ok, so first and foremost, don't go partisan in discussing it, but....
What is the essence of the affordable care act?
As best this poor soul can figure out, there are two basics:
you must have insurance. if you're poor enough, the gov't will subsidize it. if you're not poor enough, the gov't will penalize you for not having it.
the act makes it easy for your work place to not cover you when you retire. It may just be coincidence, but starting in 2015, almost everywhere, when you retire, you're on your own.
So, all you believers, convince me. What else did the affordable care act do to make the health care business more affordable.
I really hope this isn't political, but it's something I've been thinking about, and most of what I'm thinking is I must be missing something. Tell me what I'm missing.
If you agree w/ universal healthcare, then I can respect that. But the ACA is just a clusterfuck all around that accomplishes nothing for all "sides".
What car to drive, what house to buy...they can be non political. Why is health insurance any different?
Before I get jumped all over I have my own healthcare and this bill probably hurts me more than helps me.
Keep kids on till 26 I think
Helps people get insurance that couldn't afford otherwise
But makes things worse for more people
Higher rates for lower levels of coverage for many...If they threw me a bone and let me write off my health insurance on my taxes...I might feel better about it.
But it's a start -- the pre existing condition issue was a big one
No real input other than to preemptively antagonize another person.
I retired in 2001.
In 2005 my former employer took away the "for life" free drug coverage they had promised my wife and me for the 21 years I worked for them.
The next year, 2006, they took away the "for life" free medical coverage they had promised my wife and me for the 21 years I worked for them.
I've been on my own in this respect before anyone heard of Barack Hussein Obama or "the act".
my insurance went from a nice HMO to a high deductible plan (which sucks, but I don't know as it had anything to do with the ACA. it was coming. the company didn't want to pay what it would take to keep me in a good insurance plan, so they downgraded. was going to happen one way or another)
"It really does nothing to control costs ... Highter deductibles, higher co-pays ... Networks are also narrower." I assume you're referring to the Medicare Prescription Drug plan since 2005.
Less care. Well if you are paying more in premiums, copays and have a higher deductible, you will probably not go to the doctor as often. So the ACA is doing exactly the opposite of what it promised to do. What Obamacare does is give people a false sense of security that they are 'covered'. You can have insurance and not get good care.
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Unless you get a subsidy, you are likely paying more and getting less. Highter deductibles, higher co-pays and less care. Networks are also narrower.
"It really does nothing to control costs ... Highter deductibles, higher co-pays ... Networks are also narrower." I assume you're referring to the Medicare Prescription Drug plan since 2005.
You won't find me defending that. Anytime the government gets involved, stuff costs more and is less efficient.
If you're referring to the Medicare Prescription Drug plan, I fully agree.
The health care industry was on a path to canniblize the entire economy, and the law, creating new markets, allowed the cost curve to shift without rationing or putting in price controls, either of which which would been more constitutionally suspect.
And ironically, its a huge transfer of wealth from blue states who support it to red states that despise it, so the likelihood of repeal is pretty remote.
When the Medicare Prescription Drug plan was enacted it was a mess. Both side of the aisle tried to make it work. No one talked about repeal. Is that too political?
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1) no I could not keep my same plan, 2) my premiums increased 3) I have a deductible now when i didn't before and 4) my coverage got worse
If you're referring to the Medicare Prescription Drug plan, I fully agree.
My prescription plan actually remained exactly the same. I have no problems with my prescription plan on its own, but like I said, I now have higher premiums for worse coverage and a deductible.
My health insurance doubled in the decade before Obamacare.
The Hillary attempt at universal health care taught that a free society can't control health care on a level as intimate as the patient/physician relationship, so the ACA took a different tact: incentivize it. Create markets for patients no-one previously wanted to cover, reward foward thinking behavior, risk reduction, preventive care, incentivize more efficent practice models: electronic records, accountable care organizations. Its dismantling the old broken system in a death by a thousand cuts. Something new will grow out of this, and it will be better, because it has to.
Court case doesn't matter. The republicans came out and said the subsidies will be funded no matter what the outcome. Nobody loses coverage.
As far as the ACA? It is what it is. As mentioned above, I would feel better is they threw me a bone with a tax deduction for my premiums. Other than that, insurance was a shit show before and it's a shit show now.
If you have a specific question, I can answer it.
I begged for someone to educate me otherwise.
Do you wish to contribute to the conversation? Or just dismiss my question as a rant?
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I don't disagree with you as far as the direction health industry was going, but, again, I'm looking for an explanation of how the ACA is staving off the health industry abuse. I see it as feeding the industry, not controlling it.
