NFT: affordable care act

In comment 12164940 kicker said:

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In comment 12164913 WideRight said: Quote: So why don't you challenge yourself, rather than say stupid things like I should "read more about how experts say it's a no-go"? These problems will be solved - and I will suggest to you that they are already - but I'm a dolt... Yes, you are, especially if you believe that these problems are already solved. Interesting; the rest of the developed world hasn't solved any of these issues, but the U.S. did in one fell swoop... And yeah, I think the problem of not reading is more of a lack of intellectual challenge on your part, but hey, wallow away.

I don't believe anything. You know that. And yes, the majority of the most enterprising solutions to the worlds problems starts in the US.

"My point was necessity brought part time workers into retail decades ago, blaming the ACA is ridiculous."

I was agreeing with you. That the model was studies in 1980's management 101 kind of enforces that.

The only impact that the ACA could possibly have is reducing the number of part time hours available to work for part timers by reducing the full time work week to 30 hours.

I don't know if there is any data available one way or the other or if there is a big concern about it in that work force.

In comment 12164990 ctc in ftmyers said:

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I was agreeing with you.

Yes, we'll have to do it again sometime. :-)

I really fail to see the widespread benefits here. Obviously getting subsidized healthcare to those who legitimately can't afford it is a good thing. However, doing so at the expense of many others is not. These expenses include raised premiums, reduced service, less doctors available, less networks available, raised co-payments, and raised deductibles in many cases. How are these good? I also don't agree with forcing people to have to purchase care, especially in a controlled market.

This is a big reason I am so thankful I have been working for the city for the last 4 years. I get free healthcare (for now anyway) for me and my family. If I stay here through retirement, I will continue to receive my healthcare. That, plus the pension are enough of golden handcuffs for me. I get a little frustrated about salary in the short term, but realize for the long term someone would have to blow me away with an offer to get me to leave. Last Fall I got an offer for about 10K more. But, with the cost for their health plan and added commuting costs, I would have ended up bringing home less.

the federal government does not have the authority to compel private citizens to pursue any sort of business arrangement, health insurance or otherwise. The argument that a clearly punitive fine is a tax is laughable. There is no authority at the Federal level for a law like this.

That was one problem I had with this. But, also the negative impact on small to mid-sized businesses and the residual impact on the workforce.

Also, and I forget the exact circumstances, but the "refund" businesses receive for spending a certain percentage on health care. The "refund" is supposed to be used to further support their employees. However, there is very little in terms of regulations on how this needs to be spent. Some 9very few) companies have given that money directly back to employees either in the form of payment or a reduction in their employee contribution to health care coverage. But, a lot simply put it back in their operating budget to be used as general funds, which was not the intended (on paper) nature of the refund.

Pretty remarkable from a historical perspective.

This case has one similarity in that the legal precedent does allow the case to go either way based on the scope of the ruling, but it differs in that the politics have changed; the non-compliant red states would suffer if its overturned.

...How do you justify your statements concerning providing insurance "at the expense of many others" as a negative, yet at the same time, you blithely state that you enjoy no-cost healthcare, both now and into the future, at the expense of the taxpayers?

There's a clear disconnect here.

I do recognize that can seem like a disconnect. But, that is a longtime benefit of working for the city. However, that is also considered part of a municipal employee's total compensation, since salaries are generally below market. There is a fundamental difference between compensating employees for service to the city and providing a service for free.

Regardless, as my initially point stated, I do support the idea of providing care to those who otherwise couldn't afford it. When I say "not at the expense of others" I am saying it shouldn't come at the expense of reducing services and increasing costs for others. Find the funding for this program.

does reduce services available, and increases the costs, for the rest of us.

Unless we now think that zero-priced medical services don't induce additional consumption on a rather fixed number of suppliers.

a joke this country can't provide workable health insurance for all it's citizens. The medical industry
fights it every way they know how.Politicians run scared,
afraid to be the guy that supports health care for many of the people he represents.

