Will Obamacare succeed where term limits failed?

[Strike For The South]

Obamacare is terrible legislation that does nothing but deliver a fat payday to insurance companies. The best healthcare in America is still "Don't get sick, asshole"

The part time jobs thing seems counter intuitive to me. The company I work for is raising wages and making more people full time but hiring less. This seems to be the same course of action other business are taking, based on my conversations. Perhaps this is selection bias.

Companies are going to cut costs. Why let a good crises go to waste? Cut some fat and endear half the country towards you in the process. I feel the same way about the companies that I do the goverment, don't hate them for doing what they were made to do.

[Lemur]

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

Yup, that's about the size of it. Major difference is that the controls on the "basic" health insurance aren't nearly as broad or well-defined as the Swiss/Dutch model. And the "X" number is 50, I believe.

It's the best we could do under the circumstances, which is a long way from saying it's good.

If the Republicans ever undo their cranial-rectal inversion on the subject, they could be rather helpful in debating it like grownups, and ultimately making its implementation less worse.

Unfunded giveaway to big pharma and seniors? Yes please! Private-insurance-based reform modeled on the Swiss/Dutch model? SOCIALISMO!

[rvg]

If the Republicans ever undo their cranial-rectal inversion on the subject, they could be rather helpful in debating it like grownups, and ultimately making its implementation less worse.

Although I personally do not support Obamacare, I have to agree that the obstructionism generated by the House Republicans has crossed all the possible lines out of civilized discourse and firmly into hardcore ideological frothing.

[Fisherking]

Although I personally do not support Obamacare, I have to agree that the obstructionism generated by the House Republicans has crossed all the possible lines out of civilized discourse and firmly into hardcore ideological frothing.

That is nothing new, just the Out of Power Syndrome.

[Lemur]

That is nothing new, just the Out of Power Syndrome.

Actually, by any objective metric you care to choose, the Republican congressional members under the Obama admin have taken obstructionism to new and uncharted heights. Among other achievements, they've pretty much wrecked the filibuster.

To say they're just experiencing Out of Power Syndrome is willfully ahistorical.

[Xiahou]

Although I personally do not support Obamacare, I have to agree that the obstructionism generated by the House Republicans has crossed all the possible lines out of civilized discourse and firmly into hardcore ideological frothing.

I'm morally opposed to the mandate, but it'd be a lot easier to swallow if it allowed for low-priced catastrophic / high deductible plans. From what I've seen, even the bronze level plans are required to offer comprehensive coverage. But then, making young, healthy people pay for coverage they don't need is how Obamacare gets the numbers to add up...

Any real healthcare insurance reform (let's face it, that's what it is- not healthcare reform, but insurance reform) needs to decouple coverage from employment. I don't know that Obamacare helps much in that regard.

[Fisherking]

Actually, by any objective metric you care to choose, the Republican congressional members under the Obama admin have taken obstructionism to new and uncharted heights. Among other achievements, they've pretty much wrecked the filibuster.

To say they're just experiencing Out of Power Syndrome is willfully ahistorical.

Seems just like what the Democrats did with W. I guess they are still learning. They both play this little games. I thought ‘what comes around goes around’ was rich because she was there when it was them holing up nominations. But I expect most people may have covalently forgotten that.

[Fisherking]

Its all in the numbers dude. This congress has accomplished less than any other congress. They've accomplished much less than half of a particular congress that was actually dubbed the "Do-Nothing" congress.

Judging form what gets passed when they work, I would count that as a big plus.

[Xiahou]

Its all in the numbers dude. This congress has accomplished less than any other congress. They've accomplished much less than half of a particular congress that was actually dubbed the "Do-Nothing" congress.

Why is that a bad thing? When everything they do is a screwup, maybe nothing is better. What happened to the people who used to wish for gridlock?

Personally, I think number of bills passed is a very poor metric for success...

As to the filibuster, it's been wrecked ever since they decided you could have endless debate without actually having to debate (or speak).

[drone]

Seems just like what the Democrats did with W. I guess they are still learning. They both play this little games. I thought ‘what comes around goes around’ was rich because she was there when it was them holing up nominations. But I expect most people may have covalently forgotten that.