The Hillary attempt at universal health care taught that a free society can't control health care on a level as intimate as the patient/physician relationship, so the ACA took a different tact: incentivize it. Create markets for patients no-one previously wanted to cover, reward foward thinking behavior, risk reduction, preventive care, incentivize more efficent practice models: electronic records, accountable care organizations. Its dismantling the old broken system in a death by a thousand cuts. Something new will grow out of this, and it will be better, because it has to.
Reports coming out are that ER visits are steady rising. This time of year, season in Fl., 3 weeks to get a doctors appointment. What's left?
I'm not so sure that in won't turn into a two tiered system like many other countries. It already has to an extent.
Must be profits then. Why I mentioned either or.
Thanks.
When the Medicare Prescription Drug plan was enacted it was a mess. Both side of the aisle tried to make it work. No one talked about repeal. Is that too political?
This is such a crucial point. The ACA probably has some problems. Congress could be working on improvements, revamps etc. They arent. Anything more I could say would be too political (though I dont blame one side 100%).
Plenty of examples of the government taking over private enterprise, with improvement in quality and cost. Right?
Things mandated by the government since the mid-2000's.... EMR, resulting in significant increase in cost and physician workload with no real evidence that quality improves.
Shifting of payments from physicians to hospitals and MSG.... which tend to cost more from the outset. Great move?
Significant increase in roadblocks to creating ambulatory surgery centers, even though they have ridiculously less costs than hospital based OR's. Hooray!
Meaningful use requirements that few physicians can meaningfully use. Government inaction....
Proliferation of special extortion units to railroad physicians to give hard-earned money back to the government. After all, if you call it fraud, it must be bad, right?
from the beginning, I explained I wanted a discussion. I said what my thought of the ACA was, and I begged for someone to educate me. Don't make this into something it isn't. I sincerely want to know if my view of the ACA is wrong.
HH, if you have nothing to contribute to the thread other than snarky comments, please do not post. it is not productive.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
Well pumping money that is borrowed into the market will do that. Plus interests rates are non-existant so there is no where else to put your money. But that will change and it won't be pretty.
Add in how hard it is to have price sensitivities in any regardless of who is paying. You have a doctor, has been your doc for 10 years. He sends you for an MRI, he has no idea how much it costs or it is in his practice and it would be really weird to start negotiating. Or you're having a heart attack -- stop to negotiate? Shoot, you're in the hospital and random docs send you bills, ones you dont even remember seeing.
Now look at the distorting power of market participants with too much power. In many places, eg. NYC, the insurance companies are kind of at the mercy of the hospitals, which are banding together in bigger and bigger consortiums (or corporations where allowed). How are you going to be an insurer in NY and not have Sinai/Beth Israel, or Cornell/Columbia? These hospitals can make their own rates. I understand there is essentially one entity that controls all hospitals in Pittsburgh. Then turn to drugcos (who I think are sometimes unfairly maligned). They often have patent monopolies which lead to good new drugs, but really high drug prices.
The healthcare "market" is naturally dysfunctional. This isnt Obama's fault, and it isnt the GOP's fault. It's impossible to try to replicate and Adam Smith type model of small buyers and small sellers all with perfect information setting market prices and allocating resources through the invisible hand. You cant pretend that but-for the guv'mint, this would all work out fine.
The ACA also isn't a single payer system, and wasn't designed to be one, though the health outcomes of single payer systems are superior to ours in a number of ways, and inferior in others.
The ACA is an attempt to patch over the significant number of pitfalls in our system, including quality of care, health outcomes, costs, and access to care.
However, it has created a significant number of issues.
Healthcare cannot, and will not, ever be run without government intervention.
But, as Canadian economist Robert Evans has pointed out, and that people forget to remember:
"Nations do not borrow other nations' institutions. The Canadian system may be "better" than the American...It would not fit because you do not see the world, or the individual, or the state, as we do..."
Just my humble opinion.
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
Here's an article on it. Kentucky has expanded Medicare and is seeing more ER use:
Plus, some patients who have been uninsured for years don't have regular doctors and are accustomed to using ERs, even though it is much more expensive.
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I see the access to care, which I refer to as subsidization, but what I'm asking is what is the rest of it? How is ACA addressing anything other than access to care?
2. The "tiers" of service favor those who are wealthier. This is, again, a feature of any healthcare delivery system found around the world. Hence, the redistributive nature of tax-financed systems.
3. All healthcare delivery systems create some form of rationing of care; even the private insurance market. What kind of care is rationed depends on the specifics of the system, but it happens to all.