In comment 12165171 Matt M. said:

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I do recognize that can seem like a disconnect. But, that is a longtime benefit of working for the city. However, that is also considered part of a municipal employee's total compensation, since salaries are generally below market. There is a fundamental difference between compensating employees for service to the city and providing a service for free. Regardless, as my initially point stated, I do support the idea of providing care to those who otherwise couldn't afford it. When I say "not at the expense of others" I am saying it shouldn't come at the expense of reducing services and increasing costs for others. Find the funding for this program.

The simple answer, I suppose, lies in how one views a society's responsibility to its members.

I have yet to see it at all adequately demonstrated that overall services have been reduced/costs increased other than as a continuation of a long-term trend that pre-dates the ACA by quite a long time.

Unfortunately, the whole issue has been clouded by the extreme politicization wrought by both sides. There is so much dis- and mis-information spread around that it's difficult to separate the facts from the beliefs.

My own contention remains as it was at the beginning of the ACA...it's a needed starting point that has to evolve in order to become better for everyone. If it did nothing more than remove the "pre-existing condition" factor, it would be worthwhile. It does somewhat more than that, but not at all perfectly (or anything approaching any sort of ideal).

The essential head-scratcher to me is the contention that everything was better before the ACA, which is demonstrably untrue.

This is just the first, hopefully, in a series of steps that should target the bad legislation, but promote the idea that healthcare should not be a for-profit endeavor and that, in a just society, access to healthcare is a social right and responsibility.

It won't/can't be free. It will have to be supported by taxes and fees, similar to municipal services like a police force or fire brigade, or a national service like the military, the highway system, etc.

What it can't be is, "I've got mine, so fuck the rest of you."

In comment 12164678 kicker said:

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now, and I seriously doubt it, in 10 years it will look nothing like what we have today in any case. No country with universal access and any public component has not instituted, recently, significant reform to their own systems in the 2000's. Germany, France, UK, the Scandinavian countries. But, even more importantly, cost cutting has got to be one of the most boneheaded goals of a public insurance plan. It's not even clear that cost cutting is inherently desirable. It's also not clear that cost cutting procedures will work, given that all the countries face annual price increases in healthcare that are similar to the U.S. Lastly, public cost cutting initiatives (like global budgeting in France, for instance) always have very bad perverse side effects, such as a reduction in technology (look at MRI's per capita in France). And, of course, they don't solve any of the significant inequities found in healthcare (LE in France/UK between professional workers and laborers).

There is cost cutting because budgets are getting eaten alive by medical costs. The fastest growing portion of most state budgets is Medicaid. Although in some cases the feds offer to fund Medicaid expansion was politically driven, in others it was fear that the increased cost would eat even more of state budgets.

with the point about "global budgeting" which is one response to local budgets getting swamped by health care costs...

First, I do agree with you that at least some of the complaints are really about issues that were already representative of the health care trend before ACA (rising costs, reduction in services, etc.). Second, I also agree with you that removing the pre-existing condition exemption is a major accomplishment.

Where i disagree is the notion that people think the system was better nor not broken prior to ACA. I don't think too many people truly believe that. However, it is not wrong to say that many think the overall healthcare climate is either no better off or worse.

In my opinion, the two areas most in need of national governing and overhauls are healthcare and education. However, I also think the only way to really yield the most positive and accepted results for either area really boils down to socializing the issues. That is not going to be accepted any time soon, nor is it wholly realistic. It is impossible to completely change the economic culture and system. Likewise, the desired results would come at an extremely high cost that I don't think anyone, even the most staunchly Left Wing proponents, is really ready to accept.

For example, you see so many people point to education or healthcare in some European countries like Finland, Sweden, etc. When you mention tax rates 50% or higher their argument usually ends there.

The rising costs and exploitation by insurance companies could no longer be left unchecked. An open market was no longer the most beneficial to the general population. However, the current form of government oversight and regulations is also not necessarily ideal for the majority. Neither is acceptable, but the same can be said with most of the solutions.

...It amazes me that many on this thread haven't touched on this. Add to that the fact that it has been under constant fire from the ideological Right and has no hope of a political solution.