The difference between the Dems with W and the GOP with Obama is huge. The Dems would whine and complain for a while, then cave in when the right-wingers started calling them freedom-hating pinkos. Pelosi and Reid were spineless and naive as party leaders, and it never even occured to them to shut things down like the GOP is doing at the moment. And now they only have themselves to blame, since Reid is the one responsible for shutting down the Senate with the 60-vote rule. Self-serving idiots, the both of them.

Halting nominations is child's play compared to the current situation.

[Kralizec]

I'm morally opposed to the mandate, but it'd be a lot easier to swallow if it allowed for low-priced catastrophic / high deductible plans. From what I've seen, even the bronze level plans are required to offer comprehensive coverage. But then, making young, healthy people pay for coverage they don't need is how Obamacare gets the numbers to add up...

That really depends on...which way you look at it, or something.

Young people not wanting to be in the same insurance scheme as old people is an example of negative selection. Meaning; you think that being in the same pool as some old guy (more prone to disease) is a bad choice, and so you refuse. As a result, the insurance payments of all the old people will rise.

As a young person, I'm in effect paying for the medical care of the elderly. But since I hope and expect to become old too, I don't think it's unfair. Besides, the scheme also covers a lot of treatments that could theoretically befall me too and which I can't possibly afford on my own. Insurance is a form of solidarity.

There will always be questions: in one case, I remember looking at the optional choices of one insurance company and noticed that the only way I could get dental coverage with that company was to buy Package A which included dental care but also various forms of bull****, sometimes called "alternative medicine". I refused out of principle, which is another form of negative selection I suppose.

If you accept that it's morally undesirable to deny a patient treatment for a certain condition, then mandatory insurance is pretty much inevitable.

[Xiahou]

NBC realizes the obvious...

Employers around the country, from fast-food franchises to colleges, have told NBC News that they will be cutting workers’ hours below 30 a week because they can’t afford to offer the health insurance mandated by the Affordable Care Act, also known as Obamacare.

“To tell somebody that you’ve got to decrease their hours because of a law passed in Washington is very frustrating to me,” said Loren Goodridge, who owns 21 Subway franchises, including a restaurant in Kennebunk. “I know the impact I’m having on some of my employees.”

Many of us have been pointing this out since the law was passed- better late than never NBC.

[Papewaio]

Really poorly implemented. Just pick any other first world country and implement their health system. It will be better, faster and cheaper then what this monstrosity will get you.

I cannot point to a more expensive, less effective health system then that in the US.

[Beskar]

NBC realizes the obvious...
Many of us have been pointing this out since the law was passed- better late than never NBC.

Perhaps less regulation would fix the issue?

[a completely inoffensive name]

The free market stinks at organizing the distribution of anything that is not a non-essential, consumable product. How long until the US figures that out?

[Xiahou]

Obama's hometown newspaper takes a dump on Obamacare.

If you've tried to sign up online for health coverage under the problem-plagued Obamacare exchange, our sympathies. Many people have tried to create accounts and shop for insurance under the new law. Few have succeeded. Those that have enrolled have found that the system is prone to mistakes. Some applications have been sent to the wrong insurance company.

Wait. It gets worse. Those who have managed to browse the marketplace have often been hit by sticker shock. Take Adam Weldzius, a nurse practitioner and single father from Carpentersville. He sought the same level of coverage on the exchange as he and his 7-year-old daughter have now, with the same insurer and the same network of doctors and hospitals. At best, Weldzius found, his monthly premium of $233 would more than double. If he chose a plan priced at the same level, the annual deductible would be $12,700, more than three times his current $3,500 deductible.

It goes on, but you can read it yourself.

If you like your insurance you probably won't get to keep it. If you like your doctor, you might not keep him. Higher premiums, higher deductibles. None of it should be a surprise to anyone.

For giggles, here's a DailyKos blogger who is shocked- shocked that his insurance premiums are going to double...

My wife and I just got our updates from Kaiser telling us what our 2014 rates will be. Her monthly has been $168 this year, mine $150. We have a high deductible. We are generally healthy people who don't go to the doctor often. I barely ever go. The insurance is in case of a major catastrophe.

