48 thoughts on “Obama’s Lasting Domestic Legacy”

  1. Not news at all. Opponents have been predicting disaster since the bill was signed. And since then 20 million more people have coverage, government spending on health care has fallen dramatically below projections, tens of thousands of deaths have been averted, health care inflation has been at record low levels, the number of Americans having trouble paying medical bills fell for the first time since 2005, no one can be turned away or charged more because of gender or pre-existing conditions, uncompensated hospital care has fallen, etc.

    It’s an formidable legacy.

    1. Still carrying the flame I see. Here’s an example of what you missed:

      Does this mean that Obamacare is finally entering its “death spiral”? Not exactly. As my American Enterprise Institute colleague Scott Gottlieb explains, while commercial insurers are starting to leave Obamacare, they are being replaced by Medicaid health maintenance organizations (HMOs) offering skimpy plans that mirror what they offer in Medicaid — our nation’s emergency health insurance program for the poorest of the poor.

      This is a catastrophe for people stuck in Obamacare. According to a 2014 McKinsey survey, about three-quarters of those in the exchanges were previously insured on commercial plans, either through their employers or the individual market. They were doing fine without taxpayer-subsidized insurance but were pushed into Obamacare. They now face rising premiums and smaller provider networks — and as commercial insurers flee, they will increasingly be stuck in horrible, Medicaid-style plans.

      Medicaid and “Medicaid-style plans” will be the new uninsured.

      1. Medicaid and “Medicaid-style plans” will be the new uninsured.

        This is really a howler. Do you remember when the rap on Obamacare was that the law required insurers to cover too much, when what customers really wanted was bare-bones plans with catastrophic coverage? So now the critics are doing a 180º turn, and the rap is that having an exchange policy is like having no coverage at all.

        Exchange plans are robust, have no cap on benefits, and are available to anyone regardless of health history. Compared to the pre-2014 status quo, they’re a major improvement.

        1. I remember those. I used to pay “too little” for that plan (according to you.) Now I pay for more than I need, ostensibly for my own good but in reality to pay for you.

        2. The straw men you developed failed to catch fire as they are not mutually exclusive. Insurers are being asked to cover too much, which is why the exchanges are failing. Further, high premiums and high deductibles means individuals are paying more for insurance and not getting any real coverage unless catastrophic.

          And there is no cap on coverage assuming you are young enough to receive coverage. What you don’t mention is that Medicare won’t compensate for some procedures if the bureaucracy deems the patient too old to receive the treatment.

          1. Insurers are being asked to cover too much, which is why the exchanges are failing. Further, high premiums and high deductibles means individuals are paying more for insurance

            You have a contradiction. Higher premiums and deductibles, and no “real coverage” — i.e. more money going from customers to insurers, and less from insurers to care providers — should mean big profits for the insurers. Instead, you insist that insurers are suffering. So where’s the money going?

            The answer is that before Obamacare there were millions of people who needed care, and weren’t getting it. Now they are. You are making a powerful argument that the law is delivering exactly what was promised, and what millions of Americans desperately needed.

        3. Do you remember when the rap on Obamacare was that the law required insurers to cover too much, when what customers really wanted was bare-bones plans with catastrophic coverage? So now the critics are doing a 180º turn, and the rap is that having an exchange policy is like having no coverage at all.

          I’ve had opportunity to see how Medicaid works these days. It may not have been great in the first place, but it hasn’t gotten better. And all you care about is propaganda coherence.

          Calling it “robust” is just a bit of Orwellian doublespeak.

          1. “The answer is that before Obamacare there were millions of people who needed care, and weren’t getting it. Now they are. You are making a powerful argument that the law is delivering exactly what was promised, and what millions of Americans desperately needed.”

            The 16 (not 20) million or so who are now “getting care” are simply sick, high-risk individuals getting high-cost medical care at the expense of the insurance companies, which means at the expense of the insurance companies’ paid customers. It won’t last, and in fact isn’t lasting. United Health Care’s withdrawal from the market is not a matter of choice. Either they don’t provide insurance, or they don’t provide insurance because they don’t exist any more.