Any sort of change, be it social (and, just to forestall, I'm not talking Socialism) technological, political et al takes time. The more fundamental the change, typically the longer it takes to get traction.

Until/unless the ACA has a chance to be fully-implemented in all states, I see little criticism outside of some of the mechanics that can be deemed really valid. The only grade one can grant to the ACA at this point is: Incomplete.

I can support that assessment. I always thought the technical issues at the launch were overblown. They were easy to correct in the system and by simply extending deadlines.

That just lead me to another question though...why the calendar deadlines? If the goal is to have everyone covered, why wouldn't it be open enrollment?

In comment 12165277 Matt M. said:

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The rising costs and exploitation by insurance companies could no longer be left unchecked. An open market was no longer the most beneficial to the general population. However, the current form of government oversight and regulations is also not necessarily ideal for the majority. Neither is acceptable, but the same can be said with most of the solutions.

Other nations prove that notion wrong. ACA is basically legislation born of a rape. It is going to take time for the hard feelings, fear and rage to settle down. At some point, legislators will be able to act like reasonable adults and introduce the much-needed changes that will get it to an operational efficiency inline with our first world counterparts.

before this, you could go to the hospital, say have a baby, stay 7 days and be able to pay the hospital bill. You had doctors that made house calls and charged a fee you could pay.There was no need for Health Insurance back then, everyone had a doctor. The HMO can into being and now you give birth, you stay 2 days max in the hospital and 1% of the population can pay out of pocket for the bill. You want a doctor that makes house calls? Go to Tibet

There hasn't been a major piece of spending/economic restructuring legislation in modern history that wasn't followed by a technical corrections bill--except for the ACA.

Even the issue now before SCOTUS would historically been handled with a few word fix in a TCB. So, once you get past issues of the basic philosophy of the legislation, where there is certainly massive room for disagreement, many of the other complaints would historically have been handled in follow-up.

And that's not even getting into resistances at the state level to optimize the benefits with state exchanges and/or Medicaid expansion.

In comment 12165367 Headhunter said:

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before this, you could go to the hospital, say have a baby, stay 7 days and be able to pay the hospital bill. You had doctors that made house calls and charged a fee you could pay.There was no need for Health Insurance back then, everyone had a doctor. The HMO can into being and now you give birth, you stay 2 days max in the hospital and 1% of the population can pay out of pocket for the bill. You want a doctor that makes house calls? Go to Tibet

HMO's spend significantly less per person than fee-for-service treatments, and yet report nearly identical health outcomes and satisfaction measures.

They aren't a cure all, but they certainly aren't the devil's work.

have significant issues with their own health care systems. Including health care costs spiraling out of control, a sizeable amount of medical tourism, and limited ingenuity by domestic doctors.

Look at satisfaction of healthcare across countries. It is mediocre to very poor in these "havens" of healthcare (Canada, UK, Germany).

In comment 12165367 Headhunter said:

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before this, you could go to the hospital, say have a baby, stay 7 days and be able to pay the hospital bill. You had doctors that made house calls and charged a fee you could pay.There was no need for Health Insurance back then, everyone had a doctor. The HMO can into being and now you give birth, you stay 2 days max in the hospital and 1% of the population can pay out of pocket for the bill. You want a doctor that makes house calls? Go to Tibet

There's some time in between that act and the rise of HMOs, though. In some ways, HMOs were conceived to correct that period. From my experience, my parents both worked and had coverage through my father's company in the form of BC/BS. I believe at the time (early 80s) that was the common coverage. My mother had a condition that required several doctor's visits and ultimately surgery. The specialists and surgery left my parents drowning from medical bills just from the 20% patient responsibility.

There are some/many that will never like ACA because of ideological/political reasons... but there are many more who have a fundamental dislike of it because of how it came to be.

"Born of rape" is an apt line... considering it was jammed down America's throat by one party in power... quotes such as "you have to pass it to read what's in it" and subsequent revelations by J. Gruber should have made more people mad but sadly, they got little play in the press and most just forgot about it (or never knew).

That said, the right thing to do is for the people in charge (namely Repubs) to act like adults and fix what needs to be fixed so there is a workable and sustainable healthcare system going forward.