Great point. I agree. There is a reason that of the 5 hospitals in my county, 1 isn't owned by the county healthcare systems. And no one who knows better will go to the one. They have taken over every doctors office under their umbrella. It's happening everywhere in the country. They just got awarded more money per procedure for medicare for their "efficiency".
Don't cry for the insurance companies. They are selling more product. That means more profit.
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the market is up over 100% since Bush left office.
Well pumping money that is borrowed into the market will do that. Plus interests rates are non-existant so there is no where else to put your money. But that will change and it won't be pretty.
Short the market when this pumping thing ends. Sounds easy enough.
Nice that the dollar is so strong now.
SS is a government program. The ACA is just a law to require you to buy insurance from an insurance company with some new regulations. Don't want to get into it again, but we do need an actual government program like SS to provide medical care. No shopping around, no getting ripped off, no confusing multitude of companies and plans ...if you are a citizen, you're covered, period, just like SS.
I see the access to care, which I refer to as subsidization, but what I'm asking is what is the rest of it? How is ACA addressing anything other than access to care?
What did the ACA try to do? The implementation of these features is debatable, but the goals are not.
Health outcomes by reduced price preventive services, or attempting to minimize the use of ER's as the PCP. Attempts to use managed care organizations (MCO's), which act as gatekeeper models to promote prevention.
Also, an attempt to mitigate the "cadillac" plans, which mean that people spend more of the first few dollars out of their own pocket, which incentivizes them to be more cautious stewards of their own health.
Costs by using MCO's (prevent people from running to the specialist), and using payment systems where doctors receive fixed payments per patient, and get to keep anything if they contain costs.
Quality of care by meeting certain health outcome guidelines, and by limiting the use of unnecessary referrals and supply-induced demand (i.e., doctors telling patients what they need because it benefits the doctors, and may or may not benefit the patients).
I see the access to care, which I refer to as subsidization, but what I'm asking is what is the rest of it? How is ACA addressing anything other than access to care?
I think there is a lot of funding for information exchange and study. Essentially best practices for care to let doctors know what tests/care actually has positive results. E.g. there was something about routine prostate testing not leading to better health outcomes, and therefore being wasteful. And of course end of life counseling (the dreaded Death Panels). End of life care is INSANELY expensive. 25% of Medicare $$ is used on the 5% of beneficiaries who die each year. Lots of people are getting care they dont even want -- it literally just happens because they have a proactive doctor and they're too old/frail/etc. to say "enough".
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
It was a report on the local news IIR. With it so cold up north and it being season, it's so crowded down here it isn't funny. I thought it mentioned nationwide. ER's are always the easiest ports in a storm. It really is a hassle to go to a doctor for a lot of lower income people.
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
Not too long ago doctors regularly had office hours on Saturdays and one or two evenings a week. The running joke was ... "if you need to see a doctor on Wednesday you have to go to a golf course". I didn't have to take time off to see a doctor and when my kids were young I never missed going with my wife to an appointment. The doctors themselves have shrunk access and it happened way before the ACA.
yeah, it's time for me to go to bed, because I can't wrap my head around the idea that affordable health coverage (as in, I have a problem, I can go see my doctor without paying 100% of the bill until I meet my deductible) is somehow a bad thing.
good night all. I thank those of you have made an attempt at positive contribution. If morning finds this thread a mess, I'll delete it.
That was for River Mike
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
Few physicians know the cost of a lot of stuff they order. For some of this stuff there is no way to even know -- every insurer pays differently. Doc could send you for an MRI, and depending on where you go, the cost to insurance could be 10x what it is down the road. It's an insane "market".
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
yeah, it's time for me to go to bed, because I can't wrap my head around the idea that affordable health coverage (as in, I have a problem, I can go see my doctor without paying 100% of the bill until I meet my deductible) is somehow a bad thing.
good night all. I thank those of you have made an attempt at positive contribution. If morning finds this thread a mess, I'll delete it.
Yes; the goal is to get people to pay first-dollar coverage. So, they won't run to a provider because it is cheap. Something like for each $7 of health care spent, a Cadillac plan makes each person pay $1.
A Cadillac plan is an inefficient subsidy. An extremely inefficient subsidy that puts a strain on the system because providers have to give care every time Timmy gets a sniffle.
It's meant to ease the burden on the providers, but also as a way limit unnecessary trips by a patient that could typically be solved using prevention.
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they are shit out of luck. All those doctor appointments you've made, you better cancel them. You scheduled surgery? No surgery for you. You finally feel like you are part of society? Back to second class no insurance status for you
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
through the end of the year, right?
