This may be true, but most people don’t get their insurance from the exchanges so it’s not just the 15% that feel the brunt of the costs, but it includes the much larger # of people who get insurance not through the exchanges.
I think the ACA has been great for those people who are now able to get insurance who previously could not. For everyone else it’s pretty terrible.
Forgive me for not having all of this down cold, but I think you are right. The GOP Congress held up funding during the Federal Budget showdown, but ended up funding it.
But that still leaves a bunch of states who have not supported Medicaid Expansion, leaving those states (I think) without access to the larger subsidies available from the Federal government.
Nope. The primary goals were to cover more people, and not to get rid of the private health insurance industry (the latter a (failed) concession to get Republicans to vote for it.)
Well before it was passed, most analysts were pointing out that it would do little or nothing to costs of health care itself (although it might reduce premiums by adding people to the pool), and that it was merely a first step to a more comprehensive system. But the complete dysfunction of congress’s ability to govern has basically locked it in at “first pass” stage, and it’s not looking like we’re going to make any progress on it any time soon.
Health care’s been rising at high rates for my entire adult life; it’s hard to tell whether costs would have been higher or lower without the ACA – it’s entirely possible it did reduce costs.
[QUOTE= HMS Irruncible]
The ‘affordable’ part of the ‘affordable care act’ is accomplished by lowering the cost of insurance, which is accomplished by spreading risk over the largest possible pool of consumers. You can argue whether ACA is accomplishing that…
[/QUOTE]
Since it isn’t accomplishing that, I don’t see how it can be argued. The cost of insurance is going up, not down.
You are talking about rationing, which is at once the only possible answer, and an answer no politician will talk about.
It’s political suicide to say “we are going to let people die in order to save money.” And there is no other answer.
No, it isn’t different in Europe - they ration health care there already. If the US doesn’t ration based on ability to pay, we are going to have to ration based on something else.
:shrugs: This is just after-the-fact rationalization as soon as it was clear that Obamacare wasn’t going to do what Obama said it would.
Regards,
Shodan
Don’t worry, Hillary and the Republicans will work together to find a solution.
Sure, analysts said that. But analysts aren’t the people who put folks in office, and who sway public opinion.
I never said the goal was to get rid of the private health insurance industry, and I don’t intend to fight that strawman you’ve decided to inject into this conversation.
[QUOTE=President Obama]
"The cost of health care has weighed down our economy and our conscience long enough. So let there be no doubt, health-care reform cannot wait, it must not wait and it will not wait another year,"
[/quote]
[QUOTE=President Obama]
But let there be no doubt – the cost of inaction is greater. If we fail to act, premiums will climb higher, benefits will erode further, and the rolls of uninsured will swell to include millions more Americans.
If we fail to act, one out of every five dollars we earn will be spent on health care within a decade. In thirty years, it will be about one out of every three – a trend that will mean lost jobs, lower take-home pay, shuttered businesses, and a lower standard of living for all Americans.
[/quote]
The ACA was the result of Obama attempting to address skyrocketing costs, which left people broke and uninsured.
Lack of coverage was (one) symptom of the larger issue of health care costs. The ACA was a finger in the dyke. We managed to get people covered, which is great. The ACA may have accomplished all it intended, but the larger backdrop of health care reform and cost reduction against which the ACA is cast remains largely untouched. Which is sad, because that was the real issue in the first place. It’s what Obama was after, and it’s what those of us who supported him and our congresscritters in that mission were after.
I don’t care if I have insurance if I can’t afford it, or if I can afford it but my premiums are crazy high, or if those things happen in 5 or 10 years.
I’m not sure where this desire to rewrite history comes from. Well, I do. It’s a reflexive defensive response to criticism, and a desire to elevate the rhetoric around the outcome.
For sure. Don’t get me wrong, I think that in the short term the ACA was undoubtedly a net positive. It’s just that it does nothing to address in a meaningful way the fundamental problem we have in this country WRT health care, which is skyrocketing costs.
Exactly. Point is 20MM more people have coverage now.
That will save the taxpayers a bundle in health care.
I suspect you’ll have little disagreement with that from pretty much anybody.
You’re assuming facts not in evidence.
Costs have not changed in a way that is measurable to make this determination. More people have coverage yes, but the overall costs of the services provided may overall be more than it was before. The cost of care for the people newly insured may decrease, but the overall cost of healthcare could also increase for the larger population.
