Monday, April 17, 2017

ACA: To Do or Not to Do

I moved these comments before they distracted us away from the violence and gore...
"Sean points out that "something" is rarely if ever a single action, and still more rarely the perfect solution to the problem. If Obamacare has taught us anything, it is that "doing something" that complex is highly unlikely to be the right thing.." Jerry

"Whereas doing nothing was demonstrably worse." Anonymoose
My view is that "doing nothing" or "doing ACA" would have both had consequences...  Both good and bad.  

17 comments:

jerrye92002 said...

Well, there is "doing something" and then there is "doing the RIGHT thing." Being unable to discern the right thing is typical of pontificating politicians, so doing nothing is the best course of action and that, Congress will not do. I still claim the status quo ante (doing nothing) was better than Obamacare, certainly for myself.

"... the thing about my jokes is that they don't hurt anybody. ... But with Congress — every time they make a joke it's a law. And every time they make a law it's a joke." Will Rogers

John said...

I do agree that ACA has:
- cost the wealthy a lot of money.
- cost the middle class folks significant money
- helped the poor / lower income folks in multiple ways
- helped people with pre-existing conditions in multiple ways

As I said: there are good and bad aspects...

That of course is why citizens are conflicted...

John said...

Now that is a cool link, since you can filter by certain demographics.

jerrye92002 said...

It's all a whitewash. Poor people with pre-existing conditions could get on Medicaid, or could participate in high-risk pools, or buy insurance with a limited PEC exemption.
Helping the poor doesn't seem to have happened, since most of them were eligible for Medicaid to begin with, and getting the more expensive (total cost) Obamacare policies left them without care, since they couldn't afford the huge deductibles. That is no doubt why, contrary to justifications for the ACA, emergency room visits for routine care went UP. The simple downside is that as a whole society, we are paying more and getting less. The only thing keeping this thing afloat are lies and fear-mongering.

I have been suggesting that Congress do one simple thing: repeal Obamacare lock, stock and fish barrel, but with two added provisions. First, Congress must be covered by it, as the original legislation specified and until an alternative is available, and second, that anyone with an Obamacare policy now may keep it as long as they like. IN other words, let's UNdo the do.

Anonymous said...

It's all a whitewash. Poor people with pre-existing conditions could get on Medicaid, or could participate in high-risk pools, or buy insurance with a limited PEC exemption.

It is the basic argument. We should shift the risk of the most expensive health care to the taxpayer. I don't know why that appeals to people really. There is no reason to think that would reduce the cost of health care in America. It doesn't change the basic dynamic of health care policy which is that the burden must fall somewhere.

Congress must be covered by it, as the original legislation specified and until an alternative is available, and second, that anyone with an Obamacare policy now may keep it as long as they like.

Generally, the idea that policy decisions affecting three hundred million Americans should be based on the concerns of 535 highly atypical individuals who live on the east coast, has little appeal to me. I mean really, what is the argument for projecting the private concerns of such a small and unrepresentative sampling of America on the population as a whole?

==Hiram

jerrye92002 said...

The argument here is that Congress ought to live by the laws they pass for the rest of us. This was wisely written into the ACA but shortly after it was passed, our Anointed Ones found that it was completely unworkable for their staffs, vastly inferior and less desirable than the plans they liked and wanted to keep. SO, Obama saw to it that they got a cobbled-together executive-order exemption. Forcing them back on to Obamacare would, quite quickly and simply, force them to lift that burden for the rest of us in their own self-interest.

John said...

Jerry,
Well the good news is that most Republican politicians understand the benefits of ACA... That is why an alternative was not passed.

jerrye92002 said...

I find that very difficult to believe. I think the Republicans are scared witless by the prospect of having this Democrat albatross transferred to their necks, and the relentless bad press for shooting this #$%^ dodo bird in the first place. I am certain that forcing Democrats and their staffs ONTO O'care would find a sudden HUGE change in support for an alternative-- any alternative.