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Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
Few physicians know the cost of a lot of stuff they order. For some of this stuff there is no way to even know -- every insurer pays differently. Doc could send you for an MRI, and depending on where you go, the cost to insurance could be 10x what it is down the road. It's an insane "market".
Well, yes and no.
Sure, since there are a variety of cost codes, it is impossible for a doctor to know the current costs incurred by the system as a whole.
But, certainly, we can use historical costs (up to a year before the doctor orders it) as a guidepost; that is what I meant by the proper cost-benefit decisions that a physician makes.
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In comment 12164131 ctc in ftmyers said:
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
It was a report on the local news IIR. With it so cold up north and it being season, it's so crowded down here it isn't funny. I thought it mentioned nationwide. ER's are always the easiest ports in a storm. It really is a hassle to go to a doctor for a lot of lower income people.
ERs are also more profitable than they have been in a while. More patients with insurance and high deductibles means they get to go after everybody (insurer and patient for $$). So ERs are expanding to accomodate more visits and make more $$. Ironic that some think that the increased business means that the system is stressed out. Hospitals administrators are laughing all the way to the bank.
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And poor people often can't take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.
Not too long ago doctors regularly had office hours on Saturdays and one or two evenings a week. The running joke was ... "if you need to see a doctor on Wednesday you have to go to a golf course". I didn't have to take time off to see a doctor and when my kids were young I never missed going with my wife to an appointment. The doctors themselves have shrunk access and it happened way before the ACA.
I'm not going to disagree. But the point is that reduced use of expensive ERs was on of the perks of the ACA. There was a lot of talk about doctor shortages, but it was all brushed aside.
I'm not denying that something had to be done. But the ACA is just a political boondoggle that doesn't really solve any problems.
ERs are also more profitable than they have been in a while. More patients with insurance and high deductibles means they get to go after everybody (insurer and patient for $$). So ERs are expanding to accomodate more visits and make more $$. Ironic that some think that the increased business means that the system is stressed out. Hospitals administrators are laughing all the way to the bank.
So was the goal to make ERs more profitable? Is that what you are arguing now? Most of the increase in ER use is by Medicaid patients. So that 'profit' is just coming out of our pockets. More tax dollars spent. Just what we need.
There were provisions in earlier versions of the bill to encourage and pay for people to speak with their doctors about their desired end of life care.
This was derided as "Death panels for seniors" and removed from the bill.
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In comment 12164248 kicker said:
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Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
Few physicians know the cost of a lot of stuff they order. For some of this stuff there is no way to even know -- every insurer pays differently. Doc could send you for an MRI, and depending on where you go, the cost to insurance could be 10x what it is down the road. It's an insane "market".
Well, yes and no.
Sure, since there are a variety of cost codes, it is impossible for a doctor to know the current costs incurred by the system as a whole.
But, certainly, we can use historical costs (up to a year before the doctor orders it) as a guidepost; that is what I meant by the proper cost-benefit decisions that a physician makes.
So big data will solve the real time cost issue, thats the easy part. The benefit part of the cost-benefit ratio is where the money is....if you know how to answer this in real time there is no limit to the amount of money you can make....
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In comment 12164159 Headhunter said:
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they are shit out of luck. All those doctor appointments you've made, you better cancel them. You scheduled surgery? No surgery for you. You finally feel like you are part of society? Back to second class no insurance status for you
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
through the end of the year, right?
Why do you want to make this political? I aint biting. read and learn from a lot of the good back and forth on this thread and learn.
I truly don't understand why you always want to derail threads that have good information being asked for and given?
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
While there has been no real plan forthcoming from the majority the states ...
Five Republican state governors say they will not rescue a crucial part of Obamacare if it is struck down by the Supreme Court ... In response to Reuters' queries, spokespeople for the Republican governors of Louisiana, Mississippi, Nebraska, South Carolina and Wisconsin said the states were not willing to create a local exchange to keep subsidies flowing ... State government officials in Georgia, Missouri, Montana and Tennessee - a mix of Republicans and Democrats - said that opposition by majority Republican state legislators could make it all but impossible to set up a new exchange ... Six states - Delaware, Maine, Ohio, Pennsylvania, South Dakota and Virginia - are discussing contingency plans to keep the subsidies but each faces substantial logistical or political barriers, according to officials ... Ten states did not respond to Reuters queries, while three others had no comment. Iowa, Wyoming, Oklahoma and West Virginia said they were not currently considering setting up exchanges; Alaska said it has not ruled it out
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Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
The problem is that when the data conflict with personal experience or received wisdom or financial interests, the results are derided or discarded.
