# 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:** 3
**Author:** ![Cyberhwk](https://avatars.discourse-cdn.com/v4/letter/c/7993a0/32.png) [@Cyberhwk](https://boards.straightdope.com/u/Cyberhwk)\ **Post date:** [October 28, 2016, 9:41am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/41 "2016-10-28T09:41:26Z")
> [@septimus](#): > > Public option. I’ve read that there was no push for this, especially by Obama himself, when ACA was being designed. :mad: The bill didn’t have a single vote to spare and Lieberman supposedly refused to vote for the bill if it had a Public Option. ---
**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, 12:06pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/42 "2016-10-28T12:06:23Z")
> [@GulfTiger](#): > > 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. What is the “private insurance and med system” and when did it die? ---
**Author:** ![cmkeller](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cmkeller/32/118_2.png) [@cmkeller](https://boards.straightdope.com/u/cmkeller)\ **Post date:** [October 28, 2016, 12:09pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/43 "2016-10-28T12:09:20Z")
watchwolf49: > [@](#): > > 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 … So a drug company is going to keep themselves shut out of a market of 300 million people because the entity representing them in purchasing power won’t agree to gouge-level profit pricing? I doubt it. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [October 28, 2016, 2:37pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/44 "2016-10-28T14:37:36Z")
> [@DagNation](#): > > 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. You’re tripling the cost of labor, here (more if you include weekends), unless you’re offering walk-in, DIY, unsupervised MRIs, laundromat-style. ---
**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, 3:09pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/45 "2016-10-28T15:09:02Z")
A state-of-the-art scanner plus its associated construction costs can top $4 to $5 million – it takes a lot of labor costs to equal the cost of the equipment. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [October 28, 2016, 3:24pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/46 "2016-10-28T15:24:23Z")
> [@DrCube](#): > > Eliminating the middleman, for one. Why should the government pay insurance companies to pay health care bills rather than just paying the healthcare bills directly? > > Busting regional insurance monopolies is another bonus. Plus it’s step one on the path to UHC. Also, it changes “make them buy health insurance” into less of a “let them eat cake” scenario. If you’re going to mandate that people buy health insurance, you need to actually make it available and affordable to them, or else it’s nothing but a $700 tax on poor people. The government can do that, but it can’t force insurance companies to. Because insurance companies are already in the insurance business and thus are likely to be better at it than the government who is not in the insurance business. The reason regional monopolies exist is that there are barriers to entry in those regions, presumably the public options would still face those barriers. Under the ACA the government already subsidizes those who are too poor to afford the premiums. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [October 28, 2016, 3:26pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/47 "2016-10-28T15:26:39Z")
> [@BobLibDem](#): > > Take a look at the lavish headquarters and huge CEO salaries of the insurance behemoths. All that money comes from premiums that isn’t going to provide health care. Moreover, they all have staff whose jobs depend on finding ways to deny claims. Replace them with civil servants whose loyalty is to the public. Those lavish headquarters were not built on the profits earned on the exchanges since there really have not been any. Almost no insurer has made any money on the exchanges and have been relying on subsidies and reinsurance to stay in it. That is why no that the reinsurance subsidies are expiring the price is going up so much. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [October 28, 2016, 3:40pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/48 "2016-10-28T15:40:33Z")
