Obamacare needs its own thread...so here it is!

[Anonymous]

every political thread ends up at Obamacare, so i thought I'd dedicate a new thread to it!

Ok, I'll start with this article I found today. It's very well-written and an easy read. Full disclosure here: the author is liberal and the blog is not unbiased. So feel free to dissect it and check all the facts. I'm posting it because it addresses most of the concerns that come up around here in a very concise way.

http://www.policymic.com/articles/10565/obamacare-protects-the-free-market-why-repealing-it-would-mean-a-return-to-socialism

Let's discuss!

[Anonymous]

I think it's very imperfect, but I'm happy it passed. I think a single payer system would have been better. But anything that moves us away from thinking basic healthcare is only for the lucky or privileged is fine by me. It should be considered a right.

[Anonymous]

I think it is smart to cover pre-existing conditions, and I understand the need for getting everyone to be insured in order to not create a moral hazard - ie for people to not buy insurance until they are already sick.

I think that it is very smart to make preventive services free. The problem is that any one insurer is not incented to provide preventive care, because the patient is probably on another health plan by the time they are 50-60 and the benefits show up. But we know that if everyone does it, we all save money in the long run. So good for that.


I am disappointed that the government did not do more to address the underlying cost of care. We pay too much for procedures (way too much - I mean should an appendectomy be 2-4x the cost here?). And we order too many of them. But the government cannot just set prices like in Israel or Britain or other countries with national health care.

However they could use market clout. I wish we could create a national health plan that anyone could buy into. For all the complaining about medicare/medicaid reimbursement, doctors by and large still take them. And if the general public had a health plan that negotiated aggressively on rates, we could cut costs because the private insurers would be strongly incented to do the same. Right now we have to beg them not to spend premiums on overhead and marketing.

One thing we could do, and I would catch hell for this if I said it in front of the doctors in our family, but we should cut the power / privilege of doctors. They are too expensive and they are highly motivated to add cost to care.

But medicine is only rarely a thing that requires the best and brightest, and none of it requires a doctor to be the child of wealthy parents. Other countries pay for medical school. And they churn out lots of doctors who treat their job like a job - regular hours, salary, etc. They aren't setting up MRI clinics to refer their own patients. They care about their patients but they don't order test after test and they don't recommend every procedure they can. A good neurologist can detect serious neurological conditions by a physical exam - which pays very little. But throw the patient in an MRI and the dollars start flowing. As a result, someone stuck me at 18 in an MRI for headaches caused by seasonal allergies, which I told them because I am always sneezing and stuffy. OK not a big deal because an MRI is not radiation like a CT scan but come on! MRi's were insanely expensive back then too.

All professions throughout history have moved from the highly technical and restricted, to the more ordinary. Blacksmiths, cobblers, accountants. It is the way things go. It has happened in other countries already, and their life spans are better than ours. It needs to happen in medicine, too.

[Anonymous]

Anonymous wrote:I think it's very imperfect, but I'm happy it passed. I think a single payer system would have been better. But anything that moves us away from thinking basic healthcare is only for the lucky or privileged is fine by me. It should be considered a right.

But in that regard, nothing has changed - only the lucky or privileged can still afford healthcare, and now the underprivileged have to pay a tax penalty for being underprivileged and unable to afford healthcare - and they still get no healthcare. It's a scam.

[Anonymous]

We need national health care. The only people benefiting from the current system are the people making profits in the health care industry. Period.

We spend 18% of our GDP on health care. EIGHTEEN. That's higher than any other country. We also have worse outcomes than most developed countries, so it's not like we're getting anything for that 18% (other than possible bankruptcy caused by medical bills). It's a total waste.

[Anonymous]

8:56- One of the biggest reasons doctors order expensive tests is because of the high risk of a lawsuit. You had the MRI to cover the Neurologist's butt in the small chance you had something more serious causing your headaches. I work in the Emergency Department and I order expensive tests all the time and admit people all the time... even when I am 99% sure there is nothing seriously wrong with the patient. It's crazy how much radiation people are exposed to. That's the climate we live in. I realize it's a waste of money. And I don't make more money based on how many tests I order.... gosh, it would be great if I did.

[Anonymous]

9:01 You probably just haven't learned enough about how the law will work when these provisions go into effect to understand that there is substantial assistance to help people buy insurance that is built into th system --help for families that do not have any help with insurance now. Here is a short description of these provisions:

Premium Subsidies

Households with incomes below 400 percent and above 133 percent of the federal poverty line (FPL) who are enrolled in insurance plans offered through the exchanges are eligible for premium assistance financed by the federal government (Medicaid will cover families with incomes below 133 percent of FPL). In 2010, the FPL is $22,050 for family of four. The new law establishes a sliding scale of assistance based on limitations on required family contributions to the cost of coverage. For instance, at 150 percent of FPL in 2014, ObamaCare limits the amount that such households must contribute toward their health insurance premium to 4 percent of their annual income. At 400 percent of the FPL, households must contribute 9.5 percent of their income toward insurance premiums. Whatever portion of the total health insurance premium for their coverage is not paid by these households is covered by the new federal premium assistance program.