Sure. Though I’d also note that (as one of your articles mentions) A) cost-based health care decisions, risk-mitigation decisions, and others already happen all the time. It’s folly to believe otherwise (and, I might add, it was disgustingly harmful and deceitful for right-wing politicians at the time to stand up and pretend that this would be something new and terrifying), and B) most businesses involved in health care in this country are for profit, so I don’t know how anyone would expect anything other than a ‘rationing’ approach anyway. Health care doesn’t grow on trees, right? It’s a business, right? Do Republicans expect private enterprise to give away their product just because?
It’s only ‘political suicide’ to say that because the Republican party worked so very hard to instill fear about it in the minds of their constituents (while at the same time being the party of “fiscal responsibility”).
It’s pretty slimy for a right-winger to stand up in 2016 and say “There’s no other choice but rationing.”
You are forgetting that Public health, which is mainly County Hospitals, etc, provide free service to the poor. This costs billions. That saves the taxpayers.
Looking at the cost of County hospitals and saying that is sufficient to to conclude on net savings would be as shortsighted as looking at the cost of rising premiums elsewhere and concluding on net increases in expenditures.
Yes, but cost reduction and affordability are not the same things. As much as I support healthcare reform, I wish Obama had not sold ACA as making medical care more affordable for everybody. Considered purely as an insurance product, that’s not possible. It was about getting more people access to healthcare. Part of that was about introducing higher risk consumers without charging them higher premiums, which necessarily means higher premiums for everybody else.
UNLESS - some magic happens and costs get reduced. That’s how ACA proponents assured us that premiums would stay the same, you’d get to keep your plan, taxes wouldn’t need to go up, and everything would be rosy. But cost reduction was never the point of ACA. Cost reduction was never the primary goal. It was just part of the explanation of how we’d get to have our cake (more people covered) and eat it too (we’d get equal or greater value for our premiums).
I chose an extreme example, but it’s not necessary. Instead choose something in the $15,000 range, which is pretty normal for a lot of common procedures. Or make it a medication that costs $200 a month. Cut it by a third, and we’re still in financially dangerous territory for lots of people.
This is why healthcare is an insured expense, not a cash-paid expense. Disaster strikes. You shouldn’t need to have $30K on hand in case a drunk driver hits you and you need extensive rehab.
I agree with that, but I don’t think punishing people for being unlucky is part of that conversation, nor do I think forcing customers to value-shop for every medical need would necessarily result in better long-term outcomes.
As to the “death-panel” discussion, I tend to think that a very high-deductible plan for catastrophic care might be a better tactic. Then consumers would have some incentive to be prudent about their health and the demands they put on the healthcare system, but they wouldn’t live in fear of getting wiped out by a random catastrophe.
Eh. I still think you’re putting the cart before the horse. Obama embarked on his reform journey with a stated goal of reducing costs (or reducing cost increases, which is kind of the same thing). If you read his speeches from early on in the process, it was about addressing affordability full stop. When it got down to brass tacks, what our government was able to accomplish was much more focused on access to insurance than the larger picture. But it was an outcome of a process that was initially intended to address cost. No, the ACA was not designed to do so, but the year of lobbying and speechifying and all that stuff that lead up to it was all about making health care affordable.
So, to me, the ACA failed at providing the reform that we were promised. It certainly succeeds at doing the things that are written into it.
I don’t disagree with this, and I don’t know where the idea comes from that I’m making some kind of argument for an insurance-free world. My only point is that for situation/procedure X, we should be making thoughtful decisions about what and how much we’re willing to pay for. Maybe ensuring that we all have $30k available for rehab after a car accident makes sense. Maybe ensuring that we all have $700k available for rehab doesn’t. I don’t know. But let’s talk about those things.
On the same page, completely (again, not sure where the strawaman that I want to punish the unlucky comes from. Ultimately, I think you and I are nitpicking positions from the same side of the argument, for the most part).
The self-employed taxpayer who is now paying 20K to 40K per year for health insurance and deductibles isn’t exactly saving a bundle.
OK, maybe I have you wrong then. Often when people start talking about health consumers taking more responsibility for their spending, they’re headed toward a discussion of making it fee-based. There are logical arguments for that… I mean, if I’m spending someone else’s money, what’s my incentive to be frugal? I don’t know how to create those incentives without eliminating health insurance altogether, but maybe somebody smarter than me can think of something.
Did I miss a cite for the OP’s claim?
Here you go. Washington Post.
The USA already rations on the basis of ability to pay and whether your insurance company will stump up for the treatment.
In the UK at least a heart transplant is done on the basis of medical need and likelihood of success. I know which method of rationing makes sense to me.
thanks. So this was helpful:
The rest of the piece reminds me how complicated the market is.