            Young, healthy people in a market for insurance would normally pay less, because they are a lower risk. Sick, older people would pay more. You think it’s great that for a short time the situation is reversed. But it isn’t working the way you think it is. Young people don’t enter the insurance market, despite the penalty, because they can’t afford it. I have a niece in Tennessee who’s 26, and she doesn’t have health insurance because she can’t afford it. It doesn’t matter anyway, because there is no way for the Federal government to collect their “penalty” (or Roberstian “tax”). She’s not alone.

            The “care” being provided to the newly insured sick, however many they may be, will last until the system collapses. It’s doing so now, and can’t be propped up by subsidies (nor should the government try to do so). It’s just a temporary shell game, and will end badly for everyone.

    2. As usual, you are completely wrong about an issue.

      NPR AND HARVARD SAY: OBAMACARE IS A COMPLETE FAILURE: http://www.powerlineblog.com/archives/2016/03/npr-says-obamacare-is-a-complete-failure.php

      7 Obamacare failures that have hurt Americans:

      3 Ways Obamacare has failed:

      Chart shows one big failure of Obamacare:

      8 of 11 Surviving Obamacare Co-Ops facing failure: http://dailycaller.com/2016/02/25/breaking-eight-of-11-surviving-obamacare-co-ops-facing-failure/

      You throw out numbers that are either greatly exaggerated or downright wrong and fail to recognize the hardships it has wrought (and is continuing to get worse).

      1. NPR AND HARVARD SAY: OBAMACARE IS A COMPLETE FAILURE

        The actual article is the results of a public opinion survey, in which more respondents say that Obamacare has helped the people of their state than that it has hurt them. I readily admit that Obamacare is unpopular with half the population; making it unpopular has been GOP Job 1 for the last seven years. That doesn’t make it a failure, much less a complete failure, unless the only way you measure policy is by political gain.

        8 of 11 Surviving Obamacare Co-Ops facing failure

        Yes, that’s a shame. Fortunately their success is not critical to the law overall.

        You throw out numbers that are either greatly exaggerated or downright wrong

        Such as?

        fail to recognize the hardships it has wrought

        I totally recognize that it has created hardships. That is to be expected: even the most successful public policy will leave some people worse off. But critics of the law typically fail to acknowledge all the hardships it has relieved.

        1. So far, the only hardship relieved seems that to be your self professed claim to receive insurance that you didn’t previously. Many more people in this comment section lost insurance and doctors they had, you selfish prat.

          1. There are 20 million more people with insurance than before. That’s a world of hardships relieved.

          2. It is much, much easier to get health care with insurance than without. The doom crying about insurers losing money over all the care they are paying for suggests that Obamacare’s coverage expansion is, indeed, delivering actual health care to people who could not get it before.

          3. It is much, much easier to get health care with insurance than without.

            It’s easier to get health care with cash than it is with insurance. And it’s easier to get health care with normal health insurance than it is with Medicaid and “Medicaid-style plans”. Jim, you can blather on about how “robust” everything is, but huge portions of the new health insurance system are cutting back on their benefits.

      1. The whole U.S. health care system is a crazy patchwork quilt; no one in their right mind would design the system we have if they were starting from scratch. Fortunately Obamacare has patched one of the biggest holes in that quilt, more successfully and at lower cost than even its advocates thought likely.

        1. No, not true. In fact, if we had not cobbled together a monstrosity created by the democrat party in the 1960s, we wouldn’t have had a problem.

          1. Major aspects of our system — such as the tax break for employer-provided coverage — go back much further than Ted Kennedy.

    3. Wow, quite a comment. Does it matter that none of it is true? Some of these stats are just wrong, others (e.g., health care inflation) are worldwide with causes that have nothing whatever to do with Obamacare. Then there many other measures (cost of health care to the middle class, availability of health care) which have become much worse in the last five years. Then there are measures (financial health of insurance company exchanges, of hospitals,…) which make it obvious that things are going to get a long worse still.

      Not only is it not true in an objective sense, the median American hates it and would get rid of it if he could. But you know better…

      1. Some of these stats are just wrong

        Which ones?

        others (e.g., health care inflation) are worldwide with causes that have nothing whatever to do with Obamacare

        Opponents of the law predicted it would increase U.S. health care inflation. Instead, U.S. health care inflation went down. That’s a good thing.

        there many other measures (cost of health care to the middle class, availability of health care) which have become much worse in the last five years

        How are you measuring those things?

        financial health of insurance company exchanges

        Some insurers are doing better, some are doing worse. That’s how markets go. The system overall is doing better than before: there are more people with coverage.