> [@puddleglum](#): > > Because insurance companies are already in the insurance business and thus are likely to be better at it than the government who is not in the insurance business. > The reason regional monopolies exist is that there are barriers to entry in those regions, presumably the public options would still face those barriers. > Under the ACA the government already subsidizes those who are too poor to afford the premiums. They’re better at making money, but not necessarily at providing the best care possible to everyone. As an example, I got far better health care while I was active duty military than I do now with private insurance through my employer – appointments were much faster, I paid much less, there was much less paperwork, prescriptions were much easier to get, etc. The government may not always run a great health care system, depending on the details of the system, but it certainly is capable of it, as proven by the health care our active duty service men and women get. ---
**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 28, 2016, 4:30pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/49 "2016-10-28T16:30:25Z")
> [@iiandyiiii](#): > > They’re better at making money, but not necessarily at providing the best care possible to everyone. As an example, I got far better health care while I was active duty military than I do now with private insurance through my employer – appointments were much faster, I paid much less, there was much less paperwork, prescriptions were much easier to get, etc. The government may not always run a great health care system, depending on the details of the system, but it certainly is capable of it, as proven by the health care our active duty service men and women get. Not sure the VA is the [best example of government expertise](https://www.washingtonpost.com/news/fact-checker/wp/2016/10/12/obamas-claim-a-whole-bunch-of-people-who-are-in-charge-of-va-facilities-were-fired-over-wait-times/) in health care. Maybe better for active duty, but the Pentagon has a huge budget to cover those costs. Providing the same care to the US population as a whole will take a chunk of change. ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [October 28, 2016, 4:40pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/50 "2016-10-28T16:40:43Z")
> [@Duke\_of\_Rat](#): > > Not sure the VA is the [best example of government expertise](https://www.washingtonpost.com/news/fact-checker/wp/2016/10/12/obamas-claim-a-whole-bunch-of-people-who-are-in-charge-of-va-facilities-were-fired-over-wait-times/) in health care. Maybe better for active duty, but the Pentagon has a huge budget to cover those costs. Providing the same care to the US population as a whole will take a chunk of change. The VA is an entirely separate organization from active duty military health care. The two aren’t related at all in how they function. ---
**Author:** ![urban1a](https://avatars.discourse-cdn.com/v4/letter/u/e47c2d/32.png) [@urban1a](https://boards.straightdope.com/u/urban1a)\ **Post date:** [October 29, 2016, 1:24am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/51 "2016-10-29T01:24:30Z")
> [@BobLibDem](#): > > … Replace them with civil servants whose loyalty is to the public. According to [this site](http://www.ssdrc.com/8-13.html) only about 35% percent of all disability applications are approved the first time. Some of the disapprovals, of course, are never approved, but it doesn’t seem like these civil servants are all that loyal to the public. Anecdotally, I have known people, with real disabilities, who have had to hire lawyers to get them the approval process and it has taken years. Bob ---
**Author:** ![DagNation](https://avatars.discourse-cdn.com/v4/letter/d/ee7513/32.png) [@DagNation](https://boards.straightdope.com/u/DagNation)\ **Post date:** [October 29, 2016, 2:02am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/52 "2016-10-29T02:02:39Z")
> [@DrCube](#): > > You’re tripling the cost of labor, here (more if you include weekends), unless you’re offering walk-in, DIY, unsupervised MRIs, laundromat-style. The marginal hourly cost to run a scanner is mostly electricity and staff. The fixed costs of the imaging center is in the $10-50 million range, and they are good for 20-30 years. Just to pull some numbers out of the air, suppose it is a $30 million installation cost and 30 years of useful life - the annual amortized cost (simple method, not any tax method) would be $1 million. per hour amortized cost running 2,000 hours a year = $500/hr per hour amortized cost running 8,000 hours a year = $125/hr As a guess, the scanner would need two skilled nurse staff and a receptionist = less than $200/hour, electricity less than $10/hour. rounded up total $250. So, $750 per hour if used only 40 hrs per week, $375 per hour if used 8,000 out of the 8,760 hours per yer. As a rough estimate, about 1/2 the per use cost. Cite: none. ---
