OBAMA/TRUMPCARE MEGATHREAD

[Texsox]

I think it is amazing that he was even born alive thanks to modern medicine. He should have been dead a long time ago but thru our medical system he is alive. He even stated it himself, born 20 years earlier or perhaps in a different place, he wouldn't be here at all. It says he lost his coverage. Do we know why?

 

Yet we're clinging to a financial model of medical treatment that is from WW2.

[Jake]

When society as a whole is paying for it, there is still a finite supply. If it takes 25% of the available supply to keep him healthy, and that same 25% can keep 100 other people health, who gets the care? Do you tell the 100 people that they can't get what they need because his care is so extreme and expensive that he has used it all up? Because it will happen. There is only so much money, time and facilities to go around, and those may be shrinking as less people decide to become doctors.

 

For one, more people are deciding to become doctors by every measure. More apply, more enroll, more matriculate.

 

Your market-based approach doesn't make sense because there isn't a finite supply of healthcare in the American context. We have the resources to care for everyone for as much as they need. This is evidenced by the fact that we spend more per person on healthcare than anywhere else in the world. Letting the free markets run wild has, of course, led to a horrifying inefficiency in our expenditures...but we could start to take care of that too.

 

If you're really worried about doctors...we could also start to prioritize our education spending and make the process of becoming a doctor (or college educated in general) much less expensive. I was shocked when I applied to a Canadian college and was offered a $12k/year scholarship; I thought this was a complete non-starter, I'd never be able to afford it. Woops! That actually covers all costs for an international student at a top-rated university! And yes, that even includes housing.

 

The best part is that if I decide to go there (why oh why did I decide to study American politics? It appears Canadians don't give a s*** about my specialty) I also get in on that free healthcare.

 

Why should Canada do better than us on this stuff? They're not even the only ones...we're pretty much the worst in the Western world. Ideology is holding us back from everyone having a better, healthier, happier life.

Edited September 22, 2013 by Jake

[Texsox]

Also affecting supply is how people are accessing care. Currently the best option for people without insurance is to visit an ER for everything. We need cheaper access. A whole lot of minor illnesses could be treated more effectively by PAs and Nurse Practitioners.

[greg775]

Obamacare is a disaster.

 

Is it a disaster because nobody is cooperating? The Rebubicans are fighting it every way possible? One thing is certain. Everybody needs health care and the system before Obamacare was OK for the rich and s***ty for everybody else. Something needs to be done.

 

It didn't help these govtment officials are so stubborn. I was reading this week Lawrence Memorial Hospital would have been given 1.2 million this year or something had Brownback not declined the boost from Obamacare. Instead they are getting something like 2 million dollars less and are in dire straights because of Brownback. WTF is going on? People in this state elect Republicans no matter what. They don't even know the issues or the track record of these s*** candidates.

Edited September 23, 2013 by greg775

[Brian]

Also affecting supply is how people are accessing care. Currently the best option for people without insurance is to visit an ER for everything. We need cheaper access. A whole lot of minor illnesses could be treated more effectively by PAs and Nurse Practitioners.

 

I was talking to my doctor about health care costs during a session and he brought up this exact fact. Illegals and people without insurance legally can not be turned away in an ER so they basically get taken care of than split without paying a cent, driving up costs for others to make up for the difference.

 

I had to be taken to an ER one night a year ago and I walked in and the place was full of people, that I will unfortunately stereotype, as illegals or low income folks. Luckily I called my DR ahead and didn't have to wait.

 

Too bad we are so far from a single payer system.

[Jenksismyhero]

Also affecting supply is how people are accessing care. Currently the best option for people without insurance is to visit an ER for everything. We need cheaper access. A whole lot of minor illnesses could be treated more effectively by PAs and Nurse Practitioners.

 

Walk-in clinics are everywhere and are relatively cheap for those without insurance. And I agree they should be used more. The problem is a visit to a walk-in clinic still costs someone money. Stroger's ER is free. Maybe if the free option was taken away or made more difficult to obtain...

[Cknolls]

Is it a disaster because nobody is cooperating? The Rebubicans are fighting it every way possible? One thing is certain. Everybody needs health care and the system before Obamacare was OK for the rich and s***ty for everybody else. Something needs to be done.

