27 thoughts on “ObamaCare”

  1. Ponnuru is right — you can’t fix Obamacare by keeping the popular parts and tossing the rest. The rest is there for a reason. There are minor unpopular parts (e.g. the employer mandate) that you could drop without much effect, but the individual mandate is key to the whole thing. Obamacare is a three-legged stool: everyone has to have good insurance, insurers can’t discriminate, and people who can’t afford coverage get subsidies or Medicaid. If you pull out any of those three legs the whole thing falls down.

    1. You forgot the fourth leg, massive transfer of wealth through taxes and subsidization through premiums. Then there is the fifth leg, government control of every aspect of how doctors run their practices.

      Obama should have just made a website that helps people shop for insurance and started a program to provide medical care to poor people except both of those things already existed.

      1. You forgot the fourth leg

        No, I didn’t, that’s the third leg: “people who can’t afford coverage get subsidies or Medicaid”. Obviously those subsidies and Medicaid costs are paid for by taxes.

        Then there is the fifth leg, government control of every aspect of how doctors run their practices

        That is not a thing.

        Obama should have just made a website that helps people shop for insurance

        That doesn’t help you if the insurer can charge you more, or refuse to cover you, based on your health history.

        started a program to provide medical care to poor people except both of those things already existed

        Most poor people didn’t qualify for Medicaid pre-ACA. Obama tried to expand Medicaid so that any poor or near-poor person would qualify, only to have the Supreme Court make that part of the law optional, with the result that in about half the states most poor people still don’t qualify.

    2. Jim said, “:Obamacare is a three-legged stool: everyone has to have good insurance, insurers can’t discriminate, and people who can’t afford coverage get subsidies or Medicaid.”

      Obamacare isn’t good insurance. Even leaving aside whether or not it’s insurance, it’s certainly not good, given the massive deductibles.

      As for subsidies, they do nothing at all for people who can afford the premiums but can’t afford the deductibles. The effect of this has been a major increase in the yearly individual cost of healthcare.

      I’ll also note that the biggest problem of the US healthcare system pre-Obamacare was the high prices. Did Obamacare do anything about those? Yep, it made them far worse.

      1. it’s certainly not good, given the massive deductibles.

        It’s good insurance in the sense that it’s comprehensive, and has no limits.

        As for subsidies, they do nothing at all for people who can afford the premiums but can’t afford the deductibles

        There are subsidies for out-of-pocket expenses as well.

        I’ll also note that the biggest problem of the US healthcare system pre-Obamacare was the high prices. Did Obamacare do anything about those? Yep, it made them far worse.

        Actually, health care price inflation has been low since Obamacare passed.

          1. The above is in reference to Jim’s statement: “Actually, health care price inflation has been low since Obamacare passed.”

          2. http://online.wsj.com/news/articles/SB10001424127887323342404579081312680485476

            “The prices paid for medical care in July rose just 1% from a year earlier, the slowest annual rate of growth since the early 1960s, according to Commerce Department data. Health-care increases now trail overall inflation, which itself has been historically slow in recent years.

            The price data help explain why growth in overall health spending has slowed down in the past several years. The trend, if continued, has big implications for the government’s finances because health-care costs are the biggest long-term driver of the federal deficit.”

            Which is also why the budget deficit has been shrinking.

    3. The whole this is a massive stinking stool.

      Jim, why do you say these things as if they are facts? Why on earth do you think the system will work at all? Why do you think the individual mandate is key? Where is your evidence that it will work? Have you gone to some other country like the UK and have seen that it works? From what I see over there, it’s falling apart.

      It’s amazing what people will see as the truth with hope as their glasses.

      1. I’ve lived under a single-payer system all my life in Canada – with two notable exceptions. Up here long wait times are the norm. Up until the US passed the ACA, Canadians could go to the USA for faster service. All our best doctors move to the USA, and we’re left with almost exclusively immigrant doctors.

        The notable exceptions? Optometry and Dentistry are not covered by the Canada Health Act. I can get my glasses in an hour. There are five dental clinics within two blocks of my house. In those two areas of health care, the service is top notch and affordable, even without insurance.

      2. Why on earth do you think the system will work at all?

        A similar system worked in Massachusetts, and the doom-crying predictions of critics have one by one proved unfounded.

        Why do you think the individual mandate is key?

        Without an individual mandate, more people, particularly healthier people, will take their changes and not buy insurance. Since the remaining customers will on average be more likely to have medical expenses, premiums will be higher. That in turn will encourage more healthy people to bail. That cycle of sicker pool -> higher premiums -> even sicker pool -> even higher premiums is called a death spiral. Requiring that everyone have insurance keeps a death spiral from starting.

        Have you gone to some other country like the UK and have seen that it works?

