The Repeal of Obamacare/ACA: Step-bystep, Inch-by-inch

[FuriousGeorge]

@Broomstick

I disagree with you. I’m not going to dress that up in nice euphemisms.

While I defend your right to have your own opinion MY opinion is that YOUR opinion is wrong, stupid, and cruel. If you can’t handle someone disagreeing with you get off the internet.

Leveraging an existing system to include those it misses is stupid, wrong and cruel? Fair enough

@Broomstick

What we need to do is not only expand something like Medicare or Medicaid but also dismantle the private insurance industry.

This is wrong and stupid and cruel in my opinion.

@Broomstick

There’s usually a strong correlation. If I guessed wrong please feel free to proclaim and party affiliation, or lack thereof. Also throw in if your capitalist, [del]communist[/del] socialist, anarchist, libertarian, or whatever. It does help if we don’t have to guess at these things.

You could not guess or assume. There’s that. You don’t have to know what my party affiliation is to know what my position is on the ACA. My party affiliation (assuming I even have one) is completely irrelevant. I could be a Hillary flag waving Democrat and still disagree with ACA. Party affiliation is irrelevant to ones individual issue beliefs.

@Broomstick

I’ve been consistently pro-UHC since I first signed on here, even way back when I worked for the health insurance industry. It’s an unnecessary layer, a parasitical middle-man. I worked for them because that was the ONLY way I could get insurance coverage for my spouse. Now… well, I live in an enlightened state (Republican, contrary to the expectations of many) where they actually make an effort to help the poor, the sick, the injured, and those belong to two or more of those categories. My health insurance is no longer tied to my workplace, which made climbing out of dire poverty much easier because it opened up more jobs I could take without causing undue hardship to the rest of the family. It works better than the “pure” private health industry so many in our current Congress hold up as an ideal.

I disagree. I think privatized insurance has a place and valuable place. I think that Medicaid could be leveraged to take care of the basics and catastrophes for those that need it with privatized insurance adding the extra benefits to those that can and are willing to take it. Because at the core we want the basics and the catastrophes sorted, right? The hue and cry is for the sick and dying who have nothing. Extras and niceties and expanded benefits are… exactly that.

@Broomstick

My spouse was recently diagnosed with cancer. Unlike Walter White, we won’t have to cook meth to pay for his chemo. That’s the way it should be for everyone in this country. The fact it isn’t should be a source of shame to Americans.

I’m not necessarily disagreeing with you.

[FuriousGeorge]

@Euphonious_Polemic

You seem to be under the misapprehension that opinions are the same as facts. If most people are of the opinion that the sun moves around the earth, this does not make it factually true.

You, uh, think quite highly of yourself there… your opinion is not a fact. Sorry to break that to you.

[wolfpup]

@Broomstick

Why are you limiting it to democracies? Cuba has better health outcomes (see this article for a start) and it’s far from wealthy or a democracy.

Universal healthcare has lower costs and better outcomes whether under a capitalist or socialist economy, whether under a democracy or authoritarian government. I see zero reason why it couldn’t work in the US, other than some people being greedy, judgemental, empathetic assholes.

I don’t doubt it. I’ve been comparing the US fiasco to industrialized first-world democracies to try to keep the comparisons to economically similar wealthy nations, and moreover, to nations where health care policies are responsive to informed voter preferences.

Such apples-to-apples comparisons can be quite instructive. We’ve been hearing all about the American aversion to “socialized medicine”, for instance, and how Americans love their freedoms, and how nobody can agree on how to fix the health care system, and all the rest of the usual bullshit. But cross the border into Canada, which is virtually indistinguishable from the US in most practical respects – including a vibrant private sector health care provider system – and single-payer universal health care is so entrenched and valued that it’s a national icon, and not even the most conservative politicians dare to undermine it. How can crossing a border make such a huge difference? The only difference is that Canadians know what it is, having lived with it for half a century. Many Americans know only the bullshit spewed by Republican mouthpieces and shills for the insurance industry.

[Euphonious_Polemic]

@FuriousGeorge

You, uh, think quite highly of yourself there… your opinion is not a fact. Sorry to break that to you.