        1. Opponents of the law predicted it would increase U.S. health care inflation. Instead, U.S. health care inflation went down. That’s a good thing.

          Maybe if you keep saying this it will magically come true. Keep trying, Jim and click your heels three times while you’re at it.

          1. As I said, the rate of health care inflation went down in pretty much every country in the world, driven by the recession. It had nothing to do with Obamacare. That won’t stop Jim from quoting it, because he has little to point to that is actually attributable to Obamacare.

            I’m in the health care industry, and Obamacare has made our job significantly harder. Hospitals have closed and doctors have moved into concierge care. Every time that happens, people die who would have been saved. In the LA area, a number of hospitals no longer offer emergency rooms. When that happens, people die who would have been saved. A significant number of the people who now have insurance find that they cannot find decent medical care; Jim’s statistics will not know about it. This has increased most people’s medical expenses – when I did my taxes, my wife’s rough estimate was that it cost us over $8000 overall, counting higher premiums and higher deductibles and higher taxes. Some people on the margin will have moved into financial instability as a result; Jim’s statistics will not know about it, because it wasn’t part of a catastrophic medical bill. Etc.
            Liberals don’t care. They could have paid for every poor person’s medical care for what this cost, but instead they chose to put grit in the wheels of every medical institution in the country.
            Remarkably enough, pretty much everything conservatives were saying in 2008 has come true; some is still in the process of coming true. A slow-motion train wreck, and pretty much everyone hates it if they aren’t ideologically forced to like it.

          2. driven by the recession

            That doesn’t explain why it has stayed so low, years after the recession was over.

            I’m in the health care industry, and Obamacare has made our job significantly harder.

            Caring for more people, while keeping cost growth down, can’t be easy.

    4. No dime-store analysis necessary here. You’ll always defend those that loot the US Treasury in your favor.

    5. The CBO now projects 40% less of those 20 million enrolling this year, but Jim clings to old numbers. Further, the 20 million is 9 million fewer people covered than had ACA not passed according to the 2013 CBO projections. That’s putting aside people like Jim and Gerrib that claimed 50 million uninsured prior to ACA.

      As for uncompensated costs, the data is from 2014 and not updated since.

      Also, by existing law prior to ACA, nobody could be turned away from medical care due to gender or pre-existing condition. The only change is now they can wait to buy insurance until they have a condition.

      Oh, and CNBC reported on Dec 2015: “Annual national health spending hit $3 trillion for the first time in 2014, as a half-decade of historically low growth in the sector’s inflation came to an end due both to full implementation of Obamacare that year and a sharp increase in spending on retail prescription drugs.”

      1. The CBO now projects 40% less of those 20 million enrolling this year, but Jim clings to old numbers.

        I didn’t say 20 million were enrolled, I said that 20 million more have insurance.

        the 20 million is 9 million fewer people covered than had ACA not passed according to the 2013 CBO projections.

        Are you saying that in 2013 the CBO projected that had ACA not passed, 29 million more people would have insurance now than had it in 2010? Quite a claim. Do you have a link?

        Also, by existing law prior to ACA, nobody could be turned away from medical care due to gender or pre-existing condition.

        They could be turned away from buying individual medical insurance, or charged more. I was turned down flat.

        as a half-decade of historically low growth in the sector’s inflation came to an end

        A half-decade of record lows is no small thing, and even now it’s still lower than pre-Obamacare.

        1. You don’t provide links or sources for any claim you made Jim. Unlike you though, I provided a source. You provide no source for anything, including your debunked claim of low inflation.

          That you were turned down for insurance is uninteresting. For your argument to be valuable, you have to believe everyone should get what they wanted no matter how much everyone else has to pay for it. That you are selfish is nothing new, Jim.

          1. That you were turned down for insurance is uninteresting.

            That it was me is uninteresting. What’s interesting is that it could and did happen to millions of people who’s only fault having bad luck. Our pre-2014 answer to such people was simply: it sucks to be you.

            Our answer today is better.