**Author:** ![GulfTiger](https://avatars.discourse-cdn.com/v4/letter/g/e79b87/32.png) [@GulfTiger](https://boards.straightdope.com/u/GulfTiger)\ **Post date:** [October 29, 2016, 4:22pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/53 "2016-10-29T16:22:57Z")
If we get a public system I want the Euro style that has a private system alongside it. Not the Canadian one where it was illegal to privately treat people for private pay. ---
**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\ **Post date:** [October 29, 2016, 7:31pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/54 "2016-10-29T19:31:18Z")
> [@GulfTiger](#): > > If we get a public system I want the Euro style that has a private system alongside it. Not the Canadian one where it was illegal to privately treat people for private pay. Since when? Canada has a thriving system of private physicians and clinics right alongside the public system. (It is generally illegal for a physician to operate in both sectors–they have to choose to be wholly public or wholly private. That doesn’t make it illegal to treat private patients, however.) Toronto Life, e.g., advertises some of the [top private clinics in that city](http://torontolife.com/style/health-and-beauty/best-private-medical-clinics-toronto/). See this article on how [the system really works](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/). ---
**Author:** ![Kent\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kent_clark/32/105_2.png) [@Kent\_Clark](https://boards.straightdope.com/u/Kent_Clark)\ **Post date:** [October 29, 2016, 9:10pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/55 "2016-10-29T21:10:14Z")
> [@DagNation](#): > > The marginal hourly cost to run a scanner is mostly electricity and staff. The fixed costs of the imaging center is in the $10-50 million range, and they are good for 20-30 years. > > Just to pull some numbers out of the air, suppose it is a $30 million installation cost and 30 years of useful life - the annual amortized cost (simple method, not any tax method) would be $1 million. > > per hour amortized cost running 2,000 hours a year = $500/hr > per hour amortized cost running 8,000 hours a year = $125/hr > > As a guess, the scanner would need two skilled nurse staff and a receptionist = less than $200/hour, electricity less than $10/hour. rounded up total $250. > > So, $750 per hour if used only 40 hrs per week, $375 per hour if used 8,000 out of the 8,760 hours per yer. As a rough estimate, about 1/2 the per use cost. > > Cite: none. Why do you assume a scanner running 8,000 hours per year would last as long as one that only runs 2,000 per year? Wouldn’t its life be measured in number of scans? ---
**Author:** ![DtypeJag](https://avatars.discourse-cdn.com/v4/letter/d/e480ec/32.png) [@DtypeJag](https://boards.straightdope.com/u/DtypeJag)\ **Post date:** [October 29, 2016, 9:19pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/56 "2016-10-29T21:19:59Z")
Nobody likes the insurance companies and certainly most criticism of them is justified. CEO pay, profit margins, overhead etc. They are the obvious scapegoats simply because they are the ones we or our employers send the money to every month. The main drivers of the cost of health care in this country is the cost of medical care. Doctors pay, medical equipment & devices, drug costs, and an outragous amount of bookeeping. All of these are much higher than in other civilized countries with a comparable or higher standard of living. For example a doc here makes about 1/3 to 1/2 more than his foreign equivalent. Most are not on a salary but on a profit sharing plan in a small group that may own expensive equipment such as an imaging machine that must be used as often as possible. Drug reps are allowed to offer incentives (trips to Hawaii) for prescribing the latest high cost pill that usually is no better than the generic. Drug companies are allowed to advertise prescription drugs to the public under the guise of it being “informational” a situation duplicated only in New Zealand. The budget for doing this is about equal to the R&D costs of the drug companies. Someone else on the site found that there are 1 1/2 bookeepers per doctor overall to keep some order and people still can’t understand their bill. We spend something like 40% to 50% more per head than these other countries yet the WHO rates us about 25th to 35th as a system. The Democrats are flat wrong in defending the ABA and its lawsuits but the pressure from the right for reform concentrates only on the large headline grabbing awards for millions of dollars, while the real money is in class action suits and the everyday $10k-$100k awards that are the cause of the enormous premiums most docs have to pay. I realize this is a minor driver of costs but I had to mention it. So, yes