See, I think the GOP made a huge tactical mistake in saying "repeal and REPLACE." They should have said they were offering "pro-choice" health insurance.

John said...

Now you are forgetting the big problem with "pro-choice" insurance...

~50% of US households make less than $54,000 and therefore can not afford food, housing, clothing, child care and health insurance. I mean at ~$5,000 per family member it sure eats at those small household budgets pretty fast.

John said...

I do agree though that government should be buying their health insurance like companies do. What is good for the goose should be good for the gander.

jerrye92002 said...

So who says the average family needs to pay $5000/year for insurance? Even counting the employer subsidy, mine was costing about $3600, and it was "deluxe." Given a competitive market, costs could be expected to be cut an additional 50%, and that's AFTER the 50% cuts we'll make by repealing Obamacare. Or 100%, if you count the O'care deductibles.

Anonymous said...

The argument here is that Congress ought to live by the laws they pass for the rest of us.

Well sure. If you feel a Congressman is violating the law concerning health care, the proper remedy is to call the cops. But I don't see that to have any policy implications. Just because a congressman might get a traffic ticket is no reason for me to pay the fine.

" I think the GOP made a huge tactical mistake in saying "repeal and REPLACE."

As John has quite rightly pointed out, a decision to do nothing is also a decision to do domething. Republicans made an issue out of people losing their health insurance under Obamacare. Doing the same thing themselves would be politically awkward to say the least.

"who says the average family needs to pay $5000/year for insurance?"

Lots of people don't need health insurance. They can go back to freeloading of the rest of us. I don't quite understand the appeal of that policy but appeal to Republicans it does. One thing it does is make health care costs harder to assess, and there harder to assess blame. Part of the point of Republican policy in this area is to shift political responsibility to other levels of government. In political terms, I don't think that should be allowed. For me, politicians need to understand that a shift in power will never be allowed to become a shift of responsibility.

--Hiram

John said...

Jerry,
If you were paying $3,600 per year, you were likely not paying enough to cover the expenses you may have incurred.

PBS Per Capita Healthcare Cost

John said...

Well I guess you could have if your pockets were real deep when cancer, heart problems, etc hit...

jerrye92002 said...

John, what you have missed was it was a different KIND of insurance, based on the doctor doing no more and no less than what was needed keep my family healthy. That eliminated all the =unnecessary= office visits, prescriptions, tests that currently add cost, but add nothing to health. It was half the price of the previous "fee for service" plan I had, and the improvement in health care quality was striking. My son spent two weeks in hospital with a broken leg; it cost me $16. It can be done; you just need to ignore Democrat talking points and think outside the box a bit.

John said...

No Democratic talking points required... I know what my company and I pay for my family's coverage. About $5,000/ person per year if you include out of pocket expenses...

And after a mixture of surgeries, stitches, casts, physical therapy, counseling, etc we have used a fair amount of that. Thankfully we have not had anything really expensive like cancer, heart issues, etc.

The interesting part of your statement is the concern that Doctors / Insurance Companies are signing off on, and people are willingly enduring a lot of extra tests and medications. They must have different Doctors and Insurance companies than I do.

jerrye92002 said...

$5K/person??? My $3500 was for family coverage! And what you are pointing out is not that Doctors are being greedy, it is the difference between a third-party, fee-for-service system and what I call "pre-paid" insurance. Each time you went to a doctor, they billed the insurance company (overhead +), and they billed for anything reasonably connected to your care. Part of that was defensive medicine, and part was simply adding enough extra service to compensate for the low reimbursement rates the insurer offered. With pre-paid, the insurance company has no say after the initial (annual) negotiation. The doctor treats what ails you as quickly and effectively as she knows how, because anything excess comes "out of their pocket" (the prepaid amount). If you don't need it you don't get it, but if you insist on something, you pay for it. And if the Doc doesn't treat you and you get really sick, that comes out of their pocket, too. It was great, until government comes along and says you can't have it anymore and your cost skyrockets.