As an example, a long and comprehensive study on mammography has revealed that strongly suggests that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care.
But essentially nobody believes this or says they don't believe it. There are a lot of entrenched interests in the business of encouraging women to get annual mammograms and they're not giving up without a fight.
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to utilize best practices, and share that information with providers across regions.
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
The problem is that when the data conflict with personal experience or received wisdom or financial interests, the results are derided or discarded.
As an example, a long and comprehensive study on mammography has revealed that strongly suggests that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care.
But essentially nobody believes this or says they don't believe it. There are a lot of entrenched interests in the business of encouraging women to get annual mammograms and they're not giving up without a fight.
Including by breast cancer survivors themselves.
But your points above are also why the early provisions to constrain end-of-life costs would not have mattered much, if at all.
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In comment 12164176 sphinx said:
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In comment 12164131 ctc in ftmyers said:
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Reports coming out are that ER visits are steady rising.
Do the reports clarify the numbers between states that have accepted Medicaid expansion ... or not?
It was a report on the local news IIR. With it so cold up north and it being season, it's so crowded down here it isn't funny. I thought it mentioned nationwide. ER's are always the easiest ports in a storm. It really is a hassle to go to a doctor for a lot of lower income people.
ERs are also more profitable than they have been in a while. More patients with insurance and high deductibles means they get to go after everybody (insurer and patient for $$). So ERs are expanding to accomodate more visits and make more $$. Ironic that some think that the increased business means that the system is stressed out. Hospitals administrators are laughing all the way to the bank.
I have a buddy of mine who is on the hospital board. Haven't seen him for a while and we are due to get together. I'll run a lot of this by him. I know the government is dictating, through money(imagine that), a lot how the operate.
in 2013. He came back on and doubled down that 2014 was the year when it kicks in that 1/6 of the economy was going down in flames
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to utilize best practices, and share that information with providers across regions.
Few physicians actually know what the cost-benefit of procedures is for each life-year saved, and thus can sometimes tend to prescribe treatments that make little sense (a pap smear every 2 years, compared to every 3; the time between mammograms).
If you look at the variability in procedures, even among university teaching hospitals, it's tremendous. There can be up to a 7x difference in the rate that different procedures are performed for identical maladies.
The problem is that when the data conflict with personal experience or received wisdom or financial interests, the results are derided or discarded.
As an example, a long and comprehensive study on mammography has revealed that strongly suggests that annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care.
But essentially nobody believes this or says they don't believe it. There are a lot of entrenched interests in the business of encouraging women to get annual mammograms and they're not giving up without a fight.
Gary serving up softballs...
The referenced study is a Canadian semi-randomized study from over 25 years ago. Terrible mammograhy equipment and technique and patients were pre-screened by physical examination for breast masses. And it's updated every five years with flawed analysis and propogated in the lay press to the harm of many. Considering there are multiple other studies documenting a 30% reduction in mortality with mammography in the 45-65 age group, why did you select that study and what point are you trying to make? That we don't really know how to calculate the benefit of many of the practices in use today?
$61,500 for each year life is extended for annual breast exam and mammography for women aged 55-65.
$22,000 for annual breast exam for this same group.
Genetic variant of unknown significance?
Gail risk asessment/low risk?
Or just any fucking patient including a few trannys that want to get off on the mammo machine?
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In comment 12164159 Headhunter said:Quote:they are shit out of luck. All those doctor appointments you've made, you better cancel them. You scheduled surgery? No surgery for you. You finally feel like you are part of society? Back to second class no insurance status for you
Apparently you haven't watched the news today. No matter what the court decides, the subsidies will be funded. That from the majority. Keep on ranting.
While there has been no real plan forthcoming from the majority the states ...
Five Republican state governors say they will not rescue a crucial part of Obamacare if it is struck down by the Supreme Court ... In response to Reuters' queries, spokespeople for the Republican governors of Louisiana, Mississippi, Nebraska, South Carolina and Wisconsin said the states were not willing to create a local exchange to keep subsidies flowing ... State government officials in Georgia, Missouri, Montana and Tennessee - a mix of Republicans and Democrats - said that opposition by majority Republican state legislators could make it all but impossible to set up a new exchange ... Six states - Delaware, Maine, Ohio, Pennsylvania, South Dakota and Virginia - are discussing contingency plans to keep the subsidies but each faces substantial logistical or political barriers, according to officials ... Ten states did not respond to Reuters queries, while three others had no comment. Iowa, Wyoming, Oklahoma and West Virginia said they were not currently considering setting up exchanges; Alaska said it has not ruled it out
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Article from a few days ago. reports I hear on fox today were that the GOP isn't going to let the subsides lapse no matter the ruling. All's it takes is a little congressional action. You think Obama will veto it? Talk radio is furious from the little I was in the truck today. Win for everyone around. Doomsday doesn't happen.
