Will Obamacare succeed where term limits failed?

[Fisherking]

I have not followed this, as I live outside the country and hope I am not effected by it.

But I do have a question or two.

If it is so good, why is there a tax penalty for individuals who don’t want to use it?
And, what happens to Doctors who are not employees of a large health care provider?

Most of the rest, I assume is a degree of scare mongering by the Republicans.

The only other thing I have heard that could be alarming is the supposed doubling or tripling of individual plans. This could be more of the scare tactics, I hope, but maybe not.

Also, as everyone is to be insured and everyone must be excepted but smokers pay a higher premium, I find that somewhat disingenuous.

After all, doesn’t someone obese or with another lifestyle related condition, not an equally high risk nonsmoker or not as the smokers who have to pay higher premiums? Just a little social engineering to go along with the program, huh?

[Lemur]

If it is so good, why is there a tax penalty for individuals who don’t want to use it?

Because if we are to prop up and nurse along our broken system of private insurance, we have to expand the pool and convince the majority of citizens to buy some sort of coverage. In other words, force the reckless, the healthy, and the young to buy coverage they otherwise might not, thus spreading the pool and market to cover the sick, the lame, and the old.

I believe it's superficially similar to what's implemented in Switzerland.

Of course, I would argue that there is zero evidence that private insurance is the appropriate way to fund healthcare, but that's because I don't see evidence that market forces work properly in healthcare. Market capitalism is great at many, many things. But when there's no evidence that it works in a certain context, it's time to re-think.

For example, I become a screaming socialist state-lover when it comes to the military. I think PMCs are a horrible idea. I don't much like mercenaries or their side-effects. I think the military should be paid for straight outta taxes. I hear that makes me a pinko commie.

Likewise, I simply do not see evidence that national healthcare is best run by market principles—and those who advocate complete privatization and deregulation have nothing but theory and ideology on their side (which should tell you a great deal). But if we need to broaden the market to force our jackalope system to limp along for a bit ... eh, okay.

At least Obamacare sets up state exchanges, out of which something useful may grow.

[HoreTore]

I support government services where that is efficient(healthcare, military).
I support private services where that is efficient(groceries and tv's).
I support a combination of the two above where that is efficient(kindergartens).

The distance from a conservative US republican(Lemur) and a Norwegian socialist(myself) isn't always so huge...

[drone]

The distance from a conservative US republican(Lemur) and a Norwegian socialist(myself) isn't always so huge...

Lemur comes across more as a 90's moderate, which in this day and age means he's a freedon hating pinko to most of the Republican base.

I'm a bit further to the right, but even I knew this scheme would be a disaster. If true healthcare reform is to happen, we need to go to a single-payer system. As it stands (both pre- and post-Obamacare) the system's main goal is to siphon as much money out of your pockets before your die. As long as healthcare is not non-profit, this will always be the case.

[Fisherking]

It was passed by Congress, so there is no doubt it is flawed.

Just looking from here, without reading the thing I figure the main beneficiaries of the program are insurance companies, large healthcare providers and government agencies.

It is just an estimation but I think the people will take it in the shorts, and the pocket of course.

The German system works well here, but I have serious doubts that it can work there. I shudder at the thought of a government run healthcare system as it would be under funded and so filled with red tape you would long since have died before you got in to see a government doctor.

My guess is this will be about as good as you can get. You will never find a way of getting back to charging according to the means of the patient to pay. Docs don’t work for a chicken dinner any more.

[HoreTore]

The need to avoid waste, the number one leading cause of birth among bureaucrats, will always be present, private or public.

Though the extreme number of people who wish to "avoid waste of tax payer money" do seem to have a special ability when it comes to pissing away money on useless levels of red tape.

Yes, I'm looking at you, conservatives.

[Lemur]

I figure the main beneficiaries of the program are insurance companies, large healthcare providers and government agencies.

Largely correct. Health Insurance and hospital stocks skyrocketed the moment Obamacare was passed.

It is just an estimation but I think the people will take it in the shorts, and the pocket of course.

Hard to estimate. Our pre-Obamacare system was already outpacing inflation by well over 100%. As economists say, trends that cannot continue ... don't. So something was (is) going to break. I doubt you can blame the deep dysfunction of our healthcare system exclusively or even primarily on an initiative as watered-down and modest as Obamacare. Not that people won't try, bless their little hearts.

I shudder at the thought of a government run healthcare system as it would be under funded and so filled with red tape you would long since have died before you got in to see a government doctor.

If this were true, you would see corresponding health data from single-payer systems, showing less efficiency and worse health results. The opposite is true.

My guess is this will be about as good as you can get.

What are you basing that on? Other nations have enacted objectively better systems than ours, and have decades of documented experience to back it up. I am continually amazed by the empiricism-free and data-free nature of these sorts of objections.