Its remarkable that state governments haven't flipped red/blue or visa/versa because of the issue. The decision to expand Medicaid and start the state exchanges rests with the governor; not a single governer has been bumped because of his or her handling of the issue. If the Law had a clear impact one way or another, you would expect citizens to voice their opinions with their ballots.

were poor to lower middle class. I don't remember anyone not being able to see a doctor or go to the hospital. Maybe it was an issue, but I don't remember any of my friends having a brother or sister in their homes with a midwife because they couldn't afford the hospital

a uniform problem across countries for decades, even before the advent of HMO's and gatekeepers.

There are certainly less PCP's and GP's per 100,000 population than there were, but there were significant shortages and limitations in the availability of doctors in mid-century America.

Does describe the dilema. If their was an injustice, that was it. But Justice Roberts intially ruled otherwise, calling it a tax and declaring that it is not the role of the courts to do the job of a democracy.

The only reason why he may change his mind this time is if he feels there's enough red state support to start working on a compromise solution (rather than blowing it up entirely)

And while the ACA certainly been a positive in terms of membership growth for the HMO behemoths, and they are protected from downside with risk corridors provided by the government, the law has not bent the cost curve in any meaningful way as suggested by this administration. Any leveling off in utilization has been because the economy has been in a rut for 5+ years, suppressing care, and the explosion of high deductible plans over the same time period, which impacts members seeking care significantly. PwC has recently published a report predicting the increase of cost of care utilization starting in 2015 and beyond to be in the 6-7% + range, increasing the gap between healthcare inflation and overall inflation, as pent up demand will lead to more doctor and hospital visits, and thus more tests and pharmacy prescriptions.

Once the penalties for not buying insurance really kick-in next year, where 1% of your income is at stake, I expect the noise level to really increase amongst those forced to buy individual insurance. When people who expect to receive refunds from the IRS at tax season no longer get that money because those dollars will be used to pay off the penalty for not having insurance, the fun will begin...

The only good part of the ACA was the removal of the pre-existing condition factor. I think that was smart, albeit an additional risk hit, and long overdue...

Look, the government does nothing well. It's too big to stick it's nose squarely in a $2.8 trillion industry, and then have the gall to think they can effectively curb costs. It's laughable. I've dealt with many at CMS and HHS over the years, two of the biggest government departments neck deep in the healthcare space. They are hugely disorganized, make it up as the go along, and abhor the private sector. Ultimately, I think both will be on the same level as the IRS for most disrespected government agencies.

In comment 12165366 x meadowlander said:

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In comment 12165277 Matt M. said: Quote: The rising costs and exploitation by insurance companies could no longer be left unchecked. An open market was no longer the most beneficial to the general population. However, the current form of government oversight and regulations is also not necessarily ideal for the majority. Neither is acceptable, but the same can be said with most of the solutions. Other nations prove that notion wrong. ACA is basically legislation born of a rape. It is going to take time for the hard feelings, fear and rage to settle down. At some point, legislators will be able to act like reasonable adults and introduce the much-needed changes that will get it to an operational efficiency inline with our first world counterparts.

The same (born of rape) can be said of Social Security, Medicare/Medicaid, and others. These are all still highly-contentious issues that, through the various political ideologies, have hardened into bedrock positions. Do you see legislators acting like reasonable adults in reference to these issues?

''..The ACA is in its infancy...
BMac : 2:39 pm : link : reply
...It amazes me that many on this thread haven't touched on this. Add to that the fact that it has been under constant fire from the ideological Right and has no hope of a political solution.

Any sort of change, be it social (and, just to forestall, I'm not talking Socialism) technological, political et al takes time. The more fundamental the change, typically the longer it takes to get traction.

Until/unless the ACA has a chance to be fully-implemented in all states, I see little criticism outside of some of the mechanics that can be deemed really valid. The only grade one can grant to the ACA at this point is: Incomplete....''

