Your wit is both good and original. Unfortunately, what is original is not good, and what is good is not original.
- Samuel Johnson (paraphrase, attrib. w/o source)
No, the plaintive cry of someone who actually groks that government is a societal construct to serve societal ends. I’m sorry you don’t want to hear that.
It looks like there is a post out there now claiming that half of individual market people will get lower premiums with “little changed” plans, and the other half will pay higher premiums. We don’t know specifically why the other half will pay higher premiums, but the post source speculates in part it’s because of the restriction on very high deductible plans. (I believe you’re eligible for an HSA with a deductible of $1,500, so anything above $1,500 is technically a HDHP. I personally consider something with a deductible above 6500-8000 or so to be bordering on “catastrophic” only coverage and that appears to be what the health law limits to some degree.) But the hard numbers I’d want still aren’t really there.
For one, the half who “will get roughly similar plans and pay lower premiums” might include someone like Edie Sundby. She’ll probably be eligible for lower premiums from a marketplace plan, that provides “technically” (in terms of deductible, coverage amounts etc) good coverage, but gives her access to only 1/3rd of the doctors she has used to fight cancer. It just shows that we need more in detail, hard numbers to really know the answer here.
To be honest, I doubt we can get those numbers in a convenient dataset.
Probably the best we’ll get is a year from now “satisfaction survey” where people basically tell us how they feel about their PPACA exchange plans versus their individual coverage, for persons who transitioned from the private individual market to the exchange plans.
Interestingly an argument I read today, and agree with, is that Obamacare might actually be unprecedented in its ambition and riskiness. The reason being is simple, while a complete overhaul to an NHS style single payer system would seem “very drastic” it’s a complete solution that several countries have followed that basically we know a lot about. Maybe not here in America, but it’s a known quantity.
The German approach (everyone must buy health insurance, States operate plans that cover any who want to be in them at free or reduced cost to the poor, private plans are an option for anyone who wants a different option), is also drastic compared to what we have because it totally abolishes the employer group health system and also creates State-run plans and there is a firmer mandate (we just have a minimal tax fine which is small enough to be meaningless at least initially.) But in reality, the German approach isn’t that drastic, we know how it works–pretty well.
Most of the civilized world uses some form of universal healthcare either similar to the single payer NHS or the universal but multipayer system the Germans and others use.
Our system with the PPACA instead is trying to do a lot of things all at once. We’re trying to expand government coverage for the poor through Medicaid expansion probably one of the few areas of the PPACA that quite obviously will work as intended. We’re trying to make sure we preserve (for some reason) the employer-linked group health plans, but at the same time we add new coverage requirements to insure those plans provide good coverage (but which may cause some employers to stop offering health insurance entirely.) However, while our goal should really be to move everyone out of employer provided insurance, we actually fine employers who don’t offer insurance, which creates some level of incentive for employers to keep offering health insurance (and by extension employees to continue expecting insurance to be linked to employment.) We created exchanges to theoretically insure anyone who really wants coverage can go out and get it (if they are so poor they can’t afford it, they can get expanded Medicaid, if they are so poor they can barely afford it, they’re typically eligible for subsidies), but we’ve guaranteed the exchanges will be relatively small and full of sick people because we have done nothing to address the fact the vast majority of the country will continue to receive group coverage through an employer and many of the uninsured poor will get expanded Medicaid. It’s sort of like we’re saying “well, we don’t want to mess with employer provided health care. But we do want these exchanges for people who don’t have that, but we want them in Medicaid if they’re poor. But we want the exchanges to be big and robust so exchange plans are affordable and all the insurers don’t drop out of them due to going in the red. People can choose the exchange over employer coverage, but we’re not offering them any subsidies if they do no matter their income because we’d really prefer they stay with employer coverage, even to the point of fining employers that don’t offer it…even though as long as most people have employer coverage the exchanges will never be as robust as they could be.”
So yeah, in some ways by creating a Byzantine law that attempts to apply strange pressures on hundreds of aspects of the current health care system (which few will defend rationally), the PPACA is far more risky, ambitious and in danger of failing than would have been a full overhaul. It seems strange to me when Obama chose to push it in over extreme objections from much of the country and everyone in Congress not in his party, and did so using reconciliation in contravention of norms (not the first such contravention, but it’s a contravention) he would do it with a strange bastard law and not some sweeping overhaul. He already got zero support from across the aisle, I don’t understand why he didn’t go all in with reform much more likely to work (because we’ve seen it work in other countries.)
