Yes, the nation, as an abstract entity, existed before the ACA, and if the ACA were repealed, it would continue to exist. So what? I don’t care about abstract entities; I care about people. And a lot of people did indeed cease to exist because of the piss-poor system we had before the ACA, and if it were repealed, a lot more would cease to exist because of that.
Speaking as someone who supports the ACA, it’s perfectly clear to me that my view of the success so far of the ACA is an opinion, not a fact. The ACA consists of trade offs and some unfulfilled promises, which in my view have been worth the incremental improvements. But if someone sees the downsides of the ACA as impacting their situation or values in a more concerning way than they impact me, then I can’t say someone is factually wrong for criticizing the ACA.
As everyone has, I’ve been trying to understand the nature of campaign finance and political contributions since I first heard the claim made that bribery takes place. The more I’ve explored it, and the more debates like this which I’ve observed, the more convinced I’ve become that it’s such a big and complicated interaction of all sorts of factors, that almost no one gets the understanding right.
A few things I’ve come to realize:
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straight up bribery is very rare. And it’s not rare because “people are mostly good and honorable,” it’s rare because it’s too easy to get caught and suffer the opposite consequences.
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a lot of the larger contributors, give money to both sides, strongly suggesting that they aren’t so much directly trying to buy a given vote, as they are trying to get WHOEVER wins, to think of them as friends, in a political sense. Maybe a bit of “access purchasing” in there as well. In any case, because of this, politicians will always get money from the wealthier contributors, even when those contributors don’t think the politician will vote in their favor.
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EVERYONE uses each other’s , as well as their own recorded contributions, to make political points; and those political points are always exaggerated and usually based more in innuendo, than in carefully framed political goal seeking.
* there is a recent sort of fad in play, wherein those who want us to ignore the insane amount of cash gushing over these politicians, point out every time the person who spends the lesser amount wins. The people who are most supporting this fad, are a tellingly mixed lot. I say tellingly, because the fact that it IS a mixed group, is directly related to the entire big picture of the world of political struggle.
* it's tempting and common to assume that the reason all those rich guys do as they do, is because they really know what they are doing and why, and that what they are doing actually works: but that is complete bullshit of the first order. The reality is, that all those rich donors and would-be bribers, are following in the well-worn trails of all the other jerks who came before, and who built the backstage edifice that is campaign finance. And the media are just as involved with the self-delusion and nonsense of it all as the politicians are, to the point where pretty much everyone in a position to deal with it or change it, is more deluded than they are informed.
Essentially, the political world is much like the real world of us peasants. Everyone starts out hoping to live a fairy tale life, and even after we learn that there are no real knights of pure heart, or princesses with magically innocent wisdom, we keep looking for the knights and princesses elsewhere. Maybe there’s a real princess celebrity or a real knight errant rock star. And maybe a political movement or media star will finally prove that the dream of a hero who fixes everything, will come to pass for us. But that is countered by the alternate fantasy that almost everyone takes on, when the first one fails us: the dream of at least seeing the more inept fake knights brought low, and maybe an occasional bad guy going down by chance.
In this case, there are a LOT more elements affecting Republican behavior than the relatively small sum of four hundred million dollars. It’s relatively small, because as I mentioned above, political contributions are almost never quid pro quo. So even if there really IS such an offer on a secret table somewhere, they wont be turning ALL of it down if they don’t abase themselves openly in front of the donor.
I am personally convinced that there’s really only one central reason for this latest effort at repeal/replace: they are doing it so that they can tell their more ardent supports that they did. That’s it. Win or lose, at the next election, they will be able to say truthfully that they tried every chance they could.
How much the money offer plays a part, and on whose side, is hard to know. Just as it’s really happened that large, essentially bribe offers are made, it’s also really happened that opposition camps have made more out of the possibility of such bribes, in order to try to sabotage stronger opponents.
On the good side for me, all the skulduggery over the years, finally convinced me to ignore who is doing what behind the scenes for the most part, and to support or oppose a given group or proposal on whether or not I personally think it’s best for the country and for me. This particular issue is of no interest to me. The ACA is a terrible idea, and the Republican proposals to replace it are worse. If they fail, I will be slightly happy that things haven’t been made worse; if they win, I will hope that the destruction that results will finally contribute to someone coming up with a GENUINE good idea.
That only means they’ve been bribed 50 some-odd times. At some point the bribers are going to write them off; it’s only surprising they haven’t done it yet.
Possible, sure, useful, not really.
Prior to ACA, you had to call the insurance company, answer a whole bunch of questions, who would call you back within 5 business days with a quote. If you accepted the quote, then great, you have insurance. If not, then they would not guarantee the quote if you wanted to get it later. IOW, they did not allow you to do comparison shopping. They did not allow you to look at the price of different plans, and choose the one that fit you best. They prevented competition. This is not the free market.
Prior to ACA, if you have a pre-existing condition, you either paid a higher premium, had no coverage, or had limited coverage. As I had had a sciatica flare-up a few years prior to picking up insurance, they refused to cover anything involving my back or joints, but didn’t give me any sort of discount for their lack of coverage, which sucked, as the biggest medical need I had at the time was to visit the doctor for a few muscle relaxers when I had a flare-up, and my insurance wouldn’t even cover the co-pay if it my visit officially had anything to do with my back.
