Indeed. I’ve greatly enjoyed the series thusfar, and look forward to his future OPs “Obamacare: Threat or Menace?” and “ACA: We’re all gonna DIE! AIEEEEEEEEE!!!”
Well, given the high hopes that supporters of the law were expressing a short while ago, a promise that we’ll “muddle through” certainly sounds like a downgrade to expectations.
Yet even the report you linked to predicts bankruptcy of the trust fund by 2029, while the Trustees of Medicare say it will happen in 2026. Eonwe is basically correct in asserting that Medicare is careening towards disaster and neither side has a feasible proposal for stopping that.
No. Is there something wrong with discussing Obamacare? Are we all just supposed to accept our cancelled policies, higher premiums, and lower benefits in silence?
Is there something wrong with the numerous threads you’ve already started to complain about those things?
Obamacare extended that trust fund by 12 years, from 2017 to 2029. That gets us a heck of a lot closer to the end of the baby boom generation. And those estimates do not include all the long-term effects of cost control measures.
To call that “not addressing the problem” is setting crazy high expectations. It does not solve the problem. We can all agree on that. But it is extremely rare for any single piece of legislation to completely solve any large national problem, and this one is a doozy.
It is just absolutely false that Democrats and Republicans are in parity in refusing to deal with Medicare. Republicans have done nothing but add to Medicare’s costs in the last two decades, substantially, while Democrats–and Democrats alone–have cut its costs substantially without substantially affecting benefits.
I’m not aware that I’ve started any prior threads about cancelled policies, higher premiums, or lower benefits, though perhaps some other people have. I recall starting one thread about the malfunctions on the federal exchange and another about the low enrollment numbers thus far. But the thing about Obamacare is that it’s failing in so many ways that one thread couldn’t possible be adequate for all of them. Heck, we haven’t even had a thread about the soaring premiums, the failure of high-risk pools, the risk corridors, the sky-high deductibles in bronze and silver plans, the fact that many patients are losing access to their doctors, … Any of these topics is surely worth its own thread.
Are these problems directly related to the ACA? Because high deductibles, rising premiums, and limitations on care-givers are complaints people have had with * insurance companies * for years. I’m not hearing any suggestions from you – all I’m hearing is “Is Obamacare going to be a huge failure, oh, please, please let it happen.” Which is getting tiresome.
I’m pretty sure that if the ACA was repealed, we’d be dealing with sky-high deductibles, high premiums, but probably not high-risk pools because the insurance companies would just outright refuse to insure the high-risk patients.
This whole “obamacare is a failure” meme is ridiculous! How can it be a failure when the main part will not start for 6 more weeks? And even then, it will be months before there is any financial reporting from insurance companies. This is like saying a kid is failing out of high school when s/he is still in the 6th grade! Let it happen, then get super critical and jump on any minor problems. Sheesh!
Also, this is the Heritage Foundation plan, not a Democratic or Obama plan, so any problems are really on the shoulders of the right, on the state governments that did not do their part, and on the obstructionists in congress. The right plan would be a single payer system with increased Medicare payroll deductions, but that did not happen - lets hope it happens soon.
As Richard Parker explains in #24, the ACA does make some inroads on the high cost side. But the fact that US healthcare takes 17.6 percent of GDP (compared to 12.0 percent in second place Netherlands) means it will take a lot more to bring our costs down to first world international norms. And until then, premiums and copays will be high. And even at first world international norms, the fact is that health care is a very big expense.
As for limitations on care-givers, this is tricky. Some of the best health plans (Kaiser in California) limit provider choice much more stringently than the exchange plans. Fact is, everyone in Eastern Massachusetts cannot go to Massachusetts General*, and not everyone in the bay area can go to UCSF Medical Center. And, for that matter, not every child needing serious care in southeastern England can go to Great Ormond Street. Whatever system is worked out for determining who goes to the most prestigious centers (and who gets seen by a prominent professor rather than a resident) is going to be in some measure unfair. In my area, the Hospital of the University of Pennsylvania, which controls its physician network, charges Blue Cross much more than do also-rans. So, somewhere, there have to be tradeoffs. Politicizing it won’t change that. To answer your question, it is actually less related to ACA than to the fundamental unfairness of some aspects of life.
- Often considered the best US hospital, although US News and World Report is currently ranking it at #2 behind Johns Hopkins.
Yes, they are. I assume we all agree that deductibles do not fall into a binary “high”/"not high"category. Suppose a person’s current deductible is $2,000, and then the ACA cancels that plan and the best they can afford is a bronze plan with a deductible of $5,000. They might reasonably have complained about the $2,000 deductible first, while being a lot angrier about the much higher deductible in their new plan. Similar logic prevails for the issues of premiums and network limitations.