 

It didn't help these govtment officials are so stubborn. I was reading this week Lawrence Memorial Hospital would have been given 1.2 million this year or something had Brownback not declined the boost from Obamacare. Instead they are getting something like 2 million dollars less and are in dire straights because of Brownback. WTF is going on? People in this state elect Republicans no matter what. They don't even know the issues or the track record of these s*** candidates.

 

 

You know what? The Dems do the same s*** in this state. How can we stop this madness?

[Jenksismyhero]

http://www.forbes.com/sites/theapothecary/...family-of-four/

 

It was one of candidate Obama’s most vivid and concrete campaign promises. Forget about high minded (some might say high sounding) but gauzy promises of hope and change. This candidate solemnly pledged on June 5, 2008: “In an Obama administration, we’ll lower premiums by up to $2,500 for a typical family per year….. We’ll do it by the end of my first term as President of the United States.” Unfortunately, the experts working for Medicare’s actuary have (yet again[1]) reported that in its first 10 years, Obamacare will boost health spending by “roughly $621 billion” above the amounts Americans would have spent without this misguided law.

 

$621 billion is a pretty eye-glazing number. Most readers will find it easier to think about how this number translates to a typical American family—the very family candidate Obama promised would see $2,500 in annual savings as far as the eye could see. So I have taken the latest year-by-year projections, divided by the projected U.S. population to determine the added amount per person and multiplied the result by 4.

 

Simplistic? Maybe, but so too was the President’s campaign promise. And this approach allows us to see just how badly that promise fell short of the mark. Between 2014 and 2022, the increase in national health spending (which the Medicare actuaries specifically attribute to the law) amounts to $7,450 per family of 4.

[Balta1701]

Wow, that may very well be the 2 most completely distinct numbers I've ever seen treated as representing the same thing.

[Jenksismyhero]

Yeah, let's excuse it on a technicality that he meant premiums, not overall costs.

[Jake]

http://www.forbes.com/sites/theapothecary/...family-of-four/

 

http://thinkprogress.org/health/2013/09/23...macare-article/

 

One economist interviewed by ThinkProgress, the Center for Budget and Policy Priorities’ Paul Van de Water, described this calculation as one of the stupidest things he’s read in a long time and likened it to arguing that college costs will increase for a “typical” family if the federal government adopts policies that help lower-income Americans afford college education. Yes, the nation will spend more on education if more students enroll in colleges and universities, but the “typical” student already attending college won’t; she or he will continuing paying tuition at more or less the same rate, while the newly-enrolled student will presumably benefit from some sort of subsidized tuition rate.

 

The same is true here. The so-called “typical” family that Conover describes already receives health care insurance through their employer. The existence of 30 million newly-insured people — many of whom will receive tax credits if they purchase insurance in the law’s exchanges — won’t do much to move their premiums in one way or another. (Health advocates hope that the law will slow the rate of growth in health care spending, but that’s a long-term proposition.)

 

In fact, if anything, the CMS report that Conover links to shows that Obamacare is a good financial proposition. In 2022, total health care spending will increase by 1.5 percent, while the number of non-elderly adults with health care coverage will increase by 9 percent. That’s a pretty good deal any way you slice it.

 

Conover produces “an average that doesn’t mean anything for anyone,” Van de Water told ThinkProgress. “He understates the value of the coverage that uninsured will be getting, but greatly overstates and mis-states the cost that the typical family will experience. Typical is employer-sponsored insurance and that is not being affected to any significant extent.”

 

“This is a typically misleading use of data by opponents of Obamacare,” MIT’s Jonathan Gruber added. “The bottom line is that the government has consistently reported that Obamacare will raise national health spending by about 1 to 2 percent.” “This is a small fraction of the typical 5 to 7 percent annual growth rate in health care – and is a small price to pay for insuring 30 million or more Americans.”