        Obamacare isn’t at all like the UK or Canadian systems. In the UK the doctors and hospitals work for the government, like our VA and military health systems. In Canada the government pays medical bills for services performed by private doctors, similar to Medicare here. Obamacare is private insurers, paying for services by private doctors and hospitals; it’s a bit like the system in Switzerland (which delivers great care, although at higher costs than you see in Canada or the UK).

        1. “A similar system worked in Massachusetts, and the doom-crying predictions of critics have one by one proved unfounded.”

          In actual fact, the system in Massachusetts is crumbling and crumbling fast. Articles illustrating this were presented to you months ago and they shut you up then. But now that the topic resurfaces, so do your delusions.

          Wait times – way up

          Costs WAY WAY up

          Doctor population…down.

          From the Boston Globe (certainly not a right wing rag):

          Why is it so hard to find a doctor?
          Half of primary care physicians in our state are not accepting new patients. A prescription for the problem.

          October 2013

          “Quirk’s woes reflect a broader problem in the Boston area: It’s hard to get a doctor. Entire practices are booked. Even if she wanted to go back to her old doctor in Boston, he probably wouldn’t be able to take her. His practice is part of Massachusetts General Hospital, and primary care openings at MGH are like snowflakes in September.
          Related

          Across Massachusetts, about half of primary care doctors aren’t taking new patients, according to the Massachusetts Medical Society’s 2013 Patient Access to Care Study. The rate for internal medicine specialists, or internists, who often also serve as primary care doctors, is 55 percent. If you’ve found a new doctor and want to schedule a routine visit, be prepared to wait. It takes an average of 39 days for new patients to get an appointment with a family physician and 50 days to see an internist. That’s better than last year, when the average wait was a whopping 45 days, but up from 29 days in 2010.
          Meanwhile, when the state reformed health care in 2006, it expanded insurance coverage, increasing access to care without boosting the supply of doctors.

          MassHealth and other government subsidized programs are not an open door to primary care doctors, as Stanley Kisob found out. Kisob, a resident of Framingham, lost his job in June and with it his Harvard Pilgrim insurance. He signed up for Commonwealth Care — another state-subsidized insurance program (to be phased out as ACA comes online) — and called his doctor to schedule his annual physical. “They wouldn’t do it because I didn’t have insurance they would take,” Kisob says.

          It was reported all over the place by all sorts of news outlets. And like the Globe, they aren’t all Conservative.

          How about ABC News:

          Doctor Shortage Could Cause Health Care Crash
          Nov. 13, 2012
          By NISHA NATHAN, M.D. via World News

          The United States will require at least 52,000 more family doctors in the year 2025 to keep up with the growing and increasingly older U.S. population, a new study found.

          Perhaps the best known example of this approach has been Massachusetts, which since 2006 has mandated that every resident obtain health insurance and those that are below the federal poverty level gain free access to health care. But although the state has the second-highest ratio of primary care physicians to population of any state, they are struggling with access to primary care physicians.

          Here’s CNN:

          Doctor shortage, increased demand could crash health care system
          By Jen Christensen, CNN
          updated 5:37 PM EDT, Wed October 2, 2013

          From Ameridcan Medical News:

          Physician shortage in Massachusetts continues to squeeze primary care
          ■ General surgery and internal and family medicine are among the hardest-hit specialties.

          By Tanya Albert Henry — Posted Oct. 12, 2011

          Editorial: Western Massachusetts doctor shortage in critical condition

          “Doctors are avoiding Western Massachusetts like the plague – and that spells trouble for patients who live in Hampden County where the wait time for a new patient appointment with a family doctor is 58 days. ”

          After spending millions trying to integrate the Ma. web system with Obamacare they gave up.

          And what with the bus loads of illegals headed our way the system is about to get it’s back broken.

          I HAVE a primary care physician and once I got him, I had to way a full year before I could get a yearly check up.

          IN this, like so many other topics regarding the administration, you are either lying or are supremely ignorant.

    4. I’d be happy if they got rid of the creepy database that will track every American’s health. I don’t see how that is needed, and the government has already shown it will abuse data like this.

      1. Would you be happier if your doctor had to keep your records in a
        unified data format, so when you move doctors the file can be transferred
        in a second or two?

  2. The rest is there for a reason

    I love when you are honest Jim. I just wish you’d go all the way, not using the talking points crutch so often. Progress can only occur when intelligent people, like yourself, acknowledge reasonable points. I’m acknowledging yours.

    Are they good reasons?

    Would you acknowledge that Obamacare is not insurance? You can’t claim it’s insurance just because it takes some features and then leaves others out.

    Insurance has always had to deal with adverse selection. Doing so it has always been a competitive industry. This is a good thing. Central control is a bad thing.

    1. Obamacare isnt’ insurance, ti’s really just an insurance market and rules.

      That’s why the whinging was so unhinged. OCare was basically a commoditization of Health
      insurance and simplified underwriting

      1. Wow, Deny Guy is right…. sort of.

        Obamacare isn’t insurance, because insurance is something that covers unexpected or unlikely events. Obamacare specifically requires people to prepay for expected and likely events.