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Ah, so you prefer to wallow in ignorance. Considering that there are plenty of links to newer studies that confirm a variety of the findings.
Got it.
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Real-time individualized risk/benfit assesment is the holy grail, and nothing from 1997 is going to be of any use in 2015 and beyond.
Ah, so you prefer to wallow in ignorance. Considering that there are plenty of links to newer studies that confirm a variety of the findings.
Got it.
So some of the findings are confirmed? Wow! But not all? Oh you mean things might be a little different? We might have learned a little more since 1997 and need to update that review? So if those original numbers are used in a risk/benefit model, the model will get pounded by one with more accurate data? And you would put your money on what?
But, you would have known that had you chosen to actually look at something and read it.
By the way, they use the exact same procedures that the purported "big data" enthusiasts champion. You should check it out; may learn how individualized risk-benefit assessments are being widely considered no-go's among a variety of experts, and how more variegated averages are being used.
But, yet again, that would actually require reading...
So, ctc, are you really confident that the most conservative component of the House is going to let Boehner pass a fix that is fairly simnilar to the ACA itself in terms of its impact? Really?
And then, ctc there is this, also from your link:
It's always fun when someone with an opposing view makes your strongest arguments for you. Thanks.
Seriously?
But, you would have known that had you chosen to actually look at something and read it.
By the way, they use the exact same procedures that the purported "big data" enthusiasts champion. You should check it out; may learn how individualized risk-benefit assessments are being widely considered no-go's among a variety of experts, and how more variegated averages are being used.
But, yet again, that would actually require reading...
No-go because they can't calculate it? Really? An expert said that?
An expert in 2015 is just a fool in 2020.
Its a pleasure speaking with you, though I have to go read now....hmm, I don't see a single link....1997?
everyone focuses on the must buy insurance
and everyone jokes that noone read the bill well that was because
it was a big bill for a reason
there are real cost cutting measures in ACA
What you need to know about Obamacare’s cost-cutting measures - ( New Window )
my insurance went from a nice HMO to a high deductible plan (which sucks, but I don't know as it had anything to do with the ACA. it was coming. the company didn't want to pay what it would take to keep me in a good insurance plan, so they downgraded. was going to happen one way or another)
Holy crap! You up until recently still had an HMO? That amazes me.
I guess I don't understand the complaints about cost going up and plans being suckier, because since ~2003/2004, my health insurance has been doing exactly that. Long before the ACA came around. I've been on a high deductible plan for 8 or so years.
Currently my family deductible is $6500/yr. Luckily to help a bit with that, I have an HSA that as long as I let them suck some blood once a year so that they can justify charging more because of all of the fatties, that my company inputs $500 and then matches up to $1500/yr.
What's hilarious, is that currently I'm going to end up paying almost exactly the same out of pocket for the upcoming birth of my child that I would be paying if I had no insurance and just paid the hospital up front (~$2400). The only real savings I have using the insurance is something that's not even required- the company seed money in my HSA.
This current form of PPO that I have now hasn't changed for 5 or so years- it was a little different at first (8 or so years ago)- basically with a lower deductible and more seed money.
Anyway- the point is that higher costs and shittier plans were already coming. Don't fool yourself into thinking that without the ACA your costs weren't going to go up or your coverage wasn't going to go down. That's just silly.
As far as providing insurance after retirement? 20yrs ago my company provided that...but you had to pay in full the entire cost- which with the HMO we had back then was around $900/mo. I can't think of many employers that were going to provide the exact same coverage for retirees as for current employees- someone correct me if I'm wrong, but basically the perk of insurance for retirees was that you stayed in the group insurance and hence were paying the group rate that's a significantly lower rate than just buying your own- especially if you're in a large group.
They did away with the retirement insurance benefit back in 2001. So again- don't fool yourself into thinking the ACA was the driving force...that was pretty much coming already- with the costs skyrocketing, there's no way companies could keep offering that benefit.
I would like to see less of the burden on the middle class- and I'd also like to see more of a single payer system- so please don't take this post as me being a fan of the ACA at all- I'm not. I just want to clear up the really silly myths about how it's raised the cost for everyone. The cost was going up anyway- at least now there are people that previously didn't have insurance (which we were already paying for when they went to the emergency room) who have it.