[The Lurker Below]

I agree with Drone that a single payer system is the best solution, and is long overdue. I wonder though, the more things change, the more they stay the same. It's been implied in posts here that our bureaucratic red tape creators would make our single payer system a dysfunctional system, getting nothing done. People with money would still find the healthcare they want, only at additional expense than the taxes they already pay. Long term, no difference.

At least Obamacare sets up state exchanges, out of which something useful may grow.

Currently over half the states have refused to set up the exchanges, and due to laws within their state, might never do so. This means that in those states the federal gov't will set up the exchange, which Obamacare legislation itself declares cannot be done.

[Papewaio]

This is a strange one.

There are so many healthcare systems in the world.

Why not look at the top ten as rated for infant mortality, life expectancy, emergency queue length, surgery queue length.

Then look at the cost to implement these and how they were implemented.

Pick and choose based on real world results.

[Fisherking]

I would prefer to be optimistic and say it is only a small problem that can quickly brought under control.

I know other governments have done a decent job of it and single payer systems can work.
My pessimism is based on how the US Government tends to function and how Congress behaves.

I am truly sorry to hear that healthcare has skyrocketed to those levels.

[Lemur]

I would prefer to be optimistic and say it is only a small problem

It's a huge problem. Costs in the USA healthcare system are completely out of control.

Just in the last few years, healthcare as a percentage of our national gross domestic product went from 16.6% (2008) to 17.9% (2011).

Note that healthcare growth as a percentage of the economy slowed during this period. And still managed to leave inflation, and every other national economic sector, in the dust.

Like I said, trends that can't continue, don't. My hope is that we have a soft rather than hard landing.

People with money would still find the healthcare they want, only at additional expense than the taxes they already pay

That's how most single-payer systems work. A national baseline of healthcare, and then more or faster or better service if you have the means to pony up. Seems to work pretty well.

My mother and step-father are obsessive Fox News viewers, and they insist that private healthcare is illegal in Great Britain. Because, you know, socialism and stuff. No matter how many times I explained that this was false, to this day they will tell anyone who will listen how private doctors are illegal in Merry Olde Englande.

Fact-free. So much of this debate is blissfully devoid of data and empiricism. Makes me crazy.

[Papewaio]

In Aus it works like this:

1.5% Medicare tax
After a certain threshold:
1.5% Medicare tax + Private Health Insurance or 2.5% Medicare tax without Private Health Insurance.

Medicare covers the basic health system and it is the primary one for emergency care.
Private health insurance reduces and/or removes private health costs. The private health system allows either a private room in the same hospitals, more options, quicker access via private hospitals etc. Private health is also the primary way for elective surgery.

If you are really rich you could just pay outright for private health. But if you really are rich you would know how to reduce your cost base in the first place.

So it is similar to a free to play game where you can pay to get better outfits or shorter queue to server.

[Beskar]

That's how most single-payer systems work. A national baseline of healthcare, and then more or faster or better service if you have the means to pony up. Seems to work pretty well.

My mother and step-father are obsessive Fox News viewers, and they insist that private healthcare is illegal in Great Britain. Because, you know, socialism and stuff. No matter how many times I explained that this was false, to this day they will tell anyone who will listen how private doctors are illegal in Merry Olde Englande.

Fact-free. So much of this debate is blissfully devoid of data and empiricism. Makes me crazy.

If you was curious, the biggest private providers in the UK are Bupa.

I would be interested for you to use their "get a quote" to get a price comparison. To see if it is cheaper or more expensive than typical insurance in the US.

For me by myself, it looks between £41-65 per month. So $61-100 in your money.

This could be cheaper due to the public funding aspects as well.

[Papewaio]

I am with Bupa here. Costs vary by state and type of cover.

I don't have hospital cover just extras such as optical and dental.

So I pay the 2.5% Medicare rate.

[a completely inoffensive name]

Eventually the US will move to single payer. It's only a matter of time. The current situation will literally choke us to death financially and it has been, and only then will Americans come kicking and screaming to the same policy that every other industrialized nation has adopted.

[Xiahou]

Union leaders who helped push Obamacare's passage, now seem to be suffering from buyer's remorse...

Union Letter: Obamacare Will ‘Destroy The Very Health and Wellbeing’ of Workers

Can't say we didn't try to warn them....

[Fisherking]

The link didn’t work!

But here it is: http://blogs.wsj.com/corporate-intel...ng-of-workers/

I do find it disturbing that the Named Representatives are called Leader, regardless of what ever title they may have in Congress.

Smacks too much of Der Führer.

[Lemur]

Union leaders who helped push Obamacare's passage, now seem to be suffering from buyer's remorse...