Well, now, because of Obamacare, my wife's rate is gong to $302 per month and mine is jumping to $284.

I am canceling insurance for us and I am not paying any fucking penalty. What the hell kind of reform is this?

Oh, ok, if we qualify, we can get some government assistance. Great. So now I have to jump through another hoop to just chisel some of this off. And we don't qualify, anyway, so what's the point?

I never felt too good about how this was passed and what it entailed, but I figured if it saved Americans money, I could go along with it.

I don't know what to think now. This appears, in my experience, to not be a reform for the people.

What am I missing?

The theme seems to be that if you are young and relatively healthy, you can expect to pay a lot more for healthcare.

[Husar]

So basically you're unable to fix a broken system?

[Xiahou]

So basically you're unable to fix a broken system?

Nobody has asked me to.

Personally, were I to replace the old broken system with a new broken system, I'd try to make sure it's not worse. I know that's a high standard for politicians though.....

[Husar]

Nobody has asked me to.

Personally, were I to replace the old broken system with a new broken system, I'd try to make sure it's not worse. I know that's a high standard for politicians though.....

Not you personally, your country.

[Seamus Fermanagh]

The higher rates are a necessity. Adverse selection under the must-insure clause of the ACA guarantees participation by those in greatest need. Costs to insure must be passed on to the broader population or the whole system goes teats up in a hurry. If they truly wish for this new system to work, they are going to have to ramp up the penalties to a level at or near the cost of the least expensive exchanges. Otherwise, the very folks required to make the new system fiscally sound by putting in their higher premiums for relatively little service will opt out, pay the small fine, and self-insure their limited risk until they become chronically ill and the exchange represents an economic windfall.

[Montmorency]

I can't help but think that actually lowering costs across the board would be more effective as regards the Democrats' ideological goals than merely increasing the costs while forcing more individuals to pay toward them.

[Xiahou]

The higher rates are a necessity.

Not just for the reasons you mention. What happens to prices when you increase demand for a good or service while having the same or decreased supply?

[Seamus Fermanagh]

I can't help but think that actually lowering costs across the board would be more effective as regards the Democrats' ideological goals than merely increasing the costs while forcing more individuals to pay toward them.

The total cost of care cannot be lower and must be significantly higher. Government figures suggest roughly 15% of all Americans are uninsured. 70% of that figure is uninsured for economic reasons -- coverage being too costly. Another portion cannot get insurance because they have been denied coverage due to pre-existing conditions that generate a high morbidity risk (these people were screened out of coverage by Insurance companies because insuring them, with their high likelihood of high costs, would have jacked up the overall rates of the coverage more.

Thus, in trying to cover everybody, we are increasing the number of people to be insured by 15-17 percent (depending on illegals). Moreover, some of those 15% include high morbidity cost individuals who are likely to create a greater cost vector than the "average" person. Let us assume that, all things being equal, aggregate cost of healthcare increases by 16% solely on volume (I would actually presume it to be more).

Some of this is supposed to be "headed off at the pass" by a greater reliance on preventive medicine to minimize the need for more costly interventions later. Recent projections put this savings at less than one quarter of one percent...but let's be perky and assume that over time we can make that a full 5%.

That takes our 116% total health costs and drops it back to 110% of current (again, I think I am being kind). However, 60% of that increased medical need (the uninsured) are because they cannot afford it NOW (poor, working poor, above poverty level but no room for frills). So that cost factor MUST be shoved onto those who are already paying (directly or indirectly) for their own insurance. If it isn't, it must be absorbed as additional debt by the Government.

In addition to those for whom the health care exchange packages must be more or less fully subsidized, other groups are being subsidized by the government as well, particularly for those in what we label our "lower middle class," to make their care "affordable." Those subsidies too must be passed on to the full price paying customers or absorbed as debt.

Costs for health care cannot go down and must go up. TANSTAAFL.

[Montmorency]

The total cost of care cannot be lower and must be significantly higher.