My $.02
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All's it takes is a little congressional action.
Seriously?
Cobra-like insurance could bridge the gap for people losing coverage if King v. Burwell goes the GOP’s way.
So within a week I will introduce legislation that uses the 1985 “Cobra” law as a temporary model to protect those harmed by ObamaCare. Cobra offers workers who have lost their jobs the option to keep their health coverage for 18 months—so Congress should offer individuals losing insurance the ability to keep the coverage they picked, with financial assistance, for 18 transitional months. This would simultaneously avert the full-scale implementation of ObamaCare in these 37 suddenly desperate states. It would also help protect suffering patients entangled in the court’s decision to strike down illegal subsidy payments.
Link - ( New Window )
Thankfully, I don't see a majority of SCOTUS justices ruling in the plaintiffs favor. Obamacare survives.
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That's possible, but Chait may not be factoring in the power of Republican anti-Obamacare ideology. Some Republican states have expanded Medicaid because it makes economic and humanitarian sense; but many others still hew to GOP orthodoxy that such a step is a capitulation to evil Obamacare. Ideology might yet prevent the Republican Congress and Republican statehouses from acting rationally to ameliorate the effects of a Supreme Court ruling.
So, ctc, are you really confident that the most conservative component of the House is going to let Boehner pass a fix that is fairly simnilar to the ACA itself in terms of its impact? Really?
And then, ctc there is this, also from your link:
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In fact, every objective analysis has shown that the ACA has brought down the rate of healthcare cost increases and materially lowered the nation's uninsurance rate. If the GOP analysis of the state of America's healthcare is as off-base as Sasse's, the party has no chance of designing a reasonable plan of its own.
It's always fun when scomeomeone with an opposing view makes your strongest arguments for you. Thanks.
Manh
They have no choice. We are to far into it to start from scratch. If you read my first post on this thread. I stated the ACA is what it is. I'm talking reality for the situation that is today. You can't change the past, you can only move forward. Those who live in the past are doomed to failure. That's about how political I'll get on this board.
The whole point of obamacare was to get as many people covered as possible. Get the poor out of the emergency room and in to a doctors office. It would bring down costs.
The whole point of obamacare was to get as many people covered as possible. Get the poor out of the emergency room and in to a doctors office. It would bring down costs.
Which states are those?
Actually that is what the SCOTUS heard arguments about yesterday. The question is will the poor LOSE coverage due to subsides being cut to those states that didn't setup exchanges.
Those federal subsidies appear, maybe, possibly, the way the law is written, will only be available to states that set up their own exchanges.
As far as emergency room usage. read the thread. A lot of good insight on here.
I don't remember what states. Mostly down south i believe.
I don't remember what states. Mostly down south i believe.
That's a different discussion and will turn too political for this board. IMHO
It seems the ACA has caused companies to hire part-timers instead of full-timers who would otherwise cost more under ACA. This appears to me with the large retail stores in my area and really impacts the quality of service due to the many people being hired having no interest in actually working.
Second, it appears that the ACA is tax regressive. I think that MIT professor was right after all; it is a tax. However, the tax is on the lower-middle classes! Good job leaders! So it is good for me but does not appear to be better for the folks working part-time at Whole Foods and the few nannies I run accross who want and have paid for healthcare complain about "Obamacare" inecessantly as their costs went up!
That is all anectdotal but down here in the trenches, working for the man, that is what is being seen. I presume that some economist (maybe the MIT guy) will jump in and claim the old system was not tenable so a change had to happen. Well, it did, tax the loweer classes and let the corporations effected do a work-around.
My answer to that is that the complexity of the ACA has created many messes like the one you list here. My answer to it is that given time, that will go away.
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).
Businesses facing tremendous uncertainty don't start cutting en masse; they wait.
There has been some evidence that part-time jobs are not falling after the recession, which (in part) can be attributed to the ACA:
But it's far too early to tell.
Similarly, we should expect to see continued wage declines after the recession, as firms compensate workers with more benefits and lower wages.
This graph below can again, in part, be contributed to the ACA:
It does not mean that it is significant nor long lasting. There are effects, but claiming that something has or has not happened is moronic.
Can we blame that on the ACA too?
And as far as stagnating median income, a growing proportion of economists believe that accelerating technological change is playing an increasing role, one which will only increase over time. I guess we can blame the ACA for that, as well.