 

http://www.middleclasspoliticaleconomist.c...diocy-from.html

 

First of all, this is not $7450 per year, but over the entire 10-year (or more likely 9-year; he usually refers to 2014-22) period. So the he's hyping shock value that isn't there. As he explains, he divides the $621 billion by total population over the period to give a per capita cost, which he then multiplies by 4 to get the cost to his "typical family of 4." So what we're actually looking at, before we start tearing up his calculation, is ($7450/9)/4 = $207 per capita higher spending per year on average. Recall that in 2011 the United States spent $8174.90 per person on health care (see link on how to navigate to the ultimate source for this data, stats.oecd.org).

 

Second, Conover doesn't understand present value. He writes, "Of course, all these figures are in nominal dollars. In terms of today’s purchasing power, this annual amount will rise steadily." Of course, it is just the opposite. A dollar in 2022 is worth less than a dollar today. In 2013 dollars, the amount is less than $207 per person per year (how much less depends on what you consider an appropriate discount rate). How does an editor not catch this? I have a screen shot to memorialize the error after it eventually gets fixed.

 

...

 

Then, there's the little matter of the newly insured. By 2022, according to the CMS report Conover cites, 30 million more people will have insurance than would be the case without Obamacare. While many of those people will be receiving subsidies, a lot of them will be paying something for their insurance, adding even further to the sources of income that don't come out of what the "typical family" will pay.

 

Finally, the new 30 million people will be covered very efficiently. $621 billion divided by 9 years is $69 billion per year, divided by 30 million people is $2300 per person per year. While that figure is too low because we won't be insuring all 30 million immediately, remember that 2011 U.S. health spending per capita was $8174.90. Any way you look at it, the newly insured will be costing far less per person than those currently in the insurance system.

 

There you have it. Forbes' most-read story of the day (with over 26,000 Facebook shares and 3400 tweets as I write this) is simply false. Between all the new taxes and the premiums from the newly insured, you can cover the total increase in health care spending. The typical, already insured family isn't going to see increases due to the rise in overall health care spending. You add 30 million new insured at a far lower cost than what we currently spend per person. And the editors didn't catch a blatant error on present value.

 

 

[DukeNukeEm]

Oh healthcare, its the one issue I flip back and forth on the more I think about it. I just can't seem to nail down what fits within my personal opinions on government.

 

On one hand, I support at least the public option but really more towards an NHS style system. I've said on this forum a million times, governments's only job is to protect our rights to life, liberty and economic freedom from those who would infringe upon those rights either domestically or from abroad. Insurance companies and healthcare providers have crossed this criminal line in the sand where the system they've been in charge of has become so bloated and broken that they're actually violating our right to life (obviously) and our right to economic freedom. The first one should be clear, the second will take a sentence or two to explain. When confronted with the cost of healthcare people do not do a cost/benefit analysis, the value someone puts on their own life is infinite. Insurance companies and providers know this, so they go absolutely apes*** with these prices, its all just arbitrary--the market has no say because people will spend every cent they have if it means saving themselves or a family member. Healthcare happens to be that one thing we all need universally, rename healthcare to the more apt label life care and you get the true meaning: We are all alive, we all need something done to preserve that condition.

 

So is it within the government's purview to provide healthcare? Probably, I mean maybe, I mean... no?

 

The problem is causation, the idea that government should pass laws against the act of our rights being taken away but not the circumstances under which they are taken. Ban murder, not thr instruments of murder. In this case I have a very difficult time figuring out if the current system is actually engaging in act of killing peope or just a cricumstance behind which murder happens. Does that make sense?

 

Also, the government should never pass a law protecting one set of rights by violating another. This gets so muddled in my head I cannot even articulate into the written word without being even more disorganized than I usually am.

 

Either way, Obamacare is an awful law because it empowers rotten institutions with taxpayer money (enough of which they get already via outrageous premiums) and then forces us to buy stuff from them. I can't get over the second one, its just wrong on so many levels and shows that were headed down this brutal path of corporate socialism, were all forced to buy stuff from a set of government protected highly subsidized companies who have zero incentive to compete because they are fool proofed by our money. Then on top of that we are forced to contribute to their profits by law. So we get put in a state of wage slavery where our bills perfectly match our paychecks and the part that gets taken out in taxes is filtered through the state to be handed out in whatever corrupt way they can think of before being brought back to the very people who we are already paying mandated money to.