The basic facts are these: private insurers will only offer a plan if they expect it to make a profit. The ACA greatly increases the expenses that the majority of plans must cover. Hence, to make a profit on such plans, the companies must make changes to either send out less money or take in more money. The inevitable result is higher premiums, higher deductibles, and more limited networks. While Obama may be surprised to learn about the results of the law that he’s been championing for three-and-a-half years, others have been predicting these outcomes since it was first written.
No, it is not the inevitable result at all. You’re right that if they have more they have to pay for, then they must be getting more money somehow. But you’re ignoring the obvious places where that money is coming from: more people buying insurance, and many people buying it with government subsidies.
It’s fine to have an opinion about what will happen with premiums. But it is ignorant to assert that we know as a matter of fact or of economic theory that premiums must go up as a matter of Obamacare.
Whether pre-subsidy premium costs increase substantially will depend on how many people join up (obviously a problem right now) and on how successful the cost control measures are. To assume you know the answers to either of those questions, as you’ve done here, is to wildly overstate our knowledge about how this will all shake out.
So that’s why everybody calls the PPACA “Heritagecare”?
This may well be the most desperate excuse yet. The PPACA was written by Democrats, voted for by Democrats, and signed into law by a Democrat. A few weeks ago, the Democrats were patting each other on the back as they listed the seats they would pick up thanks to the law’s upcoming success. Now apparently you’re hoping to deny any link between it and the Democrats? Good luck with that.
As it happens, I just read an article today. The basic argument is that the law was designed with full knowledge that it would drive up premiums for many people, that the ‘wonks’ have known this since the beginning, but that now ordinary people are discovering it for the first time.
When he was seeking passage of the Affordable Care Act, one of the things President Obama really wanted to be able to say was that his plan didn’t increase the deficit. So the law was designed to hold down explicit spending by relying heavily on mandates and cross-subsidies to get people covered without direct government outlays.
That choice is causing a lot of the political headaches the president is facing today.
Obamacare’s explicit funding sources are mostly new taxes on people with high incomes and cuts to Medicare provider payments. But some of the “shadow fiscal policies” in Obamacare are effective tax increases on people with moderate incomes; these people didn’t expect to face a tax increase under Obamacare, and now that they’re discovering they are, they’re getting angry.
This is another example of the closing wonk gap: Members of the general public figuring out facts about Obamacare that policy wonks on both sides of the debate have known for years.
Obamacare relies heavily on cross-subsidies as it greatly expands the market for individually-purchased health insurance. Premiums in this market will be tightly regulated so young and healthy people pay more than they’re expected to get back in claims and older and sicker people pay less. This is a tax, of sorts, on a subset of young and healthy people that goes to finance health care for people who need more of it. And the individual mandate is designed to make sure they pay the tax, one way or another.
That sounds right to me. The Democrats made promises such as “What we know for sure the bill will do is that it will lower the cost of buying non-group health insurance” and “everybody will have lower rates, better quality care and better access”. At the time that they said these things, they knew that large numbers of people would face rising prices. They were merely hoping to prevent us from finding out for as long as possible.
Not deperate at all. Here is a point by point comparison between the 1993 plan and the ACA.
The key points of each are certainly quite similar, if not identical, regardless of who gets authoring credit.
This confused me.
By using a stringent definition, one expert claimed in 2010 that Canada, Cuba, and North Korea are the
only countries that have a true single-payer system.
Using less stringent definitions, or, really, any definition, Japan, Israel, Switzerland and Germany are multiple-payer.
Personally, I would like to see something like the German system – universal coverage with competing non-profit insurers.
And a two-tier system where everyone who has any money to spend buys supplemental coverage, for extra comfort. (e.g., a private room rather than a ward, etc.) The taxes on the supplements help subsidize the basic care.
(This is the Australian system, among others, and seems very workable indeed.)
**Is the real health care disaster yet to come?
**Sure. Any minute now. With a little patience it will all end in tears, you mark my words. Just as true today as it was when Catullus said it.
Obama delenda est
- Cujo
No, thank Pasta someone passed something that is moving us in the right direction, even though it is a crappy plan full of half measures. The democrats managed to push something through, and I am happy for that.
The point is that the left bent over backwards to accommodate the right, and yet still the right is having a fit and blaming the left for a “failed policy” that has not even started yet.
The major flaws in ACA/Obomneycare are mostly due to compromise with the party of “NO”. If we could have single payer - or at least something closer to it - there could be much less of a roll out problem. For instance there might not be cancellations to worry about, and registration might be much less complicated.
It is logical to be happy with the direction of movement while still lamenting the horrid and intentionally obstructive compromises that were made.
“We have to do something” is an idiot’s plan. You should expect more of the Democrats than that they should provide a different kind of fuck up.
Every single person who voted for this bill was a Democrat. They did not bend over backwards to accommodate the right, and they didn’t have to: they had the votes to pass whatever law they wanted without the Republicans’ help, and that’s exactly what they did.
Not one Republican voted for the ACA and people like you still pretend that it’s their fault. If the ACA was moving us in the right direction, why are you so intent on finding a scapegoat?