        The underwriting is simply a wealth transfer mechanism in which those who have earned income are required to pay for those who have decided not to work. Nancy Pelosi calls that aspect Freedom, because it means artist can quit their productive job and pursue their weak talent. In Nancy claim is the fallacy of Obamacare and Socialism, because if everyone quit working, then it can’t be funded. Fact is, like the failure of the housing market being underwritten by Freddie Mac, it doesn’t require everyone to quit. It just takes a small percentage (housing market was like 7% foreclosures) for a cascading effect to occur.

        1. “Obamacare isn’t insurance, because insurance is something that covers unexpected or unlikely events. Obamacare specifically requires people to prepay for expected and likely events.”

          Who expects to get cancer?

          1. Who expects to get cancer?

            Pretty much everyone who has ever watched a family member die of cancer. Do you have a point, or do you just like demonstrating your ignorance?

          2. Few people expect to get cancer, although the incidence is about 1/3 (IIRC). Ditto for heart disease. But you are asking the wrong question.

            What Obamacare (and all other forms of health insurance) is covering is the event of contracting life-threatening disease or suffering life-threatening injury, at some time in the future. And this risk (something life-threatening happening to you at some time in the future) is 100%, for everyone. Unless you happen to know someone who is immortal.

            The real main problem with health costs is that we have been too successful (in financial terms) in developing new treatments. In the 1950s, someone whose only hope of survival was a heart bypass would simply have died – cost approximately zero. Now, although I don’t know the figure for sure, the cost of treating someone in that situation is probably around $100,000. The situation with cancer treatments is similar.

            This situation might change, if and when ultratech treatments such as nanotech come into play. Until then, it’s only going to get worse.

        2. Obamacare isn’t insurance, because insurance is something that covers unexpected or unlikely events

          Obamacare does cover unexpected or unlikely events. It also covers expected expenses, like annual physicals. So it’s insurance, plus mandatory prepayment for routine care.

          Nancy Pelosi calls that aspect Freedom, because it means artist can quit their productive job and pursue their weak talent.

          It means an artist (or mechanic, or businessperson, or whatever) can leave a job that offers health benefits, and take a different job that doesn’t offer health benefits or start a new business, and know that they can still buy health insurance. Before the ACA a lot of people were locked into jobs simply because they didn’t have an alternative way to get good insurance. Now they do.

          1. they didn’t have an alternative way to get good insurance.

            Sure they did. Many people purchased private insurance and paid for their own healthcare. However, if they decided to quit their job that paid them, so they could pursue a line of work they sucked at performing; they had no ability to have taxpayers cover their stupidity. Now they do. Congratulations for expanding the number of people no longer seeking gainful employment!

          2. Sure they did.

            Millions did not — they would have been turned down or charged exorbitant premiums on the individual market. Millions more weren’t sure — maybe they’d be able to get insurance, maybe they wouldn’t — and so chose not to take a chance.

            they had no ability to have taxpayers cover their stupidity

            It must be comforting to believe that people are only poor because they choose to be.

          3. Millions still don’t have insurance, why many others have left the workforce. The economy is contracting. And your previously touted CBO report claiming Obamacare would cut the deficit has been junked by the CBO itself.

          4. The topic goes away……..

            It comes back after a while and you still spout the same old disproven-a-thousand-times lies.:

            “Millions did not — they would have been turned down or charged exorbitant premiums on the individual market. Millions more weren’t sure — maybe they’d be able to get insurance, maybe they wouldn’t — and so chose not to take a chance.”

            The number of un-insured was, as you well know, – inflated by irrelevant examples:

            kids who could and didn’ t buy insurance
            rich people who could but didn’t buy insurance

            etc.

            The number who wanted it but couldn’t buy it was very small.

            So small that it would have been cheaper to just by them insurance in a big, fed pool.

            And you wouldn’t have destroyed a system that was great for 85% of the population.

            What is it that makes you think your incorrect bloated talking points would be any more convincing the 50th time around?

  3. We’ve heard all the lame garbage before…..the fictitious 47 million who couldn’t get health insurance…

    cost curve being bent down…..

    you can keep your doctor…

    you can keep your insurance…..

    Well we predicted it woudl flop and it has flopped. That it would flop is onvious to even the most casual of observers.

    Equally obvious was that Obama-cide had nothing zero zip to do with health insurance. It had to do with power, control, and the ultimate goal of government run single payer. Obama said that’s what he wanted as did many many other Democrats.

    Why can’t it be fixed? Because it deals with a system that relies on millions and millions of decisions taken by millions of people every day. Each person having their own unique circumstances, situation, needs.

    No system created by 535 knuckleheads in DC can manage that, as efficiently as the market

Comments are closed.