Congress will too since they purchase ACA plans. But surely they would pass some legislation to override their stupidity.
The higher premiums force a tax increase on consumers. The insurance companies must pay a tax to the Divisions of Insurance in all 50 states. So those increase premiums mean more money in the state's coffers. An unfair tax burden for sure with an inflated hidden tax.
3
They could raise my taxes 100% and I'd still come out ahead in the long run.
7
"They could raise my taxes 100% and I'd still come out ahead in the long run."...
Absolutely. Except for those with very high incomes, state taxes don't compare to health insurance premiums for a family.
The dumbfounding part of the piecemeal demolition of the ACA is that poor people who are hurt the most and benefit the most from subsidized coverage are typically very strong Trump supporters.
I cannot grasp the workings of minds that can stand idly by and let their healthcare go away and then got back to the polls and reelect the Senators and Congressmen who effectively allowed it to be taken away.
It is like an opioid addiction in which patients really know that they need to vote for ACA supporters, but can't force themselves to vote, effectively, for a Democrat. In actuality, the Republican poor who rely on the ACA could demand support from their Republican representative or vote for an alternate candidate. But there isn't another candidate, largely, I suppose, because the Republicans who win the primaries are the ones funded by special interests.
202
The Republican poor mostly depend on Medicaid and ER services, when they can get it as many Republican-led states have restricted access to Medicaid and are now coming up with schemes to make people work--whether they are disabled, addicted, or taking care of others more dependent, sick or elderly.
http://nymag.com/daily/intelligencer/2018/02/gop-states-want-to-impose-t...
1
The failure of trump supporters who do and would continue to vote for those who are undermining the ACA is due to the Democrats and the media's failure to do the simple math over and over until they connect the dots. Amy McGrath made it a point to call out McConnell and others in Kentucky that there were killing the ACA. We need more like her. A lot more like her!!!!!!!!!!
1
The poor get to have a lot of babies.
The republican party has tried to cause death by a thousand cuts (administratively) to the ACA ( Obama Cares), but they know they can't finish the job without removing the individual mandate. They know that the weight of only sick people buying into insurance plans would be the death knell for the entire system.
The whole health care debate continues to be fought in the abstract as tens of millions of people are still falling through the cracks. Those people are showing up time and time again to be put in triage in the hospital emergency room which is the most costly and least efficient way possible.
The ones pushing for privatizing the entire system know that the those emergency room costs get downloaded onto the tax payer, while the profits get funneled back to them. This is the system that they do not want disrupted at any cost. (even death of millions)
It all comes down to whether health care (not triage) is a basic human right ( I believe it is ) and whether all of us should pay into a system (just like we do with taxes as a whole) Why is health care excluded, when roads, or schools or war for that matter, is not ?
Someone should pose that question to the Supreme Court Judges, or maybe they have, but were rebuffed by the conservative court.
At some point, we as a society must choose life over profit.
196
I live in Michigan and I can tell you in this state, schools and roads and even clean water don't seem to be considered 'basic human rights', either.
124
"At some point, we as a society must choose life over profit."
Why start now?
17
Meanwhile... CEOs of 70 of the largest health care companies in the country cumulatively earned $9.8 billion since the beginning of Obamacare. The CEO of Gilead leads with paychecks totally $900 million. Earning at the expense of sick people really pays.
"As Cost Of U.S. Health Care Skyrockets, So Does Pay Of Health Care CEOs"
http://www.npr.org/sections/health-shots/133188447/health-inc
5
I'm on temporary assignment here in Michigan after having lived in Italy for a number of years. Being back in the U.S., up close and personal with the "scam" that Americans accept as their health care system, makes me want to move back to Italy as soon as possible.
I find it amazing that Americans don't rise up against their legislators, the doctors, the insurance companies and all of the vulture collection agencies and attorneys that pick your pockets and force huge numbers of you into bankruptcy or into years of fighting usurious collection agencies (1 in every 5 Americans is being pursued by agencies for medical debt).
Guess what, you're stupid to put up with this nonsense. You believe you have the greatest system in the world when the facts are quite different. You pay twice as much for outcomes that aren't any better or worse than what Europeans experience. And, no, the system isn't "free" as we all pay into it.
So, you go ahead and be "proud to be American," but I have no idea what you have to be proud about when you can't even go to a doctor without worrying about going bust.