 

You cannot defend it. I don't care how in the bag you are for Obama because he's you Great Liberal Hope, this law of his is f***ing evil on a vast array of levels and has to be stopped at nearly any cost.

[Jake]

Oh healthcare, its the one issue I flip back and forth on the more I think about it. I just can't seem to nail down what fits within my personal opinions on government.

 

On one hand, I support at least the public option but really more towards an NHS style system. I've said on this forum a million times, governments's only job is to protect our rights to life, liberty and economic freedom from those who would infringe upon those rights either domestically or from abroad. Insurance companies and healthcare providers have crossed this criminal line in the sand where the system they've been in charge of has become so bloated and broken that they're actually violating our right to life (obviously) and our right to economic freedom. The first one should be clear, the second will take a sentence or two to explain. When confronted with the cost of healthcare people do not do a cost/benefit analysis, the value someone puts on their own life is infinite. Insurance companies and providers know this, so they go absolutely apes*** with these prices, its all just arbitrary--the market has no say because people will spend every cent they have if it means saving themselves or a family member. Healthcare happens to be that one thing we all need universally, rename healthcare to the more apt label life care and you get the true meaning: We are all alive, we all need something done to preserve that condition.

 

So is it within the government's purview to provide healthcare? Probably, I mean maybe, I mean... no?

 

The problem is causation, the idea that government should pass laws against the act of our rights being taken away but not the circumstances under which they are taken. Ban murder, not thr instruments of murder. In this case I have a very difficult time figuring out if the current system is actually engaging in act of killing peope or just a cricumstance behind which murder happens. Does that make sense?

 

Also, the government should never pass a law protecting one set of rights by violating another. This gets so muddled in my head I cannot even articulate into the written word without being even more disorganized than I usually am.

 

Either way, Obamacare is an awful law because it empowers rotten institutions with taxpayer money (enough of which they get already via outrageous premiums) and then forces us to buy stuff from them. I can't get over the second one, its just wrong on so many levels and shows that were headed down this brutal path of corporate socialism, were all forced to buy stuff from a set of government protected highly subsidized companies who have zero incentive to compete because they are fool proofed by our money. Then on top of that we are forced to contribute to their profits by law. So we get put in a state of wage slavery where our bills perfectly match our paychecks and the part that gets taken out in taxes is filtered through the state to be handed out in whatever corrupt way they can think of before being brought back to the very people who we are already paying mandated money to.

 

You cannot defend it. I don't care how in the bag you are for Obama because he's you Great Liberal Hope, this law of his is f***ing evil on a vast array of levels and has to be stopped at nearly any cost.

 

There's some good stuff here. I think you've made a compelling libertarian argument about the healthcare issue. I say libertarian and not free market because you rightly see that there is an issue of liberty at hand. The markets have infringed upon our right to life - and your reasoning is very good, I haven't tried to put this in market terms before but you're exactly right. We can't be rational actors in the market when we will say yes to any price to save our life. Even in free market theory, these things don't work if we can't act rationally. This is why libertarian god Friedrich Hayek advocated for a strong social safety net, arguing that the poor are too likely to be coerced due to their lack of resources to be rational actors.

 

As far as this issue of circumstance, I'm afraid I can't help you there. Instead of trying to balance this complicated argument just to fit your normal model for political thinking, why not just try another angle? It is clear that it may meet your condition for needing policy. Let's think about from a utilitarian viewpoint, instead. Right now, we're terribly inefficient at health. Advanced measures say that 1. we spend more per person on healthcare than anyone and 2. the healthcare received in the USA is not as good as many other developed countries. This suggests we have to do something.

 

From there, still thinking as a utilitarian, what can we do to improve things? Getting everyone insured and doing it without great financial peril to those that are most vulnerable seems like a top priority. We can agree that Obamacare meets this need.

 

I also agree that there are some serious issues with this law and that is that we are still married to a private system. The funny thing is that while I am certainly more anti-business than you are, I don't see this as so immediately dire. For one, I can see a potential stimulus here, though it is sadly (in effect) a stimulus of businesses rather than people, at least in some cases. On the bright side, maybe I can justify this as a stimulus from the bottom if it is saving people money on their health costs. It will do this for some people for sure, I am just uncertain as to those people's buying power.