the insurance industry is partly to blame for this but is not the major cause of the high costs. Obviously, the profit motive driven health industry is a failure when judged by the rest of the civilized world. When we recognize that Health Care is a right of citizenship not a product to be made a profit on then maybe something will happen. Once we roughly know where the major problems are the only question is what do we do about it? Obamacare was a flawed step in the right direction but had no real cost control measures. They were politically impossible to put into place at the time. The only real option is to adopt some sort of single payer system where it can bargain from a position of strength and can say here is what we will pay, take it or leave it. Unfortunately given the virilence of the alt-right types and our post-fact era I wouldn’t hold your breath. ---
**Author:** ![SmartAlecCat](https://avatars.discourse-cdn.com/v4/letter/s/67e7ee/32.png) [@SmartAlecCat](https://boards.straightdope.com/u/SmartAlecCat)\ **Post date:** [October 29, 2016, 11:09pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/57 "2016-10-29T23:09:20Z")
> [@kunilou](#): > > Why do you assume a scanner running 8,000 hours per year would last as long as one that only runs 2,000 per year? Wouldn’t its life be measured in number of scans? Is it? Many high-tech items life span is governed more by technical obsolescence rather than wear on physical parts. ---
**Author:** ![Skypist](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/skypist/32/169_2.png) [@Skypist](https://boards.straightdope.com/u/Skypist)\ **Post date:** [October 30, 2016, 12:48am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/58 "2016-10-30T00:48:31Z")
> [@DagNation](#): > > “ACA-I: The Obama Care Hope”, subtitled: “Just enough to get America hooked” has been the law for about 6 years now. Nearly all of the provisions are in place, and now we are seeing results! About 2/3 of the people who were previously uninsured are now insured, and lots of people have better insurance for less money. On the other hand, there is a hole in the marketplace plan that does not supplement some people enough, there are a number of states that do not have enough insurers to provide competition, and there are other issues that have prevented the remaining ~10 million from getting insurance. > > Six years into this, most people are at least OK with ACA-I, and at the same time we’ve seen where it has weaknesses. What would you suggest for improvements that will go into the sequel: “ACA-II: Hilary Care strikes back!”, subtitled “even better in the 21st century” > > Some things I would like to see: > An option to buy into Medicare through the marketplace. > Fix the supplement hole in the marketplace. > Remove the ceiling on Medicare taxes (SS tax too, but that is a different thread) > Apply Medicare (and SS) taxes to investment income and some other unearned income. > Extend Medicare to kids up to at least age 18, preferably 26. Long term: all people get Medicare. Employers or individuals could then buy supplemental insurance from the private market to reduce co-pays or to get premium service. > > In 8 years we can look forward to “ACA-III: Return of the ???” Not nearly enough attention has been paid to the fact that the stupid Supreme Court allowed Republican governors to opt out of the Medicaid expansion. Something needs to be done about that, but it will probably not happen in my lifetime. It would have to be universal insurance/Medicaid or Medicare for all with no option for Republican governors to reject it. :o ---
**Author:** ![GulfTiger](https://avatars.discourse-cdn.com/v4/letter/g/e79b87/32.png) [@GulfTiger](https://boards.straightdope.com/u/GulfTiger)\ **Post date:** [October 30, 2016, 2:28pm UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/59 "2016-10-30T14:28:37Z")
Some Classic Tweets on the ACA for everyone to enjoy: [Just a trip down memory lane](http://i.imgur.com/AZhadQ4.jpg) ---
**Author:** ![DagNation](https://avatars.discourse-cdn.com/v4/letter/d/ee7513/32.png) [@DagNation](https://boards.straightdope.com/u/DagNation)\ **Post date:** [October 31, 2016, 8:47am UTC](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841/60 "2016-10-31T08:47:10Z")
> [@DtypeJag](#): > > Nobody likes the insurance companies and certainly most criticism of them is justified. …[but there are lots of other cost drivers] Can you provide any examples of ways to reduce these other cost drivers? [Previous page](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841.md?page=2) [Next page](https://boards.straightdope.com/t/aca-obama-care-is-great-but-it-is-time-to-fix-it/769841.md?page=4)