250
Boy did you hit the nail on the head! Americans have swallowed the poison pill that their country is the very best country in the world - and they have fallen for it for decades. It is truly shocking what business is allowed to get away with here. Even the most liberal American get very nervous when you question their foreign policy, their racist history and their persistence that nobody does it better.
3
because Americans are hoodwinked into believing that universal healthcare system is "SOCIALISM". only expats who have spent time in other countries providing various forms of national healthcare system will understand. only Americans who have to declare bankruptcies under this ridiculous system will understand what you are talking about. US healthcare system is the worst manifestation of CAPITALISM.
3
Well said! All of these proud Americans that believe we have the best system in the world when it comes to healthcare, have not had any experience outside the US.
We allow the pharmaceutical companies to charge hundreds of thousands of dollars a year for a drug that keeps you alive because they are lining the Congress members' pockets, and medicare cannot legally negotiate with them for pricing more favorably.
We allow healthcare to be a for profit enterprise because capitalism infiltrates every aspect and moment of our lives.
These fellow Americans need to study, learn, and experience life in another country before they can claim that we have it best here. By not doing so, they perpetuate their ignorance.
4
Please note - everyone is one doctor’s visit from a pre-existing condition
155
Yes ... one visit away from disaster. Our mid-twenties daughter has just been diagnosed with MS and other related disorders, when her COBRA is about to expire. Her life is just beginning. However, it may become one of despair and frustration. Our evolved society cannot let this happen for all citizens.
5
i read a personal story written by a Republican working as appointed official under George W. Bush administration. after he left the government job, he had to apply for his own private medical insurance coverage. he was sent a medical history form to be filled. he was in general good health , but mentioned that he had some discomfort on hip joints when riding bicycles, thinking it probably was from "arthritis" ( he was in young 50's). he was rejected by the insurance company for a policy. ( yes, without ACA, insurance companies can reject any application for any reason). he wrote the article arguing FOR Affordable Care Act.
4
It needn't be a Doctor Visit. It could be a birth defect,
the problem is you only find out when the coverage is denied.
1
Today I received a letter from my healthcare provider saying they have applied for a rate increase and if successful my insurance will go from $602 a month to $870 a month. Didn't Trump promise "great healthcare for much less money"?
113
I got the same letter, but dont kid yourself I was getting double digit increases while Obama was President and the mandate was in place. If you are in the middle class in America you are getting destroyed by Obamacare. Only the poor and the irresponsible benefit under Obamacare. The end is near.
12
My health care went from $900 a month to $1,300 a month. I just got a letter saying they are requesting a rate increase of 35% more.
Then there is "co-insurance" and my medicines have also gone up astronomically.
And I fight for each and every appointment. I feel that I have NO medical care.
33
My wife’s insurer has applied for slightly more than a 35% increase. We already pay more than $ 1,200 a month. We may be able to afford it. But you can bet your life I never vote republican.
The core issue with "affordable care" act, is that it did nothing to address actual causes of health care inflation. "The lawsuit, filed in February, hinges on the statute’s “individual mandate,” which requires everyone — the healthy and the less so — to buy insurance as a way to help keep prices down. "
This blatant transfer of wealth taxes the young and healthy, to pay for those with a higher cost burden on the system. The fans of it cheer that now so many more people are insured - including those drafted against their will. May this country always stand for freedom, and individual choices. May this country always stand for freedom and individual responsibility.
2
How old were you when you started paying social security and Medicare taxes? Is that a transfer of wealth?
27
Do you mean the freedom to become bankrupt because of an accident or illness? Do you mean the individual choice between food or medicine? And, of course, don't forget the responsibility to never get sick, especially with a chronic illness like diabetes. I am assuming that Mr. Yohka is young and healthy and feels he doesn't need health insurance himself, but having freedom doesn't protect you from an unexpected cancer diagnosis or a car accident. A just society takes care of those who need help.
92
When your bankrupt because even with a good professional salary your can't afford health care for yourself or your family because of a preexisting condition freedom's just another word for nothing left to loose.
25
I see Republicans getting rid of Obamacare and then passing legislation that would be , for all intents and purposes, the same health plan and call it Trumpcare. It will be like the quote used in that graduation speech. Everyone will cheer when they think Trump thought of it. And will get all upset when it’s pointed out Obama did. The biggest problem isn’t the details for these folks. It’s that a black guy came up with it.
21