-well, sorry, but, so, is what you are saying that 'it wont work until 100% of the people in all states have signed up?' well, sorry, but that really does sound -exactly- like the never ending excuses that were put forward for the failure of and damage from 'international socialism' for 100 years, I mean, you brought it up yourself, so.

or, in addition to; one could look at ways to decrease the cost of healthcare by increasing supply:

- make all healthcare professional income 100% income tax free.
- make all healthcare education 100% tax deductable
- if you PAY for someone elses professional healthcare education, THAT should be 100% tax deductable
- if you pay for your healthcare or anyones healthcare, in cash, THAT should be 100% income tax deductable
- speed up PHD licsensing for nationals of certain nations to provide healthcare services here
-accredit certain over seas healthcare education institutions

in addition, even without tearing down the bill, you could allow the freedom to buy health insurance from anywhere and add-on any other market solutions as suggested prior by some.

Does anyone remember how the Medicare Prescription Drug plan came into being and what its' rollout was like?

right or a privilege?

In comment 12165716 Headhunter said:

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right or a privilege?

A loaded question?

Where in the constitution does it say it is?

Another loaded question.

In comment 12165706 sphinx said:

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Does anyone remember how the Medicare Prescription Drug plan came into being and what its' rollout was like?

Bad example. Part D was a bi-partisan effort, albeit a stupid one, and had large support from the Medicare/AARP segment. It wasn't aimed at the entire population as a mandate; it was another Medicare option. The roll-out was a struggle largely because of the incompetency of CMS, and there ended-up being 100+ options to chose from.

with all the foresight our Founding Fathers had, in their wildest projections, they couldn't have imagined the role health care would play in America

In comment 12165766 Headhunter said:

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with all the foresight our Founding Fathers had, in their wildest projections, they couldn't have imagined the role health care would play in America

Than what difference does it make if it's a right or a privilege?

I believe as a not much of a religious person that we should take of our brother.

As an atheist, I'm glad you have the same view point.

everybody out for themselves. If I don't make you don't give a shit, if you don't make I don't give a shit. But I still ask is health care a right or a privilege?

you think and why?

tends to go vastly beyond what was envisioned by the Founding Fathers. Whether it is a right or a privilege is less relevant at this point than what the consensus can be convinced to support.

Not being financially bankrupt in your old age isn't necessarily a right either. The consensus supported Social Security.

The consensus also supports some forms of food programs for the poor, which weren't considered by the Founding Fathers.

The world has changed a whole bunch. It's about to change
again as pressures on the middle class continue to mount in a world of accelerating technological change--and as people live a whole lot longer, post retirement. The implications for the political process and social policy from these factors are going to be massive, fascinating, and scary, I believe.

Watch this space.

I think I should get the best health care I could get and pay for that's my privilege. I think ones kids under the age of 16 should have excellent Heath care and those over 16 should have an affordable health care plan according to their means. If they have no means then some kind of bare bones plan

with Manh.

It's not an issue how you framed it.

MG. A solid well thought out position

In comment 12165556 idiotsavant said:

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''..The ACA is in its infancy... BMac : 2:39 pm : link : reply ...It amazes me that many on this thread haven't touched on this. Add to that the fact that it has been under constant fire from the ideological Right and has no hope of a political solution. Any sort of change, be it social (and, just to forestall, I'm not talking Socialism) technological, political et al takes time. The more fundamental the change, typically the longer it takes to get traction. Until/unless the ACA has a chance to be fully-implemented in all states, I see little criticism outside of some of the mechanics that can be deemed really valid. The only grade one can grant to the ACA at this point is: Incomplete....'' -well, sorry, but, so, is what you are saying that 'it wont work until 100% of the people in all states have signed up?' well, sorry, but that really does sound -exactly- like the never ending excuses that were put forward for the failure of and damage from 'international socialism' for 100 years, I mean, you brought it up yourself, so.

No, and in you inimitable fashion (read brain-dead) you've completely subverted what I said. Not that I'm surprised, mind you. You just aren't particularly sharp.

should be. Politicians, of course, pretend it isn't an issue, because there aren't easy solutions they can turn into slogans. Try this one on for size:



Sorry about the size, but it's a useful point.