What this means is that families with incomes even going up to 80,000 plus would have their insurance expenses capped and, if they had expenses higher than that, the fed gov would be making up the difference. Moreover, many lower income families up to $29,326 for a family of four would be able to get on Medicaid which they are not necessarily eligible for now. So it is simply not true that Obamacare would tax people who can't afford health insurance but not do anything to help people buy health insurance. It does a lot to help people buy health insurance.

[Anonymous]

Like others, I consider it imperfect. I would prefers single payer and power to negotiate drug costs. But as a strategy, getting something in place and then adjusting details makes a lot of sense to me. I think it's tragic that the GOP chose to make a political issue of the whole thing.

[Anonymous]

Anonymous wrote:8:56- One of the biggest reasons doctors order expensive tests is because of the high risk of a lawsuit. You had the MRI to cover the Neurologist's butt in the small chance you had something more serious causing your headaches. I work in the Emergency Department and I order expensive tests all the time and admit people all the time... even when I am 99% sure there is nothing seriously wrong with the patient. It's crazy how much radiation people are exposed to. That's the climate we live in. I realize it's a waste of money. And I don't make more money based on how many tests I order.... gosh, it would be great if I did.

The data does not bear this out. In states with strict liability caps it did not reduce cost or rates of procedures ordered.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think it's very imperfect, but I'm happy it passed. I think a single payer system would have been better. But anything that moves us away from thinking basic healthcare is only for the lucky or privileged is fine by me. It should be considered a right.

But in that regard, nothing has changed - only the lucky or privileged can still afford healthcare, and now the underprivileged have to pay a tax penalty for being underprivileged and unable to afford healthcare - and they still get no healthcare. It's a scam.

Underivikehed people are exempt from the tax penalty.

[Anonymous]

Anonymous wrote:9:01 You probably just haven't learned enough about how the law will work when these provisions go into effect to understand that there is substantial assistance to help people buy insurance that is built into th system --help for families that do not have any help with insurance now. Here is a short description of these provisions:

Premium Subsidies

Households with incomes below 400 percent and above 133 percent of the federal poverty line (FPL) who are enrolled in insurance plans offered through the exchanges are eligible for premium assistance financed by the federal government (Medicaid will cover families with incomes below 133 percent of FPL). In 2010, the FPL is $22,050 for family of four. The new law establishes a sliding scale of assistance based on limitations on required family contributions to the cost of coverage. For instance, at 150 percent of FPL in 2014, ObamaCare limits the amount that such households must contribute toward their health insurance premium to 4 percent of their annual income. At 400 percent of the FPL, households must contribute 9.5 percent of their income toward insurance premiums. Whatever portion of the total health insurance premium for their coverage is not paid by these households is covered by the new federal premium assistance program.

What this means is that families with incomes even going up to 80,000 plus would have their insurance expenses capped and, if they had expenses higher than that, the fed gov would be making up the difference. Moreover, many lower income families up to $29,326 for a family of four would be able to get on Medicaid which they are not necessarily eligible for now. So it is simply not true that Obamacare would tax people who can't afford health insurance but not do anything to help people buy health insurance. It does a lot to help people buy health insurance.

a family of four making $80,000/year can't afford to spend $533/month for health insurance. That's insane. I can't afford that and we have HHI of $135,000

[Anonymous]

Actually, maybe it's more than $533/month - more they cannot afford. If you don't have insurance, it's mostly because you cannot afford it.

If someone can't afford something, they can't. What don't these privileged people on capital hill not get.

They just don't get it. Guess they have been well off for too long - out of touch.

[Anonymous]

Obamacare pays subsidies so that low income people can get coverage.

[Anonymous]

Anonymous wrote:I think it's very imperfect, but I'm happy it passed. I think a single payer system would have been better. But anything that moves us away from thinking basic healthcare is only for the lucky or privileged is fine by me. It should be considered a right.[/quote]

+100000. Health care should be a right, just as it is in every other developed nation on Earth.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I think it's very imperfect, but I'm happy it passed. I think a single payer system would have been better. But anything that moves us away from thinking basic healthcare is only for the lucky or privileged is fine by me. It should be considered a right.

But in that regard, nothing has changed - only the lucky or privileged can still afford healthcare, and now the underprivileged have to pay a tax penalty for being underprivileged and unable to afford healthcare - and they still get no healthcare. It's a scam.

You are ill informed, nor not very bright. A tax penalty? Huh? Where did you come up with that, Mr. Rove?