 

I am not ready to wholly embrace that this law is less competitive. The system, as it is, is not very competitive. For people with pre-existing conditions that cause them to be denied coverage, they have no choices beyond a casualty program. Many people lack the capacity to "shop," which is what this law is making easy. It has been difficult for people to act rationally in the marketplace when it has been highly inconvenient at best to comparison shop. This should help with that. Beyond that, the fact that subsidies don't cover everything still causes everyone to act as a consumer and make choices based on how much money they are willing to spend. In the near term, with so many new consumers, there should be a race to the bottom as well. My parents are excited to be off of casualty insurance (neither has a pre-existing condition by the way, they are just a bad mixture of slightly too old and slightly too fat) and have the ability to use the exchanges. They won't even get a subsidy.

 

I think the main reason we feel differently, though, is the way we interpret lawmaking. Your distrust of the institution leads you to believe that the only way the law might be amended over time is to make it worse, more pro-corporate, anti-choice, etc. I am optimistic that this can be a step in a different direction, towards a Canada-style single-payer system that keeps the medical industry innovating in the market but keeps healthcare consumers from being victim to an oppressive insurance scheme. I am hopeful that over time, we can see healthcare as an essential right in a thriving democracy (I wonder if the ninth amendment will be used to argue this) and that private institutions are eroding that right.

 

[TaylorStSox]

I'm not going to get into a political debate, but it just amazes me that we live in an industrialized, supposedly progressive country where you can pay about 35% tax and still not have universal healthcare. I work around 60 hours a week. I'm the working poor. I'm fairly well educated, have a degree, provide a service people need and want, yet still can't afford health care. Its really embarrassing for us as Americans. I know several Europeans who work in the same industry, and their standard of living is on a whole different level. It really is night and day. Sure, my occupation is my choice. Yet, the amount of working poor in this country is just insane.

[greg775]

I'm not going to get into a political debate, but it just amazes me that we live in an industrialized, supposedly progressive country where you can pay about 35% tax and still not have universal healthcare. I work around 60 hours a week. I'm the working poor. I'm fairly well educated, have a degree, provide a service people need and want, yet still can't afford health care. Its really embarrassing for us as Americans. I know several Europeans who work in the same industry, and their standard of living is on a whole different level. It really is night and day. Sure, my occupation is my choice. Yet, the amount of working poor in this country is just insane.

 

You said what I feel. I'm even more mad our Kansas government turned down some major benefits in the new plan for people.

Please respond to Taylor's post, people. I am also embarrassed for our country. He said it best. We pay TONS of taxes and a major illness could take away all my savings in a f***ing second once I get laid off (thanks to f***ing greedy corporate assholes who have laid off half of America!!!!)

[Jake]

I have found that many people are not very convinced by comparing to other countries.

 

A couple factors - we tax less than many other countries, especially on the highest earners. Also, we have a giant defense budget while many of the people providing better services are essentially relying on our military for their defense. Mostly, though, we are generally far less willing to implement government services for some reason or another. There is a strange fear of anything that could be called socialist, which is how we failed to implement universal healthcare while Truman, JFK, and Nixon thought about implementing these things. The Nixon administration, cooperating with Ted Kennedy, actually got pretty close while marketing it as "Medicare for all" after people really started to love Medicare.

[Jenksismyhero]

I have found that many people are not very convinced by comparing to other countries.

 

A couple factors - we tax less than many other countries, especially on the highest earners. Also, we have a giant defense budget while many of the people providing better services are essentially relying on our military for their defense. Mostly, though, we are generally far less willing to implement government services for some reason or another. There is a strange fear of anything that could be called socialist, which is how we failed to implement universal healthcare while Truman, JFK, and Nixon thought about implementing these things. The Nixon administration, cooperating with Ted Kennedy, actually got pretty close while marketing it as "Medicare for all" after people really started to love Medicare.

 

The fear is that more government intervention/services just means more problems in the future (GENERALLY speaking there). You want a liberal point on that, look at the military industrial complex. Once the government starts printing checks, it never stops. it just continues to grow.