It’s not my opinion that the US has worse health outcomes than many countries with single payer systems. That is a fact.

It is not my opinion that the US spends far more per capita on healthcare than other countries with single payer systems. This is a fact.

It is not my opinion that doctors spend far less time and money recovering payments from insurers in countries with single payer systems compared to doctors in the United States dealing with multiple (or even a single) insurer. This is a fact.

It is not my opinion that private insurance companies in the United States operate for profit, and seek to maximize that profit, therefore taking dollars out of what is actually spent on healthcare services. This is a fact.

It is not my opinion that prior to the ACA, many Americans were uninsured, and therefore had to rely on emergency room treatments at a very high cost - costs which were ultimately passed along to the consumers with insurance. This is a fact.

[Broomstick]

@FuriousGeorge

Leveraging an existing system to include those it misses is stupid, wrong and cruel? Fair enough.

No, your assumptions about the system were wrong. Medicaid is not the panacea you seem to think it is. As you noted, it does cover kids decently, but adults need coverage too and all to often they are systematically excluded from Medicaid. Just as healthy young people are systematically excluded from Medicare and civilians are excluded from Tricare and VA benefits. It’s not so much a system as a patchwork. If you, for example, expanded “Medicare for all” then it wouldn’t be Medicare anymore.

This is wrong and stupid and cruel in my opinion.

Oh, we could have a small private health insurance industry - many countries with universal coverage do. But nothing like what we have now which functions mainly to delay treatment and drive up costs.

You could not guess or assume. There’s that. You don’t have to know what my party affiliation is to know what my position is on the ACA. My party affiliation (assuming I even have one) is completely irrelevant. I could be a Hillary flag waving Democrat and still disagree with ACA. Party affiliation is irrelevant to ones individual issue beliefs.

No, it is not. If you identify with a particular party, or particular system it does inform your beliefs on topics. That doesn’t mean you can’t deviate from the party line (in fact, I wish more people would do just that) but you can’t stand with a party and claim to be in no way influenced by that party.

I also asked you about other beliefs you may or may not hold - someone subscribing to the repugnant positions of Ayn Rand is going to be different than someone who is an ardent socialist, and both will be different from yet other people.

I disagree. I think privatized insurance has a place and valuable place. I think that Medicaid could be leveraged to take care of the basics and catastrophes for those that need it with privatized insurance adding the extra benefits to those that can and are willing to take it. Because at the core we want the basics and the catastrophes sorted, right? The hue and cry is for the sick and dying who have nothing. Extras and niceties and expanded benefits are… exactly that.

So… what do you define as the “basics” and “catastrophic”? I’d really like to know, because how I define “the basics” may well be different. What I consider “basic”, once covered, doesn’t leave a whole lot left for private coverage to take care of.

I’m not necessarily disagreeing with you.

I believe you are, and I don’t have a problem with that. Disagreement isn’t inherently bad.

[Slash1972]

@Broomstick

No, your assumptions about the system were wrong. Medicaid is not the panacea you seem to think it is. As you noted, it does cover kids decently, but adults need coverage too and all to often they are systematically excluded from Medicaid. Just as healthy young people are systematically excluded from Medicare and civilians are excluded from Tricare and VA benefits. It’s not so much a system as a patchwork. If you, for example, expanded “Medicare for all” then it wouldn’t be Medicare anymore

Sorry, but your criticism of his “Expand Medicare” plan seems to be “You can’t use Medicare, because it doesn’t cover everybody”

Isn’t that sort of the point? Simply expand Medicare to cover everyone. Maybe in stages or whatever.

Call it “Medicare for all” if you want.

Also, I would think in a country where we had UHC, there would still exist private insurance for people who don’t want to use the UHC and can afford better insurance and/or doctors.

[filmore]

@Slash1972

Also, I would think in a country where we had UHC, there would still exist private insurance for people who don’t want to use the UHC and can afford better insurance and/or doctors.

What is private insurance used for in countries with UHC? Are there doctors which don’t take UHC, so it’s cash or private insurance only? Or do you get upgraded treatment like shorter wait times, private hospital rooms, longer rehab treatments, etc.?