With the ACA, I was able to find a plan that actually cost less than the one that I had prior to ACA, that covered more. I make too much to get a subsidy, but the market still improved my coverage and costs considerably. I need insurance to protect my assets more than anything else. With my business and my personal finances a bit inexorably tied together, if I were to suffer a serious illness that I had to pay out of pocket, I would have to close my doors and let all my employees go.
My employees, also, are on the ACA, as I am not large enough to have my own plan yet. If they were dropped from those roles, they would need to find jobs that provided health insurance, leaving my business sans employees. I know that I left a few employer pre-aca because they did not offer insurance.
So, personally, I find the ACA to be a friend to small business. It would be much more difficult to open and grow without the knowledge that health coverage is not something that needs to be taken care of for yourself or for your employees. Small businesses are also the main drivers of growth in the economy. Most larger businesses that can offer insurance plans are not growing. They are atrophying or even laying off their workforce.
My prediction, removal of the ACA will hurt small businesses the most. Fewer will open, and they will grow more slowly. Many will close their doors, as the owners are no longer able to afford to keep up premiums for themselves, or forgo the premiums, find themselves with a severe illness, and have to declare bankruptcy and close their doors. This will slow down overall economic growth considerably and increase unemployment.
Maybe the uptick in preventable deaths will not be too great. We will only have a few tens of thousands of people dying a year due to lack of ability to pay for healthcare, and if a few tens of thousands of deaths is the price we pay for having a more robust economy, or lower healthcare costs for the survivors, then that’s a debate we can have. But, as I see it, the repeal of the ACA will not only result in people dying due to lack of money, but will also see the economy suffer, and premiums for the rest of us go up.
I get that there is some higher noble principle involved here, and that if you were socrates, you would drink the hemlock out of that principle, but even socrates wouldn’t insist that you martyr yourself for his cuase. And that’s what I am seeing here. The idea that there are principles that are worth other people suffering for.
So you’d rather make millions of people homeless while they’re houses are completely gutted and renovated? THAT’S your solution to healthcare?
It’s a fact that it has succeeded or failed based on what you consider success.
More people, especially those of lesser means, having health insurance and care? Success, as the numbers prove out time and again.
Shrink the government to the size it can be killed in a bathtub (minus military spending, of course)? Horrendous failure.
This is exactly right. I feel like the ACA harmed me more than it benefited me, but I understand that’s just my perspective and I realize that there are people out there, like our very own GIGObuster and Ravenman, that are on the opposite side of the cost-benefit analysis and that’s ok. My position led me to vote for people that want to wind back the ACA, and their position led them to vote for people that want to maintain it. Neither position was or is irrational. They result from our various circumstances.
Do you know that the ACA harmed you more than it helped?
Many employers used the ACA as an excuse to reduce their level of contribution to your premiums, repeal of the ACA will not in any way, get them to bring them back to what they were.
I know quite a number of people who think that they were harmed more than helped by the ACA, because their premiums went up, but after looking closer at their employment based healthcare plan, I see that the premiums did not increase by much, if at all, it’s just the employer contribution that went down.
So, are you sure that it is the case that your premiums went up, that the ACA actually did harm you, or have you checked to see if it was not actually your employer shifting the burden of your healthcare more firmly onto your shoulders that increased your costs?
ETA: Do you think that repeal of the ACA will reduce your premiums to what they were pre-ACA?
ETA2: Do you think that if the ACA had not been enacted, that your premiums would be what they were pre-ACA?
Remember those news stories? About people who had contracted some dreadfully expensive disease, then some well-paid guy at the insurance company ferreted out some fact about their medical history and…guess what!..you’re boned! Die, or go broke trying not to, we don’t care, we don’t have to, its our country, you just live here.
Not many of those lately. Inclined to think that’s a good thing. Yeah, pretty sure.
I believe it has, but I don’t claim certainty on the matter.
In my case, I’m confident that it’s not my employer’s fault. My employer actually increased their contribution to my health insurance coverage quite generously last year.
I doubt they’ll get all the way back down that far. My hope would be that a repeal would reduce them from where they are today. In other words, if it dropped back to the halfway point between where they are today, and where they were before ObamaCare, I’d consider that a win for me personally.
No. I suspect they would have gone up from pre-ACA days (inflation), but probably not as much.
In a different universe in which everything was the same except your circumstances were different such that you believed the ACA actually improved your family’s specific circumstances, would you support the law?
Go ahead. Using postulates that are objectively provable, of course.
I care about abstract entities.
And now what?
Not even if I offer you a buck to do it?
In that case, forget I offered the buck…
That would seem to be a problem. Especially if you disagree with the state of campaign finance jurisprudence, or don’t understand the connection between money, and it’s ability to facilitate speech.
