kind of a GQ/IMHO subject, but there is too much potential for intense debate:
Assume that “Obamacare” never passed, or was successfully completely repealed before any of its provisions could have any effect. What would the US healthscape look like today?
My instinct is to imagine that it would look more or less exactly as it did 5 years ago. If a year of debate and stuff had yielded nothing, I am thinking the AHIPA group would be busily working on crafty new fleams for draining even more revenue from as many people as possible.
Would we have been able to manage any kind of improvement to what is still being described as a broken system? Or would there now be the “selling across state lines” RW scheme in place, along with more deregulation?
I don’t know why so many people are comfortable with our failed health system. Either people don’t use it enough to know how broken it can be, or they are too blinded by nationalism to understand that we have serious problems.
Had the PPACA not passed, I don’t see much changing. About 10 million new people have coverage (that may grow to 20-30 million by the end of the decade) so for them it means something. But most people are fairly healthy most of the time pre-65 (and by old age you get medicare). So even having insurance isn’t really something you’d notice. I’m assuming most people either don’t meet their deductible or don’t go much above it most years. With high premiums, copays and deductibles there are still just as many barriers to seeing a doctor as there were pre-PPACA. I was uninsured through most of my 20s. Had I had the protection of my parents insurance until I was 26 that would’ve been nice, but I maybe visited a doctor once or twice in my early 20s so it really wouldn’t have mattered. So people still have high barriers to getting care, and they usually don’t use insurance enough to hit their deductible. Plus you can still go bankrupt if you get sick because premiums/copays/deductibles/etc are high plus if you buy a plan that only covers in network care and you get OON care, or if the insurance company refuses to cover your care you are fucked. So in many ways not much has changed. Some of the more inhuman parts of our system were abolished but enough inhuman parts were left that this is just a half a loaf.
The PPACA doesn’t offer real solutions to our out of control medical costs. Nobody has any real plans with that as actual cost reduction would piss off too many rich and powerful people. The only real hope of that is if entrepreneurs and market forces somehow drive down costs combined with the fact that for many people medical costs are unsustainable. There is still demand for medical care, but little supply of affordable care. I don’t see political will in that front anytime soon, at least not on the federal level (even the states have been pussies about it). I think, sadly, the public and small start ups will be the ones that drive down medical costs by innovating new ways to do business and new devices that work (almost) as well as existing devices and services but cost much less. And the big motivation will be, again, there is a massive market for affordable quality health care in the US but not really much supply. We have a supply of insanely expensive medical care of quality that ranges from excellent to a dangerous waste of money, but not really a supply of affordable high quality care. But even that could be a problem. Maybe large conglomerates will lobby to have the competition banned. I recently read a Doctors group was opposed to the walk in clinics at retail stores. They said it was because they cared about patient health, but the fact that patients could get (roughly) the same quality medical care for 1/4 the price played a role too I’m sure.
Without the PPACA I doubt any other legislation would’ve gotten passed in this congress.
One good thing Obamacare did was outreach. In just the states that didn’t expand coverage, almost 4 million people were eligible for Medicaid prior to its passing but never applied; who knows how many more could have been covered earlier in states that expanded too. Thanks to the publicity for Obamacare getting info out to the eligible, many of these people are now taking the coverage they could have had all along if only they’d been aware of it. So…if the AHCA hadn’t passed, these people would still be uninsured.
One impression I seemed to be getting from HCR opponents – especially the more, um, adamant ones, was that having the government involved in healthcare would have far-reaching effects. In order to reduce outlays for treatments, the government would start to ban things like twinkies and soda pop. Encroaching upon our precious freedom of slow suicide.
(“Ban” is the strawdog for “tax heavily” – which I personally have a hard time objecting to: freedom is not free, nor should it ever be.)
The number of uninsured would be vastly higher. If wages are increasing 3% or so a year and health insurance premiums are increasing 10%+ a year it is obvious that this is going to price a lot of people out of the health insurance market.
If Obamacare hadn’t passed Congress might have passed the alternative Republican proposals which were being discussed at the time. Does anyone remember the details? I think they were things like tax credits for health insurance.
Now of course the Republicans are much more conservative than they were in 2009 (all the Tea Party types) and have no interest whatsoever in doing anything about the health care crisis–that’s why you see them almost always say “We need to repeal Obamacare” and virtually never say “We need to replace Obamacare with this alternative”.
Minus: We’d have a lot fewer people with health insurance.
Plus: The Teabaggers wouldn’t have formed. The Republican wave of 2010 wouldn’t have happened, fewer states would have gerrymandered their districts after the 2010 census to guarantee Republican overrepresentation, Obama would have still easily beaten Romney, and Nancy Pelosi would have kept her gavel all these years.
The tea party was becoming a thing by February of 2009. Like it or not, they arose when a black democrat with a supermajority in congress came to power. They were going to come about anyway and the health reform bill was just gasoline on the fire, not the spark. TARP also pissed many of them off (which they blamed on Obama naturally).
I don’t think the GOP ever had serious ideas about health reform. They just don’t want to come across as not having a plan for some reason. There never was a ‘replace’ in repeal and replace, it is just a talking point.
GOP health reform is designed to empower corporations, starve the beast via tax cuts and dismantle the social safety net, not to provide high quality affordable care. Allowing insurance to sell across state lines, block grants for medicaid, raising the medicare retirement age, tax cuts for insurance, etc. Any solutions they have or will have will fall along those lines.
I wouldn’t have had a full blood workup a couple weeks ago warning me that I’m not likely to die anytime soon, and the gummint would be paying the quarter-mill, so far, on my wife’s treatments. Though I still think the dialysis company has a hell of a lot of nerve charging what they do per treatment. $4200 three times a week is a lotta book, but that’s BCBS’s problem now.
Those may have been offered by Congress as an alternative to the ACA, but once Obamacare was dead they would have opposed them as well, exactly the same way they proposed an ACA like system in opposition to Hillarycare, but opposed it when there was any chance that it would actually be written into law.
Well, if Obamacare hadn’t passed, the economy wouldn’t have cratered with companies scared of hiring people, and the stock market wouldn’t be under 10,000. Oh wait. That’s what the Republicans said would happen. Not what actually did.
I suspect we’d be seeing much higher increases in insurance costs (though only 23% of the reduction in price rises are attributable to ACA) and a much weaker healthcare industry. The Times noted that insurance companies, originally against it, are doing great and strongly support keeping it.
It is too soon to see cost reductions from the various parts of the bill supporting evidence based medicine, but they should happen.
Well, Vermont wouldn’t have passed its single-payer plan, given that it relies extensively on ACA funds for financing. Paradoxically, however, CA MIGHT have passed SB 810 back in 2012, which would’ve created a single-payer system here. With the ACA, legislators here are far too concerned with ensuring the success of Covered CA, which, by all accounts, is going swimmingly.