Did we read the same letter? They just want some specific changes made to the implementation, and they're using apocalyptic language in a fit of overstatement. Nowhere do they demand the repeal of Obamacare; rather, like everybody with fingers in this pie, they want bits bent to suit their needs. Seems like perfectly normal lobbying.

Deeply amused that it's signed by Jimmy Hoffa. Does this mean they found him?

[Ironside]

Deeply amused that it's signed by Jimmy Hoffa. Does this mean they found him?

Close. Being aware of his forthcoming death, Jimmy Hoffa decided to conduct a biochemical project, where he implanted his genetical material into a living host, where the specimen grew, to eventually emerge after the incubation period ended. Due to limitation in this process, genetical material from the host were also used, creating only a partial clone, that despite having a diffferent upbringing decided to pursue a similar career.

Spoiler Alert, click show to read: 

Or in other words, he had a son.

[Fisherking]

Did we read the same letter? They just want some specific changes made to the implementation, and they're using apocalyptic language in a fit of overstatement. Nowhere do they demand the repeal of Obamacare; rather, like everybody with fingers in this pie, they want bits bent to suit their needs. Seems like perfectly normal lobbying.

Deeply amused that it's signed by Jimmy Hoffa. Does this mean they found him?

It sounded concerned enough for me. I have wondered about those 30 hour part time help limits my self.

If employers have incentives to cut work hours to save an expense they will not hesitate.

I would have also thought that existing employer/union plans would have been grandfathered in.

Tax exemptions and subsidies one would think would be based on income and not on whether the plan was a non profit or for profit plan.

Isn’t supposed to be about getting people affordable health care instead of benefiting large Insurance plans and major health care corporations?

If this were a sane world workers and small businesses would have woken up and seen that both established parties were only out to please the big money of corporations and founded a new party.

Instead they just believe the lies of their preferred group and blame the other side. And nothing changes.

[Lemur]

Instead they just believe the lies of their preferred group and blame the other side. And nothing changes.

As stated earlier, I expect that something useful might grow out of the exchanges. Example:

Health Plan Cost for New Yorkers Set to Fall 50%

State insurance regulators say they have approved rates for 2014 that are at least 50 percent lower on average than those currently available in New York. Beginning in October, individuals in New York City who now pay $1,000 a month or more for coverage will be able to shop for health insurance for as little as $308 monthly. With federal subsidies, the cost will be even lower.

Supporters of the new health care law, the Affordable Care Act, credited the drop in rates to the online purchasing exchanges the law created, which they say are spurring competition among insurers that are anticipating an influx of new customers. The law requires that an exchange be started in every state.

-edit, yet another example-

Vermont Releases Final Health Insurance Rates

The Green Mountain Care Board — the regulatory authority for insurance and hospital rates in Vermont — announced this week that it negotiated 4.3% to 5.3% rate cuts in individual and small-group plans offered by Blue Cross Blue Shield of Vermont and MVP Health Care. The rates go into effect Jan. 1.

Vermont approved six “metal” plans in its health insurance Marketplace, also called an Exchange. There are two bronze, two silver, one gold, and one platinum plan, each with different combinations of copayments, coinsurance rates, and limits on annual out-of-pocket spending.

[Xiahou]

McClatchy has reported that in 2013, 97% of jobs created have been part-time jobs!

Ok, so where does Obamacare come in? Here:

“There is something going on if such a large share of the hiring is part time,” Hall said.

He said the overall share of part-time jobs to all jobs, 19 percent, wasn’t a problem – yet.

Hall speculated that the implementation of the Affordable Care Act, shorthanded as Obamacare, might be resulting in employers shifting workers to part-time status to avoid coming health care obligations.

“There’s been so much talk about the effects of Obamacare on part-time work,” he said. “This is such an unusual thing to see.”

So who's "Hall" you're thinking? From the article...

Hall is no ordinary academic. He ran the Bureau of Labor Statistics, the agency that puts out the monthly jobs report, from 2008 to 2012.

[Xiahou]

Assuming just a straight hourly wage, companies would prefer to hire full-time over part-time. It would mean less people to train up, less people to manage, and less schedules to coordinate. Any disincentives for full-time employees are going to be attributable to government interference- some necessary.... some not.

Obamacare is saying that if you have employees work for more than 30 hours a week, it's going to cost you more money. So what do you do? Hire as many people at under 30 hours a week as you can. I don't get where you're seeing this as something nefarious on the part of business owners. They're trying to save money- the same as most anyone would.

[Fisherking]

You still have that two party mind set GC. There are plenty of Rich Corporate Types that pay tribute to the DNC and their candidates. McDonald’s got a government exemption from Obamacare and no one screamed.