  2. They could be turned away from buying individual medical insurance, or charged more. I was turned down flat.

    Jim, when your side decided to ignore republicans and instead, walk with a big gavel on the way to the vote, your argument on having a pre-existing condition was rendered moot.

    This could have been worked out, but your side didn’t play according to the rules.

    1. Wasn’t Obamacare also “deemed to have been passed” by the House in the dead of night, without an actual vote?

      One wonders whether Jim will be so enthusiastic about such cavalier disregard for “rules” when the day comes that Republicans begin using these and other precedents that Democrats have established, like using RICO forfeiture against particularly annoying Enemies of the State.

  3. The whole U.S. health care system is a crazy patchwork quilt

    Diversity is good. Didn’t you get that talking point? By system are you talking about medical care or medical finance?

    Free enterprise is robust because it’s a patchwork. Consolidate it and you make it more fragile.

    If it’s about paying for poor people we can do much better without a federal takeover (which is about power, not health.)

    1. If it’s about paying for poor people we can do much better

      Coulda, woulda, shoulda. The GOP blocked or tried to block every other attempt to pay for health care for the poor in the last century. But we’re supposed to believe they would have made it happen if it just weren’t for the mean Democrats passing Obamacare? Ask me to kick the football again, Lucy.

      1. You’re such a liar.

        When somebody disagrees with you, it doesn’t mean blocking, it means your side has to compromise.

        Which it never does, because you’re all a bunch of ideologues.

        Schadenfreude is wonderful. It’s too bad people are suffering, otherwise I would love your grand system crash to earth. In 2007 I would’ve cared about your pre-existing conditions, but with your current behavior, I could care less today.

        1. Max Baucus spend 2009 bending over backwards trying to compromise with Republicans on health care, incorporating a number of GOP proposals into the bill that became the ACA. But the Republicans made a strategic political decision to vote against any bill, so Obama could not claim a bipartisan policy victory.

          The GOP could have addressed health care coverage for the poor when either Bush was president, but of course they didn’t. The GOP House and Senate could send an Obamacare alternative to Obama’s desk today, just to show that they’re serious. But of course they won’t, because they aren’t.

          1. Baucus the savior! What a lie. They never took republican proposals seriously. Baucus’ compromise still showed massive, massive deficits which were unacceptable to republicans. With cooked books, Baucus thought he could get republicans to go along. He was wrong.

            Where was Pelosi for the compromise? That’s right, she was off getting her Cornhusker Kickback ready and her big gavel made to achieve her great legacy.

            Under Bush two we had the prescription drug reform and that was terrible. The democrat party’s motive was to disgrace Bush for everything. They would never have reached a compromise out of hatred for that man.

            And Bush 1? Are you serious? Democrats were still in charge of congress, and they did nothing. Don’t try to blame any of this on republicans.

          2. They never took republican proposals seriously.

            Yes, they did. Why does Obamacare use state exchanges instead of one federal exchange (which was the case in the House bill)? Because GOP Senators Olympia Snowe, Charles Grassley and Mike Enzi wanted it that way. Snowe even voted for the bill in committee, only to vote against it in the full Senate in order to preserve the united front of GOP opposition.

            Baucus’ compromise still showed massive, massive deficits which were unacceptable to republicans

            You have got to be kidding. Baucus’s bill was scored as *reducing* the deficit. Meanwhile, those same GOP lawmakers had passed Medicare Part D without any pay-fors whatsoever — the entire cost was added to the deficit.

            George W. Bush could have put forward a proposal for health care for the poor. He didn’t even try. Republicans are only interested in the topic when it’s time to block or repeal a Democratic plan.

  4. Jon Chait has a good rebuttal to the Thiessen piece, in particular pointing out the dishonesty of the “three quarters already had insurance” claim:

    Thiessen cites a McKinsey survey that came out a few months after the exchanges had opened, purporting to show three-quarters of the customers already had insurance. This data point drew widespread, delirious coverage in the right-wing press. But as more data came in, it became clear that the vast majority of exchange customers were previously uninsured. The initial right-wing insistence that Obamacare was merely shifting people onto different kinds of insurance has been overwhelmingly refuted by a mountain of evidence that is utterly unanimous on the bottom line that the law is reducing the uninsured rate.

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