 

And as someone who deals with Medicare a decent amount for work as an attorney, it's f***ing terrible. I feel awful for my parents/in-laws as they are soon to be medicare eligible. It's a broke, corrupt system with stupid limitations (limitations that are put in place because it's f***ing expensive to pay for old people's healthcare. Healthcare which in many cases is purely elective.)

 

I'm with Duke. I see the need (and responsibility) of our society to make sure people don't die on the streets and to protect them from a broken system that makes healthcare unaffordable. HOWEVA, Obamacare does jacks*** to help with the real problem with our healthcare system - the cost of the actual care/treatment/procedures. f*** doctors, f*** big pharma and f*** just about everyone involved in any sort of medical equipment ever created. They're all vastly overpaid/overpriced and THAT is the reason why healthcare is unaffordable. It has nothing to do with the availability of insurance.

 

And I have yet to understand how adding 30 million people on the government payroll is going to lessen the cost of healthcare for everyone. Someone explain that to me. You're talking about poor people here. Let's assume they can afford to pay their premiums. What happens when these people want to start having surgeries and can't afford to 3-5k per yer deductible. Who gets stuck with that bill? You and me. And we're back in the same spot we're in today.

[Texsox]

Doesn't reducing the number of patients that never compensate the providers lower costs?

[Jenksismyhero]

Doesn't reducing the number of patients that never compensate the providers lower costs?

 

I don't know who you are referring to here. The people that can't afford healthcare now go to doctors/clinics that still get paid by someone (medicaid/non-profits, etc.). So nothing changes there.

 

And what business do you know of that will drop their prices when their demand goes up?

[bmags]

Insurance companies use purchasing power leverage to force lower costs for procedures and medicine. Pushing more people into insurance would facilitate that. I do find it funny that during the creation of the law the idea of cost controls was DOA, yet as soon as it was removed all the sudden the biggest rightwing critique was "it does nothing to control costs!". Well it does throw the book at every marginal cost control idea to control costs, more price transparency, batched payments, etc. It also pushes a bunch of people into medicaid which has cost controls on payments.

[Cknolls]

What happens to states' budgets when the federal medicaid subsidy ends in a few years?

[cabiness42]

I don't remember if I've mentioned this idea here before or not. Federal civilian employees can choose from dozens of different plans from a variety of providers, with the employer (government) picking up 3/4 of the cost and the employee paying the other 1/4 via pre-tax payroll deduction.

 

Because the workforce is so large (> 2 million), the prices are lower than what some random person could get buying directly from an insurance company and also lower than what small employers could get for group plans.

 

Why could the government not just pass a law requiring insurance providers to offer the same prices to every American that they offer to Federal employees? Then, even if private employers aren't providing it to employees, at least the employees have affordable options. Then you could throw in some kind of incentive for employers to cover some/most/all of the cost.

[Jenksismyhero]

Insurance companies use purchasing power leverage to force lower costs for procedures and medicine. Pushing more people into insurance would facilitate that. I do find it funny that during the creation of the law the idea of cost controls was DOA, yet as soon as it was removed all the sudden the biggest rightwing critique was "it does nothing to control costs!". Well it does throw the book at every marginal cost control idea to control costs, more price transparency, batched payments, etc. It also pushes a bunch of people into medicaid which has cost controls on payments.

 

That was my beef from day one. Along with the "tax" requirement. I did like the pre-existing condition part of the law though.

[Jenksismyhero]

What happens to states' budgets when the federal medicaid subsidy ends in a few years?

 

Kick the can down the road. It's what states/governments have been doing for decades.

[bmags]

I don't remember if I've mentioned this idea here before or not. Federal civilian employees can choose from dozens of different plans from a variety of providers, with the employer (government) picking up 3/4 of the cost and the employee paying the other 1/4 via pre-tax payroll deduction.

 

Because the workforce is so large (> 2 million), the prices are lower than what some random person could get buying directly from an insurance company and also lower than what small employers could get for group plans.

 

Why could the government not just pass a law requiring insurance providers to offer the same prices to every American that they offer to Federal employees? Then, even if private employers aren't providing it to employees, at least the employees have affordable options. Then you could throw in some kind of incentive for employers to cover some/most/all of the cost.

 

You mean like setting up exchanges?