Then there are guys like the owner of Obama’s next vacation home. David M. Schulte http://www.chilmarkpartners.com/davi...e-pages-18.php

http://newsbusters.org/blogs/michell...neyard-vulture

Personally, I still think the plan is more about helping Insurance Companies than people. But hay, that is just me.

[Lemur]

I still think the plan is more about helping Insurance Companies than people. But hay, that is just me.

You're not wrong.

To look at it from a genealogical/Biblical perspective:

Swisscare begat Heritage Foundationcare, which begat Romneycare, which begat Obamacare.

But what got lost pretty much the moment the plan left Switzerland was the deep governmental (and therefore public, and publicly debated) involvement in the foundation-level, minimum insurance. That was tossed out from Heritagecare on.

Swiss are required to purchase basic health insurance, which covers a range of treatments detailed in the Federal Act. It is therefore the same throughout the country and avoids double standards in healthcare. Insurers are required to offer this basic insurance to everyone, regardless of age or medical condition. They are not allowed to make a profit off this basic insurance, but can on supplemental plans.

Regulations also restrict the allowable policies and profits that a private insurer may offer, as noted by healthcare economics scholar Uwe Reinhardt in a review in the Journal of the American Medical Association:

"To compete in the market for compulsory health insurance, a Swiss health insurer must be registered with the Swiss Federal Office of Public Health, which regulates health insurance under the 1994 statute. The insurers were not allowed to earn profits from the mandated benefit package, although they have always been able to profit from the sale of actuarially priced supplementary benefits (mainly superior amenities).

Regulations require "a 25-year-old and an 80-year-old individual pay a given insurer the same premium for the same type of policy.... Overall, then, the Swiss health system is a variant of the highly government-regulated social insurance systems of Europe... that rely on ostensibly private, nonprofit health insurers that also are subject to uniform fee schedules and myriad government regulations."

The insured person pays the insurance premium for the basic plan up to 8% of their personal income. If a premium is higher than this, the government gives the insured person a cash subsidy to pay for any additional premium.

[Papewaio]

I take it that the Swiss fees are flat given the example of a 25 yr old paying the same as an 80 yr old.

So I assume the 8% of your income is to cover low wage earners.

[Xiahou]

Maybe I'm just a poor capitalist because I don't sympathize with them at all, nor do I think they should be doing it. Its not really nefarious, its just lazy and greedy. If our pitiful attempt at subsidized healthcare is going to fail because business owners are cheap, then we should have just fought for true universal healthcare to begin with. The healthcare act, as it is, is a gentle nudge in the right direction for businesses. Chambers of commerce and small business associations can be major republican lobby bases, and I wouldn't be surprised if there was a lot of pressure coming from those places to put the blame on Obamacare and make a public stink about it all. Either way, their reaction proves that they need a harsher prodding instead.

Do you go out of your way to pay more for American made products? If not that, do you make sure you only buy FairTrade produce? Do you shop small, local businesses instead of big box stores? If not, can I call you lazy and greedy?

[a completely inoffensive name]

I remember when I lived in Santa Cruz, they heavily restricted the amount of chain stores coming in. I couldn't find a single McDonalds and I am pretty sure they banned Wal-Mart from coming in entirely.

They had to cave in to the college students though and let about 4 Taco Bells into town.

[Lemur]

An interesting historical note from a blogger: Socialized medicine came to the USA in 1986, and was signed into law by Saint Reagan the Immaculate:

[S]ince 1986, hospitals have been legally required to treat anyone seriously ill who presents himself at an emergency room, with clear medical needs. In the most fundamental way, that was the moment the US socialized medicine – and Ronald Reagan signed the bill. Alas, like so many Reagan domestic initiatives, there was no federal money provided to pay for this. And we all know what happened next: all those extra costs for the uninsured drove up premiums for everyone else, drove up hospital costs, giving them a reason to raise prices even further, and played a role in rendering healthcare unaffordable for many others.

What Obamacare does, like Romneycare before it, is end this free-loading.

The law is telling these young adults that if you want to go without insurance, you are not going to make everyone else pay for it if your risk-analysis ends up faulty. You have to exercise a minimum of personal responsibility to pay for your own potential healthcare. In other words, rights come with responsibilities in a liberal democracy. At least that is what I always understood the conservative position to be.

[Kralizec]

As far as I know, the Dutch system is superficially similar to the Swiss, in that:

1) health care insurance is mandatory
2) as far as the "base package" is concerned, a government defined group of medical procedures, insurance companies are not allowed to refuse clients. For stuff that's not included, like dental care or eyeglasses, they're a lot more free in what they offer and at which cost.

The insurance obligation lies on the individual; however many employers in the Neth's have brokered deals with insurance companies that allow the employees to apply there at lower rates.
To be clear, is this how Obamacare works (?):
- an individual obligation to get insured
- companies with >X full time employees must offer a collective package for their workforce