I guess we’ll see over the next few years, assuming your government doesn’t get shut down again at each implementation stage of the plan.
Well, you forgot the bit about companies having to spend at least 80% of premiums on actual healthcare. So there’s at least a little something on the plus side of the ledger.
There’s a lot on the plus side. problem is, the known minuses were enough that more people opposed the law than supported it.
We live in a nation where most people have insurance they like, and some don’t have access to insurance. Any solution that covers the uninsured by raising rates on the insured is not going to go over well, and predictably, it didn’t.
Yes, I simplified - but the penalties in the early years are small. Subsidies may reduce the price, but they do not change the actual cost. The cost is simply shifted, and with more people receiving services, costs would increase unless there are savings in other areas.
I agree with this - to the extent it affects the price of services. It doesn’t change the cost and I’m not sure if it exceeds the other increased costs.
Mingled in with the minuses was (and is) a great deal of “this is a minus because Obama says it’s a plus”, is worth pointing out.
Here’s the real problem that Americans wanted dealt with that the ACA does nothing about: the cost of health care. It is well documented that:
- Most prices that the doctor/hospital come up with for services and procedures are pulled out of their ass with no basis for actual costs.
- On the schedule of fees, insurance companies pay a discounted amount with the non-insured pay full price - a price that even when discounted for the insurance companies still makes a profit for the doctor/hospital.
- A growing mistrust of doctors thought to be in the pockets of big pharma. Certainly a lack of any innovative thinking in diagnosis and treatments.
- The de-emphasis of primary care which would lower costs and improve health.
So yes it’s cool that every American can theoretically get insurance but at what (financial) cost for everyone else and does it really resolve the healthcare issues?
The problem with cost controls and health care are clear. Everyone demands the latest technology. If your child is afflicted with a disease that will kill him or her, you don’t want 1950 technology or even 2011 technology. You want to do everything known up until 11 seconds ago to solve the problem. Even if it is absurdly expensive. You want and demand the latest and greatest.
For everything else that is impossible. Joe Sixpack doesn’t drive the latest car with GPS Navigation, heated seats, and XM radio. He doesn’t live in the house that is climate controlled from the internet. His TV isn’t 3D with all of the porn channels and whole house surround sound.
But with health care, we never say that a person with average means has to settle for average health care. I’m not saying we should, and I don’t have the solution either.
Don’t forget the fact that reimbursement rates for PCPs has been strangling the PCP area for 20 years and that we are soon to fall into a PCP shortage that will change the medical landscape dramatically. We already have a decent wait time (most people will nod if you ask if they have a 14 day wait for their PCP). The ACA says that you can receive care from a PA or NP, but that isn’t even looking to be enough to fill the gap.
That right there. The only question right now is which changed plans should still be grandfathered and which plans should lose their status and truly be called “same in name only.”
Can we all agree that that’s the real issue here? That that’s where the debate should be? Because it seems to me that one side is saying “premiums change every year” and the other is saying “greedy companies jack up the prices.”
I’m not looking for agreement on the answer, here. I’m looking for agreement on what the real question is.
Emphasis added. Are you sure about that? 
That’s why someone has to be able to say “no”. Ezra Klein has made the case for years that the government is in the best position to do so. When insurance companies say no it becomes a national news story. Government can say no without consequences.
You are only in the position you are because the US government made a conscious decision to encourage people to obtain things like health insurance as fringe benefits tied to their employer instead of spending the same money in the open market. Employer-sponsored health insurance is free from income tax, while individually sponsored health insurance is not.
The base knowledge required to make wise decisions about buying beer or choosing which book to read is far lower than that required to either make long-term financial investment decisions or to make medical decisions. That’s why we have experts, like “financial advisers” and “doctors” to consult… if you can afford to do so.
People who choose a plan with a 3k benefit cap because the premiums are cheap are making a very poor decision because what you need is coverage for the truly catastrophic, the million dollar (and more) injuries and illnesses. Basing your coverage decision solely on cost is poor decision making. Yes, I understand that premiums can put insurance out of reach - I’ve been there more than once in my life. That’s a slightly different problem that “Is this health insurance actually a good buy for the money you spend?”
