# ACA (Obama Care) is great, but it is time to fix it **URL:** \ **Category:** Great Debates\ **Created:** [October 27, 2016, 12:13pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841 "2016-10-27T12:13:21Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [October 27, 2016, 5:01pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/21 "2016-10-27T17:01:05Z")
> [@Ludovic](#): > > The profit motive argument, OTOH, is nuts. There’s nothing in the free market theory that says that non-profit entities, government or not, cannot compete with private business on a level playing field. If it’s revenue neutral and provides more health care to more people for less total cost, it’s a success. It’s not so much “non-profit vs. profit-driven business” it’s “companies that require positive cash flow to survive versus government services that can operate at a loss for generations as long as the tax money rolls in”. Yes, we can set up government services to pay for themselves without taxpayer subsidies, like the post office, but that’s not the impression people get. They see businesses that have to earn money going head to head with an organization that can give their services away free if they want because they obtain revenue at gunpoint. ---
**Author:** ![watchwolf49](https://avatars.discourse-cdn.com/v4/letter/w/e9c0ed/32.png) [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)\ **Post date:** [October 27, 2016, 5:05pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/22 "2016-10-27T17:05:05Z")
> [@snowthx](#): > > Public Option or Medicare available to all, and allow negotiating with Pharmaceutical companies for volume discounts on their products, as is done in other civilized countries. That ability was stripped-out of Medicare Part D when is was implemented 10 years ago by, you guessed it, legislators in the pocket of Pharma. Do you mean using the current government procurement process? That’s fine for drugs whose patent has expired … but if the government sets out for bid for a drug for which only one company can lawful bid on … that company can simply triple the cost and the government is stuck paying it … or not procure the drug at all … Is that good enough for 80% of the population? ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [October 27, 2016, 6:18pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/23 "2016-10-27T18:18:01Z")
> [@DrCube](#): > > They see businesses that have to earn money going head to head with an organization that can give their services away free if they want because they obtain revenue at gunpoint. That argument works both ways. Must insurance companies take on the same burden of the poor and elderly that are covered in Medicare and Medicaid? If the poor and elderly receive better care from private insurance and it’s cheaper, why then!, the government will be compelled to disband those programs. Think of all the profits insurance companies could rake in by applying the virtues of the freemarket! Strange this powerful lobby hasn’t attempted to make that happen, huh? ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [October 27, 2016, 7:02pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/24 "2016-10-27T19:02:28Z")
Public option. I’ve read that there was no push for this, especially by Obama himself, when ACA was being designed. :mad: > [@DrCube](#): > > Businesses are rightly afraid of competing with taxpayer-subsidized, no-profit-motive government services. The government-provided insurance (or HMO) _need not be subsidized_ (except with the ACA subsidies private insurers also get). The government service could be priced to make a small profit. Its purpose would be to serve as insurer of last resort and to keep private insurers honest. I wonder if it would be possible to extend the VA hospital system to care for more. Contrary to Republican whingeing (making the VA a scapegoat for their “Let’s all hate government” program), many veterans are pleased with their VA healthcare. ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [October 27, 2016, 7:20pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/25 "2016-10-27T19:20:16Z")
> [@HurricaneDitka](#): > > [I’m pretty sure this is incorrect](http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html#polls). When the polling has disaggregated people who oppose the ACA from people who wish it had gone further (i.e., public option), it has generally shown that the people who want it repealed are in the [minority](http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-october-2016/). ---