I was in retail management back in the 60s and 70s. We started going to the part time model back then because it was realized that stores are busier at certain hours of certain days and floor coverage (customer service) could be vastly improved with the flexibility. We found many capable and willing workers, who wanted part time jobs to fit their schedules ... moms with kids in school, college students ... etc). Of course there still has to be a backbone of full timers working towards advancement but part time employees is, and has been, the way to go to a large retail environment for many, many years.
Can we blame that on the ACA too?
And as far as stagnating median income, a growing proportion of economists believe that accelerating technological change is playing an increasing role, one which will only increase over time. I guess we can blame the ACA for that, as well.
Question, Manh -- Hasn't median income been stagnating for quite some time? Just asking for clarification. Also, the point about the rest of the world still being in more dire economic straits that the U.S. is a telling one. I guess they shouldn't have adopted the ACA, eh?
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It seems the ACA has caused companies to hire part-timers instead of full-timers who would otherwise cost more under ACA. This appears to me with the large retail stores in my area and really impacts the quality of service due to the many people being hired having no interest in actually working.
I was in retail management back in the 60s and 70s. We started going to the part time model back then because it was realized that stores are busier at certain hours of certain days and floor coverage (customer service) could be vastly improved with the flexibility. We found many capable and willing workers, who wanted part time jobs to fit their schedules ... moms with kids in school, college students ... etc). Of course there still has to be a backbone of full timers working towards advancement but part time employees is, and has been, the way to go to a large retail environment for many, many years.
Sphinx
Wasn't that the Sears model that didn't workout too well for them at the time,but the model everyone changed to?
Trying to remember ancient management 101.
Perhaps you can instruct these betters to give you a reading lesson.
You were complaining about people lamenting the extreme negative effects of the ACA (the short-run) and I was calling them dolts, not you.
This is an internet bulletin board, so you may not get the respect you're accustomed to, but that should be a challenge to you, not an insult.
Couldn't give 2 shits if internet strangers respect me. Plenty of people that matter do, and that's enough, whether its warranted or not.
These problems will be solved - and I will suggest to you that they are already - but I'm a dolt...
On Long Island, thru the late 50s stores were closed on Sundays and only open one or two evenings a week, usually Monday and Friday. Almost all the employees were full time. Scheduling was easy. Then when the stores started opening on Sundays and every evening Mon thru Sat scheduling became more of a challenge. At first more full timers were hired but it was slowly learned that wasn't the way to go because the schedule was too rigid. Little by little when a full timer left he/she was replaced by two or three, maybe even four, part timers. My point was necessity brought part time workers into retail decades ago, blaming the ACA is ridiculous.
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 absolutely believe that the ACA is having some material effect on the pt/ft ratio. It would be fairly absurd for some lower wage employers to not factor this in.
But is the ACA suppressing wages (not sure if kicker argues this)? That's a tougher sell. Wage stagnation (or worse) seems to exist, but the attribute it to the ACA and not the worst recession in 75 years leading to a particularly abnormal oversupply of labor (people who would take a job in their industry at any wage still not having jobs), the increased ability to offshore production and work (b/c of IT, lower shipping costs etc), productivity gains, and a host of other reasons (shareholder activism/private equity) seems too selective. How do you prove that the ACA contributed in any way to a lack of wage growth? Also, do health benefits count as wages? If I make $10 in year 1 and 2, but get more fringe benefits in year 2, do you say my wages stagnated?
It's another topic, but it's technological change and other forms of bureaucratic creep, as well as some notable labor market issues.
I think that the ACA may play a contributory role in wage stagnation, but is not the primary driver. I also think that it will be pointed to as the cause because of the false correlation, but it would be wrong.
Benefits count towards broader measures of "wages" like total compensation. Common datasets impute a monetary value for health insurance and the like. So, with your statement, total wages stagnated, but total compensation did not. But, you have to remember that part of the wage decreases may be, in fact, due to increases in non-wage fringe benefits.
It's what happened with mandated maternity coverage.
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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.
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.
Yes, we'll have to do it again sometime. :-)
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.
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.
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.
There's a clear disconnect here.
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.
Unless we now think that zero-priced medical services don't induce additional consumption on a rather fixed number of suppliers.
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.
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."
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).
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.
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.
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?
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.
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.
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.
Look at satisfaction of healthcare across countries. It is mediocre to very poor in these "havens" of healthcare (Canada, UK, Germany).
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.
"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.
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.
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)
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.
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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.
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?
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.
- 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.
A loaded question?
Where in the constitution does it say it is?
Another loaded question.
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.
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.
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.
It's not an issue how you framed it.
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.
Sorry about the size, but it's a useful point.
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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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.
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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