Some of the plans being eliminated are basically crap and SHOULD be eliminated. Are some good plans being trashed, too? Yes, probably, but I don’t which of those two categories are the majority here.
A far more serious problem in my mind are the extremely limited networks for some of the plans offered on the exchanges.
I don’t quite understand the point. If hospitals could raise costs with a guarantee they would always be reimbursed, the costs would skyrocket.
Instead, the Affordable Care Act has provisions to control costs. For one way to view this, see:
For another, see:
New York outlaws for-profit hospitals. Now, the great majority of Americans can choose to go to non-profit health care providers. But I haven’t heard many saying that for-profit ones should be closed. If people start being against such, this would likely be handled at the state level.
As for the high prices charged to (and often left unpaid by) by the non-insured, this is because they need to have someone negotiate rates for them, since you can’t do that when sick. This is what the Affordable Care Act is all about.
Are you saying that providers should be forced to charge everyone the same price? And that government should set the price? This sounds a little like the just price theory of the Middle Ages. Then, it also sounds a bit like parts of Canadian health care. We could debate that.
I favor outlawing of drug advertising, include gift-giving such as free lunches. So I hope that is what you are getting at here.
Forget the Cochrane Collaboration. Forget the standard of care. Instead, use innovative diagnoses and made-up-just-now treatments. This is what the American people want? Or do I misunderstand?
We must not read the same newspapers. Chipping away at the specialist bias of US healthcare is a significant part of the Affordable Care Act. See:
No country ever has, or ever will, “really resolve the healthcare issues.” But for tens of million of moderate income people who never before could afford health coverage, now they can. This makes the Affordable Care Act a big step forward. Play with this calculator to see how it affects such people:
How so? News story (made up): Here’s little Suzie, age 7. Just diagnosed with Baddeathkilleosis. It killed everyone who had it within 6 months until July, 2013 when doctors in Switzerland developed a procedure to stop the growth of the disease and allow patients to live a normal life. However, the procedure is very expensive, and costs $1.2 million dollars. The government said “no.”
People would be outraged and talk about how Suzie’s treatment is only 0.000000X percent of what we spent in Iraq or on the stimulus and want to fire and/or hang the government official who didn’t approve little Suzie’s treatment. I’ll bet a poll would show that 87% of Americans would believe that the government should pony up. Any politician who spoke out against it couldn’t be elected dog catcher.
That’s a part of democracy.
Here’s MediaMatters on why this “OBAMA LIED!” kerfluffle is a load of crap.
No, it’s not a load of crap. I know Obama is a lawyer, but it is disingenuous to say that “If you like your current insurance you can keep it” when you are crafting regulations that will make that current insurance not compliant with the new mandate.
Oh, some of the plans are garbage and don’t provide proper coverage, etc. (leaving aside the fact that more than half of the population can go without maternity care or oral contraception, both examples of minimum coverage) but that isn’t what he said. If I like my coverage I can keep it. If I like paying less for garbage coverage, then I can keep it. It’s what the man said.
Now, he had his lackeys go out and give cryptic messages about how “some” plans might be tossed because they were bad. But why would the average American who “liked” his current coverage think that applied to him? Since he liked it, he thought it was good coverage. And even if he was wrong and it really was’t good, the President himself said he could keep it.
Is the takeaway from this that Americans should have read the whole bill and predicted future regulations instead of taking the President at his word? He clearly didn’t mean the very words he said.
Well, that tears it! I’m certainly not voting for the man again! :rolleyes:
Here is more, including a few more links.
Obama’s ‘You Can Keep Your Plan’ Failed To Anticipate How Much Americans Love Cheap Crappy Plans That Cover Nothing
He and the backers of ACA repeatedly said that Republicans and opponents who said that Obamacare would cause people to lose their health plans that they were lying Nd trying to scare the American people.
It turns out there are now millions of people who are losing their health plans who wouldn’t have if the ACA hadn’t passed.
I’m an Obama supporter but anyone who denies his claims weren’t, at best, grossly misleading is lying either to you or to themselves .