**Author:** ![Duke\_of\_Rat](https://avatars.discourse-cdn.com/v4/letter/d/ad7895/32.png) [@Duke\_of\_Rat](https://boards.straightdope.com/u/Duke_of_Rat)\ **Post date:** [October 27, 2016, 8:18pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/26 "2016-10-27T20:18:24Z")
> [@DrCube](#): > > Businesses are rightly afraid of competing with taxpayer-subsidized, no-profit-motive government services. In most cases I agree the government should stay out of the market. But in the case of healthcare I say let the insurance companies burn. A buddy has kidney stones periodically. His last doctor bill had $1050 for a regular old saline IV. If you were a doctor charging $1050 for a bag of water, who would you rather submit the bill to: An insurance company who might dispute the cost, or the government who would just pass the bill on to the taxpayers? The insurance companies aren’t the ones setting the cost of the IV, and I realize that there are hidden costs - sterilization, purification, training to properly administer the IV - but $1050 still seems a bit steep. I know who I’d rather submit the bill to, the American taxpayer. As an American taxpayer, I’d rather not pay $1050 for a bag of water. Seems like getting a handle on the COST of healthcare would be a good place to start while we try to sort out who is going to pay for it. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [October 27, 2016, 8:38pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/27 "2016-10-27T20:38:26Z")
> [@Duke\_of\_Rat](#): > > A buddy has kidney stones periodically. His last doctor bill had $1050 for a regular old saline IV. If you were a doctor charging $1050 for a bag of water, who would you rather submit the bill to: An insurance company who might dispute the cost, or the government who would just pass the bill on to the taxpayers? > > The insurance companies aren’t the ones setting the cost of the IV, and I realize that there are hidden costs - sterilization, purification, training to properly administer the IV - but $1050 still seems a bit steep. I know who I’d rather submit the bill to, the American taxpayer. As an American taxpayer, I’d rather not pay $1050 for a bag of water. > > Seems like getting a handle on the COST of healthcare would be a good place to start while we try to sort out who is going to pay for it. The whole argument for single-payer seems to be that the government will negotiate vigorously against high prices. But…there’s the saying about the US government spending hundreds of dollars on a single hammer, or toilet seat, etc. ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [October 27, 2016, 8:58pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/28 "2016-10-27T20:58:59Z")
The ACA definitely needs to be tweaked, but we cannot trust Republicans to do that. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [October 27, 2016, 9:12pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/29 "2016-10-27T21:12:31Z")
> [@Velocity](#): > > The whole argument for single-payer seems to be that the government will negotiate vigorously against high prices. But…there’s the saying about the US government spending hundreds of dollars on a single hammer, or toilet seat, etc. [Myth](http://www.govexec.com/federal-news/1998/12/the-myth-of-the-600-hammer/5271/) ---
**Author:** ![YogSothoth](https://avatars.discourse-cdn.com/v4/letter/y/8edcca/32.png) [@YogSothoth](https://boards.straightdope.com/u/YogSothoth)\ **Post date:** [October 27, 2016, 11:27pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/30 "2016-10-27T23:27:37Z")
> [@Velocity](#): > > The whole argument for single-payer seems to be that the government will negotiate vigorously against high prices. But…there’s the saying about the US government spending hundreds of dollars on a single hammer, or toilet seat, etc. That’s from Independence Day, isn’t it? 😛 ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [October 28, 2016, 12:11am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/31 "2016-10-28T00:11:02Z")
> [@Duke\_of\_Rat](#): > > A buddy has kidney stones periodically. His last doctor bill had $1050 for a regular old saline IV. If you were a doctor charging $1050 for a bag of water, who would you rather submit the bill to: An insurance company who might dispute the cost, or the government who would just pass the bill on to the taxpayers? What leads you to think the insurance company is really going to dispute the cost, though? They can get you (or, for most of us, your employer) to pay higher premiums anyway. It’s not like there’s really all that much competition in the health insurance market. For example, about seven times as many people get their insurance through an employer (theirs, their spouse’s, or their parents’) as through a nongroup plan. It’s typical to have one choice of company in an employers’ plan; it’s fairly rare to have more than two or three choices. Blue Cross/Blue Shield of Kansas has more than half of the large-group market in this state; the three largest insurers have close to 90% ([cite](http://kff.org/other/state-indicator/market-share-and-enrollment-of-largest-three-insurers-large-group-market/?currentTimeframe=0&selectedRows=%7B%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D)). There are states in which one individual insurer has more than 80%+ of the group market (BC/BS of South Carolina, e.g., covers 