In comment 12165763 bw in dc said:

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In comment 12165706 sphinx said: Quote: Does anyone remember how the Medicare Prescription Drug plan came into being and what its' rollout was like? Bad example. Part D was a bi-partisan effort, albeit a stupid one, and had large support from the Medicare/AARP segment. It wasn't aimed at the entire population as a mandate; it was another Medicare option. The roll-out was a struggle largely because of the incompetency of CMS, and there ended-up being 100+ options to chose from.

It was a mandate for those 65 and older, not just another Medicare option ... "The late enrollment penalty is an amount added to your Medicare Part D premium. You may owe a late enrollment penalty if, at any time after your initial enrollment period is over, there's a period of 63 or more days in a row when you don't have Part D or other creditable prescription drug coverage."

As for how it got through the House, per Bruce Bartlett ...

Even with a deceptively low estimate of the drug benefit’s cost, there were still a few Republicans in the House of Representatives who wouldn’t roll over and play dead just to buy re-election. Consequently, when the legislation came up for its final vote on Nov. 22, 2003, it was failing by 216 to 218 when the standard 15-minute time allowed for voting came to an end.

What followed was one of the most extraordinary events in congressional history. The vote was kept open for almost three hours while the House Republican leadership brought massive pressure to bear on the handful of principled Republicans who had the nerve to put country ahead of party. The leadership even froze the C-SPAN cameras so that no one outside the House chamber could see what was going on.

Among those congressmen strenuously pressed to change their vote was Nick Smith, R-Mich., who later charged that several members of Congress attempted to virtually bribe him, by promising to ensure that his son got his seat when he retired if he voted for the drug bill. One of those members, House Majority Leader Tom DeLay, R-Texas, was later admonished by the House Ethics Committee for going over the line in his efforts regarding Smith.

Eventually, the arm-twisting got three Republicans to switch their votes from nay to yea: Ernest Istook of Oklahoma, Butch Otter of Idaho and Trent Franks of Arizona. Three Democrats also switched from nay to yea and two Republicans switched from yea to nay, for a final vote of 220 to 215. In the end, only 25 Republicans voted against the budget-busting drug bill. (All but 16 Democrats voted no.)

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Just curious, why is 16 years old the cutoff for you?

Basically, in NYS and others, even before ACA this was the case. Child Health Plus guarantees free or vastly reduced coverage for all children (under the age of 18). This is regardless of parental income. Only certain income levels qualified for full family coverage. But, every child qualified for Health Plus.

I used this when my old company raised the employee contribution for family coverage by over $200/month. Instead, we were paying the max premium of approx. $65 per child. There were two other tiers, free or $18 per child per month. No other costs were ever required. No deductible. No copayment. No prescription costs. No fees.

It is currently capped at $60/child with a max of $180 per family. I don't know what the plan is like now, but it used to be administered through BC/BS and had a large number of good doctors. Now, it is administered through the NYS marketplace for ACA.

Anthony Kennedy had asked about “Chevron deference,” a doctrine of law that describes how much leeway the executive branch should have in interpreting laws. Verrilli, not surprisingly, said that the Chevron doctrine gave the Obama Administration more than adequate permission to read the law to allow subsidies on the federal exchange. “If you’re right about Chevron,” Roberts said, at long last, “that would indicate that a subsequent Administration could change that interpretation?” Perhaps it could, Verrilli conceded.

The question suggests a route out of the case for Roberts—and the potential for a victory for the Obama Administration. Roberts came of age as a young lawyer in the Reagan Administration, and there he developed a keen appreciation for the breadth of executive power under the Constitution. To limit the Obama Administration in this case would be to threaten the power of all Presidents, which Roberts may be loath to do. But he could vote to uphold Obama’s action in this case with a reminder that a new election is fast approaching, and Obamacare is sure to be a major point of contention between the parties. A decision in favor of Obama here could be a statement that a new President could undo the current President’s interpretation of Obamacare as soon as he (or she) took office in 2017. In other words, the future of Obamacare should be up to the voters, not the justices.

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