[FuriousGeorge]

@Broomstick

No, your assumptions about the system were wrong. Medicaid is not the panacea you seem to think it is. As you noted, it does cover kids decently, but adults need coverage too and all to often they are systematically excluded from Medicaid. Just as healthy young people are systematically excluded from Medicare and civilians are excluded from Tricare and VA benefits. It’s not so much a system as a patchwork. If you, for example, expanded “Medicare for all” then it wouldn’t be Medicare anymore.

Sure, but as I have noted a couple times now, I would be totally on board with expanding Medicaid or Medicare to include those excluded. I don’t care what you call it. If that’s the national health initiative we have in place and it needs to be revisited and expanded. OK, leverage it. Make it available. We don’t need to create an entire new infrastructure that is a hot mess and not really worth the bang for the buck as it were.

There is no panacea, even the ACA isn’t a panacea. There are still millions uninsured for myriad reasons despite the ACA. I happen to think that the ACA is a mismanaged, unneeded mess of a not panacea cobbled together too quickly and thrown in to law. That’s my opinion. I think there are better options.

@Broomstick

Oh, we could have a small private health insurance industry - many countries with universal coverage do. But nothing like what we have now which functions mainly to delay treatment and drive up costs.

Well I disagree with this assessment, but again as you state, disagreement isn’t inherently bad.

@Broomstick

No, it is not. If you identify with a particular party, or particular system it does inform your beliefs on topics. That doesn’t mean you can’t deviate from the party line (in fact, I wish more people would do just that) but you can’t stand with a party and claim to be in no way influenced by that party.

I also asked you about other beliefs you may or may not hold - someone subscribing to the repugnant positions of Ayn Rand is going to be different than someone who is an ardent socialist, and both will be different from yet other people.

I do not join a political party to find my beliefs on topics. I align myself to a political party that more closely aligns with my already held beliefs on topics and it’s vision going forward.

If you join a party in order to be groomed to your beliefs, you are doing it wrong.

In this thread, whether I sleep with a copy of The Fountainhead or an autographed 8x10 glossy of Hugo Chavez under my pillow is irrelevant. My beliefs on ACA are what’s relevant here.

@Broomstick

So… what do you define as the “basics” and “catastrophic”? I’d really like to know, because how I define “the basics” may well be different. What I consider “basic”, once covered, doesn’t leave a whole lot left for private coverage to take care of.

…and therein lies the rub. What I define as the basics will be different than you will be different than a devout Catholic. The ACA defined some basics. I assume you are on board with those but not one hundred percent satisfied. Medicaid has their definition of basics. Privatized insurance has their definition of basics.

I think that’s where the meat of the discussion needs to be. What are the basics? I can guarantee you that neither you nor I will be one hundred percent satisfied unless the Donald has a stroke and tweets at one of us to write the immutable framework for national healthcare coverage.

@Broomstick

I believe you are, and I don’t have a problem with that. Disagreement isn’t inherently bad.

Well, I guess, I think that there should be some sort of national healthcare coverage for those that can’t get it elsewhere. That’s where I don’t think we disagree.

Where we do disagree, however, is that I don’t think single payer/universal healthcare for all is the answer. I definitely don’t think ACA is the answer for all. I don’t think privatized insurance can be the answer for all though there is value in that industry. I think that a national healthcare… default… for lack of a better term is possible with some viable opportunities for more complex and variable coverages by the private companies for those that would take advantage of that.

[wolfpup]

@filmore

What is private insurance used for in countries with UHC? Are there doctors which don’t take UHC, so it’s cash or private insurance only? Or do you get upgraded treatment like shorter wait times, private hospital rooms, longer rehab treatments, etc.?

It depends on the country. To some limited degree this is the case in the UK and Germany, where the private system gets you better amenities, more comfortable hospitals, etc. In Canada, some of those things are true as well, while medically necessary procedures are protected from the influence of money under the principles of UHC to prevent the encroachment of what would essentially be bribery for bypassing medical triage. Any sort of two-tier system for medically necessary health care is prohibited by provincial health care plans as a condition of accepting federal health transfer payments. Amenities are fine – you can have private insurance get you a private hospital room with premium TV service, and for all anyone cares you can have your own butler and dancing girls if you want. But private insurance is fundamentally prohibited from covering medically necessary procedures, nor are doctors allowed to extra-bill for anything deemed medically necessary. Any wait times for anything are triaged purely on medical priority, not on insurance, wealth, or ability to pay.