As long as I get to decide who the third party is. But really, that’s not the way free speech works. Political speech enjoys much greater protection than commercial advertising. And it’s factually incorrect that cigarette advertisements are not legal - they are highly restricted, but endorsements still exist, and billboards are present in the states that continue to allow them.
Here is where you go off the rails in your argument. Your hammer analogy is not on point so it’s comparative value is worthless. You continue your journey as the king of the excluded middle with the focus on bankruptcy. Having the ability to choose different benefit levels is not similar to hammer punching your face. Bankruptcy isn’t the only negative to guard against. So yes, I highly doubt you could illustrate a proof to support the muddled position you are advancing.
Even if what you say is accurate, you seem to be only considering the cost portion of the equation, and only one aspect of the cost - death. For every choice, there is a set of costs and a set of benefits. You note premiums but handwave them away. Ignoring the benefit portion of the equation affects the analysis of the outcome. That’s why your equation analogy fails as well. It’s not an accurate representation of the relative values, or even complete in capturing the variables.
Ok. Here’s my position.
Humans like being alive. A lot. Almost infinitely much.
So let’s see if we can find things we agree on. There is a certain probability you will be alive in 5 years. (picking a 5 year window since some diseases take several years to kill you). All things held equal, if you have access to 50% of available medical treatments, versus 90% of available medical treatments, do you agree that the probability of you being alive in 5 years is higher?
So the total Expected value = (value of being alive) * (Probability of being alive).
Why did I imply the ACA increases access to medical treatments if you personally have the best corporate health insurance? The reason is that there is a non-zero chance you will be fired, wrongfully even if you are the company’s best performer, and lose access to that. That puts you on the individual market, where pre ACA plans only give you access to a small subset of available treatments, practiced policies of dropping people who make claims, and exclude treatments for any pre-existing conditions.
Oh, but you have $50,000+ saved up, and can keep making the $2000 a month COBRA payments until you get a new job. Well, good for you, but statistically you are rare and if you were the only ones voting against the ACA, it wouldn’t be in any danger of getting repealed.
Where I think you have an argument is what if you don’t value your life very much. But you hugely value new rims for your truck. So you resent being made to pay for health insurance (individual mandate), and would rather have an additional 10-20% of your income so you can buy the new rims and chrome and all the rest for your hobbies.
I would simply counter that since you do value things that give you enjoyment (the rims), and you get 0 value if dead, in fact you do value your life quite a lot, and you’re simply wrong when you claim you don’t. And if you then go for policies that shorten your life at the benefit of some small increase in marginal short term enjoyment, I’d say you’re acting stupidly, and from an objective sense, you are.
Note that these assumptions are based on the fact that the individual mandate combined with the tax credits limits the amount you spend on insurance to a reasonably small fraction. Since money has a diminishing utility, having 80% of your available income versus 100% makes not much of a difference, you can get the things that you enjoy in life on a moderately lower budget pretty well. If buying insurance meant you had to eat bread and water and shiver in the cold for the rest of your life, while you could live like a king as an uninsured, that would be a different scenario. (since if living like a king = 10x more enjoyment from being alive, a shorter total life with more enjoyment is better)
Well, there’s one very obvious consequence: bankrupt people are not in fact paying their own costs. Instead, they’re pushing their costs onto everyone else.
I don’t think it’s a stretch to say that the people least likely to have health insurance (because they’re unemployed or their insurance sucks) are also the least able to pay for themselves. Instead, they use the emergency room for health care. Because the ER is about the most expensive form of health care, uninsured people are unlikely to pay even a small fraction of the total costs. These costs are passed onto the insured, whether they like it or not.
One could avoid this problem by allowing hospitals to demand cash or insurance in advance of emergency treatment. There is the slight image problem of people dying in the hospital lobby. And a political risk that a VIP might get caught without ID, and be denied treatment despite actually being insured. A small price to pay, though, for the philosophically pure notion of making people pay their own way–even if it doesn’t ever work out that way in practice.
You know, I did think of a way to make the “pay your own way” feasible. This is a very libertarian philosophy. The trouble is, all pharmaceutical drugs are only available from government approved companies within the borders of the USA, and the government puts onerous barriers in the way of approval of even generics. All surgeries and prescriptions are only available from government licensed professionals, and due to the actions of the government, there’s a severe shortage of them. All medical clinics and hospitals must have government approval, or they can’t stay open.
When you have a good that has inelastic demand and you restrict supply, prices skyrocket. The only ultimate ceiling on medical costs would be if they were eating up every dollar in the economy not being spent to keep the economy running at all.
There’s a fix for this. Same as the fix for lowering the cost of computer programmers or DVD players. Imports on a mass scale. Any foreign trained doctor ought to be able to just show up and open up shop. They should be able to open clinics anywhere, without needing approval. Any pharmaceutical drug made by a licensed company anywhere should be imported.
Relieve the supply, and prices would fall back to some fraction of reasonable. Of course, there’s going to be a bunch of low quality drugs and medical professionals on the market, but in theory the government could force them to label themselves as such, and patients with means would avoid the lower cost ones.
Sorry, but making sense is decidedly not one of the elements of such conspiracy theories.