93% of that state’s large-group insureds). With that kind of near-monopoly position, and with substantial barriers to entry (making deals with a large-enough share of the doctors, hospitals, MRI centers, etc., to attract customers), why would an insurer spend a great deal of time and effort disputing the cost of individual line items? > [@Duke\_of\_Rat](#): > > The insurance companies aren’t the ones setting the cost of the IV, and I realize that there are hidden costs - sterilization, purification, training to properly administer the IV - but $1050 still seems a bit steep. I know who I’d rather submit the bill to, the American taxpayer. As an American taxpayer, I’d rather not pay $1050 for a bag of water. In addition to the costs of sterilization, etc., that $1050 has to cover the costs of all the people who received IV saline and didn’t bother to pay the bill or went bankrupt on the bill, plus the costs of preparing and submitting claims to the various insurance companies, preparing all of the different paperwork each company requires, chasing down the companies (and individuals) who are slow in paying, etc. > [@Duke\_of\_Rat](#): > > Seems like getting a handle on the COST of healthcare would be a good place to start while we try to sort out who is going to pay for it. A big chunk of the COST of healthcare, though, is figuring out who’s going to pay for it. A quarter of all hospital spending, e.g., goes to administrative costs[http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs](http://www.commonwealthfund.org/publications/in-the-literature/2014/sep/hospital-administrative-costs). For primary care physicians, a survey a few years ago found they spent an average of 3.5 hours a week dealing with insurance companies; that’s not counting the average of 19 hours of RN/LPN time and 34 hours of clerical staff time per week per physician dealing with payment issues. [cite](http://content.healthaffairs.org/content/28/4/w533.long). That means for every full-time primary care doctor, there are one and a half full-time staff sorting out who’s going to pay for the care the doctor is providing. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [October 28, 2016, 12:21am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/32 "2016-10-28T00:21:17Z")
> [@YogSothoth](#): > > That’s from Independence Day, isn’t it? 😛 Yup! 🙂 The good (1996) version. ---
**Author:** ![watchwolf49](https://avatars.discourse-cdn.com/v4/letter/w/e9c0ed/32.png) [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)\ **Post date:** [October 28, 2016, 12:33am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/33 "2016-10-28T00:33:32Z")
> [@Velocity](#): > > The whole argument for single-payer seems to be that the government will negotiate vigorously against high prices. But…there’s the saying about the US government spending hundreds of dollars on a single hammer, or toilet seat, etc. Of course we spend hundreds of dollars for a toilet seat … the toilet itself cost $19 million … [“NASA’s $19 Million Toilet”](http://www.popsci.com/scitech/article/2007-07/nasas-19-million-toilet), _Popular Science_, July 2007 ---
**Author:** ![Chessic\_Sense](https://avatars.discourse-cdn.com/v4/letter/c/7c8e57/32.png) [@Chessic\_Sense](https://boards.straightdope.com/u/Chessic_Sense)\ **Post date:** [October 28, 2016, 1:40am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/34 "2016-10-28T01:40:05Z")
> [@Richard\_Parker](#): > > When the polling has disaggregated people who oppose the ACA from people who wish it had gone further (i.e., public option), it has generally shown that the people who want it repealed are in the [minority](http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-october-2016/). My wife and I once purchased a new car. When the salesman gave it to us, we were surprised to see that it was only the left half of the car. This thing was split right down the middle- two tires, two seats, a gaping hole where the center should be. I said “This is ridiculous! You can’t even drive this thing! Take it back!” My wife said “This is absurd! It doesn’t even run! Give us the other half!” The salesman said “Excellent. Six seconds into this, and on average, you guys are at least OK with this.” ---
**Author:** ![Richard\_Parker](https://avatars.discourse-cdn.com/v4/letter/r/35a633/32.png) [@Richard\_Parker](https://boards.straightdope.com/u/Richard_Parker)\ **Post date:** [October 28, 2016, 3:17am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/35 "2016-10-28T03:17:16Z")
> [@Chessic\_Sense](#): > > My wife and I once purchased a new car. When the salesman gave it to us, we were surprised to see that it was only the left half of the car. This thing was split right down the middle- two tires, two seats, a gaping hole where the center should be. > > I said “This is ridiculous! You can’t even drive this thing! Take it back!” > My wife said “This is absurd! It doesn’t even run! Give us the other half!” > The salesman said “Excellent. Six seconds into this, and on average, you guys are at least OK with this.” Interpreting this as charitably as possible, you seem to be assuming that the people who want ACA expansion think it is currently broken and worthless. That assumption is incorrect. ---