As I mentioned earlier, my own experiences have been with elderly relatives until a few weeks ago, when I entered hospital for the first time in my long life and the experience was personal. Surgical procedures were considered time-sensitive but not urgent, and in all cases the kinds of wait times discussed with me were like “in half an hour”, “this afternoon”, or “tomorrow morning”. I have no complaints and nothing but praise for everyone involved in my experience, and it didn’t cost me one thin dime in co-pays or anything else. And I am totally fed up with dogmatic right-wing morons who have not the first clue about how UHC or single-payer actually works but insist on pontificating on it [ETA: I don’t mean you – I was just replying to your question. :)]

[Spoons]

@filmore

What is private insurance used for in countries with UHC?

Generally, for the things that the single-payer plan doesn’t cover.

I cannot speak for anyplace else, but here in Canada, for example, the big stuff is covered by the various provincial insurance plans: services of GPs and specialists, and the procedures they perform, are pretty much all covered.

But things like prescriptions, dental care, and vision care are not. (Some exceptions apply.) So, many people have supplementary health insurance to cover those. It is often provided as a benefit by employers, or it can be purchased privately.

[Broomstick]

@Slash1972

Sorry, but your criticism of his “Expand Medicare” plan seems to be “You can’t use Medicare, because it doesn’t cover everybody”

First of all, he said expand Medicaid, not Medicare. They are not the same program and they are not interchangable.

Medicaid is state-by-state and varies considerably between states.

Medicare is Federal and the same everywhere, and would be a better program to expand.

It would help if you used terms correctly, and remember what other people have said.

Also, I would think in a country where we had UHC, there would still exist private insurance for people who don’t want to use the UHC and can afford better insurance and/or doctors.

It’s not so much “don’t want to use UHC” as “want more than UHC offers” - such, as noted, private rooms or other personal perks. Most countries don’t have a two-tier system where the best doctors are all private and the dross are left for those on the public system. Something like purely cosmetic surgery wouldn’t be covered by the public system, but reconstructive surgery would.

[Grim_Render]

@filmore

What is private insurance used for in countries with UHC?

In general not much. Insurance is a smaller part of a general spectrum of private health care, unlike the US where it is nearly synonymous with private health care.

There is travel insurance, of course. Some employers want to insure key workers to minimize time away from work. There is also private citizens who buy medical insurance, but those plans have been fined for offering no benefit, and sometimes the agent selling them forgets to hang up before laughing at the customer (Both are real events).

Private health care is much larger though. Generally on a cash basis. It offers second opinions etc, but the big areas are cosmetic surgeries and government work. Private hospitals can specialize far more than large public ones and so can put in winning bids when big batches of surgeries are put out to tender. Of course the patients don’t pick up the bill if it is a government contract.

@filmore

Are there doctors which don’t take UHC, so it’s cash or private insurance only? Or do you get upgraded treatment like shorter wait times, private hospital rooms, longer rehab treatments, etc.?

It would generally be cash, or government covered, although insurance would be possible but uncommon. I am not dure I understand the second bit, do you mean like a two-tier public system? I’ve not heard of that.

This is to the best of my knowledge accurate for Norway. Other countries may do it differently, there is a vast number of ways to do it.

[raventhief]

I reiterated my question to Clothahump in the other (now closed) thread. If anyone else who supports the repeal of the ACA has an answer for me, I am all ears. Frankly, I am trying to figure out how this is going to work out for my family.

[Leaper]

And considering the person you’re querying said in that thread that the pre-ACA state of affairs was just fine, I reiterate my prediction. I think it’s safe to take it as the actual answer until and unless someone says otherwise.

[Weisshund]

[QUOTE=ThelmaLou;19891003the highly popular* (yes, it is) and highly successful* (yes, it is) Affordable Care Act over the next few weeks, months.[/QUOTE]

That entirely depends on who you ask.