You have this bizarre idea that “connect the dot” is witty and not stupid. You’re wrong.
I’m not even sure that satisfaction surveys are the best way to measure the programs effectiveness
To suggest that the program is a failure because there is a substantial number of people who are worse off is naive. Any change in any rules will have winners and losers. If Obama had a magic wand that -poof- could feed every hungry child in the world, such a thing would probably hurt the profit margins of small farmers, but on the whole be a good thing.
With something like insurance this effect is magnified. It is the nature of insurance that for the vast majority of people they don’t get out of it as much as they put into it. It is only a tiny minority for whom this investment pays off. But for this minority it pays off in a big way. So that on the average it is a very good thing to have. the ACA is just expanding this further. The majority will be lucky enough not to see benefits, but since they could fall at any time into the unlucky minority that benefit greatly, overall people will be better off for having it.
The problem is that most people don’t think beyond their immediate circumstances. As Homer Simpson would say “Well, you bought all those smoke alarms, and we haven’t had a single fire.” Also given that bad news makes better television than good news, it is possible that those upset about it will put enough pressure on it that it will be gutted. If that happens it will unfortunately be another 20 years of suffering before the political will can be summoned to try again.
The problem is that he misjudged the stubbornness of the opposition against him. He thought that by coming out with a compromise plan that had previously been put forward by the right he could get easy bipartisan passage. After having compromise after compromise thrown back in his face it became clear that a bipartisan solution wasn’t possible. But by then it was too late to go back to a more extreme single payer or even a government option plan.
And so the Terr solution to the problem those unable to afford healthcare and those with pre-existing conditions is …
More directly, even those who do not lose the injury/illness lottery *still *come out ahead, by knowing that it would not destroy them and their families if it were to happen. They can plan and act without that fear hanging over them.
There was a real chance of a partial public option, consisting of lowering the eligibility age for Medicare to 55, but it needed Lieberman’s support and his sponsors in the Hartford insurance industry wouldn’t have it. They calculated, correctly, that they could keep all the new policy-buyers and their premiums to themselves with enough pressure from Ol’ Vote #60.
But phasing in expanded access to the well-proven, highly-efficient Medicare system is still the obvious and most-feasible way to transition to single-payer, and get the bloated, parasitic insurance industry out of the game.
Community clinics. Doctors working pro bono. Donations. Charities. State and local government-initiated programs. Hell, if some state wants to try completely socialized solution - let it try. I’d move out of that state, but if enough people like it, all power to them.
And how many thousands of spaghetti suppers does it take to cover a round of cancer treatment? I guess we better start cooking.
The problem with this is that there is the danger of the ill flocking to states that provide health care to residents, thus overloading the system. I know that if I didn’t have insurance to cover my wife’s neuro-muscular disease I would start looking for jobs in Massachusetts. In terms of trying out a socialized solution we have dozens of examples around the world and every one of them works better than what we had.
I don’t hold much with “dozens of examples around the world”. I didn’t move to the US because it was like everyone else. I moved to the US because it was, at the time, an island of freedom in an increasingly statist world (not so much anymore, and getting worse all the time). So I object to the movement to be like everyone else. If I wanted a European system, I would move to Europe.
Let all those *other *suckers pay for it, yeah. Good luck when it’s *your *turn to need some.
But not the feds? What’s the difference?
US Constitution. And relative ease of voting with your feet.
I don’t see much migration to the states that provide wider welfare to its residents. In fact, the net migration is mostly the other way.
And Terr gets his wish.
Kudos for a brave effort. The perils are too obvious to outline, and besides, somebody else will do it. But gutsy little Vermont shows the rest of us what courage is. Bravo!
And yet another broad, sweeping generalization without a hint of citation!
I am not in Vermont. I am not paying for that scheme, and I am not getting any benefits from it. So if it works, fine, if it fails, even better (pour encourager les autres).
Your warm and generous humanity is exceeded only by your sparkling sense of humor.
State-to-State Population Migration - you can clearly see the trend
You mean the supremacy clause? Or the commerce clause, maybe? Perhaps you’re not aware that “states’ rights” is a fiction and has always been one.
America, love it or leave it, huh? 