**Author:** ![GulfTiger](https://avatars.discourse-cdn.com/v4/letter/g/e79b87/32.png) [@GulfTiger](https://boards.straightdope.com/u/GulfTiger)\ **Post date:** [October 28, 2016, 4:01am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/36 "2016-10-28T04:01:32Z")
Congress needs to work out a trade. Public option for the FairTax and private insurance and med system resurrected so that the people with some money don’t have to use the crapola public system. There, done, everyone gets something out of the deal. That is what you call bi-partisan compromise. ---
**Author:** ![DagNation](https://avatars.discourse-cdn.com/v4/letter/d/ee7513/32.png) [@DagNation](https://boards.straightdope.com/u/DagNation)\ **Post date:** [October 28, 2016, 5:43am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/37 "2016-10-28T05:43:42Z")
> [@Salvor](#): > > I agree with this completely, but ideally I’d prefer we do something similar to the estate tax where X dollar amount is tax free, but beyond that there is a tax. > > I’m not sure what the level ought to be, but say something like anything over 10% of 100k per year investment returns gets taxed. At some point investments become your “job” and such people ought not have their income privileged over people who are actually earning an income with their labor. I agree, an exemption of the first $25-100K of investment income would be reasonable. ---
**Author:** ![DagNation](https://avatars.discourse-cdn.com/v4/letter/d/ee7513/32.png) [@DagNation](https://boards.straightdope.com/u/DagNation)\ **Post date:** [October 28, 2016, 6:21am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/38 "2016-10-28T06:21:25Z")
> [@watchwolf49](#): > > The OP seems to be using the amount of people who have insurance as the benchmark …{1} > > The flaw with the ACA is that it only deals with the costs of _insurance_ … {2} > It’s about trade-offs … we can substantially reduce health care costs (and the insurance) if we socialize the industry… {3} {1} It is an easy number to use, but the fact that many people have better care at lower total out of pocket cost is really a big deal too. {2} That is a part of an answer to my question - ACA aimed mostly to get everybody insurance, but did not do a whole lot in other ways - what else could ACA-II (electric boogaloo) include to improve health care and control costs? {3} Are there any examples of partially socialized medicine that get some of the cost savings with less trade offs? ---
**Author:** ![DagNation](https://avatars.discourse-cdn.com/v4/letter/d/ee7513/32.png) [@DagNation](https://boards.straightdope.com/u/DagNation)\ **Post date:** [October 28, 2016, 6:26am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/39 "2016-10-28T06:26:48Z")
> [@YogSothoth](#): > > The ACA definitely needs to be tweaked, but we cannot trust Republicans to do that. I am assuming that the dems control both houses and the President - I know it is a long shot, but this is a “If I got my way” thread. ---
**Author:** ![DagNation](https://avatars.discourse-cdn.com/v4/letter/d/ee7513/32.png) [@DagNation](https://boards.straightdope.com/u/DagNation)\ **Post date:** [October 28, 2016, 6:58am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/40 "2016-10-28T06:58:50Z")
I see that the most popular adjustment to ACA is the idea of adding a medicare buy-in or some other public option. I see that many people are OK with that as long as there are still private options, if for no other reason, to provide the government option some competition. The second most popular idea here seems to be giving the federal govt the ability to negotiate for bulk drug prices. I am willing to bet that we will need serious campaign finance reform before anything good happens in this area! Any other areas for improvement? One poster suggested working in other ways to reduce health care costs - For instance there are a few MRI/PET/CAT scanners in my city, and as far as I know, they only operate about 40 hours a week. It would not be that expensive to run those things 24 hours a day, if there are untreated people needing them. That could cut the cost per scan by nearly 2/3, since the biggest cost is the initial build of the imaging center. People with good insurance would get the nice daytime appointments, Medi-Cal people get the 3 AM appointments. Should there be an education or student loan component? A new facility and upgrade fund? How else can the cost of medicine be pushed down while providing better care to more people? Thanks for your participation! [Previous page](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841.md?page=1) [Next page](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841.md?page=3)