Nonsense. The list of treatments, tests, medications, etc. that are identical from country to country yet 5, 10, 20, or more times as expensive in the United States is of untold length. The fact of the matter is that there is a price-race between hospitals and insurance agencies and that obliterating the highly-inflated costs of the medical sector would easily permit the underfunded individuals that ACA purports to service to obtain affordable insurance on their own initiative.

Costs for health care cannot go down and must go up.

No, no, and no. This is an extremely dangerous position to take - just pay, and pay, and pay, and who cares why it costs so much or where the money is going, just keep paying!

[Xiahou]

No, no, and no. This is an extremely dangerous position to take - just pay, and pay, and pay, and who cares why it costs so much or where the money is going, just keep paying!

That's the whole premise of insurance. Who cares what it costs? It's not my money!

It's not surprising that costs spiral upwards when you setup perverse incentives like this....

[Seamus Fermanagh]

Nonsense. The list of treatments, tests, medications, etc. that are identical from country to country yet 5, 10, 20, or more times as expensive in the United States is of untold length. The fact of the matter is that there is a price-race between hospitals and insurance agencies and that obliterating the highly-inflated costs of the medical sector would easily permit the underfunded individuals that ACA purports to service to obtain affordable insurance on their own initiative.
....
No, no, and no. This is an extremely dangerous position to take - just pay, and pay, and pay, and who cares why it costs so much or where the money is going, just keep paying!

My comments were directed at the current system as modified by the ACA. What you are suggesting would involve a far more sweeping alteration than what is scheduled to occur. Perhaps we will head that way in time, but that is not the impact this law, as currently constituted, will have.

[Montmorency]

Fair enough, though I don't see why

Costs for health care cannot go down and must go up.

would be justified even in a narrow context.

It really is an alarming thought.

[Seamus Fermanagh]

Of course it is alarming. That's one of the reasons so many on the political right in the USA oppose it -- and I am not talking about the fruit bat fringe.

The basic idea is that more people will be provided service (the purpose of the act in the first place). That greater total amount of service will require more health care spending overall, even if there is somewhat less spending on a per capita basis (which is being argued).

Can that be altered? Yes.


To alter it in a substantial way would require:

1) A decrease in services.

2) An alteration in the services provided (shift to preventative for example).

3) An alteration in the population's behavior (overeating, under-exercising, & tobacco use).

4) Price controls on various elements of the health care system, notably salaries for medical licensed health care providers.

or some combination of 1-4.

#1 runs counter to the stated goal of making health care better for all, while 3 & 4 are problematic in implementation under our current system of governance. 3 & 4 would really only become possible under a full-on national health care system.


I should note here that any number of those on America's political left, along with some issue-by-issue types among the moderates, are angry with the situation and with the ACA precisely because it does NOT take the necessary steps to shift us to a true national health care system. I suspect that they're frustrated as well precisely because they believe that nothing less than such a system could truly influence the largest components of American Health Care costs: Poor lifestyle choices, Physician and specialist salaries, and Medical malpractice/insurance therefrom.

[Lemur]

Poor lifestyle choices, Physician and specialist salaries, and Medical malpractice/insurance therefrom.

To which I would add the biggest rotting apple in the barrel: Unrealistic pricing.

You don't see many $500 hammers like you did in the old days of government contracting, but now you see plenty of $800 bags of saline solution that cost $1 to manufacture and distribute.

Price gouging, like so many government functions, has been privatized.

[Montmorency]

Unfortunately I doubt that the long-term trend would look much different with a continuation of the (former) status quo. The ACA isn't enough, but it's conceivable that overall the net is at least a little benefit. It could also be argued for as a component of a minimalist program - after all, the TPers weren't just spontaneously generated by the mooting of health-care reform...

notably salaries for medical licensed health care providers.

First, get at the chargemasters and the admin layers. If services rendered become much cheaper, insurers will in turn be left without an excuse to maintain high premiums. Physician and specialist salaries are not so harmful as the rest.

An alteration in the services provided (shift to preventative for example).

Simultaneously with discouragement of reflexive recourse to maximalist end-of-life care.

Consider not commissioning 6-figures in services to keep gramps vegging along for another few weeks or months.