Me?
I had healthcare before obamacare, i had exactly what i wanted, and none of the stuff i did not want need nor would ever use.

Then came Obama care…

1st thing that happend
Company cancelled my plan, said it was no longer allowable.
My only choices were plans that were more than 5 times the cost

2nd thing that happened
My company would up dropping the entire thing all together and said we are all going to go to healthcare.gov because the plans and prices were better.

Well that was not true, they wanted just as much and the doctors in their networks are too far away, i’m not driving 35 miles to get stitches, i’ll do it myself
And i have to take coverage for things i do not want.

I had something i could afford, it got traded for Nobama care, where i get told what i can chose or decline to be covered for, that i can’t afford.

I’m old and beat up and creaky, i dont want to be insured against dying, everybody dies, id just like someone to kindly sew the blood leaking hole i made in myself shut.
But now you cant just get that kind of stuff, it’s not a legal plan.
I dont want insured against the things i have already broken, they are already broken, they arent going to fix themselves any better than they already are.

Though to be fair, it looks like if it just quit working, they would insure me free.
Ok fine, thats great for those who had 0 income, not saying they didnt need health care.

But more people got screwed over than anyone is ever going to admin.

And for the people i know that have the Obama plans, at least where i live, they keep losing doctors, the doctors drop out of the plans and wont take any of them.
They take medicare/medicade/blue cross/tricare and that’s about it.

Who wants to drive 40 miles to a participating doctor?

The whole thing needs fixed, from the insurance, to the hospitals to the doctors to the pharmaceuticals.
What we have now is fixed for some but broken for others, like all it did was trade people around, and that does not fix anything.

And for the record, the only insurance claims i have made in my entire life were work claims, only for stiches and one to remove the rest of the tooth where someone accidently shot a drift pin through my cheek.

Things i broke, i just paid the doc for, you used to be able to do that, now they dont take cash.
And the reason that matters is they offer me rates like someone who has claimed 32 liver transplants and a new puppy (not to be used by mods in goal posts)

[elucidator]

The line from Obamacare is that if your insurance was “unacceptable” under the new rules, its because your “insurance” doesn’t really deserve the name. You said it yourself, you made few if any claims. So, really, you never found out what you had, because you didn’t need it. Someone sells you an umbrella that dissolves in water, you may not find out until it rains.

[John_Mace]

That’s a good point. Who better to tell us what we need than Obama? I’m forever grateful, as I could never do that myself.

[wolfpup]

@John_Mace

That’s a good point. Who better to tell us what we need than Obama? I’m forever grateful, as I could never do that myself.

I’m fairly sure that if you thought about it, you could do it yourself. Here’s how it works where I live. If I have a health problem, and in the opinion of a doctor medical intervention is necessary, then it’s covered. In full. 100%.

It really is that simple. When I read about US private insurance schemes whose policies appear to be several hundred pages of conditions and exclusions, or Medicare parts A, B, C, D, X, Y, and Z, it makes my head spin. When I’m sick I just go to a doctor, or a hospital. I never see a bill, never pay a penny. It’s called medical care. It’s a simple concept. Everyone should have it.

[John_Mace]

@wolfpup

I’m fairly sure that if you thought about it, you could do it yourself. Here’s how it works where I live. If I have a health problem, and in the opinion of a doctor medical intervention is necessary, then it’s covered. In full. 100%.

It really is that simple. When I read about US private insurance schemes whose policies appear to be several hundred pages of conditions and exclusions, or Medicare parts A, B, C, D, X, Y, and Z, it makes my head spin. When I’m sick I just go to a doctor, or a hospital. I never see a bill, never pay a penny. It’s called medical care. It’s a simple concept. Everyone should have it.

I’ve said several times on this MB that I’d prefer true, UHC to Obamacare any day. Obamacare (for whatever good it does) makes the worst part the US’s h/c system even more entrenched than it was before.

[wolfpup]

Fair enough, from that perspective there’s certainly an argument to be made that the ACA could have been structured a lot better. Still, from the evidence I’ve seen I think for most folks it provides some strong net benefits, but it’s frustrating that it leverages a fundamentally broken system. The public option was a tremendous missed opportunity.